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Article ; Online: Erector spinae plane block as part of an opiod-sparing anesthesia in enhanced recovery after surgery program in laparoscopic gastric surgery.

Ridolfi, Matteo / Conti, Duccio / Antognozzi, Elisa / Garulli, Gianluca / Monari, Francesco / Montomoli, Jonathan / Pavoni, Vittorio / Gamberini, Emiliano

Minerva anestesiologica

2023 Volume 89, Issue 1-2, Page(s) 108–109

MeSH term(s)	Humans ; Enhanced Recovery After Surgery ; Paraspinal Muscles ; Nerve Block ; Laparoscopy ; Pain, Postoperative/prevention & control ; Analgesics, Opioid
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-02-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.22.16813-6
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Zs.A 516: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: The importance of the mesofascial interface in complete mesocolic excision.

Siani, Luca Maria / Garulli, Gianluca

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2017 Volume 15, Issue 4, Page(s) 240–249

Abstract: Complete mesocolic excision (CME) with Central Vascular Ligation (CVL) is progressively gaining acceptance as the most updated surgical treatment in the multimodal management of colonic cancer. The concept is based on excision of the affected organ with ... ...

Abstract	Complete mesocolic excision (CME) with Central Vascular Ligation (CVL) is progressively gaining acceptance as the most updated surgical treatment in the multimodal management of colonic cancer. The concept is based on excision of the affected organ with its related primitive dorsal mesenterium as an intact package to maximize local clearance, and high tie ligation to boost regional control, translating the original concept of Total Mesorectal Excision proposed by Heald for rectal cancer. Aim of this review is to analyze the modern concept of the mesenteric organ, with particular regard to the interfaces between its single components and the importance of the meso-fascial interface as the correct plane of separation. The integrity of the mesocolon excised along the meso-fascial interface (meso-fascial separation) prevents any breach of its surface and underlying structures, preserving the radial margin and the complex network of the meso-structure, avoiding any spillage of neoplastic cells within the surgical field. Central Vascular ligation allows for the most effective harvesting of lymph nodes, particularly of the apical ones, whose removal appears to be crucial in optimizing regional control. A surgical plane developed along the meso-fascial interface, coupled with high tie ligation, yields higher quality of surgical specimen, with better oncologic outcome in terms of local recurrence rate, disease-free and overall survival.
Language	English
Publishing date	2017-08
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2016.10.006
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Article ; Online: Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Ruffo, Giacomo / Viola, Massimo Giuseppe / Borghi, Felice / Garulli, Gianluca / Pirozzi, Felice / Delrio, Paolo / De Luca, Raffaele / Baldazzi, Gianandrea / Scatizzi, Marco

International journal of colorectal disease

2024 Volume 39, Issue 1, Page(s) 53

Abstract: Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any ... ...

Abstract	Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. Methods: A prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). Twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. The primary endpoints were AL, SSIs, and OM. All the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). Results: Compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). Conclusions: MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP.
MeSH term(s)	Humans ; Prospective Studies ; Anastomosis, Surgical ; Anastomotic Leak/etiology ; Machine Learning ; Colorectal Neoplasms/surgery ; Italy/epidemiology
Language	English
Publishing date	2024-04-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-024-04627-6
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Zs.A 2121: Show issues

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Article: Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: A comprehensive review.

Siani, Luca Maria / Garulli, Gianluca

World journal of gastrointestinal surgery

2016 Volume 8, Issue 2, Page(s) 106–114

Abstract: Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological ... ...

Abstract	Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail, focusing on the latest studies of the mesenteric organ, its dissection by mesofascial and retrofascial cleavage planes, and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen, yielded through mesocolic, intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence, overall and disease-free survival, according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence, which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection, laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery, with all the advantages of laparoscopic techniques, both in faster recovery and better immunological response. The importance of minimally invasive meso-resectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.
Language	English
Publishing date	2016-03-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v8.i2.106
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Article ; Online: Intracorporeal anastomosis versus extracorporeal anastomosis after laparoscopic right hemicolectomy for colon cancer: morbidity comparison at long-term follow-up.

Veneroni, Simone / Palini, Gian M / Pirrera, Basilio / Fantini, Enrico / Monari, Francesco / Alagna, Vincenzo / Vallicelli, Carlo / Garulli, Gianluca

Minerva surgery

2022 Volume 77, Issue 6, Page(s) 531–535

Abstract: Background: Minimally invasive right hemicolectomy is nowadays considered the gold standard for treatment of malignant right colon disease. What is still debated is instead the choice between intracorporeal or extracorporeal anastomosis. The aim of this ...

