1
|
Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, Rossi G, Tarasconi A, Tian BWCA, Bonati E, Mentz R, Mazzini FN, Campana JP, Gasser E, Kafka-Ritsch R, Felsenreich DM, Dawoud C, Riss S, Gomes CA, Gomes FC, Gonzaga RAT, Canton CAB, Pereira BM, Fraga GP, Zem LG, Cordeiro-Fonseca V, de Mesquita Tauil R, Atanasov B, Belev N, Kovachev N, Meléndez LJJ, Dimova A, Dimov S, Zelić Z, Augustin G, Bogdanić B, Morić T, Chouillard E, Bajul M, De Simone B, Panis Y, Esposito F, Notarnicola M, Lauka L, Fabbri A, Hentati H, Fnaiech I, Aurélien V, Bougard M, Roulet M, Demetrashvili Z, Pipia I, Merabishvili G, Bouliaris K, Koukoulis G, Doudakmanis C, Xenaki S, Chrysos E, Kokkinakis S, Vassiliu P, Michalopoulos N, Margaris I, Kechagias A, Avgerinos K, Katunin J, Lostoridis E, Nagorni EA, Pujante A, Mulita F, Maroulis I, Vailas M, Marinis A, Siannis I, Bourbouteli E, Manatakis DK, Tasis N, Acheimastos V, Maria S, Stylianos K, Kuzeridis H, Korkolis D, Fradelos E, Kavalieratos G, Petropoulou T, Polydorou A, Papacostantinou I, Triantafyllou T, Kimpizi D, Theodorou D, Toutouzas K, Chamzin A, Frountzas M, Schizas D, Karavokyros I, Syllaios A, Charalabopoulos A, Boura M, Baili E, Ioannidis O, Loutzidou L, Anestiadou E, Tsouknidas I, Petrakis G, Polenta E, Bains L, Gupta R, Singh SK, Khanduri A, Bala M, Kedar A, Pisano M, Podda M, Pisanu A, Martines G, Trigiante G, Lantone G, Agrusa A, Di Buono G, Buscemi S, Veroux M, Gioco R, Veroux G, Oragano L, Zonta S, Lovisetto F, Feo CV, Pesce A, Fabbri N, Lantone G, Marino F, Perrone F, Vincenti L, Papagni V, Picciariello A, Rossi S, Picardi B, Del Monte SR, Visconti D, Osella G, Petruzzelli L, Pignata G, Andreuccetti J, D'Alessio R, Buonfantino M, Guaitoli E, Spinelli S, Sampietro GM, Corbellini C, Lorusso L, Frontali A, Pezzoli I, Bonomi A, Chierici A, Cotsoglou C, Manca G, Delvecchio A, Musa N, Casati M, Letizia L, Abate E, Ercolani G, D'Acapito F, Solaini L, Guercioni G, Cicconi S, Sasia D, Borghi F, Giraudo G, Sena G, Castaldo P, Cardamone E, Portale G, Zuin M, Spolverato Y, Esposito M, Isernia RM, Di Salvo M, Manunza R, Esposito G, Agus M, Asti ELG, Bernardi DT, Tonucci TP, Luppi D, Casadei M, Bonilauri S, Pezzolla A, Panebianco A, Laforgia R, De Luca M, Zese M, Parini D, Jovine E, De Sario G, Lombardi R, Aprea G, Palomba G, Capuano M, Argenio G, Orio G, Armellino MF, Troian M, Guerra M, Nagliati C, Biloslavo A, Germani P, Aizza G, Monsellato I, Chahrour AC, Anania G, Bombardini C, Bagolini F, Sganga G, Fransvea P, Bianchi V, Boati P, Ferrara F, Palmieri F, Cianci P, Gattulli D, Restini E, Cillara N, Cannavera A, Nita GE, Sarnari J, Roscio F, Clerici F, Scandroglio I, Berti S, Cadeo A, Filippelli A, Conti L, Grassi C, Cattaneo GM, Pighin M, Papis D, Gambino G, Bertino V, Schifano D, Prando D, Fogato L, Cavallo F, Ansaloni L, Picheo R, Pontarolo N, Depalma N, Spampinato M, D'Ugo S, Lepre L, Capponi MG, Campa RD, Sarro G, Dinuzzi VP, Olmi S, Uccelli M, Ferrari D, Inama M, Moretto G, Fontana M, Favi F, Picariello E, Rampini A, Barberis A, Azzinnaro A, Oliva A, Totaro L, Benzoni I, Ranieri V, Capolupo GT, Carannante F, Caricato M, Ronconi M, Casiraghi S, Casole G, Pantalone D, Alemanno G, Scheiterle M, Ceresoli M, Cereda M, Fumagalli C, Zanzi F, Bolzon S, Guerra E, Lecchi F, Cellerino P, Ardito A, Scaramuzzo R, Balla A, Lepiane P, Tartaglia N, Ambrosi A, Pavone G, Palini GM, Veneroni S, Garulli G, Ricci C, Torre B, Russo IS, Rottoli M, Tanzanu M, Belvedere A, Milone M, Manigrasso M, De Palma GD, Piccoli M, Pattacini GC, Magnone S, Bertoli P, Pisano M, Massucco P, Palisi M, Luzzi AP, Fleres F, Clarizia G, Spolini A, Kobe Y, Toma T, Shimamura F, Parker R, Ranketi S, Mitei M, Svagzdys S, Pauzas H, Zilinskas J, Poskus T, Kryzauskas M, Jakubauskas M, Zakaria AD, Zakaria Z, Wong MPK, Jusoh AC, Zakaria MN, Cruz DR, Elizalde ABR, Reynaud AB, Hernandez EEL, Monroy JMVP, Hinojosa-Ugarte D, Quiodettis M, Du Bois ME, Latorraca J, Major P, Pędziwiatr M, Pisarska-Adamczyk M, Walędziak M, Kwiatkowski A, Czyżykowski Ł, da Costa SD, Pereira B, Ferreira ARO, Almeida F, Rocha R, Carneiro C, Perez DP, Carvas J, Rocha C, Ferreira C, Marques R, Fernandes U, Leao P, Goulart A, Pereira RG, Patrocínio SDD, de Mendonça NGG, Manso MIC, Morais HMC, Cardoso PS, Calu V, Miron A, Toma EA, Gachabayov M, Abdullaev A, Litvin A, Nechay T, Tyagunov A, Yuldashev A, Bradley A, Wilson M, Panyko A, Látečková Z, Lacko V, Lesko D, Soltes M, Radonak J, Turrado-Rodriguez V, Termes-Serra R, Morales-Sevillano X, Lapolla P, Mingoli A, Brachini G, Degiuli M, Sofia S, Reddavid R, de Manzoni Garberini A, Buffone A, Del Pozo EP, Aparicio-Sánchez D, Dos Barbeito S, Estaire-Gómez M, Vitón-Herrero R, de Los Ángeles Gil Olarte-Marquez M, Gil-Martínez J, Alconchel F, Nicolás-López T, Rahy-Martin AC, Pelloni M, Bañolas-Suarez R, Mendoza-Moreno F, Nisa FGM, Díez-Alonso M, Rodas MEV, Agundez MC, Andrés MIP, Moreira CCL, Perez AL, Ponce IA, González-Castillo AM, Membrilla-Fernández E, Salvans S, Serradilla-Martín M, Pardo PS, Rivera-Alonso D, Dziakova J, Huguet JM, Valle NP, Ruiz EC, Valcárcel CR, Moreno CR, Salazar YTM, García JJR, Micó SS, López JR, Farré SP, Gomez MS, Petit NM, Titos-García A, Aranda-Narváez JM, Romacho-López L, Sánchez-Guillén L, Aranaz-Ostariz V, Bosch-Ramírez M, Martínez-Pérez A, Martínez-López E, Sebastián-Tomás JC, Jimenez-Riera G, Jimenez-Vega J, Cuellar JAN, Campos-Serra A, Muñoz-Campaña A, Gràcia-Roman R, Alegre JM, Pinto FL, O'Sullivan SN, Antona FB, Jiménez BM, López-Sánchez J, Carmona ZG, Fernández RT, Sierra IB, de León LRG, Moreno VP, Iglesias E, Cumplido PL, Bravo AA, Simó IR, Domínguez CL, Caamaño AG, Lozano RC, Martínez MD, Torres ÁN, de Quiros JTMB, Pellino G, Cloquell MM, Moller EG, Jalal-Eldin S, Abdoun AK, Hamid HKS, Lohsiriwat V, Mongkhonsupphawan A, Baraket O, Ayed K, Abbassi I, Ali AB, Ammar H, Kchaou A, Tlili A, Zribi I, Colak E, Polat S, Koylu ZA, Guner A, Usta MA, Reis ME, Mantoglu B, Gonullu E, Akin E, Altintoprak F, Bayhan Z, Firat N, Isik A, Memis U, Bayrak M, Altıntaş Y, Kara Y, Bozkurt MA, Kocataş A, Das K, Seker A, Ozer N, Atici SD, Tuncer K, Kaya T, Ozkan Z, Ilhan O, Agackiran I, Uzunoglu MY, Demirbas E, Altinel Y, Meric S, Hacım NA, Uymaz DS, Omarov N, Balık E, Tebala GD, Khalil H, Rana M, Khan M, Florence C, Swaminathan C, Leo CA, Liasis L, Watfah J, Trostchansky I, Delgado E, Pontillo M, Latifi R, Coimbra R, Edwards S, Lopez A, Velmahos G, Dorken A, Gebran A, Palmer A, Oury J, Bardes JM, Seng SS, Coffua LS, Ratnasekera A, Egodage T, Echeverria-Rosario K, Armento I, Napolitano LM, Sangji NF, Hemmila M, Quick JA, Austin TR, Hyman TS, Curtiss W, McClure A, Cairl N, Biffl WL, Truong HP, Schaffer K, Reames S, Banchini F, Capelli P, Coccolini F, Sartelli M, Bravi F, Vallicelli C, Agnoletti V, Baiocchi GL, Catena F. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago. World J Emerg Surg 2024; 19:14. [PMID: 38627831 PMCID: PMC11020610 DOI: 10.1186/s13017-024-00543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.
Collapse
Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Mario Giuffrida
- General Surgery Unit, Maggiore Hospital, Parma, Italy.
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy.
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vitor F Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marco Livrini
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Antonio Tarasconi
- General Surgery Department, UO Chirurgia Generale, ASST Cremona, Cremona, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Elena Bonati
- General Surgery Unit, Maggiore Hospital, Parma, Italy
| | - Ricardo Mentz
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico N Mazzini
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan P Campana
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elisabeth Gasser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlos Augusto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Felipe Couto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Cassio Alfred Brattig Canton
- Medical Course, Department of Surgery - Emergency Surgery and Trauma Sector, Padre Albino University Center, Catanduva, Brazil
| | | | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Leticia Gonçalves Zem
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Boyko Atanasov
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikolay Belev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikola Kovachev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - L Juan José Meléndez
- Trauma and Acute Care Surgeon Hospital Rafael Angel Calderón Guardia, San José, Costa Rica
| | - Ana Dimova
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Stefan Dimov
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Zdravko Zelić
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branko Bogdanić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Trpimir Morić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Elie Chouillard
- Department of General and Bariatric Surgery, American Hospital in Paris, Paris, France
| | - Melinda Bajul
- Emergency and General Minimally Invasive Surgery, Poissy and St Germain Hospital, Poissy, France
| | - Belinda De Simone
- Department of Emergency and General Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve-Saint-Georges, France
| | - Yves Panis
- Colorectal Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Francesco Esposito
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | | | | | - Venara Aurélien
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Marie Bougard
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Maxime Roulet
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | | | - Irakli Pipia
- N.Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | | | | | | | - Sofia Xenaki
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Stamatios Kokkinakis
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | | | | | - Ioannis Margaris
- 4th Surgical Department "Attikon" University Hospital, Chaidari, Greece
| | | | | | - Jevgeni Katunin
- Department of Digestive Surgery, Athens Bioclinic Hospital, Athens, Greece
| | | | | | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Michail Vailas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Athanasios Marinis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Ioannis Siannis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Eirini Bourbouteli
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | | | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | | | | | - Dimitrios Korkolis
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Evangelos Fradelos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - George Kavalieratos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | | | | | | | - Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Despina Kimpizi
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | | | - Alexandros Chamzin
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Maximos Frountzas
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Boura
- National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratia Baili
- National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Ioannidis
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Lydia Loutzidou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Elissavet Anestiadou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Ioannis Tsouknidas
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Georgios Petrakis
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Eleni Polenta
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Sudhir K Singh
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Archana Khanduri
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Miklosh Bala
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Kedar
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marcello Pisano
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Mauro Podda
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Gennaro Martines
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuseppe Trigiante
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuliano Lantone
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Antonino Agrusa
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Massimiliano Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Rossella Gioco
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Gastone Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Luigi Oragano
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | - Sandro Zonta
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | | | - Carlo V Feo
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Antonio Pesce
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Giulio Lantone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabio Marino
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabrizio Perrone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Leonardo Vincenti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Vincenzo Papagni
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Arcangelo Picciariello
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | | | - Diego Visconti
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giulia Osella
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Luca Petruzzelli
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giusto Pignata
- Chirurgia Generale 2 ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | - Stefano Spinelli
- Chirurgia Generale PO Valle d'Itria ASL TA, Martina Franca, Italy
| | | | - Carlo Corbellini
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Leonardo Lorusso
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Alice Frontali
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Isabella Pezzoli
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandro Bonomi
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Chierici
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Giuseppe Manca
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Antonella Delvecchio
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Nicola Musa
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | | | - Laface Letizia
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Emmanuele Abate
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Giorgio Ercolani
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Fabrizio D'Acapito
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Leonardo Solaini
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Gianluca Guercioni
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Simone Cicconi
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Diego Sasia
- Santa Croce and Carle Hospital, Cuneo, Italy
| | | | | | - Giuseppe Sena
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Pasquale Castaldo
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Eugenia Cardamone
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | | | | | | | - Romina Manunza
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | - Marcello Agus
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | | | | | - Davide Luppi
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Massimiliano Casadei
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Angela Pezzolla
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | | | - Rita Laforgia
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | - Maurizio De Luca
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Monica Zese
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Dario Parini
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Elio Jovine
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giuseppina De Sario
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Raffaele Lombardi
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giovanni Aprea
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giuseppe Palomba
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Marianna Capuano
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giulio Argenio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gianluca Orio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Marina Troian
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Martina Guerra
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Carlo Nagliati
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Alan Biloslavo
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Paola Germani
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Giada Aizza
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Igor Monsellato
- SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Fransvea
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Bianchi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Boati
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Palmieri
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Pasquale Cianci
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Domenico Gattulli
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Nicola Cillara
- Chirurgia Generale PO Santissima Trinità - ASL Cagliari, Cagliari, Italy
| | | | - Gabriela Elisa Nita
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Jlenia Sarnari
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Roscio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Federico Clerici
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Ildo Scandroglio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Stefano Berti
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alessandro Cadeo
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alice Filippelli
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Luigi Conti
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Carmine Grassi
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | - Marina Pighin
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | - Davide Papis
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | | | | | | | - Daniela Prando
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luisella Fogato
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Fabio Cavallo
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luca Ansaloni
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Roberto Picheo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Nicholas Pontarolo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Norma Depalma
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Marcello Spampinato
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Stefano D'Ugo
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Luca Lepre
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Michela Giulii Capponi
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Rossella Domenica Campa
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Giuliano Sarro
- G.Fornaroli" Hospital, Magenta ASST Ovest Milanese, Milan, Italy
- Istituto Clinico San Gaudenzio - Novara, Novara, Italy
| | | | | | | | | | - Marco Inama
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Gianluigi Moretto
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Michele Fontana
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Francesco Favi
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Alessia Rampini
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Andrea Barberis
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Antonio Azzinnaro
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Alba Oliva
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | | | | | - Gabriella Teresa Capolupo
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Maurizio Ronconi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Silvia Casiraghi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Giovanni Casole
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Desire Pantalone
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Giovanni Alemanno
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Maximilian Scheiterle
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | | | | | | | - Federico Zanzi
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Stefano Bolzon
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Enrico Guerra
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Francesca Lecchi
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola Cellerino
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Ardito
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rosa Scaramuzzo
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | | | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Claudio Ricci
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Torre
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Iris Shari Russo
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Rottoli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marta Tanzanu
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Belvedere
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Milone
- University of Naples "Federico II", Naples, Italy
| | | | | | - Micaela Piccoli
- General Surgery,Emergencies and New Technologies, Baggiovara Civil Hospital Modena, Baggiovara, Italy
| | | | - Stefano Magnone
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bertoli
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Massucco
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | - Marco Palisi
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | | | - Francesco Fleres
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Guglielmo Clarizia
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Alessandro Spolini
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | | | | | | | | | | | | | - Saulius Svagzdys
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Henrikas Pauzas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justas Zilinskas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Matas Jakubauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Asri Che Jusoh
- Department of General Surgery, Hospital Sultan Ismail Petra, Kuala Krai, Kelantan, Malaysia
| | | | - Daniel Rios Cruz
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Aurea Barbara Rodriguez Elizalde
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Alejandro Bañon Reynaud
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | | | | | | | | | | | | | - Piotr Major
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Łukasz Czyżykowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | | | - Bela Pereira
- Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal
| | | | - Filipe Almeida
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ricardo Rocha
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Carla Carneiro
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Diego Pita Perez
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - João Carvas
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - Catarina Rocha
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | | | | | | | - Pedro Leao
- General Surgery Grupo Trofa Saúde, Porto, Portugal
| | | | - Rita Gonçalves Pereira
- General Surgery Department, Centro Hospitalar Barreiro Montijo, E.P.E., Barreiro, Portugal
| | | | | | | | | | | | - Valentin Calu
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adrian Miron
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Elena Adelina Toma
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Abakar Abdullaev
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Taras Nechay
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Alexander Tyagunov
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Anvar Yuldashev
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | | | | | - Arpád Panyko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Zuzana Látečková
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Vladimír Lacko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Dusan Lesko
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Marek Soltes
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Jozef Radonak
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Victor Turrado-Rodriguez
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Roser Termes-Serra
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Xavier Morales-Sevillano
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Pierfrancesco Lapolla
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Silvia Sofia
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | | | | | | | | | | | - Mercedes Estaire-Gómez
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rebeca Vitón-Herrero
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - José Gil-Martínez
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Felipe Alconchel
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Tatiana Nicolás-López
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Aida Cristina Rahy-Martin
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - María Pelloni
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Raquel Bañolas-Suarez
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Manuel Díez-Alonso
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Silvia Salvans
- Emergency Surgery Unit, Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Pablo Sancho Pardo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - Jana Dziakova
- Hospital Clínico San Carlos in Madrid, Madrid, Spain
| | | | | | | | | | | | | | - Juan Jesús Rubio García
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Sevila Micó
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joaquín Ruiz López
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Alberto Titos-García
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Jose Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Laura Romacho-López
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Luis Sánchez-Guillén
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Veronica Aranaz-Ostariz
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marina Bosch-Ramírez
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | - Elías Martínez-López
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | | | - Granada Jimenez-Riera
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Javier Jimenez-Vega
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Jose Aurelio Navas Cuellar
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | | | - Anna Muñoz-Campaña
- Emergency Surgery Unit at Hospital Universitari Parc Tauli, Sabadell, Spain
| | | | - Javier Martínez Alegre
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Francisca Lima Pinto
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Sara Nuñez O'Sullivan
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | | | | | - Jaime López-Sánchez
- General Surgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | | | | | | | - Eva Iglesias
- Hospital Universtario Puerta de Hierro, Madrid, Spain
| | | | | | - Ignacio Rey Simó
- HPB and Transplantation Unit, Head of Emergency Surgery Unit, Seville, Spain
| | | | | | - Rafael Calleja Lozano
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Manuel Durán Martínez
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Álvaro Naranjo Torres
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | | | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ahmed K Abdoun
- Department of Sugery, Almoalem Medical City, Khartoum, Sudan
| | | | - Varut Lohsiriwat
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Aitsariya Mongkhonsupphawan
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Oussama Baraket
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Karim Ayed
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Imed Abbassi
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | | | | | | | - Elif Colak
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | - Suleyman Polat
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | | | - Ali Guner
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Mehmet Arif Usta
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Murat Emre Reis
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Baris Mantoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emrah Akin
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Necattin Firat
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Arda Isik
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ufuk Memis
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | | | | | - Yasin Kara
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Seker
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nazmi Ozer
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Semra Demirli Atici
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Korhan Tuncer
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Kaya
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Zeynep Ozkan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Onur Ilhan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Ibrahim Agackiran
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | | | - Eren Demirbas
- Department of General Surgery, Bursa Kestel State Hospital, Kestel, Turkey
| | - Yuksel Altinel
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Derya Salim Uymaz
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Giovanni D Tebala
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hany Khalil
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mridul Rana
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mansoor Khan
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | - Cosimo Alex Leo
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Lampros Liasis
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Josef Watfah
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | | | - Edward Delgado
- Hospital de ClínicasClínica Quirúrgica ¨F¨, Montevideo, Uruguay
| | | | - Rifat Latifi
- Department of Surgery, School of Medicine, Westchester Medical Center, New York Medical College, Valhalla, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Sara Edwards
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ana Lopez
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - George Velmahos
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ander Dorken
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony Gebran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amanda Palmer
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - Jeffrey Oury
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - James M Bardes
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | | | | | | | | | | | | | | | | | | | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, USA
| | - Tyler R Austin
- Department of Surgery, University of Missouri, Columbia, USA
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | | | - Vanni Agnoletti
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| |
Collapse
|
2
|
Picciariello A, Dezi A, Vincenti L, Spampinato MG, Zang W, Riahi P, Scott J, Sharma R, Fan X, Altomare DF. Colorectal Cancer Diagnosis through Breath Test Using a Portable Breath Analyzer-Preliminary Data. Sensors (Basel) 2024; 24:2343. [PMID: 38610554 PMCID: PMC11014225 DOI: 10.3390/s24072343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
Screening methods available for colorectal cancer (CRC) to date are burdened by poor reliability and low patient adherence and compliance. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a non-invasive potential diagnostic tool for distinguishing CRC patients from healthy controls (HC). The aim of this study was to evaluate the reliability of an innovative portable device containing a micro-gas chromatograph in enabling rapid, on-site CRC diagnosis through analysis of patients' exhaled breath. In this prospective trial, breath samples were collected in a tertiary referral center of colorectal surgery, and analysis of the chromatograms was performed by the Biomedical Engineering Department. The breath of patients with CRC and HC was collected into Tedlar bags through a Nafion filter and mouthpiece with a one-way valve. The breath samples were analyzed by an automated portable gas chromatography device. Relevant volatile biomarkers and discriminant chromatographic peaks were identified through machine learning, linear discriminant analysis and principal component analysis. A total of 68 subjects, 36 patients affected by histologically proven CRC with no evidence of metastases and 32 HC with negative colonoscopies, were enrolled. After testing a training set (18 CRC and 18 HC) and a testing set (18 CRC and 14 HC), an overall specificity of 87.5%, sensitivity of 94.4% and accuracy of 91.2% in identifying CRC patients was found based on three VOCs. Breath biopsy may represent a promising non-invasive method of discriminating CRC patients from HC.
Collapse
Affiliation(s)
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Ionian Area and Interdepartmental Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, 70124 Bari, Italy
| | - Leonardo Vincenti
- Surgical Unit, IRCCS de Bellis, Castellana Grotte, 70013 Bari, Italy;
| | | | - Wenzhe Zang
- Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA; (W.Z.); (J.S.); (R.S.); (X.F.)
| | - Pamela Riahi
- Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA; (W.Z.); (J.S.); (R.S.); (X.F.)
| | - Jared Scott
- Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA; (W.Z.); (J.S.); (R.S.); (X.F.)
| | - Ruchi Sharma
- Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA; (W.Z.); (J.S.); (R.S.); (X.F.)
| | - Xudong Fan
- Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA; (W.Z.); (J.S.); (R.S.); (X.F.)
| | - Donato F. Altomare
- Department of Precision and Regenerative Medicine and Ionian Area and Interdepartmental Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, 70124 Bari, Italy
| |
Collapse
|
3
|
Medkova Y, Tulina I, Novikov I, Nikonov A, Ischenko A, Aleksandrov L, Altomare DF, Dezi A, Picciariello A, Tsarkov P. Thrombosed external hemorrhoids during pregnancy: surgery versus conservative treatment. Updates Surg 2024; 76:539-545. [PMID: 38151682 DOI: 10.1007/s13304-023-01741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/11/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
The management of thrombosed external hemorrhoids (TEH) during pregnancy is still under debate because of the fear of potential adverse effects on the fetus. This study aims to compare efficacy and safety of conservative versus surgical treatment of acute TEH in pregnant women. Furthermore, the outcome of two different surgical approaches was evaluated. This is a prospective observational study including a sub-analysis on two randomized groups of pregnant women affected by TEH. The primary outcome measured was the impact of conservative and surgical treatment defined in terms of VAS, clinical patient grading assessment scale (CPGAS) and the SF-12 questionnaire. In a randomized sub-analysis of the surgical treatment, the outcome of local excision (LE) versus thrombectomy (TE) was compared. Fifty-three patients entered the study. Twenty-six patients had conservative treatment and 22 underwent surgery. Within the surgical group, 8 were randomized for TE and 14 for LE. VAS, SF-12 and CPGAS improved in both groups after 3 and 10 days from the treatment. However, physical (PCS) and mental health (MCS) domains of the SF-12 and CPGAS showed a significant difference in favor of surgery on the 10th day (PCS: p < 0.002 and MCS: p = 0.03; CPGAS: p = 0.002). The surgical group showed an earlier significant reduction of pain on the 3rd day (p = 0.0004). In the surgical group, randomization was halted due to ethical concerns arising from a notable difference in the primary end point between subgroups during interim analysis. Specifically, the re-thrombosis rate was 38% (3/8) after TE and 7% (1/14) after LE. No complications occurred for either mothers or fetuses. Both surgical and conservative treatments are safe and effective. However, surgery allows a faster relief of anal pain. Thrombectomy is associated with higher risk of re-thrombosis when compared to local excision (clinicaltrials.gov ID number NCT04588467).
