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Article ; Online: Hemorrhoids and anal fissures in inflammatory bowel disease.

D'Ugo, S / Stasi, E / Gaspari, A L / Sileri, P

Minerva gastroenterologica e dietologica

2015 Volume 61, Issue 4, Page(s) 223–233

Abstract: Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and ... ...

Abstract	Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.
MeSH term(s)	Fissure in Ano/etiology ; Fissure in Ano/therapy ; Hemorrhoids/etiology ; Hemorrhoids/therapy ; Humans ; Inflammatory Bowel Diseases/complications ; Risk Factors
Language	English
Publishing date	2015-12
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1077354-x
ISSN	1827-1642 ; 1121-421X ; 0026-4776
ISSN (online)	1827-1642
ISSN	1121-421X ; 0026-4776
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Article ; Online: Saving time stitching thick biological mesh during laparoscopic ventral rectopexy.

Sileri, P / Franceschilli, L / Gaspari, A L

Techniques in coloproctology

2012 Volume 16, Issue 5, Page(s) 393–394

Abstract: We present a trick to save time at stitching of thick biological mesh during laparoscopic ventral mesh rectopexy by the use of a belt hole puncher. ...

Abstract	We present a trick to save time at stitching of thick biological mesh during laparoscopic ventral mesh rectopexy by the use of a belt hole puncher.
MeSH term(s)	Biocompatible Materials ; Humans ; Laparoscopy ; Rectal Prolapse/surgery ; Surgical Mesh ; Suture Techniques/instrumentation
Chemical Substances	Biocompatible Materials
Keywords	covid19
Language	English
Publishing date	2012-04-24
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/s10151-012-0832-7
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Article ; Online: Different characteristics of circular staplers make the difference in anastomotic tensile strength.

Giaccaglia, V / Antonelli, M S / Franceschilli, L / Salvi, P F / Gaspari, A L / Sileri, P

Journal of the mechanical behavior of biomedical materials

2016 Volume 53, Page(s) 295–300

Abstract: Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics ... ...

Abstract	Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics in order to guarantee good performances. The aim of our study was to evaluate, ex vivo, pressure resistance and tensile strength of anastomosis performed with different circular staplers available in the market. We studied 7 circular staplers of 3 different companies, 3 of them used for gastrointestinal anastomosis and 4 staplers for hemorrhoidal prolapse excision. A total of 350 anastomoses, 50 for each of the 7 staplers, were performed using healthy pig fresh intestine, then injected saline solution and recorded the leaking pressure. There were no statistically significant differences between the mean pressure necessary to induce an anastomotic leak in the various instruments (p>0.05). For studying tensile strength, we performed a total of 350 anastomoses with 7 different circular staplers on a special strong paper (Tyvek), and then recorded the maximal tensile force that could open the anastomosis. There were statistically significant differences between one brand stapler vs other 2 companies staplers about the strength necessary to open the staple line (p<0.05). In conclusion, we demonstrated that different circular staplers of three companies available in the market give comparable anastomotic pressure resistance but different tensile strengths. This is probably due to different technical characteristics.
MeSH term(s)	Anastomosis, Surgical/instrumentation ; Animals ; Digestive System Surgical Procedures ; Male ; Pressure ; Surgical Staplers ; Swine ; Tensile Strength
Language	English
Publishing date	2016-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2378381-3
ISSN	1878-0180 ; 1751-6161
ISSN (online)	1878-0180
ISSN	1751-6161
DOI	10.1016/j.jmbbm.2015.08.029
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Article ; Online: Modified laparoscopic ventral mesh rectopexy.

Sileri, P / Capuano, I / Franceschilli, L / Giorgi, F / Gaspari, A L

Techniques in coloproctology

2013 Volume 18, Issue 6, Page(s) 591–594

Abstract: We present a modified laparoscopic ventral mesh rectopexy procedure using biological mesh and bilateral anterior mesh fixation. The rectopexy is anterior with a minimal posterior mobilization. The rectum is symmetrically suspended to the sacral ... ...

