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Book: Innovation in esophageal surgery

Bonavina, Luigi

2012

Author's details	Luigi Bonavina ed
Keywords	Esophagus--Surgery
Language	English
Size	XIV, 136 S. : zahlr. Ill., graph. Darst., 24 cm
Publisher	Springer
Publishing place	Milan u.a.
Publishing country	Italy
Document type	Book
HBZ-ID	HT017469698
ISBN	978-88-470-2468-7 ; 88-470-2468-4 ; 9788847024694 ; 8847024692
Database	Catalogue ZB MED Medicine, Health

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Article: Progress in the esophagogastric anastomosis and the challenges of minimally invasive thoracoscopic surgery.

Bonavina, Luigi

Annals of translational medicine

2021 Volume 9, Issue 10, Page(s) 907

Abstract: The esophagogastric anastomosis is most commonly performed to restore digestive tract continuity after esophagectomy for cancer. Despite a long history of clinical research and development of high-tech staplers, this procedure is still feared by most ... ...

Abstract	The esophagogastric anastomosis is most commonly performed to restore digestive tract continuity after esophagectomy for cancer. Despite a long history of clinical research and development of high-tech staplers, this procedure is still feared by most surgeons and associated with a 10% leakage rate. Among specific factors that may contribute to failure of the esophageal anastomosis are the absence of serosa layer, longitudinal orientation of muscle fibers, and ischemia of the gastric conduit. It has recently been suggested that the gut microbiome may influence the healing process of the anastomosis through the presence of collagenolytic bacterial strains, indicating that suture breakdown is not only a matter of collagen biosynthesis. The esophagogastric anastomosis can be performed either in the chest or neck, and can be completely hand-sewn, completely stapled (circular or linear stapler), or semi-mechanical (linear stapler posterior wall and hand-sewn anterior wall). Because of the lack of randomized clinical trials, no conclusive evidence is available, and the debate between the hand-sewn and the stapling technique is still ongoing even in the present era of robotic surgery. Centralization of care has improved the overall postoperative outcomes of esophagectomy, but the esophagogastric anastomosis remains the Achille's heel of the procedure. More research and network collaboration of experts is needed to improve safety and clinical outcomes.
Language	English
Publishing date	2021-06-07
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm.2020.03.66
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Commentary: Evaluation of Anterior Phrenoesophageal Ligament Preservation During Hiatus Hernia Repair in Laparoscopic Sleeve Gastrectomy as an Anti-Reflux Measure by Elmaleh

Bonavina, Luigi

Journal of laparoendoscopic & advanced surgical techniques. Part A

2021 Volume 31, Issue 5, Page(s) 515–516

MeSH term(s)	Gastrectomy/methods ; Gastroesophageal Reflux/etiology ; Gastroesophageal Reflux/prevention & control ; Hernia, Hiatal/complications ; Hernia, Hiatal/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Ligaments/surgery ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Postoperative Complications/prevention & control ; Treatment Outcome
Language	English
Publishing date	2021-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1381909-4
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2021.29036.lb
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Article ; Online: Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment.

Manara, Michele / Bona, Davide / Bonavina, Luigi / Aiolfi, Alberto

Updates in surgery

2024

Abstract: Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic ... ...

Abstract	Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2-10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7-12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6-9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51-0.69), 24 (HR 0.64, 95% CI 0.55-0.73), 36 (HR 0.67, 95% CI 0.55-0.79), and 60 months (HR 0.69, 95% CI 0.51-0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up.
Language	English
Publishing date	2024-02-06
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-024-01761-2
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Article ; Online: Esophageal emergencies.

Chirica, Mircea / Bonavina, Luigi

Minerva surgery

2022 Volume 78, Issue 1, Page(s) 52–67

Abstract: The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the ... ...

Abstract	The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.
MeSH term(s)	Humans ; Emergencies ; Esophageal Perforation/diagnosis ; Esophageal Perforation/etiology ; Foreign Bodies/complications ; Caustics
Chemical Substances	Caustics
Language	English
Publishing date	2022-12-13
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.22.09781-7
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Article ; Online: Is Endoscopic Surveillance Needed After Laparoscopic Sleeve Gastrectomy?

Aiolfi, Alberto / Bona, Davide / Lipham, John C / Bonavina, Luigi

Current obesity reports

2024 Volume 13, Issue 1, Page(s) 183–185

MeSH term(s)	Humans ; Gastrectomy ; Laparoscopy ; Obesity, Morbid/surgery ; Treatment Outcome
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Letter
ISSN	2162-4968
ISSN (online)	2162-4968
DOI	10.1007/s13679-023-00545-w
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Safety profile of magnetic sphincter augmentation for gastroesophageal reflux disease.

Froiio, Caterina / Aiolfi, Alberto / Bona, Davide / Bonavina, Luigi

Frontiers in surgery

2023 Volume 10, Page(s) 1293270

Abstract: Background: The magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated.: ... ...

