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  1. Article ; Online: The Use of Antibiotics Before Transanal Endoscopic Microsurgery.

    Balla, Andrea

    Journal of investigative surgery : the official journal of the Academy of Surgical Research

    2017  Volume 31, Issue 6, Page(s) 555–556

    MeSH term(s) Anti-Bacterial Agents ; Humans ; Proctoscopy ; Rectal Neoplasms/surgery ; Transanal Endoscopic Microsurgery
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2017-11-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639444-9
    ISSN 1521-0553 ; 0894-1939
    ISSN (online) 1521-0553
    ISSN 0894-1939
    DOI 10.1080/08941939.2017.1382621
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  2. Article ; Online: Invited commentary on "Prediction of postoperative mortality and morbidity in octogenarians with gastric cancer - Comparison of P-POSSUM, O-POSSUM, and E-POSSUM: A retrospective single-center cohort study".

    Paganini, Alessandro M / Balla, Andrea

    International journal of surgery (London, England)

    2020  Volume 78, Page(s) 22–23

    MeSH term(s) Aged, 80 and over ; Cohort Studies ; Gastrectomy ; Humans ; Morbidity ; Retrospective Studies ; Stomach Neoplasms/surgery
    Language English
    Publishing date 2020-04-18
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1016/j.ijsu.2020.04.020
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  3. Article ; Online: Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives.

    Morales-Conde, Salvador / Balla, Andrea / Navarro-Morales, Laura / Moreno-Suero, Francisco / Licardie, Eugenio

    Cirugia espanola

    2023  Volume 101 Suppl 1, Page(s) S11–S18

    Abstract: The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There ... ...

    Abstract The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females. Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias. Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.
    MeSH term(s) Female ; Humans ; Hernia, Inguinal/surgery ; Treatment Outcome ; Artificial Intelligence ; Laparoscopy/methods ; Forecasting
    Language English
    Publishing date 2023-11-10
    Publishing country Spain
    Document type Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2023.01.007
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  4. Article ; Online: Nationwide analysis of inpatient laparoscopic ventral hernia repair in Italy from 2015 to 2020.

    Botteri, Emanuele / Ortenzi, Monica / Williams, Sophie / Balla, Andrea / Podda, Mauro / Guerrieri, Mario / Sartori, Alberto

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1661–1670

    Abstract: Since 2010, several guidelines and consensus papers have been proposed to support surgeons in the decision-making process (Cuccurullo et al. in Hernia 17(5):557-566, 2013; Silecchia et al. in Surg Endosc 29:2463-2484, 2015; Bittner et al. in Surg Endosc ... ...

