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Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing
BackgroundLaparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques.MethodsPatients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively.ResultsLARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS.ConclusionLaparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes.
Journal Article
A systematic review of the predictive factors for the recurrence of acute pancreatitis
Purpose
Acute Pancreatitis (AP) is a prevalent clinical pancreatic disorder characterized by acute inflammation of the pancreas, frequently associated with biliary or alcoholic events. If not treated with cholecystectomy after the first episode, patients may experience a recurrence of AP, with consequent need for emergency surgery and increased risk of death. Analyzing the risk factors that may contribute to the recurrence of Biliary and Alcoholic Pancreatitis (BAP and AAP), future research can be driven toward new solutions for preventing and treating this pancreatic disease.
Methods
A systematic review was conducted selecting studies from BiomedCentral, PubMed, Scopus and Web of Science by two independent reviewers. Publications were considered only if written in English in the time interval between January 2000 and June 2024 and investigated the risk factors for the recurrence of BAP and AAP. At the end of the selection, a quality assessment phase was conducted using the PROBAST tool.
Results
In this systematic review, 8 articles were selected out of 6.945, involving a total sample of 11.271 patients of which 38.77% developed recurrence episodes. 37.5% of the included studies focus on recurrent acute biliary pancreatitis (RBAP), while 62.5% are dedicated to recurrent acute alcoholic pancreatitis (RAAP). The risk factors for the recurrence of AP showed a clear differentiation between the alcoholic and biliary etiology. Most of the considered studies adopted a retrospective design, characterized by a susceptibility to potential methodological biases. However, the trend indicated a more recent increase in prospective studies, together with a greater focus on identifying and understanding the possible risk factors associated with the recurrence of acute pancreatitis (RAP). This result highlighted the progress in the scientific approach toward a more rigorous and systematic assessment of the causes and dynamics that influence the recurrence of the disease.
Conclusion
Studies highlighted the importance of lifestyle factors, clinical complications, and surgical interventions that can impact the risk of biliary or alcoholic recurrent acute pancreatitis. Increased and systematic adoption of artificial intelligence-based tools could significantly impact future knowledge relating to the risks of recurrence and relative possibilities of prevention.
Journal Article
Alcune osservazioni sulla lingua degli storiografi arcaici
Dans cet article, on étudie De Orat. 2, 62-64, 2, 55, De leg. 1, 5 et d'autres remarques de Cicéron sur les traits caractéristique de l'historiographie avant lui. À partir des observations de l'auteur de la Rhétorique à Herennius sur les tria genera dicendi, on montre, à travers l'analyse des fragments du IIe siècle av. n. è. des historiens tels Calpurnius Piso Frugi et Caton, que les remarques de Cicéron sont justes et qu'elles ne devraient pas être attribuées au préjugé classicisant de l'orateur habile et raffiné qu'il était. En effet, les historiens du IIe siècle av. n. è., autant que nous pouvons le reconstruire, étaient de simples narratores rerum, sans aucune préoccupation du style. Il contributo ha per oggetto l'analisi di Cic. De Orat. 2, 62-64; 2, 55 e De leg. 1, 5 e le osservazioni dell'Arpinate sulle caratteristiche della storiografia a lui precedente. Partendo dalle considerazioni dell'auctor della Rhetorica ad Herennium relative ai tria genera dicendi si mostra, attraverso l'analisi dei frammenti degli storiografi del II sec. a. C., ed in particolare di quelli di Calpurnio Pisone Frugi e di Catone, come le critiche di Cicerone risultino fondate e non siano da ascrivere al pregiudizio classicistico di un oratore scaltrito e dal gusto raffinato quale egli fu. In effetti, per quello che possiamo ricostruire, gli storici del II sec. a. C. furono effettivamente dei semplici narratores rerum, privi di qualsiasi cura dello stile.