Collapse
Affiliation(s)
- Yuliia Medkova
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Inna Tulina
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ivan Novikov
- Department of Hearth Rhythm Disorders, Federal State Budget Organization "National Medical Research Center of Cardiology" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Andrey Nikonov
- Snegirev Clinic of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anatoliy Ischenko
- Snegirev Clinic of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Leonid Aleksandrov
- Snegirev Clinic of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Donato F Altomare
- Department of Precision and Regenerative Medicine and Ionian Area and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University "Aldo Moro" of Bari, Piazza G. Cesare, Bari, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Ionian Area and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University "Aldo Moro" of Bari, Piazza G. Cesare, Bari, Italy
| | | | - Petr Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
4
|
Gallo G, Picciariello A, Tufano A, Camporese G. Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review. Updates Surg 2024; 76:423-434. [PMID: 38356039 PMCID: PMC10995001 DOI: 10.1007/s13304-024-01776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Chronic venous disease (CVD) and hemorrhoidal disease (HD) are among the most common vascular diseases in the world, with CVD affecting 22-41% of the population in Europe and HD having a point prevalence of 11-39%. The burden is substantial in terms of the effect of symptoms on patients' health-related quality of life (HRQoL) and direct/indirect medical costs. Treatment begins with lifestyle changes, compression in CVD and topical therapies in HD, and escalates as needed through oral therapies first and eventually to surgery for severe disease. CVD and HD share etiological features and pathological changes affecting the structure and function of the tissue extracellular matrix. Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate, has been demonstrated to positively impact the underlying causes of CVD and HD, regenerating the glycocalyx and restoring endothelial function, in addition to having antithrombotic, profibrinolytic, anti-inflammatory, antiedema and wound-healing effects. In clinical trials, oral mesoglycan reduced the severity of CVD signs and symptoms, improved HRQoL, and accelerated ulcer healing. In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding. In patients undergoing excisional hemorrhoidectomy, adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone. The clinical effects of mesoglycan in patients with CVD or HD are consistent with the agent's known mechanisms of action.
Collapse
Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | | | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Camporese
- Department of Internal Medicine, Padua University Hospital, Padua, Italy
| |
Collapse
|
5
|
Pata F, Tutino R, Picciariello A, Cantarella F. Editorial: Colorectal surgery and proctology: past, present, and future. Front Surg 2024; 11:1373867. [PMID: 38371881 PMCID: PMC10870640 DOI: 10.3389/fsurg.2024.1373867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Department of Surgery, AO Annunziata, Cosenza, Italy
| | - Roberta Tutino
- Department of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | | | - Francesco Cantarella
- CPEP (Centre for Proctology and Perineology), Ospedali Privati Forlì, Forlì, Italy
| |
Collapse
|
6
|
Gallo G, Picciariello A, Armellin C, Lori E, Tomasicchio G, Di Tanna GL, Santoro GA, Alharbi M, Sorrenti S, Grossi U. Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis. Tech Coloproctol 2024; 28:28. [PMID: 38261136 PMCID: PMC10806988 DOI: 10.1007/s10151-023-02908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the safety and efficacy of sclerotherapy methods for hemorrhoidal disease (HD) over the past 40 years. METHODS The review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive literature search was conducted, including studies reporting the use of sclerotherapy in patients with HD. Study eligibility criteria were defined, and data were extracted independently by the authors. Random-effects meta-analyses were performed to assess outcomes of interest. RESULTS Out of 1965 records identified, 44 studies met the inclusion criteria, involving 9729 patients. The majority of studies were conducted in Japan, followed by the UK, Italy, and Portugal. The median age of participants was 52 years, and the majority were male. The Goligher grade distribution indicated varying degrees of HD severity. Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent. The procedure was generally performed without pre-injection analgesia. The meta-analysis of 14 randomized controlled trials (RCTs) revealed that sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92). CONCLUSIONS This systematic review highlights the safety and efficacy of sclerotherapy for HD, which yields similar success rates and fewer complications compared to other conservative or surgical approaches. Further research is warranted to optimize sclerotherapy techniques and evaluate long-term outcomes. REGISTRATION PROSPERO 2023 CRD42023396910.
Collapse
Affiliation(s)
- G Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | - A Picciariello
- Department of Experimental Medicine, University of Salento, Lecce, Italy
| | - C Armellin
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - E Lori
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - G Tomasicchio
- Department of Experimental Medicine, University of Salento, Lecce, Italy
| | - G L Di Tanna
- Department of Business Economics, Health and Social Care, SUPSI - University of Applied Sciences and Arts of Southern Switzerland, Viganello-Lugano, Switzerland
| | - G A Santoro
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - M Alharbi
- Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - S Sorrenti
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - U Grossi
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy.
| |
Collapse
|
7
|
Avellaneda N, Al Masri M, Baimakhanov A, Balasubramaniam D, Bhangu A, Bouchagier K, Bozbiyik O, Carpelan A, Chwat C, Cunha M, Dawson BE, Mallen MVD, Ellebæk MB, Gonzalez TE, Elshami M, Fakhradiyev I, Ozkan OF, Fleres F, Futaba K, Gallo G, Ghosh D, Glasbey JC, Harrison E, Hooper RL, Jain R, Kamarajah S, Veetil SK, Kamer E, Keatley J, Knowles CH, Kulimbet M, Lal P, Li E, Polamreddy BM, Minaya-Bravo A, Mittal R, Morton DG, Nadal LRM, Negoi I, Nepogodiev D, Omar O, Pata F, Pinkney T, Potter MA, Rottoli M, Santos G, Smith I, Spinelli A, Venn M, Hooper R, Morton D, Bywater E, Evans J, Magill L, McKay S, Bordom DO, Simões J, Venn ML, Adeyeye A, Avellaneda N, Buchs N, Cato L, Finch D, Umar GI, Bravo AM, Junior HM, Neary P, Poskus T, Roslani A, Samadov E, Sbaih M, Shalaby M, Singh B, Sinha A, Vardanyan A, Chaudhry S, Frasson M, Millward J, Sánchez-Guillén L, Stijns J, Zimmerman DDE, Beard D, Campbell M, Moug S, Aytac E, Blackwell S, Buchwald P, Chowdhury SM, Dardanov D, Dulskas A, Elhadi M, El-Hussuna A, Garoufalia Z, Aslam MI, Kelly M, Knowles C, Mendes B, Ng S, Pellino G, Sebastian S, Sivrikoz E, Tejedor P, Vaizey C, Bianchi R, Christensen P, Lee SH, Lohsiriwat V, Mantoo SK, Mazlan L, Um JW, Wang JY, Watanabe J, Yao H, Bengueddach A, Tidjane A, Tabeti B, Behilil C, Boudjenan-Serradj N, Bensafir S, Meharzi SEI, Aissat A, Ghouali AK, Larabi K, Riffi O, Kacimi SEO, Mesli SN, Rezoug W, Mitidieri A, José A, Pablo C, Rodriguez CA, Panettiere MF, Barbalace N, Juan T, Lucena J, Houdin A, Fernandez E, Lococo J, Pedro L, Loban M, Vecchio P, Grinblat A, Carrie A, Veracierto F, Santillan M, Napolitano M, Rosa SL, Gonzalez CM, Ferro E, Muñoz JP, Ventorutti T, Cabrera C, Carrizo C, Mospane C, Leiro F, Espino J, Trama M, Potolicchio A, Dindri F, Buey L, Lucas N, Catalano P, Astilleta R, Quiroga Y, Valli D, Alexandre F, Martres G, Rosato G, Lemme G, Romero V, Doniquian AM, Pachajoa DAP, Llahi F, Fiorenza JM, Parodi M, Ocaña N, Gallardo A, Valenzuela A, Perriello J, Nador R, Fermani C, Garay L, Blanco P, Villalobos S, Posner F, Vieyra N, Fiorito P, Ciabattari P, de Kort C, Daryanani D, Smit J, Gosselink MP, Janssen N, Feiss A, Lee CHA, Taylor D, Edington J, Chen N, Ong WM, Aigner F, Moitzi G, Gemes G, Braumille M, Mitteregger M, Gerald S, Uranitsch S, Belarmino A, Waha J, Kahn J, Treiber M, Schemmer P, Mikalauskas S, Ibrahimli A, Orujova E, Namazov I, Alikhanli J, Asgarov M, Kutkut A, Almahmeed E, Aljawder H, Juma I, Johnston K, Saeed MF, Khairi S, Matovic E, Omerasevic M, Delibegovic S, Hodzic S, Rudell AG, Fuzari J, Farah JF, Dos Santos MBA, Lupinacci RA, Pereira TS, da Silveira Sete A, Filho AL, de Souza Pires BL, de Queiroz FL, Amaral HAT, Dos Santos MAM, de Miranda Silvestre SC, Hanan B, Reis C, Cassia G, da Luz M, Delgado M, Campanati R, Silva R, Bomfa-Barbosa A, Alves BC, Costa BXM, Cortes BGW, Lemos FHT, Arreguy-Borges K, Silva TB, Assis A, Freitas AH, Rezende D, Silva H, Alvarenga I, Cascais R, Silva T, Pinto H, Silva I, Leite L, Massahud M, Meyer M, Tibúrcio R, Martinez CAR, Espinha DR, Marson FAL, de Oliveira Góes IA, de Souza Artioli LM, Boschiero MN, Takahashi CY, de Oliveira FG, Junior HFL, de Oliveira JCC, Dos Santos JM, Gerber MT, Erdmann TR, Barbosa A, Fernandes A, Júnior AN, Júnior HM, Moreira J, Ribeiro M, Moreira P, Carvalho A, Santos B, Fidelis F, Cruz I, Codes L, Aibe R, Boudoux S, Favacho BC, Pinto F, Gava G, Pivati IR, Vilain LF, Kim N, Nunes RL, Dimitrov D, Peneva K, Karamanliev M, Dimitrova S, Ivanov T, Atanasov B, Dzharov G, Shtereva M, Slavchev M, Belev N, Krastev P, Arabadzhiev A, Tonova D, Tzoneva D, Sokolov M, Gribnev P, Maslyankov S, Pavlov V, Bakmaz B, Dijan E, Ćoza I, Mihanovic J, Kučić J, Sulen N, Katušić Z, Hudáček K, Farkašová M, Marková M, Grolich T, Kala Z, Pazdírek F, Hoch J, Filipová L, Kocián P, Přikryl P, Høgn A, Møller B, Slot DK, Bælum JK, Cour KL, Eriksen ND, Mahmoud A, Abdellatif A, Nafea A, Ewedah M, Soliman M, Yakout N, Argawy O, Sallam I, Kamel I, Sherif M, Ashmawy S, Ali A, Saad M, Ahmed M, Mohamed M, Mohamed N, Mahmoud S, Mahmoud S, Rashed AM, Abd-Errazik MA, Ammar MA, Mohammed R, Ebrahem A, Abd El Aal A, Abdou K, Wagdy M, Qassem M, Taha M, El-Wafa YA, Shehta A, El Metwally A, Hamed H, Ali MA, Elrefai M, El Sorogy M, Abdelkhalek M, Ragab A, Refky B, Metwally IH, Abdelkhalek M, Kamal M, Zuhdy M, Shetiwy M, Sakr A, Elfallal A, Elfeki H, Eldakroury I, Elbahrawy K, Mostafa M, Emile S, Tessema A, Tasew A, Gezahegn H, Bekele K, Belay M, Gudisa Z, Teferu Z, Väyrynen A, Kechagias A, Turunen A, Katunin J, Parhiala M, Pengerma P, Lahti P, Vihervaara H, Huhtinen H, Pasonen J, Heino R, Pakarinen S, Falenius V, Pinard B, Nobile C, Duchalais E, Drissi F, Meurette G, Podevin J, Lepenndu M, Hoetzel A, Jud A, Jauch D, Stefan FF, Neeff H, Holzner P, Nguyen P, Ryl A, Kehl F, Pullig F, Baral J, Münch S, Fütterer C, Reißfelder C, Sandra-Petrescu F, Herrle F, Hardt J, Lamm L, Seyfried S, Gharbi A, Aydin F, Stavrou G, Sperber J, de Deken J, Schwarzkopf K, Widyaningsih R, Polidorou A, Mpakas A, Tokidis E, Loun L, Petropoulou T, Balalis D, Korkolis D, Manatakis D, Assimakopoulou E, Bourazani M, Gklavas A, Kalamara E, Papaconstantinou I, Theodoraki K, Chardalias L, Konstadoulakis M, Theodosopoulos T, Soulioti E, Kavezou F, Filippou J, Papadoliopoulou M, Michalopoulos N, Vassiliu P, Sidiropoulos T, Charakopoulou A, Panagiotou A, Kokkinakis K, Lambridi E, Psarologos M, Maria S, Giannaraki S, Kapiris S, Triantafyllou A, Theodoropoulos C, Matthaiou G, Westzaan N, Etelka S, Triantafyllou T, Schizas D, Mpaili E, Karydakis L, Mpoura M, Danassi D, Karavokyros I, Dimitriou N, Livanou X, Kikira A, Tsourouflis G, Tomara NK, Nikiteas N, Dorovinis P, Tsiotos G, Stamou K, Kocka N, Ballian N, Kalakonas S, Athanasakis E, Chrysos E, Xynos E, Tsiaoussis J, Papadaki K, Xenaki S, Nyktari V, Sarakatsianou C, Bompou E, Arnaoutoglou E, Tzovaras G, Baloyiannis I, Mamaloudis I, Perivoliotis K, Apostolidi E, Mulita F, Karpetas G, Maroulis I, Vailas M, Petra A, Kontis E, Kaouras E, Katsaros I, Katsiaras L, Manikis P, Papadopoulou T, Papadopoulos A, Manioti E, Zeringa G, Katsinelis I, Mouzakis O, Kouki P, Nikolaou V, Marinis A, Alexopoulou K, Papadaki M, Vederaki SA, Samara A, Giakoustidis D, Christodoulidis G, Bareka M, Chatzikomnitsa P, Tsigara S, Papadopoulos V, Zarzava E, Anestiadou E, Lydia L, Apostolakidou M, Ioannidis O, Simeonidis S, Mpitsianis S, Tam PTH, Ng SSM, Lau VNM, Tse WK, Bánky B, Dolhai E, Horváth É, Golub J, Marton J, Lakatos L, Suszták N, Maurya AP, Kumawat H, Saxena P, Lather R, Waindeskar V, Khanduri A, Goyal L, Gupta R, Singh S, Saksena AR, Rayani BK, Kasula J, Raju K, Shah MM, Thammineedi SR, Patnaik SC, Rathod D, Poonia DR, Vishnoi JR, Sharma N, Byshetty R, Yadav RK, Misra S, Dhali A, Dhali GK, Biswas J, Ray S, Ghose T, Pipara A, Singh HM, Roy MK, Desai N, Thambudorai R, Ishwarappagol V, Chaturvedi A, Verma D, Akhtar N, Gupta S, Rajan S, Tiwari T, Kumar V, Mahajan A, Jain D, Liddle D, Jyoti J, Haque PD, Prem W, Lakshminarayana B, S BV, Poojary PH, Bhat RRK, Mathew S, Gupta L, Bains L, Kumar M, Singh N, Sharma A, Kumar A, Garg L, Aggarwal M, Jakhar R, Kumar A, Bose B, Huda F, Thakur N, Dhar P, Seenivasagam RK, Prakash S, Chaudhari A, Shukla A, Mahakalkar C, Saxena G, Mahuli K, Kaple M, Kshirsagar S, Mehraj A, Parray F, Aziz G, Chowdri N, Wani R, Gurcoo S, Shah Z, Madhavan S, Subbarayan S, Vino S, Aravindan U, George G, Ck H, Yadev IP, Chisthi M, Ps R, Sreekumar RC, Vijayan V, Theodore B, Victor C, Jesudason MR, Arulappan N, Philip R, Durai S, Creavin B, Cullinane C, Davis C, Flynn C, Liam D, Cooke F, Earley H, Peter M, Hamilton V, Trani AD, Conversano I, Cianci P, Petta R, Picciariello A, Altomare DF, Martines G, Grasso S, Moffa S, Papagni V, Zanoni A, Belvedere A, Romano A, Croce GD, Tanzanu M, Cardelli S, Lauro A, Sartarelli L, Binetti M, Cervellera M, Tonini V, Sanna B, Pusceddu E, Runfola M, Manunza R, Pisanu A, Cois A, Frongia F, Esposito G, Podda M, Mura P, Marzella A, Scotto B, Cuneo D, Ascari F, Giulino G, Varoli M, Laquatra N, Fortunato C, Marino F, Perrone F, Pace M, Convertini O, Cutellè C, Ammerata G, Sena G, Pignataro M, Scozzafava M, Mazza M, Bruni A, Curro G, Hila J, Ammendola M, Curcio S, Signorelli V, Marano A, Sasia D, Borghi F, Giuffrida MC, Bonardello M, Palmisano S, Testa V, Porta A, Scaltrini F, Iacob G, Gaspa I, Guatteri L, Coladonato M, Zapparoli A, Pesce A, Feo CV, Pindozzi F, Bigoni I, Torchiaro M, Fabbri N, Cianchi F, Staderini F, Elena F, Coratti F, Barbato G, Fortuna L, Romagnoli S, Bergamini C, Villa G, Cecchini I, Martellucci J, Izzo M, Trafeli M, Scheiterle M, Manoocheehri F, Cagnazzo F, Spampinato MG, Adam N, Depalma N, D'Ugo S, Garritano S, Mazzeo C, Cucinotta E, Melita F, Viscosi F, Biondo SA, Tripodi VF, Foppa C, Greco M, Sacchi M, Carvello M, Deac V, Laurenti V, Frontali A, Zappone A, Cammarata F, Colombo F, Ferrario L, Currà MC, Danelli P, Vignali A, Umberto C, Mastriale F, Riccardo R, Turi S, Elmore U, Galimberti A, Ceretti AP, Vespo D, Opocher E, Longhi M, Mariani NM, Flandoli C, Ciulli C, Vaira G, Ripamonti L, Cigagna L, Oldani M, Tamini N, Palumbo A, Castaldi A, Antropoli C, Rupealta N, Palmiero N, Donatiello V, Novi A, Cappiello A, Bianco F, de Luca M, Incollingo P, Esposito R, Gili S, Aprea G, de Simone G, Palomba G, Capuano M, Basile R, D'Angelo S, Tropeano FP, Luglio G, Pagano G, de Palma GD, Cricrì M, Milone M, Manigrasso M, Anoldo P, Boccia G, Raiano G, Nuzzo MMD, Calabria M, Peltrini R, Castiglioni S, Bracale U, Cervone C, Rega D, Caliendo D, Benetti E, Delrio P, Guarino R, de Franciscis S, Coppolino F, Romano FM, Selvaggi F, Sciaudone G, Selvaggi L, de Stefano M, Resendiz A, Carosso F, Degiuli M, Salusso P, Reddavid R, Benetti S, Callari C, Miceli DD, Pardo D, Sabatino G, Licari L, Lirosi MC, Sorce V, Peri A, Mori A, Pugliese L, Filardo M, Nuccio P, Dominioni T, Massimo C, Giuseppina F, Angelo F, Raffaele G, Michele M, Roberto P, Mondini A, Muratore A, Valentino C, Calabro' M, Danna R, Cremonini C, Sbarbaro C, Tartaglia D, Coccolini F, Chiarugi M, Musetti S, Pagani S, Neri CM, Leoni C, Rossi E, Randisi E, Puccini M, Buccianti P, Balestri R, Vasale A, Crescentini G, Ranieri G, Sinibaldi G, Biondi A, Sanesi AP, Vacca C, Lorenzon L, Sollazzi L, Persiani R, Pezzuto R, Ferroni AF, Stipa F, Volturo L, Moretti M, Tierno SM, Marina S, Mingoli A, Fiori E, Pugliese F, Brachini G, Carta G, Sapienza P, Lapolla P, Mazzotta E, Carannante F, Capolupo GT, Masciana G, Sica I, Caricato M, Antonelli S, Fiume D, Spoletini D, Lisi G, Carlini M, Menduni V, Arturi A, Proietto B, de Lucia C, Baldi C, Passantino DG, Romeo G, Paola MD, Sensi B, Sica G, Siragusa L, Dauri M, Franceschill M, Campanelli M, Bellato V, Porcu A, Garau AGG, Masala ML, Oggianu S, Tedde T, Perra T, Pazzola V, Venezia DF, Roviello F, Giacomini G, Carbone L, Marano L, Verre L, Marano M, Ciccarese AA, Bagnardi F, Shahu J, Siciliano W, Iacomino A, Armellin C, Marson F, Zanus G, Santoro GA, de Paoli M, Grossi U, Sekimoto M, Kobayashi T, Horiguchi A, Koike D, Yonekura H, Kato H, Yoshino K, Arakawa S, Asano Y, Alawneh F, Rajab I, Ramadan M, Masri MA, Qaisi MA, Alsamneh M, Mubaidin O, Al-Jarrah A, Ababneh H, Khdair K, Tawarh T, Sabri W, Arida ZA, Dzhumabekov B, Klyshbayeva D, Ispbayeva K, Nadyrov M, Tanabayeva S, Saliev T, Jumanov A, Aitbaeva A, Arynov A, Nadyrov M, Maulenov N, Dushimova Z, Park EJ, Kim H, Kang J, Baik SH, Song Y, Kwak HD, Kim J, Son JH, Chung JS, Lee H, Baek JH, Nam KH, Lee KC, Lee WS, Jeon Y, Kim CW, Park SE, Son GM, Ahn HM, Lee IY, Kim TK, Pcolkins A, Sivins A, Lobovs D, Ancans G, Kreice I, Budnikova I, Jelovskis I, Emhareb A, Abaidalla A, Hammed A, Khairallah M, Jibreel SS, Mohmmad WAS, Hasan W, Venskutonis D, Daugėla E, Dainius E, Juočas J, Kutkevičius J, Vaitkutė K, Bradulskis S, Macas A, Pauzas H, Jokubauskas M, Lizdenis P, Budrikienė R, Svagzdys S, Saladzinskas Z, Volkoviene G, Makauskiene J, Kuliavas J, Bernotaite V, Danys D, Kontrimaviciute E, Poskus E, Kryzauskas M, Jakubauskas M, Jotautas V, Zakaria AD, Kai MWP, Zainy RHM, Tan SS, Zain WZW, Zakaria Z, Yusoff ZM, Raduan F, Sagap I, Razali NYF, Rahman NA, Kanthan SBC, Nie YC, Azman ZAM, Ang CW, Tang CY, Poh KS, Ng K, Hashim NM, Xavier R, Khong TL, Amir AS, Ali CSC, Yew CK, Henry F, Muniandy J, Baharom S, Eng SCR, Hu FSM, Amin-Tai H, Jabar MF, Satar MHSA, Fathi NQ, Rao PS, Podesta AMC, Cini C, Psaila J, Debono M, Sammut M, Spiteri N, Andrejevic P, Muro AG, Leon BP, Perez JAV, Quiñonez JRA, Vera MTR, Gutierrez VMM, Bobadilla BJ, Martinez CM, de León Rendón JL, Hererro JAV, Cuichan MVY, Baez NF, Prevost PG, Hoyos-Torres A, Ruiz-Muñoz EA, Alvarez-Bautista FE, Ortíz-Méndez G, Zamudio-Bautista JL, Salgado-Nesme N, Vergara-Fernández O, Sanchez-Valdivieso E, Martinez G, Navarrete-Aleman J, Perez-Arellano J, Maldonado-Barron R, Hernandez-Krauss R, Ousadden A, Benjelloun EB, Bzikha I, Ibnmajdoub K, Mazaz K, Marghich O, Touzani S, Benkabbou A, Souadka A, El Ahmadi B, Zaari F, Laamri I, Majbar MA, Mohsine R, Van CB, Seuren D, Gillissen F, Aarts F, Konsten J, Van MH, Schlooz S, Naiqiso A, Merrie A, Varghese C, Pugh F, Bissett I, Wilson K, Mitchell S, Dawson C, Hill C, Wright D, Hubley S, Lin A, Jones D, Siggins L, Fagan P, Wu S, Ekwesianya A, Nwoye C, Agara D, Ejiofor G, Sundaynweke N, Kwentoh N, Ewah R, Aremu A, Ballah A, Ningi A, Ohia E, Mienda I, Aliyu M, Oloko N, Okunlola A, Abiyere H, Bolanle OE, Babatunde O, Fatudimu S, Orewole T, Mba EL, Felix MS, Abdulfatah M, Ibrahim N, Masoro U, Fakoya A, Irabor D, Anyadike F, Ulasi I, Orji M, Afuwape O, Ayandipo O, Aremu I, Adegboye K, Gbadegesin P, Aminu B, Aghadi IK, Makama JG, Joshua S, Kache SA, Sheshe AA, Bala AM, Garzali IU, Abdullahi MMM, Muhammad N, Umar NA, Muhammad S, Okoye A, Emegoakor C, Nwosu C, Egwuonwu OA, Ekwunife O, Amadigwe R, Ojiakor S, Akere A, Okereke C, Olaleye O, Ige O, Olubayo O, Olatiilu T, Idris M, Shehu A, Oluyori D, Nwabuoku E, Ukwubile L, Bashir M, Daniyan M, Rauf H, Ali M, Zakaria M, Hameed M, Amanullah N, Chawla T, Waqar U, Jamal A, Butt A, Kerawala A, Samson S, Dodhy AA, Gill AJ, Malik A, Ali D, Mohsin H, Afzal MF, Batool S, Suleman A, Khalid J, Zafar M, Dilawar M, Janjua MH, Sarwar MZ, Naqi SA, Akbar A, Afzal A, Anwar J, Gondal KM, Shaukat M, Waheed M, Sohail M, Mukhtiar N, Ammar AS, Hussain