    Abstract Since 2010, several guidelines and consensus papers have been proposed to support surgeons in the decision-making process (Cuccurullo et al. in Hernia 17(5):557-566, 2013; Silecchia et al. in Surg Endosc 29:2463-2484, 2015; Bittner et al. in Surg Endosc 33(11):3511-3549, 2015) with the conclusion that laparoscopic repair (LR) has gained popularity in the treatment of IH.To date, however, it is not yet clear as to the uptake of LR for IH on national basis. Only dated studies encompassing of all types of incisional hernia repairs are available in literature (Bisgaard et al. in Br J Surg 96:1452-1457, 2009). The aim of our study is to present a snapshot of Italian data for LR of ventral hernias, over a 6 years period, including volume of LR, procedural features and major postoperative outcomes. Data were extracted from the Italian Hospital Information System (HIS) that collects clinical and administrative information regarding each hospital admission of every patient discharged from any hospital in Italy. Using Hospital Discharge records regional Databases (HDD), all laparoscopic ventral hernia procedures carried out in public and private hospitals between 2015 and 2020, in patients over 18 years and resident in Italy, were collected based on diagnosis and procedure codes. The National Agency for Regional Health Services (AgeNaS) oversees the management and analysis of data. All hospital admissions that occurred between 2015 and 2020 were analyzed.A total of 154,546 incisional hernia repairs were performed in Italy from 2015 to 2020. Of these, 20,789 (13.45%) were minimally invasive repairs. The number of procedures performed increased significantly over time, constituting 11.96 and 15.24% of all procedures performed in 2015 and 2020 respectively. However, considering the whole period, the mean annual change was-5.58% (CI - 28.6% to 17.44%; p < 0.0001).Urgent minimally invasive repairs were performed in 1968 cases (1.27%). The absolute rate of laparoscopically treated patients needing an urgent surgical procedure increased overtime (from 7.36% in 2015 to 13.418% in 2020). The mean annual change registered over the whole period was 7.42%. 92% (CI - 0.03 to 14.09%; p < 0.0001). However, when considering the period from 2015 to 2019, the mean annual change was 10.42% (CI 6.35 to 14.49%; p < 0.0001). To our knowledge this is the first nationwide Italian report presenting the national workload of surgical units and the main perioperative features of minimally invasive surgery for ventral hernia repairs.
    MeSH term(s) Humans ; Herniorrhaphy/methods ; Incisional Hernia/surgery ; Inpatients ; Hernia, Ventral/surgery ; Hernia, Ventral/etiology ; Laparoscopy/methods ; Surgical Mesh
    Language English
    Publishing date 2023-03-14
    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/s13304-023-01460-4
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  5. Article ; Online: Prospective Italian validation of the Vaizey and Wexner and fecal incontinence severity index (FISI) questionnaires.

    Ortenzi, Monica / Guerrieri, Mario / Saraceno, Federica / Reggiani, Angelica / Lepiane, Pasquale / Sileri, Pierpaolo / Balla, Andrea

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1617–1623

    Abstract: Several objective severity measurement questionnaires of the fecal incontinence (FI), are available to describe type, frequency and degree of FI, and their impact on quality of life, aiming to establish baseline scores measure response to treatment over ... ...

    Abstract Several objective severity measurement questionnaires of the fecal incontinence (FI), are available to describe type, frequency and degree of FI, and their impact on quality of life, aiming to establish baseline scores measure response to treatment over time and allow comparison among patients treated using different strategies. Presently, despite their widespread use in clinical practice, none of these questionnaire have been validated in the Italian language. The aim is to test the translated Italian version of the Vaizey and Wexner and Fecal Incontinence Severity Index (FISI) questionnaires assessing their reliability and validity among Italian-speaking patients. Two researchers proficient in spoken English and Italian translated both questionnaires in the Italian language. They independently translated the two questionnaires from English and then they met to produce a single version of the two questionnaires, to solve any possible discrepancy. A forward-backward translation was then obtained by a professional bilingual translator, so as to define the final version of the questionnaires. The questionnaires were independently administered twice to 100 Italian-speaking patients by two different and independent raters. Cronbach's α of the first and second Vaizey and Wexner questionnaire was 0.755 and 0.727, respectively. While Cronbach's α of the first and second FISI questionnaire was 0.810 and 0.806, respectively. Spearman correlation and inter-rater reliability were 0.937 and 0.913 for Vaizey and Wexner questionnaire, respectively, and 0.915 and 0.871 for FISI questionnaire, respectively. Italian version of the Vaizey and Wexner and FISI questionnaires proved good consistency, reliability, reproducibility, showing good psychometric properties.
    MeSH term(s) Humans ; Quality of Life ; Reproducibility of Results ; Prospective Studies ; Fecal Incontinence/diagnosis ; Severity of Illness Index ; Language ; Surveys and Questionnaires ; Italy
    Language English
    Publishing date 2023-06-27
    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/s13304-023-01567-8
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  6. Article ; Online: Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience.

    Morales-Conde, Salvador / Licardie, Eugenio / Alarcón, Isaias / Balla, Andrea

    Cirugia espanola

    2022  Volume 100, Issue 9, Page(s) 534–554

    Abstract: Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, ... ...

