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2. 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)

Author

Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., and Oldani A.

Abstract

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 registrat

Published
2021

3. 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)

Author

Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A., Podda, M., Botteri, E., Passera, R., Agresta, F., Arezzo, A., Guerrieri, M., Ortenzi, M., Cavallo, F., Zese, M., Prando, D., Restini, E., Cianci, P., Millo, P., Brachet Contul, R., Serrao, A., Abatini, F., Altomare, D. F., Picciariello, A., Chetta, G., Lattanzio, F., Tonini, V., Gori, A., Jovine, E., Mastrangelo, L., Sartarelli, L., Frena, A., Malpaga, A., Bertelli, F., Pignata, G., Andreuccetti, J., Sanna, S., Lares, B., Sechi, R., Cillara, N., Pisanu, A., Delogu, D., Ciaccio, G., Farulla, M., Casati, M., Laface, L., De Luca, M., Russello, D., Latteri, S., Longoni, M., Masci, E., Vigna, S., Campanile, F. C., Foti, N., Lepiane, P., Balla, A., Cantore, F., Raveglia, V., Borghi, F., Giraudo, G., Verzelli, A., Budassi, A., Patriti, A., Foghetti, D., Montin, U., Amadio, L., Anania, G., Bombardini, C., Fabbri, N., Feo, C., Cianchi, F., Manetti, A., Lucchese, M., Soricelli, E., Ceccarelli, G., Patiti, M., Frascio, M., Stabilini, C., Filauro, M., Barberis, A., Troian, M., Nagliati, C., Campagnacci, R., Maurizi, A., Berti, S., Gennai, A., Marvaso, A., D'Antonio, D., Feo, C. V., Mazzola, L., Selvaggi, F., Carini, S., Costanzo, F., Boccia, L., Pascariello, A., Perrotta, N., Celiento, M., Opocher, E., Giovenzana, M., Stella, M., Ferrara, F., Boni, L., Abate, E., Da Lio, C., Valli, V., Gelmini, R., Serra, F., Piccoli, M., Gozzo, D., Gattolin, A., Sasia, D., Balani, A., Petronio, B., Calo, P. G., Canu, G. L., Contarini, E., Piatto, G., Vettoretto, N., Caprioli, M., Braga, M., Chiappetta, M. F., Maida, P., Tammaro, P., De Palma, G., Milone, M., Bottino, V., Canfora, A., Bagaglini, G., Agrusa, A., Barone, M., Mirabella, A., Marino, M. V., Gulotta, G., Romano, G., Sorrentino, M., Ferfoglia, S., Papagni, V., Eramo, S., Boselli, C., Basti, M., Caracino, V., Moretto, G., Inama, M., Capelli, P., Conti, L., Muratore, A., Cuoghi, M. M., Zerbinati, A., Corso, S., Vasino, M. C., Montuori, M., Fidanza, F., Lucchetta, A., Giuliani, A., Dinatale, G., Zanzi, F., Guariniello, A., Bonilauri, S., Frazzetta, G., Garino, M., Marafante, C., Gioffre, A., Del Monte, S. R., Sganga, G., Fransvea, P., Grande, M., Siragusa, L., Sica, G., Paola, M., Passantino, D. G., Catani, M., Ricci, F., Lauro, E., Facci, E., Parini, D., Armellino, M. F., Argenio, G., Porcu, A., Perra, T., Bordoni, P., Fleres, F., Parisi, A., Rossi, S., Saracco, R., Bono, D., Viora, T., Orlando, F., Ferrero, A., Fontana, A. P., De Paolis, P., Visconti, D., Quaglino, F., Festa, F., Palagi, S., Lo Secco, G., Morino, M., Allaix, M. E., Salzano, A., Tirone, G., Motter, M., Zanus, G., Passuello, N., Massani, M., Tutino, R., Manzini, N., Terranova, S., Merenda, R., Nordio, S., Zonta, S., Lovisetto, F., Guglielmi, A., Campagnaro, T., Amedeo, E., Scollica, M., Amodio, P., Giannotti, D., Olmi, S., Oldani, A., Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D.F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F.C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C.V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P.G., Canu