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Surgery for inflammatory bowel disease in the era of laparoscopy

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World Journal of Gastroenterology 2013年第16期19卷 2445-2448页

作者： Giuseppe S Sica livia biancone GastroIntestinal Surgical Unit Tor Vergata University of Rome

During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction.

关键词： Laparoscopy Ulcerative colitis Surgery Inflammatory bowel disease Laparoscopic surgery Proctocolectomy Ileoanal pouch anastomosis

Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease

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World Journal of Gastroenterology 2012年第42期18卷 6088-6095页

作者： Sara Onali Emma Calabrese Carmelina Petruzziello Francesca Zorzi Giuseppe Sica Roberto Fiori Marta Ascolani Elisabetta Lolli Giovanna Condino Giampiero Palmieri Giovanni Simonetti Francesco Pallone livia biancone Department of Systems Medicine University "Tor Vergata"00133 RomeItaly Department of Surgery University "Tor Vergata"00133 RomeItaly Radiology Unit Department of ImagingUniversity "Tor Vergata"00133 RomeItaly Pathology Unit University "Tor Vergata"00133 RomeItaly

AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,

关键词：计算机断层扫描技术评估小肠回肠病理组织学检查灌肠造影超声

Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

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World Journal of Gastroenterology 2011年第41期17卷 4602-4606页

作者： Giuseppe S Sica Edoardo Iaculli livia biancone Sara Di Carlo Rosa Scaramuzzo Cristina Fiorani Paolo Gentileschi Achille L Gas-pari Department of Surgical Sciences "Tor Vergata"University Hospital Department of Internal Medicine Gastrointestinal Unit"Tor Vergata"University Hospital

AIM:To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrec-tomy in a single unit.METHODS:From February 2000 to September 2004,all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial.Primary endpoint was cancer-related survival and secondary endpoints were overall survival,evaluation of surgical complications and mortality.RESULTS:Fifty-eight patients were enrolled.Forty-seven patients were followed-up(range 11-103,me-dian 38 mo).Four patients were lost at follow up.Twenty-two patients underwent a laparoscopic gastric surgery(LGS)and 25 had a standard open procedure(OGS).No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate(50% vs 52%,P = 1),and 5 years overall mortal-ity rate(54.5% vs 56%,P = 1).Accordingly,cancer-related and overall survival probability by Kaplan-Meier method showed comparable results(P = 0.81 and P = 0.83,respectively).We found no differences in surgical complications in the 2 groups.There was no conversion to open surgery in this series.CONCLUSION:LGS is as effective as OGS in the man-agement of advanced gastric cancer.However LGS can-not be recommended routinely over OGS for the treat-ment of advanced gastric cancer.

关键词：腹腔镜胃癌管理切除术开放式 LGS 随机试验生存概率

Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

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World Journal of Gastroenterology 2008年第34期14卷 5290-5300页

作者： livia biancone Emma Calabrese Giampiero Palmieri Carmelina Petruzziello Sara Onali Giuseppe Sigismondo Sica Marta Cossignani Giovanna Condino Kiron Moy Das Francesco Pallone Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Anatomia ed Istologia Patologica Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Chirurgia Generale Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina Interna Università di "Tor Vergata" GI Unit Department of Gastroenterology & Hepatology University of Medicine & Dentistry of New Brunswick

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

关键词：溃疡性结肠炎肠阻塞回盲肠吻合术结肠组织转化

Multiplex gene expression profile in inflamed mucosa of patients with Crohn’s disease ileal localization: A pilot study

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World Journal of Clinical Cases 2019年第17期7卷 2463-2476页

作者： Francesco Giudici Letizia Lombardelli Edda Russo Tiziana Cavalli Daniela Zambonin Federica Logiodice Ornela Kullolli Lamberto Giusti Tatiana Bargellini Marilena Fazi livia biancone Stefano Scaringi Ann Maria Clemente Eloisa Perissi Giovanni Delfino Maria G Torcia Ferdinando Ficari Francesco Tonelli Marie-Pierre Piccinni Cecilia Malentacchi Department of Experimental and Clinical Medicine University of FirenzeFirenze 50134Italy Dipartimento Chirurgico Ortopedico Ospedale Carlo Poma di MantovaFirenze 50134Italy Department of Experimental and Clinical Biomedical Sciences “Mario Serio” University of FirenzeFirenze 50134Italy Surgical Unit Department of Surgery and Translational MedicineUniversity of FirenzeFirenze 50134Italy Department of Internal Medicine University of Roma Tor VergataRoma 00133Italy

