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Di Furia M, Della Penna A, Puccica I, Stifini D, Salvatorelli A, Sista F, Guadagni S, Clementi M. Combined approach with negative pressure wound therapy and biological mesh for treatment of enterocutaneous fistula after synthetic mesh repair of incisional hernia. A case report. Ann Ital Chir 2021; 10:S2239253X21035039. [PMID: 33843724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Enterocutaneous fistula is a rare but severe complication of prosthetic incisional hernia repair. Management requires re-exploration with intestinal repair/resection and mesh removal. Repair of the parietal defect in this contaminated field is challenging. MATERIAL OF STUDY A 58-years male patient presented to our department one year after synthetic mesh repair of large incisional hernia with mesh infection and enterocutaneous fistula. The diagnosis was confirmed by ultrasound guided drainage and CT scans with oral contrast. A multiple-step surgical approach has been adopted: first, the mesh was removed, intestinal resection performed and posterior fascial closure obtained by bilateral transversus abdominis release (TAR) and supra-fascial NPWT (negative pressure wound therapy) was positioned and maintained for one week; second, a definitive repair was obtained by a biological prothesis fixed to posterior fascia and covered by anterior fascia closure. Then, new NPWT was positioned and maintained for 6 days on the skin closure. At 18-months follow-up, the patient showed no clinical or radiological signs of recurrence or reinfection. DISCUSSION Surgical strategies to face enterocutaneous fistula after prosthesis ventral hernia repair are not standardized. After bowel fistula treatment and mesh removal, the challenge of abdominal wall closure stay unsolved because of the high rate of complication and failure of a new prosthetic repair. A case-by-case management plan, often with the use of a multi-step strategy, may be an option. CONCLUSION This is a single recovery multiple-step strategy combined approach using NPWT and biological prothesis to manage a case of mesh infection by an enterocutaneous fistula. This unique approach has revealed safe and effective for the treatment of parietal defect in infected field resulting from a mesh removing procedure. KEY WORDS Biological prosthesis, Bowel mesh erosion, Enterocutaneous fistula, Negative Pressure Wound Therapy, Open incisional hernia repair.
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Romano L, Giuliani A, Di Furia M, Meloni D, Cianca G, Mattei A, Fiasca F, Tonelli E, Carlei F, Schietroma M. Drain Amylase Levels in the Early Diagnosis of Gastric Leak after Laparoscopic Sleeve Gastrectomy. Med Princ Pract 2021; 30:487-492. [PMID: 34348292 PMCID: PMC8562055 DOI: 10.1159/000517949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric option. Gastric leak is the most dreaded septic complication after this procedure. This study investigated levels of drain amylase that could be useful for predicting gastric leak before its clinical presentation. SUBJECTS AND METHODS This prospective observational study was carried out in 167 patients who underwent sleeve gastrectomy for morbid obesity between February 2014 and March 2020. Measurement of drain amylase levels (DALs) was adapted as a routine procedure. The results of the receiver operative characteristic (ROC) curve analysis revealed an optimal drain amylase levels cutoff point of 814.18 IU/L. Consequently, the DALs were classified as DALs <814.18 or DALs ≥814.18 for all subsequent analyses. RESULTS Gastric leak occurred in 6 patients. Drain amylase levels of 167 patients were tested. The mean value for patients without leak was 71.13 ± 72.11 IU/L; for patients with leak, it was 4,687 ± 6,670 IU/L (p < 0.001). Using ROC curve analysis, the mean ± standard error of the area under the curve for DALs on postoperative day 1 was 0.9927 ± 0.0075, CI = 0.978-1.00, and a cutoff level at 814.18 IU/L for predicting gastric leak achieved 83.33% sensitivity and 100% specificity with positive predictive value of 100% and negative predictive value 99.38%. All patients with a leak, but one, had a drain amylase level >814.18 IU/L. CONCLUSION The determination of drain amylase levels after sleeve gastrectomy is a significant indicator of gastric leak with high sensitivity and specificity.
