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Article ; Online: Kinetics of different blood biomarkers during Polymyxin-B extracorporeal hemoperfusion in abdominal sepsis.

Cotoia, Antonella / Parisano, Valeria / Mariotti, Paola Sara / Lizzi, Vincenzo / Netti, Giuseppe Stefano / Ranieri, Elena / Forfori, Francesco / Cinnella, Gilda

Blood purification

2024

Abstract: Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three ... ...

Abstract	Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three biomarkers in septic post-surgical abdominal patients in Intensive care Unit (ICU) treated with PMX-HA and their prognostic value. Methods Ninety abdominal postsurgical patients were enrolled into different groups according to the evidence of postoperative sepsis or not. Non-septic patients admitted in the surgical ward were included in C group (control group). ICU septic shock patients with endotoxin levels <0.6 EAA receiving conventional therapy were addressed in S group and those with endotoxin levels ≥0.6 EAA receiving treatment with PMX-HA, besides conventional therapy, were included in SPB group. Presepsin, procalcitonin, endotoxin and other clinical data were recorded at 24h (T0), 72h (T1) and 7 days (T2) after surgery. Clinical follow-up was performed on day 30. Results SPB group showed reduced levels of the three biomarkers on T2 vs T0 (P<0.001); presepsin, procalcitonin and endotoxin levels decreased respectively of 25%, 11% and 2% on T1 vs T0, and of 40%, 41%, 26% on T2 vs T0. All patients in C group, 73% of patients in SPB group vs 37% of patients in S group survived at follow-up. Moreover, procalcitonin had the highest predictive value for mortality at 30 days, followed by presepsin. Conclusion The present study showed the reliability of presepsin in monitoring PMX-HA treatment in septic shock patients. Procalcitonin showed better predicting power for the mortality risk.
Language	English
Publishing date	2024-04-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000538870
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Article: How emergency surgery has changed during the COVID-19 pandemic: A cohort study.

Tartaglia, Nicola / Pavone, Giovanna / Lizzi, Vincenzo / Vovola, Fernanda / Tricarico, Fausto / Pacilli, Mario / Ambrosi, Antonio

Annals of medicine and surgery (2012)

2020 Volume 60, Page(s) 686–689

Abstract: Introduction: Various surgical societies constantly update their recommendations in order to adapt surgical activity on current Pandemic conditions. The aim of this study is to analyze how hospitalizations and emergency operations have changed in our ... ...

Abstract	Introduction: Various surgical societies constantly update their recommendations in order to adapt surgical activity on current Pandemic conditions. The aim of this study is to analyze how hospitalizations and emergency operations have changed in our Department of Medical and Surgical Sciences in the Hospital of Foggia during covid-19 pandemic. Methods: Our cohort-study was conducted by analyzing two groups of patients admitted to the Department of Medical and Surgical Sciences of the Hospital of Foggia: those admitted during the no-covid period from March 09th, 2019 to May 09th, 2019 and those during the covid period from March 09th, 2020 to May 09th, 2020. Results: A total of 750 patients admitted during the no-covid period of 2019 and 171 during the covid period of 2020, of these 222 were emergency admission during 2019 and 97 during 2020, 528 were elective admission during 2019 and 74 during 2020. Of the emergency admissions (222 during 2019 and 97 during 2020), 91 were operated during the no covid period in 2019 and 52 during the covid period in 2020. The mean Mannheim Peritonitis Index Score, that is a scoring system used in peritonitis which is simple and cost-effective, were 15.6 during the no covid period of 2019 and 22.2 during the covid period of 2020. We observed 29 post-operative complications during 2019 and 26 during 2020. Conclusions: Contraction of admissions for urgent and emergent conditions in the first period of lockdown has been followed from some positive effects as well as aggravating consequences.
Language	English
Publishing date	2020-12-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1016/j.amsu.2020.12.001
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Article ; Online: Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer.