BACKGROUND Crohn’s disease (CD) is a complex disorder resulting from the interaction of genetic,environmental,and microbial factors.The pathogenic process may potentially affect any segment of the gastrointestinal tract,but a selective location in the terminal ileum was reported in 50% of patients.AIM To characterize clinical sub-phenotypes (colonic and/or ileal) within the same disease,in order to identify new therapeutic targets.METHODS 14 consecutive patients undergoing surgery for ileal CD were recruited for this study.Peripheral blood samples from each patient were collected and the main polymorphisms of the gene Card15/Nod2 (R702W,G908R,and 1007fs) were analyzed in each sample.In addition,tissue samples were taken from both the tract affected by CD and from the apparently healthy and disease-free margins (internal controls).We used a multiplex gene assay in specimens obtained from patients with ileal localization of CD to evaluate the simultaneous expression of 24 genes involved in the pathogenesis of the disease.We also processed surgery gut samples with routine light microscopy (LM) and transmission electron microscopy (TEM) techniques to evaluate their structural and ultrastructural features.RESULTS We found a significant increase of Th17 (IL17A and IL17F,IL 23R and CCR6) and Th1 (IFN-γ) gene expression in inflamed mucosa compared to non-inflamed sites of 14 CD patients.DEFB4 and HAMP,two genes coding for antimicrobial peptides,were also strongly activated in inflamed ileal mucosa,suggesting the overwhelming stimulation of epithelial cells by commensal microbiota.IFN-γ and CCR6 were more expressed in inflamed mucosa of CD patients with ileal localization compared with patients with colonic localization suggesting a more aggressive inflammation process in this site.Morphological analysis of the epithelial lining of Lieberkün crypts disclosed enhanced release activity from goblet mucocytes,whereas the lamina propria contained numerous cells pertaining to various lines.CONCLUSION We observed that the expres

关键词： Crohn's disease Ileum Colon Messenger ribonucleic acid Th1/Th17 Microbiota Inflammation

Treatment of peri-anal fistula in Crohn's disease

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World Journal of Gastroenterology 2014年第37期20卷 13205-13210页

作者： Giuseppe S Sica Sara Di Carlo Giorgia Tema Fabrizio Montagnese Giovanna Del Vecchio Blanco Valeria Fiaschetti Giulia Maggi livia biancone Department of Surgery Tor Vergata University Hospital San Giuseppe Hospital Albano LazialeRome 00041Italy Department of Medicine Tor Vergata University Hospital Department of Radiology Tor Vergata University Hospital

Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.

关键词： Fistula Crohn’s disease Perianal fistula Sur-gery

Intestinal duplication in adulthood: A rare entity, difficult to diagnose

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World Journal of Gastrointestinal Surgery 2011年第8期3卷 128-130页

作者： Cristina Fiorani Rosa Scaramuzzo Alessandra Lazzaro livia biancone Giampiero Palmieri Achille L Gaspari Giuseppe Sica Department of Surgical Science Tor Vergata University Hospital Department of Medicine Gastroenterology Unit Tor Vergata University Hospital Department of Pathology Tor Vergata University Hospital

Duplications of the alimentary tract (ATD) are rare congenital anomalies often found early in life. They may occur anywhere in the intestinal tract but the ileum is the most frequently affected site. Clinical presentation of ATD in adults is variable and because these lesions occur so infrequently they are rarely suspected. In the present report we describe a case of ileal duplication in a 61-year-old patient with Crohn’s disease. Despite various radiological investigations and medical consultations, the diagnosis was only made on the surgical specimen.

关键词： Intestinal duplication Adulthood Intestinal obstruction Surgical resection Abdominal pain