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Article ; Online: Technical modifications for cost optimization in robot-assisted ventral mesh rectopexy: an initial experience.

Marra, A A / Campennì, P / De Simone, V / Parello, A / Litta, F / Ratto, C

2023 Volume 27, Issue 7, Page(s) 551–557

Abstract: Background: Robot-assisted ventral mesh rectopexy is considered a valid option in the treatment of rectal prolapse. However, it involves higher costs than the laparoscopic approach. The aim of this study is to determine if less expensive robotic surgery ...

Abstract	Background: Robot-assisted ventral mesh rectopexy is considered a valid option in the treatment of rectal prolapse. However, it involves higher costs than the laparoscopic approach. The aim of this study is to determine if less expensive robotic surgery for rectal prolapse can be safely performed. Methods: This study was conducted on consecutive patients who underwent robot-assisted ventral mesh rectopexy at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, from 7 November 2020 to 22 November 2021. The cost of hospitalization, surgical procedure, robotic materials, and operating room resources in patients undergoing robot-assisted ventral mesh rectopexy with the da Vinci Xi Surgical Systems was analyzed before and after technical modifications, including the reduction of robotic arms and instruments, and the execution of a double minimal peritoneal incision at the pouch of Douglas and sacral promontory (instead of the traditional inverted J incision). Results: Twenty-two robot-assisted ventral mesh rectopexies were performed [21 females, 95.5%, median age 62.0 (54.8-70.0) years]. After an initial experience performing traditional robot-assisted ventral mesh rectopexy in four patients, we adopted technical modifications in other cases. No major complication or conversion to open surgery occurred. In total, mean cost of hospitalization, surgical procedure, robotic materials, and operating room resources was €6995.5 ± 1058.0, €5912.7 ± 877.0, €2797.6 ± 545.6, and €2608.3 ± 351.5, respectively. Technical modifications allowed a significant reduction in the overall cost of hospitalization (€6604.5 ± 589.5 versus €8755.0 ± 906.4, p = 0.001), number of robotic instruments (3.1 ± 0.2 versus 4.0 ± 0.8 units, p = 0.026), and operating room time (201 ± 26 versus 253 ± 16 min, p = 0.003). Conclusions: Considering our preliminary results, robot-assisted ventral mesh rectopexy with appropriate technical modifications can be cost-effective and safe.
MeSH term(s)	Female ; Humans ; Middle Aged ; Rectal Prolapse/surgery ; Robotics ; Laparoscopy/methods ; Surgical Mesh ; Treatment Outcome ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2023-02-18
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/s10151-023-02756-8
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Article ; Online: The role of extracellular vesicles as biomarkers in colorectal cancer.

Lucchetti, D / Litta, F / Ratto, C / Sgambato, A

Techniques in coloproctology

2018 Volume 22, Issue 12, Page(s) 989–990

MeSH term(s)	Biomarkers ; Colonic Neoplasms ; Colorectal Neoplasms ; Extracellular Vesicles ; Humans
Chemical Substances	Biomarkers
Language	English
Publishing date	2018-11-16
Publishing country	Italy
Document type	Letter ; Comment
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-018-1880-4
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Article: Would Surgeons Like to Be Submitted to Anal Fistulotomy? An International Web-Based Survey.

Ratto, Carlo / Marra, Angelo Alessandro / Parello, Angelo / De Simone, Veronica / Campennì, Paola / Litta, Francesco

Journal of clinical medicine

2023 Volume 12, Issue 3

Abstract: Traditional fistulotomy is the most performed surgical procedure in anal fistula surgery. We conducted an international online survey to explore colorectal surgeons' opinions and preferences on fistulotomy. Considering the healing and continence ... ...

Abstract	Traditional fistulotomy is the most performed surgical procedure in anal fistula surgery. We conducted an international online survey to explore colorectal surgeons' opinions and preferences on fistulotomy. Considering the healing and continence impairment rates reported in the literature, surgeons were invited to answer as a hypothetic patient susceptible to being submitted to fistulotomy for low and high anal fistula. A total of 767 surgeons completed the survey from 72 countries. The majority of respondents were consultants, having treated more than 20 anal fistulas in the last year. Most of them declared that anal fistula would be able to negatively affect quality of life and would be worried/anxious about it. Taking into account all aspects, 87.5% and 37.8% of respondents would agree to be treated with a fistulotomy in case of a low and high fistula, respectively, with an acceptance rate that varied worldwide. At multivariate analysis, factors correlated to the acceptance of anal fistulotomy were male gender (
Language	English
Publishing date	2023-01-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12030825
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Article ; Online: Patient Selection Is a Key Factor to Evaluate Treatments of Hemorrhoids.

