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Article ; Online: Outcomes and risk factors for spontaneous spondylodiscitis: Case series and meta-analysis of the literature.

Giordan, E / Marton, E / Scotton, G / Canova, G

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2019 Volume 68, Page(s) 179–187

Abstract: Despite recent improvements in surgical and antimicrobial therapies, few generally applicable guidelines exist for spondylodiscitis management. We reviewed a consecutive series of patients as well as the past 18 years of the literature and analyzed ... ...

Abstract	Despite recent improvements in surgical and antimicrobial therapies, few generally applicable guidelines exist for spondylodiscitis management. We reviewed a consecutive series of patients as well as the past 18 years of the literature and analyzed outcomes for either conservative or surgical treatment. We analyzed a consecutive series of adults with spontaneous spondylodiscitis treated at our institution over the last 6 years. We analyzed predictors for neurological deficits, vertebral collapse, and surgical treatment. We also performed a meta-analysis of the literature between 2000 and 2018, stratifying the results between surgical and conservative treatment outcomes. A younger age at diagnosis, cervical location, tubercular infection, coexistence of morbidities, and vertebral collapse were predictors of surgical intervention. Cervical spondylodiscitis, vertebral collapse, and epidural collection were associated with a higher risk of developing neurological deficits, while tubercular spondylodiscitis was associated with a higher risk of vertebral collapse. Based on the current literature, conservative treatment has success rates similar to those of surgical treatment but lower complication and mortality rates. In cases without an absolute indication for surgery, a conservative approach should be considered as the first-line treatment. A closer diagnostic and clinical follow-up should be recommended in patients with cervical tract or tubercular spondylodiscitis because of the higher risk of developing bone collapse and neurological deficits.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Discitis/complications ; Discitis/pathology ; Discitis/therapy ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Retrospective Studies ; Risk Factors ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-07-09
Publishing country	Scotland
Document type	Journal Article ; Meta-Analysis
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2019.06.040
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Article ; Online: A rare case of reverse midgut rotation and jejunal transmesenteric internal hernia in an adult with Beckwith-Wiedemann syndrome.

Guerra, Martina / Iacuzzo, Cristiana / Scotton, Giovanni / Biloslavo, Alan / de Manzini, Nicolò

Annali italiani di chirurgia

2021 Volume 92, Page(s) 560–564

Abstract: Intestinal malrotation is a rare congenital condition with an incidence in adulthood between 0,0001% and 0,19%, affecting nearly 1:500 live births. It results from an abnormal rotation of the bowel within the peritoneal cavity during embryogenesis. ... ...

Abstract	Intestinal malrotation is a rare congenital condition with an incidence in adulthood between 0,0001% and 0,19%, affecting nearly 1:500 live births. It results from an abnormal rotation of the bowel within the peritoneal cavity during embryogenesis. Generally it involves both small and large bowel, leading to an increased risk of intestinal obstruction. Depending on which phase of midgut embryological development is stopped or disrupted, a variety of anatomic anomalies may occur. Reverse rotation is the most rare form of intestinal malrotation (2-4%) and is more common in women. It origins from premature return of the caudad midgut into the abdominal cavity while the duodenal loop rotates clockwise during fetal life, between 4th and 12th gestational week. The cecum begins its migration and shifts to the right behind the superior mesenteric artery (SMA). As a result the transverse colon lies behind the duodenum and the SMA. Malrotation's most common clinical manifestations in neonates are acute duodenal obstruction and midgut volvulus, lifethreatening conditions resulting in acute bowel obstruction and ischemia. In adult patients the risk of volvulus decreases and clinical presentation is more aspecific, leading to delayed diagnosis, that may cause dangerous consequences. We report a rare case of an adult male patient presenting with acute abdominal symptoms caused by a reverse midgut rotation in a Beckwith-Weidemann Syndrome (BWS), a rare genetic disorder characterized by the association between adrenal cytomegaly, hemihypertrophy, macroglossia, omphalocele and pancreatic islet hyperplasia. KEY WORDS: Beckwith-Wiedemann syndrome, Reverse midgut rotation, Jejunal transmesenteric hernia.
MeSH term(s)	Adult ; Beckwith-Wiedemann Syndrome ; Duodenal Obstruction ; Female ; Humans ; Infant, Newborn ; Internal Hernia ; Intestinal Volvulus/complications ; Intestinal Volvulus/diagnostic imaging ; Male ; Rotation
Language	English
Publishing date	2021-11-18
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Can the American College of Surgeons NSQIP Surgical Risk Calculator Accurately Predict Adverse Postoperative Outcomes in Emergency Abdominal Surgery? An Italian Multicenter Analysis.