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
- *Lucia Romano,
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Marino Di Furia
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Danilo Meloni
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Giovanni Cianca
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabiana Fiasca
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Emilio Tonelli
- U.O.C. di Emergenza e d'Urgenza, S. Salvatore Hospital, L'Aquila, Italy
| | - Francesco Carlei
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Di Furia M, Romano L, Salvatorelli A, Brandolin D, Lomanto D, Cianca G, Schietroma M, Carlei F, Giuliani A. Indocyanine Green Fluorescent Angiography During Laparoscopic Sleeve Gastrectomy: Preliminary Results. Obes Surg 2020; 29:3786-3790. [PMID: 31290111 DOI: 10.1007/s11695-019-04085-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Indocyanine green (ICG) fluorescent angiography has been routinely applied for various laparoscopic procedures to evaluate the tissue blood supply. A promising branch for this technology is represented by bariatric surgery, especially to estimate the risk of gastric leak after laparoscopic sleeve gastrectomy (LSG), which seems mainly related to ischemia of the stomach. MATERIALS AND METHODS 43 consecutive patients from January 2018 to March 2019 underwent in our institution LSG with intravenous injection of 5 ml ICG after the realization of gastric tube to evaluate the blood supply of the gastric tube. RESULTS In all 43 cases, there have been no adverse events related to ICG. The vascular supply to stomach was estimated "satisfactory" along the stapled line in all cases. However, one patient showed signs and symptoms indicative of gastric leak in the fifth post-op day and diagnosis was confirmed by CT scan with Gastrografin. CONCLUSIONS From our preliminary data, the intraoperative view of the blood supply of the stomach does not seem to represent a prognostic factor for the risk of gastric leak, suggesting a complex multifactorial etiology (intragastric hypertension? Abnormal inflammatory response?) which needs further data to be established.
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Affiliation(s)
- Marino Di Furia
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy.
| | - Lucia Romano
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Andrea Salvatorelli
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Denise Brandolin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Davide Lomanto
- Department of Surgery, Division of Upper Gastrointestinal Surgery, National University Hospital, Singapore, Singapore
| | - Giovanni Cianca
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Mario Schietroma
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy
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Giuliani A, Romano L, Papale E, Puccica I, Di Furia M, Salvatorelli A, Cianca G, Schietroma M, Carlei F, Amicucci G. Post-surgical abdominal damage: management and treatment with vacuum therapy and biological mesh. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04912-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Di Furia M, Romano L, Salvatorelli A, Brandolin D, Lazzarin G, Schietroma M, Carlei F, Giuliani A. Giant Spigelian Hernia presenting as small bowel obstruction: Case report and review of literature. Int J Surg Case Rep 2019; 63:118-121. [PMID: 31585321 PMCID: PMC6796652 DOI: 10.1016/j.ijscr.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/26/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
Spigelian Hernia is a rare abdominal wall hernia. Urgent presentation with small bowel obstruction is uncommon. Laparoscopy could be an option in elective surgery but in emergent setting laparotomy is required. Mesh repair is mandatory to avoid recurrence.
Introduction Spigelian Hernia is an uncommon pathology of abdominal wall (0.12–2.4%), usually small sized and with vague symptoms. It rarely presents as Small Bowel Obstruction or reaches dimensions that becomes clinically remarkable. Presentation of case 84-year-old woman entered our Surgical Department for Small Bowel Obstruction due to a giant (8 × 7 cm) abdominal wall hernia, which was intraoperatively identified as Spigelian Hernia. We performed a minilaparotomy with reduction of viable small bowel and preperitoneal positioning of polypropilene mesh. Postoperative course was uneventfull. Discussion Due to its small dimensions and infrequence, the diagnosis could be challenging even if the patient undergoes a CT scan. The presentation with clear signs of small bowel obstruction associated with a large abdominal hernia is rare and suggests a urgent surgical approach with mesh repair to avoid recurrences. Conclusion Even if rarely symptomatic, the Spigelian Hernia is an entity to consider in the differential diagnosis of small bowel obstruction in a virgin abdomen. Preoperative diagnosis, when available, is mandatory to guide a correct surgical approach.
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Affiliation(s)
- Marino Di Furia
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy.
| | - Lucia Romano
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Andrea Salvatorelli
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Denise Brandolin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Gianni Lazzarin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Mario Schietroma
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
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Giuliani A, Romano L, Papale E, Puccica I, Di Furia M, Salvatorelli A, Cianca G, Schietroma M, Amicucci G. Complications of postlaparoscopic sleeve gastric resection: review of surgical technique. MINERVA CHIR 2019; 74:213-217. [PMID: 30761827 DOI: 10.23736/s0026-4733.19.07883-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a very frequent procedure in bariatric surgery. Despite its simplicity, it can have serious complications. Among these, gastric leak is one of the most feared complications. Numerous intraoperative maneuvers have been suggested in an attempt to decrease the incidence of leak. In our center, we decided to study one of the intraoperative measures proposed, which consists in positioning the suture machine to 1.5 cm from His corner. METHODS This retrospective study reported 101 cases of LSG performed in our center from 2012 to 2017. The patients were divided into two groups, with comparable anthropometric parameters and comparable inclusion criteria. In the two groups the operative technique used was the same, except for a maneuver: in the second group, attention was paid to keep a distance from the angle of at least 1.5 cm. RESULTS On a total of 101 procedures performed, the overall complication rate was 4,95%. In group 1 the rate of gastric staple line leak was 6.78%. In group 2 the rate was 2.38%. CONCLUSIONS The analyzed surgical technique seems to decrease the risk of leak without significantly impacting weight loss, and we have noticed in our clinical experience a decrease in the incidence of fistula from the time this measure was adopted. Also the statistical analysis encourage the continuation of experimentation.
