Clinical and Functional Outcome After Abdominal Wall Incisional Hernia Repair: Evaluation of Quality-of-Life Improvement and Comparison of Assessment Scales.

Background Hernias severely impact patient quality of life (QoL), and 80% of patients need surgical operation. The primary outcome of the study is to assess improvements in balance, posture and deambulation after abdominal hernia repair. Moreover, the study investigated the improvement in the postoperative QoL. Methods Patients operated at the Policlinico “Paolo Giaccone” at Palermo University Hospital between June 2015 and June 2017 were identified in a prospective database. The functional outcome measures and QoL assessment scales used were numeric rating scale for pain, performance-oriented mobility assessment (POMA) scale, Quebec back pain disability scale, center of gravity (barycenter…

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery.A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a c…

The non-surgical management for hemorrhoidal disease. A systematic review

The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC). We performed a systematic review in order to evaluate: do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are? A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS. In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%. IV degree prolapse should have a more invasive treatment. Th…

Evidence-Based Strategies to Promote Long-Term Cardiac Implant Site Health: Review of the Literature

Cardiac implantable electronic devices (CIEDs) are commonly used nowadays. The association between CIED placement and infections is responsible for the high mortality and device explantation rate. Since CIED placement has increased in the past decade, CIED-related complications have risen. In order to reduce the CIED-related complications rate, the prevention of device infection represents the main goal. Over time, many different studies have proven the importance of the measures to prevent CIED-related infections. This review aims to collect the actual recommendations for CIED infection prevention, providing an overview of the main evidence-based strategies.

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multiva…

Rectal bleeding and prolapse… not always benign diseases rather anal cancer. The importance of a correct decision making since primary care

Rectal bleeding is very common in general population with a prevalence of 10-20 %. Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduct a decision making for the correct management. We report a case of a 61-years-old woman, complaining rectal bleeding and an anal mass attended to their family doctor who does a visit but without a digital rectal examination and diagnosed a hemorrhoidal prolapse suggesting medical therapy. For the persistence of symptoms she comes to our service from emergency attention. Inspection and digital rectal examination revealed an anal mass. CT scan was performed showing a large anal mass involving hal…

Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study

Background Open abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur. Methods Non-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients’ records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta ‘‘modified’’ technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), ab…

Retrospective Analysis of 29 Patients with Multiple Pulmonary Metastases from Colorectal Carcinoma Resected by a 1318-nm Laser

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The abdominal wall hernia in cirrhotic patients: A historical challenge

Abstract Background The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. Methods Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records…

An investigation of bedside laparoscopy in the ICU for cases of non-occlusive mesenteric ischemia

Background: Acute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI. Methods: Thirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive. If necrosis was already present or suspected, surgical approach was done. Endovascular or surgical embolectomy was performed when necessary. Twenty N…

Closed Incision Negative Pressure Therapy Achieves Better Outcome Than Standard Wound Care: Clinical Outcome and Cost-Effectiveness Analysis in Open Ventral Hernia Repair With Synthetic Mesh Positioning

BackgroundSurgical site infections (SSIs) and surgical site occurrences (SSOs) are frequent post-operative complications that are dependent on the presence of different risk factors. The use of closed incision negative pressure therapy (ciNPT) is considered a measure by the WHO guidelines for prevention of SSIs. The prevention of SSOs is an extremely important issue in the ventral hernia repair (VHR) surgical field. SSO onset not only affects the patient's quality of life, but can also cause the onset of life-threatening conditions that may require re-hospitalization, re-intervention and often mesh removal. Such outcome can become extremely costly, contributing to increased health care cost…

Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review

Background. Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. Methods. The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were “minimally inva…

The abdominal wall incisional hernia repair in cirrhotic patients

BACKGROUND: The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. PATIENTS AND METHODS: Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and Decemb…

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis.

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (pro…

Is it really useful the Harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series.