A, Khan AN, Sarwar A, Khan I, Khattak S, Oqaili B, Saada B, Zatari D, Jubran F, Hamdan F, Emar M, Alawi R, Jacome G, Insturain I, Arauz J, Hurtado M, Beron RI, Castaño R, Cao VHB, Kwiatkowski A, Dobkowski G, Bartosiak K, Walędziak M, Możański M, Zadrożna M, Kowalewski P, Fiedziuk A, Wątroba A, Los A, Sitarska M, Rząca M, Zawadzki M, Czarnecki R, Tavares C, Santos F, Borges F, Real JC, Lima MJ, Carlos S, Pereira V, Pacheco A, Gomes G, Pimenta J, Elisiario L, Jervis M, Gonçalves V, Pedro V, Jordão D, Neves FR, Conceição L, Ângelo MD, Marques P, Saraiva RP, Caroço TV, Windels A, Machado A, Ribeiro C, Velez C, Oliveira J, Melo MR, Lima R, Pires A, Lareiro C, Martins R, Revez T, Martins A, Cardoso D, Alegre I, Estevão P, Andrade D, Gomes DC, Duarte MJ, Custódio P, Nemésio RA, Rodrigues S, Correia A, Domingos H, Herrando I, Azevedo J, Fernandez L, Azevedo P, Vieira P, Torre A, Amado A, Paiva M, Saraiva R, Costa S, Mendes T, Queirós T, Silva A, Faustino A, Freitas A, Mendes J, Amaral L, Quintanilha R, Silva R, Coelho AM, Ribeiro A, Pinto C, Ribeiro N, Reis R, Costa S, Fernandes V, Sanches A, Amorim E, Miguel I, Rachadell J, Sanches M, Oliveira S, Baptista V, Roxo A, Devesa H, Teslyak O, Barradas R, Marques S, Martins S, Pepino S, Silva A, Deus AC, Ferreira A, Marinho D, Sousa D, Martins MJ, Matias N, Pinto A, Correia D, Amado F, Cordeiro L, Morales M, Lamas M, Marçal S, Rodrigues AI, Santos A, Marçal A, Oliveira A, Gomes C, Ferreira C, Marques R, Chitul A, Alexandrescu C, Bezede C, Cristian D, Mandi D, Grama F, Ungureanu R, Stoica B, Diaconescu C, Ciubotaru C, Tanase I, Grintescu I, Negoita VM, Calin C, Simeanu C, Ciotarla DC, Caltea M, Mirica RM, Luca A, Pasca A, Vlad C, Bonci EA, Stefanescu I, Achimas-Cadariu PA, Gata VA, Capusan A, Petrisor C, Dindelegan G, Seicean R, Scurtu R, Bintintan V, Fagarasan V, Ionescu C, Crisan D, Zanc L, Ene-Cocis MV, Muresan MS, Mihalcea SM, Dudric V, Musina AM, Ristescu AI, Roata CE, Moglan M, Dimofte MG, Lunca S, Iacob S, Dychko A, Litvin A, Kapustina A, Provozina A, Anokhin E, Zabiyaka M, Shin A, Djumabayev K, Kuznetsova M, Gordeyev S, Kochkina S, Mamedli Z, Markaryan D, Galliamov E, Semina E, Agapov M, Malahov P, Garmanova T, Kakotkin V, Zaycev A, Sumbaev A, Bedzhanyan A, Orman E, Petrenko K, Bredikhin M, Frolova Y, Tulina I, Bashilkina O, Tsarkov P, Rodimov S, Stamov V, Balaban V, Alexnder A, Yanishev A, Rogozhev D, Yakunina N, Chubukova N, Nugmanov R, Karachun A, Petrov A, Domanskiy A, Panaiotti L, Smolina M, Sapronova T, Pelipas Y, Zagaynov E, Khrykov G, Davidovskaja L, Burlov N, Mankevich N, Tverdohlebova T, Bogatikov A, Lodygin AV, Krasnoselsky C, Vasiukova ES, Kopteyev NR, Ovchinnikov T, Kashchenko VA, Novikova A, Terentyeva E, Kuleshov O, Pavlov R, Koshel A, Kostromitsky D, Drozdov E, Klokov S, Camacho A, Khan FN, Bandar MA, Shamim R, Chowdhury S, Kovacevic B, Krdzic I, Zdravkovic M, Kenic M, Milentijevic M, Petkovic N, Radulovic R, Ngu J, Teo NZ, Singh PA, Ong SY, Li S, en Siew B, Chee C, Koh JJM, Lee KY, Tan KK, Wong SC, Loh W, Pujol AF, Rubio JC, Farrés LP, Vendrell LL, Del Olmo MIU, Pedregosa AB, Galmes C, Luckute D, Casanova D, Artigot M, Guedes X, Olivella Y, Sarda MS, Toscano MJ, Damieta MP, Pera M, Gonçalvez SA, Galvez ST, Ruiz SS, Espin-Basany E, Marinello F, Villarino-Villa L, Heras MVL, Martin-Sanchez R, Mata RM, Blanco-Colino R, Otero A, de Lacy AM, Sanahuja JM, Bravo R, Ferraz T, Gonzabay V, Gonzalez F, Menendez P, Del Castillo VCG, Lopez-Pelaez VM, Silva ÁS, Lillo-García C, Tauler EM, Manresa MCE, Pérez SL, Llopis SQ, Rubio AV, Castillo ER, Miramón FJJ, Rodriguez JLR, Rizo-Lamberti LA, Garrido PG, Carneros VJ, Alfonso BA, Sierra BG, Amador CG, Gomendio MDP, Palomino MVR, de La Plaza Llamas R, Cafranga EG, Ramos JLE, Estudillo MC, Pérez RE, Pernas RM, de Lebrusant Fernández S, Bautista WMS, Llamazares AL, Valbuena AL, Moran LA, Alvarez LJ, Raposo LG, Ceron SF, Calvo AC, Valcárcel CR, Peña JP, Gómez LMJ, Díez MC, Lindenbaum PD, Mata SK, Ruiz-De-La-Hermosa A, Abad-Motos A, Toribio-Combarro B, Ripollés-Melchor J, Fuenmayor-Valera ML, Ortega-Domene P, Loscos A, Del Pueblo CS, Dziakova J, Mugüerza JM, Carlin PS, Anula R, Mouvet Y, Forero-Torres A, Andrés BDS, Marcos CM, Rubio I, Pascual I, Yague J, Alcolea NG, Alonso A, Diéguez B, Ibañez I, Pérez JL, Losada M, García-Conde M, Hernández M, Blazquez-Martin A, Vera-Mansilla C, Mendoza-Moreno F, Hernandez-Salvan J, Diez-Alonso M, Hernandez-Juara P, Barrena-Blazquez S, Minaya-Bravo AM, Galván-Pérez A, Miguel-Méndez CS, Gonzalez-Gonzalez E, Alvarez-Díez M, García-Ureña MÁ, Llorente-Moreno M, Ruiz-Lozano C, Colás-Ruiz E, Pérez-Calvo J, Gomila-Sanso JA, Álvarez-Llano L, Serrano-Fuentes SC, Soto-Montesinos C, Dedeu-Bastardas I, Perez-Reche I, Labró-Ciurans M, Pardo-López S, Pérez EG, Fernández IO, Canals LO, Espino PC, Ruano PG, Ricardo V, Ros EP, Manuel EM, Buleje JAB, Prats MMC, Baños PAP, González PM, Celdrán RG, Pellicer-Franco EM, Valero-Navarro G, Vicente-Villena JP, Martinez-Mercader MM, Baeza-Murcia M, Mengual-Ballester M, Soria-Aledo V, Fernández-Martínez D, Varela-Rodríguez L, Garcia-Flórez LJ, Fernández-Hevia M, Gonzalez-Diaz MJ, Fernández-Arias S, Puertas CP, de San Pío Carvajal E, Cebolla ES, Brainsa E, Bayo JMM, Castro MC, Blanco RR, Gutierrez E, Pinto FL, Alegre JM, Flores N, ÓSullivan SN, Fernández BF, Alonso JE, Conde JGA, Ropero NM, Bayón RÁ, Dominguez SH, Ramirez S, Martin de Pablos A, Perez-Sanchez A, Cano-Matias A, Del-Rio-Lafuente FJ, Caballero-Delgado J, Valdes-Hernandez J, Gomez-Rosado JC, Martinez C, Cholewa H, Sancho-Muriel J, Alberola MJ, Navasquillo M, Primo V, Moreno V, Espí-Macías A, Moro-Valdezate D, Carrascosa-Morales I, Martín-Arévalo J, Soro-Domingo M, García-Botello S, Pla-Marti V, Abellán AM, Pérez CM, Cortés GFV, Blasco LF, Chornet MR, Martín RS, Diego ARD, Vázquez-Fernández A, Pascual A, de Andrés-Asenjo B, Beltrán de Heredia J, Ruiz-Soriano M, Rodríguez-Jiménez R, Iribarren EM, Rodríguez EVF, Del Carmen Casas García M, García-Señoráns MP, Valderrama ÓC, Rodríguez PF, Santos RS, Currás RP, Vigorita V, Roche CG, Delgado E, Lafuente F, Gascon I, Saudi S, Fraj V, Wickramasinghe D, de Zoysa I, Samarasekera N, Wickramarathne R, Dassanayake V, Balathayalan Y, de Silva D, Perera M, Pulleperuma S, Jayasekara S, Wijenayake W, Gunetilleke B, Abeysinghe N, Chandrasinghe P, Kumarage S, Abdalradiy AG, Widatalla ABH, Ahmed AY, Mohamed HA, Hamid HKS, Ali MH, Eldin SJ, Agger E, Jutesten H, Lindgren J, Lepsenyi M, Azhar N, Hansdotter P, Ekepil A, Lindén Å, Brandström G, Smedberg J, Schiffer E, Ris F, Longchamp G, Meyer J, Dupret L, Galetti K, Regusci L, Grischott M, Malugani M, Mouhandes AEF, Danial AK, Khayat M, Sbahi MHE, Marawy MK, Abdullah MA, Douba Z, Mansour A, Niazi A, Hamza A, Mohamad AH, Awead M, Mohammad S, Salloum S, Jabar AA, Zazo A, Shebli B, Ayoub K, Younes L, Bannoud MH, Zazo R, Saad A, Hamdan A, Wakkaf H, Adra L, Souliman M, Anton M, Hannouf S, Li KL, Cheng KI, Ji SJ, Hsieh YC, Parlak EA, Demir M, Kara U, Peker YS, Yiğit D, Unal N, Iflazoğlu N, Yalkin Ö, Topal S, Gulcu B, Ozturk E, Gümbelek G, Terkanlıoğlu S, Koklucan A, Ince G, Sen M, Isik O, Kural S, Akesen S, Yilmazlar T, Sungurtekin H, Sungurtekin U, Vural U, Ozgen U, Isik A, Onk D, Kurnaz E, Ozker TS, Ipek A, Ferlengez A, Erturk C, Tatar C, Sevik H, Akay O, Sensoy O, Hayirlioglu MB, Aktas S, Ozben V, Aliyeva Z, Mutlu AU, Gökay BV, Saraçoğlu C, Aytaç E, Gülmez M, Işık MÜ, Hacim A, Akbas A, Soyhan F, Turgut MA, Demirgan S, Meric S, Altinel Y, Baris B, Akova E, Kahraman E, Kucuk HF, Saracoglu KT, Kaya S, Lel S, Gurbulak EK, Caz E, Kostek M, Mihmanli M, Yazici P, Oba S, Kırkan EF, Ulgur HS, Kalın M, Dinkci MD, Duzgun O, Ozturk S, Zengin AK, Aşkar A, Şanlı AN, Erginöz E, Özçelik MF, Ergün S, Uludağ SS, Kara D, Yılmaz G, Sarıcı IŞ, Kara Y, Incesu A, Arican C, Atici SD, Kaya T, Gezer T, Kirmizi Y, Aydin G, Namdaroglu O, Adakaya S, Canda AE, Ozzeybek D, Coskun N, Sokmen S, Ozkardesler S, Bisgin T, Miftari A, Caliskan C, Akgun E, Avseren G, Deniz N, Yoldas T, Güreşin A, Zayakov G, Pösteki G, Utkan NZ, Tatar OC, Akçay Ö, Güler SA, Mantoğlu B, Demirel E, Akın E, Gonullu E, Altintoprak F, Palabıyık O, Bayhan Z, Ciftci AB, Colak E, Aybar E, Celik HK, Eraslan H, Yemez K, Ozbilgin SS, Senol S, Gultekin FA, Piskin O, Guler O, Karadere Y, Kakeeto A, Oguttu B, Sikakulya FK, Lule H, Rybachuk A, Shudrak A, Beznosenko A, Lisnyy I, Rozhkova V, Zvirych V, Alawlaqi D, El Jamali F, Balooshi IA, Ahmed M, Albers M, Ali NA, Church R, Dudas G, Wells J, Pavlova M, Sebastiani S, Paterson C, Kaushal M, Patel P, Panchal S, Handa S, Tezas S, Zaidi SN, Raj G, Wright J, Hallam S, Karandikar S, Gates Z, Marshall A, Thompson A, Tennakoon A, Rao M, Callan R, Tufail S, Rajendran G, Polisetty K, Husain N, Clarke N, Naranayanasamy S, Hallett A, Lorejo E, Ward N, Antakia R, Xanthis A, Simillis C, Tweedle E, Panagiotopoulou I, Grimes L, Mounstephen L, Bocancia R, Carden C, Lynch J, Noveros MS, Shaalan R, Khalil T, Marshall W, Hodge K, Balfour J, Mcintosh K, Buijs L, Yule M, Vaughan-Shaw PG, Smith S, Anderson T, Mcdermott FD, Daniels IR, Tapp J, Smart N, Rajaretnam N, Bethune R, Clark T, Delimpalta C, Liao C, Banham G, Induruwage L, Velchuru V, Lawrence A, Rahman A, Bennett J, Badawi M, Harshen R, Bhargava A, Gorrela K, Jumah M, Hanson M, Arya S, Atendido T, Shrestha A, Cook E, Rakhimov I, Collins J, Alamin N, Vigneswaran N, Basnyat P, Shamardal A, Chacko A, Wanshantha D, Bisheet G, Ebdewi H, Abdellatif M, Adu-Poku P, Tore A, Adams F, Allen K, Ahmed K, Kulkarni N, Chitnis A, Patel H, Magsino J, Sarodaya V, Minicozzi A, Dempsy C, Ahmed H, Jayasinghe JD, Okail MH, Thaha M, Hallworth S, Parmar C, Chua L, Pizanias M, Samin R, Young T, Sagar J, Yorkmui L, Cirocchi N, Ahmed S, Barreda SC, Kudchadkar S, Baker A, Jayasankar B, Jackson J, Abdelsaid K, Hassan M, Shetty S, Coldwell C, Davies E, Nader H, Raistrick M, Ryska O, Hawkin P, Raymond T, Witjes C, Van de Steen K, Crabtree N, Boyce S, Somera W, Woodward A, Ryan K, Kassai M, Aleem M, Ghosh A, Rixson D, Lewis E, Lynch N, Shovelton C, Zywicka E, Guest F, Barton J, Purnell R, Bamford R, Teare T, Adams B, Chmielewski G, Smith L, Connolly L, Niblett R, Singh A, Halliwell G, Paraoan M, Doree N, Asaad P, Kilbride C, Carpenter H, Wilson J, Fletcher J, Vijayagopal KA, Abbakar M, Zaimis T, Walsh A, Kubisz-Pudelko A, Nono J, Pippard L, Chowdhary M, Dalton R, Moussa T, Dominguez F, Solla G, Curbelo J, Laurini M, Viola M, Brito N, Al-Alnsi A, Al-Naggar H, Saryah L, Al-Shehari M, Alsayadi R, Al-Hutheifi R, Shream S, Saeed S, Spurring EM. Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
Collapse
|
8
|
Tomasicchio G, Giove C, Dezi A, Picciariello A, Lantone V, Martines G, De Fazio M, Rinaldi M. The management of low trans-sphincteric anal fistula during the COVID-19 pandemic: revisiting the role of the seton. Updates Surg 2024; 76:163-167. [PMID: 38123906 DOI: 10.1007/s13304-023-01713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/01/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
The management of trans-sphincteric anal fistula (TAF) includes several surgical options; however, during the COVID-19 pandemic, the access to the operating rooms was severely limited, leaving only the choice of minimally invasive procedures. This study aimed to evaluate the safety and effectiveness of the slow cutting seton technique for TAF performed in an outpatient setting during the COVID-19 pandemic.Patients treated for TAF between January 2020 and July 2022 and followed-up for at least 12 months were retrospectively evaluated. A vascular silicone tie used as seton was positioned in the fistula tract using a Lockhart-Mummery fistula probe. The seton was maintained in moderate tension until the sphincter muscle was passed. Percentage and time for healing, recurrence, SF-36, VAS and Vaizey's Score were recorded.Fifty-eight patients [36 male/22 female, median age 56.5 years (IQR 41.25-65.75) [with TAF were included. After a median time of 4 months, complete healing occurred in 53 cases (91.5%), the anal pain VAS decreased from 6 to 0, the anal incontinence scores did not change significantly and the QoL improved significantly in all the SF36 domains. No complications were recorded, but the fistula recurred in five cases (8.5%). Two of them had additional seton treatment, and three underwent other surgical procedures after the COVID-19 emergency.The slow cutting seton technique is a safe and effective treatment for outpatient procedure with minimal patient discomfort. This treatment option in healthcare delivery for TAF should be reconsidered, even outside the limited in-hospital access during the COVID-19 pandemic.
Collapse
Affiliation(s)
- G Tomasicchio
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - C Giove
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - A Dezi
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy.
| | - A Picciariello
- Department of Experimental Medicine, University of Salento, Lecce, Italy
| | - V Lantone
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - G Martines
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - M De Fazio
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - M Rinaldi
- Surgical Unit "M. Rubino", Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
9
|
Gallo G, Dezi A, Grossi U, Picciariello A. Sclerotherapy with 3% polidocanol foam in the treatment of hemorrhoidal disease: unveiling the missing pieces for a comprehensive evaluation. Front Surg 2023; 10:1344724. [PMID: 38179315 PMCID: PMC10764418 DOI: 10.3389/fsurg.2023.1344724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Roma, Roma, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Bari, Italy
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology – DISCOG, University of Padua, Padua, Italy
| | | |
Collapse
|
10
|
Picciariello A, Kim HJ, Choi GS, Song SH. Robotic abdominoperineal resection for T4b rectal cancer using the da Vinci SP platform. Tech Coloproctol 2023; 27:1119-1122. [PMID: 37368080 DOI: 10.1007/s10151-023-02792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/14/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The aim of the present report wasto describe a novel technique of robotic abdominoperineal resection (APR) for the treatment of T4b low rectal cancer using the da Vinci® Single-Port (SP) system (Intuitive Surgical, Sunnyvale, CA, USA). METHODS A 3-cm transverse incision was made in the left lower quadrant of the abdomen, in the area designated for permanent colostomy. A Uniport® (Dalim Medical, Seoul, Korea) was introduced and a 25 mm multichannel SP trocar was inserted into the Uniport. A 5-mm laparoscopic assistant port was introduced on the upper midline. A video showing each step of the technique is attached. RESULTS Two consecutive female patients (70 and 74 years old) underwent SP robotic APR with partial resection of the vagina 8 weeks after preoperative chemoradiotherapy. In both cases, rectal cancer was located 1 cm above the anal verge and invaded the vagina (initial stage and ymrT stage T4b). Operative time was 150 and 180 min, respectively. Estimated blood loss was 10 and 25 ml, respectively. No postoperative complications occurred. The length of postoperative hospital stay was 5 days in both cases. The final pathological stage was ypT4bN0 and ypT3N0 respectively. CONCLUSIONS In this first experience, SP robotic APR appears to be a safe and feasible procedure for locally advanced low rectal cancer. In addition, the invasiveness of the procedure is reduced by means of the SP system, which only requires a single incision in the area designated for colostomy. Prospective studies on a larger number of patients are necessary to confirm the outcomes of this technique compared to other minimally invasive approaches.
Collapse
Affiliation(s)
- A Picciariello
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-Gu, Daegu, 41404, Korea
- Department of Precision and Regenerative Medicine and Ionian Area, University "Aldo Moro" of Bari, Bari, Italy
| | - H J Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-Gu, Daegu, 41404, Korea
| | - G-S Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-Gu, Daegu, 41404, Korea.
| | - S H Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-Gu, Daegu, 41404, Korea
| |
Collapse
|
11
|
Picciariello A, Dezi A, Altomare DF. Undeserved authorship in surgical research: an underestimated bias with potential side effects on academic careers. Updates Surg 2023; 75:1807-1810. [PMID: 37440127 PMCID: PMC10543946 DOI: 10.1007/s13304-023-01581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
The incidence of courtesy authorship in research over time has probably increased due to the enormous pressure to publish to increase the bibliometric indexes necessary to achieve an academic role. The aim of this survey was to quantify and characterize this research malpractice among a very selected group of surgeons from different surgical specialties belonging to the European Association of Surgery (ESA). E-mail addresses for the invitation to take part to the survey were collected by the Twenty-eighth Annual Meeting final program. Five-item were designed and developed by the authors using an online platform. Eighty-six members from 21 countries completed the survey (female/male ratio: 0.09). In the last 10 years, almost half of the responders (41, 47.7%, 37 academics) have included colleagues for courtesy authorship. The most common reason of courtesy authorships was to support the academic career of another researcher (62.5%). Other reasons were fear of retaliation (12.5%), reciprocal authorship (12.5%) or support for a partner (10%). This survey showed that undeserved authorship is sadly confirmed to be a common research misconduct across any countries and medical specialties, even among a very selected group of surgeons with international reputation irrespective of the academic position.
Collapse
Affiliation(s)
- Arcangelo Picciariello
- Surgical Unit M. Rubino, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Azienda Ospedaliero Universitaria Policlinico Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Agnese Dezi
- Surgical Unit M. Rubino, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Azienda Ospedaliero Universitaria Policlinico Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Donato F. Altomare
- Surgical Unit M. Rubino, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Aldo Moro of Bari, Azienda Ospedaliero Universitaria Policlinico Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| |
Collapse
|
12
|
Manzo CA, Annicchiarico A, Valiyeva S, Picciariello A, Gallo G, Bislenghi G. Practice of proctology among general surgery residents and young specialists in Italy: a snapshot survey. Updates Surg 2023; 75:1597-1605. [PMID: 37217636 DOI: 10.1007/s13304-023-01540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
Anal diseases are very common and, in most of the cases, require surgery of minor or medium complexity, and, therefore, are among the most accessible diseases for surgeons in training. Aim of this study is to investigate the status of the training in proctology in Italy. A 31-items questionnaire was administered to residents and young specialists (≤ 2 years) in general surgery, using mailing lists, and the social media accounts of the Italian Society of Colorectal Surgery. Answers from 338 respondents (53.8% males) were included in the final analysis. Overall, 252 respondents (74.5%) were residents and 86 (25.5%) young specialists. Two hundred and fifty-five (75.4%) respondents practiced proctology for the first time early on during their postgraduate training, but only 19.5% did it continuously for ≥ 24 months. Almost all respondents (334; 98.8%) had the chance to participate in proctological procedures, 205 (60.5%) as first surgeon. This percentage decreases according to the complexity of the surgery. In fact, only 11 (3.3%) and 24 (7.1%) of the respondents were allowed to be the first surgeon in more complex proctological diseases such as surgery for rectal prolapse and fecal incontinence. The present survey suggests that, in Italy, most surgeons in training deal with anal diseases. However, only few of them could achieve sufficient professional skills in the management of proctological diseases to be able to practice autonomously as young specialists.
