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2. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., Sommacale D., De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de'Angelis N., Catena F., Memeo R., Coccolini F., Martinez-Perez A., Romeo O. M., De Simone B., Di Saverio S., Brustia R., Rhaiem R., Piardi T., Conticchio M., Marchegiani F., Beghdadi N., Abu-Zidan F. M., Alikhanov R., Allard M. -A., Allievi N., Amaddeo G., Ansaloni L., Andersson R., Andolfi E., Azfar M., Bala M., Benkabbou A., Ben-Ishay O., Bianchi G., Biffl W. L., Brunetti F., Carra M. C., Casanova D., Celentano V., Ceresoli M., Chiara O., Cimbanassi S., Bini R., Coimbra R., Luigi de'Angelis G., Decembrino F., De Palma A., de Reuver P. R., Domingo C., Cotsoglou C., Ferrero A., Fraga G. P., Gaiani F., Gheza F., Gurrado A., Harrison E., Henriquez A., Hofmeyr S., Iadarola R., Kashuk J. L., Kianmanesh R., Kirkpatrick A. W., Kluger Y., Landi F., Langella S., Lapointe R., Le Roy B., Luciani A., Machado F., Maggi U., Maier R. V., Mefire A. C., Hiramatsu K., Ordonez C., Patrizi F., Planells M., Peitzman A. B., Pekolj J., Perdigao F., Pereira B. M., Pessaux P., Pisano M., Puyana J. C., Rizoli S., Portigliotti L., Romito R., Sakakushev B., Sanei B., Scatton O., Serradilla-Martin M., Schneck A. -S., Sissoko M. L., Sobhani I., ten Broek R. P., Testini M., Valinas R., Veloudis G., Vitali G. C., Weber D., Zorcolo L., Giuliante F., Gavriilidis P., Fuks D., and Sommacale D.

Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021

4. Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study

Author

Pellino, G., Podda, M., Pata, F., Di Saverio, S., Ielpo, B., Caruso, R., Gravante, G., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Paz Yanez, A., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Martinez Roldan, A., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, A., Prestera, A., Ramos-De la Medina, A., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., De Simone, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Lo Faro, C., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Del Pozo Andres, E., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Gallo, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Gunadi, Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Hamilton, Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., San Roman, I. A., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., al-Najami, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Pejanovic, J., Parreira, J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pinto, J. P., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S. J., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Bartolome, M. A. H., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Zulfiqar Ali, M., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Win Than, N., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., De'Angelis, N., Gica, N., Nicolaescu, D. C., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Lui, R., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Lopez, B. S., Fuentes, S., de las Casas, S. G., Napetti, S., de Guzman, S. O., Awad, S., Lujan, S. A. W., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Rao Katta, V., De Simone, V., Primo Romaguera, V., Garcia Orozco, V., Luraschi, V., Rachkov, V., Turrado-Rodriguez, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, Orengia, A, Chowdary, A, Kulkarni, A, Kuvvetli, A, Navarro, A, Smith, A, Cavero Ibiricu, A, D Nacion, A J, Alsaleh, A, Alhazmi, A, Elmabri, A, Wani, A, Rencuzogullari, A, Sarriugarte Lasarte, A, Valle Rubio, A, Bavikatte, A, Kumar, A, Jamiri, A-R, M Alvarado Padilla, A, Cacurri, A, de San Ildefonso, A, Porcu, A, Sartori, A, Rocca, A, Paz Yáñez, A, Becaria, A, Solís-Peña, A, Sretenović, A, Urbistondo, A, Bandin, A, Najar, A, De Luca, A, Boddy, A, Charalabopoulos, A, Tzivanakis, A, Amendola, A, Ramirez-Gutierrez de Velasco, A, Cihat Yildirim, A, Frontali, A, O Toure, A, García-Granero, A, Martínez Roldan, A, Sanz Larrainzar, A, Sanjiva Ratnayake, A, M Gonzalez-Ganso, A, M Minaya-Bravo, A, Das, A, Bondurri, A, Costanzi, A, Lucchi, A, Mazzari, A, Musig, A, Peloso, A, Piano, A, Police, A, Mihailescu, A, Pouy, A, Romano, A, Iossa, A, C Leonetti, A, Guariniello, A, Isaac, A, P Delli Bovi, A, Chessa, A, Tromba, A, Álvarez Martínez, A, Brillantino, A, Caira, A, Castaldi, A, Ferronetti, A, Giuliani, A, Prestera, A, Ramos-De la Medina, A, Tarasconi, A, Tornambè, A, Picciariello, A, Ioannidis, A, Leppäniemi, A, Khan, A, Rashid, A, E Pérez-Sánchez, A L, Mittal, A, Rahman Mitul, A, Mehraj, A, Laharwal, A, Dorismé, A, Marinis, A, Iqbal, A, Moncada, A, Braccio, B, Alkhafaji, B, de Andrés Asenjo, B, Martin-Perez, B, De Simone, B, Sánchez Pérez, B, Creavin, B, Calì, B, Pascotto, B, Stubbs, B, Zavala Retes, B, Jovanovic, B, P Goh, B K, Sensi, B, Biddau, C, Gazia, C, Vallicelli, C, A Fagundes, C, Cerdán Santacruz, C, Chirico, C, J Gómez Díaz, C, Petrola, C, Sánchez Rodriguez, C, Yánez Benítez, C, Dammaro, C, Lo Faro, C, Reinke, C, Dominguez Paez, C, Oliva, C, Paranjape, C, Thomas, C, Fung Chia, C, Kwan Kong, C, De Lucia, C, Ovalle Chao, C, Arcudi, C, Guerci, C, Chia, C, Parise, C, Folliero, C, Varela, C, M Ferguson, D, Camacho, D, Popowich, D, Souza Lima, D, Rega, D, Delogu, D, Zigiotto, D, Vinci, D, D'Antonio, D, Parini, D, A Merlini, D, E Zimmerman, D D, Moro-Valdezate, D, Pertile, D, M Giusti, D, S Keller, D, Tarik, D, Kalivaçi, D, Mazingi, D, G Maldonado-Pintado, D, Sasia, D, Linardoutsos, D, Osilli, D, Murrone, D, Russello, D, Rodas, E, A Acuña Roa, E, Ricciardi, E, Rosso, E, Saladino, E, Flores-Villalba, E, Ruiz Ajs, E, Smith-Singares, E, Baili, E, Kouroumpas, E, Bourmpouteli, E, Douka, E, Martin-Perez, E, Guaitoli, E, Samadov, E, Francone, E, Vaterlini, E, Morales, E, Peña, E, Zhao, E, Del Pozo Andres, E, Benzoni, E, Erdas, E, Pinotti, E, Colás-Ruiz, E, Aytac, E, Laterza, E, Agastra, E, Foianini, E, Moscoso, E, Laviano, E, Marra, E, Cardamone, E, Licardie, E, Mpaili, E, Pinna, E, Varo, E, M Navarro, F, Marino, F, Medas, F, Romano, F, Maraska, F, Saliu, F, Madrid, F, Rosa, F, Mastella, F, Gheza, F, Luvisetto, F, Alconchel, F, Monge Vieira, F, Pareja, F, Agresta, F, Luna, F, Bonilla, F, Cordera, F, Burdió, F, Mendoza-Moreno, F, Muñoz Flores, F, Pardo Aranda, F, Taylor, F, L Ramos, F, Fernandes, F, P Tropeano, F, Balestra, F, Bianco, F, Ceci, F, Colombo, F, Di Marzo, F, Ferrara, F, Lancellotti, F, Lazzarin, F, Litta, F, Martini, F, Pizza, F, Roscio, F, Virdis, F, Blanco Antona, F, Cervantes Ramírez, F, M Fernandez, F, O Llinares, F, Quezada, F, Schlottmann, F, Herrera-Almario, G, Massaferro, G, Bislenghi, G, van Ramshorst, G, Gallo, G, Luglio, G, Bointas, G, Kampouroglou, G, Papadopoulos, G, Arredondo Manrique, G, Calini, G, Nastri, G, Formisano, G, Galiffa, G, M Palini, G, Colucci, G, Pagano, G, Vanni, G, Casoni Pattacini, G, De Paola, G, Lisi, G, Partida, G, Bellanova, G, De Nobili, G, Sammy Necchi, G, Sinibaldi, G, Tebala, G, Bagaglini, G, Izzo, G, Argenio, G, Brisinda, G, Candilio, G, Di Grezia, G, Esposito, G, Faillace, G, Frazzetta, G, La Gumina, G, Nigri, G, Romeo, G, Chocarro Amatriaín, G, Ortega, G, Martin-Martin, G, A Stavrou, G, Gunadi, G, Armand Ugon, G, Machain, G, Marcucci, G, Martínez-Mier, G, M Machain, G, Nari, G, Calvo, H, Fathy, H, Hamilton, H, Ahmed, H, Faraj, H, Nava, H, Ordas Macias, H, Nikaj, H, Solano, H, Ahmed Khan, H, Sánchez Alarcón, H, Ebied, H, Giani, I, Villalabeitia Ateca, I, Neri, I, A San Roman, I, Fidoshev, I, Martinez Rodriguez, I, Negoi, I, Ortega, I, Bernescu, I, Shari Russo, I, Vincente Rodríguez, I, Palomares, I, Baltazar, I, Jaén Torrejimeno, I, M Cornejo Jurado, I, Reccia, I, Hussain, I, Brito Toledo, I, Mora-Guzmán, I, Al-Najami, I, Dogaru, I, Romic, I, Balciscueta, I, C Kenington, J, Sagolsem, J, Y Jang, J, Olivier, J, Lammel-Lindemann, J, Dziakova, J, I Roldán Villavicencio, J, Salinas, J, Pejanovic Jose Gustavo Parreira, J, Rincón Pérez, J, S Reyes, J A, A Medina Luque, J, Mak, J, Salas Rodriguez, J, H Herrera Kok, J, Krook, J, A Diaz-Elizondo, J, Castell, J, Eduardo García-Flores, J, M Jover Navalón, J, M Silva Rodrigues, J, Pereira Pinto, J, T Castell Gómez, J, Bellido Luque, J, C Martín Del Olmo, J, C Salamea, J, F Coronel Olivier, J, L Blas Laina, J, M Ordoñez, J, Gutierrez, J, Abba, J, Ahmad Sofi, J, Sherafgan, K, Sahnan, K, Yanaga, K, Beatson, K, Asim, L, Alvarez, L, Siragusa, L, Farber, L, Ong, L, Athanasios, L, García-Bruña, L, De Martino, L, Ferrario, L, Giordano, L, Gordini, L, Pio, L, Ponchietti, L, Moletta, L, Curella, L, Poggi, L, Taglietti, L, Bonavina, L, Conti, L, Goffredi, L, A Garcia Ruiz, L, Barrionuevo, L, E Fregoso, L, F Cabrera, L, G Rodriguez, L, Grande, L, G Osoria, L, J Kantun Gonzalez, L, Sánchez-Guillén, L, Tallon-Aguilar, L, Tresierra, L, Giavarini, L, Hasabelnabi, M, Odovic, M, Uemura, M, Khan, M, Artiles-Armas, M, David, M, Di Martino, M, G Spampinato, M, F Ribeiro, M A, Viola, M, Angrisani, M, Calussi, M, Cannistrà, M, Catarci, M, Cereda, M, Conte, M, Giordano, M, Pellicciaro, M, Vito Marino, M, E Vaterlini, M, F Jiménez, M, G Lolli, M, I Bellini, M, Lemma, M, M Chiarello, M, Nicola, M, Arrigo, M, Caneda Mejia, M, Montes Manrique, M, Rodriguez-Lopez, M, Serradilla-Martín, M, Zambrano Lara, M, Martínez, M, Bagnall, M, Peter, M, Cañón Lara, M, Jimenez Gomez, M, Paniagua-Garcia-Señorans, M, Perez Gonzalez, M, Rutegård, M, Salö, M, Franceschilli, M, Silveri, M, Veroux, M, Pezzulo, M, Nardi, M, Rottoli, M, Tolonen, M, Pedraza Ciro, M, Zuluagua, M, Cannavò, M, Cervellera, M, Iacobone, M, Montuori, M, García Domínguez, M, Bingol-Kologlu, M, Tahir, M, Lim, M, J Wilson, M S, Wilson, M, Campanelli, M, Bisaccia, M, De Rosa, M, Maruccia, M, Paterno, M, Pisano, M, Torre, M, Treviño, M, Zuolo, M, A Hernandez Bartolome, M, Farina, M, Pera, M, Prieto Calvo, M, Sotelo, M, Myat Thway, M, Hassan, M, Salah Eldin Hassan, M, Azfar, M, Bouhuwaish, M, Taha, M, Zaieem, M, Korkoman, M, Guraieb, M, Shalaby, M, A Raza, M, U Younis, M, Elhadi, M, Zulfiqar Ali, M, Quazi, N, N Dudi-Venkata, N, Alselaim, N, Loria, N, Villan Ramírez, N, Win Than, N, Smart, N, Trelles, N, Pinto, N, Allievi, N, Petrucciani, N, Antonacci, N, Cillara, N, De'Angelis, N, Gica, N, C Nicolaescu, D, Krystek, N, Falco, N, Pecorelli, N, Tamini, N, A Dallas, N, Machairas, N, Brito, N, Ahmed Fieturi, N, Ortega, N, Avila Mercado, O, Irkorucu, O, Alsherif, O, Valles, O, Ioannidis, O, Hernández Palmas, O, I Hernandez Palmas, O, Sanz Guadarrama, O, Bozbiyik, O, Omelanczuk, P, Ottolino, P, Rodrigues, P, Ruiz, P, Campenni, P, Chiarade, P, Prieto Olivares, P, Baroffio, P, Panaccio, P, Wintringer, P, Di Fronzo, P, Talento, P, Favoriti, P, Sendino, P, Marsanic, P, Mifsut, P, Andrade, P, Ajawin, P, Abadía-Barnó, P, A Najar Castañeda, P, O Sillas Arevalos, P, Palazón Bellver, P, Soon Koh, P, Souza, P, Major, P, Singh Bali, R, Mohan Khattar, R, Lui, R, Bessa Melo, R, Ebrahiminia, R, Azar, R, López Murga, R, Pirolo, R, Brady, R, J Davies, R, Dholakia, R, Rattan, R, Singhal, R, Lim, R, Angelico, R, M Isernia, R, Tutino, R, Faccincani, R, Peltrini, R, Carrera-Ceron, R, Tejos, R, Kashyap, R, Fajardo, R, Lozito, R, Madariaga Pareja, R, Garbarino, S, Morales-Conde, S, Benli, S, Mansour, S, Flores, S, Limon Suarez, S, Santiago Lopez, B, Fuentes, S, Gortazar de Las Casas, S, Napetti, S, Ortiz de Guzmán, S, Awad, S, A Weckmann Luján, S, Gentilli, S, Grimaldi, S, Olivares Pizarro, S, Tayar, S, Nabi, S, M Chan, S, Junaid, S, Rojas, S, Monetti, S, García, S, Salvans, S, Tenconi, S, Shaw, S, Santoni, S, A Parra, S, Cárdenas, S, Pérez-Bertólez, S, Chiappetta, S, Dessureault, S, Delis, S, Amore Bonapasta, S, Rausei, S, Scaringi, S, Keswani, S, M Ali, S, Cetinkunar, S, D Fung, T L, Rawashdeh, T, N López, T, De Campos, T, Calderon Duque, T, Perra, T, Liakakos, T, Daskalakis, T, Barnes, T, Koëter, T, Zalla, T, E González, T, Elosua, T, Campagnaro, T, Brown, T, Luoto, T, Alpha Oumar, T, Giustizieri, U, Grossi, U, Bracale, U, Rivas, U, Sosa, V, Testa, V, Andriola, V, Tonini, V, Balassone, V, Celentano, V, Progno, V, Raju, V, Carroni, V, Cavallaro, V, Rao Katta, V, De Simone, V, Primo Romaguera, V, H García Orozco, V, Luraschi, V, Rachkov, V, Turrado-Rodriguez, V, Visag-Castillo, V, Dowling, V, Graham, V, Papagni, V, Vigorita, V, Cordeiro Fonseca, V, Jimenez Carneros, V, Bellato, V, Gonçalves, W, F Powers, W, Grigg, W, O Bechstein, W, B Lim, Y, Altinel, Y, Golubović, Z, Balciscueta, Z, Pellino G., Podda M., Pata F., Di Saverio S., Ielpo B, Rottoli M., and Tonini V.