Scotton, Giovanni / La Greca, Antonio / Lirusso, Chiara / Mariani, Diego / Zago, Mauro / Chiarugi, Massimo / Tartaglia, Dario / de Manzini, Nicolò / Biloslavo, Alan

Journal of the American College of Surgeons

2022 Volume 236, Issue 2, Page(s) 387–398

Abstract: Background: The American College of Surgeons NSQIP surgical risk calculator provides an estimation of 30-day postoperative adverse outcomes. It is useful in the identification of high-risk patients needing clinical optimization and supports the informed ...

Abstract	Background: The American College of Surgeons NSQIP surgical risk calculator provides an estimation of 30-day postoperative adverse outcomes. It is useful in the identification of high-risk patients needing clinical optimization and supports the informed consent process. The purpose of this study is to validate its predictive value in the Italian emergency setting. Study design: Six Italian institutions were included. Inclusion diagnoses were acute cholecystitis, appendicitis, gastrointestinal perforation or obstruction. Areas under the receiving operating characteristic curves, Brier score, Hosmer-Lemeshow index, and observed-to-expected event ratio were measured to assess both discrimination and calibration. Effect of the Surgeon Adjustment Score on calibration was then tested. A patient's personal risk ratio was obtained, and a cutoff was chosen to predict mortality with a high negative predicted value. Results: A total of 2,749 emergency procedures were considered for the analysis. The areas under the receiving operating characteristic curve were 0.932 for death (0.921 to 0.941, p < 0.0001; Brier 0.041) and 0.918 for discharge to nursing or rehabilitation facility (0.907 to 0.929, p < 0.0001; 0.070). Discrimination was also strong (area under the receiving operating characteristic curve >0.8) for renal failure, cardiac complication, pneumonia, venous thromboembolism, serious complication, and any complication. Brier score was informative (<0.25) for all the presented variables. The observed-to-expected event ratios were 1.0 for death and 0.8 for discharge to facility. For almost all other variables, there was a general risk underestimation, but the use of the Surgeon Adjustment Score permitted a better calibration of the model. A risk ratio >3.00 predicted the onset of death with sensitivity = 86%, specificity = 77%, and negative predicted value = 99%. Conclusions: The American College of Surgeons NSQIP surgical risk calculator has proved to be a reliable predictor of adverse postoperative outcomes also in Italian emergency settings, with particular regard to mortality. We therefore recommend the use of the surgical risk calculator in the multidisciplinary care of patients undergoing emergency abdominal surgery.
MeSH term(s)	Humans ; United States/epidemiology ; Risk Assessment/methods ; Postoperative Complications/etiology ; Retrospective Studies ; Surgeons ; Quality Improvement ; Risk Factors
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000445
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Article ; Online: Impact of COVID-19 pandemic on general surgery training program: An Italian experience.

Bernardi, Laura / Germani, Paola / Del Zotto, Giulio / Scotton, Giovanni / de Manzini, Nicolò

American journal of surgery

2020 Volume 220, Issue 5, Page(s) 1361–1363

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; General Surgery/education ; Humans ; Internship and Residency/methods ; Italy/epidemiology ; Pandemics
Keywords	covid19
Language	English
Publishing date	2020-06-11
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.2020.06.010
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Article ; Online: Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients.

Pedrazzani, Corrado / Tripepi, Marzia / Turri, Giulia / Fernandes, Eduardo / Scotton, Giovanni / Conci, Simone / Campagnaro, Tommaso / Ruzzenente, Andrea / Guglielmi, Alfredo

Scientific reports

2020 Volume 10, Issue 1, Page(s) 1072

Abstract: Increasing evidence advocates the prognostic role of RDW in various tumours. We analysed 591 patients to assess whether RDW is a prognostic factor for overall (OS) and cancer-related survival (CRS) for patients with colorectal cancer (CRC). The data were ...

