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  1. Article ; Online: Laparoscopic Appendectomy in the Days of COVID-19.

    Abramov, Roi / Neymark, Mariya / Harbi, Asaf / Gilshtein, Hayim

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2021  Volume 31, Issue 5, Page(s) 599–602

    Abstract: Background: Acute appendicitis is one of the most common emergencies treated by general surgeons. The treatment of choice in the majority of cases is laparoscopic appendectomy. In the era of the COVID-19 pandemic, there is a concern for a delayed ... ...

    Abstract Background: Acute appendicitis is one of the most common emergencies treated by general surgeons. The treatment of choice in the majority of cases is laparoscopic appendectomy. In the era of the COVID-19 pandemic, there is a concern for a delayed referral of patients and thus a more advanced presentation of the disease leading to a prolonged and complicated course.
    Methods: Retrospective review of a computerized database of patients who were admitted with acute appendicitis and underwent laparoscopic appendectomy during the COVID pandemic in a single tertiary center in Israel. Patients were compared with those who were admitted and operated for appendicitis in the same period in the previous year.
    Results: One hundred twenty-three patients underwent laparoscopic appendectomy in the study period in 2020, compared with 109 who had surgery in 2019. During the COVID pandemic 41 patients presented with complicated appendicitis versus 22 patients in 2019 (P=0.0174). The placement of peritoneal drains was more prevalent during the pandemic, 5.5% versus 11.4%, and the use of stapler device for appendicular stump closure (P=0.0105).
    Conclusions: During the first stage of the COVID-19 pandemic, there was a significant increase in the rate of complicated appendicitis. Patients should be strongly encouraged not to refrain from medical treatment and go to the emergency room with the persistence of symptoms.
    MeSH term(s) Appendectomy ; Appendicitis/surgery ; COVID-19 ; Humans ; Laparoscopy ; Length of Stay ; Pandemics ; Retrospective Studies ; SARS-CoV-2
    Language English
    Publishing date 2021-05-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/SLE.0000000000000952
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Initial Experience with Transition from Open to Robotic-assisted Proctectomy for Patients with Rectal Cancer.

    Gilshtein, Hayim / Neymark, Mariya / Harbi, Asaf / Lutsyk, Myroslav / Duek, Daniel

    The Israel Medical Association journal : IMAJ

    2021  Volume 23, Issue 11, Page(s) 731–734

    Abstract: Background: The learning curve for transition from open to laparoscopic proctectomies is difficult. Most surgeons have considerable laparoscopic experience prior to performing robotic-assisted procedures. There are data regarding the transition from ... ...

    Abstract Background: The learning curve for transition from open to laparoscopic proctectomies is difficult. Most surgeons have considerable laparoscopic experience prior to performing robotic-assisted procedures. There are data regarding the transition from open to robotic proctectomies. Minimally invasive anterior resection for rectal cancer has gained widespread popularity in recent years, especially when using a robotic platform.
    Objectives: To analyze the experience to the transition from open to robotic anterior resection for rectal cancer.
    Methods: We performed a retrospective analysis of a computerized database. All patients who had a robotic-assisted proctectomy between December 2016 and March 2019 were included and were compared to patients who underwent an open anterior resection in the same time period. A single experienced colorectal surgeon with no prior experience in colorectal laparoscopic surgery performed the procedures.
    Results: During the study period, 55 patients underwent robotic-assisted proctectomy and 55 had an open proctectomy. Patients had similar pre-operative demographic and clinical characteristics with the majority of patients receiving neoadjuvant chemoradiation. The surgical time was significantly lower in the open surgery group (168 minutes vs. 310 minutes, P = 0.005). Both the surgical and pathological outcomes did not differ significantly between the two groups, with good short-term oncologic outcomes and low complication rates.
    Conclusions: The transition from open to robotic-assisted proctectomy is feasible and safe and provides a good alternative for undertaking a minimally invasive surgery for the experienced open colorectal surgeon.
    MeSH term(s) Clinical Competence ; Feasibility Studies ; Female ; Humans ; Learning Curve ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/adverse effects ; Minimally Invasive Surgical Procedures/methods ; Neoplasm Staging ; Operative Time ; Outcome and Process Assessment, Health Care ; Patient Safety ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Proctectomy/adverse effects ; Proctectomy/methods ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods
    Language English
    Publishing date 2021-11-22
    Publishing country Israel
    Document type Journal Article
    ZDB-ID 2008291-5
    ISSN 1565-1088 ; 0021-2180
    ISSN 1565-1088 ; 0021-2180
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5470: Show issues Location:
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  3. Article ; Online: Anorectal Malignancies Presenting as a Perianal Abscess or Fistula.

