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Rizzuto A, Andreuccetti J, Bracale U, Silvestri V, Pontecorvi E, Reggio S, Sagnelli C, Peltrini R, Amaddeo A, Bozzarello C, Pignata G, Cuccurullo D, Corcione F. Shifting paradigms: a pivotal study on laparoscopic resection for colovesical fistulas in diverticular disease. Front Surg 2024; 11:1370370. [PMID: 38496209 PMCID: PMC10940422 DOI: 10.3389/fsurg.2024.1370370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background Colovesical fistulas (CVFs) pose a challenge in diverticulitis, affecting 4% to 20% of sigmoid colon cases. Complicated diverticular disease contributes significantly, accounting for 60%-70% of all CVFs. Existing studies on laparoscopic CVF management lack clarity on its effectiveness in diverticular cases compared to open surgery. This study redefines paradigms by assessing the potentiality, adequacy, and utility of laparoscopy in treating CVFs due to complicated diverticular disease, marking a paradigm shift in surgical approaches. Methods Conducting a retrospective analysis at Ospedale Monaldi A.O.R.N dei Colli and University Federico II, Naples, Italy, patients undergoing surgery for CVF secondary to diverticular disease between 2010 and 2020 were examined. Comprehensive data, including demographics, clinical parameters, preoperative diagnoses, operative and postoperative details, and histopathological examination, were meticulously recorded. Patients were classified into open surgery (Group A) and laparoscopy (Group B). Statistical analysis used IBM SPSS Statistic 19.0. Results From January 2010 to December 2020, 76 patients underwent surgery for colovesical fistula secondary to diverticular disease. Laparoscopic surgery (Group B, n = 40) and open surgery (Group A, n = 36) showed no statistically significant differences in operative time, bladder suture, or associated procedures. Laparoscopy demonstrated advantages, including lower intraoperative blood loss, reduced postoperative primary ileus, and a significantly shorter length of stay. Postoperative morbidity differed significantly between groups. Mortality occurred in Group A but was unrelated to surgical complications. No reoperations were observed. Two-year follow-up revealed no fistula recurrence. Conclusion This pivotal study marks a paradigm shift by emphasizing laparoscopic resection and primary anastomosis as a safe and feasible option for managing CVF secondary to diverticular disease. Comparable conversion, morbidity, and mortality rates to the open approach underscore the transformative potential of these findings. The study's emphasis on patient selection and surgeon experience challenges existing paradigms, offering a progressive shift toward minimally invasive solutions.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Science, University of Magna Graecia, Catanzaro, Italy
| | | | - Umberto Bracale
- Department of Medicine, University of Salerno, Fisciano, Italy
| | - Vania Silvestri
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Emanuele Pontecorvi
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Stefano Reggio
- Department of General, Laparoscopic and Robotic Surgery, Monaldi Hospital, Naples, Italy
| | - Carlo Sagnelli
- Department of General, Laparoscopic and Robotic Surgery, Monaldi Hospital, Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela Amaddeo
- Department of Medical and Surgical Science, University of Magna Graecia, Catanzaro, Italy
| | - Cristina Bozzarello
- Department of Medical and Surgical Science, University of Magna Graecia, Catanzaro, Italy
| | - Giusto Pignata
- Department of General Surgery, Civil Hospital of Brescia, Brescia, Italy
| | - Diego Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, Monaldi Hospital, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease. Surg Endosc 2019; 34:598-609. [PMID: 31062152 DOI: 10.1007/s00464-019-06804-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Benefits of minimally invasive surgical approaches to diverticular disease are limited by conversion to open surgery. A comprehensive analysis that includes risk factors for conversion may improve patient outcomes. METHODS The US Premier Healthcare Database was used to identify patients undergoing primary elective sigmoidectomy for diverticular disease between 2013 and September 2015. Propensity-score matching was used to compare conversion rates for laparoscopic and robotic-assisted sigmoidectomy. Patient, clinical, hospital, and surgeon characteristics associated with conversion were analyzed using multivariable logistic regression, providing odds ratios for comparative risks. Clinical and economic impacts were assessed comparing surgical outcomes in minimally invasive converted, completed, and open cases. RESULTS The study population included 13,240 sigmoidectomy patients (8076 laparoscopic, 1301 robotic-assisted, 3863 open). Analysis of propensity-score-matched patients showed higher conversion rates in laparoscopic (13.6%) versus robotic-assisted (8.3%) surgeries (p < 0.001). Greater risk of conversion was associated with patients who were Black compared with Caucasian, were Medicaid-insured versus Commercially insured, had a Charlson Comorbidity Index ≥ 2 versus 0, were obese, had concomitant colon resection, had peritoneal abscess or fistula, or had lysis of adhesions. Significantly lower risk of conversion was associated with robotic-assisted sigmoidectomy (versus laparoscopic, OR 0.58), hand-assisted surgery, higher surgeon volume, and surgeons who were colorectal specialties. Converted cases had longer operating room time, length of stay, and more postoperative complications compared with minimally invasive completed and open cases. Readmission and blood transfusion rates were higher in converted compared with minimally invasive completed cases, and similar to open surgeries. Differences in inflation-adjusted total ($4971), direct ($2760), and overhead ($2212) costs were significantly higher for converted compared with minimally invasive completed cases. CONCLUSIONS Conversion from minimally invasive to open sigmoidectomy for diverticular disease results in additional morbidity and healthcare costs. Consideration of modifiable risk factors for conversion may attenuate adverse associated outcomes.
