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How to identify early complications in patients undergoing distal gastrectomy?

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 974-981页

作者： Giuseppe Tropeano maria michela chiarello Valeria Fico Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy

In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal *** with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric *** studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and *** factors can contribute to the onset of complications with consequent effects on prognosis and increased *** complications can be divided in complications related to anastomosis,to motility and to surgical site *** study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative *** study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with D2 lymph node *** these patients,16%developed early postoperative *** univariate analysis showed that prealbumin level,hypertension,diabetes,history of abdominal surgery,R0 resection,and blood transfusion were factors influencing early postoperative complications after distal ***,the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension,diabetes,a history of abdominal surgery,and blood transfusion were independent predictors of postoperative *** conclusion,preoperative and intraoperative factors can be used to establish an early postoperative nomogram *** results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.

关键词： Gastric cancer Gastrectomy Lymph node dissection Morbidity Mortality Surgical site infections

Indocyanine green:The guide to safer and more effective surgery

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 641-649页

作者： Pietro Fransvea maria michela chiarello Valeria Fico maria Cariati Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Department of Surgery Azienda Sanitaria Provinciale di CrotoneCrotone 88900Italy Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal *** authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal *** also highlight future perspectives of the use of indocyanine green in mini-invasive ***-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in *** can be administered in-travenously or *** its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and *** these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant ***-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic *** regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient *** the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic *** use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency ***,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine g

关键词： Indocyanine green Colorectal surgery Fluorescence-guided surgery Gastrointestinal surgery Hepato-biliary surgery Pancreatic surgery Surgical oncology

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

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World Journal of Clinical Cases 2024年第33期12卷 6580-6586页

作者： Pietro Fransvea maria michela chiarello Valeria Fico maria Cariati Giuseppe Brisinda Emergency and Trauma Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRoma 00168Italy Department of Surgery Provincial Health AuthorityCosenza 87100Italy Department of Surgery Provincial Health AuthorityCrotone 88900Italy Translational Medicine and Surgery Catholic School of MedicineRoma 00168Italy

In developed countries,the average life expectancy has been increasing and is now well over 80 *** life expectancy is associated with an increased number of emergency surgical procedures performed in later age *** appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute *** these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be *** the elderly,surgical treatment outcomes are influenced by *** must be considered a precursor of frailty,a risk factor for physical function *** has a negative impact on both elective and emergency surgery regarding mortality and *** from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function ***,prediction of function decline is *** emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before *** this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

关键词： Acute appendicitis Appendectomy Elderly Frailty Sarcopenia

Colonic Crohn’s disease-decision is more important than incision:A surgical dilemma

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World Journal of Gastrointestinal Surgery 2021年第1期13卷 1-6页

作者： maria michela chiarello maria Cariati Giuseppe Brisinda Department of Surgery General Surgery Operative UnitSan Giovanni di Dio HospitalCrotone 88900Italy Department of Medical and Surgical Sciences Abdominal Surgery Clinical AreaCatholic School of MedicineFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal *** is estimated that patients with CD have one in four chance of undergoing surgery during their *** surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to *** on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat *** elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous *** most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal *** completely removes all colonic and rectal disease and avoids the use of a potentially diseased *** will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.

关键词： Crohn’s disease Colonic Crohn’s disease Surgery Surgical treatment Colonic resection Segmental colectomy Total colectomy

Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery

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World Journal of Gastroenterology 2022年第28期28卷 3747-3752页

作者： maria michela chiarello Valentina Bianchi Pietro Fransvea Giuseppe Brisinda Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168taly Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Anastomotic leakage(AL)has a wide range of clinical features ranging from radiological only findings to peritonitis and sepsis with multiorgan *** early diagnosis of AL is essential in order to establish the most appropriate treatment for this *** AL continues to be a dreadful complication after colorectal surgery,there has been no consensus on its ***,based on patient’s presentation and timing of the AL,there has been a gradual shift to a more conservative management,keeping surgery as the last option Reoperation for sepsis control is rarely necessary especially in those patients who already have a diverting stoma at the time of the leak.A nonoperative management is usually preferred in these *** are several treatment options,also for patients without a stoma who do not require a reoperation for a contained pelvic leak,including recently developed endoscopic procedures,such as clip placement or endoluminal vacuum-assisted *** conservative treatments could be an option in patients who are clinically stable or in presence of a small defect.