Abstract	Background: The magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated. Methods: Retrospective study on a prospectively collected database. Patients who underwent MSA procedure between March 2007 and September 2021 in two tertiary-care referral centers for esophageal surgery were included. The trend of MSA explant, the changes in the sizing technique and crura repair over the years, the technique of explant, and the clinical outcomes of the revisional procedure were reviewed. Results: Out of 397 consecutive patients, 50 (12.4%) underwent MSA removal, with a median time to explant of 39.5 [IQR = 53.7] months. Main symptoms leading to removal were dysphagia (43.2%), heartburn (25%), and epigastric pain (13.6%). Erosion occurred in 2.5% of patients. Smaller (12- and 13-bead) devices were the ones most frequently explanted. The majority of the explants were performed laparoscopically with endoscopic assistance. There was no perioperative morbidity, and the median length of stay was 2.8 ± 1.4 days. After 2014, changes in sizing technique and crura repair resulted in a decreased incidence of explants from 23% to 5% ( Conclusion: Oversizing and full mediastinal dissection with posterior hiatoplasty may improve the outcomes of the MSA procedure and possibly reduce removal rates.
Language	English
Publishing date	2023-11-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1293270
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Article ; Online: Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery.

Bonavina, Giuseppe / Zackova, Monika / Bet, Luciano / Bonavina, Luigi

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

2023 Volume 4, Issue 1, Page(s) e252

Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ISSN	2691-3593
ISSN (online)	2691-3593
DOI	10.1097/AS9.0000000000000252
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effect of gastric ischemic conditioning prior to esophagectomy: systematic review and meta-analysis.

Aiolfi, Alberto / Bona, Davide / Bonitta, Gianluca / Bonavina, Luigi

Updates in surgery

2023 Volume 75, Issue 6, Page(s) 1633–1643

Abstract: Ischemia at the anastomotic site is thought to be a protagonist in the development of anastomosis-related complications while different strategies to overcome this problem have been reported. Gastric ischemic conditioning (GIC) prior to esophagectomy has ...

Abstract	Ischemia at the anastomotic site is thought to be a protagonist in the development of anastomosis-related complications while different strategies to overcome this problem have been reported. Gastric ischemic conditioning (GIC) prior to esophagectomy has been described with this intent. Evaluate the effect of GIC on anastomotic complications after esophagectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to March 31st, 2023. We considered articles that appraised short-term outcomes after GIC vs. no GIC in patients undergoing esophagectomy. Anastomotic leak (AL), anastomotic stricture (AS), and gastric conduit necrosis (GCN) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Fourteen studies (1760 patients) were included. Of those, 732 (41.6%) underwent GIC, while 1028 (58.4%) underwent one-step esophagectomy. Compared with no GIC, GIC was related to a reduced RR for AL (R RR = 0.63; 95% CI 0.47-0.86; p < 0.01) and AS (RR = 0.51; 95% CI 0.29-0.91; p = 0.02), whereas no differences were found for GCN (RR = 0.56; 95% CI 0.19-1.61; p = 0.28). Postoperative pneumonia (RR = 1.09; p = 0.99), overall complications (RR = 0.87; p = 0.19), operative time (SMD - 0.58; p = 0.07), hospital stay (SMD 0.66; p = 0.09), and 30-day mortality (RR = 0.69; p = 0.22) were comparable. GIC prior to esophagectomy seems associated with a reduced risk for AL and AS. Further studies are necessary to identify the subset of patients who can benefit from this procedure, the optimal technique, and the timing of GIC prior to esophagectomy.
MeSH term(s)	Humans ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Stomach/surgery ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Ischemia/complications ; Ischemia/surgery ; Anastomosis, Surgical/methods ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Postoperative Complications/etiology
Language	English
Publishing date	2023-07-27
Publishing country	Italy
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-023-01601-9
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Article ; Online: Short-term Outcomes of Different Techniques for Gastric Ischemic Preconditioning Before Esophagectomy: A Network Meta-analysis.

Aiolfi, Alberto / Bona, Davide / Bonitta, Gianluca / Bonavina, Luigi

Annals of surgery

2023 Volume 279, Issue 3, Page(s) 410–418

Abstract: Background: Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the ... ...

Abstract	Background: Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported. Purpose: Compare short-term outcomes among different GIC techniques. Materials and methods: Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrIs) were used to assess relative inference. Results: Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC versus noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC versus noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC versus noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC versus noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC versus AngioGIC in terms of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments. Conclusions: Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS.
MeSH term(s)	Humans ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Network Meta-Analysis ; Stomach/surgery ; Stomach/blood supply ; Ischemic Preconditioning/adverse effects ; Ischemic Preconditioning/methods ; Anastomotic Leak/surgery ; Anastomosis, Surgical/methods ; Ischemia/surgery ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/complications
Language	English
Publishing date	2023-10-13
Publishing country	United States
Document type	Systematic Review ; Meta-Analysis ; Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006124
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