    Boaz, Elad / Freund, Michael R / Harbi, Asaf / Dagan, Amir / Gilshtein, Hayim / Reissman, Petachia / Yellinek, Shlomo

    The American surgeon

    2022  Volume 89, Issue 6, Page(s) 2572–2576

    Abstract: Background: Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby ... ...

    Abstract Background: Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer.
    Methods: We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient.
    Results: Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn's disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms.
    Conclusions: A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn's disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.
    MeSH term(s) Humans ; Abscess/diagnosis ; Abscess/surgery ; Anus Neoplasms/complications ; Anus Neoplasms/diagnosis ; Anus Neoplasms/pathology ; Crohn Disease/surgery ; Retrospective Studies ; Rectal Neoplasms/complications ; Rectal Neoplasms/diagnosis ; Anus Diseases/diagnosis ; Anus Diseases/surgery ; Rectal Diseases/surgery ; Rectal Fistula/diagnosis ; Rectal Fistula/surgery ; Rectal Fistula/pathology ; Sepsis
    Language English
    Publishing date 2022-05-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348221101481
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Acute Appendicitis: Still a Surgical Disease? Results from a Propensity Score-Based Outcome Analysis of Conservative Versus Surgical Management from a Prospective Database.

    Allievi, Niccolò / Harbi, Asaf / Ceresoli, Marco / Montori, Giulia / Poiasina, Elia / Coccolini, Federico / Pisano, Michele / Ansaloni, Luca

    World journal of surgery

    2017  Volume 41, Issue 11, Page(s) 2697–2705

    Abstract: Objective: The aim of the present study was to compare the outcomes of conservative versus surgical treatment for acute appendicitis.: Background: Although acute appendicitis is a common disease, great debate exists regarding the appropriate ... ...

    Abstract Objective: The aim of the present study was to compare the outcomes of conservative versus surgical treatment for acute appendicitis.
    Background: Although acute appendicitis is a common disease, great debate exists regarding the appropriate management of patients. Conservative treatment has shown positive results in several RCTs, eliciting questions about indications to surgery, therapeutic appropriateness and ethical conduct.
    Methods: Data were prospectively collected; a Propensity Score-based matching method was implemented in order to reduce bias arising from characteristics of the patients; a proportion of patients (69 in total) were excluded to obtain two comparable groups of study (1a). Main outcomes of the study were: failure rate, in-hospital length of stay (at first admission and cumulative), post-discharge absence from work. Within the medical group, failure was defined as the necessity for appendectomy after conservative treatment, while it was identified with complications and negative appendectomy within the surgical group (Failure 1). In parallel, an additional definition of failure was proposed (Failure 2) and excluded negative appendectomy from the reasons for failure within the surgical group (5b).
    Results: The failure rate for the conservative treatment resulted to be inferior, as compared to the surgical treatment (16.5 vs. 28.4%, OR 0.523 p = 0.019), considering negative appendectomy as a reason for failure. When excluding negative appendectomy from the definition of failure, medical and surgical treatment appeared to perform equally (failure rate: 16.5 vs. 18.3%, OR 1.014 p = 0.965). Patients managed conservatively showed to have a shorter length of stay at first admission than the patients who underwent appendectomy (3.11 vs. 4.11 days, β = -0.628 days, p < 0.0001). A lower number of lost work days after discharge resulted from a conservative approach (6 vs. 14.64 days, β = -8.7 days, p < 0.0001).
    Conclusions: Considering each outcome as part of a wide-angle analysis, the conservative management of acute appendicitis resulted to be safe and effective in the selected group of patients. In terms of failure rate, the medical treatment resulted to perform as effectively as surgical treatment, if negative appendectomy was excluded from failure, or better, when negative appendectomy was included in the definition of failure. A diminished length of stay during the first admission and a reduced number of lost work days were evident with a conservative approach. The comparison between medical and surgical treatment for acute appendicitis requires a change in perspective, from a spare 'effectiveness analysis' to a more thorough 'appropriateness analysis': in the present study, the conservative treatment showed to address the clinical requirements in terms of therapeutic appropriateness. Although acute appendicitis is considered a 'surgical disease', increasing evidence supports the effectiveness and safety of a conservative approach for selected groups of patients.
    Language English
    Publishing date 2017-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-017-4094-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1336: Show issues Location:
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  5. Article: Critical view of safety during laparoscopic cholecystectomy.