G.L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M.F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M.V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M.M., Zerbinati A., Corso S., Vasino M.C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S.R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D.G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M.F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A.P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M.E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, Alberto, Podda, Mauro, Botteri, Emanuele, Passera, Roberto, Agresta, Ferdinando, Arezzo, Alberto, M Guerrieri, M Ortenzi, F Cavallo, M Zese, D Prando, E Restini, P Cianci, P Millo, R Brachet Contul, A Serrao, F Abatini, D F Altomare, A Picciariello, G Chetta, F Lattanzio, V Tonini, A Gori, E Jovine, L Mastrangelo, L Sartarelli, A Frena, A Malpaga, F Bertelli, G Pignata, J Andreuccetti, S Sanna, B Lares, R Sechi, N Cillara, A Pisanu, D Delogu, G Ciaccio, M Farulla, M Casati, L Laface, M De Luca, D Russello, S Latteri, M Longoni, E Masci, S Vigna, F C Campanile, N Foti, P Lepiane, A Balla, F Cantore, V Raveglia, F Borghi, G Giraudo, A Verzelli, A Budassi, A Patriti, D Foghetti, U Montin, L Amadio, G Anania, C Bombardini, Niccolò Fabbri, Carlo Feo, F Cianchi, A Manetti, M Lucchese, E Soricelli, G Ceccarelli, M Patiti, M Frascio, C Stabilini, M Filauro, A Barberis, M Troian, C Nagliati, R Campagnacci, A Maurizi, S Berti, A Gennai, A Marvaso, D D'Antonio, C V Feo, N Fabbri, L Mazzola, F Selvaggi, S Carini, F Costanzo, L Boccia, A Pascariello, N Perrotta, M Celiento, E Opocher, M Giovenzana, M Stella, F Ferrara, L Boni, E Abate, C Da Lio, V Valli, R Gelmini, F Serra, M Piccoli, D Gozzo, A Gattolin, D Sasia, A Balani, B Petronio, P G Calò, G L Canu, E Contarini, G Piatto, N Vettoretto, M Caprioli, M Braga, M F Chiappetta, P Maida, P Tammaro, G De Palma, M Milone, V Bottino, A Canfora, F Selvaggi, G Bagaglini, A Agrusa, M Barone, A Mirabella, M V Marino, G Gulotta, G Romano, M Sorrentino, S Ferfoglia, V Papagni, S Eramo, C Boselli, M Basti, V Caracino, G Moretto, M Inama, P Capelli, L Conti, A Muratore, M M Cuoghi, A Zerbinati, S Corso, M C Vasino, M Montuori, F Fidanza, A Lucchetta, A Giuliani, G Dinatale, F Zanzi, A Guariniello, S Bonilauri, G Frazzetta, M Garino, C Marafante, A Gioffrè, S R Del Monte, G Sganga, P Fransvea, M Grande, L Siragusa, G Sica, M Paola, D G Passantino, Marco Catani, F Ricci, E Lauro, E Facci, D Parini, M F Armellino, G Argenio, A Porcu, T Perra, P Bordoni, F Fleres, A Parisi, S Rossi, R Saracco, D Bono, T Viora, F Orlando, A Ferrero, A P Fontana, P De Paolis, D Visconti, F Quaglino, F Festa, S Palagi, G Lo Secco, M Morino, M E Allaix, A Salzano, G Tirone, M Motter, G Zanus, N Passuello, M Massani, R Tutino, N Manzini, S Terranova, R Merenda, S Nordio, S Zonta, F Lovisetto, A Guglielmi, T Campagnaro, E Amedeo, M Scollica, P Amodio, D Giannotti, S Olmi, A Oldani, Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, and Oldani, A