Collapse
Affiliation(s)
- Carlo Alberto Manzo
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Unit of General Surgery, Vaio Hospital, Fidenza, Parma, Italy
| | - Sayali Valiyeva
- Surgical Coloproctology, University of L'Aquila Department of Clinical Medicine and Biotecnology, Val Vibrata Hospital, Sant'Omero, TE, Italy
| | - Arcangelo Picciariello
- Division of General Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | - Gaetano Gallo
- Department of Surgery, La Sapienza" University of Rome, Rome, Italy
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| |
Collapse
|
13
|
Martines G, Dezi A, Giove C, Lantone V, Rotelli MT, Picciariello A, Tomasicchio G. Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients. Obes Facts 2023; 16:457-464. [PMID: 37579738 PMCID: PMC10601677 DOI: 10.1159/000531459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/25/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m2) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up. METHODS Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m2), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded. RESULTS Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m2 vs. 53.6 kg/m2; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05). CONCLUSION A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.
Collapse
Affiliation(s)
- Gennaro Martines
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Carlo Giove
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Valerio Lantone
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Maria Tersa Rotelli
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Arcangelo Picciariello
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
14
|
DI Gilio A, Palmisani J, Picciariello A, Zambonin C, Aresta A, De Vietro N, Franchini SA, Ventrella G, Nisi M, Licen S, Barbieri P, Altomare D, de Gennaro G. Identification of a characteristic VOCs pattern in the exhaled breath of post-COVID subjects: are metabolic alterations induced by the infection still detectable? J Breath Res 2023. [PMID: 37379826 DOI: 10.1088/1752-7163/ace27c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
SARS-CoV-2 is expected to cause metabolic alterations due to viral replication and the host immune response resulting in increase of cytokine secretion and cytolytic activity. The present prospective observational study is addressed at exploring the potentialities of breath analysis in discrimination between patients with a documented previous history of symptomatic SARS-CoV-2 infection and, at the moment of the enrollment, exhibiting a negative nasopharyngeal swab and acquired immunity (post-COVID) and healthy subjects with no evidence of previous SARS-CoV-2 infection (no-COVID). The main purpose is to understand if traces of metabolic alterations induced during the acute phase of the infection are still detectable after negativization, in the form of a characteristic VOCs pattern. An overall number of 60 volunteers aged between 25 and 70 years were enrolled in the study (post-COVID: n.30; no-COVID: n. 30), according to well-determined criteria. Breath and ambient air samples were collected by means of an automated sampling system (Mistral) and analyzed by Thermal Desorption-Gas Chromatography-Mass Spectrometry (TD-GC/MS). Statistical tests (Wilcoxon/Kruskal-Wallis test) and multivariate data analysis (Principal Component Analysis, Linear Discriminant Analysis) were performed on data sets. Among all compounds detected (76 VOCs in 90% of breath samples), 5 VOCs (1-propanol, isopropanol, 2-(2-butoxyethoxy)ethanol, propanal and 4-(1,1-dimethylpropyl)phenol) showed abundances in breath samples collected from post-COVID subjects significantly different with respect to those collected from no-COVID group (Wilcoxon/Kruskal-Wallis test, p-values < 0.05). Although not completely satisfactory separation between the groups was obtained, variables showing significant differences between the two groups and higher loadings for PCA are recognized biomarkers of COVID-19, according to previous studies in literature. Therefore, based on the outcomes obtained, traces of metabolic alterations induced by SARS-CoV-2 infection are still detectable after negativization. This evidence raises questions about the eligibility of post-COVID subjects in observational studies addressed at the detection of COVID-19. (Ethical Committee Registration number: 120/AG/11).
Collapse
Affiliation(s)
- Alessia DI Gilio
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Jolanda Palmisani
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazzale Giulio Cesare 11, Bari, Puglia, 70124, ITALY
| | - Carlo Zambonin
- Department of Bioscience, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Antonella Aresta
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Nicoletta De Vietro
- Department of Chemistry , Università degli Studi di Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Silvana Angela Franchini
- Department of Biosciences, Biotechnolgies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Gianrocco Ventrella
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Marirosa Nisi
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| | - Sabina Licen
- Department of Chemical and Pharmaceutical Sciences , University of Trieste, Piazzale Europa 1, Trieste, Friuli-Venezia Giulia, 34127, ITALY
| | - Pierluigi Barbieri
- Department of Chemical and Pharmaceutical Sciences , University of Trieste, Piazzale Europa 1, Trieste, Friuli-Venezia Giulia, 34127, ITALY
| | - Donato Altomare
- Department of Emergency and Organ Transplantation, Università degli Studi di Bari Aldo Moro, Piazzale Giulio Cesare 11, Bari, Puglia, 70124, ITALY
| | - Gianluigi de Gennaro
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, via Orabona 4, Bari, Puglia, 70125, ITALY
| |
Collapse
|
15
|
Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri E, Martínez EG, Myriokefalitaki E, Wong EG, Samara E, Agbeno EK, Drozdov E, Tokidis E, Shah FA, Barra F, Carbone F, Ferreli F, Marino F, Martinelli F, D'acapito F, Masciello F, Bàmbina F, Issa F, Salameh FT, Kethy F, Mahmood F, Gareb F, Idrees F, Karimian F, Ashraf F, Haji F, Inayat F, Begum F, Nabil F, Rosa F, Haider F, Parray F, Calculli F, Ferracci F, Saraceno F, Coppola F, Coccolini F, Fusini F, Migliorelli F, Pecoraro F, Alconchel F, Coimbra FJF, Trivik-Barrientos F, Naegele F, Almarshad F, Agresta F, Fleming F, Mendoza-Moreno F, Brzeszczyński F, Carannante F, Wu F, Aljanadi F, Hayati F, Campo F, Sorbi F, Milana F, Takeda FR, Shekleton F, Gessler F, Recker F, Grama F, Cherbanyk F, Faponle F, Angelis F, Calabretto F, Gaino F, Toia F, Bianco F, Bussu F, Cammarata F, Castagnini F, Colombo F, Ferrara F, Fleres F, Guerrera F, Litta F, Mongelli F, Pata F, Roscio F, Mulita F, Ardura F, Tejero-Pintor FJ, Calvo FJR, Escobedo FJB, Camacho FJB, Odicino F, Schmitt F, Bloemers F, Hölzle F, Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, Pilkington I, Kirac I, Trostchansky I, Gawron IM, Trebol J, Martellucci J, Andreuccetti J, Abou-Khalil J, Shah J, Manickavasagam J, De Alarcón JR, Mihanovic J, O'riordan J, Archer J, Ashcroft J, Blair J, Hamill J, Munthali J, Park J, Parry J, Ryan J, Tomlinson J, Wheeler J, Wilkins J, Balogun JA, Hodgetts JM, Vatish J, Žatecký J, Dziakova J, Martin J, Beatty JW, Stijns J, Faiz J, Ripollés-Melchor J, Mata J, Vásquez JAG, Mitra JK, Tuech JJ, Mvukiyehe JP, Fallah JM, Díaz JT, Vishnoi JR, Van Den Eynde J, Rickard J, Rolinger J, Kaplowitz J, Meyer J, Reid J, Rossaak J, Smelt J, Thomas JJ, Reyes JAS, Davies J, Luc J, Alonso JAM, Hajiioannou J, Querney J, Van Acker J, Pu JJ, Cama J, Simoes J, Cozens J, Barbosa-Breda J, Ribeiro J, De Haro J, Nigh J, Bowen J, Pollok JM, Strotmann JJ, Doerner J, Edwards J, Green J, Massoud J, Mcgrath J, Squiers J, Street J, Windsor J, Santoshi JA, Meara JG, Abebrese JT, Reilly JJ, Zabaleta J, Phillips J, Herron J, Horsnell J, Dawson J, Sheen J, Kauppila JH, Konsten J, Raurich-Leandro J, Romera JS, Nuñez J, Gass JM, Blanco J, Calvache JA, Iturralde JLF, D’addino JL, Hermosa JMG, Guillen JRO, Beristain-Hernandez JL, Sole-Sedeno JM, Vives JMM, Attwood J, Furey J, Hadaya J, Mckay J, Meilak J, Natale J, Shalhoub J, Jung J, Arthur J, Kealey J, Wright J, Moreau J, Miskovic J, Juloski J, Bauset JCC, Segura-Sampedro JJ, Cisneros JRT, Gomez-Rosado JC, Arneja J, Heider J, Fernández JD, Plata-Bello J, Villanueva J, Olaogun J, Hing JX, Košir JA, Daruwalla J, Yeung J, Wormald J, Seyi-Olajide J, Rani J, Wong KY, Hristova K, Kajal K, Algarni K, Theivendran K, Futaba K, Elsayem K, Kapur K, Bailey K, El-Boghdadly K, Ataya K, Lacorbiniere K, Shah K, Tellez KSM, Szyluk K, Rangasamy K, Iyengar K, Szabómihályová K, Atkinson K, Camargo-Parra K, Galliard K, Dickson K, Singh K, Qader K, Hasan K, Spellar K, Feeney K, Ajenifuja K, Oh KE, Okunade K, Adanu K, Bateman K, Saracoglu K, Ho KW, Enwerem K, Mishra K, Verhoeff K, Bensoltane K, Larabi K, Hamdan KH, Nadi K, Fozo K, Abdelwahab K, Al-Sayaghi K, Dajani K, Algahtany K, Abdel-Galil K, Ahmed K, Bajunaid K, Bhatti K, Sofi K, Abdulsalam K, Tamoos K, Dzhumabaev K, Samo KA, Purich K, Madhvani K, Qin KR, Underwood K, Senanayake KJ, Augestad KM, Sigamoney K, Apostolou K, Bouchagier K, Bouliaris K, Bramis K, Gousias K, Lasithiotakis K, Paraskevopoulos K, Perivoliotis K, Roditis K, Stamatis K, Stroumpoulis K, Paraskevas KI, Govindarajan KK, Šimko K, Olson KA, Khobragade K, Seah KM, Kishore K, Ayad K, Papavasiliou K, Angelou K, Paniagua LC, Czako L, Ching LVK, Rai L, Gupta L, Ismail L, Mbodi L, Dasanayake L, Schröder L, Baiyewu LA, Fortuna L, Fernandez LG, Vivancos LG, Jack L, Keçi L, Lavalle L, Leonard L, Shelmerdine L, Vaassen L, Hasan L, Lazarou L, Tzelves L, Matos L, Siragusa L, Licari L, Lima LS, Solaini L, Lichman L, Moral LT, Cabeza L, Kaplan L, Valeanu L, Kaman L, Karout L, Pieteris L, Chan L, Grüßer L, Zamora L, Catarzi L, Rampersad L, Anyanwu LJ, Cheung LK, Rodríguez LV, Andreani L, Cobianchi L, Petagna L, Howse L, Gonzalez LE, Bains L, Vohra L, Ansaloni L, Bertolaccini L, Ferrario L, Orecchia L, Tirloni L, Zanin L, Morelli L, Scaravilli L, Locatello LG, García LD, Vida L, Carbone L, Heindl LM, Bonavina L, Conti L, Marano L, Verre L, Conte LE, Boccalatte L, Tellez LGS, Loureiro L, Sánchez-Guillén L, Tallon-Aguilar L, Nakano L, Alvarez-Lozada LA, Gonzalez LAS, Flórez LJG, Capitan-Morales LC, Kowalski LP, Widmer LW, Harper L, Render L, Wheldon L, Abdur-Rahman L, Doğan L, Prusty L, Katsiaras L, Gourbault L, Siddiqui MT, Saleh M, Karthigeyan M, Rodriguez M, Chowdhury M, Nagappa M, Sultania M, Bashir M, Alam M, Elshahawy MAM, Elfiky M, Loubani M, Marei M, Mewafy M, Alali M, Nassar MA, Alobied M, Bilfaqirah M, Ahmad M, Rius M, Manangi M, Dornseifer MD, Tripathi M, S M, Sokolov M, Pigeolet M, Alonso MD, Losada M, Carretero MM, Tousidonis M, Cotovio MD, Wijeyaratne M, Boira MA, Franza M, Albdour M, Alkhatieb M, Déserts MDD, Niewiera M, Vallve-Bernal M, Kavanagh MM, Migliore M, Calabrò M, Martino MD, Reicher M, Baia M, Caricato M, Clementi M, De Zuanni M, Fiore M, Giacometti M, Inama M, Maestri M, Materazzo M, Sparavigna M, Pascale MM, Nemeth M, Serra M, Fahim MMF, Soucheiron MC, Papadoliopoulou M, Wittmann M, Sotiropoulou M, García-Conde M, Ranucci MC, Amo MDAD, Boedo MJM, Velázquez MJM, Pissaridou MK, Petersen ML, Sacras ML, Modolo MM, Caubet MM, Di Nuzzo MM, Ntalouka MP, Menna MP, Aguilera-Arevalo ML, Rela M, Capuano M, Hollyman M, Olivos M, Sacdalan MD, Raphael MC, Takkenberg M, Bortul M, Cabrera M, Castaño M, D'oria M, Giuffrida M, Laborde MM, Rodriguez-Lopez M, Trejo-Avila M, Papa MV, Ghobrial M, Kryzauskas M, Anwer M, Cheetham M, Davies M, Higgins M, Siboe M, Tarle M, Velten M, Wurm M, Süleyman M, Bauer M, O’dwyer M, Caretto M, De La Rosa-Estadella M, Fragoso M, Serra ML, Merayo M, Golet MR, Martínez-Sánchez MI, Domingo MMA, Gosselink M, Batstone M, Reichert M, Salö M, Soljic M, Zambon M, Angeles MA, Abdulkhaleq M, Abdelkarim M, Alsefri M, Iwasaki M, Shiota M, Veroux M, Molina-Corbacho M, Frasson M, Serenari M, De Pastena M, Desio M, Risaliti M, Rottoli M, Bence M, Chan M, Watson M, Wiles M, Boisson M, Berselli M, Capobianco M, Di Bartolomeo M, Fehervari M, Pacilli M, Romano M, Zizzo M, Domanin M, Montuori M, Podda M, Zago M, Dzogbefia M, Frountzas M, Thaw MH, Al-Juaifari M, Gharat M, Mohamed M, Hannan MJ, Venketeswaran M, Chisthi M, Dessalegn M, Kaplan M, Çakıcı MÇ, Ulutaş ME, Hassan M, Elsadek M, Mengesha MG, Gómez ME, Elbadawy MA, Pitcher M, Tanal M, Tokocin M, Ergenç M, Çelik MN, Bareka M, Pekcici MR, Cappuccio M, Dasa M, Dewan M, El Boghdady M, Ezeanochie M, Greenhalgh M, Jenkinson M, Kelly M, Spartalis M, Zyskowski M, Racine M, De Cillia M, Chu MJJ, Mallmann MR, Zhu MZL, Klimovskij M, Vailas M, Kisielewski M, Adamina M, Campanelli M, Carvello M, Ammendola M, Manigrasso M, Scopelliti M, White M, Collins ML, Chevallay M, Borges MF, Mayo-Yáñez M, Melo MR, Ruiz-Marín M, Eiras MAF, Cunha MF, Pertea M, Slavchev M, Davidescu M, Prieto M, Agapov M, Gahwagi M, Prats MC, Rudic M, Verbic MS, Kostusiak M, Stoleriu MG, Lucas MA, Barone M, Ahmad M, Alemu MAA, Fatima M, Ida M, Sahu M, Muhaisen M, Salem M, Emara MM, Oludara M, Sotudeh M, Kassab MB, Abdelkhalek M, Alsori M, Anwar M, El-Kassas M, Elbahnasawy M, Eldabaa M, Rabie M, Hassanin MA, Thaha MA, Ali MSM, Alhamid M, Almoshantaf MB, Keramati MR, Bafaquh M, Abuzaid M, Al-Shehari M, Alharthi M, Alkahlan M, Alwash M, Alyousef M, Amir M, Basendowah M, Deputy M, Jibreel M, Alam MS, Alsharif M, Issahalq MD, Omer MEA, Abubakar MK, Draman MR, Elnour MAE, Eltayeb M, Castillo MN, Jawad M, Raut M, Ghalleb M, Katsura M, Lebe M, Abbas M, Abdelrahman M, Shalaby M, Farhan-Alanie M, Farooq M, Musadaq M, Arshad M, Anjum MA, Usman M, Chaudhary MA, Raza MA, Karim MFSA, Chaudhary MH, Janjua MH, Khokhar MI, Malik MIK, Pirzada MT, Younis MU, Elhadi M, Suer MS, Ergenç M, Binnawara M, Emmanuel M, Abbasi M, Naimzada MD, Kulimbet M, Kusunoki M, Eugene M, Chauhan M, Shokor MA, Aljiffry M, Kalın M, Kurawa M, Dincer MB, Tolani MA, Soytas M, Yakubu M, Usman MI, Aremu M, Paranyak M, Talat N, Kausar N, Dudi-Venkata N, Bazzi N, Hasan NB, Van Wyk NN, Shaban N, Almgla N, Kandevani NY, Alzerwi N, Alvarez N, Motas N, Rincón NAR, Blencowe N, Simon N, Aghtarafi N, Ghuman NK, Sharma N, Wijekoon N, Kumar N, Hassan N, Onyemaechi N, Prijović N, Özçay N, Goel N, Segaren N, Sharma N, Kalyva N, Palacios NM, Alonso NFP, Onyeagwara N, Petrucciani N, Daddi N, Lightfoot N, Power N, Segaren N, Starr N, Dreger NM, Cillara N, Colucci N, Eardley N, Tartaglia N, Zanini N, Bacalbasa N, Campuzano N, Mouawad N, Federico NSP, Tamini N, Mariani NM, Beasley N, Adu-Aryee NA, Burlov N, Dimitrokallis N, Gouvas N, Machairas N, Memos N, Thomakos N, Tsakiridis N, Schizas N, Börner N, Theochari N, Al-Saadi N, Glass N, Horesh N, R NE, Gahlot N, Ismail N, Aljirdabi N, Maria NUH, Trabulsi N, Akeel N, Borges N, Moda N, Redondo NV, Nyarko OO, Ginghina O, Enciu O, Okere O, Ekwunife OH, Quadri O, Ogundoyin O, Tucker O, Mateo-Sierra O, Azzis O, Ojewuyi O, Habeeb O, Idowu O, Elebute O, Agboola O, Ladipo-Ajayi O, Oyinloye O, Adebola O, Ekor O, Ogundoyin O, Salamanca O, Vergara-Fernandez O, Wafi O, Aladawi O, Bahassan OM, Tammo Ö, Ozkan OF, Williams OM, Salami O, Akinajo O, Sakhov O, Gallo O, Sole OM, Milella O, Alser O, Bettar OA, Alomar O, Osman OS, Aisuodionoe-Shadrach O, Basnayake O, Bozbiyik O, Hodges O, Ojo O, Yanık Ö, Mutlu ÖPZ, Kazan O, Calavia P, García PR, Urriza PV, Lopez PR, Christidis P, Dorovinis P, Kokoropoulos P, Mourmouris P, Papatheodorou P, Garg PK, Patel P, Vassiliu P, Campennì P, De Nardi P, Bernante P, Ubiali P, Baroffio P, Pizzini P, Sapienza P, Myrelid P, Chatzikomnitsa P, Tsiantoula P, Gada P, Avella P, Cianci P, Romero P, Méndez PS, Pazmiño PAF, Coughlin P, Kirchweger P, Pessaux P, Maguire PJ, Petrone P, Cullis P, Köglberger P, Marriott P, Nankivell P, Santos-Costa P, Martins PN, Panahi P, Botelho P, Teixeira P, Escobar P, Vázquez PJG, Gribnev P, Nolte P, Agbonrofo P, Bobak P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, Othman R, Saad R, Amores RR, Colombari RC, Radivojević RC, Patrone R, Novysedlák R, Palacios Huatuco RM, Baertschiger R, Liang R, Luckwell R, Escrevente R, Rezende RF, Cruz RP, Lenzi R, Rosati R, Donovan R, Egan R, Morris R, Page R, Seglenieks R, Unsworth R, Wilkin R, Skipworth RJ, Davies RJ, Bezirci R, Talwar R, Azami R, Bohmer R, Crichton R, Fruscio R, Hooker R, Jach R, Parker R, Pillerstorff R, Sinnerton R, Stabler R, O'connell RM, Ragozzino R, Tutino R, Angelico R, Cammarata R, Colasanti R, Macchiavello R, Peltrini R, Pirrello R, Vaschetti R, Pires RE, Papalia R, Arrangoiz R, Hompes R, Mittal R, Salah R, Pinto R, Flumignan R, Callan R, Cuthbert R, Dennis R, Scaramuzzo R, Macías RM, Sánchez R, Ogu R, Ramely R, Sgarzani R, Ramli R, Hillier R, Thumbadoo R, Ooi R, Abdus-Salam R, Masri R, Hodgson R, Mathew R, Wade R, D'archi S, Khan S, Ngaserin S, Kale S, Hassan S, Merghani S, Benamar S, Muhammad S, Badran S, Elsahli S, Heta S, Hammouche S, Baeesa S, Paiella S, Eldeen STEHT, Arkani S, Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, Amin S, Ahmad S, Shoukrie SIM, Karar S, Patkar S, Abdulsalam S, Lin S, Hegde S, Fiorelli S, Quaresima S, Redondo SV, Palmisano S, Ruggiero S, Balogun S, Cais S, Cole S, Federer S, Le Roux S, Ippoliti S, Meneghini S, Viola S, Manfredelli S, Novello S, Gananadha S, Mesli SN, Kale S, Tani SI, Malik S, Anastasiadou S, Boligo S, Esposito S, Valanci S, Xenaki S, Pejkova S, Bandyopadhyay S, Trungu S, Basu S, Alkhatib S, Pérez-Bertólez S, Flores SL, Donoghue S, Lunca S, Orsoo S, Potamianos S, Devarakonda S, Suresh S, Croghan SM, Turi S, Capella S, Lucchini S, Magnone S, Salizzoni S, Scabini S, Scaringi S, Cioffi SPB, Seyfried S, Degener S, Potten S, Taha-Mehlitz S, Ali S, Angamuthu S, Mcaleer S, Knight SR, White S, Mantziari S, Kykalos S, Goh SK, Chowdhury SP, Ibrahim S, Elzwai S, Bansal S, Tripathy S, Amrayev S, Anwar SL, Banerjee S, Thakar S, Saeed S, Venkatappa SK, Das S, Techapongsatorn S, Dube SK, Lee S, González-Suárez S, Henriques S, Konjevoda S, Gisbertz S, Bravo SL, Mannan S, Bukhari SI, Zafar SN, Batista S, Chin SL, Arif T, Lawal TA, Aktokmakyan TV, Osborn T, Szakmany T, Sztipits T, Triantafyllou T, Valadez TAC, Singh T, Khaliq T, Patel T, Fadalla T, Jichi T, Sammour T, Al-Shaiji T, Naggs T, Barišić T, Nikolouzakis T, Bisgin T, Perra T, Uprak TK, Dagklis T, Liakakos T, Sidiropoulos T, Adjeso TJK, Dölker T, Oung T, Aherne T, Diehl T, Pinkney T, Raymond T, Rhomberg T, Schmitz-Rixen T, Madhuri TK, Lohmann TK, Yeoh T, Zaimis T, Bright T, Vilz TO, Glowka TR, Board T, Hardcastle T, Cohnert T, Mahečić TT, William TG, Klatte T, Abbott T, Watcyn-Jones T, Mendes T, Kulis T, Sečan T, Campagnaro T, Frisoni T, Simoncini T, Violante T, Safranovs TJ, Risteski T, Pang T, Akinyemi T, Yotsov T, Laeke T, Kochiyama T, Sholadoye TT, Alekberli T, Ezomike U, Giustizieri U, Grossi U, Köksoy ÜC, Bork U, Kisser U, Ronellenfitsch U, Saeed U, Bracale U, Jayarajah U, Rauf UHA, Bumbasirevic U, Ferrer UMJ, Ahmed U, Bello UM, Jogiat U, Sadia U, Galandarov V, Narayanan V, Calu V, Bianchi V, Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
Collapse
|
16
|
Manzo CA, Annicchiarico A, Valiyeva S, Picciariello A, Gallo G, Bislenghi G. Correction to: Practice of proctology among general surgery residents and young specialists in Italy: a snapshot survey. Updates Surg 2023:10.1007/s13304-023-01556-x. [PMID: 37294495 DOI: 10.1007/s13304-023-01556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Carlo Alberto Manzo
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Unit of General Surgery, Vaio Hospital, Fidenza, Parma, Italy
| | - Sayali Valiyeva
- Surgical Coloproctology, University of L'Aquila Department of Clinical Medicine and Biotecnology, Val Vibrata Hospital, Sant'Omero, TE, Italy
| | - Arcangelo Picciariello
- Division of General Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | - Gaetano Gallo
- Department of Surgery, La Sapienza" University of Rome, Rome, Italy
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| |
Collapse
|
17
|
Altomare DF, Dezi A, Picciariello A. The effect of misunderstanding the St Matthew evangelical message on academic medical practice: The Matthew effect. Eur J Clin Invest 2023:e14005. [PMID: 37039723 DOI: 10.1111/eci.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/16/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Donato F Altomare
- Dept of Emergency and Organ transplantation - University Aldo Moro of Bari, Italy
| | - Agnese Dezi
- Dept of Emergency and Organ transplantation - University Aldo Moro of Bari, Italy
| | | |
Collapse
|
18
|
Gallo G, Picciariello A, Pietroletti R, Novelli E, Sturiale A, Tutino R, Laforgia R, Moggia E, Pozzo M, Roveroni M, Bianco V, Realis Luc A, Giuliani A, Diaco E, Naldini G, Trompetto M, Perinotti R, D'Andrea V, Lobascio P. Sclerotherapy with 3% polidocanol foam to treat second-degree haemorrhoidal disease: Three-year follow-up of a multicentre, single arm, IDEAL phase 2b trial. Colorectal Dis 2023; 25:386-395. [PMID: 36268758 DOI: 10.1111/codi.16380] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/12/2022] [Accepted: 10/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I-II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow-up of more than 1 year. The purpose of this study was to analyse the long-term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II-degree HD. METHODS This was an open label, single-arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS-HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. RESULTS The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow-up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow-up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10-13) and 18 (15-20) to 0 (0-2) and 4 (0-4), respectively. Symptom-free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo-sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. CONCLUSIONS Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate.