Giordano, Guido / Cincione, Raffaele Ivan / Losavio, Francesca / Senia, Tiziano / Aquilini Mummolo, Arianna / Pacilli, Mario / Lizzi, Vincenzo / Bruno, Giuseppina / Piscazzi, Annamaria / Conteduca, Vincenza / Landriscina, Matteo

The oncologist

2023 Volume 28, Issue 9, Page(s) e793–e800

Abstract: Background: At diagnosis, more than 80% of patients with pancreatic cancer (PC) suffer from significant weight loss due to malnutrition which is a major concern for patient management, and this may negatively impact treatment outcomes and patient ... ...

Abstract	Background: At diagnosis, more than 80% of patients with pancreatic cancer (PC) suffer from significant weight loss due to malnutrition which is a major concern for patient management, and this may negatively impact treatment outcomes and patient prognosis. Patients and methods: We performed an observational, retrospective study on patients with metastatic PC (mPC) undergoing first-line chemotherapy with nab-Paclitaxel containing schedules and receiving or not receiving nutritional support (NS) and pancreatic enzyme replacement therapy (PERT) to investigate their relevance in this setting. Results: We observed that PERT and ancillary dietary interventions are related to longer overall survival (OS; median: 16.5 vs. 7.5 months, P < .001) and have a significant, independent, prognostic impact for better outcomes (P = .013), independently from the therapeutic regimen. Furthermore, PERT and NS prevented weight loss during chemotherapy and obtained an improvement of nutritional parameters such as phase angle and free-fat mass index, after 3 months of anticancer treatment. Consistently, the positive impact on OS correlated also with the prevention of Karnofsky performance status deterioration and a lower incidence of maldigestion-related symptoms. Conclusions: Our data suggest that an early and well-conducted NS in patients with mPC may impact on survival and preserve performance status, thus improving quality of life.
MeSH term(s)	Humans ; Gemcitabine ; Deoxycytidine ; Retrospective Studies ; Quality of Life ; Pancreatic Neoplasms/pathology ; Nutritional Support ; Paclitaxel/adverse effects ; Weight Loss ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Albumins
Chemical Substances	Gemcitabine ; Deoxycytidine (0W860991D6) ; Paclitaxel (P88XT4IS4D) ; Albumins
Language	English
Publishing date	2023-05-06
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1409038-7
ISSN	1549-490X ; 1083-7159
ISSN (online)	1549-490X
ISSN	1083-7159
DOI	10.1093/oncolo/oyad101
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Article ; Online: Functional results of surgical treatment of low-ultralow rectal cancer.

Tartaglia, Nicola / Pacilli, Mario / Pavone, Giovanna / Fersini, Alberto / Lizzi, Vincenzo / Vovola, Fernando / Facciorusso, Antonio / Neri, Vincenzo / Ambrosi, Antonio

Annali italiani di chirurgia

2021 Volume 92, Page(s) 521–530

Abstract: Introduction: The improvement of surgical procedures and oncological outcomes in the treatment of low-ultralow rectal cancer, made important the evaluation of functional results. The aim of this study is to evaluate the functional results after open and ...