Background. The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. Patients and Methods. From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD)…

Pulmonary Laser Metastasectomy by 1318-nm Neodymium-Doped Yttrium-Aluminum Garnet Laser: A Retrospective Study About Laser Metastasectomy of the Lung

Background. The lungs are among the first organ affected by remote metastases from many primary tumors. The surgical resection of isolated pulmonary metastases represents an important and effective element of therapy. This is a retrospective study about our entire experience with pulmonary resection for metastatic cancer using 1318-nm neodymium-doped yttrium-aluminum garnet laser. Method. In this single-institution study, we retrospectively analyzed a group of 209 patients previously treated for primary malignant solid tumors. We excluded 103 patients. The number and location of lesions in the lungs was determined using chest computed tomography and positron emission tomography-computed tom…

Bowel wall thickening: inquire or not inquire? Our guidelines

Introduction Bowel wall thickening is not an uncommon finding among patient undergoing abdomen CT scan. It may be caused by neoplastic, inflammatory, infectious or ischaemic conditions but also be a normal variant. Although specific radiologic patterns may direct to a precise diagnosis, occasionally misidentification may occur. Thus, in the absence of guidelines, further and not always needed diagnostic procedures (colonoscopy, esophagogastroduodenoscopy or capsule endoscopy) are performed. Patients and methods We conducted a retrospective study on data collected from May 2016 to June 2017. We selected 40 adult patients, admitted in Emergency Department with "abdominal pain" and undergone a…

Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study

Abstract Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score. It was recorded the laparoscopic or open treatments, the type of surgical …

Preliminary results about a novel technique of mesh positioning in the abdominal wall hernia repair.

INTRODUCTION: The surgical techniques described to approach the incisional hernia repair are various and there is not consensus about which of them to use. The Intra-Peritoneal Onlay Technique (IPOM) with classic mesh positioning is burdened by high post-operative complication rate. The study shows the preliminary results of a novel technique of open IPOM mesh positioning with "percutaneous" approach. PATIENTS AND METHODS: From January 2010 to December 2016 patients with abdominal wall incisional hernia that underwent surgical operation via open mesh technique for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital were identified and the data col…

Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis

Introduction. Acute Secondary Peritonitis due to abdominal visceral perforation is characterized by high mortality and morbidity risk. Risk stratification allows prognosis prediction to adopt the best surgical treatment and clinical care support therapy. In Western countries elderly people represent a significant percentage of population Aim. Evaluation of Mannheim Peritonitis Index (MPI) and consideration upon old people. Patients and methods. Retrospective study on 104 patients admitted and operated for “Acute Secondary Peritonitis due to visceral perforation”. MPI was scored. In our study we want to demonstrate efficacy of MPI and the possibility to consider older age an independent …

De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia

AbstractDe Garengeot hernia is a rare femoral hernia defined as the presence of the appendix within the femoral hernia sac. The incidence of appendicitis in this type of hernia is a rare condition that accounts for 0.08–0.13% of all De Garengeot hernias. We describe the case of a 61-year-old woman that presented at the emergency department with a tender mass (diameter 10 × 8 cm) in the right groin region for 5 days associated with pain in lower right abdomen and accompanied by fever (38 °C). Computed tomography (CT) of the abdomen revealed the presence of a complex fluid collection with small foci of air in the right inguinal region, measuring 9 × 7 × 10 cm in the 3 orthogonal dimensions an…

Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit

Acute appendicitis is common in an Emergency Surgery Unit. Although the laparoscopic approach is a method accepted for its treatment, no strong data are available for determining how many procedures must an experienced surgeon carry out for obtaining all the advantages of this technique and if this approach can become the gold standard in the activity of a general emergency unit with senior surgeons variously skilled on the basic laparoscopy. 142 patients that underwent appendectomy (90 laparoscopic, 52 conventional) for acute appendicitis were enrolled in this institutional retrospective cohort study. The surgeons were classified with a descriptor-based grading and divided in two groups re…

Uncommon localizations of hydatid cyst. Review of the literature

Introduction Hydatid disease is an endemic anthropozoonosis with usual localization in liver and lungs. Rarely it localizes in uncommon sites as spleen, skeleton, kidney, brain, cardiac muscle, peritoneum, sub cutis. Complications of uncommon localizations are the same that for usual ones. Material and methods Review of the literature on rare and atypical localization of hydatid cysts in soft tissues. Key-words used on Pub-Med [(echinococ OR hydatid) AND (soft tissue OR subcutaneous OR cutaneous)] without time limit. There were found 282 articles; 242 were excluded because of muscular or bone localizations. 40 were coherent. Results Different variables are taken into account: age, sex, geog…

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit

Introduction: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. Methods: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complic…

Open versus laparoscopic approach in the treatment of abdominal emergencies in elderly population