Subjects
medicine.medical_specialty, COVID-19 Pandemic, Coronavirus disease 2019 (COVID-19), Endoscopic surgery, NO, Appendectomy, Appendicitis, Machine learning, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Retrospective Studie, Pandemic, medicine, Humans, Appendiciti, Laparoscopy, Pandemics, Retrospective Studies, medicine.diagnostic_test, business.industry, COVID-19 Pandemic, Appendicitis, Appendicectomy, Machine learning, SARS-CoV-2, COVID-19, Length of Stay, medicine.disease, Settore MED/18, Surgery, Italy, 030220 oncology & carcinogenesis, appendicitis, COVID-19 pandemic, machine learning, appendectomy, cohort studies, humans, length of stay, pandemics, postoperative complications, retrospective studies, laparoscopy, 030211 gastroenterology & hepatology, Observational study, Original Article, Postoperative Complication, Appendicectomy, Cohort Studie, business, Complication, Cohort study, Human
Abstract

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 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, 2020

Published
2021

5. Role of arterial variants in pancreatic surgery

Author

Benucci, C., primary, Santilli, M., additional, Roberto, C., additional, Casciani, E., additional, Prezioso, G., additional, Dinatale, G., additional, Sacco, L., additional, Farelli, F., additional, Pulvirenti, A., additional, and Chirletti, P., additional

Published
2013
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11. Sweeping for Leakage in Masked Circuit Layouts

Author

Danilo Šijačić, Josep Balasch, Ingrid Verbauwhede, DiNatale, G, Bolchini, C, and Vatajelu, EI

Subjects
010302 applied physics, Computer science, Computation, 02 engineering and technology, Inductor, 01 natural sciences, 020202 computer hardware & architecture, law.invention, Capacitor, Test vector, law, 0103 physical sciences, Hardware_INTEGRATEDCIRCUITS, 0202 electrical engineering, electronic engineering, information engineering, Electronic engineering, Resistor, Leakage (electronics)
Abstract

Masking schemes are the most popular counter-measure against side-channel analysis. They theoretically decorrelate information leaked through inherent physical channels from the key-dependent intermediate values that occur during computation. Their provable security is devised under models that abstract complex physical phenomena of the underlying hardware. In this work, we investigate the impact of the physical layout to the side-channel security of masking schemes. For this we propose a model for co-simulation of the analog power distribution network with the digital logic core. Our study considers the drive of the power supply buffers, as well as parasitic resistors, inductors and capacitors. We quantify our findings using Test Vector Leakage Assessment by relative comparison to the parasitic-free model. Thus we provide a deeper insight into the potential layout sources of leakage and their magnitude.

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12. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines.

Author

Coccolini F, Cucinotta E, Mingoli A, Zago M, Altieri G, Biloslavo A, Caronna R, Cengeli I, Cicuttin E, Cirocchi R, Cobuccio L, Costa G, Cozza V, Cremonini C, Del Vecchio G, Dinatale G, Fico V, Galatioto C, Kuriara H, Lacavalla D, La Greca A, Larghi A, Mariani D, Mirco P, Occhionorelli S, Parini D, Polistina F, Rimbas M, Sapienza P, Tartaglia D, Tropeano G, Venezia P, Venezia DF, Zaghi C, and Chiarugi M

Subjects
Humans, Cholecystectomy methods, Drainage methods, Italy, Societies, Medical, Cholecystitis, Acute surgery, Critical Illness
Abstract

Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds. The final version of the statements was discussed during the annual meeting in Rome (September 2022). The present paper presents the definitive conclusions of the discussion. Fifteen statements based on the literature evidence were provided. The statements gave precise indications regarding the decisional process and the management of patients who cannot temporarily or definitively undergo cholecystectomy for acute cholecystitis. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients should be multidisciplinary. The different gallbladder drainage methods must be tailored according to each patient and based on the expertise of the hospital. Percutaneous gallbladder drainage is recommended as the first choice as a bridge to surgery or in severely physiologically deranged patients. Endoscopic gallbladder drainage (cholecystoduodenostomy and cholecystogastrostomy) is suggested as a second-line alternative especially as a definitive procedure for those patients not amenable to surgical management. Trans-papillary gallbladder drainage is the last option to be reserved only to those unfit for other techniques. Delayed laparoscopic cholecystectomy in patients with percutaneous gallbladder drainage is suggested in all those patients recovering from the conditions that previously discouraged surgical intervention after at least 6 weeks from the gallbladder drainage., (© 2023. Italian Society of Surgery (SIC).)

Published
2024
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13. Effect of surgery on pancreatic tumor-dependent lymphocyte asset: modulation of natural killer cell frequency and cytotoxic function.

Author

Iannone F, Porzia A, Peruzzi G, Birarelli P, Milana B, Sacco L, Dinatale G, Peparini N, Prezioso G, Battella S, Caronna R, Morrone S, Palmieri G, Mainiero F, and Chirletti P

Subjects
Aged, Coculture Techniques, Female, Flow Cytometry, Humans, Immunophenotyping, K562 Cells, Leukocyte Count, Lymph Node Excision, Male, Neoplasm Staging, Pancreatic Neoplasms pathology, Time Factors, Treatment Outcome, Tumor Burden, Cytotoxicity, Immunologic, Killer Cells, Natural immunology, Lymphocytes, Tumor-Infiltrating immunology, Pancreatic Neoplasms immunology, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Tumor Microenvironment
Abstract