    Abstract Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
    MeSH term(s) Anastomosis, Surgical ; Coloring Agents ; Fluorescence ; Humans ; Indocyanine Green ; Sentinel Lymph Node
    Chemical Substances Coloring Agents ; Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2022-06-11
    Publishing country Spain
    Document type Journal Article ; Review
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2022.06.023
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  7. Article: Unusual presentation of small bowel GIST: diffuse omental & mesenteric sarcomatosis.

    Catarci, Marco / Balla, Andrea / Coppola, Luigi

    Journal of surgical case reports

    2020  Volume 2020, Issue 9, Page(s) rjaa341

    Abstract: Gastrointestinal stromal tumors (GISTs) represent ~1% of gastrointestinal (GI) tract neoplasms. Unusual presentation of a small bowel GIST with diffuse omental and mesenteric implants in a symptomatic patient is reported. CT scan in a 68-years-old woman ... ...

    Abstract Gastrointestinal stromal tumors (GISTs) represent ~1% of gastrointestinal (GI) tract neoplasms. Unusual presentation of a small bowel GIST with diffuse omental and mesenteric implants in a symptomatic patient is reported. CT scan in a 68-years-old woman showed multiple processes with solid density and colliquation areas in the abdominal cavity. At surgery, an uncommon finding of multiple omental and mesenteric secondary implants was evident. The index mass with 40 cm of adjacent small bowel, omentum and all peritoneal lesions were completely removed. Definitive pathology report showed a small bowel GIST with focal areas of necrosis and high mitotic activity (35 mitosis/50 High Power Fields), with multiple metastases on mesentery and omentum. Patient was therefore submitted to adjuvant treatment with Imatinib and a close follow-up program. Small bowel GIST with high mitotic activity may present with diffuse omental and mesenteric peritoneal seedings. Complete surgical clearance remains the mainstay of treatment.
    Language English
    Publishing date 2020-09-21
    Publishing country England
    Document type Case Reports
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjaa341
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  8. Article ; Online: Management of postoperative complications after laparoscopic left hemicolectomy: an approach in modern times after incorporation of indocyanine green and full mobilization of the splenic flexure.

    Morales-Conde, Salvador / Balla, Andrea / Alarcón, Isaias / Licardie, Eugenio

    Minerva surgery

    2021  Volume 76, Issue 4, Page(s) 303–309

    Abstract: Background: The aim of this study was to report our experience in the management of complications after laparoscopic left hemicolectomy (LLH) after the incorporation in our clinical practice of intraoperative indocyanine green (ICG) fluorescence ... ...

    Abstract Background: The aim of this study was to report our experience in the management of complications after laparoscopic left hemicolectomy (LLH) after the incorporation in our clinical practice of intraoperative indocyanine green (ICG) fluorescence angiography (FA).
    Methods: In our last period after incorporation of ICG-FA, 277 unselected consecutive patients underwent laparoscopic colorectal surgery with this technology. Ninety-seven (35%) right hemicolectomy, 19 segmental resection of the splenic flexure (6.9%), 54 anterior resection of the rectum (19.5%) and 107 LLH (38.6%) were performed. Complications were graded according to Clavien-Dindo classification, and anastomotic leakages (AL) were graded according to Clavien-Dindo classification and to International Study Group of Rectal Cancer (ISGRC) classification.
    Results: Eight surgical and one medical complications (8.4%) were observed. Two AL occurred (1.9%). One drained spontaneously by drainage placed intraoperatively (Clavien-Dindo I, ISGRC A) and one treated by laparoscopic peritoneal lavage, leakage suture and ileostomy (Clavien-Dindo III-b, ISGRC C). Other complications were: wound infection (Clavien-Dindo II) (2); postoperative anemia caused by rectorrhagia (Clavien-Dindo II) (2); pelvic abscess between bladder and uterus (Clavien-Dindo III-a) (1); hemoperitoneum secondary to inferior mesenteric artery bleeding treated with peritoneal lavage and hemostasis (Clavien-Dindo III-b) (1); atrial fibrillation (Clavien-Dindo II) (1). All complications have been resolved.
    Conclusions: The complication rate after LLH after the incorporation of ICG-FA is low, since the number of AL have dramatically decreased in comparison to our previous experience. The management of these patients proved to be safe and effective due to in all cases the complication has been resolved. Further studies are required to standardize the management of these patients.
    MeSH term(s) Colectomy ; Colon, Transverse ; Female ; Humans ; Indocyanine Green ; Laparoscopy ; Postoperative Complications/epidemiology
    Chemical Substances Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2021-04-14
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 3067899-7
    ISSN 2724-5438
    ISSN (online) 2724-5438
    DOI 10.23736/S2724-5691.21.08642-9
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  9. Article ; Online: Telemedicine in surgery during COVID-19 pandemic: are we doing enough?