AIM: To evaluate the role of laparoscopy in the treatment of surgical emergency in old population. PATIENTS AND METHODS: Over-70 years-old patients submitted to emergency abdominal surgery from January 2013 to December 2014 were collected and grouped according to admission diagnoses. These accounted small bowel obstruction, colonic acute disease, appendicitis, ventral hernia, gastro-duodenal perforation, biliary disease. In each group it was analyzed the operation time (OT), the morbidity rate and the mortality rate comparing open and laparoscopic management using T-test and Chi-square test. RESULTS: 159 over 70-years-old patients underwent emergency surgery in the General and Emergency sur…

Abdominal wall incisional hernia repair improves respiratory function: results after 3 years of follow-up

Abstract Purpose Hernias severely impact patient quality of life (QoL), and 80% of patients require a surgical operation. Moreover, hernias are responsible for respiratory function alterations. This study aims to investigate the postoperative alterations in respiratory function after open ventral hernia repair in patients with incisional hernia. Methods Patients operated on at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2015 and December 2016 were identified in a prospective database. Fifty-one patients were enrolled in the study. The respiratory outcome measures used were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio…

Deep SSI after mesh-mediated groin hernia repair: Management and outcome in an Emergency Surgery Department

Aim. Mesh-mediated groin hernia repair is considered the goldstandard procedure. It has low recurrence rate. Rarely a deep Surgical Site Infection (SSI) is seen when a synthetic prosthesis is used. Case report. We describe a rare case of bilateral deep SSI after mesh- mediated groin hernia repair. Diagnosis was performed through the physical examination and radiological exams. Microbiological samples identified a methicillin-resistant Staphylococcus aureus responsible of the infection. Target therapy was performed and re-operation performed in order to remove the infected prosthesis and to apply a biological one to create the fibrous scaffold. During follow-up time, right side recurrence wa…

The management of the slow transit constipation in the laparoscopic era

The slow transit constipation (STC) is a functional bowel pathology with slow total gut transit time with normal calibre colon in addition to a variety of other systemic symptoms. Patients with an abnormal colonic motility refractory to conservative treatment are regarded as appropriate candidates for surgery. Laparoscopic total colectomy with ileum-rectum anastomosis represents the commonest surgical operation in the treatment of STC, in well selected patients, after failure of conservative treatment. From 2012 to 2016, 8 patients suffering constipation according to Roma III criteria and diagnosed as STC were submitted to a total colectomy in our O.U. We evaluated the long-term post-operat…

Laparoscopic ileocecal resection in acute and chronic presentations of Crohn's disease. A single center experience

Introduction The terminal ileum is the most involved tract in Crohn's disease. The obstruction in this location is the most frequent complication. Acute or chronic presentations can occur. Surgery finds a role in the management of chronic strictures and in acute clinical presentations with complications not improving with conservative therapy. Patients and methods We investigate the outcome of patients with obstruction of the ileo-cecal bowel tract laparoscopically managed. It was analyzed the average operative time (OT), the conversion rate and the occurrence of re-operation due to surgical complications. Results 21 patients underwent an ileocecal resection for complicated Crohn's disease …

Multiparametric evaluation of risk factors associated to seroma formation in abdominal wall surgery

INTRODUCTION: Incisional hernia is one of the main topics in the general surgery since there is not a unanimous consensus concerning to the best surgical methodology to adopt. It seems that prosthetic surgery is the best technique, even if responsible for the development of periprosthetic seroma. The aim of this study is to assess whether the preoperative abnormalities of the bio-humoral parameters may be considered as risk factors for seroma. PATIENTS AND METHODS: From July 2016 to July 2017 at the "Policlinico Paolo Giaccone", Palermo, Department of Emergency Surgery, 56 patients included in this study, underwent laparotomic mesh repair. The inclusion criteria were: age > 18 years, inc…

Functional outcome of patients with uncomplicated acute sigmoid diverticulitis after conservative and surgical treatment: risk factors for recurrence.

Non-occlusive mesenteric Ischemia (NOMI) in Parkinson’s disease: Case report

Non-occlusive mesenteric ischemia (NOMI) is a severe pathological condition characterized by signs and symptoms of bowel obstruction, intestinal necrosis resulting from acute and/or chronic inadequate blood perfusion, in the absence of an organic vascular obstruction detectable by imaging techniques. A 64 years old man case with a history of Parkinson’s disease in high-functioning levodopa treatment is presented. Clinical and radiological signs of intestinal obstruction were observed. He underwent surgical operation with total colectomy and terminal ileostomy for generalized secondary peritonitis due to perforation of sigmoid colon. Ischemic pancolitis was first suspected. In third post-o…