La videolaparosurrenectomia nella sindrome di Conn. Analisi di 39 casi osservati

Da un’analisi di 39 pazienti affetti da sindrome di Conn ed osserva - ti a partire dal 1985, gli Autori traggono alcune considerazioni cliniche alla luce delle nuove tecnologie chirurgiche apparse negli ultimi anni. L’introduzione della tecnica laparoscopica, eseguita pressoché costantemente negli ultimi sette anni e nella quasi totalità dei casi, si è rivelata il “gold standard” chirurgico per tale affezione. Infatti la videolaparosurrenectomia rappresenta l’ideale per questa affezione caratterizzata dalla monolateralità pressoché esclusiva della malattia, in genere dalle piccole dimensioni della tumefazione surrenalica e dalla rarità estrema di malignità biologica. Viene inoltre sottolineata la possibilità di eseguire interventi più conservativi di adenomectomia surrenalica, ritenuti fattibili da alcuni Autori anche in videolaparascopia. Poiché tuttavia manca al riguardo una esperienza sufficiente, si può affermare che tale tecnica conservati - va di “enucleazione” possa essere presa in considerazione in casi selezio - nati di bilateralità della lesione o in presenza di tumefazioni in sede periferica surrenalica

\u201cComplex abdominal wall\u201d management: evidence-based guidelines of the Italian Consensus Conference

To date, there is no shared consensus on a definition of a complex abdominal wall in elective surgery and in the emergency, on indications, technical details, complications, and follow-up. The purpose of the conference was to lay the foundations for a homogeneous approach to the complex abdominal wall with the primary intent being to attain the following objectives: (1) to develop evidence-based recommendations to define \u201ccomplex abdominal wall\u201d; (2) indications in emergency and in elective cases; (3) management of \u201ccomplex abdominal wall\u201d; (4) techniques for temporary abdominal closure. The decompressive laparostomy should be considered in a case of abdominal compartment syndrome in patients with critical conditions or after the failure of a medical treatment or less invasive methods. In the second one, beyond different mechanism, patients with surgical emergency diseases might reach the same pathophysiological end point of trauma patients where a preventive \u201copen abdomen\u201d might be indicated (a temporary abdominal closure: in the case of a non-infected field, the Wittmann patch and the NPWT had the best outcome followed by meshes; in the case of an infected field, NPWT techniques seem to be the preferred). The second priority is to create optimal both general as local conditions for healing: the right antimicrobial management, feeding\u2014preferably by the enteral route\u2014and managing correctly the open abdomen wall. The use of a mesh appears to be\u2014if and when possible\u2014the gold standard. There is a lot of enthusiasm about biological meshes. But the actual evidence supports their use only in contaminated or potentially contaminated fields but above all, to reduce the higher rate of recurrences, the wall anatomy and function should be restored in the midline, with or without component separation technique. On the other site has not to be neglected that the use of monofilament and macroporous non-absorbable meshes, in extraperitoneal position, in the setting of the complex abdomen with contamination, seems to have a cost effective role too. The idea of this consensus conference was mainly to try to bring order in the so copious, but not always so \u201cevident\u201d literature utilizing and exchanging the expertise of different specialists

Protocolli gestionali-diagnostico-terapeutico-assistenziali in chirurgica tiroidea. 2° Consensus Conference.

Aim. To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). Method. The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. Conclusions. The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years

A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)

Purpose: Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. Methods: All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Trial registration: Clinicaltrials.gov ID: NCT03080103