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Article ; Online: Anthropometric Variables Predict Feasibility and Long-term Outcomes of Trans-oral Septum Stapling for Zenker Diverticulum.

Milito, Pamela / Siboni, Stefano / Asti, Emanuele / Bonavina, Luigi

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 27, Issue 3, Page(s) 590–593

MeSH term(s)	Humans ; Zenker Diverticulum/surgery ; Feasibility Studies ; Esophagoscopy ; Treatment Outcome ; Surgical Stapling ; Retrospective Studies
Language	English
Publishing date	2022-08-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05432-8
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Minimally invasive esophagectomy for cancer in COVID hospitals and oncological hubs: are the outcomes different?

Milito, Pamela / Asti, Emanuele / Resta, Marco / Bonavina, Luigi

European surgery : ACA : Acta chirurgica Austriaca

2022 Volume 54, Issue 2, Page(s) 98–103

Abstract: Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has caused significant delays in oncological care worldwide due to restriction of elective surgery and intensive care unit capacity. It has been hypothesized that COVID-free oncological ... ...

Abstract	Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has caused significant delays in oncological care worldwide due to restriction of elective surgery and intensive care unit capacity. It has been hypothesized that COVID-free oncological hubs can provide safer elective cancer surgery compared to COVID hospitals. The primary aim of the present study was to analyze the outcomes of minimally invasive esophagectomy for cancer performed in both hospital settings by the same surgical staff. Methods: All esophagectomies for cancer performed during the pandemic by a single team were reviewed and data were compared with control patients operated during the preceding year. Screening for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) was performed prior to surgery, and special precautions were taken to mitigate hospital-related transmission of COVID-19 among patients and healthcare workers. Results: Compared to the prepandemic period, the esophagectomy volume decreased by 64%. Comorbidities, time from onset of symptoms to first visit, waiting time between diagnosis and surgery, operative approach and technique, and the pathological staging were similar. None of the patients tested positive for COVID-19 during in-hospital stay, and esophagectomy was associated with similar outcomes compared to control patients. Conclusion: Outcomes of minimally invasive esophagectomy for cancer performed in a COVID hospital after implementation of a COVID-free surgical pathway did not differ from those obtained in an oncological hub by the same surgical team.
Language	English
Publishing date	2022-03-18
Publishing country	Austria
Document type	Journal Article
ZDB-ID	2073941-2
ISSN	1682-4016 ; 1682-8631 ; 1682-1769
ISSN (online)	1682-4016
ISSN	1682-8631 ; 1682-1769
DOI	10.1007/s10353-022-00751-1
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Zs.A 535: Show issues

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Article ; Online: Comparison of pleural drain amylase and serum C-reactive protein for early detection of intrathoracic esophago-gastric anastomotic leaks.

Andreatta, Erika / Buogo, Alberto / Asti, Emanuele / Boveri, Sara / Bonavina, Luigi

Langenbeck's archives of surgery

2022 Volume 407, Issue 7, Page(s) 2715–2724

Abstract: Introduction: Early detection of anastomotic leaks following esophagectomy has the potential to reduce hospital length of stay and mortality. The aim of this study was to compare the predictive value of pleural drain amylase and serum C-reactive protein ...

Abstract	Introduction: Early detection of anastomotic leaks following esophagectomy has the potential to reduce hospital length of stay and mortality. The aim of this study was to compare the predictive value of pleural drain amylase and serum C-reactive protein for the early diagnosis of leak. Methods: A retrospective observational cohort study was conducted on 121 patients who underwent Ivor Lewis esophagectomy and intrathoracic gastric conduit reconstruction. Pleural drain amylase levels were measured daily until postoperative day (POD) 5 and compared with CRP values measured on POD 3, 5, and 7. Specificity and sensitivity for both tests, and the respective ROC curves, were calculated. Results: Anastomotic leak occurred in 12 patients. There was a significant statistical association between pleural drain amylase and serum CRP levels and the presence of anastomotic leakage. Pleural drain amylase cutoff of 209 IU/L on POD 2 yielded a sensitivity of 75% and a specificity of 94% (AUC = 0.813), whereas CRP cutoff value of 22.5 mg/dL on POD 3 yielded a sensitivity of 56% and a specificity of 92% (AUC = 0.772). The negative likelihood ratio of pleural drain amylase was 0.27 and 0.12 on POD 2 and 5, respectively. There was no statistically significant difference between ROC curves of amylase and CRP on POD 3 and 5 (p = 0.79 and p = 0.14, respectively). Conclusions: Pleural drain amylase seems more efficient than serum CRP for early detection of esophago-gastric anastomotic leak. The practice of monitoring drain amylase and CRP may allow safer implementation of enhanced postoperative recovery pathway.
MeSH term(s)	Humans ; Anastomotic Leak/diagnosis ; Esophagectomy/adverse effects ; Amylases ; C-Reactive Protein/analysis ; Retrospective Studies ; Early Diagnosis ; Biomarkers
Chemical Substances	Amylases (EC 3.2.1.-) ; C-Reactive Protein (9007-41-4) ; Biomarkers
Language	English
Publishing date	2022-05-17
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02550-4
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Article ; Online: Does the Pittsburgh Severity Score Predict Patients' Outcomes in Benign Esophageal Perforations?

