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INTRODUCTION: The Coronavirus (COVID-19) pandemic activated a global health crisis. The best practice in operating room (OR) is a discussed argument. This review was performed to clarify the importance and effectiveness of standardized clinical practice (procedure, organization, guidance), identifying contemporary evidence deduced from some international experience. We decided to make a narrative review that analyses the most current shared guidelines and procedures in management of COVID-19 patients in perioperative theatre. EVIDENCE ACQUISITION: Medline was searched using PubMed (from 1 April 2020 to 22 December 2020) for relevant study according with Prisma Guidelines. The studies were assessed and classified for levels of evidence and recommendation. Three factors were extracted: OR organization, personnel safety and procedures. EVIDENCE SYNTHESIS: 44 articles were identified: eleven met eligibility criteria: of these, four articles are expert opinion/experience/descriptive study, one is a multicenter/descriptive study and six are review/systematic review. 33 articles were excluded because did not meet inclusion criteria. The studies selection is focused on clinical processes in the operating theatre, guidelines for the OR safety, correct procedures for personal protective equipment use, experience and recommendations related to COVID-19 context. CONCLUSIONS: Despite the modest number of studies and high evidence, all the publications show agreement about many aspects of OR practice. Global experiences selection confirms the role and the importance of a standardized practice in operating theatre instead personal interpretation; this study aims to provide a guidelines qualitative synthesis for all surgical staff, enclosing basic behaviors for the staff and patient safety in a complex assistant approach on a pandemic time.
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COVID-19 , COVID-19/epidemiología , Salud Global , Humanos , Estudios Multicéntricos como Asunto , Quirófanos , Pandemias , Equipo de Protección PersonalRESUMEN
BACKGROUND: Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter. CASE PRESENTATION: We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years. CONCLUSIONS: The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication.
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Absceso/etiología , Canal Anal/patología , Antibacterianos/administración & dosificación , Incontinencia Fecal/terapia , Anciano , Enfermedades del Ano/terapia , Femenino , Humanos , Calidad de Vida , Resultado del TratamientoRESUMEN
INTRODUCTION: Considering the extensive experience developed in 28 years of medical practice in a specialist facility dedicated to proctological surgery and the treatment of 2.467 patients presenting with an anal fistula, the authors review problems associated with this disease from an aetiopathogenic, classifying, diagnostic, and therapeutic viewpoint. MATERIALS AND METHODS: The surgical treatment of Arnous's French School was adopted. The method envisions slow sectioning of the sphincter by means of elastic constriction, even dividing surgical sessions. RESULTS: Results were excellent, recording 99.5% of complete healings, while failures and complications numbered 0.3% of incomplete healings, 0.2% of relapses, 2.8% of soiling, and 1.4% of transitory gas incontinence. CONCLUSIONS: Correct diagnosis of the type of fistula, the choice of a perfect surgical technique, and thorough long-term follow-up of the postoperative progress of surgical wounds are the basic premises to achieve the patient's healing.
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Canal Anal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Fístula Rectal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Incontinencia Fecal , Humanos , Complicaciones Posoperatorias/epidemiología , Cicatrización de HeridasRESUMEN
INTRODUCTION: Radiofrequency is a treatment option for patients suffering from fecal incontinence. OBJECTIVE: To assess the one-year follow-up results following the radiofrequency procedure for fecal incontinence. DESIGN: Prospective, single-center, observational study. MATERIALS AND METHODS: Twenty-one patients underwent the SECCA® radiofrequency procedure, 19 of who completed the one-year of follow-up (Cleveland Clinic Florida Fecal Incontinence score, Fecal Incontinence Quality of Life Scale (FIQoL), anorectal manometry, and endoanal ultrasound). MAIN OUTCOME MEASURES: Any change in the Fecal Incontinence Score or Fecal Incontinence Quality of Life scales post SECCA® radiofrequency procedure. RESULTS: The mean Fecal Incontinence Score significantly improved at three months' follow-up from 14.5 prior to treatment to 11.9 post-treatment, and was maintained at six months (12). A slight decrease was observed at one year (12.9), which had no impact on the global satisfaction. During the same period, only 1/4 subsets of the Fecal Incontinence Quality of Life score improved. Manometry and endoanal ultrasound did not show significant changes post procedure. LIMITATIONS: Limited number of patients. CONCLUSIONS: Radiofrequency is a valid treatment option for patients with mild-to-moderate fecal incontinence. This treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statistically significant reductions in the Fecal Incontinence Score as well as significant improvements in Fecal Incontinence Quality of Life scores at six months, with a slight, though not clinically significant, decrease at one year follow-up.