Journal Article
ONCOLOGY NURSE NAVIGATOR: PRELIMINARY EXPERIENCE OF A NOVEL PATIENT- CENTERED PROJECT IN A GENERAL SURGERY UNIT IN CENTRAL ITALY
The role of oncology nurse navigator (ONN) is a specialized nurse offering personalized care to oncologic patients to help them throughout the healthcare system. In our general surgery unit in Italy, we have started such project since January 2023, aiming to enhance the diagnostic-therapeutic and assistance pathway of each oncologic patients. Primary outcomes are reduction of time interval between the first contact with patient and each phase of diagnostic and therapeutic pathway. Secondary outcomes assessment of the number and frequency of contacts between the patient and his ONN, as well as of the quantity and type of procedures organized and patient satisfaction assessment. Prospective cohort study has been conducted with a control group represented by the parameters measured in 2022 for the oncologic patients treated in our same surgical unit not followed by ONN. Both groups consisted of 30 patients. Contacts have been recorded with a dedicated cell phone number. Patient-Satisfaction-With-Cancer-Care (PSCC) questionnaire has been given to the patients in a blind way by third party to avoid biases. The study group included 30 cancer patients, out of them 18 had colorectal cancer, 6 liver mets and 6 pancreatic cancer. Average time from first contact to the primary diagnostic test was 8 days vs 20 days in 2022 (control group, p<0.001). All patients underwent MDT discussion and time to Multidisciplinary Team meeting (MDT) was not different between the two groups. 5 patients were considered not fit for surgery and average time of referral to medical oncologist was 5 days in the study vs 10 days in the control group (p
Journal Article
Multisociety research collaboration: timing of cholecystectomy following cholecystostomy drainage for acute cholecystitis
BackgroundPatients with acute cholecystitis (AC) presenting with unfavorable systemic or local conditions are often managed with percutaneous cholecystostomy (PC) as a temporary measure. The clinical outcomes of interval cholecystectomy following PC remain unclear. The aim of the study was to identify the association between the timing of cholecystectomy following PC for AC and perioperative complication rates at interval cholecystectomy. We hypothesized that there would be a specific time interval to cholecystectomy associated with lower risk for adverse events.MethodsThis was a retrospective (2018–2020) multicenter study at 8 participating hospital systems of adult patients with AC, managed with PC and interval cholecystectomy. Demographics, comorbidities, treatment details, and outcomes were examined. Patients were grouped based on quartiles for timing of surgery after PC (< 7, 7–9, 10–13, > 13 weeks). The primary outcome was a composite endpoint of bile duct injury, reoperation, readmission, image-guided intervention, endoscopic intervention, conversion to open surgery, or death.ResultsThere were 188 patients with a median age of 66 years with AC classified as mild (41%), moderate (47%), and severe (12%). Median days from PC to surgery were 65 (Q1 = 48, Q3 = 91). Laparoscopic cholecystectomy (89.9%) was the most commonly planned approach (robotic 6.4%, 3.7% open) and 28 (14.9%) were converted to open. The composite endpoint was reported in 51 patients (27.1%). A biliary injury occurred in 7 (3.7%) patients. Time to surgery and intraoperative drain placement were independently associated with the composite outcome. Cholecystectomy within 7 weeks of PC was associated with decreased risk (OR = 0.36, 95% CI 0.13–0.97) of the composite endpoint, compared to patients undergoing surgery > 13 weeks after PC.ConclusionTiming of surgery following PC was associated with procedural outcomes. Patients undergoing surgery before 7 weeks experienced significantly less morbidity than patients having delayed cholecystectomy. These results should be considered in patient selection and management after PC.
Journal Article
Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years
BackgroundInguinal hernia repair via multi-trocar laparoscopy (MTL) has gained an increasing popularity worldwide. Single-incision laparoscopy (SIL) has been introduced to reduce the port-related complications and to improve the cosmetic results. The authors report a prospective randomized study comparing SIL versus MTL totally extraperitoneal (TEP) inguinal hernia repair.MethodsBetween January 2013 and May 2015, 113 versus 97 patients were prospectively randomized between SILTEP and MTLTEP. Perioperative, short-term, and mid-term outcomes have been assessed. The primary endpoint was the mid-term outcomes (late postoperative complications, late inguinal hernia recurrence, surgical and cosmetic satisfactions). Secondary endpoints were perioperative outcomes (operative time, mesh fixation, operative complications, postoperative pain, and hospital stay) and short-term outcomes (early postoperative complications, early inguinal hernia recurrence, and days to return to normal activities).ResultsAfter a mean follow-up of 27 ± 8 months, a statistically significant difference was found between the two groups in terms of mean operative time for both unilateral and bilateral inguinal hernia repair (p = 0.016; p = 0.039) and cosmetic satisfaction (p = 0.003).ConclusionPerioperative, short-term, and mid-term outcomes were comparable between the two groups. At 2-year follow-up, a significant shorter operative time after MTLTEP and a greater cosmetic satisfaction after SILTEP have been found.
