Clinical Study Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures

Towards a permanent deep sea observatory,: the GEOSTAR European Experiment.

GEOSTAR is the prototype of the first European long-term, multidisciplinary deep sea observatory for continuous monitoring of geophysical, geochemical and oceanographic parameters. Geostar is the example of a strong synergy between science and tecnology addressed to the development of new technological solutions for the observatory realisation and management. The GEOSTAR system is described outlining the enhancements introduced during five years of project activity. An example of data retrieved from the observatory being the deep sea mission running is also given.Published111-1202.5. Laboratorio per lo sviluppo di sistemi di rilevamento sottomarinireserve

GEOSTAR, an observatory for deep sea geophysical and oceanographic researches: characteristics, first scientific mission and future activity

GEOSTAR (GEophysical and Oceanographic STation for Abyssal Research) is a project funded by in the 4th Framework Programme of the European Commission, with the aim of developing an innovative deep sea benthic observatory capable of carrying out long-term (up to 1 year) scientific observations at abyssal depths. The configuration of the observatory, conceived to be a node of monitoring networks, is made up of two main subsystems: the Bottom Station, which in addition to the acquisition and power systems and all the sensors also hosts the communications systems; and the Mobile Docker, a dedicated tool for surface-assisted deployment and recovery. At present the Bottom Station is equipped with a triaxial broad-band seismometer, two magnetometers (fluxgate and scalar), CTD, transmissometer, ADCP, but it can easily host other sensors for different experiments. The first phase of the project, started in November 1995, was concluded with the demonstration mission in Adriatic Sea at shallow water depth (42 m) in August - September 1998. Some preliminary results of this first scientific experiment are presented and discussed. The second phase, started in 1999, will end with a long-term deep sea scientific mission, scheduled during 2000 for 6-8 months at 3400 m.w.d. in the southern Tyrrhenian bathyal plain.Published491-4973A. Ambiente MarinoN/A or not JCRrestricte

Mission results from the first GEOSTAR observatory (Adriatic Sea, 1998)

We assess the first mission of the GEOSTAR (GEophysical and Oceanographic STation for Abyssal Research) deep-sea multidisciplinary observatory for its technical capacity, performance and quality of recorded data. The functioning of the system was verified by analyzing oceanographic, seismological and geomagnetic measurements. Despite the mission’s short duration (21 days), its data demonstrated the observatory’s technological reliability and scientific value. After analyzing the oceanographic data, we found two different regimes of seawater circulation and a sharp and deepening pycnocline, linked to a down-welling phenomenon. The reliability of the magnetic and seismological measurements was evaluated by comparison with those made using on-land sensors. Such comparison of magnetic signals recorded by permanent land geomagnetic stations and GEOSTAR during a “quiet” day and one with a magnetic storm confirmed the correct functioning of the sensor and allowed us to estimate the seafloor observatory’s orientation. The magnitudes of regional seismic events recorded by our GEOSTAR seismometer agreed with those computed from land stations. GEOSTAR has thus proven itself reliable for integrating other deep-sea observation systems, such as modular observatories, arrays, and instrumented submarine cablesPublished361-373ope

European Seafloor Observatory Offers New Possibilities For Deep Sea Study

The Geophysical and Oceanographic Station for Abyssal Research (GEOSTAR), an autonomous seafloor observatory that collects measurements benefiting a number of disciplines during missions up to 1 year long, will begin the second phase of its first mission in 2000. The 6-8 month investigation will take place at a depth of 3400 m in the southern Tyrrhenian basin of the southern Tyrrhenian basin of the central Mediterranean. GEOSTAR was funded by the European Community (EC) for $2.4 million (U.S. dollars) in 1995 as a part of the Marine Science and Technology programme (MAST). The innovative deployment and recovery procedure GEOSTAR uses was derived from the "two-module" concept successfully applied by NASA in the Apollo and space shuttle missions, where one module performs tasks for the other, including deployment, switching on and off, performing checks and recovery. The observatory communication system, which takes advantage of satellite telemetry, and the simultaneous acquisition of a set of various measurements with a unique time reference make GEOSTAR the first fundamental element of a multiparameter ocean network. GEOSTAR's first scientific and technological mission, which took place in the summer of 1998 in the Adriatic Sea, verified the performance and reliability of the system. The mission was a success. providing 440 hours of continuous seismic magnetic and oceanographic data. Thje second phase of the mission, which was funded by the EC for$2 million (US dollars), will carry equipment for chemical, biological and isotopic analyses not used in the first phase, which will broaden the data collection effort.Published45, 48-492.5. Laboratorio per lo sviluppo di sistemi di rilevamento sottomariniN/A or not JCRreserve

Bollettino Sismico Italiano: Analisys of Early Aftershocks of the 2016 MW 6.0 Amatrice, MW 5.9 Visso and MW 6.5 Norcia earthquakes in Central Italy

The Amatrice-Visso-Norcia seismic sequence is the most important of the last 30 years in Italy. The seismic sequence started on 24 August, 2016 and still is ongoing in central Apennines. At the end of February 2017 more than 57,000 events were located, 80,000 events up to the end of September 2017 (Fig. 1). The mainshocks of the sequence occurred on 24 August 2016 (Mw 6.0 and Mw 5.4), 26 October 2016 (Mw 5.4 and Mw 5.9), 30 October 2016 (Mw 6.5), 18 January 2017 (four earthquakes Mw≥ 5.0). In this seismic sequence, all the waveforms recorded by temporary stations deployed by the SISMIKO emergency group (stations T12**; Moretti et al., 2016) where available in real- time at the surveillance room of INGV. Because of the high level of seismicity and the dense seismic network installed in the region, more than 150 events per day were located at the end of February 2017; still 60 events per day were located up to the end of August 2017.The Amatrice-Visso-Norcia is the most important seismic sequence since 2015, the time when the analysis procedures of the BSI group (Bollettino Sismico Italiano) were revised (Nardi et al., 2015). BSI is now available every four months on the web: bulletins contain revised earthquakes (location and magnitude) with ML≥ 1.5, quasi-real time revision of ML≥ 3.5 earthquakes and phase arrivals from waveforms recorded on seismic stations available from the European Integrated Data Archive (EIDA), (Mazza et al., 2012). These last procedures allow the integration of signals from temporary seismic stations (Moretti et al., 2014) installed by the emergency group SISMIKO (Moretti and Sismiko working group, 2016), even when they are not in real time transmission, if they are rapidly archived in EIDA, together with real time signals from the seismic stations of the permanent INGV network. The analysis strategy of the BSI group for the Amatrice -Visso - Norcia seismic sequence (AVN.s.s in the following) was to select the earthquakes located in the box with min/max latitude: 42.2/43.2 - and min/max longitude: 12.4/14.1 to prepare a special volume of BSI on the seismic sequence.PublishedTrieste, Italy1SR. TERREMOTI - Servizi e ricerca per la Societ

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Bollettino Sismico Italiano gennaio – aprile 2019

Nel periodo che va dal 1 gennaio al 30 aprile 2019, gli analisti del BSI hanno revisionato tutti gli eventi di magnitudo M≥1.5, mentre i parametri dei terremoti di magnitudo inferiore a tale soglia di revisione sono stati calcolati in tempo reale, nella sala di sorveglianza sismica di Roma.Istituto Nazionale di Geofisica e Vulcanologia - Dipartimento di Protezione CivilePublished4IT. Banche dat

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years