Subjects
medicine.medical_specialty, business.industry, COVID-19, Perioperative, Appendicitis, COVID-19 testing, humans, healthcare disparities, mass screening, perioperative care, Perioperative Care, Settore MED/18 - Chirurgia Generale, Healthcare Disparitie, COVID-19 Testing, Pandemic, Acute appendicitis, medicine, Humans, Mass Screening, Surgery, Appendiciti, Healthcare Disparities, Intensive care medicine, business, Human
Abstract

Acute appendicitis remains a common reason for hospital admission. Reports have suggested a reduction in patients attending emergency departments during the acute phase of the SARSCoV- 2 pandemic. Moreover, a global surge in conservative management of acute appendicitis has recently been registered by the Appy Study of the Association of Italian Surgeons in Europe (ACIE)1. This is a treatment option that has been known for some years, although quite seldom used before the pandemic2–4. As most countries are experiencing new waves of the pandemic, the attitude of surgeons towards SARS-CoV-2 screening policies and personal protective equipment (PPE) used during the management of patients with acute appendicitis need to be established. According to a subanalysis of the ACIE Appy Study, half of surgeons globally were testing patients for SARS-CoV-2 only when symptomatic or there was suspicion of infection; approximately 12 per cent did not test patients at all (Fig. 1 and Table S1). There were regional differences. In Europe, respondents tested all patients (50.8 per cent) or those with suspected infection (43.9 per cent), with only 5.3 per cent not being tested at all. In the USA, the majority of participants only tested patients with a suspected infection (65.6 per cent). A similar picture of testing only those with a suspected infection was also reported from Latin America (57.2 per cent), Asia/Middle East (76.8 per cent), and Africa (41.7 per cent). Even more worrisome, 58.3 per cent of respondents from Africa and 27.6 per cent from Latin America were not testing patients at all before appendicectomy. Concerning the screening modality, most respondents used PCR alone or in combination with chest imaging. Serology was rarely used overall and never in Africa (Fig. 1 and Table S2 ). It is now accepted that chest imaging is not routinely required and that PCR is an accurate screening modality. Serology might, however, be useful to shed light on the disease course and previous exposure to the virus, but respondents from some countries still have restricted access to this test. In terms of PPE during appendicectomy, most African respondents did not use different PPE compared with the prepandemic period in patients who tested negative for COVID-19. More concerning is that 58.3 per cent did not use different PPE in untested patients. This differed from other regions where the rate of those not considering a change of PPE in untested patients did not exceed 22 per cent. One in 10 respondents from Latin America also reported that they were not using different PPE compared with the prepandemic phase in patients who tested positive for COVID-19. These data, and taking into account the high prevalence of acute appendicitis, leads to the conclusion that omission of routine patient screening may have contributed to local clusters among patients and threatened the safety of healthcare workers5. In this respect, it is likely that limited access to PPE explains the attitude of surgeons towards patients with unknown SARSCoV- 2 status or those infected, raising ethical concerns about the safety of surgical staff. It is of outmost importance that, even during challenging times and stress on economic stability, industrialized countries make efforts to sustain low-income countries and those with limited resources. This would ensure equal working conditions, safer treatment for patients with acute appendicitis, and better control of the pandemic

Published
2021

5. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

De'Angelis, N., Catena, F., Memeo, R., Coccolini, F., Martínez-Pérez, A., Romeo, O.M., Simone, B. De, Saverio, S. Di, Brustia, R., Rhaiem, R., Piardi, T., Conticchio, M., Marchegiani, F., Beghdadi, N., Abu-Zidan, F.M., Alikhanov, R., Allard, M.A., Allievi, N., Amaddeo, G., Ansaloni, L., Andersson, R., Andolfi, E., Azfar, M., Bala, M., Benkabbou, A., Ben-Ishay, O., Bianchi, G., Biffl, W.L., Brunetti, F., Carra, M.C., Casanova, D., Celentano, V., Ceresoli, M., Chiara, O., Cimbanassi, S., Bini, R., Coimbra, R., de'Angelis, G. Luigi, Decembrino, F., Palma, A., Reuver, P.R. de, Domingo, C., Cotsoglou, C., Ferrero, A., Fraga, G.P., Gaiani, F., Gheza, F., Gurrado, A., Harrison, E., Henriquez, A., Hofmeyr, S., Iadarola, R., Kashuk, J.L., Kianmanesh, R., Kirkpatrick, A.W., Kluger, Y., Landi, F., Langella, S., Lapointe, R., Roy, B., Luciani, A., Machado, F., Maggi, U., Maier, R.V., Mefire, A.C., Hiramatsu, K., Ordoñez, C., Patrizi, F., Planells, M., Peitzman, A.B., Pekolj, J., Perdigao, F., Pereira, B.M., Pessaux, P., Pisano, M., Puyana, J.C., Rizoli, S., Portigliotti, L., Romito, R., Sakakushev, B., Sanei, B., Scatton, O., Serradilla-Martin, M., Schneck, A.S., Sissoko, M.L., Sobhani, I., Broek, R.P. Ten, Testini, M., Valinas, R., Veloudis, G., Vitali, G.C., Weber, D., Zorcolo, L., Giuliante, F., Gavriilidis, P., Fuks, D., Sommacale, D., De'Angelis, N., Catena, F., Memeo, R., Coccolini, F., Martínez-Pérez, A., Romeo, O.M., Simone, B. De, Saverio, S. Di, Brustia, R., Rhaiem, R., Piardi, T., Conticchio, M., Marchegiani, F., Beghdadi, N., Abu-Zidan, F.M., Alikhanov, R., Allard, M.A., Allievi, N., Amaddeo, G., Ansaloni, L., Andersson, R., Andolfi, E., Azfar, M., Bala, M., Benkabbou, A., Ben-Ishay, O., Bianchi, G., Biffl, W.L., Brunetti, F., Carra, M.C., Casanova, D., Celentano, V., Ceresoli, M., Chiara, O., Cimbanassi, S., Bini, R., Coimbra, R., de'Angelis, G. Luigi, Decembrino, F., Palma, A., Reuver, P.R. de, Domingo, C., Cotsoglou, C., Ferrero, A., Fraga, G.P., Gaiani, F., Gheza, F., Gurrado, A., Harrison, E., Henriquez, A., Hofmeyr, S., Iadarola, R., Kashuk, J.L., Kianmanesh, R., Kirkpatrick, A.W., Kluger, Y., Landi, F., Langella, S., Lapointe, R., Roy, B., Luciani, A., Machado, F., Maggi, U., Maier, R.V., Mefire, A.C., Hiramatsu, K., Ordoñez, C., Patrizi, F., Planells, M., Peitzman, A.B., Pekolj, J., Perdigao, F., Pereira, B.M., Pessaux, P., Pisano, M., Puyana, J.C., Rizoli, S., Portigliotti, L., Romito, R., Sakakushev, B., Sanei, B., Scatton, O., Serradilla-Martin, M., Schneck, A.S., Sissoko, M.L., Sobhani, I., Broek, R.P. Ten, Testini, M., Valinas, R., Veloudis, G., Vitali, G.C., Weber, D., Zorcolo, L., Giuliante, F., Gavriilidis, P., Fuks, D., and Sommacale, D.

Abstract

Contains fulltext : 238974.pdf (Publisher’s version ) (Open Access), Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021

6. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Author

Ielpo, B., Podda, M., Pellino, G., Pata, F., Caruso, R., Gravante, G., Di Saverio, S., Gallo, G., Lui, R., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Pisanu, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Yanez, A. P., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Roldan, A. M., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, Antonio, Prestera, A., la Medina, A. R. -D., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Faro, C. L., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, Fausto, Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, Giuseppe, Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Gunadi, Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Hamilto, Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Jovanovic, Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Giuliani A. (ORCID:0000-0002-0773-2162), Rosa F. (ORCID:0000-0002-7280-8354), Ielpo, B., Podda, M., Pellino, G., Pata, F., Caruso, R., Gravante, G., Di Saverio, S., Gallo, G., Lui, R., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Pisanu, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Yanez, A. P., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Roldan, A. M., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, Antonio, Prestera, A., la Medina, A. R. -D., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Faro, C. L., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, Fausto, Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, Giuseppe, Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Gunadi, Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Hamilto, Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Jovanovic, Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Giuliani A. (ORCID:0000-0002-0773-2162), and Rosa F. (ORCID:0000-0002-7280-8354)

Abstract

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.