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Ablación por Catéter , Incontinencia Fecal , Anciano , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Ablación por Catéter/estadística & datos numéricos , Incontinencia Fecal/epidemiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/cirugía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Estudios Prospectivos , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
Parastomal hernia is one of the most common stoma related complication, with the correlated risk of incarceration, obstruction, and strangulation. The incidence is high (30-50%) and depends on the length of follow up. Different surgical options for repairing are defective with a 25-70% failure and recurrence rate. Prevention of parastomal hernia with mesh reinforcement seems to be effective. Three available trials are recruiting patients: Prism (with matrix porcine prothesis), Prevent (with preperitoneal polypropylene mesh), and the stapled polypropylene mesh stoma reinforcement technique (SMART). We performed the SMART procedure in six patients undergoing definitive colostomy. Our cases show that the procedure is rapid (duration range 15-20 minutes), cost effective (500 euro), and safe (in our experience, there are no post-surgical complications that are procedure-related). A long term follow-up and a higher number of patients will give us confirmation of the initial hopeful results.
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Hernia Abdominal/cirugía , Herniorrafia/instrumentación , Herniorrafia/métodos , Mallas Quirúrgicas , Estomas Quirúrgicos/efectos adversos , Suturas , Diseño de Equipo , Análisis de Falla de Equipo , Hernia Abdominal/diagnóstico , Hernia Abdominal/etiología , Humanos , Proyectos Piloto , Engrapadoras Quirúrgicas , Grapado Quirúrgico/instrumentación , Grapado Quirúrgico/métodos , Resultado del TratamientoRESUMEN
INTRODUCTION: The patients with Crohn's disease (CD) have a greater risk of gastrointestinal and hemopoietic cancers compared with background population. Identify groups of people affected by CD with exposition to factors that play a role in the development of cancer could be useful to plan correct diagnostic and therapeutic methods. METHODS: A reaserch on "pubmed" with "Risk factors for cancer in patients with Crohn's disease", "Cancer and Crohn's disease" Crohn's disease and cancer risk" as key-words was conducted. We identified 35 studies and analized also references reported inside each single work. RESULTS: Patients with CD have a higher risk of colorectal cancer (CRC). The risk of colon cancer alone was found to be increased, with no significant increase in the risk of rectal cancer. Factors that play a role in the development of CRC are: diagnosis of CD before 25-years-old, duration of disease, severity of inflammation, habit to cigarette's smoke, a familial history of CRC and immunosuppressive therapies. The risk of small bowel cancer was found to be increased, even if overall risk remains low. Although the role of immunosuppressive therapies remain to clarify yet, patients with CD have a higher risk of development lymphoma compared with background population. CONCLUSION: Patients with CD are at high risk of large bowel, small bowel, extraintestinal and hemopoietic cancers. Selected patients with extensive colonic disease, which has been present from a young age, are at high risk of cancer and should be candidates for colonscopic surveillance.
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Neoplasias Colorrectales/etiología , Enfermedad de Crohn/complicaciones , Vigilancia de la Población , Colonoscopía , Enfermedad de Crohn/diagnóstico , Medicina Basada en la Evidencia , Neoplasias Hematológicas/etiología , Humanos , Neoplasias Intestinales/etiología , Linfoma/etiología , Vigilancia de la Población/métodos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/efectos adversos , Factores de TiempoRESUMEN
BACKGROUND: The objective of this study was to evaluate outcomes of mesh versus primary suture procedures for repair of anterior abdominal wall midline hernias. RESULTS: Between 1995 and 2005, 98 patients (46 males) underwent repair of umbilical (69 cases) or epigastric (29 cases) hernias. Primary suture of the defect was performed in 34 cases (group 1). A polypropylene mesh was positioned in 64 cases (group 2). Overall, mean aponeurotic defect diameter was 2.5 cm (range 0.5 +/- 10 cm). Procedures were carried out under local anesthesia in 76 instances (71% group 1 vs. 81% group 2). Complications occurring in group 2 comprised three seromas, one hematoma and one prosthetic infection. Follow up was scheduled yearly up to the fifth postoperative year. Recurrence rate in group 1 was 14.7% compared to 3.1% in group 2 (logrank test p 0.0475). CONCLUSIONS: Anterior preperitoneal mesh repair of abdominal wall midline hernias under local anesthesia seems to be a safe and effective technique that can be performed as a day surgery procedure. A slightly increased risk of postoperative local complications following mesh repair is offset by a reduced rate of recurrence in comparison to suture repair.
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Hernia Ventral/cirugía , Mallas Quirúrgicas , Técnicas de Sutura , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Umbilical/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
BACKGROUND: The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). METHODS: Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,. RESULTS: Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 +/- 4.5 days. Patients were followed for a mean of 24.7 +/- 10.9 months (range: 6-42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change. CONCLUSIONS: According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.