Ratto, Carlo / Litta, Francesco / Orefice, Raffaele

Diseases of the colon and rectum

2020 Volume 63, Issue 9, Page(s) e516

MeSH term(s)	Hemorrhoidectomy ; Hemorrhoids/therapy ; Humans ; Ligation ; Patient Selection ; Rectum
Language	English
Publishing date	2020-11-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000001756
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Article ; Online: Fistulotomy and primary sphincteroplasty for anal fistula: long-term data on continence and patient satisfaction.

Litta, F / Parello, A / De Simone, V / Grossi, U / Orefice, R / Ratto, C

Techniques in coloproctology

2019 Volume 23, Issue 10, Page(s) 993–1001

Abstract: Background: The aim of this study was to evaluate the safety and long-term efficacy of fistulotomy and primary sphincteroplasty (FIPS). Secondary endpoints were its impact on postoperative continence status and patients' satisfaction.: Methods: A ... ...

Abstract	Background: The aim of this study was to evaluate the safety and long-term efficacy of fistulotomy and primary sphincteroplasty (FIPS). Secondary endpoints were its impact on postoperative continence status and patients' satisfaction. Methods: A retrospective study was conducted on patients with cryptoglandular anal fistula (AF) who had FIPS between June 2006 and May 2017. Patients were evaluated with standardized telephone interviews and clinical/instrumental assessment. Main outcome measures included fistula healing rate, continence status, and patient satisfaction. Incontinence was defined as an inability to hold either gas, liquid, or solid stools, as well as postdefecation soiling, and was measured by the Cleveland Clinic fecal incontinence score. Patient satisfaction was evaluated by an 11-point numeric rating scale. Results: There were 203 patients (139 males; mean age: 48.7 years) who had FIPS. The overall healing rate was 93% (188 patients) with a mean follow-up period of 56 ± 31 months. Half of the total cohort (51%) had a complex fistula. Preoperatively, 8 (4%) patients complained of postdefecation soiling and 2 (1%) of gas incontinence. Postoperatively, 26 (13%) patients had continence impairment (de novo n = 24), mainly consisting of postdefecation soiling (10%). In univariate analysis, patients with recurrent (RR 6.153 95% CI 2.097-18.048; p = 0.002) or complex (RR 3.005 95% CI 1.203-7.506; p = 0.012) AF and those with secondary tracts (RR 8.190 95% CI 2.188-30.654; p = 0.004) or previous set on drainage (RR 5.286 95% CI 2.235-12.503; p = 0.0001) were at higher risk of incontinence. In multivariate analysis, no significant predictors were found, although fistula complexity approached statistical significance (RR 5.464 95% CI 0.944-31.623; p = 0.050). The mean patient satisfaction numeric rating scale was 9.3 ± 1.6. Lower satisfaction rates were found in patients with transphincteric (p = 0.011) or complex (p = 0.0001) AF, with secondary tracts (p = 0.041) or previous seton drainage (p = 0.008), and in those with postoperative continence impairment (p = 0.0001). Postoperative onset of incontinence was the only significant factor in multivariate analysis (p = 0.0001). Conclusions: FIPS should be considered a valid therapeutic option for selected AF. However, the risk of postoperative minor fecal incontinence exists, and should be discussed during preoperative patient counselling.
MeSH term(s)	Adult ; Anal Canal/surgery ; Fecal Incontinence/epidemiology ; Fecal Incontinence/etiology ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction/statistics & numerical data ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Period ; Reconstructive Surgical Procedures/adverse effects ; Reconstructive Surgical Procedures/methods ; Rectal Fistula/complications ; Rectal Fistula/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2019-09-19
Publishing country	Italy
Document type	Evaluation Study ; Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-019-02093-9
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Article ; Online: Anxiety and depression should be considered more in rectal prolapse surgery: an analysis of long-term results after ventral mesh rectopexy.

Marra, Angelo A / Porfiri, Federica / Biffoni, Beatrice / Parello, Angelo / Campennì, Paola / Simone, Veronica De / Litta, Francesco / Ratto, Carlo

Surgery

2023 Volume 174, Issue 6, Page(s) 1486–1487

MeSH term(s)	Humans ; Depression ; Rectal Prolapse/surgery ; Surgical Mesh ; Anxiety/etiology
Language	English
Publishing date	2023-06-26
Publishing country	United States
Document type	Letter
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.05.043
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Article ; Online: Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review.

Ratto, C / Litta, F / Donisi, L / Parello, A

Techniques in coloproctology

2015 Volume 19, Issue 7, Page(s) 391–400

Abstract: There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the ... ...