Abstract	Increasing evidence advocates the prognostic role of RDW in various tumours. We analysed 591 patients to assess whether RDW is a prognostic factor for overall (OS) and cancer-related survival (CRS) for patients with colorectal cancer (CRC). The data were retrieved from a retrospective database. The optimal cut-off value for RDW was set at 14.1%; accordingly, two groups were considered: those with a value equal or lower than 14.1% (L-RDW), and those with a value higher than 14.1% (H-RDW). The mean value of RDW rose from pT1 to pT4 tumours. H-RDW correlated with age above the mean, colonic location of the lesion, pT and TNM stage. Finally, H-RDW was significantly associated with the intent of surgery: almost 50% of patients who underwent a non-curative resection presented H-RDW, compared to 19.3% in R0 resections. OS was significantly lower in patients with H-RDW. CRS was similar in the two groups. Stratifying patients according to TNM stage worse OS was associated with H-RDW only in early stages, whereas there was no difference for stages II-IV. Multivariate analysis confirmed that H-RDW was not an independent prognostic factor. Although H-RDW correlated with some negative clinical-pathological factors, it did not seem to independently influence OS and CRS.
MeSH term(s)	Aged ; Colorectal Neoplasms/blood ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Erythrocyte Count ; Erythrocyte Indices ; Erythrocytes/cytology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival
Language	English
Publishing date	2020-01-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-020-57721-4
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Article ; Online: From Laparoscopic Right Colectomy with Extracorporeal Anastomosis to Robot-Assisted Intracorporeal Anastomosis to Totally Robotic Right Colectomy for Cancer: The Evolution of Robotic Multiquadrant Abdominal Surgery.

Scotton, Giovanni / Contardo, Tania / Zerbinati, Antonio / Tosato, Sara Maria / Orsini, Camillo / Morpurgo, Emilio

Journal of laparoendoscopic & advanced surgical techniques. Part A

2018 Volume 28, Issue 10, Page(s) 1216–1222

Abstract: Background: Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic ... ...

Abstract	Background: Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic procedures. In the literature, few works have been published comparing laparoscopic, hybrid, and totally robotic right colectomies. The aim of this study is to retrospectively analyze the improvements brought on by the evolution of robotic surgery at our specialized center. Materials and methods: Two hundred six (hybrid and totally) robotic right colectomies (RRCs) with IA were compared with 160 laparoscopic right colectomies (LRCs) with EA. A separate analysis carried out by the robotic group compared 30 totally robotic right colectomies (TRRCs) with 176 hybrid robot-assisted right colectomies (HRRCs). Demographics, pathological features, operative details, and postoperative outcomes were retrospectively analyzed from a prospectively maintained database. Results: The groups were comparable with respect to demographics and tumor staging. When compared with LRC, RRC showed shorter time to first flatus (P < .001), stools (P < .001), solid diet (P < .001), and discharge (P < .001). The number of lymph nodes harvested was 23.13 ± 11.2 in RRC versus 20.5 ± 11.2 in LRC (P = .031). Operative time was longer in RRC (253.0 ± 47 minutes versus 209.9 ± 64 minutes; P < .001), but conversion to open (2.4% versus 18.1%; P < .001), anastomotic leaks (0.5% versus 5%; P = .012), and bleeding (0.3% versus 4.4%; P = .024) were significantly less frequent. Subsequent analysis shows no significant increase in operative time in TRRC versus HRRC (261.0 ± 41 minutes versus 251.6 ± 47.6 minutes; P = .310). Even if not statistically significant, TRRC showed faster bowel function recovery and tolerance to solid diet. Conclusions: We confirmed the clinical advantages of RRC with IA over LRC with EA in postoperative recovery outcomes and complication rate. Furthermore, our preliminary analysis in a cohort of 30 TRRC shows promising results.
MeSH term(s)	Aged ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Colectomy/adverse effects ; Colectomy/methods ; Colonic Neoplasms/surgery ; Conversion to Open Surgery/statistics & numerical data ; Female ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2018-08-17
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1381909-4
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2017.0693
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Article: Impact of COVID-19 pandemic on general surgery training program: An Italian experience

Bernardi, Laura / Germani, Paola / Del Zotto, Giulio / Scotton, Giovanni / de Manzini, Nicolò

Am. j. surg

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #593698
Database	COVID19

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Article ; Online: Impact of COVID-19 pandemic on general surgery training program

Bernardi, Laura / Germani, Paola / Del Zotto, Giulio / Scotton, Giovanni / de Manzini, Nicolò

The American Journal of Surgery ; ISSN 0002-9610

An Italian experience

2020

Keywords	Surgery ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
DOI	10.1016/j.amjsurg.2020.06.010
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Article ; Online: Analgesic efficacy of preemptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: study protocol for a randomized, multicenter, single-blind, noninferiority trial.