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Affiliation(s)
| | - Lucia Romano
- Department of Surgery, University of L'Aquila, L'Aquila, Italy -
| | - Eleonora Papale
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Ilaria Puccica
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Marino Di Furia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | | | - Giovanni Cianca
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Sista F, Abruzzese V, Carandina S, Salvatorelli A, Furia MD, Cipolloni G, Vicentini V, Guadagni S, Clementi M. Which is the correlation between carcinoid tumor and Laparoscopic Sleeve Gastrectomy? A case series and literature review. Ann Med Surg (Lond) 2018; 36:252-255. [PMID: 30568792 PMCID: PMC6287372 DOI: 10.1016/j.amsu.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction Gastric Carcinoid Tumors (GCT) are very rare in general population, but some studies evidenced a higher incidence among bariatric surgery patients. Laparoscopic Sleeve Gastrectomy (LSG) is a widely accepted procedure for the surgical treatment of morbid obesity. LSG acts both in reducing food intake and interfering with hormonal balance in the gut-brain axis. In these patients, incidental GCT diagnosis can occur both during pre-bariatric surgery investigation and during post-operative follow-up. Methods We retrospectively analyzed the database of obesity patients submitted to LSG in two different centers to find out incidence of GCT in patients treated by surgery from May 2013 to March 2018. Results From the 560 obese consecutive patients underwent LSG, we recorded two cases of patients with GCT (0.36%): the case 1 was a patient who had a pre-operative diagnosis of GTC receiving a curative LSG which totally included the carcinoid in the resected portion; the case 2 was a patient that received a curative endoscopic resection 42 months after LSG. Discussion the predisposing factors that can correlate GCT with obesity and LSG and in particular the hormonal changes have been discussed. We illustrated our experience about the management of these tumors in obese patients. Conclusion there are neither certain data which evidence a correlation between obesity and GCT, nor data to support the hypothesis of a higher incidence of GCT after bariatric surgery. Based on our experience in obese patients the finding of GCT in the pre-operatory phase is not an absolute contraindication for bariatric surgery. Recent observations showed a high incidence of Gastric Carcinoid Tumor (GCT) in candidate patients for bariatric surgery. From a multicenter experience with Laparoscopic Sleeve Gastrectomy. We retrospectively recorded two GCT cases in obese patients (the first found out during pre-operative investigations and the second one detected 52 months after surgery). The possible correlations between obesity, LSG and GTC have been discussed.
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Affiliation(s)
- Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Valentina Abruzzese
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center(CCO), Clinique Saint Michel, Toulon, France
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Gianluca Cipolloni
- Pathology Unit, Biomedical Department, San Salvatore Hospital, Via L Natali 1, 67100, Coppito (AQ), Italy
| | - Vincenzo Vicentini
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S, Tommasi, 67100, Coppito (AQ), Italy
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Di Furia M, Salvatorelli A, Della Penna A, Vicentini V, Sista F, Chiominto A, Guadagni S, Clementi M. Advantage of laparoscopic resection for pelvic Schwannoma: Case report and review of the literature. Int J Surg Case Rep 2018; 45:38-41. [PMID: 29571063 PMCID: PMC6000728 DOI: 10.1016/j.ijscr.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/11/2018] [Indexed: 01/19/2023] Open
Abstract
Retroperitoneal schwannomas are usually asymptomatic, rare neoplasms. Diagnosis can only be achieved with surgical removal of mass. Laparoscopy is the most useful therapeutic approach.