Objectives: Tumor burden and invasiveness establish a microenvironment that surgery could alter. This study shows a comprehensive analysis of size, dynamics, and function of peripheral lymphocyte subsets in pancreatic cancer patients before and at different times after duodenopancreatectomy., Methods: Lymphocyte frequency and natural cytotoxicity were evaluated by flow cytometry and in vitro assay on peripheral blood from initial and advanced-stage pancreatic cancer patients before (BS), at day 7 (PS7), and at day 30 (PS30) after surgery., Results: An increase in natural killer (NK) cells and the diminution of B-cells occurred at PS30, whereas cytotoxicity decreased at PS7. The positive correlation between NK frequency and cytotoxicity at BS and PS7 revealed an altered NK behavior. The elevation of NK cell frequency at PS30, an initial defect in CD56bright NK, and the aberrant correlation between NK frequency and cytotoxicity remained significant in advanced-stage patients, whereas the diminution of NK cytotoxicity only affected initial stage patients., Conclusions: The NK cell functional ability is altered in presurgery patients; duodenopancreatectomy is associated with short-term impairment of NK function and with a long-term NK cell augmentation and reversion of the aberrant NK behavior, which may impact on immunosurveillance against residual cancer.

Published
2015
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14. Pancreaticojejuno anastomosis after pancreaticoduodenectomy: brief pathophysiological considerations for a rational surgical choice.

Author

Caronna R, Peparini N, Cosimo Russillo G, Antonio Rogano A, Dinatale G, and Chirletti P

Abstract

Introduction. The best pancreatic anastomosis technique after pancreaticoduodenectomy (PD) is still debated. Pancreatic fistula (PF) is the most important complication but is also related to postoperative bleedings and pancreatic remnant involution. We support pancreaticojejuno anastomosis (PJ) advantages describing our technique with brief technical considerations. Materials and Methods. 89 consecutive patients underwent PD with suprapyloric gastric resection and double loop reconstruction. Pancreaticojejunal end-to-end anastomosis was done by simple invagination with a single layer of interrupted pledget-supported Ticron stitches. Results. Pancreatic fistula occurred in seven patients (7.8%): six cases of grade A fistula resolved spontaneously, and in only one case of grade B fistula percutaneous drainage was necessary. Postoperative hemorrhage occurred in only two (2.2%) of 89 patients. Conclusion. Pancreaticojejunostomy with minor changes in anastomotic techniques can contribute to improvement of the outcome of Roux-en-Y reconstruction regarding PF and other related complications. The particular reconstruction reported seems also to preserve the pancreatic exocrine function.

Published
2012
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15. Adrenocortical carcinoma extending into the inferior vena cava in a patient with right kidney agenesis: Surgical approach and review of literature.

Author

Meniconi RL, Caronna R, Schiratti M, Dinatale G, Russillo GC, Liguori A, and Chirletti P

Abstract

Introduction: Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis and the association with tumor thrombus into the inferior vena cava (IVC) is not common. The best treatment is represented by radical surgery., Presentation of Case: We describe a case of a large ACC of the left adrenal gland extending into the IVC through the left renal vein in a young patient with agenesis of the right kidney and signs of acute renal failure. A midline laparotomy was performed, subsequently extended by a left thoracophrenotomy through the 7th intercostal space in order to control the proximal surface of the mass and the thoracic aorta. The tumor was completely excised preserving the kidney, and thrombectomy was performed by a cavotomy with a temporary caval clamping, without cardiopulmonary by-pass (CPB)., Discussion: We discuss surgical approaches reported in literature in case of ACC with intracaval extension. The tumor must be completely resected and the thrombectomy can be performed by different approaches: cavotomy with direct suture, partial resection of caval wall without reconstruction, resection of vena cava with graft reconstruction. These procedures could require a CPB, with an increased mortality. In our case we preserved the kidney and a thrombectomy without CPB was performed., Conclusion: Intracaval extension of ACC does not represent a contraindication to surgery. The best treatment of intracaval thrombus should be the cavotomy with direct suture. The CPB is not always required. In presence of renal agenesis, the preservation of the kidney is mandatory., (Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Published
2012
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16. Inflammatory myoglandular polyp of the cecum: case report and review of literature.