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Rizzuto A, Di Saverio S. Laparoscopic splenectomy for a simultaneous wandering spleen along with an ectopic accessory spleen. Case report and review of the literature. Int J Surg Case Rep 2018; 43:36-40. [PMID: 29482086 PMCID: PMC5907687 DOI: 10.1016/j.ijscr.2018.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Wandering spleen and accessory spleen are uncommon entity occurring during embryonic development. Wandering spleen results in an excessive mobility and migration of the spleen from its normal position in the left hypochondrium while accessory spleen is characterized by ectopic splenic masses or tissue disjointed from the main body of spleen. Due to the nonspecific and multiple symptoms the clinical diagnosis of both conditions is uncertain even with imaging techniques, such as CT and MRI. The coexistence of both diseases (wandering spleen ad accessory spleen) is uncommon. CASE REPORT A 17-year old European female with a history of minor beta thalassemia and recurrent attacks of abdominal pain. Pre- operative management consisted of routine laboratory tests, ultrasound, CT scan. An ectopic spleen along with an accessory spleen were diagnosed. After a multidisciplinary board a laparoscopic splenectomy was performed. Post-operative recovery was uneventful, and the patient was discharged on the 6th post-operative day with the indication to continue the therapy with low molecular weight heparin (LMWH) for 30 days CONCLUSIONS: This case represents a simultaneous condition of wandering splenomegaly along with an ectopic wandering spleen. The coexistence of these two rare conditions is peculiar such as the age of the patient, as literature reports such diseases to affect children or more commonly people in the range of 20-40 years of age. Laparoscopic treatment for this particular condition is also unusual.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Salomone Di Saverio
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
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Rizzuto A, Serra R, Mignogna C, Palaia I, Zittel FU, Sacco R. Single incision laparoscopic cholecystectomy in geriatric patients. Int J Surg 2016; 35:83-87. [PMID: 27663087 DOI: 10.1016/j.ijsu.2016.09.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/31/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopy is a surgical approach recommended for the treatment of gall bladder disease. It is recommended also in geriatric patients. Recently Single Incision Laparoscopic Cholecystectomy (SILC) has been proposed to minimize surgical trauma, recovery and hospitalization time. However, the results and advantages of SILC in the geriatric population have received minimal attention. This case series review is focused on the results of SILC in the geriatric population. METHODS The records of 355 patients who had undergone SILC were reviewed. This report identifies, in the entire cohort, 40 patients aged 65 years or older at the time of surgery who will be the object of this study (geriatric series). Clinical outcomes and results were evaluated. Moreover, post-operative pain of the geriatric cohort was compared to that of the entire series. RESULTS SILC was successfully completed for 347 out of 355 patients of the entire series, with no mortality reported. In total SILC was converted to standard laparoscopy in 10 patients (2.2%) but never to open procedure. No significant difference was found between the total cohort and the geriatric series in terms of median time of operation (61.20 min vs 68.38 min). Post-operative pain was significantly lower in geriatric patients. CONCLUSION SILC is an effective and safe procedure for the treatment of gallbladder disease of elderly, also in terms of post-operative pain and it represents an alternative to the standard laparoscopic approach on a routine basis.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - Chiara Mignogna
- Department of Health Science, University Magna Græcia of Catanzaro, Italy
| | - Ilaria Palaia
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | | | - Rosario Sacco
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
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