Abstract	Background: Minimally invasive right hemicolectomy is nowadays considered the gold standard for treatment of malignant right colon disease. What is still debated is instead the choice between intracorporeal or extracorporeal anastomosis. The aim of this study was to compare morbidity and the long-term results between these two techniques. Methods: This retrospective, double-center cohort study was performed between January 2013 and December 2014. A total of 197 patients were enrolled after laparoscopic right hemicolectomy for malignant disease. The extracorporeal anastomosis group (ECA) included 95 patients, while the intracorporeal anastomosis group (ICA) included 102 patients. All patients were followed up for 5 years after surgery. Data analysis was performed in February 2021. Results: The ICA group showed a reduced rate of non-surgical complications Clavien-Dindo grade I-II (10% vs. 31%; P=0.001) as well as a lower rate of wound infections (2% vs. 12%; P=0.01). Most importantly, a decreased risk of incisional hernias in a five-year follow-up period (1% vs. 8%; P=0.01) has been underlined. Conclusions: Intracorporeal anastomosis technique after totally laparoscopic right hemicolectomy showed better outcomes as it significantly reduces the risk for short and long-term complications, namely, incisional hernias.
MeSH term(s)	Humans ; Follow-Up Studies ; Incisional Hernia/surgery ; Retrospective Studies ; Cohort Studies ; Anastomosis, Surgical/adverse effects ; Laparoscopy/adverse effects ; Colectomy/adverse effects ; Colonic Neoplasms/surgery ; Morbidity
Language	English
Publishing date	2022-03-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.22.09281-4
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Article: Blood Transfusions and Adverse Events after Colorectal Surgery: A Propensity-Score-Matched Analysis of a Hen-Egg Issue.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Montemurro, Leonardo Antonio / Ciano, Paolo / Benedetti, Michele / Delrio, Paolo / Garulli, Gianluca / Pirozzi, Felice / Scatizzi, Marco

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 5

Abstract: Blood transfusions are considered a risk factor for adverse outcomes after colorectal surgery. However, it is still unclear if they are the cause (the hen) or the consequence (the egg) of adverse events. A prospective database of 4529 colorectal ... ...

Abstract	Blood transfusions are considered a risk factor for adverse outcomes after colorectal surgery. However, it is still unclear if they are the cause (the hen) or the consequence (the egg) of adverse events. A prospective database of 4529 colorectal resections gathered over a 12-month period in 76 Italian surgical units (the iCral3 study), reporting patient-, disease-, and procedure-related variables, together with 60-day adverse events, was retrospectively analyzed identifying a subgroup of 304 cases (6.7%) that received intra- and/or postoperative blood transfusions (IPBTs). The endpoints considered were overall and major morbidity (OM and MM, respectively), anastomotic leakage (AL), and mortality (M) rates. After the exclusion of 336 patients who underwent neo-adjuvant treatments, 4193 (92.6%) cases were analyzed through a 1:1 propensity score matching model including 22 covariates. Two well-balanced groups of 275 patients each were obtained: group A, presence of IPBT, and group B, absence of IPBT. Group A vs. group B showed a significantly higher risk of overall morbidity (154 (56%) vs. 84 (31%) events; OR 3.07; 95%CI 2.13-4.43;
Language	English
Publishing date	2023-03-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13050952
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Article ; Online: Laparoscopic Treatment of Incisional and Ventral Hernia.

Olmi, Stefano / Millo, Paolo / Piccoli, Micaela / Garulli, Gianluca / Junior Nardi, Mario / Pecchini, Francesca / Oldani, Alberto / Pirrera, Basilio

JSLS : Journal of the Society of Laparoendoscopic Surgeons

2021 Volume 25, Issue 2

Abstract: Background and objectives: Although several large studies regarding patients undergoing minimally invasive repair of incisional hernia are currently available, the results are not particularly reliable as they are based on heterogeneous groups, ... ...

Abstract	Background and objectives: Although several large studies regarding patients undergoing minimally invasive repair of incisional hernia are currently available, the results are not particularly reliable as they are based on heterogeneous groups, different surgical techniques, different mesh types, or with a too short follow period. Methods: We conducted a retrospective observational trial, collecting data from patients who underwent laparoscopic repair of a primary abdominal wall or an incisional hernia using the laparoscopic Intraperitoneal Onlay Mesh technique and a single mesh type, i.e., a composite polyester mesh with a hydrophilic film (Parietex Composite Results: One thousand seven hundred seventy-seven patients were enrolled. The median surgery time was 50 minutes and the median length of hospital stay was 2 days. Intraoperative complications occurred in 12 patients (0.7%), while early postoperative surgical complications occurred in 115 (6.5%); during follow-up, bulging mesh was diagnosed in 4.5% of cases and hernia recurred in 4.3% of patients. An overlap equal or greater than 4 cm resulted as a significant protective factor, while the use of absorbable fixing devices was a risk factor for recurrence (odds ration: 9.06, p < 0.001, 95% confidence interval: 4.19 - 19.57). Conclusions: Minimally invasive treatment of primary and postincisional abdominal wall hernias is a safe, effective, and reproducible procedure. An overlap equal or greater than 4 cm, the use of nonabsorbable fixing devices and a postoperative care and follow-up regime are crucial in order to obtain good results and low recurrence rates.
MeSH term(s)	Abdominal Wall/surgery ; Adult ; Aged ; Hernia, Ventral/surgery ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Humans ; Incisional Hernia/surgery ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Period ; Recurrence ; Retrospective Studies ; Surgical Mesh
Language	English
Publishing date	2021-06-29
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2011211-7
ISSN	1938-3797 ; 1086-8089
ISSN (online)	1938-3797
ISSN	1086-8089
DOI	10.4293/JSLS.2021.00007
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Article ; Online: Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort.