Author

Meniconi RL, Caronna R, Benedetti M, Fanello G, Ciardi A, Schiratti M, Papini F, Farelli F, Dinatale G, and Chirletti P

Subjects
Colonic Polyps pathology, Colonoscopy, Humans, Inflammation pathology, Male, Middle Aged, Cecum pathology, Cecum surgery, Colonic Polyps diagnosis, Colonic Polyps surgery
Abstract

Background: Inflammatory myoglandular polyp (IMGP) is a rare non-neoplastic polyp of the large bowel, commonly with a distal localization (rectosigmoid), obscure in its pathogenesis. Up till now, 60 cases of IMGP have been described in the literature, but none located in the cecum., Case Presentation: We report a case of a 53-year-old man who was admitted to our hospital for further evaluation of positive fecal occult blood test associated to anemia. A colonoscopy identified a red, sessile, lobulated polyp of the cecum, 4.2 cm in diameter, partially ulcerated. The histological examination of the biopsy revealed the presence of inflammatory granulation tissue with lymphocytic and eosinophil infiltration associated to a fibrous stroma: it was diagnosed as inflammatory fibroid polyp. Considering the polyp's features (absence of a peduncle and size) that could increase the risk of a polypectomy, a surgical resection was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, hyperplastic glands with cystic dilatations, proliferation of smooth muscle and multiple erosions on the polyp surface: this polyp was finally diagnosed as IMGP. There was also another little polyp next to the ileocecal valve, not revealed at the colonoscopy, 0.8 cm in diameter, diagnosed as tubulovillous adenoma with low grade dysplasia., Conclusions: This is the first case of IMGP of the cecum. It is a benign lesion of unknown pathogenesis and must be considered different from other non-neoplastic polyps of the large bowel such as inflammatory cap polyps (ICP), inflammatory cloacogenic polyps, juvenile polyps (JP), inflammatory fibroid polyps (IFP), polyps secondary to mucosal prolapse syndrome (MPS), polypoid prolapsing mucosal folds of diverticular disease. When symptomatic, IMGP should be removed endoscopically, whereas surgical resection is reserved only in selected patients as in our case.

Published
2010
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17. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis.

Author

Caronna R, Benedetti M, Morelli A, Rocco M, Diana L, Prezioso G, Cardi M, Schiratti M, Martino G, Fanello G, Papini F, Farelli F, Meniconi RL, Marengo M, Dinatale G, and Chirletti P

Abstract

Background: The elevated serum and peritoneal cytokine concentrations responsible for the systemic response syndrome (SIRS) and multiorgan failure in patients with severe acute pancreatitis lead to high morbidity and mortality rates. Prompted by reports underlining the importance of reducing circulating inflammatory mediators in severe acute pancreatitis, we designed this study to evaluate the efficiency of laparotomy followed by continuous perioperative peritoneal lavage combined with postoperative continuous venovenous diahemofiltration (CVVDH) in managing critically ill patients refractory to intensive care therapy. As the major clinical outcome variables we measured morbidity, mortality and changes in the Acute Physiology and Chronic Health Evaluation (APACHE II) score and cytokine concentrations in serum and peritoneal lavage fluid over time., Methods: From a consecutive group of 23 patients hospitalized for acute pancreatitis, we studied 6 patients all with Apache II scores >/=19, who underwent emergency surgery for acute complications (5 for an abdominal compartment syndrome and 1 for septic shock) followed by continuous perioperative peritoneal lavage and postoperative CVVDH. CVVDH was started within 12 hours after surgery and maintained for at least 72 hours, until the multiorgan dysfunction syndrome improved. Samples were collected from serum, peritoneal lavage fluid and CVVDH dialysate for cytokine assay. Apache II scores were measured daily and their association with cytokine levels was assessed., Results: All six patients tolerated CVVDH well, and the procedure lasted a mean 6 days (range, 3-12). Five patients survived and one died of Acinetobacter infection after surgery (mortality rate 16.6%). The mean APACHE II score was >/= 19 (range 19-22) before laparotomy and decreased significantly during peritoneal lavage and postoperative CVVDH (P = 0.013 by matched-pairs Students t-test). The decrease in cytokine concentrations in serum and lavage fluid was associated with the decrease in APACHE II scores and high interleukin 6 (IL-6) and tumor necrosis factor (TNF) concentrations in the hemofiltrate., Conclusion: In critically ill patients with abdominal compartment syndrome, septic shock or high APACHE II scores related to severe acute pancreatitis, combining emergency laparotomy with continuous perioperative peritoneal lavage followed by postoperative CVVHD effectively reduces the local and systemic cytokines responsible for multiorgan dysfunction syndrome thus improving patients' outcome.

Published
2009
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