Abstract	Introduction: The improvement of surgical procedures and oncological outcomes in the treatment of low-ultralow rectal cancer, made important the evaluation of functional results. The aim of this study is to evaluate the functional results after open and laparoscopic approach. Patients and methods: From our global experience, over the period 2000/2018, within the patients surgically treated for rectal cancer, we have gathered and studied 37 patients with low-ultralow site of lesion, submitted to sphincterpreserving surgery, subdivided based on the approach: 20 open, 17 laparoscopic, of which 8 robotic . For each type of procedure, as low and ultralow anterior resection, intersphinteric resection, abdominoperineal resection, were investigated functional outcomes, as bowel continence, urinary functions, male and female sexual functions, based on the following tests: Wexner Incontinence Score, International Prostatic Symptom Score, International Index of Erectile Function- 5, Female Sexual Function Index. The controls were performed before surgery and 3-6-12 months postoperatively. Statistical analisis: X2-test, impaired and paired t-test two tailed, Bonferroni post-hoctest. Results: The immediate surgical results and pathological features of the tumor are reported and evaluated. The evaluation of fecal continence in all patients submitted to rectal resection and primary anastomosis showed function compromission without differences statistically significant between the laparo and open approach. In the comparison between specific surgical procedures, the damage of continence function were more severe after intersphinteric resection mached with low-ultralow rectal resection. The rehabilitation therapies continued for several months after surgery showed clear improvement. The urinary continence, in male and female patients, did not show statistically significant alterations in the pre and postoperative comparison in relation to the approach and the type of resective intervention. The sexual function in male patients has had impairment after all type of surgical resection but the damage was more severe after intersphinteric resection. The female sexual function had not significant changes between pre and postoperative evaluation. Conclusion: Bowel continence damage, urinary and sexual dysfunctions after surgical treatment for low-ultralow rectal cancer are frequent and form the low anterior resection syndrome. The severity of the syndrome is connected with the site of anastomosis. The rehabilitation therapies can play an important role in achieving the appreciable improvements of the functional alterations. Key words: Laparoscopic surgery, Rectal cancer.
MeSH term(s)	Female ; Humans ; Laparoscopy ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Proctectomy ; Rectal Neoplasms/surgery ; Syndrome ; Treatment Outcome
Language	English
Publishing date	2021-09-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Robotic Versus Laparoscopic Right Colectomy for Colon Cancer: Analysis of the Initial Simultaneous Learning Curve of a Surgical Fellow.

de'Angelis, Nicola / Lizzi, Vincenzo / Azoulay, Daniel / Brunetti, Francesco

Journal of laparoendoscopic & advanced surgical techniques. Part A

2016 Volume 26, Issue 11, Page(s) 882–892

Abstract: Background: Robotic surgery was introduced to overcome laparoscopic drawbacks. This study aimed to compare the learning curve of robotic-assisted right colectomy (RRC) versus laparoscopic-assisted right colectomy (LRC) for colon cancer with respect to ... ...

Abstract	Background: Robotic surgery was introduced to overcome laparoscopic drawbacks. This study aimed to compare the learning curve of robotic-assisted right colectomy (RRC) versus laparoscopic-assisted right colectomy (LRC) for colon cancer with respect to operative times and perioperative outcomes. In addition, the health-related costs associated with both procedures were analyzed and compared. Methods: Between 2012 and 2015, 30 consecutive patients underwent RRC and 50 patients LRC for colon cancer. All procedures were performed by a surgical fellow novice in minimally invasive colorectal surgery. The operative time and the cumulative sum method were used to evaluate the learning curve of RRC versus LRC. Results: The mean operative times were 200.5 minutes for RRC and 204.1 minutes for LRC (P = .408) and showed a significant decrease over consecutive procedures (P < .0001). The number of cases necessary to identify a drop in the operative time was 16 for RRC and 25 for LRC. RRC procedures were associated with significantly reduced blood loss (P = .012). Two patients (4%) in the LRC group were converted to laparotomy, whereas no conversion was required in the RRC group. Surgery-related costs were significantly more expensive for RRC, but when combined with the hospitalization-related costs, LRC and RRC did not differ (P = .632). Conclusions: Both robotic and laparoscopic operative times decrease rapidly with practice. However, RRC is associated with a faster learning curve than LRC. The simultaneous development of these two minimally invasive approaches appears to be safe and feasible with acceptable health-related costs.
MeSH term(s)	Aged ; Aged, 80 and over ; Cecal Neoplasms/surgery ; Colectomy/education ; Colectomy/methods ; Colon, Ascending/surgery ; Colon, Transverse/surgery ; Colonic Neoplasms/surgery ; Colorectal Surgery/education ; Conversion to Open Surgery ; Fellowships and Scholarships ; Female ; Humans ; Laparoscopy/education ; Laparoscopy/methods ; Learning Curve ; Male ; Middle Aged ; Operative Time ; Robotic Surgical Procedures/education ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2016-11
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2608063-1
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2016.0321
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Article ; Online: Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era.