Introduction Single pelvic schwannomas are rare tumor arising from the retrorectal, lateral or obturatory space. Laparoscopic approach to schwannoma located in lateral pelvic space has been previously described only in one case report. We present a case of a successful laparoscopic resection of pelvic schwannoma emphasizing the advantages of such a minimal invasive approach. Presentation of case A 54-years-old, obese, male patient was admitted to our hospital referring dysuria and strangury. Abdominal CT scan showed a lateral pelvic well-circumscribed mass with smooth regular margins. A CT-guided fine needle biopsy resulted non-diagnostic. An elective laparoscopic resection was performed. The patient had a short, uneventful post-operative course. Pathological examination revealed a benign schwannoma. Discussion Using PubMed database, we reviewed the English language international literature using the MeSH terms “laparoscopic,” “minimally invasive” and “schwannoma”. We identified quite 20 previous cases of pelvic schwannomas removed by laparoscopy or robotic surgery. We found out that a preoperative diagnosis of these rare neoplasms is difficult to be obtained; in most cases, laparoscopic approach was successfully performed. Conclusion Despite it could not be proven yet, due to the rarity of this tumor, we agree with literature that laparoscopic removal of pelvic benign tumor may offer several advantages. The direct high-definition vision deeply into this narrow anatomical space, especially in obese patients, provides a detailed view that makes easier to isolate and spear the anatomical structures surrounding the tumor. Furthermore, the pneumoperitoneum may create the right plane of dissection, minimizing the risk of tumor rupture and bleeding.
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Affiliation(s)
- Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy.
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Andrea Della Penna
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Vincenzo Vicentini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Alessandro Chiominto
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Stefano Guadagni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Marco Clementi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
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Schietroma M, Colozzi S, Pessia B, Carlei F, Di Furia M, Amicucci G. Laparoscopic Nissen fundoplication: The effects of high-concentration supplemental perioperative oxygen on the inflammatory and immune response: A randomised controlled trial. J Minim Access Surg 2018; 14:221-229. [PMID: 29582795 PMCID: PMC6001299 DOI: 10.4103/jmas.jmas_120_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background A number of studies have been reported on the effects of high-concentration oxygen (HCO) on cytokine synthesis, with controversial results. We assessed the effect of administration of perioperative HCO on systemic inflammatory and immune response in patients undergoing laparoscopic Nissen fundoplication (LNF). Materials and Methods Patients (n = 117) were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 58) or 80% (n = 59). Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. White blood cells, peripheral lymphocytes subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-1 and IL-6 and C-reactive protein (CRP) were investigated. Results A significantly higher concentration of neutrophil elastase, IL-1, IL-6 and CRP was detected post-operatively in the 30% FiO2group patients in comparison with the 80% FiO2group (P < 0.05). A statistically significant change in HLA-DR expression was recorded post-operatively at 24 h, as a reduction of this antigen expressed on monocyte surface in patients from 30% FiO2group; no changes were noted in 80% FiO2group (P < 0.05). Conclusions This study demonstrated that perioperative HCO (80%), during LNF, can lead to a reduction in post-operative inflammatory response, and possibly, avoid post-operative immunosuppression.
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Affiliation(s)
| | - Sara Colozzi
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | | | - Marino Di Furia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Di Furia M, Della Penna A, Salvatorelli A, Clementi M, Guadagni S. A single thyroid nodule revealing early metastases from clear cell renal carcinoma: case report and review of literature. Int J Surg Case Rep 2017; 34:96-99. [PMID: 28376423 PMCID: PMC5379901 DOI: 10.1016/j.ijscr.2017.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION We report the case of an incidental solitary renal cancer cell (RCC) thyroid metastatic nodule treated by thyroidectomy. PRESENTATION OF CASE A 53 year male presented with a solitary, asymptomatic thyroid nodule. He was treated with left nephrectomy 1 year before for a RCC. Radiological standard follow-up was negative for secondary lesions but ultrasound (US) 12 months after surgery revealed a 1.5cm solid nodule in the right lobe of the gland. Fine needle aspiration biopsy (FNAB) was inadequate and the patient was submitted to total thyroidectomy. Histology showed the presence of solitary metastasis from RCC. At 2 years follow-up, no evidence of recurrence has been found. DISCUSSION Solitary RCC metastasis to the thyroid usually occurs late from nephrectomy and have no specific US pattern. When FNAB provides an uncertain cytological results, the patient received thyroidectomy for primary thyroid tumors and diagnosis of metastases from RCC was incidentally made. CONCLUSION Thyroid nodules in a patient with history of malignancy can pose a diagnostic challenge. The presence of a solitary thyroid nodule in a patient with history of RCC should be carefully suspected for metastasis. We suggest to extend at neck the thorax and abdomen CT scan routinely recommended during the follow-up in high-risk cases. Thyroidectomy may result in prolonged survival in selected cases of isolated thyroid metastasis from RCC.
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Affiliation(s)
- Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy.
| | - Andrea Della Penna
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S. Tommasi, 67100 L'Aquila, AQ, Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100 L'Aquila, AQ, Italy
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