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Article ; Online: Commentary on: Salvage surgery is an effective alternative for J pouch afferent limb stricture treatment.

Spinelli, Antonino / Carvello, Michele

2023 Volume 174, Issue 4, Page(s) 758

MeSH term(s)	Humans ; Colonic Pouches ; Constriction, Pathologic/surgery ; Proctocolectomy, Restorative ; Postoperative Complications/surgery ; Salvage Therapy ; Colitis, Ulcerative/surgery ; Anastomosis, Surgical
Language	English
Publishing date	2023-07-12
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.06.008
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Article ; Online: A surgical perspective on total neoadjuvant therapy for rectal cancer: Shades and lights of a new journey.

Spinelli, Antonino / Carvello, Michele

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 9, Page(s) 2223–2224

MeSH term(s)	Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2021-09-13
Publishing country	England
Document type	Editorial
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15873
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Article ; Online: Suprapubic single port ileocaecal resection for complicated Crohn's disease - a video vignette.

Spinelli, A / Carvello, M

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2017 Volume 19, Issue 10, Page(s) 946

MeSH term(s)	Cecum/surgery ; Crohn Disease/complications ; Crohn Disease/pathology ; Crohn Disease/surgery ; Female ; Humans ; Ileum/pathology ; Ileum/surgery ; Pelvic Neoplasms/etiology ; Pelvic Neoplasms/surgery ; Pelvis/surgery ; Surgical Instruments ; Young Adult
Keywords	covid19
Language	English
Publishing date	2017
Publishing country	England
Document type	Case Reports ; Letter ; Video-Audio Media
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.13854
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Article: Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease.

Carvello, Michele / Danese, Silvio / Spinelli, Antonino

Clinics in colon and rectal surgery

2022 Volume 35, Issue 1, Page(s) 72–77

Abstract: The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive ... ...

Abstract	The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand, the rationale of traditional escalating medical therapy (step-up approach) has been undermined by the top-down medical approach. Indeed, the step-up approach has the possible drawback of delaying, up to a later disease stage, the use of more effective agents such as anti-tumor necrosis factors. Conversely, the top-down approach might expose patients to an overtreatment along with side effects including hypersensitivity to biologic agents. More recently, it has been shown how early surgery could be a valid option in this subset of patients being more cost-effective than medical therapy. Involving the surgeon at an early stage is considered now a good clinical practice and, in this scenario full of possibilities, the surgeon should be included into the decision-making process from the very beginning of patient management.
Language	English
Publishing date	2022-01-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0041-1740031
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Article ; Online: Suprapubic single-port approach for complicated diverticulitis.

Spinelli, A / Di Candido, F / Carvello, M

Techniques in coloproctology

2018 Volume 22, Issue 9, Page(s) 657–662

Abstract: Background: Laparoscopic sigmoidectomy is the gold standard for elective surgical treatment of diverticulitis. A periumbilical single-port technique reduces the size of the access wound, usually to 3-4 cm. However, in the presence of large phlegmon or ... ...

Abstract	Background: Laparoscopic sigmoidectomy is the gold standard for elective surgical treatment of diverticulitis. A periumbilical single-port technique reduces the size of the access wound, usually to 3-4 cm. However, in the presence of large phlegmon or fistulae, the risk of conversion is higher and the extraction site might be enlarged. A suprapubic Pfannenstiel incision reduces the risk of incisional hernia compared to umbilical access and might provide the possibility to perform sigmoidectomy with a hybrid technique. The aim of the present study was to investigate the feasibility of laparoscopic sigmoidectomy through a single suprapubic transverse access for large diverticular phlegmon. Methods: Consecutive patients with a diverticular inflammatory mass ≥ 5 cm, with or without sigmoid-vesical fistula, were considered candidates for laparoscopic sigmoidectomy through a 5-cm single-port suprapubic (SPSP) access, extended (if required) to match the size of the inflammatory mass. Results: Twenty patients underwent SPSP sigmoidectomy at our institution in April 2014-April 2017. All procedures were completed by SPSP access, with no intraoperative complications or need for additional trocar placement. Eight patients had a sigmoid-vesical fistula (bladder sutured in three patients). The splenic flexure was mobilized in nine patients. Median operative time was 178 min and median hospital stay was 5.5 days (iqr 4-6). Postoperative complications occurred in four patients and included one subcutaneous hematoma, one urinary tract infection, and two superficial wound infections. After a median follow-up time of 25 months (interquartile range 15-38), all patients experienced complete resolution of symptoms, with no incisional hernias reported. Conclusions: SPSP sigmoidectomy for diverticulitis is feasible and effective, minimizing the size of the access wound and avoiding increased risk of hernia. This approach might be especially valuable for the management of large diverticular phlegmon and sigmoid-vesical fistula.
MeSH term(s)	Aged ; Cellulitis/etiology ; Cellulitis/surgery ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Intestinal Fistula/etiology ; Intestinal Fistula/surgery ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Urinary Bladder Fistula/etiology ; Urinary Bladder Fistula/surgery
Keywords	covid19
Language	English
Publishing date	2018-09-15
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-018-1843-9
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Article ; Online: Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis.