Collapse
Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Science, University of Catanzaro, Catanzaro, Italy
- Minerva Surgical Service, Catanzaro, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ transplantation and Inter-Department Research Centre for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Renato Pietroletti
- Proctology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Roberta Tutino
- Chirurgia 1, Azienda ULSS 2 Marca Trevigiana, Ospedale Regionale Treviso, Treviso, Italy
| | - Rita Laforgia
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Elisabetta Moggia
- Department of General Surgery, Infermi Hospital, Rivoli, Torino, Italy
| | - Mauro Pozzo
- Department of General Surgery, "Degli Infermi" Hospital, Biella, Italy
| | | | | | | | - Antonio Giuliani
- General Surgery Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elia Diaco
- Minerva Surgical Service, Catanzaro, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - Roberto Perinotti
- Department of General Surgery, "Degli Infermi" Hospital, Biella, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Lobascio
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
19
|
Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
Collapse
Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Gallo G, Guaitoli E, Barra F, Picciariello A, Pasculli A, Coppola A, Pertile D, Meniconi RL. Restructuring surgical training after COVID-19 pandemic: A nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC). Front Surg 2023; 9:1115653. [PMID: 36713665 PMCID: PMC9875563 DOI: 10.3389/fsurg.2022.1115653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 12/04/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction The COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic. Materials and methods A 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021. Results Four hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%). Conclusion Our survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions.
Collapse
Affiliation(s)
- Gaetano Gallo
- Department of Surgical Sciences, La Sapienza” University of Rome, Rome, Italy
| | | | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy,Correspondence: Arcangelo Picciariello
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology - Unit of Endocrine, Digestive and Emergency Surgery, University “A. Moro” of Bari, Policlinic of Bari, Bari, Italy
| | | | - Davide Pertile
- Department of Surgery, Policlinico San Martino, Genova, Italy
| | - Roberto Luca Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | |
Collapse
|
21
|
Tomasicchio G, Dezi A, Picciariello A, Altomare DF, Giove C, Martines G, De Fazio M, Rinaldi M. Safety and efficacy of Levorag emulgel in the treatment of anal fissures using a validated scoring system. Front Surg 2023; 10:1145170. [PMID: 37035554 PMCID: PMC10073417 DOI: 10.3389/fsurg.2023.1145170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/15/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Anal fissure is one of the most common anal disease characterized by intense anal pain, and deterioration of patients quality of life. Treatment is mainly based on the topical administration of calcium antagonist or nitric oxide ointments, and in cases refractory to medical treatment patients can undergo surgery. This study aims to assess the efficacy and safety of Levorag emulgel in the treatment of acute and chronic fissures using of a validated scoring system. Material and Methods A prospective observational study was carried out on patients with anal fissures between February and May 2022. The efficacy of the treatment was evaluated using the REALISE score, a new validated scoring system that rates VAS for pain, NSAID use, pain duration, bleeding, and quality of life (QoL), recorded after 10, 20 and 30 days from the beginning of treatment. Results Forty patients (median age 46 years, IQR 29-57, 70% women) with acute (22, 55%) or chronic (18, 45%) anal fissures entered the study. The median anal pain score according to the VAS scale decreased significantly from 7 (IQR 4.7-8) at baseline to 1 (IQR 0-3.2, p = 0.05) after 20 days. At the 30-day proctological examination, 22 patients (61%) were pain free (median VAS of 0, IQR 0-1.2, p < 0.05). Pain duration after defecation measured according to the REALISE score, showed a significant decrease after 10 days, from a median value of 2 (IQR 1-4) to 1 (IQR 1-1.2) (p < 0.005). The median value of the REALISE score decreased significantly, from 15 (IQR 11-19.25) at first proctological evaluation to 4 (IQR 4-6, p = 0.139) after 30 days of treatment. At day 30, complete fissure healing was achieved in 30 patients (80%). The healing rate was 82% and 78% in patients with acute and chronic anal fissures, respectively. Conclusion The use of Levorag® Emulgel may represent a safe and effective non-invasive first line treatment in patients affected by acute or chronic anal fissure.
Collapse
|
22
|
Gallo G, Picciariello A, Di Tanna GL, Pelizzo P, Altomare DF, Trompetto M, Santoro GA, Roviello F, Felice C, Grossi U. Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences. Colorectal Dis 2022; 24:1462-1471. [PMID: 35792887 PMCID: PMC10086798 DOI: 10.1111/codi.16248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
AIM The optimal surgical treatment for anatomical anal stenosis (AS) remains to be determined. The aim of this study was to determine the rates of complications and recurrence after anoplasty for anatomical AS and, wherever feasible, compare the outcomes for the various techniques. METHOD A PROSPERO-registered systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, PubMed, Embase, Cochrane Library of Systematic Review, Scopus and Web of Science were searched for articles published up to May 2021. Studies that assessed the outcomes of anoplasty in adult patients with anatomical AS were selected. The primary outcomes were complications and recurrence. The methodological quality of studies was appraised using the Joanna Briggs Institute critical appraisal tools. RESULTS From the total of 2705 unique screened records, 151 were assessed for eligibility. Only 29 studies (two prospective) met the inclusion criteria, reporting data on 556 patients [mean age 53 (18-83) years, 46% female]. Previous history of surgery for haemorrhoidal disease accounted for three quarters of cases. A total of 14 types of anoplasty were found, with the Y-V flap being the most performed technique [27% of cases (n = 149)]. Complications frequently occurred, with a pooled prevalence of 10.2% (95% CI 3.9%-24.1%) after Y-V flap and 11.5% (5.3%-23.0%) after rhomboid/diamond flap. Patients undergoing house flap achieved better results in terms of clinical improvement, satisfaction and quality of life compared with Y-V flap and rhomboid/diamond flap. When considering only studies with at least 12 months of follow-up, the pooled prevalence of recurrence was 4.7% (2.2%-9.8%), with significantly higher rates observed in the prospective versus retrospective series [pooled prevalence 18.9% (11.5%-29.5%) vs. 3.6% (1.7-7.8%), respectively; p < 0.001]. CONCLUSION Both complications and recurrence were significantly lower after house flap compared with rhomboid/diamond and Y-V flap. Better designed multicentre studies with longer follow-up are needed to confirm these findings. PROSPERO REGISTRATION NUMBER CRD42021239493.
Collapse
Affiliation(s)
- Gaetano Gallo
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Arcangelo Picciariello
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationUniversity ‘Aldo Moro of Bari’BariItaly
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Patrizia Pelizzo
- II Surgery UnitRegional Hospital Treviso, AULSS2TrevisoItaly
- Department of Medicine – DIMEDUniversity of PaduaPaduaItaly
| | - Donato Francesco Altomare
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationUniversity ‘Aldo Moro of Bari’BariItaly
| | | | | | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Carla Felice
- Department of Medicine – DIMEDUniversity of PaduaPaduaItaly
| | - Ugo Grossi
- II Surgery UnitRegional Hospital Treviso, AULSS2TrevisoItaly
- Department of Surgery, Oncology and Gastroenterology – DISCOGUniversity of PaduaPaduaItaly
| |
Collapse
|
23
|
Picciariello A, Rinaldi M, Grossi U, Trompetto M, Graziano G, Altomare DF, Gallo G. Time trend in the surgical management of obstructed defecation syndrome: a multicenter experience on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2022; 26:963-971. [PMID: 36104607 DOI: 10.1007/s10151-022-02705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Surgical management of obstructed defecation syndrome (ODS) is challenging, with several surgical options showing inconsistent functional results over time. The aim of this study was to evaluate the trend in surgical management of ODS in a 10-year timeframe across Italian referral centers.
Methods
Surgeons from referral centers for the management of pelvic floor disorders and affiliated to the Italian Society of Colorectal Surgery provided data on the yearly volume of procedures for ODS from 2010 to 2019. Six common clinical scenarios of ODS were captured, including details on patient’s anal sphincter function and presence of rectocele and/or rectal intussusception. Perineal repair, ventral rectopexy (VRP), transanal repair (internal Delorme), stapled transanal rectal resection (STARR), Contour Transtar, and transvaginal repair were considered in each clinical scenario.
Results
Twenty-five centers were included providing data on 2943 surgical patients. Procedure volumes ranged from 10–20 (54%) to 21–50 (46%) per year across centers. The most performed techniques in patients with good sphincter function were transanal repair for isolated rectocele (243/716 [34%]), transanal repair for isolated rectal intussusception (287/677 [42%]) and VRP for combined abnormalities (464/976 [48%]). When considering poor sphincter function, these were perineal repair (112/194 [57.8%]) for isolated rectocele, and VRP for the other two scenarios (60/120 [50%] and 97/260 [37%], respectively). The use of STARR and Contour Transtar decreased over time in patients with impaired sphincter function.
Conclusions
The complexity of ODS treatment is confirmed by the variety of clinical scenarios that can occur and by the changing trend of surgical management over the last 10 years.
Collapse
|
24
|
Tomasicchio G, D'abramo FS, Dibra R, Trigiante G, Picciariello A, Dezi A, Rotelli MT, Ranaldo N, Di Leo A, Martines G. Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction? Surgery 2022; 172:807-812. [PMID: 35791977 DOI: 10.1016/j.surg.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the most controversial issues surrounding laparoscopic sleeve gastrectomy is the development of gastroesophageal reflux disease following surgery. The aim of the study was to evaluate the occurrence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy and to analyze patients' weight loss, comorbidities, and quality of life after surgery. METHODS The clinical records of 52 patients submitted to laparoscopic sleeve gastrectomy between January and November 2018, with 3 years of follow-up, were retrospectively reviewed. At the end of the follow-up period, the patients underwent screening endoscopy, and those with postoperative esophagitis were submitted to endoscopic biopsies and pH-impedance monitoring (MII-pH). The presence of gastroesophageal reflux disease symptoms was assessed using the modified clinical DeMesteer score questionnaire. The Bariatric Analysis and Reporting Outcome System score and 36-Item Short Form Health Survey were used to assess the postoperative quality of life. RESULTS In the preoperative work-up, only 7.6% of patients had signs of esophagitis at esophagogastroduodenoscopy, whilst at 3-year follow-up, 50% of them had endoscopic signs of gastroesophageal reflux disease. Twenty-one out of 26 patients with signs of esophagitis agreed to undergo MII-pH. The median DeMesteer score questionnaire was 4.5, with only 4 patients (19%) exhibiting a value greater than the pH cut-off value (14.72), indicative of gastroesophageal reflux disease. MII-pH data analysis showed the presence of gastroesophageal reflux disease in 5 patients. An excellent outcome on the Bariatric Analysis and Reporting Outcome System score was reported in 50% of patients, and all 8 domains from the 36-Item Short Form Health Survey improved significantly. CONCLUSION This study showed an improvement in these patients' quality of life and the limited refluxogenic nature of laparoscopic sleeve gastrectomy at 3-year follow-up when diagnosis of gastroesophageal reflux disease is based on the Lyon consensus.
Collapse
Affiliation(s)
- Giovanni Tomasicchio
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
| | - Fulvio Salvatore D'abramo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Rigers Dibra
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Trigiante
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Arcangelo Picciariello
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Agnese Dezi
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Maria Teresa Rotelli
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Nunzio Ranaldo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Gennaro Martines
- General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
25
|
Picciariello A, Rinaldi M, Grossi U, Verre L, De Fazio M, Dezi A, Tomasicchio G, Altomare DF, Gallo G. Management and Treatment of External Hemorrhoidal Thrombosis. Front Surg 2022; 9:898850. [PMID: 35592120 PMCID: PMC9110961 DOI: 10.3389/fsurg.2022.898850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades. Methods This mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered. Results Traditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique. Conclusion The management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
Collapse
Affiliation(s)
- Arcangelo Picciariello
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Marcella Rinaldi
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Ugo Grossi
- II Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Treviso, Italy
- Correspondence: Ugo Grossi
| | - Luigi Verre
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Agnese Dezi
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Donato F Altomare
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| |
Collapse
|
26
|
Kuiper SZ, Gallo G, Trompetto M, Picciariello A, Breukink SO. Editorial: Haemorrhoidal Disease: Old Solutions and Future Perspectives. Front Surg 2022; 9:905570. [PMID: 35495749 PMCID: PMC9039453 DOI: 10.3389/fsurg.2022.905570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sara Z. Kuiper
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
- Correspondence: Gaetano Gallo
| | | | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Stéphanie O. Breukink
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Department of Surgery, School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
27
|
Picciariello A, Gallo G, Sturiale A, Litta F, De Simone V, Martines G, Naldini G, Ratto C, Trompetto M, Rinaldi M. Clinical and functional outcome of surgery for posttraumatic cloacal deformity. Colorectal Dis 2022; 24:497-503. [PMID: 34860453 DOI: 10.1111/codi.16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 02/08/2023]
Abstract
AIM Cloacal deformity is a disabling condition that severely affects a patient's quality of life. Surgery to repair cloacal deformity remains the mainstay of treatment. The aim of this study is to assess the clinical and functional outcome of patients treated for traumatic cloacal deformity by three different techniques. METHOD A retrospective multicentre study was carried out using data from women operated on for cloacal deformity between 2015 and 2019. Demographic characteristics, the presence of urinary and/or faecal incontinence and manometric findings were collected. The main outcome measures were represented by St Mark's and Rockwood faecal incontinence quality of life scores. RESULTS Thirty eight women with a median age of 34 years [interquartile range (IQR) 31-39 years] were enrolled. Perineoplasty was performed in 23 patients by direct suture of the rectovaginal septum, in five using the X-flap and in 10 by the Singapore flap. Median resting and squeezing pressures increased significantly from 28.15 (IQR 23-32.7) cmH2 O to 45 (IQR 31-60.7) cmH2 O (p = 0.0001) and from 47 (IQR 41.2-54.7) cmH2 O to 97.2 (IQR 80-118) cmH2 O (p = 0.0001), respectively. Maximum tolerable volume improved from 120 (IQR 90-137.5) ml to 137.5 (IQR 120-150) ml (p = 0.002). The St Mark's score decreased from 18 (IQR 14-20) to 4.5 (IQR 2-8) after 20 months (p = 0001). Sexual activity was confirmed by 16 patients preoperatively and by 27 postoperatively. A diverting stoma was performed in three patients after X-flap perineoplasty and in 14 treated by direct closure. No significant differences were found pre- and postoperatively between the three groups. CONCLUSION Regardless of the technique used, surgical repair significantly improves both clinical and functional outcomes irrespective of the presence of a covering stoma.
Collapse
Affiliation(s)
- Arcangelo Picciariello
- Department of Emergency and Organ transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Gaetano Gallo
- Department of Medical and SurgicalSciences, Universitàdegli Studi Magna Graecia di Catanzaro Scuola di Medicina e Chirurgia, Catanzaro, Italy
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Francesco Litta
- Proctology Unit, University Hospital 'A. Gemelli', Catholic University, Largo A. Gemelli, Rome, Italy
| | - Veronica De Simone
- Proctology Unit, University Hospital 'A. Gemelli', Catholic University, Largo A. Gemelli, Rome, Italy
| | - Gennaro Martines
- Department of Emergency and Organ transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Carlo Ratto
- Proctology Unit, University Hospital 'A. Gemelli', Catholic University, Largo A. Gemelli, Rome, Italy
| | - Mario Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - Marcella Rinaldi
- Department of Emergency and Organ transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
28
|
Grossi U, Romano M, Rossi S, Gallo G, Picciariello A, Felice C, Trojan D, Montagner G, Zanus G. Anal Fistula Human Amniotic Membrane Endosealing (F-HAME): A Proof of Concept Study. Front Surg 2022; 9:869923. [PMID: 35419402 PMCID: PMC8995564 DOI: 10.3389/fsurg.2022.869923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 12/14/2022] Open
Abstract
The treatment of cryptoglandular anal fistula (AF) is often a challenge for surgeons. Several sphincter-saving procedures have been described as an alternative to fistulotomy, with the common goal of promoting healing and preserve anal continence. The aim of this proof of concept study was to assess the outcomes of human amniotic membrane (HAM) implantation in cryptoglandular transphincteric AF. Two consecutive female were recruited. The primary outcome was clinical healing at 6 months. Secondary outcomes were ultrasonographic healing, complications and reinterventions, AF symptoms, fecal incontinence, psychological impact of treatment, recurrence, development of additional AF, patient satisfaction, and quality of life, as measured using validated questionnaires. Both patients (40 and 54-year-old) previously underwent incision and drainage of anal abscess with concomitant seton placement. HAM implantation was performed as a day case under local anesthesia. No intra- or post-procedural complications occurred. Clinical and radiological healing were not achieved at 6 months. However, the external outlet discharge diminished through time, with sustained improvements in quality of life. Clinical healing occurred at 7 months in both patients. Psychological impact of treatment and patient satisfaction were overall good, with improvements in the PHQ-9, GAD-7, and Short Assessment of Patients Satisfaction. HAM implantation is safe and improves patients' quality of life, progressively leading to clinical healing. Future studies are needed to assess its safety in other etiology of AF.
Collapse
Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Regional Hospital Treviso, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | | | - Serena Rossi
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Arcangelo Picciariello
- Surgical Unit ‘M. Rubino', Department of Emergency and Organ Transplantation, University ‘Aldo Moro of Bari', Bari, Italy
| | - Carla Felice
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | | | | | - Giacomo Zanus
- II Surgery Unit, Regional Hospital Treviso, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| |
Collapse
|
29
|
Tomasicchio G, Picciariello A, Dibra R, Lantone G, Trigiante G, De Fazio M, Martines G. Histopathologic findings on removed stomach after sleeve gastrectomy. Do they influence the outcome? Open Med (Wars) 2022; 17:485-491. [PMID: 35350837 PMCID: PMC8919837 DOI: 10.1515/med-2022-0450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 12/17/2022] Open
Abstract
Little is known about the role of chronic gastritis on weight loss after laparoscopic sleeve gastrectomy (LSG). This study aims to investigate the relationship between histopathologic findings of gastric specimens, excess weight loss (% EWL), and excess BMI loss (% EBL) at 6 and 12 months follow up after LSG. We retrospectively reviewed the clinical records of 95 patients who had undergone LSG between January 2017 and December 2019. Based on the histopathological findings of gastric resection specimens, patients were divided into those with chronic gastritis (CG) and those without chronic gastritis (NoCG) and compared for their % EWL and % EBL at 6 and 12 months. The mean BMI was 44.74 kg/m2 in the CG group and 44.14 kg/m2 in the NoCG group. At 6 months follow up, the CG group had a mean % EWL of 45.7 and % EBL of 40.5, while NoCG had a mean % EWL of 51.1 and % EBL of 46.7. After 1-year follow-up, the CG group had a mean % EWL of 53.1 and a % EBL of 44.8, while the NoCG group had a % EWL of 54.1 and % EBL of 44. This observational study does not support the hypothesis that the occurrence of chronic gastritis can affect postoperative % EWL and % EBL.
Collapse
Affiliation(s)
- Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Rigers Dibra
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuliano Lantone
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Gennaro Martines
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| |
Collapse
|
30
|
Picciariello A, Tomasicchio G, Lantone G, Martines G, Dibra R, Trigiante G, d'Amati A, Piscitelli D, Altomare DF. Synchronous "skip" facial metastases from colorectal adenocarcinoma: a case report and review of literature. BMC Gastroenterol 2022; 22:68. [PMID: 35172772 PMCID: PMC8848651 DOI: 10.1186/s12876-022-02141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Skin metastases from colorectal adenocarcinoma are rare conditions that are metachronous in most of cases and may represent the first sign of a recurrence. These lesions are usually located to the abdominal wall on postoperative scars, perineum and chest due to direct spread from the tumor or to the lymphatic and venous dissemination. We describe a rare case of synchronous skin metastases in a patient affected by sigmoid adenocarcinoma with no sign of liver and lung repetitive lesions. Case presentation We admitted a 59 years old male, with no relevant medical history. He was evaluated by our tertiary center of colorectal surgery complaining diarrhoea and abdominal pain. The physical examination revealed a palpable mass in left flank of the abdomen. The colonoscopy showed a sub-stenosis of the sigmoid colon (G2 adenocarcinoma). No repetitive lesions were detected by the preoperative CT scan. The patient reported a rapid grow of a soft supralabial and chin nodules in the last 2 months, which he believed to be related to the use of the mask due to COVID-19 pandemic. A laparoscopic left hemicolectomy with complete mesocolic excision and a local excision of both facial nodules were performed. The histological examination revealed a poorly differentiated signet ring cell colorectal adenocarcinoma with metastases in seven pericolic lymphonodes. The excisional biopsy of the skin nodules revealed a subcutaneous metastases from primary colorectal tumour. Conclusions As far as we know, synchronous facial metastases from colorectal cancer in the absence of any other metastases has never been described before. The onset of new skin nodules in patients affected by colorectal cancer should raise-up the clinical suspicion of metastatic lesions even when repetitive lesions are not detected in the liver or lungs.
Collapse
Affiliation(s)
- A Picciariello
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.
| | - G Tomasicchio
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Lantone
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Martines
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - R Dibra
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Trigiante
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - A d'Amati
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - D Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - D F Altomare
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| |
Collapse
|
31
|
Martines G, Tomasicchio G, Picciariello A, Dibra R, Trigiante G, Lantone G, Altomare DF. Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study. Open Med (Wars) 2022; 17:197-204. [PMID: 35111973 PMCID: PMC8772997 DOI: 10.1515/med-2022-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/29/2022] Open
Abstract
Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.
Collapse
Affiliation(s)
- Gennaro Martines
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Rigers Dibra
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuliano Lantone
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Donato Francesco Altomare
- Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| |
Collapse
|
32
|
Picciariello A, Rinaldi M, Dibra R, Trigiante G, Tomasicchio G, Lantone G, De Fazio M. Ageing with sacral nerve modulation for fecal incontinence: how many patients get benefit after more than 10 years? Updates Surg 2022; 74:185-191. [PMID: 34982410 PMCID: PMC8724665 DOI: 10.1007/s13304-021-01229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/30/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
Sacral nerve modulation (SNM) has represented a major advancement in the minimally invasive management of patients with fecal incontinence (FI). Although the success rate in the short–medium term has widely been demonstrated, the very long-term outcomes are poorly investigated. This study aims to assess the effectiveness of SNM in a cohort of patients with a follow-up longer than 10 years. Clinical records of patients submitted to SNM for FI in our tertiary referral colorectal Unit between 1998 and 2010 were retrospectively reviewed looking for status of the implantable pulse generator (IPG), follow-up duration, severity of FI by the St Marks’ score and quality of life. 58 patients fulfilled the entry criteria and 36 (58%, median follow-up, 12 years) accepted to take part to the telephone interview, while 22 (38%) were lost to the follow-up. Nineteen patients had their IPG removed (Group A) while 17 (27%) had the SNM still active after a median follow-up of 13 years (Group B). In the group A, the median baseline St Marks’ score was 13 and did not change after the IPG removal. In group B, the median baseline St Marks’ score was 14, at last IPG substitution, it was of 7 and at the last follow-up dropped to 4. In the group A, the median SF-12 physical and mental scores did not change significantly while they improved significantly in group B. A progressive deterioration of the success rate of SNM with the time has been documented after a very long-term follow-up.