Pedrazzani, Corrado / Park, Soo Yeun / Scotton, Giovanni / Park, Jun Seok / Kim, Hye Jin / Polati, Enrico / Guglielmi, Alfredo / Choi, Gyu Seog

Trials

2019 Volume 20, Issue 1, Page(s) 391

Abstract: Background: Transversus abdominis plane (TAP) block and wound infiltration (WI) are common locoregional anesthesia techniques for pain management in patients undergoing colorectal laparoscopic surgery. Comparative data between these two practices are ... ...

Abstract	Background: Transversus abdominis plane (TAP) block and wound infiltration (WI) are common locoregional anesthesia techniques for pain management in patients undergoing colorectal laparoscopic surgery. Comparative data between these two practices are conflicting, and a clear benefit of TAP block over WI is still debated. The main purpose of this study is to determine the efficacy in pain control of WI compared with WI plus laparoscopic TAP block (L-TAP) in cases of laparoscopic colorectal resection. Secondary aims are to evaluate other short-term results directly related to pain management: the need for rescue analgesic drugs, the incidence of postoperative nausea and vomiting, the resumption of gut functions, and the length of hospital stay. Methods/design: This is a prospective, randomized, controlled, two-arm, multicenter, single-blind study evaluating the efficacy of postoperative analgesic management of WI versus WI plus L-TAP in the context of laparoscopic colorectal surgery. Randomization is at the patient level, and participants are randomized 1:1 to receive either WI alone or WI plus L-TAP. Those eligible for inclusion were patients undergoing laparoscopic resection for colorectal tumor or diverticular disease at the Division of General and Hepatobiliary Surgery, Verona University, Verona, Italy, and at the Colorectal Cancer Center, Kyungpook National University, Daegu, Korea. Fifty-four patients are needed in each group to evidence a difference greater than 1 of 10 according to the numeric rating scale for pain assessment to establish that this difference would matter in practice. Discussion: The demonstration of a noninferiority of WI compared with WI plus L-TAP block would call into question TAP block usefulness in the setting of laparoscopic colorectal surgery. Trial registration: ClinicalTrials.gov, NCT03376048 . Prospectively registered on 15 December 2017.
MeSH term(s)	Abdominal Muscles/innervation ; Adult ; Aged ; Anesthetics, Local/administration & dosage ; Anesthetics, Local/adverse effects ; Colectomy/adverse effects ; Colectomy/methods ; Colorectal Neoplasms/surgery ; Diverticular Diseases/surgery ; Equivalence Trials as Topic ; Female ; Humans ; Italy ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Multicenter Studies as Topic ; Nerve Block/adverse effects ; Nerve Block/methods ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Republic of Korea ; Ropivacaine/administration & dosage ; Ropivacaine/adverse effects ; Single-Blind Method ; Time Factors ; Treatment Outcome ; Young Adult
Chemical Substances	Anesthetics, Local ; Ropivacaine (7IO5LYA57N)
Language	English
Publishing date	2019-07-02
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1468-6708
ISSN (online)	1745-6215 ; 1468-6694
ISSN	1468-6708
DOI	10.1186/s13063-019-3509-y
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Article: Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection.

Pedrazzani, Corrado / Conti, Cristian / Turri, Giulia / Lazzarini, Enrico / Tripepi, Marzia / Scotton, Giovanni / Rivelli, Matteo / Guglielmi, Alfredo

World journal of gastrointestinal surgery

2019 Volume 11, Issue 10, Page(s) 395–406

Abstract: Background: There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.: Aim: To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol ( ... ...

Abstract	Background: There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery. Aim: To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection. Methods: Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients' age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP's items were evaluated in the three study groups. Results: Among the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% Conclusion: ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
Language	English
Publishing date	2019-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v11.i10.395
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