    Vettoretto, Nereo / Saronni, Cristiano / Harbi, Asaf / Balestra, Luca / Taglietti, Lucio / Giovanetti, Maurizio

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2011  Volume 15, Issue 3, Page(s) 322–325

    Abstract: Background and objectives: Laparoscopic cholecystectomy has a 0.3% to 0.5% morbidity rate due to major biliary injuries. The majority of surgeons have routinely performed the so-called "infundibular" technique for gallbladder hilar dissection since the ... ...

    Abstract Background and objectives: Laparoscopic cholecystectomy has a 0.3% to 0.5% morbidity rate due to major biliary injuries. The majority of surgeons have routinely performed the so-called "infundibular" technique for gallbladder hilar dissection since the introduction of laparoscopy in the early nineties. The "critical view of safety" approach has only been recently discussed in controlled studies. It is characterized by a blunt dissection of the upper part of Calot's space, which does not usually contain arterial or biliary anomalies and is therefore ideal for a safe dissection, even in less experienced hands.
    Materials and methods: We applied and compared the critical view of safety triangle approach with the infundibular approach in a retrospective cohort study. We divided 174 patients into 2 groups, with a similar case-mix (cholelithiasis, chronic cholecystitis, and acute cholecystitis). Results of operations performed by a young surgeon using critical view of safety dissection were compared to results of the infundibular approach performed by an experienced surgeon. Outcome values and operative times were examined with univariate analysis (Student t test).
    Results: No difference occurred in terms of morbidity (even though comparison for biliary injuries is inconclusive because of insufficient power) and outcome; significant differences were found in operative time, favoring the critical view of safety approach in every stage of gallbladder disease, with minor significance for acute cases.
    Conclusion: We suggest this technique as the gold standard for resident teaching, because it has a similar rate of biliary and hemorrhagic complications but has a shorter operative time, builds self-confidence, and is a simple standardized method both for complicated and uncomplicated gallbladder lithiasis.
    MeSH term(s) Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Cholecystitis/surgery ; Cholelithiasis/surgery ; Humans ; Retrospective Studies
    Language English
    Publishing date 2011-10-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/108680811X13071180407474
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases.

    Ceresoli, Marco / Zucchi, Alberto / Allievi, Niccolò / Harbi, Asaf / Pisano, Michele / Montori, Giulia / Heyer, Arianna / Nita, Gabriela E / Ansaloni, Luca / Coccolini, Federico

    World journal of gastrointestinal surgery

    2016  Volume 8, Issue 10, Page(s) 693–699

    Abstract: Aim: To investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.: Methods: This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system ( ... ...

    Abstract Aim: To investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.
    Methods: This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system (more than 1 million inhabitants) from 1997 to 2013. Data about treatment, surgery, length of stay were collected. Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.
    Results: From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA, with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17, 54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92. Mortality was < 0.0001%. Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion. Laparoscopic appendectomy was performed in 48% of cases. Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.
    Conclusion: The treatment of acute appendicitis in Northern Italy is slowly changing, with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option, but rich of promising results.
    Language English
    Publishing date 2016-10-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v8.i10.693
    Database MEDical Literature Analysis and Retrieval System OnLINE

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