Collapse
Affiliation(s)
- A Picciariello
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - M Rinaldi
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Dibra
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Trigiante
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Tomasicchio
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Lantone
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - M De Fazio
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
33
|
Sena G, Picciariello A, Marino F, Goglia M, Rocca A, Meniconi RL, Gallo G. One-Stage Total Laparoscopic Treatment for Colorectal Cancer With Synchronous Metastasis. Is It Safe and Feasible? Front Surg 2021; 8:752135. [PMID: 34869559 PMCID: PMC8637405 DOI: 10.3389/fsurg.2021.752135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/02/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022] Open
Abstract
Liver is the main target organ for colorectal cancer (CRC) metastases. It is estimated that ~25% of CRC patients have synchronous metastases at diagnosis, and about 60% of CRC patients will develop metastases during the follow up. Although several teams have performed simultaneous laparoscopic resections (SLR) of liver and colorectal lesions, the feasibility and safety of this approach is still widely debated and few studies on this topic are present in the literature. The purpose of this literature review is to understand the state of the art of SLR and to clarify the potential benefits and limitations of this approach. Several studies have shown that SLR can be performed safely and with short-term outcomes similarly to the separated procedures. Simultaneous laparoscopic colorectal and hepatic resections combine the advantages of one stage surgery with those of laparoscopic surgery. Several reports compared the short-term outcomes of one stage laparoscopic resection with open resections and showed a similar or inferior amount of blood loss, a similar or lower complication rate, and a significant reduction of hospital stay for laparoscopic surgery respect to open surgery but much longer operating times for the laparoscopic technique. Few retrospective studies compared long term outcomes of laparoscopic one stage surgery with the outcomes of open one stage surgery and did not identify any differences about disease free survival and the overall survival. In conclusion, hepatic and colorectal SLR are a safe and effective approach characterized by less intraoperative blood loss, faster recovery of intestinal function, and shorter length of postoperative hospital stay. Moreover, laparoscopic approach is associated to lower rates of surgical complications without significant differences in the long-term outcomes compared to the open surgery.
Collapse
Affiliation(s)
- Giuseppe Sena
- Department of Vascular Surgery, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | | | - Fabio Marino
- Unit of Surgery, National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Marta Goglia
- Department of General Surgery, "La Sapienza" University of Rome-Sant'Andrea University Hospital, Rome, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Roberto L Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
34
|
Papagni V, Picciariello A, Cardinale P, Vincenti L. Laparoscopic dissection of a lateral pelvic Schwannoma-a video vignette. Colorectal Dis 2021; 23:3035-3036. [PMID: 34402162 DOI: 10.1111/codi.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Vincenzo Papagni
- Department of Emergency and Organ Transplantation, University 'Aldo Moro', Bari, Italy
| | | | - Pierantonio Cardinale
- Department of Emergency and Organ Transplantation, University 'Aldo Moro', Bari, Italy
| | | |
Collapse
|
35
|
Tomasicchio G, Martines G, Lantone G, Dibra R, Trigiante G, De Fazio M, Picciariello A, Altomare DF, Rinaldi M. Safety and Effectiveness of Tailored Hemorrhoidectomy in Outpatients Setting. Front Surg 2021; 8:708051. [PMID: 34485375 PMCID: PMC8415450 DOI: 10.3389/fsurg.2021.708051] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Single or double prolapsed pile instead of full muco-hemorrhoidal prolapse is a common finding in patients with symptomatic III or IV degree hemorrhoids. For this selected group of patients, relief of symptoms could be achieved by managing the single/double prolapsed piles instead of performing traditional hemorrhoidectomy. The aim of this single-center study was to evaluate the safety and medium- and long-term effectiveness of an outpatient tailored Milligan-Morgan hemorrhoidectomy (MMH) performed under local anesthesia (LA). Material and methods: Clinical records of 202 patients submitted to outpatient tailored MMH, under LA and without anal dilation, treated between 2013 and 2020, were retrospectively reviewed using a prospectively maintained database and completed by a telephone interview or outpatient consultation. Postoperative pain score, the need for painkillers, postoperative complications and symptoms recurrence, return to working activities, and patient grading assessment scale were recorded. Results: Thirty-five (17%) out of 202 patients recruited were lost to the follow-up. One hundred and fifty-two and 15 patients underwent a single and double pile hemorrhoidectomy, respectively. With regard to postoperative outcomes, visual analogue scale (VAS) decreased from a median value of 4 [interquartile range (IQR) 2–6] on the day of surgery to 1 (IQR 0–4) on the 10th postoperative day (p < 0.001). Sixty-one patients (37%) needed oral painkillers during the 1st week after surgery. There was no mortality or major postoperative complication. Bleeding requiring hospital readmission was reported in seven (4%) patients, and one patient underwent emergency surgery with no need for blood transfusion. No postoperative urinary retention, anal incontinence, or stricture occurred in the series. During the median follow-up of 39 (IQR 12–60) months, 26 patients (16%) reported symptoms of recurrence but only six underwent traditional MMH. Recovery to normal activity occurred within a median period of 6 days (IQR 3–10) and the Clinical Patient Grading Assessment Scale (CPGAS) at 1 year after surgery was reported to be a “good deal better.” Conclusions: Tailored MMH performed under LA in an ambulatory setting can be considered a safe and effective technique with high compliance and satisfaction of patients.
Collapse
Affiliation(s)
- Giovanni Tomasicchio
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Gennaro Martines
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Giuliano Lantone
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Rigers Dibra
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Giuseppe Trigiante
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Michele De Fazio
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Arcangelo Picciariello
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Donato Francesco Altomare
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - Marcella Rinaldi
- Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
36
|
Au S, Bellato V, Carvas JM, Córdoba CD, Daudu D, Dziakova J, Eltarhoni K, El Feituri N, Fung ACH, Fysaraki C, Gallo G, Gultekin FA, Harbjerg JL, Hatem F, Ioannidis A, Jakobsen L, Clinch D, Kristensen HØ, Kuiper SZ, Kwok AMF, Kwok W, Millan M, Milto KM, Ng HJ, Pellino G, Picciariello A, Pronin S, van Ramshorst GH, Ramser M, Jiménez-Rodríguez RM, Sainz Hernandez JC, Samadov E, Sohrabi S, Uchiyama M, Wang JHS, Younis MU, Fleming S, Alhomoud S, Mayol J, Moeslein G, Smart NJ, Soreide K, Teh C, Verran D, Maeda Y. Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages. Br J Surg 2021; 108:1315-1322. [PMID: 34467970 DOI: 10.1093/bjs/znab275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/24/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally. METHODS A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. RESULTS Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance. CONCLUSION Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.
Collapse
Affiliation(s)
- S Au
- NHS Education for Scotland, Edinburgh, UK
| | | | | | - C D Córdoba
- University of Lausanne, Lausanne, Switzerland
| | - D Daudu
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | - J Dziakova
- Hospital Clinico San Carlos, IDISSC, Madrid, Spain
| | | | | | - A C H Fung
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - C Fysaraki
- Urology Department, Mid Yorkshire Hospitals NHS Trust, UK
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ayca Gultekin
- General Surgery Department, Zonguldak Bulent, Ecevit University School of Medicine, Zonguldak, Turkey
| | - J L Harbjerg
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - F Hatem
- Glasgow Royal Infirmary, Glasgow, UK
| | | | - L Jakobsen
- UiT, The Arctic University of Norway, University Hospital of North Norway, Tromso, Norway
| | - D Clinch
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - H Ø Kristensen
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - S Z Kuiper
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | | | - W Kwok
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Millan
- Coloproctology Unit, Department of Surgery, La Fe University Hospital, Valencia, Spain
| | - K M Milto
- NHS Education for Scotland, Edinburgh, UK
| | - H J Ng
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, UK
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Italy
| | - S Pronin
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Ramser
- Department of Surgery, Solothurner Spitäler SoH, Bürgerspital Solothurn, Solothurn, Switzerland
| | | | - J C Sainz Hernandez
- Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - E Samadov
- Surgical Department, LEYLA Medical Centre, Baku, Azerbaijan
| | | | - M Uchiyama
- Showa University School of Medicine, Tokyo, Japan
| | - J H-S Wang
- Australasian Students' Surgical Association, New Zealand
| | - M U Younis
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | - S Fleming
- Barts and the London School of Medicine and Dentistry, London, UK
| | - S Alhomoud
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - J Mayol
- Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain
| | - G Moeslein
- Ev. Bethesda Khs Duisburg, University of Witten, Herdecke, Germany
| | - N J Smart
- Royal Devon & Exeter Hospital & University of Exeter Medical School, Exeter, UK
| | - K Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Teh
- Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney & Transplant Institute, Quezon City, Philippines
| | - D Verran
- Ramsey Health Care, Sydney, Australia
| | - Y Maeda
- Department of Colorectal Surgery, Western General Hospital and University of Edinburgh, Edinburgh, UK
| |
Collapse
|
37
|
Picciariello A, Altomare DF, Gallo G, Grossi U. Gender distribution in the editorial boards of surgical journals: A snapshot from Western Europe. Surgery 2021; 170:1292. [PMID: 34366129 DOI: 10.1016/j.surg.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.
| | | | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Padua, Italy
| |
Collapse
|
38
|
Gallo G, Picciariello A, Di Tanna GL, Santoro GA, Perinotti R, Grossi U. E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study. Updates Surg 2021; 74:163-170. [PMID: 34312817 PMCID: PMC8312353 DOI: 10.1007/s13304-021-01139-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders’ median age was 44.5 (IQR 36–60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated.
Collapse
Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy.,Apulian Breath Analysis Centre (CeRBA), IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gian Luca Di Tanna
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | | | - Roberto Perinotti
- Department of Surgery, Colorectal Surgical Unit, Infermi Hospital, Biella, Italy
| | | | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Padua, Italy
| |
Collapse
|
39
|
Guerra E, Trerotola M, Relli V, Lattanzio R, Tripaldi R, Vacca G, Ceci M, Boujnah K, Garbo V, Moschella A, Zappacosta R, Simeone P, de Lange R, Weidle UH, Rotelli MT, Picciariello A, Depalo R, Querzoli P, Pedriali M, Bianchini E, Angelucci D, Pizzicannella G, Di Loreto C, Piantelli M, Antolini L, Sun XF, Altomare DF, Alberti S. Trop-2 induces ADAM10-mediated cleavage of E-cadherin and drives EMT-less metastasis in colon cancer. Neoplasia 2021; 23:898-911. [PMID: 34320447 PMCID: PMC8334386 DOI: 10.1016/j.neo.2021.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022] Open
Abstract
We recently reported that activation of Trop-2 through its cleavage at R87-T88 by ADAM10 underlies Trop-2–driven progression of colon cancer. However, the mechanism of action and pathological impact of Trop-2 in metastatic diffusion remain unexplored. Through searches for molecular determinants of cancer metastasis, we identified TROP2 as unique in its up-regulation across independent colon cancer metastasis models. Overexpression of wild-type Trop-2 in KM12SM human colon cancer cells increased liver metastasis rates in vivo in immunosuppressed mice. Metastatic growth was further enhanced by a tail-less, activated ΔcytoTrop-2 mutant, indicating the Trop-2 tail as a pivotal inhibitory signaling element. In primary tumors and metastases, transcriptome analysis showed no down-regulation of CDH1 by transcription factors for epithelial-to-mesenchymal transition, thus suggesting that the pro-metastatic activity of Trop-2 is through alternative mechanisms. Trop-2 can tightly interact with ADAM10. Here, Trop-2 bound E-cadherin and stimulated ADAM10-mediated proteolytic cleavage of E-cadherin intracellular domain. This induced detachment of E-cadherin from β-actin, and loss of cell-cell adhesion, acquisition of invasive capability, and membrane-driven activation of β-catenin signaling, which were further enhanced by the ΔcytoTrop-2 mutant. This Trop-2/E-cadherin/β-catenin program led to anti-apoptotic signaling, increased cell migration, and enhanced cancer-cell survival. In patients with colon cancer, activation of this Trop-2–centered program led to significantly reduced relapse-free and overall survival, indicating a major impact on progression to metastatic disease. Recently, the anti-Trop-2 mAb Sacituzumab govitecan-hziy was shown to be active against metastatic breast cancer. Our findings define the key relevance of Trop-2 as a target in metastatic colon cancer.
Collapse
Affiliation(s)
- Emanuela Guerra
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Trerotola
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Valeria Relli
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Oncoxx Biotech, 66034 Lanciano (Chieti), Italy
| | - Rossano Lattanzio
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine & Dentistry, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy
| | - Romina Tripaldi
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giovanna Vacca
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Martina Ceci
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Khouloud Boujnah
- Unit of Medical Genetics, Department of Biomedical Sciences - BIOMORF, University of Messina, 98125 Messina, Italy
| | - Valeria Garbo
- Unit of Medical Genetics, Department of Biomedical Sciences - BIOMORF, University of Messina, 98125 Messina, Italy
| | - Antonino Moschella
- Unit of Medical Genetics, Department of Biomedical Sciences - BIOMORF, University of Messina, 98125 Messina, Italy
| | - Romina Zappacosta
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Pasquale Simeone
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Robert de Lange
- Roche Diagnostics GmbH, Pharma Research, D-82372 Penzberg, Germany
| | - Ulrich H Weidle
- Roche Diagnostics GmbH, Pharma Research, D-82372 Penzberg, Germany
| | - Maria Teresa Rotelli
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University 'Aldo Moro', 70124 Bari, Italy
| | - Arcangelo Picciariello
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University 'Aldo Moro', 70124 Bari, Italy
| | | | - Patrizia Querzoli
- Section of Anatomic Pathology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Massimo Pedriali
- Operative Unit of Surgical Pathology, University Hospital, 44124 Ferrara, Italy
| | - Enzo Bianchini
- Operative Unit of Surgical Pathology, University Hospital, 44124 Ferrara, Italy
| | | | | | - Carla Di Loreto
- Department of Pathology, University of Udine, 33100 Udine, Italy
| | - Mauro Piantelli
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Laura Antolini
- Department of Clinical Medicine,Center for Biostatistics, Prevention and Biotechnology, University of Milano-Bicocca, 20900 Monza, Italy
| | - Xiao-Feng Sun
- Department of Oncology, and Department of Biomedical and Clinical Sciences Linköping University, SE-581 85 Linköping, Sweden
| | - Donato F Altomare
- Roche Diagnostics GmbH, Pharma Research, D-82372 Penzberg, Germany; General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University 'Aldo Moro', 70124 Bari, Italy
| | - Saverio Alberti
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), "G. d' Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Oncoxx Biotech, 66034 Lanciano (Chieti), Italy; Unit of Medical Genetics, Department of Biomedical Sciences - BIOMORF, University of Messina, 98125 Messina, Italy.
| |
Collapse
|
40
|
Altomare DF, Delrio P, Shelgyn Y, Rybakov E, Vincenti L, De Fazio M, Simone M, Graziano G, Picciariello A. Transanal reinforcement of low rectal anastomosis versus protective ileostomy after total mesorectal excision for rectal cancer. Preliminary results of a randomized clinical trial. Colorectal Dis 2021; 23:1814-1823. [PMID: 33891798 DOI: 10.1111/codi.15685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Abstract
AIM The study aimed to show if transanal reinforcement of the suture line can prevent anastomotic leakage (AL) after rectal cancer surgery, thus avoiding the need for a covering ileostomy. METHODS This is a prospective, multicentre, parallel-arm randomized controlled equivalence trial. After standard total mesorectal excision, patients with anastomotic line at 1-3 cm from the dentate line were randomized to have transanal suture reinforcement (TAR group) or protective ileostomy (PI group). RESULTS Twenty-nine patients had PI, 25 had TAR. The two groups were comparable both for baseline characteristics and intra-operative aspects. Clinically evident AL occurred in four (16%) and five (17.24%) patients of the TAR and PI group, respectively, resulting in a difference of -1.20% (90% CI -17.93, 15.45), while subclinical AL at proctography was absent in 15 (65.22%) and 13 (50%) patients of the TAR and PI groups, respectively, resulting in a difference of 15% (90% CI -7.74 to 38.17). CONCLUSION Preliminary data suggest that transanal reinforcement of the suture line performed in rectal cancer patients with suture line at 1-3 cm from the dentate line carries a similar (even if not equivalent) AL rate to covering ileostomy, suggesting that a covering ileostomy could be avoided in this selected group of patients. This indication needs to be addressed with future larger trials (clinicaltrials.gov ID number NCT02279771).
Collapse
Affiliation(s)
- Donato Francesco Altomare
- Surgical Unit Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari,, Italy.,Surgical Department, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, 'Fondazione Giovanni Pascale' IRCCS, Naples, Italy
| | - Yuri Shelgyn
- Oncoproctology Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - Evgeny Rybakov
- Oncoproctology Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - Leonardo Vincenti
- Surgical Unit Azienda Ospedaliero-Universitaria Policlinico Bari, Bari, Italy
| | - Michele De Fazio
- Surgical Unit Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari,, Italy
| | - Michele Simone
- Surgical Department, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Giusy Graziano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Arcangelo Picciariello
- Surgical Unit Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari,, Italy
| |
Collapse
|
41
|
Picciariello A, Lobascio P, Spazzafumo L, Rinaldi M, Dibra R, Trigiante G, Laforgia R, Pezzolla A, Altomare DF. The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures. Tech Coloproctol 2021; 25:935-940. [PMID: 33987779 PMCID: PMC8289784 DOI: 10.1007/s10151-021-02459-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anal fissure (AF) is a common, painful disease that strongly affects patients' quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. METHODS The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020-September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. RESULTS One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. CONCLUSIONS The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.
Collapse
Affiliation(s)
- A Picciariello
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy. .,Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - P Lobascio
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - L Spazzafumo
- Agenzia Regionale Sanitaria (The Regional Agency for Health), Marche Region, Ancona, Italy
| | - M Rinaldi
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Dibra
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Trigiante
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Laforgia
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - A Pezzolla
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - D F Altomare
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
42
|
Picciariello A, O'Connell PR, Hahnloser D, Gallo G, Munoz-Duyos A, Schwandner O, Sileri P, Milito G, Riss S, Boccasanta PA, Naldini G, Arroyo A, de laPortilla F, Tsarkov P, Roche B, Isbert C, Trompetto M, d'Hoore A, Matzel K, Xynos E, Lundby L, Ratto C, Consten E, Infantino A, Panis Y, Terrosu G, Espin E, Faucheron JL, Guttadauro A, Adamina M, Lehur PA, Altomare DF. Obstructed defaecation syndrome: European consensus guidelines on the surgical management. Br J Surg 2021; 108:1149-1153. [PMID: 33864061 DOI: 10.1093/bjs/znab123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Management of obstructed defaecation is challenging and remains controversial. No international guidelines have been published.
Collapse
Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Munoz-Duyos
- Department of General Surgery, Colorectal Unit, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - O Schwandner
- Department of Proctology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - P Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milano, Italy
| | - G Milito
- Department of Surgery, Tor Vergata University, Rome, Italy
| | - S Riss
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - P A Boccasanta
- Istituto Humanitas Gavazzeni & Castelli, Proctology and Perineology Surgical Unit, Bergamo, Italy
| | - G Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - A Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Alicante, Spain
| | - F de laPortilla
- Gastrointestinal Surgery Department, Coloproctology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - P Tsarkov
- I. M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia
| | - B Roche
- Division of Digestive Surgery, Proctology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - C Isbert
- Department of General, Gastrointestinal and Colorectal Surgery, Amalie Sieveking Hospital, Hamburg, Germany
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - A d'Hoore
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - K Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
| | - E Xynos
- Department of Surgery, Creta Interclinic Hospital of Heraklion, Heraklion, Greece
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - C Ratto
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - E Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Infantino
- Department of Surgery, General Surgery Unit, Santa Maria dei Battuti Hospital, Pordenone, Italy
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - G Terrosu
- General Surgery and Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy
| | - E Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France
| | - A Guttadauro
- General Surgery Department, University of Milano-Bicocca, Istituti Clinici Zucchi, Monza, Italy
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - P A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
43
|
Gallo G, Grossi U, Sturiale A, Di Tanna GL, Picciariello A, Pillon S, Mascagni D, Altomare DF, Naldini G, Perinotti R. E-consensus on telemedicine in proctology: A RAND/UCLA-modified study. Surgery 2021; 170:405-411. [PMID: 33766426 DOI: 10.1016/j.surg.2021.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. METHODS A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. RESULTS Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. CONCLUSION This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
Collapse
Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Arcangelo Picciariello
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Domenico Mascagni
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Roma, Roma, Italy
| | - Donato Francesco Altomare
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Roberto Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
| | | |
Collapse
|
44
|
Altomare DF, Picciariello A, Di Ciaula A, Rinaldi M, De Fazio M, Portincasa P. Effects of temporary sacral nerve stimulation on gastrointestinal motility and function in patients with chronic refractory slow-transit constipation. Tech Coloproctol 2021; 25:291-297. [PMID: 33185809 PMCID: PMC7932968 DOI: 10.1007/s10151-020-02367-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The efficacy of sacral nerve stimulation (SNS) on patients with chronic refractory slow-transit constipation is controversial and its mechanism of action on gastrointestinal motility and transit is not fully understood. The aim of this study was to document the effects of temporary SNS on the gastrointestinal and biliary tract motility and on gastrointestinal transit in patients with refractory slow-transit constipation. METHODS This was a prospective interventional study. Patients with slow-transit chronic constipation, unresponsive to any conservative treatment, were enrolled between January 2013 and December 2018. Patients' quality of life [patient assessment of constipation quality of life (PAC-QOL) questionnaire], constipation scores (Cleveland Clinic Constipation Score) colonic transit time (CTT), orocecal transit time (OCTT), gastric and gallbladder kinetics, together with the assessment of the autonomic nerve function were evaluated before and during temporary SNS. RESULTS 14 patients (12 females, median age 38 years, range 24-42 years) had temporary SNS. The Cleveland Clinic Constipation Score did not change compared to baseline (23 ± 3 vs 21.4; p = 070). The PAC-QOL did not improve significantly during the stimulation period. Gallbladder/stomach motility (half-emptying time) did not change significantly before and after SNS. OCTT was delayed at baseline, as compared to standard internal normal values, and did not change during SNS. CTT did not improve significantly, although in two patients it decreased substantially from 97 to 53 h, and from 100 to 65 h. CONCLUSIONS Temporary SNS did not have any effect on upper/lower gastrointestinal motility and transit in patients with severe constipation.
Collapse
Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy.
- IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy.