Abstract	We present a modified laparoscopic ventral mesh rectopexy procedure using biological mesh and bilateral anterior mesh fixation. The rectopexy is anterior with a minimal posterior mobilization. The rectum is symmetrically suspended to the sacral promontory through a mesorectal window.
MeSH term(s)	Adult ; Aged ; Constipation/surgery ; Fecal Incontinence/surgery ; Female ; Humans ; Laparoscopy/methods ; Length of Stay/statistics & numerical data ; Middle Aged ; Operative Time ; Rectal Prolapse/surgery ; Surgical Mesh
Keywords	covid19
Language	English
Publishing date	2013-11-21
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/s10151-013-1094-8
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Article: Radius surgical system and conventional laparoscopic instruments in abdominal surgery: application, learning curve and ergonomy.

Di Lorenzo, N / Camperchioli, I / Gaspari, A L

Surgical oncology

2007 Volume 16 Suppl 1, Page(s) S69–72

Abstract: We illustrate our experience with a new class of instruments, the mechanical manipulators (MM), whose main features are an improved mobility, and ergonomy and a modular structure. A specific MM, the Radius Surgical System (RADIUS), has been used both for ...

Abstract	We illustrate our experience with a new class of instruments, the mechanical manipulators (MM), whose main features are an improved mobility, and ergonomy and a modular structure. A specific MM, the Radius Surgical System (RADIUS), has been used both for educational purposes as well as in clinical studies, demonstrating that it can represent an efficient tool to support surgeons performing surgical complex procedures, with a short learning curve for the postural attitude.
MeSH term(s)	Abdomen/surgery ; Clinical Competence ; Equipment Design ; Ergonomics ; Humans ; Laparoscopes ; Laparoscopy
Language	English
Publishing date	2007-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1107810-8
ISSN	1879-3320 ; 0960-7404
ISSN (online)	1879-3320
ISSN	0960-7404
DOI	10.1016/j.suronc.2007.10.028
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Article ; Online: Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases.

Franceschilli, L / Varvaras, D / Capuano, I / Ciangola, C I / Giorgi, F / Boehm, G / Gaspari, A L / Sileri, P

Techniques in coloproctology

2015 Volume 19, Issue 4, Page(s) 209–219

Abstract: Background: Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome and/or faecal incontinence. Very few ... ...

Abstract	Background: Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome and/or faecal incontinence. Very few reports exist on the use of biologic mesh for LVR. The aim of our study was to report the complication and recurrence rate of our first 100 cases of LVR for symptomatic internal rectal prolapse and/or rectocele using a porcine dermal collagen mesh. Methods: Prospectively collected data on LVR for internal rectal prolapse were analysed. Surgical complications and functional results in terms of faecal incontinence (measured with the Faecal Incontinence Severity Index = FISI) and constipation (measured with the Wexner Constipation Score = WCS) at 3, 6 and 12 months were analysed. It was considered an improvement if FISI or WCS scores were reduced by at least 25 % and a cure if the FISI score decreased to <10 and the WCS decreased to <5. Results: Between April 2009 and April 2013, 100 consecutive female patients (mean age 63 years, range 24-88 years) underwent LVR. All patients had internal rectal prolapse (grade III [n = 25] and grade IV [n = 75] according to the Oxford classification) and rectocele. Mean operative time was 85 ± 40 min. Conversion rate to open technique was 1 %. There was no post-operative mortality. Overall 16 patients (16 %) experienced 18 complications, including rectal perforation (n = 1), small bowel obstruction (n = 2), urinary tract infection (n = 8), subcutaneous emphysema (n = 3), wound haematoma (n = 2), long lasting sacral pain (n = 1) and incisional hernia (1). Median post-operative length of stay was 2 days. Ninety-eight out of 100 patients completed follow-up. At the end of follow-up, the mean FISI score improved from 8.4 (±4.0 standard deviation (SD) p = 0.003) to 3.3 ± 2.3 SD (p = 0.04). Incontinence improved in 37 out of 43 patients (86 %), and 31 patients (72 %) were cured. Similarly, the mean WCS score improved from 18.4 ± 11.6 SD to 5.4 ± 4.1 SD (p = 0.04). Constipation improved in 82 out of 89 patients (92 %), and 70 patients (79 %) were cured. No worsening of continence status, constipation or sexual function was observed. Fourteen patients (14 %) experienced persistence or recurrence of prolapse. Conclusions: LVR using biologic mesh is a safe and effective procedure for improving symptoms of obstructed defaecation and faecal incontinence in patients with internal rectal prolapse associated with rectocele.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anal Canal/physiopathology ; Anal Canal/surgery ; Biocompatible Materials/therapeutic use ; Constipation/etiology ; Constipation/surgery ; Defecation ; Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Fecal Incontinence/etiology ; Fecal Incontinence/surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Length of Stay ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; Prospective Studies ; Rectal Prolapse/complications ; Rectal Prolapse/surgery ; Rectocele/complications ; Rectocele/surgery ; Rectum/physiopathology ; Rectum/surgery ; Recurrence ; Surgical Mesh/adverse effects ; Treatment Outcome
Chemical Substances	Biocompatible Materials
Keywords	covid19
Language	English
Publishing date	2015-04
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/s10151-014-1255-4
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Article: La chirurgia metabolica.