Giordano, Guido / Parcesepe, Pietro / Bruno, Giuseppina / Piscazzi, Annamaria / Lizzi, Vincenzo / Remo, Andrea / Pancione, Massimo / D'Andrea, Mario Rosario / De Santis, Elena / Coppola, Luigi / Pietrafesa, Michele / Fersini, Alberto / Ambrosi, Antonio / Landriscina, Matteo

International journal of molecular sciences

2021 Volume 22, Issue 14

Abstract: Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such ...

Abstract	Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such a context, antiangiogenic and anti-Epidermal Growth Factor Receptor (EGFR) agents as well as immune checkpoint inhibitors have been approved as second-line options, and RAS and BRAF mutations and microsatellite status represent the molecular drivers that guide therapeutic choices. Patients harboring K- and N-RAS mutations are not eligible for anti-EGFR treatments, and bevacizumab is the only antiangiogenic agent that improves survival in combination with chemotherapy in first-line, regardless of RAS mutational status. Thus, the choice of an appropriate therapy after the progression to a bevacizumab or an EGFR-based first-line treatment should be evaluated according to the patient and disease characteristics and treatment aims. The continuation of bevacizumab beyond progression or its substitution with another anti-angiogenic agents has been shown to increase survival, whereas anti-EGFR monoclonals represent an option in RAS wild-type patients. In addition, specific molecular subgroups, such as BRAF-mutated and Microsatellite Instability-High (MSI-H) mCRCs represent aggressive malignancies that are poorly responsive to standard therapies and deserve targeted approaches. This review provides a critical overview about the state of the art in mCRC second-line treatment and discusses sequential strategies according to key molecular biomarkers.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomarkers, Pharmacological/chemistry ; Biomarkers, Pharmacological/metabolism ; Clinical Trials, Phase III as Topic ; Colorectal Neoplasms/enzymology ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Humans ; Mutation ; Precision Medicine/methods ; Randomized Controlled Trials as Topic ; ras Proteins/genetics ; ras Proteins/metabolism
Chemical Substances	Biomarkers, Pharmacological ; ras Proteins (EC 3.6.5.2)
Language	English
Publishing date	2021-07-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms22147717
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Article ; Online: High mobilization of CD133+/CD34+ cells expressing HIF-1α and SDF-1α in septic abdominal surgical patients.

Cotoia, Antonella / Cela, Olga / Palumbo, Gaetano / Altamura, Sabrina / Marchese, Flavia / Mangialetto, Nicoletta / La Bella, Daniela / Lizzi, Vincenzo / Capitanio, Nazzareno / Cinnella, Gilda

BMC anesthesiology

2020 Volume 20, Issue 1, Page(s) 158

Abstract: Background: The control of endothelial progenitor cells (CD133+/CD34+ EPCs) migrating from bone marrow to peripheral blood is not completely understood. Emerging evidence suggests that stromal cell-derived factor-1α (SDF-1α) mediates egression of EPCs ... ...