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - A Di Ciaula
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University "Aldo Moro", Bari, Italy
| | - M Rinaldi
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - M De Fazio
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - P Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University "Aldo Moro", Bari, Italy.
| |
Collapse
|
45
|
Picciariello A, Altomare DF. Big data papers and COVID-19: a "false friend" for academic surgeons. Tech Coloproctol 2021; 25:485. [PMID: 33590439 PMCID: PMC7883963 DOI: 10.1007/s10151-020-02382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
46
|
Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, Adisa AO, Aguilera ML, Al-Saqqa SW, Al-Slaibi I, Bhangu A, Biccard BM, Brocklehurst P, Costas-Chavarri A, Chu K, Dare A, Elhadi M, Fairfield CJ, Fitzgerald JE, Ghosh D, Glasbey J, van Berge Henegouwen MI, Ingabire JA, Kingham TP, Lapitan MC, Lawani I, Lieske B, Lilford R, Martin J, McLean KA, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Pata F, Pinkney T, Qureshi AU, Ramos-De la Medina A, Riad A, Salem HK, Simões J, Spence R, Smart N, Tabiri S, Thomas H, Weiser TG, West M, Whitaker J, Harrison EM, Gjata A, Modolo MM, King S, Chan E, Nahar SN, Waterman A, Vervoort D, Lawani I, Bedada AG, De Azevedo B, Figueiredo AG, Sokolov M, Barendegere V, Ekwen G, Agarwal A, Dare A, Liu Q, Camilo Correa J, Malemo KL, Bake J, Mihanovic J, Kuncarová K, Orhalmi J, Salem H, Teras J, Kechagias A, Arnaud AP, Lindert J, Tabiri S, Kalles V, Aguilera-Arevalo ML, Recinos G, Baranyai Z, Kumar B, Neelamraju Lakshmi H, Zachariah SK, Alexander P, Kumar Venkatappa S, Pramesh C, Amandito R, Fleming C, Ansaloni L, Pata F, Pellino G, Altibi AM, Nour I, Hamdun I, Elhadi M, Ghellai AM, Venskutonis D, Poskus T, Zilinskas J, Whitaker J, Malemia P, Tew YY, Borg E, Ellul S, Ramos-De la Medina A, Wafqui FZ, Borowski DW, van Dalen AS, Wells C, Adamou H, Ademuyiwa A, Adisa A, Søreide K, Qureshi AU, Al-Slaibi I, Al Saqqa S, Alser O, Tahboub H, Segovia Lohse HA, Shu Yip S, Lapitan MC, Major P, Simões J, Sampaio Soares A, Bratu MR, Litvin A, Vardanyan A, Allen Ingabire JC, Costas-Chavarri A, Gudal A, Albati N, Juloski J, Lieske B, Rems M, Rayne S, Van Straten S, Moodley Y, Chu K, Moore R, Ortega Vázquez I, Ruiz-Tovar J, Senanayake KJ, Thalgaspitiya SPB, Omer OA, Homeida A, Cengiz Y, Clerc D, Alshaar M, Bouaziz H, Altinel Y, Doe M, Freigofer M, Teasdale E, Kabariti R, Clements JM, Knight SR, Ashfaq A, Azodo I, Wagner G, Trostchansky I, Maimbo M, Linyama D, Nina H, Zeko A, Fermani CG, Modolo MM, Villalobos S, Carballo F, Farina P, Guckenheimer S, Dickfos M, Ajmera A, Chong C, Gourlay R, Hussaini S, Lee YJ, Majid A, Martin P, Miles R, Morris OJ, Phua J, Ridley W, Saluja T, Tan RR, Teh J, Wells A, Arora B, Dollie Q, Ho D, Ma Y, Perera OM, Truong A, Dawson AC, Lim B, Pahalawatta U, Phan J, Woon-Shoo-Tong XMS, Yeoh A, Charman L, Drane A, Laura S, Lo CCW, Mozes A, Poon R, Tan HH, Wall E, Chopra P, De Giovanni J, Dhital B, Draganic B, Duller A, Gani J, Goh YK, Jeong JY, McManus B, Nagappan P, Pockney P, Rugendyke A, Sarrami M, Smith S, Wills V, Wong HV, Ye G, Zhang G, Brooker E, Feng D, Lau B, Ngai C, Birks S, Gyorki D, Otero de Pablos J, Abbosh A, Gillespie C, Mahmoud A, Kwan B, Lawson J, Warwick A, Bingham J, Cockbain AJ, Dudi-Venkata NN, Ellaby-Hall J, Finlay B, Humphries E, Pisaniello J, Pisaniello M, Salih S, Sammour T, Abd Wahab HH, De Silva A, Hayward N, Iyer K, Maddern G, Prevost GA, Annapureddy N, Settipalli KP, Yeo J, Hempenstall L, Pham L, Purcell S, Talavera C, Vaska AI, Chaggar G, Chrapko P, Cocco A, Coulter-Nile SMCJ, Ctercteko G, French J, Gong H, Gosselink M, Jegathees T, Jin I, Kalachov M, Kiefhaber K, Lee K, Luong J, Phan S, Pleass H, Veale K, Zeng Z, Au A, DeBiasio A, Deng I, Myooran J, Nair A, Stewart P, Stift A, Unger LW, Wimmer K, Ahmed N, Hasan S, Rahman S, O'Shea M, Padmore G, Peters A, Perduca P, Pulcina G, Tinton N, Buxant F, Dabin E, Garofalo G, Dossou F, Lawani I, Gnangnon FHR, Imorou Souaibou Y, Bedada AG, Motlaleselelo P, Tlhomelang O, Lima Buarque I, Mendonça Ataíde Gomes G, Vieira Barros A, Batashki I, Damianov N, Stoyanov V, Dardanov D, Maslyankov S, Petkov P, Sokolov M, Todorov G, Zhivkov E, Akisheva A, Castilla Moreno MA, Genov G, Ilieva I, Ivanov T, Karamanliev M, Khan A, Mitkov E, Yotsov T, Atanasov B, Belev N, Slavchev M, Nsengiyumva C, Jones E, Stock S, Ekwen G, Kyota S, Brown J, Mabanza K. T, Nigo Samuel L, Otuneme C, Prosper N, Umenze F, Boutros M, Caminsky N, Dumitra S, Garfinkle R, Morency D, Salama E, Banks A, Ferri L, He H, Katz A, Liberman AS, Meterissian S, Pang A, Parvez E, Agarwal A, Dare A, Hameed U, Osman F, Sequeira S, Coburn N, Dare A, Jaffer A, Karanicolas P, Mosseler M, Musselman R, Liu X, Yip CW, Garces-Otero JS, Guzman C, Sierra S, Uribe Valencia A, Cabrera Rivera PA, Camelo S, Gonzalez A, González-Orozco A, Mosquera Paz MS, Perez Rivera CJ, Gonzalez F, Isaza-Restrepo A, Nino- Torres L, Arias Madrid N, Mendoza Arango MC, Sierra S, Bake J, Tsandiraki J, Jemendžic D, Kocman B, Šuman O, Canic R, Jurišic D, Karakas I, Krizanovic Rupcic A, Pitlovic V, Samardžic J, Kopljar M, Bacic I, Domini E, Karlo R, Mihanovic J, Miljanic D, Simic A, Ahmed M, Al Nassrallah M, Altaf R, Amjad T, Eltoum R, Haidar H, Hassan A, Khalil O, Qasem M, Ramesh R, Sajith G, Wisal M, Žatecký J, Bujda M, Jirankova K, Paclik A, Abdallah A, Abdulgawad Almogy M, Ayman El-sawy E, ElFayoumy AM, Elghareeb N, Esmat NA, Fadel A, Habater A, Hamdy H, Hefni A, Kamal M, Mohamed Abobakr N, Sayed A, Shaker N, Taha E, Tharwat H, Zakaria O, Abdelmotaleb I, Al-Dhufri A, Al-Himyari HS, El sheikh E, Eldmaty A, Elkhalawy A, M.Elkhashen A, Magdy K, Mostafa S, Sadia HD, Saleh MM, Samir D, Yahia Mohamed Ali M, A. Nassar M, Abdelhady S, Abdelrazek A, Abdelsalam I, El-Sawy A, Essam E, Gadelkarim M, Ghaly K, Hassabalnaby M, Masarani R, Mohamed Shaaban N, Sabry A, Salem M, Soliman NA, Zahran D, Abou El.soud MR, Badr ET, Borham H, Elmeslemany N, Elsayed M, Elsherif F, Eslam S, Gaber G, Ibrahim S, Kamh Y, Mahmoud A, Mohamed SG, Morshedy E, Omar C, Salem Soliman F, Abdelkawy S, Abdelmohsen N, Abdelshakour M, Dahy A, Gamal N, Gamal M, Hasan A, Hetta H, Mousa N, Omar M, Rabie S, Saad M, Saleh B, Sayed Mohamed M, Shawqi M, Abdelhady Mousa H, Alnoury M, Elbealawy M, Elshafey A, Essam Ibrahim El Desouki Muhammad Ahmed M, Ghonaim M, Hgag F, Ibrahim M, Morsy M, Reda Loaloa M, Refaat A, Samir H, Shahien F, Sobhy M, Sroor F, Abdellatif E, Adel M, Afifi AA, Afifi E, Antaky M, Dawoud A, El Zoghby N, El-remaily A, Elzanfaly AA, Gadallah A, Gamal FA, Hashem O, Medhat Youssef S, Muhammad Attyah A, Munir M, Shazly O, Taha E, Wilson K, Adel S, Ali A, Eid E, Elhelow E, Elmahdy M, Elshatby B, Hossam el-din Zakaria A, Hossny A, Ibrahim E, M.Yonis A, Metwalli M, Yousry B, Zid E, A Yacoub M, Abdelhakim A, Abouelsoad N, Alkhatib M, Ashraf A, Ashraf A, Elazab Y, Elfanty M, Elkabir O, Elsayed M, Elshimy A, Elsobky H, Eskander J, Gad A, Hamsho W, Khaled Abdelwahed N, Magdy M, Moharam D, Osama A, Ramadan S, Roum R, Sayed T, Shehada T, Zidan AM, Abbas K, Ali A, Attia M, Balata M, El Nakeeb A, Elewaily MIE, Elfallal A, Elfeki H, Elkhadragy A, Emile S, Ezzat H, Hosni H, Mansour I, Omar W, Othman G, Sadek K, Shalaby M, Shehab-Eldeen N, Anas khalifa R, Badr H, Eldeep M, Eldeep A, Eldoseuky mohammed A, Khallaf S, Magdy Hegazy E, Mahmoud R, Mikhail P, Morsi M, Mowafy S, Raafat D, Safy A, Sera M, Sera AS, AbdAllah MSM, Abdelkader M, Abdou AO, Ahmed A, Gaafar S, Ibrahim negm F, Lapic M, Maher A, Mahmoud H, Mostafa A, Samir M, Samy F, Semeda N, Shalaby HI, El-taweel A, Galal Elnagar A, Hemidan AG, Hussein M, Kandil A, Moawad M, Nasser Hamamah AA, Soliman M, Abdelkhalek M, Abdelmaksoud Tawakel N, Abdelwahed AM, Abdou A, Atallah K, Elsherbeny MY, Emara E, Hamdy M, Hamdy O, Haron A, Ismail S, Metwally IH, Mohamed Hamed Elgaml N, Nassar A, Refky B, Sadek M, Saleh M, Yunes A, Zakaria M, Zuhdy M, Fayed N, Mohammed MMH, Kütner S, Melnik P, Seire I, Teras J, Ümarik T, Ainoa E, Eerola V, Koppatz H, Koskenvuo L, Sallinen V, Takala S, Katunin J, Kechagias A, Turunen A, Christou N, Mathonnet M, Lavoue V, Nyangoh Timoh K, Soulabaille L, Lesourd R, Merdrignac A, Sulpice L, André B, Chantalat E, Vaysse C, Dousset B, Gaujoux S, Martin G, Clonda O, Juodis D, Kienle K, Mravik A, Palmer S, Szabadhegyi G, Agbeko AE, Gyabaah S, Gyamfi FE, Naabo N, Owusu senior A, Yorke J, Owusu F, Abantanga F, Anyomih TTK, Muntaka AJM, Owusu Abem E, Sheriff M, Tabiri S, Wondoh PM, Balalis D, Korkolis D, Gkiokas G, Pantiora E, Theodosopoulos T, Ioannidis A, Konstantinidis K, Konstantinidou S, Machairas N, Paspala A, Prodromidou A, Chouliaras C, Papadopoulos K, Baloyiannis I, Mamaloudis I, Tzovaras G, Akrida I, Argentou MI, Germanos S, Iliopoulos E, Maroulis I, Skroubis G, Theofanis G, Chatzakis C, Ioannidis O, Loutzidou L, Kalles V, Karathanasis P, Michalopoulos N, Theodoropoulos C, Theodorou D, Triantafyllou T, Garoufalia Z, Hasemaki N, Kontos M, Kouraklis G, Kykalos S, Liakakos T, Mpaili E, Papalampros A, Schizas D, Syllaios A, Tampaki EC, Tsimpoukelis A, Antonopoulou MI, Deskou E, Manatakis DK, Papageorgiou D, Zoulamoglou M, Anthoulakis C, Margaritis M, Nikoloudis N, Campo V, Ceballos A, Flores MA, Giron W, Ko D, Martinez G, Recinos G, Rivera Lara V, Rueda N, Sanchez A, Tejeda Garrido JCG, Aguilera-Arevalo ML, Alvarez Rivera AE, Bamaca Ixcajoc EB, Barreda Zelaya LE, Chacòn-Herrera P, Corea Ruiz LM, Echeverria-Davila G, Garcia M, García D, Gutiérrez Mayen EF, José N, Mazariegos N, Méndez D, Paniagua Espinoza M, Baranyai Z, Bardos D, Benke M, Illes K, Kokas BA, Szabó R, Appukuttan A, Asok A, D.k V, Malik K, Ravishankaran P, Tapkire R, Moorthy G, Abraham J, Muthuvel R, Alapatt J, Kattepur A, Pareekutty N, Garod M, Harris C, Wanniang C, Gupta A, Nehra D, Parshad S, Acharya R, Badwe R, Bhandare M, Jain U, Kirti K, Nair N, Shrikhande S, Thakkar P, Anandan P, C S A, Holenarasipur Narasannaiah A, Jagarlamudi T, Kumar Venkatappa S, M R R, Manangi M, Raghavendra A, Rao KS, S V, Sajjan V, Shenoy A, Shivashankar Chikkanayakanahalli S, Tharanath K, V S, Adidharma P, Agarwal R, Amandito R, Anggita Gultom P, Arifin GR, Billy M, Elfizri Z, Fahira A, Felicia D, Gunardi TH, Johanna N, Nugrahadi NR, Panigoro SS, Rahmayanti S, Sihotang RC, Brata SY, Winoto H, Barati N, Karami M, Khorshidi H, Naderifar H, Abdulla MA, Coleman M, Doherty RJ, Hannon R, Murphy B, Stakelum A, Winter D, Aljohmani L, Farnan R, Seldon Y, Tan T, Varghese S, Alherz M, Ather M, Bajilan M, Graziadei V, Pilkington I, Quidwai O, Ridgway P, Shiwani H, Tahir AAR, Blunnie E, Burke D, Kennedy N, Macdonagh K, O'Neill M, Rooney S, Falco G, Ferrari G, Mele S, Nita GE, Ugoletti L, Zizzo M, Confalonieri G, Pesenti G, Tagliabue F, Baronio G, Ongaro D, Pata G, Compagnoni B, Salvadori R, Taglietti L, D'Alessandro N, Di Lascio P, Pascale G, Bortolasi L, Campagnaro T, Carlini M, Lisi G, Lombardi D, Pedrazzani C, Spoletini D, Turri G, Violi P, Altomare DF, Aquilino F, Musa N, Papagni V, Picciariello A, Vincenti L, Andreotti D, Occhionorelli S, Tondo M, Basso SMM, Cirelli R, Maino MEM, Piozzi GN, Picone E, Scaramuzzo R, Sinibaldi G, Amendola A, Anastasio L, Bucci L, Caruso E, Castaldi A, Di Maso S, Dinuzzi VP, Esposito G, Gaudiello M, Giglio MC, Greco PA, Luglio G, Manfreda A, Marra E, Mastella F, Pagano G, Peltrini R, Pepe V, Sacco M, Sollazzo V, Spiezio G, Cianchetti E, Menduni N, Carvello MM, Di Candido F, Spinelli A, Corsi F, Sorrentino L, Marino F, Asti ELG, Bonavina L, Rausa E, Asta M, Belli A, Bianco F, Cervone C, Delrio P, Falato A, Fares Bucci A, Guarino R, Pace U, Rega D, De Luca E, Gallo G, Sammarco G, Sena G, Vescio G, Santandrea L, Ugolini G, Zattoni D, Chetta N, Logrieco G, Vanella S, Garulli G, Zanini N, Bondurri A, Cammarata F, Colombo F, Foschi D, Lamperti GMB, Maffioli A, Sampietro GM, Yakushkina A, Zaffaroni G, Ansaloni L, Cicuttin E, Sibilla MG, Impellizzeri H, Inama M, Moretto G, Mochet S, Ponte E, Usai A, Mancini S, Sagnotta A, Solinas L, Bolzonaro E, Tamini N, Curletti G, Galleano R, Malerba M, Campanella S, Cocorullo G, Colli F, De Marco P, Falco N, Fontana T, Kamdem Mambou LJ, La Brocca A, Licari L, Randisi B, Rizzo G, Rotolo G, Salamone G, Tutino R, Venturelli P, Malabarba S, Sgrò A, Vella I, Cirillo B, Crocetti D, De Toma G, Lapolla P, Mingoli A, Sapienza P, Belvedere A, Bianchini S, Binetti M, Birindelli A, Tonini V, Podda M, Pulighe F, De Rosa M, Bono L, Borghi F, Geretto P, Giuffrida MC, Lauro C, Marano A, Pellegrino L, Salusso P, Sasia D, Campanelli M, Realis Luc A, Trompetto M, Cardia R, Cillara N, Giordano AN, Costanzo A, Giovilli MA, Turati L, Canonico S, Pellino G, Sciaudone G, Selvaggi F, Selvaggi L, Albsoul N, AlBsoul A, Alkhatib AA, Alsallaq O, Amarin JZ, Ayoub R, Bsisu I, El Muhtaseb MS, Jabaiti M, Melhem J, Nour I, Qwaider YZ, Salameh MH, Suleihat A, Suradi HH, Alammarin M, Aljaafreh A, Bani hani M, Bani hani Z, Bani Hani F, Fahmawee T, Hamouri S, Katanani C, Tawalbeh R, Tawalbeh T, Zawahrah H, Abou Chaar MK, Abusalem L, Al-Masri M, Al-Najjar H, Barghuthi L, Ahmed Z, Maulana A, Ngotho O, Kamau C, Stanley Mwenda A, Bosire F, Mwachiro E, Parker R, Simel I, Sylvester K, Althini AAM, Elbarouni S, Elbeshina AE, Gwea A, Malek A, Masoud Farag WA, Abdalei A, Abdel Malik AB, Abo-khammash A, Abuhlaiga M, Adnan N, Albaggar M, Alfitory A, Aljanfi A, Almuzghi F, Altumei Z, Alzabti F, Ashoushan H, Assalhi M, Azzubia J, Bnhameida S, Delhen M, Elshafei H, Elteir H, Esbaga F, Gobbi AA, Hamouda F, Hilan H, Ismail R, Jebran F, Kasbour M, Maderi G, Mohammad S, Mohammed B, Murtadi H, Mustafa H, Rajab M, Trenba S, Wafaa M, Al Sagheir E, Almigheerbi A, Alzahaf A, Bahroun SG, Ben Dallah N, Elshaibani M, Eswaye H, Karar M, Omar S, Younes E, Younes M, Zreeg D, Abujamra S, Ashour F, Elgammudi M, Omar F. Aljadidi W, Saddouh E, Sharif R, Alabuzidi A, Alwerfally A, Aribi S, Bibas F, Elfaituri T, Elhajjaji Y, Khaled A, Khalil W, Layas T, Soula E, Tarek A, Abu hallalah MFK, Abujamra S, Ahmed HA, Alsharef T, Ben Saoud AA, El Gharmoul T, Elhadi A, Elrais S, Shebani A, Zarti H, Zeiton A, Ambrazevicius M, Kaselis N, Stakyte M, Aliosin O, Cizauskaite A, Dailidenas S, Eismontas V, Kybransiene M, Nutautiene V, Samalavicius N, Simcikas D, Slepavicius A, Tamosiunas A, Ubartas N, Zeromskas P, Bradulskis S, Dainius E, Juocas J, Kubiliute E, Kutkevicius J, Opolskis A, Parseliunas A, Subocius A, Venskutonis D, Virbickaite E, Zuikyte D, Bogusevicius A, Buzaite K, Cepuliene D, Cesleviciene I, Cesna V, Gribauskaite J, Ignatavicius P, Jokubauskas M, Liugailaite M, Margelis E, Mazelyte R, Pankratjevaite L, Pažusis M, Rackeviciute A, Saladyte J, Škimelyte M, Šlenfuktas V, Sudeikyte M, Tamelis A, Vanagas T, Žumbakys Ž, Atkociunas A, Dulskas A, Kuliavas J, Birutis J, Paškevicius S, Šatkauskas M, Danys D, Jakubauskas M, Jakubauskiene L, Kryzauskas M, Lipnickas V, Makunaite G, Rasoaherinomenjanahary F, Rasolofonarivo H, Samison LH, Banda B, Malemia P, Msosa V, Ahmad Izzuddin AI, Das A, Gan YY, Shong Sheng T, Siaw JY, Ab Rahim MF, Abang Jamari DZH, Che Husin N, Kamarulzaman MY, Lim YP, Mohamed Kamil NA, Mohd Hassan MR, Mohd Sahid S, Mustafa J, Ng EHB, Wan Khazim WK, Chang Ern N, Lingeshan P, Sulaiman SE, Ang SE, Bin Mohamad Sithik MN, Cheong YJ, Deva Tata M, Jia Xian L, Kadravello A, Koh IE, Ng LY, Ng We Yong YJ, Palayan K, Sam CX, Siow Jin P, Tan Ern Hwei J, Tang Y, Ter AZ, Wong MPK, Zakaria AD, Zakaria Z, Henry F, Kalaiselvan T, Abd Karim MFS, Abdul Aziz MR, Abdul Aziz N, Khong TL, Lau PC, Lim HC, Roslani AC, Seak JCK, Wong SW, Wong LF, Yeen Chin L, Anyanwu MC, Borg E, Busuttil Z, Calleja T, Chircop KL, Cutajar R, Dimech AM, Ellul S, Galea J, Gascon Perai K, Gatt R, Kelman L, Micallef E, Nwolu F, Sammut K, Thompson J, Warwicker S, Zammit M, Cordera F, Cruz González E, Sánchez-García J, Barbosa Camacho FJ, Barrera López FJ, Zuloaga Fernandez del Valle CJ, Acosta E, González Espinoza IR, Moreno P, Cortes-Flores AO, Fuentes Orozco C, Gonzalez Ojeda A, Corro Díaz González S, Martinez L, Ramos-De la Medina A, Mosqueda Amador B, Novoa A, Olazo Espejo DA, Jimenez A, Lopez Rosales F, Vanoye EG, Garcia Gonzalez LA, Miranda-Ackerman RC, Solano-Genesta M, Alvarez-Cano A, Romero-Garza HH, Medina-Franco H, Mejía-Fernández L, Salgado-Nesme N, Vergara-Fernandez O, Gutiérrez-Mota GM, Hernandez Vera FX, Llantada Lopez A, Morgan Villela G, Ramirez Padilla FDJ, Tapia Marin W, Martínez Maldonado M, Sánchez Suárez R, Troche JM, Benyaiche C, Outani O, Amine S, Benkabbou A, Majbar AM, Mohsine R, Rafik A, Oung T, Tin MM, Borowski DW, Plarre P, Borowski DW, Plarre P, Alberga A, Sluiter N, Tuynman J, Blok R, Cömert D, Hompes R, Kalff M, Stellingwerf ME, Tanis P, van Berge Henegouwen M, van Praag EM, Wisselink D, Gerhards M, Lopes Cardozo J, Westerduin E, de Jonge J, van Geloven A, van Schilt K, den Boer F, Stoots S, Vlek S, Adams J, Al-Busaidi IS, Budd G, Choi SI, Chu MJJ, Ganugapati A, McKinstry L, Pascoe R, Richards S, Rosser K, Stevenson A, White R, Farik S, Kwun J, Murad A, Cowan S, Hall T, Hayton M, Malam Sani L, Oumarou Garba S, Adamou H, Amadou Magagi I, Habou O, Aliyu H, Daniyan M, Sholadoye TT, Abdullahi L, Anyanwu LJ, Mohammad Mohammad A, Muhammad AB, Sheshe AA, Suleiman I, Adesina A, Awolowo A, Onuoha C, Salami O, Taiwo O, Taiwo A, Kache S, Makama JG, Sale D, Abiola O, Ajao A, Ajiboye A, Etonyeaku A, Olaogun J, Adebanjo A, Adesanya O, Afolayan MO, Balogun O, Makanjuola A, Nwokocha S, Ojewola RW, Olajide TO, Aderounmu A, Adesunkanmi AR, Adisa A, Agbakwuru A, Akeem Aderogba A, Alatise OI, Arowolo O, Lawal O, Mohammed T, Ndegbu C, Olasehinde O, Wuraola F, Akinkuolie A, Etonyeaku A, Mosanya A, Ayandipo O, Elemile P, Lawal TA, Ali SANI S, Garba S, Hauwa SANI R, Olori S, Onyebuashi H, Umoke I, Adenuga A, Adeyeye A, Habeeb O, Lawal B, Nasir A, Aahlin EK, Kjønås D, Myrseth E, Abbasy J, Alvi A, Saleem O, Afzal A, Nazir A, Farooq M, Liaqat A, Naqi SA, Raza A, Sarfraz M, Sarwar M, Banglani M, Munir A, Sehrish R, Ayub B, Sayyed R, Altaf A, Ayub S, Qureshi AU, Saeed K, Syed B, Akbar SA, Anwer AW, Khan RN, Khan AI, Khattak S, Mohtasham S, Parvaiz MA, Syed AA, Ansari AB, Shahzad N, Khaliq T, Rashid I, Waqar SH, Abu Al-saleem H, Abu Alqumboz A, Alqadi M, Amro A, Assa R, Awesat E, Ayyad R, Hammad M, Haymony A, Hijazi B, Hmeidat B, Lahaseh R, Qawasmi A, Rajabi A, Shehada M, Shkokani S, Yaghi Y, Yaghi N, AlZohour M, Farid M, Habes YM, Juba W, Nubani Y, Rabee A, Sa'deh M, Abed S, Al basos I, Alswerki M, Ashour D, Awad I, Diab S, El Jamassi A, El-Kahlout S, Elhout S, Hajjaj ANK, Hasanain D, Nabil hajjaj B, Obaid M, Saikaly E, Salhi A, Al-Tammam H, Almasri M, Baniowda M, Beshtawi D, Horoub A, Misk R, Mohammad B, Qasrawi R, Sholi T, Abu-Nimeh S, Abu-srour A, Abukhalaf SA, Adawi S, Alsalameh B, Ayesh K, Elqadi M, Hammouri A, Karim Mustafa F, Marzouqa N, Melhem S, Miqdad D, Mohamad B, Rawhi M, Abu Ahammala AB, Abu Ataya A, Abu Jayyab I, Al-Shwaikh S, Alagha O, Alasttal M, Awadallah H, Elblbessy M, Fares J, Jarbou A, Mahfouz I, Albahnasawi MA, Abo mahadi A, Abuelhatal H, Abuelqomboz A, Almoqayyad A, Alwali A, Balaawi R, Hamouda M, Humeid M, Jedyan A, Mahmoud Abu hamam T, Matar G, Salem A, Samra T, Shaheen N, Shihada K, A.Nemer A, Abu Al Amrain M, Abu Alamrain A, Abu Jamie N, Abu-Rous MR, Alfarra N, AlTaweel M, Alwhaidi N, Hamed R, Saqqa B, Shaheen A, Aljaber D, Aljaberi L, Alwaheidi M, Jawaada A, Khaldi H, Qahoush R, Qari J, Saadeh R, Salim A, Yacoub A, Abbas A, Abu shua`ib R, Abu Zainah B, AbuSirrees M, Babaa B, Barhoush O, Belal qadomi A, Daraghmeh L, Haji R, Khatatbeh A, Khatib L, Qarariah S, Quzmar Y, Safadi K, Salameh R, Hassan M, Herzallah S, Massad L, Nazzal A, Nazzal R, Escobar D, Machain V