Journal Article
Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case–control study
BackgroundThis multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.MethodsThis study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.ResultsFailure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23).ConclusionsNon-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.
Journal Article
Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy
Background
In patients who exhibit a complete clinical response after radio-chemotherapy for rectal cancer, the standard surgical approach might constitute overtreatment. The aim of this study is to analyse the outcomes of anorectal function and quality of life after transanal endoscopic microsurgery (TEM) in irradiated patients with complete clinical response.
Patients and methods
Between 2007 and 2014, 84 patients who were diagnosed with stage T2–T3–T4 N0 rectal cancer before chemoradiotherapy showed a complete clinical response to neoadjuvant therapy and underwent TEM. All patients were evaluated before and 1 year after TEM using the Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) questionnaire to determine the impact of this surgical technique on the degree of faecal continence. To assess the quality of life of patients after surgery, we administered the Fecal Incontinence Quality of Life Scale.
Results
Twenty-three patients exhibited a worse incontinence status after surgical intervention (27.4; 95% CI 18.2–38.2). These patients experienced a median positive absolute variation in the CCF-FIS of four points (95% CI 3.5–4.5;
p
< 0.001). Female sex and age showed a significant correlation with the worsening of continence status. Scores on the Fecal Incontinence Quality of Life Index Scale did not show a significant difference before and after TEM.
Conclusions
TEM may be an alternative treatment for patients with rectal cancer who exhibit a complete clinical response to neoadjuvant chemoradiotherapy because it offers the possibility to achieve a full thickness excision of the rectal wall. TEM also allows the identification of any residual disease and provides optimal quality of life and functional results.
Journal Article
Alcune osservazioni sulla lingua degli storiografi arcaici
Il contributo ha per oggetto l’analisi di Cic. De Orat. 2, 62-64; 2, 55 e De leg. 1, 5 e le osservazioni dell’Arpinate sulle caratteristiche della storiografia a lui precedente. Partendo dalle considerazioni dell’auctor della Rhetorica ad Herennium relative ai tria genera dicendi si mostra, attraverso l’analisi dei frammenti degli storiografi del II sec. a. C., ed in particolare di quelli di Calpurnio Pisone Frugi e di Catone, come le critiche di Cicerone risultino fondate e non siano da ascrivere al pregiudizio classicistico di un oratore scaltrito e dal gusto raffinato quale egli fu. In effetti, per quello che possiamo ricostruire, gli storici del II sec. a. C. furono effettivamente dei semplici narratores rerum, privi di qualsiasi cura dello stile.
Journal Article
Soziographie der Arbeitszufriedenheit
Der vorliegende Beitrag befasst sich mit der Soziographie der Arbeitszufriedenheit. In Studien zur Arbeitszufriedenheit werden oziographische Merkmale oft als Kontrollgrößen eingesetzt. Ihre Berücksichtigung bei der Datenanalyse soll die Frage beantworten, ob sich der Einfluss von Determinanten der Arbeitszufriedenheit (Arbeitsinhalte, Arbeitsbedingungen, persönli-che Dispositionen usw.) für unterschiedliche Personengruppen und Situationen jeweils anders darstellt. Die Berücksichtigung von Kontrollgrößen macht aber nur dann Sinn, wenn diese selbst eine empirische Beziehung entweder zu den Determinanten der Arbeitszufriedenheit und/oder zu der Arbeitszufriedenheit selbst aufweisen. Dem vorliegenden Beitrag geht es um die Frage, ob sich Zusammenhänge zwischen bedeutsamen soziographischen Merkmalen und der Arbeitszufriedenheit aufzeigen lassen. Als Datengrundlage dienen die 35 Erhebungswellen des Sozioökonomischen Panels (SOEP) von 1984 bis 2018. Im Einzelnen betrachtet werden die Variablen Erwerbsstatus, Geschlecht, Alter, Schulabschluss, Hochschulabschluss, Berufsstatus, Betriebszugehörigkeit und Unternehmensgröße. Für die meisten dieser Größen ergeben sich, wenn überhaupt, nur sehr schwache statistische Beziehungen mit der Arbeitszufriedenheit. Eine Ausnahme macht der Berufsstatus. Die Qualifikationsanforderungen, die sich damit verknüpfen und die hierarchische Position haben einen beachtlichen Einfluss auf die Arbeitszufriedenheit. Bemerkenswert ist die große Stabilität der Befunde über alle Erhebungsjahre von 1984 bis 2018 hinweg.
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