BJS open

2024 Volume 8, Issue 1

Abstract: Background: In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients ... ...

Abstract	Background: In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. Methods: A database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. The primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. The results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. Results: A total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). Group A versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). A mean postoperative duration of stay difference of 0.86 days was detected between groups. No difference was recorded between the two groups for all the other endpoints. Conclusion: This study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery.
MeSH term(s)	Humans ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Retrospective Studies ; Propensity Score ; Colorectal Surgery/adverse effects ; Drainage/methods
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrad107
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Article ; Online: Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: Safety, prognostic factors and oncologic outcome.

Siani, Luca Maria / Lucchi, Andrea / Berti, Pierluigi / Garulli, Gianluca

American journal of surgery

2017 Volume 214, Issue 2, Page(s) 222–227

Abstract: Background: To analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers.: Methods: 600 consecutive patients were studied.: Results: Mortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 ± 1639 mm3, ... ...

Abstract	Background: To analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers. Methods: 600 consecutive patients were studied. Results: Mortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 ± 1639 mm3, specimen length 24.3 ± 3.3 cm, distance from the tumor to high tie was 103 ± 6 mm and mean lymph nodes harvested was 27 ± 3; mesocolic plane was achieved in 81% of cases. Survival was 83%; stratified survival in patients with stage II, IIIA/B and in the subgroup of stage IIIC patients with negative apical nodes was 88.7%, 72.4%, 71.4% respectively; stage IIIC patients with positive apical nodes showed poor survival (27.7%). Recurrence occurred in 177 patients (29.5%) and was mainly systemic (22.7%). At the multivariate analysis, "non mesocolic" plane of resection, positive N3 apical nodes and CEA levels >5 ng/dL were found to be independent prognostic factors. Conclusions: Laparoscopic right Mesocolectomy showed to be safe and yielded surgical specimens of high quality, with impact on survival; positive N3 apical nodes and "non mesocolic" planes were independently associated to poor outcome.
MeSH term(s)	Aged ; Colectomy/adverse effects ; Colectomy/methods ; Colon/blood supply ; Colonic Neoplasms/surgery ; Female ; Humans ; Laparoscopy ; Ligation ; Male ; Mesocolon/surgery ; Prognosis ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2017-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2016.10.005
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Article ; Online: Mechanical bowel preparation in elective colorectal surgery: a propensity score-matched analysis of the Italian colorectal anastomotic leakage (iCral) study group prospective cohorts.

Updates in surgery

2023 Volume 76, Issue 1, Page(s) 107–117

Abstract: Retrospective evaluation of the effects of mechanical bowel preparation (MBP) on data derived from two prospective open-label observational multicenter studies in Italy regarding elective colorectal surgery. MBP for elective colorectal surgery remains a ... ...

Abstract	Retrospective evaluation of the effects of mechanical bowel preparation (MBP) on data derived from two prospective open-label observational multicenter studies in Italy regarding elective colorectal surgery. MBP for elective colorectal surgery remains a controversial issue with contrasting recommendations in current guidelines. The Italian ColoRectal Anastomotic Leakage (iCral) study group, therefore, decided to estimate the effects of no MBP (treatment variable) versus MBP for elective colorectal surgery. A total of 8359 patients who underwent colorectal resection with anastomosis were enrolled in two consecutive prospective studies in 78 surgical centers in Italy from January 2019 to September 2021. A retrospective PSMA was performed on 5455 (65.3%) cases after the application of explicit exclusion criteria to eliminate confounders. The primary endpoints were anastomotic leakage (AL) and surgical site infections (SSI) rates; the secondary endpoints included SSI subgroups, overall and major morbidity, reoperation, and mortality rates. Overall length of postoperative hospital stay (LOS) was also considered. Two well-balanced groups of 1125 patients each were generated: group A (No MBP, true population of interest), and group B (MBP, control population), performing a PSMA considering 21 covariates. Group A vs. group B resulted significantly associated with a lower risk of AL [42 (3.5%) vs. 73 (6.0%) events; OR 0.57; 95% CI 0.38-0.84; p = 0.005]. No difference was recorded between the two groups for SSI [73 (6.0%) vs. 85 (7.0%) events; OR 0.88; 95% CI 0.63-1.22; p = 0.441]. Regarding the secondary endpoints, no MBP resulted significantly associated with a lower risk of reoperation and LOS > 6 days. This study confirms that no MBP before elective colorectal surgery is significantly associated with a lower risk of AL, reoperation rate, and LOS < 6 days when compared with MBP.
MeSH term(s)	Humans ; Anastomotic Leak/epidemiology ; Prospective Studies ; Colorectal Surgery/adverse effects ; Retrospective Studies ; Propensity Score ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Elective Surgical Procedures/methods ; Colorectal Neoplasms/surgery ; Preoperative Care/methods ; Cathartics
Chemical Substances	Cathartics
Language	English
Publishing date	2023-10-18
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/s13304-023-01670-w
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