Abstract	Background: The control of endothelial progenitor cells (CD133+/CD34+ EPCs) migrating from bone marrow to peripheral blood is not completely understood. Emerging evidence suggests that stromal cell-derived factor-1α (SDF-1α) mediates egression of EPCs from bone marrow, while the hypoxia inducible factor (HIF) transcriptional system regulates SDF-1α expression. Our study aimed to investigate the time course of circulating CD133+/CD34+ EPCs and its correlation with the expression of HIF-1α protein and SDF-1α in postoperative laparoscopic abdominal septic patients. Methods: Postoperative patients were divided in control (C group) and septic group (S group) operated immediately after the diagnosis of sepsis/septic shock. Blood samples were collected at baseline (0), 1, 3 and 7 postoperative days for CD133+/CD34+ EPCs count expressing or not the HIF-1α and SDF-1α analysis. Results: Thirty-two patients in S group and 39 in C group were analyzed. In C group CD133+/CD34+ EPCs count remained stable throughout the study period, increasing on day 7 (173 [0-421] /μl vs baseline: P = 0.04; vs day 1: P = 0.002). In S group CD133+/CD34+ EPCs count levels were higher on day 3 (vs day 1: P = 0.006 and day 7: P = 0.026). HIF-1α expressing CD133+/CD34+ EPCs count decreased on day 1 as compared with the other days in C group (day 0 vs 1: P = 0.003, days 3 and 7 vs 1: P = 0.008), while it was 321 [0-1418] /μl on day 3 (vs day 1; P = 0.004), and 400 [0-587] /μl on day 7 in S group. SDF-1α levels were higher not only on baseline but also on postoperative day 1 in S vs C group (219 [124-337] pg/ml vs 35 [27-325] pg/ml, respectively; P = 0.01). Conclusion: Our results indicate that sepsis in abdominal laparoscopic patients might constitute an additional trigger of the EPCs mobilization as compared with non-septic surgical patients. A larger mobilization of CD133+/CD34+ EPCs, preceded by enhanced plasmatic SDF-1α, occurs in septic surgical patients regardless of HIF-1α expression therein. Trial registration: ClinicalTrials.gov no. NCT02589535 . Registered 28 October 2015.
MeSH term(s)	Abdomen/surgery ; Aged ; Aged, 80 and over ; Cell Movement ; Chemokine CXCL12/analysis ; Endothelial Progenitor Cells/physiology ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit/analysis ; Laparoscopy ; Male ; Middle Aged ; Sepsis/pathology
Chemical Substances	CXCL12 protein, human ; Chemokine CXCL12 ; HIF1A protein, human ; Hypoxia-Inducible Factor 1, alpha Subunit
Keywords	covid19
Language	English
Publishing date	2020-06-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-020-01068-w
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Article ; Online: Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy.

de'Angelis, Nicola / Abdalla, Solafah / Lizzi, Vincenzo / Esposito, Francesco / Genova, Pietro / Roy, Lydia / Galacteros, Frédéric / Luciani, Alain / Brunetti, Francesco

Surgery

2017 Volume 162, Issue 6, Page(s) 1219–1230

Abstract: Background: Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic vein thrombosis have not yet been defined. The present retrospective study aimed to investigate the role of computed tomography performed systematically ... ...

Abstract	Background: Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic vein thrombosis have not yet been defined. The present retrospective study aimed to investigate the role of computed tomography performed systematically before and after laparoscopic splenectomy to assess the incidence of portal or splenic vein thrombosis, predictors, and outcomes. Methods: Computed tomography scans were obtained from 170 patients undergoing elective laparoscopic splenectomy between 2005 and 2015. Pre- and postoperative splenic vein diameter was measured at the splenoportal junction and at a distance of 2, 4, 6 cm from it. Univariate and multivariate analyses were used to identify portal or splenic vein thrombosis risk factors and predictors of treatment outcome. Results: Overall, 68.2% of patients had benign hematologic diseases; 64.1% showed splenomegaly. Portal or splenic vein thrombosis occurred in 53.5% of patients (91/170), of whom 49.5% were asymptomatic. Preoperative splenic vein diameter measurements at 2, 4, and 6 cm from the splenoportal junction were significantly greater in portal or splenic vein thrombosis patients than in no-portal or splenic vein thrombosis patients. Patients with splenic vein diameter ≥8 mm at all measured sites had a greater risk of developing portal or splenic vein thrombosis (P = .009; odds ratio, 2.57; 95% confidence interval, 1.26-5.23). The majority of thromboses involved the distal splenic vein (45.1%, 41/91), and 41.7% of patients had thromboses located in multiple sites. Fully 71.4% showed complete resolution of portal or splenic vein thrombosis. Thrombus location at a single site predicted a favorable treatment outcome (P < .0001). Conclusion: Portal or splenic vein thrombosis is a frequent complication of splenectomy that occurs asymptomatically in half of cases. Computed tomography could have an important role in identifying patients at risk of developing portal or splenic vein thrombosis as well as in predicting portal or splenic vein thrombosis resolution.
Language	English
Publishing date	2017-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2017.07.016
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Article: A Rare Case of Functioning Adrenocortical Oncocytoma Presenting as Cushing Syndrome.