Gaspari, A L / Di Lorenzo, N / Gentileschi, P / Camperchioli, I

Il Giornale di chirurgia

2009 Volume 30, Issue 4, Page(s) 133–140

Title translation	Metabolic surgery.
MeSH term(s)	Adolescent ; Adult ; Animal Experimentation ; Animals ; Bariatric Surgery/methods ; Biliopancreatic Diversion ; Body Mass Index ; Child, Preschool ; Clinical Trials as Topic ; Consensus ; Diabetes Mellitus, Type 2 ; Female ; Follow-Up Studies ; Gastric Bypass ; Gastroplasty ; Humans ; Hypercholesterolemia ; Hypertriglyceridemia ; Male ; Metabolic Syndrome/surgery ; Obesity, Morbid/epidemiology ; Obesity, Morbid/surgery ; Prevalence ; Rats ; Time Factors ; Treatment Outcome
Language	Italian
Publishing date	2009-04
Publishing country	Italy
Document type	Comparative Study ; Editorial ; Review
ZDB-ID	605974-0
ISSN	1971-145X ; 0391-9005
ISSN (online)	1971-145X
ISSN	0391-9005
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Zs.B 2760: Show issues

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Article: Laparoscopic treatment of a gastric diverticulum.

Tebala, G D / Camperchioli, I / Tognoni, V / Innocenti, P / Gaspari, A L

European review for medical and pharmacological sciences

2010 Volume 14, Issue 2, Page(s) 135–138

Abstract: Gastric diverticula are rare disorders which present usually with vague upper abdominal symptoms. The diagnosis is based on endoscopic and radiologic findings, but it may remain uncertain until the operation. Herein we report the case of a 46-year-old ... ...

Abstract	Gastric diverticula are rare disorders which present usually with vague upper abdominal symptoms. The diagnosis is based on endoscopic and radiologic findings, but it may remain uncertain until the operation. Herein we report the case of a 46-year-old woman with a diverticulum of the posterior aspect of the upper part of the gastric fundus, referred to our attention for epigastric pain. The preoperative work out evidenced a pouch of the gastric fundus which was misinterpreted as a paraesophageal or a diaphragmatic hernia. The operation was performed by laparoscopy with a 4-port technique and the diverticulum was resected by an endoscopic stapler. The patient is well and symptom-free more than two months after the operation.
MeSH term(s)	Aged ; Diverticulum, Stomach/surgery ; Female ; Humans ; Laparoscopy/methods ; Middle Aged
Language	English
Publishing date	2010-02
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	605550-3
ISSN	2284-0729 ; 1128-3602 ; 0392-291X
ISSN (online)	2284-0729
ISSN	1128-3602 ; 0392-291X
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Article: Bariatric surgery in moderately obese patients: a prospective study.