Andreatta, Erika / Lovece, Andrea / Milani, Valentina / Asti, Emanuele / Bonavina, Luigi

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 26, Issue 8, Page(s) 1757–1759

MeSH term(s)	Esophageal Perforation/diagnosis ; Esophageal Perforation/etiology ; Esophageal Perforation/surgery ; Esophagoscopy ; Humans ; Iatrogenic Disease ; Stents
Language	English
Publishing date	2022-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05281-5
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Article ; Online: Comparative outcomes of Toupet fundoplication and magnetic sphincter augmentation.

Asti, Emanuele / Milito, Pamela / Froiio, Caterina / Milani, Valentina / Bonavina, Luigi

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2022 Volume 36, Issue Supplement_1

Abstract: Laparoscopic fundoplication is the current surgical gold standard for the treatment of refractory gastroesophageal reflux disease (GERD). Magnetic sphincter augmentation (MSA) is a less invasive, standardized, and reversible option to restore competency ... ...

Abstract	Laparoscopic fundoplication is the current surgical gold standard for the treatment of refractory gastroesophageal reflux disease (GERD). Magnetic sphincter augmentation (MSA) is a less invasive, standardized, and reversible option to restore competency of the lower esophageal sphincter. A comparative cohort study was conducted at a tertiary-care referral center on patients with typical GERD symptoms treated with systematic crural repair combined with Toupet fundoplication or MSA. Primary study outcome was decrease of Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score. Between January 2014 and December 2021, a total of 199 patients (60.3% female, median [Q1-Q3] age: 51.0 [40.0-61.0]) underwent MSA (n = 130) or Toupet fundoplication (n = 69). Operative time and hospital stay were significantly shorter in MSA patients (P < 0.0001). At a median follow-up of 12.0 [12.0-24.0] months, there was a statistically significant decrease of GERD-HRQL score in both patient groups (P = 0.001). The mean delta values did not significantly differ between groups (P = 0.7373). The incidence of severe gas bloating symptoms was similar in the two groups (P = 0.7604), but the rate of persistent postoperative dysphagia was greater in MSA patients (P = 0.0009). Six (8.7%) patients in the Toupet group had recurrent hiatal hernia requiring revisional surgery in one (1.4%). In the MSA group, eight (7.9%) patients necessitated through-the-scope balloon dilation for relief of dysphagia, and six patients had the device removed (4.6%) because of persistent dysphagia (n = 3), device disconnection (n = 1), persistent reflux (n = 1) or need of magnetic resonance (n = 1). Toupet and MSA procedures provide similar clinical outcomes, but MSA is associated with a greater risk of reoperation. Randomized clinical trials comparing fundoplication and MSA are eagerly awaited.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Fundoplication/methods ; Cohort Studies ; Deglutition Disorders/etiology ; Deglutition Disorders/surgery ; Quality of Life ; Laparoscopy/methods ; Gastroesophageal Reflux/complications ; Esophageal Sphincter, Lower/surgery ; Treatment Outcome
Language	English
Publishing date	2022-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doac090
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Zs.A 2378: Show issues

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Article ; Online: Commentary on "The effects of reoperation on surgical outcomes following surgery for major abdominal emergencies: A retrospective cohort study" (Int J Surg 2019;72:235-40).

Asti, Emanuele / Bonavina, Luigi

International journal of surgery (London, England)

2019 Volume 73, Page(s) 99–100

MeSH term(s)	Abdomen ; Emergencies ; Humans ; Reoperation ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2019-12-17
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2019.12.002
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Article ; Online: Short-term efficacy of transvaginal specimen extraction for right colon cancer based on propensity score matching: A retrospective cohort study.

Asti, Emanuele / Bonavina, Luigi

International journal of surgery (London, England)

2019 Volume 70, Page(s) 28–29

MeSH term(s)	Colectomy ; Colonic Neoplasms/surgery ; Humans ; Propensity Score ; Retrospective Studies
Language	English
Publishing date	2019-08-08
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2019.08.008
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Article: Subtotal laparoscopic cholecystectomy for gangrenous gallbladder during recovery from COVID-19 pneumonia.