Tartaglia, Nicola / Cianci, Pasquale / Altamura, Amedeo / Lizzi, Vincenzo / Vovola, Fernanda / Fersini, Alberto / Ambrosi, Antonio / Neri, Vincenzo

Case reports in surgery

2016 Volume 2016, Page(s) 8964070

Abstract: Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been ... ...

Abstract	Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been reported in other sites including choroid plexus, respiratory tract, and larynx. Histologically, they are characterized by cells with eosinophilic granular cytoplasm and numerous packed mitochondria. We reported a case of a 44-year-old female who presented with Cushing syndrome for hypersecretion of cortisol due to adrenocortical oncocytoma. Magnetic resonance of abdomen revealed a right adrenal mass. Laparoscopic adrenalectomy was performed and the tumor was pathologically confirmed as benign adrenocortical oncocytoma. After surgical treatment, Cushing's syndrome resolved.
Language	English
Publishing date	2016-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2657697-1
ISSN	2090-6919 ; 2090-6900
ISSN (online)	2090-6919
ISSN	2090-6900
DOI	10.1155/2016/8964070
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Article ; Online: Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results.

Cianci, Pasquale / Fersini, Alberto / Tartaglia, Nicola / Altamura, Amedeo / Lizzi, Vincenzo / Stoppino, Luca Pio / Macarini, Luca / Ambrosi, Antonio / Neri, Vincenzo

Surgical endoscopy

2016 Volume 30, Issue 4, Page(s) 1503–1507

Abstract: Background: Several laparoscopic approaches to the adrenal gland have been described. We prefer the lateral transabdominal approach. The aim of this study is to evaluate prospectively the presence of any anatomical and dynamic changes in the spleen ... ...

Abstract	Background: Several laparoscopic approaches to the adrenal gland have been described. We prefer the lateral transabdominal approach. The aim of this study is to evaluate prospectively the presence of any anatomical and dynamic changes in the spleen after laparoscopic transperitoneal left adrenalectomy (LTLA), which can cause an increased risk of early and late complications. Methods: We have evaluated 21 patients before and 6 months after surgery in order to verify the possible presence of a wandering spleen. A clinical and instrumental follow-up [ultrasound (US), magnetic resonance (MR)] were performed. During US protocol, in supine, right lateral, and orthostatic position, the longitudinal and anteroposterior diameter of the spleen and the resistive index within 3 cm of the origin of the splenic artery in three different measurements averaged were measured. MR protocol evaluated, in supine and right lateral position, the splenic volume and its distances from the diaphragm dome and the lateral margin of the costal arch. Results: p Values calculated for each parameter were not statistically significant. Our results confirm the absence of any anatomical and dynamic changes in the spleen after LTLA. Conclusions: The most common complications after laparoscopic adrenalectomy are well known and widely described. Our experience does not exclude the occurrence of a wandering spleen, but allows us to state that a rightful mobilization of the pancreaticosplenic block can avoid this event, and in agreement with other authors, the presence of a wandering spleen remains an isolated complication.
MeSH term(s)	Adolescent ; Adrenal Gland Diseases/surgery ; Adrenalectomy ; Adult ; Aged ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Wandering Spleen/diagnostic imaging ; Wandering Spleen/etiology ; Young Adult
Language	English
Publishing date	2016-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-015-4363-y
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