Cerci, M / Bellini, M I / Russo, F / Benavoli, D / Capperucci, M / Gaspari, A L / Gentileschi, P

Gastroenterology research and practice

2013 Volume 2013, Page(s) 276183

Abstract: Introduction. Moderate obesity (BMI 30-35 kg/m(2)) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We ... ...

Abstract	Introduction. Moderate obesity (BMI 30-35 kg/m(2)) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m(2), 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m(2). Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30-35 kg/m(2). Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.
Language	English
Publishing date	2013-12-24
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2435460-0
ISSN	1687-630X ; 1687-6121
ISSN (online)	1687-630X
ISSN	1687-6121
DOI	10.1155/2013/276183
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Article ; Online: Defecatory disorders in anorexia nervosa: a clinical study.

Sileri, P / Franceschilli, L / De Lorenzo, A / Mezzani, B / Todisco, P / Giorgi, F / Gaspari, A L / Jacoangeli, F

Techniques in coloproctology

2013 Volume 18, Issue 5, Page(s) 439–444

Abstract: Background: Defecatory disorders in patients with eating disorders have been overlooked. We evaluated the prevalence and type of defecatory disorders in patients with anorexia nervosa.: Methods: The aim of our questionnaire-based study was to ... ...

Abstract	Background: Defecatory disorders in patients with eating disorders have been overlooked. We evaluated the prevalence and type of defecatory disorders in patients with anorexia nervosa. Methods: The aim of our questionnaire-based study was to determine the prevalence of constipation and faecal incontinence (FI) in patients with anorexia nervosa attending our dedicated eating disorders outpatient clinics and whether length of illness and low body mass index (BMI) exacerbate both constipation and FI. The Wexner constipation score (WCS), Altomare's obstructed defecation score (OD score) and the faecal incontinence severity index (FISI) were used to evaluate constipation and incontinence. A WCS ≥5, OD score ≥10 and a FISI ≥10 were considered clinically relevant. Results: Eighty-five patients (83 females; mean age 28 years ± 13) with anorexia nervosa (study group) and mean BMI of 16 ± 2 kg/m(2) (range 14-19 kg/m(2)) were studied. This group was compared to 57 healthy volunteers (control group) with mean BMI of 22 ± 3 kg/m(2) (range 20-27 kg/m(2)). In the study group, 79/85 (93%) patients suffered from defecatory disorders defined as at least one abnormal score, either WCS, OD score or FISI, compared to 7/57 (12%) controls (p < 0.001). Constipation (defined as WCS ≥5) was present in 70/85 (83%) patients with anorexia and in 7/57 (12%) controls (p = 0.001), while obstructed defecation syndrome (defined as OD score ≥10) was present in 71/85 (84%) patients with anorexia and 7/57 (12%) controls (p < 0.001). In patients with anorexia, the mean WCS score was 10 ± 5 standard deviation (SD) (3 ± 2 SD in controls; p < 0.001), and the mean OD score was 12 ± 4 SD (3 ± 4 SD in controls; p < 0.001). Overall, 62/85 (73%) patients with anorexia had FI defined as FISI score ≥10, and the mean FISI score in anorexia patients was 12 ± 9 SD. A combination of constipation and FI (either both WCS and FISI abnormal or both OD score and FISI abnormal) was present in 55/85 (64%) and 8/85 (9%) presented with FI alone. Moreover, all results are influenced by the severity of the disease measured by BMI and duration. The percentage of defecatory disorders rises from 75 to 100% when BMI is <18 kg/m(2) and from 60 to 75% when the duration of illness is ≥5 years (p < 0.001 and p = 0.021, respectively). Conclusions: Defecatory disorders are associated with anorexia nervosa and increased with the duration and severity of the illness.
MeSH term(s)	Adolescent ; Adult ; Anorexia Nervosa/complications ; Body Mass Index ; Constipation/etiology ; Defecation ; Fecal Incontinence/etiology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Severity of Illness Index ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2013-09-13
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/s10151-013-1068-x
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