关键词： Anastomotic leakage Colorectal cancer Colorectal surgery Mortality Morbidity

Anastomotic leakage in rectal cancer surgery:Retrospective analysis of risk factors

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World Journal of Clinical Cases 2022年第36期10卷 13321-13336页

作者： Giuseppe Brisinda maria michela chiarello Gilda Pepe maria Cariati Valeria Fico Paolo Mirco Valentina Bianchi Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery UniversitàCattolica S CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CrotoneCrotone 88900Italy

BACKGROUND Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and *** To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort *** To identify risk factors for AL,a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was ***,demographic and operative features,intraoperative outcomes and oncological characteristics were *** The incidence of AL was 10.4%,with a mean time interval of 6.2±2.1 *** mortality was 0.8%.Mortality was higher in patients with AL(4.9%)than in patients without leak(0.4%,P=0.009).Poor bowel preparation,blood transfusion,median age,prognostic nutritional index<40 points,tumor diameter and intraoperative blood loss were identified as risk factors for *** of anastomosis,number of stapler cartridges used to divide the rectum,diameter of circular stapler,level of vascular section,T and N status and stage of disease were also correlated to AL in our *** diverting ileostomy did not reduce the leak rate,while the use of the transanastomic tube significantly *** Clinical,surgical and pathological factors are associated with an increased risk of *** adversely affects the morbidity and mortality of RC patients.

关键词： Anastomosis Leak Anterior resection Morbidity Mortality Rectal surgery

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer:A retrospective cohort study

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World Journal of Gastroenterology 2022年第3期28卷 381-398页

作者： Giuseppe Brisinda maria michela chiarello Anna Crocco Neill James Adams Pietro Fransvea Serafino Vanella Abdominal Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy General Surgery Operative Unit Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Endocrine Surgery Operative Unit Istituto Nazionale TumoriIRCCS Fondazione PascaleNapoli 80100Italy Health Sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy Department of Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of General and Oncological Surgery Azienda Ospedaliera San Giuseppe MoscatiAvellino 83100Italy

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often *** mortality and morbidity after curative gastric cancer surgery is not *** To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric *** A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric *** each patient we calculated the Kattan’s *** arbitrarily divided the study population of patients into two groups based on the nomogram score(65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and *** One-hundred and eighty-six patients underwent a curative R0 resection with D2 *** mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer *** removal of more than 35 lymph nodes does not lead to an increase in mortality.

关键词： Gastric cancer Total gastrectomy Subtotal gastrectomy Lymphadenectomy Kattan’s nomogram Mortality Postoperative complications Postoperative pancreatic fistula Hemoperitoneum Anastomotic leakage

Therapeutic strategies in Crohn’s disease in an emergency surgical setting

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World Journal of Gastroenterology 2022年第18期28卷 1902-1921页

作者： maria michela chiarello Gilda Pepe Valeria Fico Valentina Bianchi Giuseppe Tropeano Gaia Altieri Giuseppe Brisinda Department of Surgery San Giovanni in Fiore HospitalAzienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Medical and Surgical Science UniversitàCattolica del Sacro CuoreRome 00168Italy

Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the *** factors must be considered to allow development of an appropriate treatment *** therapy often precedes or complements the surgical *** indications for operative management of CD include acute and chronic disease complications and failed medical *** surgery comes into play when patients are refractory to medical treatment if they have an obstructive *** colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency *** patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision *** of each emergency should be individualized based on patient age,disease type and duration,and patient goals of ***,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical *** this review,we aimed to discuss the acute complications of CD and their treatment.

关键词： Crohn’s disease Intestinal obstruction Free perforation Intra-abdominal sepsis Perineal sepsis Acute bleeding

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

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World Journal of Gastroenterology 2022年第36期28卷 5240-5249页

作者： Giuseppe Brisinda maria michela chiarello Giuseppe Tropeano Gaia Altieri Caterina Puccioni Pietro Fransvea Valentina Bianchi Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medicine and Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can cause pancreatic damage,both directly to the pancreas via angiotensin-converting enzyme 2 receptors(the transmembrane proteins required for SARS-CoV-2 entry,which are highly expressed by pancreatic cells)and indirectly through locoregional vasculitis and *** that,there is no clear evidence that SARS-CoV-2 is an etiological agent of acute *** pancreatitis in coronavirus disease 2019(COVID-19)positive patients often recognizes biliary or alcoholic *** prevalence of acute pancreatitis in COVID-19 positive patients is not exactly ***,COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative *** respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute *** this article,we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

关键词： Acute pancreatitis SARS-CoV-2 Severe acute pancreatitis Multiparametric scores Infected necrosis Step-up approach