Published
2021

8. Factors Associated with Surgical Mortality and Complications among Patients with and without Coronavirus Disease 2019 (COVID-19) in Italy

Author

Doglietto, F., Vezzoli, M., Gheza, F., Lussardi, G. L., Domenicucci, M., Vecchiarelli, L., Zanin, L., Saraceno, G., Signorini, L., Panciani, P. P., Castelli, F., Maroldi, R., Rasulo, F. A., Benvenuti, M. R., Portolani, N., Bonardelli, S., Milano, G., Casiraghi, A., Calza, S., Fontanella, M. M., Doglietto F. (ORCID:0000-0002-7438-0734), Vezzoli M., Fontanella M. M., Doglietto, F., Vezzoli, M., Gheza, F., Lussardi, G. L., Domenicucci, M., Vecchiarelli, L., Zanin, L., Saraceno, G., Signorini, L., Panciani, P. P., Castelli, F., Maroldi, R., Rasulo, F. A., Benvenuti, M. R., Portolani, N., Bonardelli, S., Milano, G., Casiraghi, A., Calza, S., Fontanella, M. M., Doglietto F. (ORCID:0000-0002-7438-0734), Vezzoli M., and Fontanella M. M.

Abstract

Importance: There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery. Objective: To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties. Design, Setting, and Participants: This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score. Exposures: Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations. Main Outcomes and Measures: The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors. Results: Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]

Published
2020

11. Corrigendum to Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis [Int. J. Surg., 18, (2015), 196-204] Doi: 10.1016/j.ijsu.2015.04.083

Author

Coccolini F., Coccolini, F, Catena, F, Pisano, M, Gheza, F, Fagiuoli, S, Di Saverio, S, Leandro, G, Montori, G, Ceresoli, M, Corbella, D, Sartelli, M, Sugrue, M, Ansaloni, L, Coccolini F., Catena F., Pisano M., Gheza F., Fagiuoli S., Di Saverio S., Leandro G., Montori G., Ceresoli M., Corbella D., Sartelli M., Sugrue M., Ansaloni L., Coccolini F., Coccolini, F, Catena, F, Pisano, M, Gheza, F, Fagiuoli, S, Di Saverio, S, Leandro, G, Montori, G, Ceresoli, M, Corbella, D, Sartelli, M, Sugrue, M, Ansaloni, L, Coccolini F., Catena F., Pisano M., Gheza F., Fagiuoli S., Di Saverio S., Leandro G., Montori G., Ceresoli M., Corbella D., Sartelli M., Sugrue M., and Ansaloni L.

Published
2015

12. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis

Author

Coccolini, F, Catena, F, Pisano, M, Gheza, F, Fagiuoli, S, Di Saverio, S, Leandro, G, Montori, G, Ceresoli, M, Corbella, D, Sartelli, M, Sugrue, M, Ansaloni, L, Coccolini F., Catena F., Pisano M., Gheza F., Fagiuoli S., Di Saverio S., Leandro G., Montori G., Ceresoli M., Corbella D., Sartelli M., Sugrue M., Ansaloni L., Coccolini, F, Catena, F, Pisano, M, Gheza, F, Fagiuoli, S, Di Saverio, S, Leandro, G, Montori, G, Ceresoli, M, Corbella, D, Sartelli, M, Sugrue, M, Ansaloni, L, Coccolini F., Catena F., Pisano M., Gheza F., Fagiuoli S., Di Saverio S., Leandro G., Montori G., Ceresoli M., Corbella D., Sartelli M., Sugrue M., and Ansaloni L.

Abstract

Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. Material and methods: A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. Results: Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR=0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR=0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD=-4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. Conclusions: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.

Published
2015

14. Virtual Simulation in Robotic Surgery: Strengths and Pitfalls

Author

Gheza F

Subjects
Basic skills, Future perspective, business.industry, ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION, Medicine, Robotic surgery, business, Simulation
Abstract

Virtual Simulation in Robotic Surgery: Strengths and Pitfalls Virtual simulation is a consistent part of robotic surgery training, including basic skills and advanced anatomically reproduced scenarios. A critical point of view about all available options and future perspective is presented as a commentary, without any review purpose.

Published
2016
Full Text
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15. CT colonography for the detection of nonpolypoid colorectal lesions A prospective series

Author

Gian Luca BAIOCCHI, Mazza, G., Totaro, L., Missale, G., Gheza, F., Morone, M., Frittol, B., Moneghini, D., Tiberio, G., Molfino, S., Graziol, L., and Portolani, N.

Subjects
Adenoma, Male, Observer Variation, Hyperplasia, Colon, Carcinoma, Colonoscopy, Middle Aged, Sensitivity and Specificity, Humans, False Positive Reactions, Female, Neoplasm Invasiveness, Prospective Studies, Colorectal Neoplasms, Colonography, Computed Tomographic, False Negative Reactions, Aged
Abstract

To determine the diagnostic accuracy of CT-colonography (CTC) for colorectal nonpolypoid lesions.In the period 2010-2011, 51 out of 454 patients undergoing CTC received also optical colonoscopy (OC). Three human readers with high, intermediate and low expertise interpreted the images. Flat lesions were defined as 3 mm or less in height; laterally spreading type (LST) lesions were defined as nonpolypoid lesions with more than 10 mm lateral diameter.A total of 75 nonpolypoid colorectal lesions were identified in 21 patients: 43 type II-A low-grade adenomas, 2 type II-c Tis adenocarcinomas, 2 LST Tis adenocarcinomas, 24 nonadenomatous (hyperplastic) lesions and 4 LST infiltrating tumors (T1N0M0 in 2 cases and T2N0M0 in 2 cases). Per-lesion sensitivity and NPV were 44% and 80.5%, while per-patient sensitivity, specificity, PPV, NPV and accuracy were 80.9%, 93.7%, 89.5%, 88.2%, 88.7%. The readers with high and intermediate experience yielded significantly better diagnostic performances than reader with low experience (p =0.072 and p=0.030). All the infiltrating carcinomas and 75% of tis carcinomas were detected by all the readers.CTC showed a low per-lesion and an high per-patient diagnostic accuracy for all nonpolypoid colorectal lesions, but an high ability to detect nonpolypoid colorectal carcinomas. Diagnostic performances are strictly related to the reader experience.Adenoma, Colon cancer, Colonoscopy CT colonography, Non polypoid lesions, Screening.Scopo dello studio è determinare l’accuratezza diagnostica della Colon TC per l’individuazione di lesioni colorettali non polipoidi. Durante il periodo 2010-2011, 51 di 454 pazienti candidati a Colon TC sono stati successivamente sottoposti a colonscopia. I parametri utilizzati per la classificazione delle lesioni sono stati: spessore massimo di 3 mm per lesioni piatte, diametro massimo di 10 mm di Laterally spreading Tumors (LST). Le immagini sono state interpretate da 3 distinte equipes con differente esperienza. Un totale di 75 lesioni colorettali non polipoidi sono state identificate in 21 pazienti, 43 di tipo II-A con adenoma a displasia a basso grado, 2 di tipo II-C adenocarcinomi intramucosi, 2 LST con adenocarcinoma intramucoso, 24 lesioni non adenomatose iperplastiche, 4 LST con adenocarcinoma infiltrante (T1N0M0 in 2 casi T2N0M0). La sensibilità e la NPV calcolate per singola lesione sono risultate 44% e 80.5%, mentre la sensibilità, PPV, NPV e l’accuratezza per singolo paziente sono risultate 80.9%, 93.7%, 89.5%, 88.2%, 88.7%. L’interpretazione delle immagini è risultata significativamente determinata dall’esperienza degli esaminatori (p=0.072 and p=0.030). Tutti i carcinomi infiltranti ed il 75 % dei TIS sono stati identificati da entrambe le metodiche diagnostiche. Conclusione: La Colon TC ha mostrato un’alta accuratezza nell’identificazione di neoformazioni per ogni singolo paziente , considerando lesioni colorettali non polipoidi oltre ad un’alta capacità di identificare carcinomi non polipoidi. L’identificazione delle lesioni è strettamente correlata all’esperienza nella lettura di tali immagini.

