SECCA procedure for anal incontinence and antibiotic treatment: a case report of anal abscess

Background: Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter. Case presentation: We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years. Conclusions: The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication

Transvaginal ultrasonography with vs without bowel preparation in the diagnosis of rectosigmoid endometriosis: prospective study

Objectives: The primary aim of this study was to compare the diagnostic accuracy of transvaginal sonography (TVS) with vs without bowel preparation (BP) in detecting the presence of rectosigmoid endometriosis. Secondary objectives were to compare the diagnostic accuracy of the two techniques in estimating infiltration of the submucosa, length of the largest rectosigmoid nodules, distance of the nodules from the anal verge and presence of multifocal disease. Methods: This was a prospective study of patients with symptoms of pelvic pain for more than 6 months and/or suspicion of endometriosis referred to our institution between October 2016 and April 2018. Participants underwent a first TVS without BP followed by TVS with BP within a time interval of 1 week to 3 months. The examinations were performed independently and blindly by two sonographers. Only patients who underwent laparoscopy within the 6 months following the second ultrasound examination were included. Ultrasound results using the two techniques were compared with surgical and histological findings. Results: Of the 262 patients included in the study, 118 had rectosigmoid endometriosis confirmed at surgery. There was no significant difference in accuracy between TVS with and that without BP in diagnosing the presence of rectosigmoid endometriosis (93.5% vs 92.3%; P = 0.453). No significant difference was observed in accuracy between TVS with and that without BP in diagnosing submucosal infiltration (88.8% vs 84.6%; P = 0.238) and multifocal disease (97.2% vs 95.2%; P = 0.727) in patients diagnosed sonographically with rectosigmoid endometriosis. The accuracy of TVS with BP was similar to that of TVS without BP in estimating the maximum diameter of the largest nodule (P = 0.644) and the distance between the more caudal rectosigmoid nodule and the anal verge (P = 0.162). Conclusion: BP does not improve the diagnostic performance of TVS in detecting rectosigmoid endometriosis and in assessing characteristics of endometriotic nodules

Update of the international HerniaSurge guidelines for groin hernia management

International guidelines; Hernia managementDirectrices internacionales; Hernia inguinalDirectrius internacionals; Hèrnia inguinalBackground Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. Method A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. Results Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. Conclusion The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.The present guidelines were produced with the funding from European Hernia Society (EHS). The EHS provided funds to cover the budget of the process including online meetings with members and stakeholders. The executive board of the society did not interfere with the process of guidelines development

Is Shouldice the best NON-MESH inguinal hernia repair technique? A systematic review and network metanalysis of randomized controlled trials comparing Shouldice and Desarda

Background Current guidelines state that the Shouldice technique has lower recurrence rates than other suture repairs and therefore is strongly recommended in non-mesh inguinal hernia repair. Recently a new tissue repair technique has been proposed by Desarda and studied in trials against Lichtenstein technique. Methods The present study was performed according to the PRISMA Statement for Network Meta-analysis and the AMSTAR 2 checklist. The method of network meta-analysis was chosen to evaluate randomized controlled trial published on tissue repair and comparing Lichtenstein respectively with Desarda and Shouldice techniques. The following parameters: operative time, recurrence, complications (general, intraoperative, Surgical Surgical Site Occurrences), VAS score on postoperative day 1, numbness, chronic pain and return to daily activities. Results Fourteen RCTs, involving 2791 patients, fulfilled the inclusion criteria and were selected for final analysis. The anchored indirect treatment comparison showed that Desarda's technique requires a significantly shorter operative time (MD: −12.9 min; 95% CI: −20.6 to −5.2) and has a quicker recovery (MD: −6.6 days; 95% CI: −11.7 to −1.4). Outcomes concerning intraoperative complications, early postoperative pain, seroma/hematoma, hydrocele and infection rates, recurrence, numbness and chronic pain were similar among the two techniques. Conclusions Desarda's hernia repair can be a valuable alternative to Shouldice technique for the treatment of primary inguinal hernia repair if a non-mesh technique is chosen, because of its reproducibility and quicker postoperative recovery. We recommend performing well designed prospective studies comparing both techniques directly

Correction: "Timed Up & Go":A Screening Tool for Predicting 30-Day Morbidity in Onco-Geriatric Surgical Patients? A Multicenter Cohort Study (vol 9, e0086863, 2014)

<p>Correction: "Timed Up & Go": A Screening Tool for Predicting 30-Day Morbidity in Onco-Geriatric Surgical Patients? <i>A Multicenter Cohort Study</i></p