Abstract	There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex anal fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex anal fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex anal fistulas.
MeSH term(s)	Anal Canal/surgery ; Defecation ; Digestive System Surgical Procedures/methods ; Fecal Incontinence ; Humans ; Manometry ; Quality of Life ; Randomized Controlled Trials as Topic ; Rectal Fistula/surgery ; Treatment Outcome
Language	English
Publishing date	2015-07
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-015-1323-4
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Article ; Online: Efficacy of Sphinkeeper™ implant in treating faecal incontinence.

Litta, F / Parello, A / De Simone, V / Campennì, P / Orefice, R / Marra, A A / Goglia, M / Moroni, R / Ratto, C

The British journal of surgery

2020 Volume 107, Issue 5, Page(s) 484–488

Abstract: The primary aim of this prospective study was to assess the efficacy of Sphinkeeper™ (SK) implantation in patients with faecal incontinence. Forty-two patients with faecal incontinence (14 with sphincter defects) underwent SK implantation and were ... ...

Abstract	The primary aim of this prospective study was to assess the efficacy of Sphinkeeper™ (SK) implantation in patients with faecal incontinence. Forty-two patients with faecal incontinence (14 with sphincter defects) underwent SK implantation and were followed up for a mean(s.d.) of 15·9(8·6) months. SK implantation was a safe and effective method that improved patients' quality of life. Implants and incontinence.
MeSH term(s)	Aged ; Anal Canal/diagnostic imaging ; Anal Canal/physiopathology ; Anal Canal/surgery ; Fecal Incontinence/diagnostic imaging ; Fecal Incontinence/physiopathology ; Fecal Incontinence/surgery ; Female ; Humans ; Manometry ; Middle Aged ; Prospective Studies ; Prostheses and Implants/adverse effects ; Quality of Life ; Ultrasonography
Language	English
Publishing date	2020-02-17
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11558
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Article ; Online: Incidental diagnosis of true intestinal malrotation.

De Simone, Veronica / Goglia, Marta / Litta, Francesco / Ratto, Carlo

Techniques in coloproctology

2020 Volume 24, Issue 7, Page(s) 771–772

MeSH term(s)	Digestive System Abnormalities/diagnostic imaging ; Digestive System Abnormalities/surgery ; Humans ; Intestinal Volvulus/diagnostic imaging ; Intestinal Volvulus/surgery
Language	English
Publishing date	2020-04-03
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/s10151-020-02198-6
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Article ; Online: Implantation of SphinKeeper(TM): a new artificial anal sphincter.

Ratto, C / Donisi, L / Litta, F / Campennì, P / Parello, A

Techniques in coloproctology

2016 Volume 20, Issue 1, Page(s) 59–66

Abstract: Introduction: A new artificial anal sphincter, SphinKeeper(TM), was devised with the aim to treat fecal incontinence (FI) by implanting specifically designed self-expandable prostheses into the intersphincteric space. Preliminary data concerning the ... ...

Abstract	Introduction: A new artificial anal sphincter, SphinKeeper(TM), was devised with the aim to treat fecal incontinence (FI) by implanting specifically designed self-expandable prostheses into the intersphincteric space. Preliminary data concerning the procedure feasibility and prosthesis localization at 3 months are presented. Methods: SphinKeeper(TM) prostheses in the native state are dehydrated, thin, solid cylinder (length 29 mm, diameter 3 mm), changing their state (shorter--length 23 mm, thicker--diameter 7 mm--and softer, with shape memory) within 48 h of contact with fluids. In this study, 10 prostheses were implanted in each patient with FI under local anesthesia and under endoanal ultrasound (EAUS) guidance, into the upper-middle intersphincteric space of the anal canal by a specifically designed delivery system. EAUS was used postoperatively to assess prostheses dislocation. Results: Ten patients (5 females; median age 58 years, range 20-75) were enrolled and treated with SphinKeeper(TM) implantation. Median duration of procedure (performed by endoanal ultrasound guidance) was 40 min (range 30-45). Neither intraoperative nor postoperative complications were reported after a 3-month follow-up. In one patient, a partial dislocation of a single prosthesis was documented by EAUS, causing anal discomfort which resolved after 1 week. Conclusion: SphinKeeper(TM) can be safely implanted in patients with FI of different etiology. Implantation was well tolerated with no dislodgment of implants at 3-month follow-up.
MeSH term(s)	Adult ; Aged ; Anal Canal/diagnostic imaging ; Anal Canal/surgery ; Artificial Organs ; Endosonography/methods ; Fecal Incontinence/diagnostic imaging ; Fecal Incontinence/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/diagnostic imaging ; Prosthesis Design ; Prosthesis Implantation/adverse effects ; Prosthesis Implantation/methods ; Transanal Endoscopic Surgery/instrumentation ; Transanal Endoscopic Surgery/methods ; Young Adult
Language	English
Publishing date	2016-01
Publishing country	Italy
Document type	Evaluation Studies ; Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-015-1396-0
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