Published
2015

25. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Author

Benedetto, Ielpo, Mauro, Podda, Gianluca, Pellino, Pata, Francesco, Gianpiero, Gravante, Salomone Di Saverio, Gallo, Gaetano, Rashid, Lui, Adam, Orengia, Aditya, Chowdary, Aditya, Kulkarni, Adnan, Kuvvetli, Adolfo, Navarro, Adolfo, Pisanu, Adrian, Smith, Adriana Cavero Ibiricu, Aeris Jane, D Nacion, Ahmad, Alsaleh, Ahmad, Alhazmi, Ahmad, Elmabri, Ajaz, Wani, Ahmet, Rencuzogullari, Aingeru Sarriugarte Lasarte, Ainhoa Valle Rubio, Akshay, Bavikatte, Akshay, Kumar, Al-Radjid, Jamiri, Alain Michel Alvarado Padilla, Alban, Cacurri, Alberto de San Ildefonso, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Alejandro Paz Yáñez, Alejandro, Becaria, Alejandro, Solís-Peña, Aleksandar, Sretenović, Alex, Urbistondo, Alfonso, Bandin, Alfonso, Najar, Alessandro De Luca, Alex, Boddy, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Amendola, Alfredo Ramirez-Gutierrez de Velasco, Ali Cihat Yildirim, Alice, Frontali, Alpha Oumar Toure, Alvaro, García-Granero, Amaia Martínez Roldan, Amaia Sanz Larrainzar, Amila Sanjiva Ratnayake, Ana María Gonzalez-Ganso, Ana, M Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Andrea, Lucchi, Andrea, Mazzari, Andrea, Musig, Andrea, Peloso, Andrea, Piano, Andrea, Police, Andrei, Mihailescu, Andrés, Pouy, Angela, Romano, Iossa, Angelo, Anna Carmen Leonetti, Anna, Guariniello, Anna, Isaac, Anna Pia Delli Bovi, Antonella, Chessa, Antonella, Tromba, Antonio Álvarez Martínez, Antonio, Brillantino, Antonio, Caira, Antonio, Castaldi, Antonio, Ferronetti, Antonio, Giuliani, Antonio, Prestera, Antonio Ramos-De la Medina, Antonio, Tarasconi, Antonino, Tornambè, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Khan, Arshad, Rashid, Arteaga Luis Eduardo Pérez-Sánchez, Ashok, Mittal, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Asnel, Dorismé, Athanasios, Marinis, Atif, Iqbal, Augusto, Moncada, Bartolomeo, Braccio, Basim, Alkhafaji, Beatriz de Andrés Asenjo, Beatriz, Martin-Perez, Belinda Sánchez Pérez, Ben, Creavin, Benedetto, Calì, Beniamino, Pascotto, Benjamin, Stubbs, Benjamin Zavala Retes, Branislav, Jovanovic, Brian Kp Goh, Bruno, Sensi, Carlo, Biddau, Carlo, Gazia, Carlo, Vallicelli, Carlos Alberto Fagundes, Carlos Cerdán Santacruz, Carlos, Chirico, Carlos Javier Gómez, Carlos, Petrola, Carlos Sánchez Rodriguez, Carlos Yánez Benítez, Carmelisa, Dammaro, Carmelo Lo Faro, Caroline, Reinke, Casandra Dominguez Paez, Catalina, Oliva, Charudutt, Paranjape, Charlotte, Thomas, Chi Fung Chia, Chi Kwan Kong, Chiara De Lucia, Christian Ovalle Chao, Claudio, Arcudi, Claudio, Guerci, Clement, Chia, Cristiano, Parise, Cristina, Folliero, Cristopher, Varela, Dalya, M Ferguson, Daniel, Camacho, Daniel, Popowich, Daniel Souza Lima, Daniela, Rega, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, Dario, Parini, David Alessio Merlini, David DE Zimmerman, David, Moro-Valdezate, Davide, Pertile, Deborah Maria Giusti, Deborah, S Keller, Delko, Tarik, Denis, Kalivaçi, Dennis, Mazingi, Diana Gabriela Maldonado-Pintado, Diego, Sasia, Dimitrios, Linardoutsos, Dixon, Osilli, Domenico, Murrone, Domenico, Russello, Edgar, Rodas, Edisson Alberto Acuña Roa, Edoardo, Ricciardi, Edoardo, Rosso, Edoardo, Saladino, Eduardo, Flores-Villalba, Eduardo Ruiz Ajs, Eduardo, Smith-Singares, Efstratia, Baili, Efstratios, Kouroumpas, Eirini, Bourmpouteli, Eleftheria, Douka, Elena, Martin-Perez, Eleonora, Guaitoli, Elgun, Samadov, Elisa, Francone, Elisa, Vaterlini, Emilio, Morales, Emilio, Peña, Enhao, Zhao, Eneko Del Pozo Andres, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Erman, Aytac, Ernesto, Laterza, Ervis, Agastra, Esteban, Foianini, Esteban, Moscoso, Estefania, Laviano, Ester, Marra, Eugenia, Cardamone, Eugenio, Licardie, Eustratia, Mpaili, Eva, Pinna, Evaristo, Varo, Fabian Martín Navarro, Fabio, Marino, Fabio, Medas, Fabio, Romano, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federica, Mastella, Federico, Gheza, Federico, Luvisetto, Felipe, Alconchel, Felipe Monge Vieira, Felipe, Pareja, Ferdinando, Agresta, Fernanda, Luna, Fernando, Bonilla, Fernando, Cordera, Fernando, Burdió, Fernando, Mendoza-Moreno, Fernando Muñoz Flores, Fernando Pardo Aranda, Fiona, Taylor, Flavia, L Ramos, Flavio, Fernandes, Francesca Paola Tropeano, Francesco, Balestra, Francesco, Bianco, Francesco, Ceci, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Lazzarin, Francesco, Litta, Francesco, Martini, Francesco, Pizza, Francesco, Roscio, Francesco, Virdis, Francisco Blanco Antona, Francisco Cervantes Ramírez, Francisco Miguel Fernandez, Francisco Oliver Llinares, Francisco, Quezada, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabriel, Massaferro, Gabriele, Bislenghi, Gabrielle van Ramshorst, Gaetano, Gallo, Gaetano, Luglio, Georgios, Bointas, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo Arredondo Manrique, Giacomo, Calini, Giacomo, Nastri, Giampaolo, Formisano, Giampaolo, Galiffa, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gilda De Paola, Giorgio, Lisi, Giovanna, Partida, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Giovanni, Sinibaldi, Giovanni, Tebala, Giulia, Bagaglini, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Candilio, Giuseppe Di Grezia, Giuseppe, Esposito, Giuseppe, Faillace, Giuseppe, Frazzetta, Giuseppe La Gumina, Giuseppe, Nigri, Giuseppe, Romeo, Gloria Chocarro Amatriaín, Gloria, Ortega, Gonzalo, Martin-Martin, Gregor, A Stavrou, Gunadi, Gustavo Armand Ugon, Gustavo, Machain, Gustavo, Marcucci, Gustavo, Martínez-Mier, Gustavo Miguel Machain, Gustavo, Nari, Haydée, Calvo, Hamada, Fathy, Hamilto, Hazem, Ahmed, Hazem, Faraj, Hector, Nava, Hector Ordas Macias, Herald, Nikaj, Heriberto, Solano, Huma Ahmed Khan, Humberto Sánchez Alarcón, Husam, Ebied, Iacopo, Giani, Ibabe Villalabeitia Ateca, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki Martinez Rodriguez, Ionut, Negoi, Irene, Ortega, Irina, Bernescu, Iris Shari Russo, Irune Vincente Rodríguez, Irving, Palomares, Isaac, Baltazar, Isabel Jaén Torrejimeno, Isabel María Cornejo Jurado, Isabella, Reccia, Ishtiyaq, Hussain, Ismael Brito Toledo, Ismael, Mora-Guzmán, Iulia, Dogaru, Ivan, Romic, Izaskun, Balciscueta, J Cleo Kenington, Jackison, Sagolsem, Jae, Y Jang, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier Ismael Roldán Villavicencio, Javier, Salinas, Jelena, Pejanovic, Jose Gustavo Parreira, Jovanovic, Jeny Rincón Pérez, Jeryl, Asreyes, Jesus Antonio Medina Luque, Joanna, Mak, Joanne Salas Rodriguez, Johnn Henry Herrera Kok, Jon, Krook, Jose Antonio Diaz-Elizondo, Jose, Castell, José Eduardo García-Flores, José María Jover Navalón, Jose Mauro Silva Rodrigues, José, Pereira, José Tomas Castell Gómez, Juan Bellido Luque, Juan Carlos Martín Del Olmo, Juan Carlos Salamea, Juan Francisco Coronel Olivier, Juan Luis Blas Laina, Juliana Maria Ordoñez, Julieta, Gutierrez, Julio, Abba, Junaid Ahmad Sofi, Kashaf, Sherafgan, Kapil, Sahnan, Katsuhiko, Yanaga, Kevin, Beatson, Laharwal, Asim, Laura, Alvarez, Leandro, Siragusa, Lee, Farber, Lester, Ong, Liarakos, Athanasios, Lorena, García-Bruña, Luca De Martino, Luca, Ferrario, Luca, Giordano, Luca, Gordini, Luca, Pio, Luca, Ponchietti, Lucia, Moletta, Luciano, Curella, Luciano, Poggi, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luigi, Goffredi, Luis Angel Garcia Ruiz, Luis, Barrionuevo, Luis Enrique Fregoso, Luis, F Cabrera, Luis, G Rodriguez, Luis, Grande, Luis Gregorio Osoria, Luis Javier Kantun Gonzalez, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Luis, Tresierra, Luisa, Giavarini, Mahmoud, Hasabelnabi, Maja, Odovic, Mamoru, Uemura, Mansoor, Khan, Manuel, Artiles-Armas, Mara, David, Marcello Di Martino, Marcello Giuseppe Spampinato, Marcelo A, F Ribeiro, Marcelo, Viola, Marco, Angrisani, Marco, Calussi, Marco, Cannistrà, Marco, Catarci, Marco, Cereda, Marco, Conte, Marco, Giordano, Marco, Pellicciaro, Marco Vito Marino, Maria, E Vaterlini, María, F Jiménez, María Giulia Lolli, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Maria, Nicola, Mario, Arrigo, Mario Caneda Mejia, Mario Montes Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mario Zambrano Lara, Marisa, Martínez, Mark, Bagnall, Mark, Peter, Marta Cañón Lara, Marta Jimenez Gomez, Marta, Paniagua-Garcia-Señorans, Marta Perez Gonzalez, Martin, Rutegård, Martin, Salö, Marzia, Franceschilli, Massimiliano, Silveri, Massimiliano, Veroux, Massimo, Pezzulo, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluagua, Maurizio, Cannavò, Maurizio, Cervellera, Maurizio, Iacobone, Mauro, Montuori, Melody García Domínguez, Meltem, Bingol-Kologlu, Mian, Tahir, Michael, Lim, Michael Sj Wilson, Michael, Wilson, Michela, Campanelli, Michele, Bisaccia, Michele De Rosa, Michele, Maruccia, Michele, Paterno, Michele, Pisano, Michele, Torre, Michele, Treviño, Michele, Zuolo, Miguel, A Hernandez Bartolome, Miguel, Farina, Miguel, Pera, Miguel Prieto Calvo, Milagros, Sotelo, Min Myat Thway, Mohamed, Hassan, Mohamed Salah Eldin Hassan, Mohammad, Azfar, Mohammad, Bouhuwaish, Mohammad, Taha, Mohammad, Zaieem, Mohammed, Korkoman, Montserrat, Guraieb, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid Zulfiqar Ali, Nadeem, Quazi, Nagendra, N Dudi-Venkata, Nahar, Alselaim, Natasha, Loria, Nathalie Villan Ramírez, Nay Win Than, Neil, Smart, Nelson, Trelles, Nicanor, Pinto, Niccolò, Allievi, Niccolo, Petrucciani, Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolaescu Diana Cristiana, Nicolás, Nicolás, Nicolò, Falco, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos Andreas Dallas, Nikolaos, Machairas, Noelia, Brito, Nura Ahmed Fieturi, Nuria, Ortega, Octavio, Avilamercado, Oktay, Irkorucu, Omar, Alsherif, Orestes, Valles, Orestis, Ioannidis, Oscar Hernández Palmas, Oscar Isaac Hernandez Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Omelanczuk, Pablo, Ottolino, Pablo, Rodrigues, Pablo, Ruiz, Paola, Campenni, Paola, Chiarade, Paola Prieto Olivares, Paolo, Baroffio, Pascal, Wintringer, Pasquale Di Fronzo, Pasquale, Talento, Pasqualino, Favoriti, Patricia, Sendino, Patrizia, Marsanic, Patricia, Mifsut, Paúl, Andrade, Pawel, Ajawin, Valentina, Ferri, Giuseppe Massimiliano de Luca, Sara, Ingallinella, Eva, Pueyo, Francesco, Palmieri, Jesus, Silva, Ken Min Chin, Nicholas, Syn, Brian K, P Goh, Ye Xin Koh, Valeria, Tonini, Ana, Gonzales-Ganso, Vicente, Simó, Maria Victoria Diago, Pedro, Abadía-Barnó, Pedro Alfonso Najar Castañeda, Pedro Omar Sillas Arevalos, Pedro Palazón Bellver, Peng Soon Koh, Petry, Souza, Piotr, Major, Rajandeep Singh Bali, Rakesh Mohan Khattar, Renato Bessa Melo, Reza, Ebrahiminia, Ricardo, Azar, Ricardo López Murga, Riccardo, Caruso, Riccardo, Pirolo, Richard, Brady, Richard Justin Davies, Rishi, Dholakia, Rishi, Rattan, Rishi, Singhal, Robert, Lim, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Faccincani, Roberto, Peltrini, Rocío, Carrera-Ceron, Rodrigo, Tejos, Rohit, Kashyap, Roosevelt, Fajardo, Rosa, Lozito, Royer Madariaga Pareja, Sabrina, Garbarino, Salvador, Morales-Conde, Sami, Benli, Sami, Mansour, Samir, Flores, Samuel Limon Suarez, Santiago Lopez Ben, Sara, Fuentes, Sara, Napetti, Sara Ortiz de Guzmán, Selmy, Awad, Sergio, A Weckmann Luján, Sergio, Gentilli, Sergio, Grimaldi, Sergio Olivares Pizarro, Serkan, Tayar, Shakeeb, Nabi, Shannon, M Chan, Sheikh, Junaid, Sidney, Rojas, Silvana, Monetti, Silvia, García, Silvia, Salvans, Silvia, Tenconi, Simon, Shaw, Simone, Santoni, Sofia Andrea Parra, Sofía, Cárdenas, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Sophie, Dessureault, Spiros, Delis, Stefano Amore Bonapasta, Stefano, Rausei, Stefano, Scaringi, Sundeep, Keswani, Syed Muhammad Ali, Süleyman, Cetinkunar, Tak Lit Derek Fung, Tariq, Rawashdeh, Tatiana Nicolás López, Tercio De Campos, Teresa Calderon Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Theodoros, Liakakos, Thomas, Barnes, Tijmen, Koëter, Tiku, Zalla, Tomás, E González, Tomás, Elosua, Tommaso, Campagnaro, Tommy, Brown, Topi, Luoto, Touré Alpha Oumar, Ugo, Giustizieri, Ugo, Grossi, Umberto, Bracale, Uriel, Rivas, Valentina, Sosa, Valentina, Testa, Valeria, Andriola, Valerio, Balassone, Valerio, Celentano, Valerio, Progno, Varun, Raju, Vanessa, Carroni, Venera, Cavallaro, Venkateswara Rao Katta, Veronica De Simone, Vicent Primo Romaguera, Victor Hugo García Orozco, Victor, Luraschi, Victor, Rachkov, Victor, Turrado-L, Victor, Visag-Castillo, Victoria, Dowling, Victoria, Graham, Vincenzo, Papagni, Vincenzo, Vigorita, Vinicius Cordeiro Fonseca, Virginia Jimenez Carneros, Vittoria, Bellato, Walyson, Gonçalves, William, F Powers, William, Grigg, Wolf, O Bechstein, Yu Bing Lim, Yuksel, Altinel, Zoran, Golubović, Zutoia, Balciscueta, Ielpo B., Podda M., Pellino G., Pata F., Caruso R., Gravante G., Di Saverio S., Gallo G., Lui R., Orengia A., Chowdary A., Kulkarni A., Kuvvetli A., Navarro A., Pisanu A., Smith A., Ibiricu A.C., Nacion A.J.D., Alsaleh A., Alhazmi A., Elmabri A., Wani A., Rencuzogullari A., Lasarte A.S., Rubio A.V., Bavikatte A., Kumar A., Jamiri A.-R., Padilla A.M.A., Cacurri A., de San Ildefonso A., Porcu A., Sartori A., Rocca A., Yanez A.P., Becaria A., Solis-Pena A., Sretenovic A., Urbistondo A., Bandin A., Najar A., De Luca A., Boddy A., Charalabopoulos A., Tzivanakis A., Amendola A., de Velasco A.R.-G., Yildirim A.C., Frontali A., Toure A.O., Garcia-Granero A., Roldan A.M., Larrainzar A.S., Ratnayake A.S., Gonzalez-Ganso A.M., Minaya-Bravo A.M., Das A., Bondurri A., Costanzi A., Lucchi A., Mazzari A., Musig A., Peloso A., Piano A., Police A., Mihailescu A., Pouy A., Romano A., Iossa A., Leonetti A.C., Guariniello A., Isaac A., Bovi A.P.D., Chessa A., Tromba A., Martinez A.A., Brillantino A., Caira A., Castaldi A., Ferronetti A., Giuliani A., Prestera A., la Medina A.R.-D., Tarasconi A., Tornambe A., Picciariello A., Ioannidis A., Leppaniemi A., Khan A., Rashid A., Perez-Sanchez A.L.E., Mittal A., Mitul A.R., Mehraj A., Laharwal A., Dorisme A., Marinis A., Iqbal A., Moncada A., Braccio B., Alkhafaji B., de Andres Asenjo B., Martin-Perez B., Perez B.S., Creavin B., Cali B., Pascotto B., Stubbs B., Retes B.Z., Jovanovic B., Goh B.K.P., Sensi B., Biddau C., Gazia C., Vallicelli C., Fagundes C.A., Santacruz C.C., Chirico C., Diaz C.J.G., Petrola C., Rodriguez C.S., Benitez C.Y., Dammaro C., Faro C.L., Reinke C., Paez C.D., Oliva C., Paranjape C., Thomas C., Chia C.F., Kong C.K., De Lucia C., Chao C.O., Arcudi C., Guerci C., Chia C., Parise C., Folliero C., Varela C., Ferguson D.M., Camacho D., Popowich D., Lima D.S., Rega D., Delogu D., Zigiotto D., Vinci D., D'Antonio D., Parini D., Merlini D.A., Zimmerman D.D.E., Moro-Valdezate D., Pertile D., Giusti D.M., Keller D.S., Tarik D., Kalivaci D., Mazingi D., Maldonado-Pintado D.G., Sasia D., Linardoutsos D., Osilli D., Murrone D., Russello D., Rodas E., Roa E.A.A., Ricciardi E., Rosso E., Saladino E., Flores-Villalba E., Ajs E.R., Smith-Singares E., Baili E., Kouroumpas E., Bourmpouteli E., Douka E., Martin-Perez E., Guaitoli E., Samadov E., Francone E., Vaterlini E., Morales E., Pena E., Zhao E., Andres E.D.P., Benzoni E., Erdas E., Pinotti E., Colas-Ruiz E., Aytac E., Laterza E., Agastra E., Foianini E., Moscoso E., Laviano E., Marra E., Cardamone E., Licardie E., Mpaili E., Pinna E., Varo E., Navarro F.M., Marino F., Medas F., Romano F., Maraska F., Saliu F., Madrid F., Rosa F., Mastella F., Gheza F., Luvisetto F., Alconchel F., Vieira F.M., Pareja F., Agresta F., Luna F., Bonilla F., Cordera F., Burdio F., Mendoza-Moreno F., Flores F.M., Aranda F.P., Taylor F., Ramos F.L., Fernandes F., Tropeano F.P., Balestra F., Bianco F., Ceci F., Colombo F., Di Marzo F., Ferrara F., Lancellotti F., Lazzarin F., Litta F., Martini F., Pizza F., Roscio F., Virdis F., Antona F.B., Ramirez F.C., Fernandez F.M., Llinares F.O., Quezada F., Schlottmann F., Herrera-Almario G., Massaferro G., Bislenghi G., van Ramshorst G., Luglio G., Bointas G., Kampouroglou G., Papadopoulos G., Manrique G.A., Calini G., Nastri G., Formisano G., Galiffa G., Palini G.M., Colucci G., Pagano G., Vanni G., Pattacini G.C., De Paola G., Lisi G., Partida G., Bellanova G., De Nobili G., Necchi G.S., Sinibaldi G., Tebala G., Bagaglini G., Izzo G., Argenio G., Brisinda G., Candilio G., Di Grezia G., Esposito G., Faillace G., Frazzetta G., La Gumina G., Nigri G., Romeo G., Amatriain G.C., Ortega G., Martin-Martin G., Stavrou G.A., Gunadi, Ugon G.A., Machain G., Marcucci G., Martinez-Mier G., Machain G.M., Nari G., Calvo H., Fathy H., Hamilto, Ahmed H., Faraj H., Nava H., Macias H.O., Nikaj H., Solano H., Khan H.A., Alarcon H.S., Ebied H., Giani I., Ateca I.V., Neri I., Roman I.A.S., Fidoshev I., Rodriguez I.M., Negoi I., Ortega I., Bernescu I., Russo I.S., Rodriguez I.V., Palomares I., Baltazar I., Torrejimeno I.J., Jurado I.M.C., Reccia I., Hussain I., Toledo I.B., Mora-Guzman I., Dogaru I., Romic I., Balciscueta I., Kenington J.C., Sagolsem J., Jang J.Y., Olivier J., Lammel-Lindemann J., Dziakova J., Villavicencio J.I.R., Salinas J., Parreira J.P.J.G., Jovanovic, Perez J.R., Reyes J.A.S., Luque J.A.M., Mak J., Rodriguez J.S., Kok J.H.H., Krook J., Diaz-Elizondo J.A., Castell J., Garcia-Flores J.E., Navalon J.M.J., Rodrigues J.M.S., Pereira J., Gomez J.T.C., Luque J.B., del Olmo J.C.M., Salamea J.C., Olivier J.F.C., Laina J.L.B., Ordonez J.M., Gutierrez J., Abba J., Sofi J.A., Sherafgan K., Sahnan K., Yanaga K., Beatson K., Asim L., Alvarez L., Siragusa L., Farber L., Ong L., Athanasios L., Garcia-Bruna L., De Martino L., Ferrario L., Giordano L., Gordini L., Pio L., Ponchietti L., Moletta L., Curella L., Poggi L., Taglietti L., Bonavina L., Conti L., Goffredi L., Ruiz L.A.G., Barrionuevo L., Fregoso L.E., Cabrera L.F., Rodriguez L.G., Grande L., Osoria L.G., Gonzalez L.J.K., Sanchez-Guillen L., Tallon-Aguilar L., Tresierra L., Giavarini L., Hasabelnabi M., Odovic M., Uemura M., Khan M., Artiles-Armas M., David M., Di Martino M., Spampinato M.G., Ribeiro M.A.F., Viola M., Angrisani M., Calussi M., Cannistra M., Catarci M., Cereda M., Conte M., Giordano M., Pellicciaro M., Marino M.V., Vaterlini M.E., Jimenez M.F., Lolli M.G., Bellini M.I., Lemma M., Chiarello M.M., Nicola M., Arrigo M., Mejia M.C., Manrique M.M., Rodriguez-Lopez M., Serradilla-Martin M., Lara M.Z., Martinez M., Bagnall M., Peter M., Lara M.C., Gomez M.J., Paniagua-Garcia-Senorans M., Gonzalez M.P., Rutegard M., Salo M., Franceschilli M., Silveri M., Veroux M., Pezzulo M., Nardi M., Rottoli M., Tolonen M., Ciro M.P., Zuluagua M., Cannavo M., Cervellera M., Iacobone M., Montuori M., Dominguez M.G., Bingol-Kologlu M., Tahir M., Lim M., Wilson M.S., Wilson M., Campanelli M., Bisaccia M., De Rosa M., Maruccia M., Paterno M., Pisano M., Torre M., Trevino M., Zuolo M., Hernandez Bartolome M.A., Farina M., Pera M., Calvo M.P., Sotelo M., Thway M.M., Hassan M., Hassan M.S.E., Azfar M., Bouhuwaish M., Taha M., Zaieem M., Korkoman M., Guraieb M., Shalaby M., Raza M.A., Younis M.U., Elhadi M., Ali M.Z., Quazi N., Dudi-Venkata N.N., Alselaim N., Loria N., Ramirez N.V., Than N.W., Smart N., Trelles N., Pinto N., Allievi N., Petrucciani N., Antonacci N., Cillara N., Gica N., Cristiana N.D., Krystek N., Falco N., Pecorelli N., Tamini N., Dallas N.A., Machairas N., Brito N., Fieturi N.A., Ortega N., Mercado O.A., Irkorucu O., Alsherif O., Valles O., Ioannidis O., Palmas O.H., Palmas O.I.H., Guadarrama O.S., Bozbiyik O., Omelanczuk P., Ottolino P., Rodrigues P., Ruiz P., Campenni P., Chiarade P., Olivares P.P., Baroffio P., Panaccio P., Wintringer P., Di Fronzo P., Talento P., Favoriti P., Sendino P., Marsanic P., Mifsut P., Andrade P., Ajawin P., Abadia-Barno P., Castaneda P.A.N., Arevalos P.O.S., Bellver P.P., Koh P.S., Souza P., Major P., Bali R.S., Khattar R.M., Melo R.B., Ebrahiminia R., Azar R., Murga R.L., Pirolo R., Brady R., Davies R.J., Dholakia R., Rattan R., Singhal R., Lim R., Angelico R., Isernia R.M., Tutino R., Faccincani R., Peltrini R., Carrera-Ceron R., Tejos R., Kashyap R., Fajardo R., Lozito R., Pareja R.M., Garbarino S., Morales-Conde S., Benli S., Mansour S., Flores S., Suarez S.L., Ben S.L., Fuentes S., Napetti S., de Guzman S.O., Awad S., Weckmann Lujan S.A., Gentilli S., Grimaldi S., Pizarro S.O., Tayar S., Nabi S., Chan S.M., Junaid S., Rojas S., Monetti S., Garcia S., Salvans S., Tenconi S., Shaw S., Santoni S., Parra S.A., Cardenas S., Perez-Bertolez S., Chiappetta S., Dessureault S., Delis S., Bonapasta S.A., Rausei S., Scaringi S., Keswani S., Ali S.M., Cetinkunar S., Fung T.L.D., Rawashdeh T., Lopez T.N., De Campos T., Duque T.C., Perra T., Liakakos T., Daskalakis T., Barnes T., Koeter T., Zalla T., Gonzalez T.E., Elosua T., Campagnaro T., Brown T., Luoto T., Oumar T.A., Giustizieri U., Grossi U., Bracale U., Rivas U., Sosa V., Testa V., Andriola V., Tonini V., Balassone V., Celentano V., Progno V., Raju V., Carroni V., Cavallaro V., Katta V.R., De Simone V., Romaguera V.P., Orozco V.H.G., Luraschi V., Rachkov V., Turrado-L V., Visag-Castillo V., Dowling V., Graham V., Papagni V., Vigorita V., Fonseca V.C., Carneros V.J., Bellato V., Goncalves W., Powers W.F., Grigg W., Bechstein W.O., Lim Y.B., Altinel Y., Golubovic Z., Balciscueta Z., Ielpo, B., Podda, M., Pellino, G., Pata, F., Caruso, R., Gravante, G., Di Saverio, S., Gallo, G., Lui, R., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Pisanu, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Yanez, A. P., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Roldan, A. M., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, A., Prestera, A., la Medina, A. R. -D., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Faro, C. L., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, and Luglio, G