GM, Rodriguez Gonzalez A, Chachaima Mar JE, Chinchihualpa Paredes NO, Cuba V, Lopez W, Niquen Jimenez MM, Sanchez Bartra NA, Sapallanay Ojeda O, Sequeiros D, Toscano Pacheco A, Vergara M, Abarca S, Alcorta R, Borda-Luque G, Eusebio Zegarra IE, Luján López C, Marrufo M, Mogrovejo C, Nomura A, Rodríguez Angeles Y, Vidal Meza MR, Zavala G, Castillo Arrascue JN, Hidrogo Cabrera JC, Larrea vera JJM, Osorio M, Ylatoma Díaz EA, Fontanilla MA, Fuentes JR, Salazar AL, Dominguez G, Lopez MP, Macalindong S, Onglao MA, Ramirez A, Sacdalan MD, Tampo MM, Uy GL, Mangahas J, Yabut K, Cañete JP, Cansana BE, Castro EJ, Lipana MK, Roxas MF, Zara VJ, Chrol M, Franczak P, Orlowski M, Budzynski P, Budzynski A, Bury P, Czerwinska A, Dworak J, Dziedzic J, Kisielewski M, Kulawik J, Lasek A, Major P, Malczak P, Migaczewski M, Pedziwiatr M, Pisarska M, Radkowiak D, Rubinkiewicz M, Rzepa A, Skoczylas T, Stanek M, Truszkiewicz K, Wierdak M, Winiarski M, Zarzycki P, Zub-Pokrowiecka A, Kowalewski P, Roszkowski R, Waledziak M, Tomé M, Patrocinio S, Guerreiro I, Almeida F, de Sousa X, Monteiro N, Costa Santos MT, de Oliveira D, Lopes Serra M, Morgado D, Neves C, Oliveira AC, Pimentel A, Silva S, Carvalho M, Carvalho L, Magalhães J, Matos L, Monteiro T, Ramos C, Santos V, Barbosa J, Costa-Maia J, Devezas V, Fareleira A, Fernandes C, Gonçalves D, Mora H, Morais M, Silva de Sousa F, Catarino Santos S, Logrado A, Tojal A, Amorim E, Cunha MF, Fazenda A, Melo Neves JP, Sampaio da Nóvoa Gomes Miguel II, Veiga D, Azevedo J, Cardoso Louro H, Leite M, Azevedo J, Bairos Menezes M, Gama B, Brito D, Cruz Martins MC, Graça e Magalhães A, Longras AC, Lourenço R, Matos D, Castro L, Policarpo F, Romano J, Leite M, Monteiro C, Pinto D, Duarte M, Fortuna Martins S, Oliveira M, Galvão D, Martins L, Silva A, Taranu V, Vieira B, Neves J, Oliveira S, Ribeiro H, Cinza M, Felix R, Machado A, Oliveira J, Patrício J, Pedroso de Lima R, Pereira M, Rocha Melo M, Velez C, Abreu da Silva A, Claro M, Costa Santos D, Ferreira A, Capote H, Rosado D, Taré F, Nogueira O, Ângelo M, Baiao JM, Guimarães A, Marques J, Nico Albano M, Silva M, Valente da Costa A, Vieira Caroço T, Almeida Braga S, Capunge I, Fragoso M, Guimarães J, Pinto B, Ribeiro J, Angel M, Fialho G, Guerrero M, Campos Costa F, Cardoso D, Cardoso V, Alves M, Estalagem I, Louro T, Marques C, Martelo R, Morgado M, Canotilho R, Correia AM, Martins P, Peyroteo M, Gomes J, Monteiro R, Romano M, Alves DM, Peixoto R, Quintela C, Jervis MJ, Melo D, Pacheco A, Paixão V, Pedro V, Pimenta J, Pimenta de Castro J, Rocha A, Beuran M, Bratu MR, Ciubotaru C, Diaconescu B, Hostiuc S, Negoi I, Stoica B, NA NA, Anokhin E, Kuznetsov G, Oganezov G, Paramzin F, Romanova E, Rutkovskii V, Rutkovskii V, Shushval M, Zabiyaka M, Dzhumabaev K, Ivanov V, Mamedli Z, Achkasov S, Balkarov A, Nabiev E, Nagudov M, Rybakov E, Saifutdinova K, Sushkov O, Vardanyan A, Costas-Chavarri A, Joseph L, Ndayishimiye I, Allen Ingabire JC, Faustin N, Mutabazi AZ, Mvukiyehe JP, Nsengimana VJ, Uwakunda C, Abbas MM, Akeel N, Aljiffry M, Awaji K, Farsi A, Jamjoum G, Khoja A, Maghrabi A, Malibary N, Nassif M, Saleem A, Sultan A, Tashkandi W, Tashkandi H, Trabulsi N, Ba MB, Diallo AC, Ndong A, Cuk V, Jankovic U, Juloski J, Koh SZ, Koh F, Lee KC, Lee KY, Lee S, Leong WQ, Lieske B, Lui SA, Prakash P, Grosek J, Norcic G, Tomazic A, Fitchat N, Jaich R, Wineberg D, Koto MZ, Baiocchi D, Clarke D, Steenkamp CJ, Van Straten S, Bannister S, Boutall A, Chinnery G, Coccia A, Dell A, Karjiker P, Kloppers C, Loxton N, Mabogoane T, Malherbe F, Panieri E, Rayamajhi S, Spence R, van Wyngaard T, Warden C, Madiba TE, Moodley Y, Pillay N, Brooks S, Kruger C, Van Der Merwe LH, Gool F, Kariem M, Bougard H, Chu K, Kariem N, Noor F, Pillay R, Steynfaardt L, González González L, Marín Santos JM, Martín-Borregón P, Martínez Caballero J, Nevado García C, Rodriguez Fraga P, De Castro Parga G, Fernández Veiga MP, Garrido López L, Infante Pino H, Lages Cal I, López Otero M, Nogueira Sixto M, Paniagua García Señorans M, Rodríguez Fernández L, Ruano Poblador A, Rufo Crespo E, Sanchez-Santos R, Vigorita V, Alonso Batanero E, Asnel D, Cifrian Canales I, Contreras Saiz E, De Santiago Alvarez I, Díaz Vico T, Fernandez Arias S, Fernández Martínez D, García Bernardo C, García Flórez LJ, Garcia Gutierrez C, García Munar M, Márquez Zorrilla Molina CA, Merayo M, Michi Campos JL, Moreno Gijon M, Otero-Diez JL, Rodicio Miravalles JL, Solar-Garcia L, Suárez Sánchez A, Truan N, Alejandre Villalobos C, Caballero Díaz Y, Jimenez M, Montesdeoca D, Navarro-Sánchez A, Vega V, Beltrán de Heredia J, Gómez Z, Jezieniecki C, Legido Morán AP, Montes-Manrique M, Rodriguez-Lopez M, Ruiz Soriano M, Trujillo Díaz J, Vazquez Fernandez A, Argudo N, Pera M, Torrent Jansà L, García Domínguez M, Goded I, Roldón Golet M, Talal El-Abur I, Utrilla Fornals A, Zambrana Campos V, Aguilar Martinez MDM, Bosch M, García-Catalá L, Sánchez-Guillén L, Artigau E, Gomez Romeu N, Julià Bergkvist D, Espina Perez B, Morató O, Olona C, Diéguez B, Forero-Torres A, Losada M, Gomez-Abril S, Gonzálvez P, Martinez R, Navarro Martínez S, Payá-Llorente C, Pérez Rubio Á, Santarrufina Martinez S, Sebastián Tomás JC, Trullenque Juan R, Gegúndez Simón A, Maté P, Prieto-Nieto MI, Rubio-Perez I, Urbieta A, Vicario Bravo M, Abelló D, Frasson M, Garcia-Granero A, Abad Gurumeta A, Abad-Motos A, Lucena-de Pablo E, Nozal B, Ripollés-Melchor J, Salvachúa R, Ferrero E, Garcia-Sancho Tellez L, Ortega Vázquez I, Picardo AL, Rojo López JA, Zorrilla Matilla LP, Cagigas Fernandez C, Castanedo Bezanilla S, Estevez Tesouro J, Fernandez-Diaz MJ, García Cardo J, Gomez Ruiz M, Gonzalez-Tolaretxipi E, Jimeno Fraile J, Poch C, Rodriguez-Aguirre M, Troche Pesqueira N, Trugeda-Carrera MS, de la Torre J, Blanco-Colino R, Espin-Basany E, Espinosa-Bravo M, Morales Comas C, Reyes Afonso E, Rivero Déniz J, Siso Raber C, Verdaguer Tremolosa M, Chandrasinghe P, Kumarage S, Wijekoon Arachchilage N, Senanayake KJ, Abdalla Ahmed Elkamel A, A. Adam M, Saleh M, Blomme N, Thorell A, Wogensen F, Älgå A, Ansarei D, Celebioglu F, Heinius G, Nigard L, Pieniowski E, Ahlqvist S, Björklund I, Cengiz Y, Frånberg A, Håkansson M, Adamo K, Franklin O, Sund M, Wiberg R, Andersson Y, Chabok A, Nikberg M, Kugelberg A, Canonica C, Christoforidis D, Fasolini F, Gaffuri P, Giuliani M, Meani F, Popeskou SG, Pozza S, Wandschneider W, Peterer L, Widmer LW, Zimmermann B, Bakoleas P, Chanousi I, Charalampidou L, Grochola LF, Heid F, Ntaoulas S, Outos M, Peros G, Podolska-Skoczek H, Reinisch KB, Zielasek C, Clerc D, Demartines N, Gilgien J, Kefleyesus A, St-Amour P, Toussaint A, Alhimyar M, Alsaid B, Alyafi A, Alkhaledi A, Kouz B, Omarain A, Al-Sabbagh Y, Alkhatib H, Sara S, Alhaj A, Danial A, Kadoura L, Maa Albared S, Monawar Y, Nahas L, Abd B, Saad A, Wakkaf H, Bouaziz H, Bouzaiene H, Ghalleb M, Akaydin E, Akbaba AC, Atakul O, Baltaci E, Besli S, Burgu G, Cenal U, de Muijnck C, Demirkaya HC, Dogruoz A, Gezer ZI, Gündogdu Y, Kara M, Korkmaz HK, Kurtoglu GK, Ozben V, Ozmen BB, Pektas AM, Sel EK, Yenidünya N, Bengur FB, Oral BM, Yozgatli TK, Abdullayev S, Gunes ME, Sahbaz NA, Banaz T, Kargici K, Kuyumcu OF, Yanikoglu E, Yesilsancak M, Yilmaz D, Aktas MK, Rencuzogullari A, Isik A, Leventoglu S, Yalçinkaya A, Yüksel O, Kalayci MU, Kara Y, Sarici IS, Akin A, Alemdag GN, Arslan E, Baki BE, Bodur MS, Calik A, Candas Altinbas B, Cihanyurdu I, Erkul O, Gül B, Guner A, Köse B, Semiz A, Sevim S, Tayar S, Tomas K, Tüfek OY, Türkyilmaz S, Ulusahin M, Usta A, Yildirim R, Güler SA, Tatar OC, Varol E, Kirimtay B, Uysal M, Yildiz A, Kose E, Ciftci AB, Çolak E, Eraslan H, Kucuk GO, Yemez K, Lule H, Bienfait M, Lule H, Bua E, Doe M, Okalany N, Birindelli A, Basarab M, Bielosludtsev O, Freigofer M, Kolhanova K, Perepelytsia K, Romanukha K, Savenkov D, Siryi S, Tereshchenko M, Viacheslav N, Volovetskyi A, Kebkalo A, Tryliskyy Y, Tyselskiy V, Bruce E, Chow BL, Iddles E, McGuckin S, Newall N, Ramsay G, Sharma P, Stewart C, Wong J, Badran A, Bath M, Belais F, Butt E, Joshi K, Kapur M, Shaw M, Townson A, Williams CYK, Gray T, Greig R, Husain M, Murray E, Mustafa A, Asif A, Gokul A, Shah M, Akitikori MT, Charalabopoulos A, Davidson S, McNally S, Rupani S, Juma F, Mills SC, Muirhead L, Sellars K, Walsh U, Warren O, Chambers A, Hunt R, Teasdale E, Boyce S, Cornwall H, Tol I, Argyriou EO, Eardley N, Povey M, Aithie JMS, Irfan A, McGuigan MC, Starr R, Warren CR, Archibald J, Kirby G, Kisyov I, Khoo CK, Lee R, Photiou D, Davis R, Prasad U, Yang PZ, Bird J, Leung E, Summerour V, Currow C, Kiam J, Tan GJS, Muthusami A, Pegba-Otemolu I, Urbonas T, Nunoo-Mensah J, Smolskas E, Boddy A, Gravante G, Hunter D, Andrew D, Koh A, Thompson A, Adams L, Clements HA, De Silva K, Ekpete O, Haque S, Henderson S, Ibrahim B, Jayasinghe T, Livie J, Mailley K, Nair G, Tan D, Baggaley C, Dawidziuk A, Szyszka B, Barter C, Gandhi N, Hassell K, Hitchin S, Kelsall J, Nagy E, Nessa A, Whisker L, Yanni F, Ali M, Arora D, Hediwattege S, Kumarasinghe N, Rathore M, Tennakoon A, Ali Ahmad SM, Bajomo O, Nadira F, Celentano V, Bhangu A, Glasbey J, Griffiths E, Karri RS, Mak JKC, Nepogodiev D, Pipe M, Bhatti MI, Rabie M, Boyle C, Hamilton D, Mihuna A, Ng JCK, Nicholson G, Oliwa A, Pearson R, Rose A, Yong SQ, Boereboom C, Hanna M, Walter C, Greensmith TS, Mitchell R, Monaghan E, Crawford J, Moug S, Blackwell J, Boyd-Carson H, Herrod P, Al-Allaf O, Beattie M, Bullock C, Burman S, Clark G, Flamey N, Flannery O, Harding A, Kodiatt B, Lawday S, Mahapatra S, Mukundu Nagesh N, Ng M, Rye D, Yoong A, Clark L, Deans C, Edirisooriya M, Fairfield CJ, Harrison EM, Carrington EV, Wong TLE, Yusuf B, Chamberlain C, Duke K, Kmiotek E, Botes A, Condie N, Schrire T, Shah R, Thomas-Jones I, Yates C, Anthony N, Matthews E, Sahnan K, Tankel J, Tucker S, Winter Beatty J, Ziprin P, Duggan W, Kantartzi A, Sridhar S, Khaw RA, Srivastava P, Underwood C, Alves do Canto Brum H, Chopra S, Davis L, Hughes R, Tulley J, Alberts J, Athisayaraj T, Olugbemi M, Ahmad K, Chan C, Chapman G, Fleming H, Fox B, Grewar J, Hulse K, Rutherford D, Sinead M, Smith S, Speake D, Vaughan-Shaw PG, Christodoulides N, Kudhail S, Welch M, Husaini SM, Lambracos S, Anyanwu C, Suresh R, Thomas JS, Gleeson E, Platoff R, Saif A, Enumah Z, Etchill E, Gabre-Kidan A, Bernstein M, Carrano FM, Connors J, Lynn P, Melis M, Newman E, Foster DS, Perrone K, Titan A, Weiser TG, Ahmad S, Bafford ACM, Dal Molin M, Hanna N, Zafar SN, Hemmila M, Napolitano L, Wong JJ, Chandler J, Wood L, Wren S, Ottesen T, You L, Yu K, Arciénega Yañez MDP, Ferreira Fernandes M, González D, Cubas S, González MC, Zubiaurre V, Demolin R, Giroff N, Sciuto P, Campos M, Rodríguez Cantera G, Wagner G, Deepika G, Maimbo M, Simuchimba E, Bulaya A, Chibuye C, Chirengendure B, Kabale MR, Kabongo K, Linyama D, Munthali J, Mweso O, Pikiti F, Otieno J, Chan E, Lai LT, Blackman B, Richards S, Subramaniam S, Karim R, Kok N, Lee YD, Ali S, Sinha A, Corrigan R, Barnes N, Wong F, Dennis G, Jedamzik J, Phillips E, Piette W, Van hentenryck M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
Collapse
|
47
|
Martines G, Picciariello A, Dibra R, Trigiante G, Jambrenghi OC, Chetta N, Altomare DF. Efficacy of cyanoacrylate in the prevention of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a pilot study. Int J Colorectal Dis 2020; 35:2141-2144. [PMID: 32577871 DOI: 10.1007/s00384-020-03678-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative bleeding is a common complication after endoscopic polypectomy, particularly after endoscopic mucosal resection (EMR) of large non-pedunculated polyps, despite prophylactic clipping can reduce its occurrence. Cyanoacrylate glue has recently been proposed as a useful tool in reducing bleeding in surgery because of its adhesive and haemostatic properties. The aim of this study is to evaluate the usefulness of endoscopic application of a modified cyanoacrylate glue in the prevention of early or delayed post EMR bleeding. METHODS This is a pilot study. Inclusion criteria were patients between 18 and 75 years old affected by sessile or flat colonic polyps larger than 2 cm. Patients enrolled in the study were randomized in two groups: group A (EMR) and group B (EMR with the application of 0.3 ml of N-butyl-2-cyanoacrylate + methacryloxysulfolane-Glubran 2®). RESULTS Fifteen patients in both group A and B were enrolled. There were no intraoperative complications but haemostatic clipping was necessary in 3 patients in each group because of active bleeding. Delayed (after 24 h) bleeding occurred in two patients (13.3%) in group A requiring hospital readmission and re-do endoscopy with apposition of haemostatic clips. No case of bleeding was recorded in group B (p = 0.48). CONCLUSION The results of this pilot study suggest a potential role of local spray application of Glubran®2 in reducing post-procedural bleeding.
Collapse
Affiliation(s)
- Gennaro Martines
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Rigers Dibra
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - O Caputi Jambrenghi
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Nicola Chetta
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Donato Francesco Altomare
- Department of Emergency and Organ transplantation, Surgical Unit "M.Rubino", Azienda Ospedaliero Universitaria Policlinico, Bari, Italy. .,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy. .,Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.
| |
Collapse
|
48
|
Panzera P, Picciariello A, Di Salvo M, Lupo LG, Martines G, Papagni V, Altomare DF. Elective versus emergency full-thickness rectal prolapse treatment using a perineal approach - a video vignette. Colorectal Dis 2020; 22:0. [PMID: 32337765 DOI: 10.1111/codi.15092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Affiliation(s)
- P Panzera
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - M Di Salvo
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - L G Lupo
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - G Martines
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - V Papagni
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy.,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| |
Collapse
|
49
|
Altomare DF, Picciariello A, Rotelli MT, De Fazio M, Aresta A, Zambonin CG, Vincenti L, Trerotoli P, De Vietro N. Chemical signature of colorectal cancer: case-control study for profiling the breath print. BJS Open 2020; 4:1189-1199. [PMID: 32990407 PMCID: PMC8444279 DOI: 10.1002/bjs5.50354] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Effective screening for colorectal cancer can reduce mortality by early detection of tumours and colonic polyps. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a potential non-invasive diagnostic tool for detection of cancer. The aim of this study was to evaluate the reliability of breath-testing for colorectal cancer screening and early diagnosis using an advanced breath sampler. METHODS The exhaled breath of patients with colorectal cancer and non-cancer controls with negative findings on colonoscopy was collected using the ReCIVA® Breath Sampler. This portable device is able to capture the alveolar breath fraction without environmental contamination. VOCs were desorbed thermally and analysed by gas chromatography-mass spectrometry. The discriminatory ability of VOCs in detecting colorectal cancer was evaluated by receiver operating characteristic (ROC) curve analysis for each VOC, followed by cross-validation by the leave-one-out method, and by applying stepwise logistic regression analysis. RESULTS The study included 83 patients with colorectal cancer and 90 non-cancer controls. Fourteen VOCs were found to have significant discriminatory ability in detecting patients with colorectal cancer. The model with the diagnosis of cancer versus no cancer resulted in a statistically significant likelihood of discrimination of 173·45 (P < 0·001), with an area under the ROC curve of 0·979. Cross-validation of the model resulted in a true predictive value for colorectal cancer of 93 per cent overall. Reliability of the breath analysis was maintained irrespective of cancer stage. CONCLUSION This study demonstrated that analysis of exhaled VOCs can discriminate patients with colorectal cancer from those without. This finding may eventually lead to the creation of a smart online sensory device, capable of providing a binary answer (cancer/no cancer) and directing to further screening.
Collapse
Affiliation(s)
- D. F. Altomare
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
- Apulian Breath Analysis Centre (CeRBA)Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo IIBariItaly
| | - A. Picciariello
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - M. T. Rotelli
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - M. De Fazio
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - A. Aresta
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
| | - C. G. Zambonin
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
| | - L. Vincenti
- Surgical UnitAzienda Ospedaliero‐Universitaria Policlinico BariBariItaly
| | - P. Trerotoli
- Statistical Unit, Department of Biomedical Sciences and Human OncologyBariItaly
| | - N. De Vietro
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
| |
Collapse
|
50
|
Sammarco G, Gallo G, Vescio G, Picciariello A, De Paola G, Trompetto M, Currò G, Ammendola M. Mast Cells, microRNAs and Others: The Role of Translational Research on Colorectal Cancer in the Forthcoming Era of Precision Medicine. J Clin Med 2020; 9:jcm9092852. [PMID: 32899322 PMCID: PMC7564551 DOI: 10.3390/jcm9092852] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 08/11/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer (CRC) is a heterogeneous disease, molecularly and anatomically, that develops in a multi-step process requiring the accumulation of several genetic or epigenetic mutations that lead to the gradual transformation of normal mucosa into cancer. In fact, tumorigenesis is extremely complex, with many immunologic and non-immunologic factors present in the tumor microenvironment that can influence tumorigenesis. In the last few years, a role for mast cells (MCs), microRNAs (miRNAs), Kirsten rat sarcoma (KRAS) and v-raf murine sarcoma viral oncogene homologue B (BRAF) in cancer development and progression has been suggested, and numerous efforts have been made to thoroughly assess their correlation with CRC to improve patient survival and quality of life. The identification of easily measurable, non-invasive and cost-effective biomarkers, the so-called "ideal biomarkers", for CRC screening and treatment remains a high priority. The aim of this review is to discuss the emerging role of mast cells (MCs), microRNAs (miRNAs), KRAS and BRAF as diagnostic and prognostic biomarkers for CRC, evaluating their influence as potential therapy targets in the forthcoming era of precision medicine.
Collapse
Affiliation(s)
- Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.S.); (G.C.); (M.A.)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.V.); (G.D.P.)
- Correspondence: ; Tel.: +39-32-8438-5222
| | - Giuseppina Vescio
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.V.); (G.D.P.)
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Piazza G Cesare, 11, 70124 Bari, Italy;
| | - Gilda De Paola
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.V.); (G.D.P.)
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy;
| | - Giuseppe Currò
- Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.S.); (G.C.); (M.A.)
| | - Michele Ammendola
- Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (G.S.); (G.C.); (M.A.)
| |
Collapse
|