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Obstrucción Intestinal/cirugía , Enfermedades del Recto/cirugía , Recto/cirugía , Canal Anal/cirugía , Femenino , Estudios de Seguimiento , Humanos , Obstrucción Intestinal/etiología , Intususcepción/complicaciones , Intususcepción/cirugía , Masculino , Enfermedades del Recto/complicaciones , Prolapso Rectal/cirugía , Rectocele/complicaciones , Rectocele/cirugía , Grapado Quirúrgico , Resultado del TratamientoRESUMEN
Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.
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Glándula Sublingual/cirugía , Glándula Submandibular/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Humanos , Enfermedades de las Glándulas Salivales/cirugía , Glándula Sublingual/patología , Glándula Submandibular/patologíaRESUMEN
AIMS AND BACKGROUND: Carcinoids of the appendix continue to be of interest, despite their low incidence. There is still considerable controversy surrounding these tumors, especially with regard to the role of right hemicolectomy in the surgical management. The aim of this work was to explicate the current therapeutic knowledge and to review the criteria for the indications of appendectomy or hemicolectomy. METHODS: The records of patients who underwent appendectomies from 1990 to 2000 were analyzed. Seven patients were included in the study. The clinical data were reviewed for demographic details, tumor size, localization in the appendix, histological patterns and surgical procedures. All patients underwent appendectomy including removal of the mesenteriolum, and in one of them a right hemicolectomy was performed 3 weeks later. The mean follow-up was 7 years (range, 4-14). Follow-up data included symptoms, urinary 5-hydroxyindoleacetic acid, ultrasound examination, computerized tomography, and octreotide scanning. RESULTS: Seven patients (0.9% of all appendectomies) were reported to have carcinoid tumors of the appendix. They were 3 men and 4 women with a mean age of 29 years. All patients were admitted for appendicitis. None suffered from the carcinoid syndrome. The site of the tumor was the apex of the appendix in 4 cases, the body in 2 cases and the base in 1 case. Mean tumor diameter was 8 mm (range, 5-29 mm); in 6 patients it was <2 cm. Treatment was appendectomy in all cases; additional right hemicolectomy was necessary in one case because of a tumor of more than 2 cm with invasion of the mesoappendix and lymph nodes. The 7-year survival rate is 100%. Six patients are without disease, while 1 patient (the one who underwent a right hemicolectomy) developed metastases in the liver 6 years after the operation. This patient, who was treated with a liver resection, is still alive. CONCLUSIONS: According to current guidelines, an appendectomy may be performed for small carcinoid tumors (<1 cm). Reasons for more extensive surgery than appendectomy are tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. The criteria that direct us towards major (hemicolectomy) or minor surgery (appendectomy) are controversial. Tumor size is still considered the most important prognostic factor, with a presumed increase in the risk of metastasis for tumors greater than 2.0 cm. The accepted treatment of such tumors is a right hemicolectomy. However, there is no evidence demonstrating a survival benefit for right hemicolectomy over simple appendectomy in patients with carcinoids greater than 2.0 cm in diameter.
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Apendicectomía , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/cirugía , Tumor Carcinoide/secundario , Tumor Carcinoide/cirugía , Colectomía , Adolescente , Adulto , Apendicectomía/métodos , Colectomía/métodos , Femenino , Humanos , Neoplasias Hepáticas/secundario , Metástasis Linfática , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The results of endoscopic and surgical treatment in 21 patients affected by acute biliary pancreatitis are reported. All patients were managed according to the same protocol. Once the diagnosis was formulated (pain, serum amylase, ultrasonography, cholestasis and/or cholangitis) and the severity evaluated (Ranson's criteria, glucose and urea levels), the 21 patients underwent endoscopic retrograde cholangiopanctratography--within 24 hours in 8 patients (predicted severe disease) or within 72 hours in 13 patients (predicted mild disease). Endoscopic sphincterotomy was performed in 18 patients with stones in the common bile duct and was successful in 94.5% (17 patients: 3 patients underwent more than one session to confirm or achieve clearance of the duct). The morbidity rate associated with endoscopic sphincterotomy was 16% (3 patients: 2 haemorrhages, 1 perforation). There were no deaths. Cholecystectomy was performed in 16 patients within 2-9 weeks of the initial attack of acute biliary pancreatitis. There were 3 minor complications (respiratory, laparotomy, urinary infection), no major intraoperative or postoperative morbidity, and no mortality. Acute biliary pancreatitis is still associated with significant morbidity and mortality, but can be managed safely with combined medical, endoscopic and surgical treatment.