Subjects
medicine.medical_specialty, Anti-Bacterial Agents, Appendectomy, Appendicitis, COVID-19 Testing, Hospital Administration, Humans, Pandemics, Personal Protective Equipment, Practice Patterns, Physicians', Surveys and Questionnaires, Attitude of Health Personnel, COVID-19, Surgeons, Coronavirus disease 2019 (COVID-19), Settore MED/18 - CHIRURGIA GENERALE, COVID-19 pandemic. Acute appendicitis, MEDLINE, Practice Patterns, 030230 surgery, Health administration, 03 medical and health sciences, 0302 clinical medicine, Anti-Bacterial Agent, Pandemic, medicine, Surveys and Questionnaire, Appendiciti, General, Laparoscopy, Personal protective equipment, Physicians', medicine.diagnostic_test, business.industry, General surgery, Original Articles, medicine.disease, Anti-bacterial agents, appendectomy, appendicitis, COVID-19 testing, hospital administration, humans, pandemics, personal protective equipment, practice patterns physicians', surveys and questionnaires, attitude of health personnel, surgeons, appendicitis - COVI-19 - ACIE study - management, Acute appendicitis, Original Article, Surgery, Covid-19, business, Human
Abstract

Background Surgical strategies are being adapted to face the COVID‐19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X‐ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P, The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off