Lovece, Andrea / Asti, Emanuele / Bruni, Barbara / Bonavina, Luigi

International journal of surgery case reports

2020 Volume 72, Page(s) 335–338

Abstract: Introduction: Management of acute abdomen during COVID-19 pandemic may be challenging.: Presentation of case: A 42-year old man was hospitalized for Covid-19 pneumonia. Fever, respiratory symptoms and hypoxemia significantly improved over the next 2 ... ...

Abstract	Introduction: Management of acute abdomen during COVID-19 pandemic may be challenging. Presentation of case: A 42-year old man was hospitalized for Covid-19 pneumonia. Fever, respiratory symptoms and hypoxemia significantly improved over the next 2 weeks, but the patient developed abdominal pain, nausea, and low-grade fever. Computed tomography scan revealed absence of contrast enhancement of gallbladder wall and a micro-perforation of the fundus. At laparoscopy, gallbladder gangrene was confirmed and a subtotal cholecystectomy performed. Special precautions were adopted for patient transportation from the ward to a dedicated operating room, and two teams with adequate personal protective equipment took charge of the procedure. The patient was discharged home on postoperative day 7 under protective lockdown measures for 2 weeks. Discussion: The pathogenesis of acute acalcolous gangrenous cholecystitis is multifactorial. It is unknown whether a prothrombotic state induced by COVID-19 contributes to wall ischemia and perforation. Percutaneous cholecystostomy should be avoided in patients with gallbladder gangrene. Contraindications to laparoscopy are not evidence-based since aerosolization is produced during both open and laparoscopic surgical procedures. However, personal protective equipment is key for prevention. Conclusion: Early diagnosis and surgical therapy are critical in patients with gangrenous cholecystitis. Subtotal laparoscopic cholecystectomy for gangrenous gallbladder is safe and effective.
Keywords	covid19
Language	English
Publishing date	2020-06-13
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.06.038
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Article ; Online: Gangrenous cholecystitis during hospitalization for SARS-CoV2 infection.

Asti, Emanuele / Lovece, Andrea / Bonavina, Luigi

Updates in surgery

2020 Volume 72, Issue 3, Page(s) 917–919

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; COVID-19 ; Cholecystectomy ; Cholecystitis, Acute/diagnostic imaging ; Cholecystitis, Acute/etiology ; Cholecystitis, Acute/surgery ; Coronavirus Infections/complications ; Emergencies ; Female ; Gallbladder/pathology ; Gallbladder/surgery ; Gangrene/surgery ; Humans ; Immunocompromised Host ; Male ; Pandemics ; Pneumonia, Viral/complications ; Risk ; Tomography, X-Ray Computed
Keywords	covid19
Language	English
Publishing date	2020-05-26
Publishing country	Italy
Document type	Letter
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00814-6
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Zs.B 101: Show issues

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Article ; Online: Laparoscopic Toupet fundoplication for gastroesophageal reflux disease and hiatus hernia: proposal for standardization using the "critical view" concept.

Bona, Davide / Aiolfi, Alberto / Asti, Emanuele / Bonavina, Luigi

Updates in surgery

2020 Volume 72, Issue 2, Page(s) 555–558

Abstract: Laparoscopic Toupet fundoplication has gained progressive consideration in the management of patients with gastroesophageal reflux disease and hiatus hernia. Previous studies showed equivalent results in terms of reflux control with lower rate of side ... ...

Abstract	Laparoscopic Toupet fundoplication has gained progressive consideration in the management of patients with gastroesophageal reflux disease and hiatus hernia. Previous studies showed equivalent results in terms of reflux control with lower rate of side effects compared to the Nissen fundoplication. However, multiple technical variations may account for the long-lasting reputation of decreased durability and poor long-term reflux control. Inspired by the "critical view" concept, a step-by-step laparoscopic Toupet fundoplication is described and illustrated. During the study period, 2012-2017, 348 consecutive patients underwent laparoscopic Toupet fundoplication according to a standardized procedure. A large hiatus hernia was present in 39% of patients, and 14% had volvulus of the intrathoracic stomach. Sixty-four (18.4%) patients had one or more previously failed antireflux procedures. The median follow-up was 37 months (range 12-61). The Gastroesophageal Reflux Disease Health-Related Quality of Life score significantly improved compared to baseline (p < 0.001), and 77% of patients were off proton-pump inhibitors. The proposed standardization of the Toupet fundoplication based on a "critical-view" concept may help to improve reproducibility, clinical outcomes, and teaching of this procedure.
MeSH term(s)	Follow-Up Studies ; Fundoplication/methods ; Fundoplication/standards ; Gastroesophageal Reflux/surgery ; Hernia, Hiatal/surgery ; Herniorrhaphy/methods ; Herniorrhaphy/standards ; Humans ; Laparoscopy/methods ; Laparoscopy/standards ; Quality of Life ; Reproducibility of Results ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2020-03-04
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00732-7
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