La Raja, C / Foppa, C / Maroli, A / Kontovounisios, C / Ben David, N / Carvello, M / Spinelli, A

Techniques in coloproctology

2022 Volume 26, Issue 8, Page(s) 603–613

Abstract: Background: Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with ... ...

Abstract	Background: Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with diverting stoma, DCAA has regained popularity in recent years in reconstructive surgery for low RC, especially when combined with minimally invasive surgery (MIS). The aim of this study was to perform the first meta-analysis, exploring the safety and outcomes of DCAA compared to ICAA with protective stoma. Methods: A systematic search of MEDLINE, EMBASE, and CENTRAL and Google Scholar databases was performed for studies published from January 2000 until December 2020. The systematic review and meta-analysis were performed according to the Cochrane Handbook for Systematic Review on Interventions recommendations and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Results: Out of 2626 studies screened, 9 were included in the systematic review and 4 studies in the meta-analysis. Outcomes included were postoperative complications, pelvic sepsis and risk of definitive stoma. Considering postoperative complications classified as Clavien-Dindo III, no significant difference existed in the rate of postoperative morbidity between DCAA and ICAA (13% versus 21%; OR 1.17; 95% CI 0.38-3.62; p = 0.78; I Conclusions: According to the limited current evidence, DCAA is associated with a significant decrease in pelvic sepsis. Further prospective trials focusing on oncologic and functional outcomes are needed.
MeSH term(s)	Anal Canal/surgery ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Colon/surgery ; Humans ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Rectal Neoplasms/complications ; Rectal Neoplasms/surgery ; Retrospective Studies ; Sepsis/etiology ; Treatment Outcome
Language	English
Publishing date	2022-03-28
Publishing country	Italy
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-022-02601-4
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Article ; Online: The Impact of Crohn's Perianal Fistula on Quality of Life: Results of an International Patient Survey.

Spinelli, Antonino / Yanai, Henit / Girardi, Paolo / Milicevic, Slobodan / Carvello, Michele / Maroli, Annalisa / Avedano, Luisa

Crohn's & colitis 360

2023 Volume 5, Issue 3, Page(s) otad036

Abstract: Background: Crohn's perianal fistula is a disabling manifestation of Crohn's disease. However, the additional burden of perianal fistula on patients with only Crohn's disease remains to be addressed. This patient-reported survey considered outcomes of ... ...

Abstract	Background: Crohn's perianal fistula is a disabling manifestation of Crohn's disease. However, the additional burden of perianal fistula on patients with only Crohn's disease remains to be addressed. This patient-reported survey considered outcomes of two domains: "diagnosis" (eg, symptoms) and "living with the disease" (eg, quality of life, well-being, and relationships). Methods: Patients with perianal fistula and Crohn's disease completed an online, self-selective, anonymous, 46-item survey available in 11 languages hosted on the European Federation of Crohn's & Ulcerative Colitis Associations and national patient association websites. The survey was conducted between July and December 2019 in Europe and other regions. Likert scales and closed questions were used to assess outcomes. Results: Of the 820 respondents with Crohn's disease (67.2% women; median age, 40.0 years), 532 (64.9%) reported the presence of perianal fistula. Patients with perianal fistula reported a greater impact on overall quality of life ( Conclusions: Perianal fistulas impact several domains of the life of patients with Crohn's disease. These results may help healthcare practitioners plan therapeutic strategies that address the symptomatic and psychological burden experienced by patients with perianal fistulizing Crohn's disease.
Language	English
Publishing date	2023-07-25
Publishing country	England
Document type	Journal Article
ISSN	2631-827X
ISSN (online)	2631-827X
DOI	10.1093/crocol/otad036
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Article: Intriguing Role of the Mesentery in Ileocolic Crohn's Disease.