Published
2021

26. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Author

Roberto Bini, Boris Sakakushev, Carlos Domingo, Michele Pisano, Nassiba Beghdadi, Christian Cotsoglou, Giorgos Veloudis, Fikri M. Abu-Zidan, Franca Patrizi, Federica Gaiani, Mario Serradilla-Martin, Ronald V. Maier, Amine Benkabbou, Daniel Casanova, Marco Ceresoli, Anne Sophie Schneck, Angela Gurrado, Niccolò Allievi, Maria Clotilde Carra, Daniele Sommacale, Philip R. de Reuver, Gian Luigi de’Angelis, Salomone Di Saverio, Fernando Machado, Roberto Valinas, Felice Giuliante, Roberta Iadarola, Stefania Cimbanassi, Offir Ben-Ishay, Manuel Planells, Raffaele Romito, Richard P. G. ten Broek, Serena Langella, Giulio Cesare Vitali, Federico Gheza, Jeffry L. Kashuk, Miklosh Bala, Belinda De Simone, Nicola de’Angelis, Osvaldo Chiara, Umberto Maggi, Maria Conticchio, Raffaele Brustia, Olivier Scatton, Rami Rhaiem, Valerio Celentano, Juan Carlos Puyana, Alessandro Ferrero, Luca Ansaloni, Bruno M. Pereira, Stefan Hofmeyr, Alain Chichom Mefire, Francesco Decembrino, Giuliana Amaddeo, Bertrand Le Roy, Réal Lapointe, Francesco Brunetti, Kazuhiro Hiramatsu, Walter L. Biffl, Ruslan Alikhanov, Oreste Romeo, Mario Testini, Iradj Sobhani, Luigi Zorcolo, Luca Portigliotti, Reza Kianmanesh, Mohammad Azfar, Andrea De Palma, Andrew W. Kirkpatrick, Ewen M Harrison, Federico Coccolini, Enrico Andolfi, Roland Andersson, Alain Luciani, Andrew B. Peitzman, Aleix Martínez-Pérez, Yoram Kluger, Gustavo Pereira Fraga, Juan Pekolj, Dieter G. Weber, Behnam Sanei, Carlos A. Ordoñez, Fausto Catena, Giorgio Bianchi, Angel Henriquez, Riccardo Memeo, Fabiano Perdigao, Francesco Marchegiani, David Fuks, Marc Antoine Allard, Mohammed Lamine Sissoko, Raul Coimbra, Patrick Pessaux, Paschalis Gavriilidis, Filippo Landi, Tullio Piardi, Sandro Rizoli, De'Angelis, N, Catena, F, Memeo, R, Coccolini, F, Martinez-Perez, A, Romeo, O, De Simone, B, Di Saverio, S, Brustia, R, Rhaiem, R, Piardi, T, Conticchio, M, Marchegiani, F, Beghdadi, N, Abu-Zidan, F, Alikhanov, R, Allard, M, Allievi, N, Amaddeo, G, Ansaloni, L, Andersson, R, Andolfi, E, Azfar, M, Bala, M, Benkabbou, A, Ben-Ishay, O, Bianchi, G, Biffl, W, Brunetti, F, Carra, M, Casanova, D, Celentano, V, Ceresoli, M, Chiara, O, Cimbanassi, S, Bini, R, Coimbra, R, Luigi de'Angelis, G, Decembrino, F, De Palma, A, de Reuver, P, Domingo, C, Cotsoglou, C, Ferrero, A, Fraga, G, Gaiani, F, Gheza, F, Gurrado, A, Harrison, E, Henriquez, A, Hofmeyr, S, Iadarola, R, Kashuk, J, Kianmanesh, R, Kirkpatrick, A, Kluger, Y, Landi, F, Langella, S, Lapointe, R, Le Roy, B, Luciani, A, Machado, F, Maggi, U, Maier, R, Mefire, A, Hiramatsu, K, Ordonez, C, Patrizi, F, Planells, M, Peitzman, A, Pekolj, J, Perdigao, F, Pereira, B, Pessaux, P, Pisano, M, Puyana, J, Rizoli, S, Portigliotti, L, Romito, R, Sakakushev, B, Sanei, B, Scatton, O, Serradilla-Martin, M, Schneck, A, Sissoko, M, Sobhani, I, ten Broek, R, Testini, M, Valinas, R, Veloudis, G, Vitali, G, Weber, D, Zorcolo, L, Giuliante, F, Gavriilidis, P, Fuks, D, Sommacale, D, de’Angelis, Nicola [0000-0002-1211-4916], Apollo - University of Cambridge Repository, and de'Angelis, Nicola [0000-0002-1211-4916]

Subjects
Laparoscopic surgery, medicine.medical_specialty, RD1-811, medicine.medical_treatment, Iatrogenic Disease, education, Psychological intervention, Review, 030230 surgery, Guideline, Guidelines, Sciences du Vivant [q-bio]/Médecine humaine et pathologie, behavioral disciplines and activities, Laparoscopic cholecystectomy, Biliary duct injury, Magnetic resonance imaging, Antibiotic therapy, Computed tomography, Intraoperative Period, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Quality of life, medicine, Humans, Cholecystectomy, Stage (cooking), Laparoscopy, medicine.diagnostic_test, RC86-88.9, business.industry, Bile duct, Kirurgi, General surgery, Medical emergencies. Critical care. Intensive care. First aid, medicine.anatomical_structure, Quality of Life, Emergency Medicine, 030211 gastroenterology & hepatology, Surgery, Bile Ducts, business, Complication
Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00369-w.

Published
2021
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27. Proposal of set-up standardization for general surgery procedures with the CMR Versius system, a new robotic platform: our initial experience.

Author

Pisani Ceretti A, Mariani NM, Perego M, Giovenzana M, Salaj A, Formisano G, Gheza F, Gloria G, Bernardo R, and Bianchi PP

Subjects
Humans, Colectomy, Robotic Surgical Procedures methods, Robotics, Laparoscopy methods, Hernia, Inguinal surgery
Abstract

Background: The article describes our initial experience using CMR Versius platform for several procedures in general surgery., Methods: Between September 2022 and April 2023, seventy patients underwent robotic surgery in a multi-robotic referral center (San Paolo University Hospital, Milan, Italy). Three surgeons with only laparoscopic experience performed 24 cholecystectomies, 13 inguinal hernia repairs, 9 ventral hernia repairs, 7 right hemicolectomies, 11 left hemicolectomies, 1 sigmoidectomy, 1 ileocecal resection, 1 ventral rectopexy, 1 Nissen fundoplication, 1 total splenectomy, and 1 exploration with multiple biopsies., Results: All surgeries were full-robotic, with only one conversion to laparoscopy. The short length of stay and low rate of severe morbidity are promising findings. Although operative time was lengthened, clinical outcomes were not affected., Conclusions: Our experience demonstrates that the adoption of Versius system is safe and feasible in general surgery. The standardization of port placement and BSU set-up can certainly reduce the operative time., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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28. Development of an affordable, immersive model for robotic vaginal cuff closure: a randomized trial.

Author

Gheza F, Pinkard L, Grand A, Aguiluz-Cornejo G, Mangano A, and Ladanyi A

Subjects
Female, Humans, Swine, Animals, Clinical Competence, Computer Simulation, Robotic Surgical Procedures methods, Robotics education, Virtual Reality
Abstract

Safe and secure closure of the vaginal cuff is a critical component of a robotic assisted hysterectomy procedure. Our aim in this study is to develop and validate a novel vaginal cuff closure model (VC) created from porcine heart that allows trainees to obtain competency in a low-risk environment. Ten expert and 20 novice robotic surgeons performed a cuff closure exercise on the VC model and on the dV-Trainer ® , a virtual reality simulator (VR). Performances were timed, videotaped, and scored using the modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Expert robotic surgeons completed the task faster on both the VR (531 vs. 814 s, p = 0.03) and the VC platforms (311 vs. 631 s, p < 0.001) and achieved higher mGEAR scores (32.25 vs. 22.07, p < 0.0001). Knot quality and suturing accuracy were better in the VC than in the VR environment in both groups. In a post-completion survey, both expert and novice surgeons expressed strong preference towards the VC model. In this study, the novel VC model proved to be a reliable simulation tool with high face, content, and construct validity. Due to its simplicity and low cost, this high-yield simulation exercise can easily be incorporated into robotic training curricula of obstetrics and gynecology residents., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Published
2023
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29. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Author

de'Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de'Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, Ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, and Sommacale D

Subjects
Humans, Iatrogenic Disease, Intraoperative Period, Quality of Life, Bile Ducts injuries, Cholecystectomy adverse effects
Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Published
2021
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30. Atypical parathyroid adenoma: clinical and anatomical pathologic features.

Author

Galani A, Morandi R, Dimko M, Molfino S, Baronchelli C, Lai S, Gheza F, Cappelli C, and Casella C

Subjects
Humans, Parathyroid Glands, Parathyroid Hormone, Parathyroidectomy, Prognosis, Retrospective Studies, Adenoma surgery, Parathyroid Neoplasms surgery
Abstract

Background: Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum calcium or high concentrations of parathyroid hormone, or incorrect parathyroid hormone levels for serum calcium values. Primary hyperparathyroidism is due to the presence of an adenoma/single-gland disease in 80-85%. Multiple gland disease or hyperplasia accounts for 10-15% of cases of primary hyperparathyroidism. Atypical parathyroid adenoma and parathyroid carcinoma are both responsible for about 1.2-1.3% and 1% or less of primary hyperparathyroidism, respectively., Methods: We performed a retrospective cohort study and enrolled 117 patients with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. Histological and immunohistochemical examination showed that 107 patients (91.5%) were diagnosed with typical adenoma (group A), while 10 patients (8.5%) were diagnosed with atypical parathyroid adenoma (group B). None of the patients were affected by parathyroid carcinoma., Results: Significant statistical differences were found in histological and immunohistochemical parameters as pseudocapsular invasion (p <  0.001), bands of fibrosis (p <  0.001), pronounced trabecular growth (p <  0.001), mitotic rates of > 1/10 high-power fields (HPFs) (p <  0.001), nuclear pleomorphism (p = 0.036), thick capsule (p <  0.001), Ki-67+ > 4% (p <  0.001), galectin-3 + (p = 0.002), and protein gene product (PGP) 9.5 + (p = 0.038)., Conclusions: Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Atypical parathyroid adenoma compared to typical adenoma showed significant clinical, hematochemical, histological, and immunohistochemical differences. We did not find any disease relapse in the 10 patients with atypical parathyroid adenoma during 60 months of follow-up time.

Published
2021
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31. Fluorescence-guided lymphadenectomy in gastric cancer: a prospective western series.

Author

Baiocchi GL, Molfino S, Molteni B, Quarti L, Arcangeli G, Manenti S, Arru L, Botticini M, and Gheza F

Subjects
Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Lymphatic Metastasis diagnosis, Lymphatic Metastasis pathology, Male, Middle Aged, Prospective Studies, Stomach Neoplasms pathology, Fluorescence, Indocyanine Green, Lymph Node Excision methods, Stomach Neoplasms surgery, Surgery, Computer-Assisted methods
Abstract

Background: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage., Aim: The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins. The secondary outcome was the diagnostic ability of ICG to predict the presence of nodal metastases., Patients and Methods: We conducted a single-center prospective trial comprising 13 patients with gastric cancer. ICG was injected the afternoon prior to surgery or intraoperatively via the submucosal or subserosal route. Standard lymphadenectomy was performed in all patients, according to patient age and tumor stage, as usual, but after standard lymphadenectomy the residual ICG + nodes were harvested and analyzed. Each nodal station and each dissected node was recorded and classified as ICG + or ICG- (both in vivo and back table evaluation was utilized for classification). After pathological analysis, each nodal station and each dissected node was recorded as metastatic or nonmetastatic (E&E staining)., Results: The feasibility rate was 84.6% (11/13). The mean number of dissected lymph nodes per patient was 37.9. Focusing on the 11 patients in whom ICG-guided nodal navigation was successfully performed, 81 lymph node stations were removed, for a total of 417 lymph nodes. Sixty-six stations (81.48%), comprising a total of 336 lymph nodes, exhibited fluorescence. No IC- node was metastatic; all 54 metastatic nodes were ICG + . A total of 282 ICG + nodes were nonmetastatic. In two cases, some nodes outside D2 areas were harvested, being ICG + (1 case of metastatic node)., Conclusions: Fluorescence lymphography-guided lymphadenectomy is a promising new technique that combines a high feasibility rate with considerable ease of use. Regarding its diagnostic value, the key finding from this prospective series is that no metastatic nodes were found outside fluorescent lymph node stations. Further studies are needed to investigate whether this technique can help surgeons performing standard lymphadenectomy and selecting cases for D2 + lymphadenectomy.

Published
2020
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32. Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy.