Update of the international HerniaSurge guidelines for groin hernia management

Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology

EHS Rapid Guideline: Evidence-Informed European Recommendations on Parastomal Hernia Prevention—With ESCP and EAES Participation

Background: Growing evidence on the use of mesh as a prophylactic measure to prevent parastomal hernia and advances in guideline development methods prompted an update of a previous guideline on parastomal hernia prevention.Objective: To develop evidence-based, trustworthy recommendations, informed by an interdisciplinary panel of stakeholders.Methods: We updated a previous systematic review on the use of a prophylactic mesh for end colostomy, and we synthesized evidence using pairwise meta-analysis. A European panel of surgeons, stoma care nurses, and patients developed an evidence-to-decision framework in line with GRADE and Guidelines International Network standards, moderated by a certified guideline methodologist. The framework considered benefits and harms, the certainty of the evidence, patients’ preferences and values, cost and resources considerations, acceptability, equity and feasibility.Results: The certainty of the evidence was moderate for parastomal hernia and low for major morbidity, surgery for parastomal hernia, and quality of life. There was unanimous consensus among panel members for a conditional recommendation for the use of a prophylactic mesh in patients with an end colostomy and fair life expectancy, and a strong recommendation for the use of a prophylactic mesh in patients at high risk to develop a parastomal hernia.Conclusion: This rapid guideline provides evidence-informed, interdisciplinary recommendations on the use of prophylactic mesh in patients with an end colostomy. Further, it identifies research gaps, and discusses implications for stakeholders, including overcoming barriers to implementation and specific considerations regarding validity

I tumori carcinoidi dell’appendice. Quando l’emicolectomia destra?

L’osservazione di tre casi di tumore carcinoide dell’appendice (0,3 % circa di tutte le appendicectomie eseguite) ha indotto gli Autori ad una revisione della letteratura nell’intento di puntualizzare i principali aspetti biologici ed anatomo-patologici e le attuali conoscenze clinico-terapeutiche. La diagnosi viene posta preoperatoriamente solo in casi eccezionali; nella maggior parte dei pazienti essa viene formulata incidentalmente con l’esame istologico in corso di intervento condotto per una appendicite o in corso di altre procedure chirurgiche. Il tipo di intervento chirurgico, ovvero l’entità della demolizione chirurgica richiesta per il trattamento dei tumori carcinoidi dell’appendice, è ancora oggetto di controversie: appendicectomia o emicolectomia destra? È possibile identificare, già durante l’intervento eseguito per una appendicite o per altre lesioni addominali, criteri che possono orientare verso una chirurgia maggiore (dimensioni della neoplasia, invasione dei linfatici della sottosierosa, inteessamento della sierosa, diffusione nel meso-appendice, localizzazione in prossimità della base dell’appendice, interessamento dei linfonodi locoregionali, presenza di metastasi, margini di sezione, numero di mitosi, pleiomorfismo cellular

Laparoscopic total and subtotal gastrectomy for gastric cancer

Laparoscopic gastrectomy (LG) for malignancy has not fully entered into daily clinical practice. Since 1994, when Kitano performed the first laparoscopic gastrectomy with Billroth I anastomosis for early gastric cancer, there was not a wide acceptance of laparoscopic approach as in other procedures such as laparoscopic colectomy for both benign and malignant conditions, fundoplication and cholecystectomy. Technical and instrumental developments in laparoscopic surgery, however, allowed a more aggressive surgery for gastric cancer and improvedits diffusion. Several studies have been conducted in order to define the adequacy of laparoscopic approach in gastrectomies for malignant disease in terms of short, long and oncological outcomes. The aim of this chapter is to make a review of literature, about laparoscopic approach for gastric malignant disease versus the open approach, and describe the laparoscopic technique of total and subtotal gastrectomies for malignant disease. \ua9 2012 by Nova Science Publishers, Inc. All rights reserved

Single-access laparoscopic subtotal spleno-pancreatectomy for pancreatic adenocarcinoma

Laparoscopic distal or subtotal pancreatectomy can be performed safely and effectively unless there is a clear reason why not to do so. With the aim of reducing postoperative trauma and improving the cosmesis, single-access laparoscopic surgery has been introduced into daily practice. We report the first case of distal single-access laparoscopic pancreasectomy for an adenocarcinoma. The procedure was carried out in 170 minutes without postoperative complications. Despite some technical difficulties, we think that a single-access laparoscopic approach could be adequate for a pancreatic resection. However, an adequate analysis of cost-effectiveness as well as regarding the reproducibility should be carried out