Turri, Giulia / Carvello, Michele / Ben David, Nadav / Spinelli, Antonino

Clinics in colon and rectal surgery

2022 Volume 35, Issue 4, Page(s) 321–327

Abstract: Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations ...

Abstract	Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations of "creeping fat" surrounding the diseased intestine renewed interest in the mesentery, recently defined as an organ with endocrine and immune functions. According to the inside-out model, the mesentery may be primarily affected in CD and subsequent cause alterations in the mucosa. Recently, lower surgical recurrence rates have been reported with en-bloc excision of the mesentery adjoining the diseased intestine. Results of ongoing randomized controlled trials may clarify the role of the mesentery in CD and possibly lead to its adoption as standard during surgery for Crohn's disease.
Language	English
Publishing date	2022-04-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0042-1743590
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Article ; Online: Work-family conflict in a cohort of Italian nurses. An observational, multicenter, cross-sectional study.

Carvello, Maicol / Lupo, Roberto / Cicognani, Corin / Conte, Luana / Artioli, Giovanna / Vitale, Elsa / Rubbi, Ivan

Acta bio-medica : Atenei Parmensis

2023 Volume 94, Issue 4, Page(s) e2023206

Abstract: Background and aim of the work: Work-family and family-work conflict can be defined as the degree to which participation in one role, in this case as a worker, interferes with the ability to cope with the responsibilities of another role, namely that of ...

Abstract	Background and aim of the work: Work-family and family-work conflict can be defined as the degree to which participation in one role, in this case as a worker, interferes with the ability to cope with the responsibilities of another role, namely that of a member of a household. The aim of the study is to investigate the presence of indicators of work- family and/or family-work conflict in a cohort of Italian nurses and possible correlations with social and work variables. Research design and methods: An observational, quantitative, multicenter survey was conducted for the study through the computerized administration of a validated questionnaire (Work-Family and Family-Work Conflict, CLF), with the implementation of sociographic variables. The cooperation of 15 Orders of Nursing Professions throughout the country was sought for sample collection. Data collection was bimonthly. Results: Among the participating nurses, there is a statistically significant predominance of conflict in the family-work direction. In particular, the phenomenon seems to be related to age and the presence of children and/or elderly at home to care for. Some work variables seem to positively affect the prevention of potential work-life conflict, such as rostering and work articulation. Conclusions: These findings place emphasis on the need for healthcare organizations to address the work-family balance of their employees.
MeSH term(s)	Child ; Humans ; Aged ; Family Conflict ; Conflict, Psychological ; Cross-Sectional Studies ; Surveys and Questionnaires ; Italy ; Nurses
Language	English
Publishing date	2023-08-03
Publishing country	Italy
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2114240-3
ISSN	2531-6745 ; 0392-4203
ISSN (online)	2531-6745
ISSN	0392-4203
DOI	10.23750/abm.v94i4.14719
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Article ; Online: Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques.

Kotze, Paulo Gustavo / Avellaneda, Nicolas / Moretti, Rafaela de Araujo Molteni / Carvello, Michele / Tomada, Elisa Paoluzzi / Campos, Fabio Guilherme / Spinelli, Antonino

Diseases of the colon and rectum

2024 Volume 67, Issue S1, Page(s) S26–S35

Abstract: Background: Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques.: Objective: To describe ... ...

Abstract	Background: Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques. Objective: To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy. Data source: Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Study selection: Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis. Intervention: IPAA technique. Main outcome measures: Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function). Results: Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques. Limitations: A low number of studies with handsewn IPAA technique and a large number of studies added at authors' discretion were the limitations of this strudy. Conclusions: Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.
MeSH term(s)	Humans ; Colitis, Ulcerative/surgery ; Proctocolectomy, Restorative/methods ; Proctocolectomy, Restorative/adverse effects ; Anastomosis, Surgical/methods ; Anastomosis, Surgical/adverse effects ; Surgical Stapling/methods ; Anastomotic Leak/etiology ; Anastomotic Leak/epidemiology ; Colonic Pouches/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Treatment Outcome
Language	English
Publishing date	2024-02-07
Publishing country	United States
Document type	Journal Article ; Systematic Review ; Review
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000003292
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