Author

Doglietto F, Vezzoli M, Gheza F, Lussardi GL, Domenicucci M, Vecchiarelli L, Zanin L, Saraceno G, Signorini L, Panciani PP, Castelli F, Maroldi R, Rasulo FA, Benvenuti MR, Portolani N, Bonardelli S, Milano G, Casiraghi A, Calza S, and Fontanella MM

Subjects
Aged, Aged, 80 and over, Comorbidity, Female, Hospital Mortality, Humans, Italy epidemiology, Male, Middle Aged, Retrospective Studies, Risk Factors, COVID-19 complications, COVID-19 mortality, SARS-CoV-2, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative mortality
Abstract

Importance: There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery., Objective: To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties., Design, Setting, and Participants: This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score., Exposures: Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations., Main Outcomes and Measures: The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors., Results: Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-∞). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications., Conclusions and Relevance: In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

Published
2020
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33. Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review.

Author

Baiocchi GL, Gheza F, Molfino S, Arru L, Vaira M, and Giacopuzzi S

Subjects
Animals, Humans, Prospective Studies, Colorectal Neoplasms pathology, Indocyanine Green, Peritoneal Neoplasms diagnostic imaging
Abstract

Background: To review the available clinical data about the value of Indocyanine Green (ICG) fluorescence imaging for intraoperative detection of peritoneal carcinomatosis., Methods: We conducted a systematic review, according to the PRISMA guidelines, for clinical series investigating the possible role of ICG fluorescence imaging in detecting peritoneal carcinomatosis during surgical treatment of abdominal malignancies. With the aim to analyze actual application in the daily clinical practice, papers including trials with fluorophores other than ICG, in vitro and animals series were excluded. Data on patients and cancer features, timing, dose and modality of ICG administration, sensitivity, specificity and accuracy of fluorescence diagnosis of peritoneal nodules were extracted and analyzed., Results: Out of 192 screened papers, we finally retrieved 7 series reporting ICG-guided detection of peritoneal carcinomatosis. Two papers reported the same cases, thus only 6 series were analyzed, for a total of 71 patients and 353 peritoneal nodules. The investigated tumors were colorectal carcinomas in 28 cases, hepatocellular carcinoma in 16 cases, ovarian cancer in 26 cases and endometrial cancer in 1 case. In all but 4 cases, the clinical setting was an elective intervention in patients known as having peritoneal carcinomatosis. No series reported a laparoscopic procedure. Technical data of ICG management were consistent across the studies. Overall, 353 lesions were harvested and singularly evaluated. Sensitivity varied from 72.4 to 100%, specificity from 54.2 to 100%. Two series reported that planned intervention changed in 25 and 29% of patients, respectively., Conclusion: Indocyanine Green based fluorescence of peritoneal carcinomatosis is a promising intraoperative tool for detection and characterization of peritoneal nodules in patients with colorectal, hepatocellular, ovarian carcinomas. Further prospective studies are needed to fix its actual diagnostic value on these and other abdominal malignancies with frequent spread to peritoneum.

Published
2020
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34. Robotic right colonic resection. Is the robotic third arm a game-changer?

Author

Mangano A, Gheza F, Bustos R, Masrur M, Bianco F, Fernandes E, Valle V, and Giulianotti PC

Subjects
Aged, Aged, 80 and over, Anastomosis, Surgical methods, Body Mass Index, Colectomy methods, Colon, Ascending blood supply, Conversion to Open Surgery, Female, Humans, Laparoscopy, Male, Medical Illustration, Middle Aged, Retrospective Studies, Robotic Surgical Procedures instrumentation, Robotic Surgical Procedures methods, Colon, Ascending surgery
Abstract

Background: Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way. This is in part because traditional laparoscopy may have some hurdles and a long learning curve to reach mastery. The robotic technology may help in increasing the MIS penetrance in colorectal surgery. The use of the R3 can potentially increase the number of surgical options available., Methods: In this retrospective case series, after a long robotic colorectal experience connected to a robotic program started by Giulianotti et al. in October 2000, we present our results regarding a subset of colorectal patients who underwent robotic right colonic resections performed, all by a single surgeon (P.C.G.), using the R3 according to our standardized technique., Results: Out of all the robotic colorectal operations performed, this sub-sample sample included 33 patients: 21 males and 12 females. The age range was between 51 and 95 years old. The Body Mass Index (BMI) was between 21.6 to 43.1. The conversion rate to laparoscopy or to open surgery has been 0%. No intraoperative complications have been registered. The postoperative complications rates are reported in this manuscript. The perfusion check of the anastomosis by Near-infrared ICG (Indocyanine Green) enhanced fluorescence has been used. In 11.2% of the sample, the site of the anastomosis has been changed after ICG-Test. Moreover, when the ICG perfusion test has been performed no leakage occurred., Conclusions: This subset of patients suggests the potential role of R3 and the benefits correlated to robotic surgery. In fact, the laparoscopic approach uses mostly a medial to lateral mobilization. Indeed, during laparoscopic surgery an early right colon mobilization may create problems in the surgical field visualization. In robotic surgery, R3 can lift upwards the cecum/ascending colon/hepatic flexure exposing, in doing so, the anatomical structures. Hence, we can use also the same approach of the open surgery (where the first step is usually the mobilization of the ascending colon mesentery). In other words, the R3 offers more operative options in terms of surgical pathways maintaining at the same time good perioperative outcomes. However, more studies are needed to confirm our findings.

Published
2020
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35. Operative technique in robotic rectal resection.

Author

Mangano A, Valle V, Fernandes E, Bustos R, Gheza F, and Giulianotti PC

Subjects
Humans, Medical Illustration, Patient Positioning, Photography, Pneumoperitoneum, Artificial, Reproducibility of Results, Robotic Surgical Procedures education, Robotic Surgical Procedures instrumentation, Robotic Surgical Procedures standards, Rectum surgery, Robotic Surgical Procedures methods
Abstract

A still too high percentage of the colorectal resections are currently performed by open technique. This in part because laparoscopy has some technical hurdles: not ideal ergonomics, poor control on the traction exerted by the Assistant, long/steep learning curve, confined dexterity, low tactile feedback, hand-tremor and 2D vision with a not completely stable camera. The robotic approach, given the increased surgical dexterity and the better surgical view, may be used to solve the laparoscopic downsides (in particular in the most complex cases). In the present work, after an extensive robotic experience and a robotic program started by Giulianotti et al. in October 2000, we show our operative steps for the robotic rectal resection. The aim is to propose a model to standardize the surgical technique and potentially pave the way for the acquisition of more reproducible data among different centers. This proposal may be also a technical guide to learn the robotic way and also for the expert surgeons as an adjunct in the teaching strategy.

Published
2019
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36. Operative technique in robotic left colonic resection.

Author

Mangano A, Valle V, Fernandes E, Bustos R, Gheza F, and Giulianotti PC

Subjects
Humans, Colectomy methods, Robotic Surgical Procedures methods
Abstract

Minimally invasive techniques have changed the clinical practice in general surgery and provided an improvement of outcomes. Laparoscopic and open surgery have similar oncological outcomes in the colorectal field. Those findings have been proven by prospective randomized multicenter trials and systematic reviews. However, some colorectal operations are still being performed by the open approach. This is partially related to the technical hurdles of the laparoscopic approach (particularly for more complex cases). Robotic surgery can be beneficial in overcoming the laparoscopic hurdles and limitations. Indeed, given the improved dexterity, the 3D stereotactic magnified view (with the camera controlled directly by the surgeon), the tremor filtering technology and the 7 degrees of liberty of the surgical instruments can guarantee a more accurate surgical dissection and tissue manipulation. Herein, after a large robotic experience in this field connected to a robotic program started by Giulianotti et al. in October 2000, we present our approach to robotic left colonic resection with routine splenic flexure mobilization. This approach may be helpful to get more reproducible results, it may be a technical guide and also an additional training tool for surgical residents.

Published
2019
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37. Robotic-Assisted Roux-en-Y Gastric Bypass: Learning Curve Assessment Using Cumulative Sum and Literature Review.

Author

Bustos R, Mangano A, Gheza F, Chen L, Aguiluz-Cornejo G, Gangemi A, Sanchez-Johnsen L, Hassan C, and Masrur M

Abstract

Purpose: Robotic-assisted Roux-en-Y gastric bypass (RARYGB) is a procedure that is used with increasing frequency in the United States. Among other bariatric procedures, RARYGB is a good model for the robotic platform because it allows hand-sewn suturing and energy devices application. The aim of this study was to conduct a literature review of robotic approach in RARYGB, its learning curve using the cumulative sum (CUSUM) method, and our experience as Center of Excellence recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS). Methods: A total of 67 patients were included. Results revealed that the learning curve was achieved after case 11. Eighteen studies were included in the pooled analysis. Results: An increase in the operative time was noted at case 46, in which a second phase was identified. A significant difference between these two phases was found only related to previous bariatric surgery. The outcomes of this series were comparable with the ones available in the literature. Conclusions: The robotic platform is increasing its role in complex procedures such as RARYGB. The hand-sewn technique may offer important advantages in terms of shorter learning curve, reduced conversion rate, and lower leakage rate., Competing Interests: No competing financial interests exist., (Copyright 2019, Mary Ann Liebert, Inc., publishers.)

Published
2019
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39. Near-Infrared Indocyanine Green-Enhanced Fluorescence and Evaluation of the Bowel Microperfusion During Robotic Colorectal Surgery: a Retrospective Original Paper.

Author

Mangano A, Fernandes E, Gheza F, Bustos R, Chen LL, Masrur M, and Giulianotti PC

Subjects
Anastomotic Leak etiology, Anastomotic Leak prevention & control, Colorectal Surgery methods, Fluorescence, Intestine, Large blood supply, Intestine, Large surgery, Intraoperative Care, Microvessels diagnostic imaging, Retrospective Studies, Robotic Surgical Procedures adverse effects, Anastomosis, Surgical adverse effects, Anastomotic Leak diagnosis, Colorectal Surgery adverse effects, Coloring Agents, Indocyanine Green, Infrared Rays
Abstract

Background: Leakage of the anastomosis after colorectal surgery is a severe complication, and one of the most important causes is poor vascular supply. However, a microvascular deficit is often not detectable during surgery under white light. Near-infrared indocyanine green (ICG)-enhanced fluorescence may be useful for assessing microvascular deficits and conceivably preventing anastomotic leakage., Objectives: This paper presents a preliminary retrospective case series on robotic colorectal surgery. The aim is to evaluate the feasibility, safety and role of near-infrared ICG-enhanced ?uorescence for the intraoperative assessment of peri-anastomotic tissue vascular perfusion., Materials and Methods: From among more than 164 robotic colorectal cases performed, we retrospectively analyzed 28 that were all performed by the same surgeon (PCG) using near-infrared ICG-enhanced fluorescence technology: 16 left colectomies (57.1%), 8 rectal resections (28.6%), 3 right colectomies (10.8%) and 1 pancolectomy (3.6%)., Results: The rates of conversion, intraoperative complications, dye allergic reaction and mortality were all 0%. In two cases (7.1%)-1 left and 1 right colectomy-the level of the anastomosis was changed intraoperatively after ICG showed ischemic tissues. Despite the application of ICG, one anastomotic leak (after left colectomy for a chronic recurrent sigmoid diverticulitis with pericolic abscess) was observed., Conclusions: ICG technology may help to determine when to intraoperatively change the anastomotic level to a safer location. In our case series, ICG results led to a change in the level of the anastomosis in 7.1% of the cases. Despite the use of ICG, we observed one leak. This may have been related to vascularization-independent causes (e.g., infection in this case) or may reflect a need for better standardization of this ICG technology. In particular, we need a way to objectively assess the ICG signal and the related risk of leakage. More randomized, prospective, well-powered trials are needed to unveil the full potential of this innovative surgical technology.

Published
2019

41. Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients.

Author

Gheza F, Esposito S, Gruessner S, Mangano A, Fernandes E, and Giulianotti PC

Subjects
Humans, Laparoscopy methods, Hepatectomy methods, Robotic Surgical Procedures methods
Abstract

Background: Conversion to open during minimally invasive liver resection has a high rate. To identify the reasons to convert could help in defining a strategy to decrease the event "conversion.", Methods: A systematic review has been performed. Our large series of robotic hepatic resections were analyzed and included in the review., Results: Fifty papers were selected and carefully evaluated in full text. Twenty-nine were ultimately used for analysis, including all published robotic liver resections. Our series included 11 conversions out of 139 patients (7.9%). Adhesions were not a declared reason to convert. The robotic approach still had a high percentage of open conversions because of difficulties in assessing the tumor margin., Conclusions: Causes for conversion were carefully analyzed and compared with what previously described for the pure laparoscopic approach. This could be crucial in defining how to improve the performance and minimize the conversion rate., (© 2018 John Wiley & Sons, Ltd.)