    Sartori, Alberto / Balla, Andrea / Agresta, Ferdinando / Guerrieri, Mario / Ortenzi, Monica

    Minerva surgery

    2021  Volume 77, Issue 1, Page(s) 50–56

    Abstract: Introduction: The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of ...

    Abstract Introduction: The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain.
    Evidence acquisition: All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included.
    Evidence synthesis: Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review.
    Conclusions: In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients' health, cost-effectiveness and user satisfaction remain unsolved.
    MeSH term(s) Aftercare/statistics & numerical data ; COVID-19/epidemiology ; General Surgery/statistics & numerical data ; Humans ; Pandemics ; Postoperative Care/statistics & numerical data ; SARS-CoV-2 ; Telemedicine/statistics & numerical data
    Language English
    Publishing date 2021-10-25
    Publishing country Italy
    Document type Journal Article ; Systematic Review
    ZDB-ID 3067899-7
    ISSN 2724-5438
    ISSN (online) 2724-5438
    DOI 10.23736/S2724-5691.21.09100-0
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  10. Article ; Online: Single/reduced port surgery vs. conventional laparoscopic gastrectomy: systematic review and meta-analysis.

    Alarcón, Isaias / Yang, Tao / Balla, Andrea / Morales-Conde, Salvador

    Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy

    2021  Volume 31, Issue 4, Page(s) 515–524

    Abstract: Introduction: The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes.: Material and methods: After a search in ... ...

    Abstract Introduction: The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes.
    Material and methods: After a search in Pubmed and Embase, six articles were included. Pooled analysis was used to evaluate the statistically significance for each variable.
    Results: Two hundred and thirty-three and 230 patients underwent SPS/RPS and CL, respectively. One hundred and eighty-eight patients and 45 patients underwent subtotal and total gastrectomy, respectively, using the SPS/RPS approach. One hundred and eighty-five patients and 45 patients underwent subtotal and total gastrectomy, respectively, by CL. In 85 patients, an extra trocar was systematically placed at the end of surgery. Statistically significant differences were not observed about preoperative staging. The pooled analysis regarding operative time, blood loss, postoperative complications, number of harvested lymph nodes and postoperative hospital stay showed that the only statistically significant difference between the two approaches is the shorter hospital stay in case of SPS/RPS.
    Conclusions: SPS/RPS total or subtotal gastrectomy shows a lower postoperative hospital stay, with comparable operative time, blood loss, early postoperative complication rate and number of harvested lymph nodes in comparison to CL, provided extensive experience in minimally invasive gastrectomy is present.
    MeSH term(s) Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications/epidemiology ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Treatment Outcome
    Language English
    Publishing date 2021-02-18
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 1317160-4
    ISSN 1365-2931 ; 1364-5706
    ISSN (online) 1365-2931
    ISSN 1364-5706
    DOI 10.1080/13645706.2021.1884571
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