Published
2019
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42. Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review.

Author

Molfino S, Ballarini Z, Gheza F, Portolani N, and Baiocchi GL

Subjects
Carcinoma classification, Carcinoma pathology, Databases, Bibliographic, Humans, Lymph Nodes pathology, Lymphatic Metastasis, Neoplasm Staging, Peritoneum, Stomach Neoplasms classification, Stomach Neoplasms pathology, Carcinoma surgery, Stomach Neoplasms surgery
Abstract

To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329-338. https://doi.org/10.1007/s10120-015-0575-z , 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.

Published
2019
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43. Intraoperative ICG-based imaging of liver neoplasms: a simple yet powerful tool. Preliminary results.

Author

Alfano MS, Molfino S, Benedicenti S, Molteni B, Porsio P, Arici E, Gheza F, Botticini M, Portolani N, and Baiocchi GL

Subjects
Adult, Aged, Algorithms, Female, Fluorescence, Humans, Male, Middle Aged, Coloring Agents administration & dosage, Hepatectomy methods, Indocyanine Green administration & dosage, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Optical Imaging methods, Surgery, Computer-Assisted methods
Abstract

Background: Detecting small nodules that are grossly unidentifiable remains a major challenge in liver resection for cancer. Novel developments in navigation surgery, especially indocyanine green (ICG)-based fluorescence imaging, are making a clear breakthrough in addressing this issue. ICG is almost routinely administered during the preoperative stage in hepatobiliary surgery. However, its full potential has yet to be realized, partly because there are no precise guidelines regarding the optimal dose or timing of ICG injections before liver surgery. The main goal of this study was to design an algorithm for the management of ICG injections to achieve optimal liver staining results., Methods: Twenty-seven consecutive, unselected patients undergoing liver resection for cancer were enrolled and underwent preoperative liver function assessment by the LiMON test. Extra ICG i.v. injections at different doses and timings were performed. In vivo intraoperative analysis of the stain detected by near-infrared fluorescence imaging of the liver and ex vivo analysis of each resected nodule was performed and compared to the pathological analysis., Results: (i) The success rate of ICG injections in terms of liver staining was 92.6%; (ii) in the absence of or with 7 or more days from a previous ICG injection, the best dose to inject before the operation was 0.2 mg/kg, and the best timing was between 24 and 48 h before the scheduled surgery; and (iii) the ICG fluorescence patterns observed in the tumors were total fluorescence staining (41% of the cases), partial fluorescence staining (15%), rim fluorescence staining surrounding the tumor (30%), and no staining (15%)., Conclusions: This study is a building block for the characterization of liver nodules and the search for additional surface lesions undetected by preoperative radiological work-up-a crucial task for the successful treatment of liver cancer at an early stage using a safe, minimally invasive, and inexpensive technique.

Published
2019
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45. Impact of one-to-one tutoring on fundamentals of laparoscopic surgery (FLS) passing rate in a single center experience outside the United States: a randomized controlled trial.

Author

Gheza F, Raimondi P, Solaini L, Coccolini F, Baiocchi GL, Portolani N, and Tiberio GAM

Subjects
Female, Humans, Italy, Male, Self-Directed Learning as Topic, Simulation Training methods, Single-Blind Method, United States, Clinical Competence, Internship and Residency methods, Laparoscopy education, Mentoring
Abstract

Background: Outside the US, FLS certification is not required and its teaching methods are not well standardized. Even if the FLS was designed as "stand alone" training system, most of Academic Institution offer support to residents during training. We present the first systematic application of FLS in Italy. Our aim was to evaluate the role of mentoring/coaching on FLS training in terms of the passing rate and global performance in the search for resource optimization., Methods: Sixty residents in general surgery, obstetrics & gynecology, and urology were selected to be enrolled in a randomized controlled trial, practicing FLS with the goal of passing a simulated final exam. The control group practiced exclusively with video material from SAGES, whereas the interventional group was supported by a mentor., Results: Forty-six subjects met the requirements and completed the trial. For the other 14 subjects no results are available for comparison. One subject for each group failed the exam, resulting in a passing rate of 95.7%, with no obvious differences between groups. Subgroup analysis did not reveal any difference between the groups for FLS tasks., Conclusion: We confirm that methods other than video instruction and deliberate FLS practice are not essential to pass the final exam. Based on these results, we suggest the introduction of the FLS system even where a trained tutor is not available. This trial is the first single institution application of the FLS in Italy and one of the few experiences outside the US. Trial Number: NCT02486575 ( https://www.clinicaltrials.gov ).

Published
2018
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46. Affordable Laparoscopic Camera System (ALCS) Designed for Low- and Middle-Income Countries: A Feasibility Study.

Author

Gheza F, Oginni FO, Crivellaro S, Masrur MA, and Adisa AO

Subjects
Animals, Costs and Cost Analysis, Feasibility Studies, Health Resources, Humans, Income, Laparoscopy instrumentation, Models, Animal, Poverty, Swine, Curriculum, Laparoscopy economics
Abstract

Background: Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs., Methods: A common zero degrees 10 mm scope is attached on the camera of a low-price smartphone. Two elastic bands are used to fix the scope right in front of the smartphone's main camera; alternatively, a low-cost camera coupler can be used. The device is covered with sterile transparent drapes and a light source connected with a fiber-optic cable for endoscopic use. The image can be seen in real time on a common TV screen through an HDMI connection to the smartphone, with a sterile drape., Results: We were able to perform the five tasks of the Fundamentals of Laparoscopic Surgery curriculum, using our vision system with proficiency. In a pig model, we performed a tubal ligation to simulate an appendectomy and we were able to suture. No major differences were measured between the two connection systems., Conclusions: A low-cost laparoscopic camera system can benefit surgeons and trainees in LMICs. The system is already attractive for use during training, but further studies are needed to evaluate its potential clinical role in LMICs.

Published
2018
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47. Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results.

Author

Mangano A, Gheza F, and Giulianotti PC

Subjects
Colon, Transverse, Digestive System Surgical Procedures methods, Evidence-Based Medicine, Humans, Iatrogenic Disease, Intraoperative Complications epidemiology, Intraoperative Complications surgery, Minimally Invasive Surgical Procedures methods, Risk Factors, Spleen surgery, Treatment Outcome, Colorectal Neoplasms surgery, Spleen injuries
Abstract

Introduction: To assess the frequency, risk factors and outcomes of iatrogenic spleen injury during minimally invasive colo-rectal surgery with a particular focus on the routine splenic flexure mobilization tehcnique., Evidence Acquisition: Exclusion criteria: 1) topic not pertinent to the main topic of the review; 2) all case reports, editorials, conference highlights were excluded. After a title and abstract first selection and a final full-text analysis has been performed. The results of the selected articles are presented., Evidence Synthesis: The iatrogenic splenic injury rate during colorectal surgery is 0.96%. The iatrogenic injuries cause around 20% of all splenectomy. Ligaments over-traction is the most frequent mechanism of damage. The routine splenic flexure mobilization is a matter of scientific debate. Risk factors - open surgery, male sex, peripheral vascular disease, malignant neoplasia, diverticulitis, emergency surgery and teaching-hospital status. There is a risk difference according to the procedure: transverse colectomy has the highest risk, followed by left colectomy and total colectomy., Conclusions: The routine mobilization of the left colonic flexure is a debated topic. However, according to some authors (including our experience), this procedure is not a risk factor and it may be advantageous: 1) it does not excessively prolong the total operative time; 2) better surgical skills development; 3) the tension-related ischemia is avoided; 4) wider oncological dissection. Technical accuracy with cautious dissection/visualization can reduce the rate of iatrogenic splenic damage. Laparoscopy decreases the rate of splenic injury by almost 3.5 times. Robotic surgery may have the potential to further reduce this complication, but more data are needed on the topic.

Published
2018
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48. Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique : Lessons learned since the first worldwide RPD performed in the year 2001.

Author

Giulianotti PC, Mangano A, Bustos RE, Gheza F, Fernandes E, Masrur MA, Gangemi A, and Bianco FM

Subjects
Chicago, Hospitals, University, Humans, Learning Curve, Pancreaticoduodenectomy standards, Reproducibility of Results, Robotic Surgical Procedures standards, Pancreaticoduodenectomy methods, Robotic Surgical Procedures methods
Abstract

Background: Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408-410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique., Methods: We took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical "tips and tricks" to facilitate the learning curve and assist with the teaching/evaluation process., Results: 17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform., Conclusions: Standardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the 'gold standard' is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.

Published
2018
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49. Pancreas Transplantation From Pediatric Donors: A Single-Center Experience.

Author

Spaggiari M, Di Bella C, Di Cocco P, Campara M, Galen K, Gheza F, Oberholzer J, Benedetti E, and Tzvetanov I

Subjects
Adolescent, Adult, Age Factors, Body Weight, Child, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 mortality, Female, Follow-Up Studies, Glycated Hemoglobin analysis, Graft Survival, Humans, Male, Middle Aged, Organ Size, Pancreas Transplantation adverse effects, Retrospective Studies, Risk Factors, Tissue Donors statistics & numerical data, Young Adult, Diabetes Mellitus, Type 1 surgery, Donor Selection standards, Graft Rejection epidemiology, Pancreas anatomy & histology, Pancreas Transplantation methods
Abstract

Background: Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function., Methods: All pancreatic transplants, procured from donors younger than 18 years, between January 2007 and March 2017, were included in the analysis. The grafts were subdivided into 3 groups by donor's weight: less than 30 kg, 30 to 60 kg, greater than 60 kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group., Results: Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10 ± 4.13 years and 47.8 ± 21.3 kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ± 0.61% and blood glucose level of 102.75 ± 20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow-up of 37.07 months (minimum, 0.19 to maximum, 119.57). No differences among the 3 groups were identified. Long-term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants., Conclusions: Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage.

Published
2018
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50. Iatrogenic spleen injury risk during robotic left colonic and rectal resections by routine left flexure mobilization technique: a retrospective study.

Author

Mangano A, Fernandes E, Valle V, Bustos R, Gheza F, and Giulianotti PC

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Iatrogenic Disease, Male, Middle Aged, Retrospective Studies, Risk Assessment, Young Adult, Colorectal Neoplasms surgery, Intraoperative Complications etiology, Robotic Surgical Procedures methods, Spleen injuries
Abstract

Background: The routine mobilization of the left colonic flexure as a standard procedure during left colonic/rectal resection is a controversial topic in open and minimally invasive surgery. According to some authors, this maneuver may increase the risk of iatrogenic spleen damage; for others this does not change the odds. Ligaments over-traction is the most frequent injury mechanism. Some documented risk factors are reported: laparotomic approach, male gender, vascular disease, cancer, diverticulitis, surgery performed in emergency-setting. The type of procedure influences the associated risk: transverse colectomy is the riskiest, followed by left colonic resection and pancolectomy., Methods: Retrospective original paper. Sample size - a total of 125 patients have been considered. 75 robotic left colonic resections (60%), 40 robotic rectal resections (32%) and 10 robotic pancolectomy (8%). Primary outcomes - 1) percentage of iatrogenic splenic injuries; 2) conversion rate. Secondary outcomes - 1) intra-/postoperative complications; 2) anastomotic leakage rate; 3) mortality. In order to avoid potential confounding factors and technical/expertise heterogeneity, all the procedures included have been performed using the same standardized operative technique and by the same experienced surgeon (P.C.G.)., Results: We retrospectively analyzed 125 procedures. Primary outcomes - 1) iatrogenic splenic injuries: 0%; 2) conversion rate: 1.6%. Secondary outcomes - 1) intraoperative complications: 0%; 2) anastomotic leakage rate: 1 case of leakage out of 125 cases (1.3% of the left colectomy sub-sample); in this case the leakage was probably due to an infectious process rather than a vascular deficit; 3) mortality: 0%; 4) miscellanea postoperatory complications (small bowel obstructions, wound infection, pelvic collections, pneumonia and acute kidney injury) are detailed in the manuscript., Conclusions: In our experience, and according to some of the literature data as well, during robotic left colonic/rectal resections the routine mobilization of the left flexure as a standard procedure is not a risk factor in terms of iatrogenic spleen injury rate. Conversely, this technique may be beneficial as it does not excessively extend the operative time, increases the surgical skills acquirement, and reduces the tension-related anastomotic ischemia. It also allows a better oncological dissection. Standard laparoscopic approach reduces the rate of spleen by almost 3.5 times in comparison to open surgery. The improved technical accuracy provided by the robotic platform may decrease the rate of splenic injury. More studies are needed on the topic to confirm our findings.

Published
2018
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