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  1. Artikel: Progress in the esophagogastric anastomosis and the challenges of minimally invasive thoracoscopic surgery.

    Bonavina, Luigi

    Annals of translational medicine

    2021  Band 9, Heft 10, Seite(n) 907

    Abstract: The esophagogastric anastomosis is most commonly performed to restore digestive tract continuity after esophagectomy for cancer. Despite a long history of clinical research and development of high-tech staplers, this procedure is still feared by most ... ...

    Abstract The esophagogastric anastomosis is most commonly performed to restore digestive tract continuity after esophagectomy for cancer. Despite a long history of clinical research and development of high-tech staplers, this procedure is still feared by most surgeons and associated with a 10% leakage rate. Among specific factors that may contribute to failure of the esophageal anastomosis are the absence of serosa layer, longitudinal orientation of muscle fibers, and ischemia of the gastric conduit. It has recently been suggested that the gut microbiome may influence the healing process of the anastomosis through the presence of collagenolytic bacterial strains, indicating that suture breakdown is not only a matter of collagen biosynthesis. The esophagogastric anastomosis can be performed either in the chest or neck, and can be completely hand-sewn, completely stapled (circular or linear stapler), or semi-mechanical (linear stapler posterior wall and hand-sewn anterior wall). Because of the lack of randomized clinical trials, no conclusive evidence is available, and the debate between the hand-sewn and the stapling technique is still ongoing even in the present era of robotic surgery. Centralization of care has improved the overall postoperative outcomes of esophagectomy, but the esophagogastric anastomosis remains the Achille's heel of the procedure. More research and network collaboration of experts is needed to improve safety and clinical outcomes.
    Sprache Englisch
    Erscheinungsdatum 2021-06-07
    Erscheinungsland China
    Dokumenttyp Journal Article ; Review
    ZDB-ID 2893931-1
    ISSN 2305-5847 ; 2305-5839
    ISSN (online) 2305-5847
    ISSN 2305-5839
    DOI 10.21037/atm.2020.03.66
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Commentary: Evaluation of Anterior Phrenoesophageal Ligament Preservation During Hiatus Hernia Repair in Laparoscopic Sleeve Gastrectomy as an Anti-Reflux Measure by Elmaleh

    Bonavina, Luigi

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2021  Band 31, Heft 5, Seite(n) 515–516

    Mesh-Begriff(e) Gastrectomy/methods ; Gastroesophageal Reflux/etiology ; Gastroesophageal Reflux/prevention & control ; Hernia, Hiatal/complications ; Hernia, Hiatal/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Ligaments/surgery ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Postoperative Complications/prevention & control ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2021-03-26
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 1381909-4
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2021.29036.lb
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Does crural repair with biosynthetic mesh improve outcomes of revisional surgery for recurrent hiatal hernia?

    Panici Tonucci, T / Aiolfi, A / Bona, D / Bonavina, L

    Hernia : the journal of hernias and abdominal wall surgery

    2024  

    Abstract: Background: Laparoscopic revisional surgery for recurrent hiatal hernia (HH) is technically demanding. Re-recurrences are common and esophageal hiatus mesh reinforcement might improve durability of the repair, thus minimizing the risk of re-herniation.!# ...

    Abstract Background: Laparoscopic revisional surgery for recurrent hiatal hernia (HH) is technically demanding. Re-recurrences are common and esophageal hiatus mesh reinforcement might improve durability of the repair, thus minimizing the risk of re-herniation.
    Purpose: Assess safety and effectiveness of simple suture repair (no mesh group) vs. crural augmentation with a biosynthetic absorbable mesh (mesh group) in patients with recurrent HH.
    Methods: Observational retrospective study from September 2012 to December 2022. Only patients undergoing redo surgery for previous failures of hiatal hernia repair were enrolled. Surgical failure was defined as symptomatic recurrent HH with > 2 cm of gastric tissue above the diaphragmatic impression at upper gastrointestinal endoscopy and/or swallow study. Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and Short Form-36 (SF-36) questionnaires were used to assess and preoperative and postoperative symptoms and quality of life.
    Results: One hundred four patients were included. Overall, 60 patients (57.7%) underwent mesh-reinforced cruroplasty, whereas 44 (42.3%) underwent simple suture cruroplasty. Mesh and no mesh groups had similar baseline demographics, symptoms, prevalence of esophagitis and Barrett's esophagus, and HH size. A composite crural repair was most commonly performed in the mesh group (38.3% vs. 20.5%; p = 0.07). In addition to cruroplasty, most patients (91%) underwent a Toupet fundoplication. The 90-day postoperative complication rate was 8.6%, and there was no mortality. Recurrent HH was diagnosed in 21 patients (20.2%) with a clinical trend toward reduced incidence in the mesh group (16.7% vs. 25%; p = 0.06). Compared to baseline, there was a statistically significant improvement of median GERD-HRQL score (p < 0.01) and all SF-36 items (p < 0.01).
    Conclusions: Laparoscopic revisional surgery for recurrent HH is safe and effective. Selective use of biosynthetic mesh may protect from early recurrence and has the potential to reduce re-herniation in the long-term.
    Sprache Englisch
    Erscheinungsdatum 2024-03-29
    Erscheinungsland France
    Dokumenttyp Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-024-03023-x
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment.

    Manara, Michele / Bona, Davide / Bonavina, Luigi / Aiolfi, Alberto

    Updates in surgery

    2024  

    Abstract: Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic ... ...

    Abstract Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2-10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7-12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6-9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51-0.69), 24 (HR 0.64, 95% CI 0.55-0.73), 36 (HR 0.67, 95% CI 0.55-0.79), and 60 months (HR 0.69, 95% CI 0.51-0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up.
    Sprache Englisch
    Erscheinungsdatum 2024-02-06
    Erscheinungsland Italy
    Dokumenttyp Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-024-01761-2
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  5. Artikel ; Online: Esophageal emergencies.

    Chirica, Mircea / Bonavina, Luigi

    Minerva surgery

    2022  Band 78, Heft 1, Seite(n) 52–67

    Abstract: The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the ... ...

    Abstract The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.
    Mesh-Begriff(e) Humans ; Emergencies ; Esophageal Perforation/diagnosis ; Esophageal Perforation/etiology ; Foreign Bodies/complications ; Caustics
    Chemische Substanzen Caustics
    Sprache Englisch
    Erscheinungsdatum 2022-12-13
    Erscheinungsland Italy
    Dokumenttyp Journal Article
    ZDB-ID 3067899-7
    ISSN 2724-5438
    ISSN (online) 2724-5438
    DOI 10.23736/S2724-5691.22.09781-7
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel: Is paravertebral block the new standard of care for postoperative analgesia after thoracoscopic surgery?

    Aiolfi, Alberto / Bona, Davide / Shabat, Galyna / Resta, Marco / Bonavina, Luigi

    Journal of thoracic disease

    2024  Band 16, Heft 4, Seite(n) 2677–2680

    Sprache Englisch
    Erscheinungsdatum 2024-04-10
    Erscheinungsland China
    Dokumenttyp Editorial ; Comment
    ZDB-ID 2573571-8
    ISSN 2077-6624 ; 2072-1439
    ISSN (online) 2077-6624
    ISSN 2072-1439
    DOI 10.21037/jtd-23-1896
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  7. Artikel ; Online: Is Endoscopic Surveillance Needed After Laparoscopic Sleeve Gastrectomy?

    Aiolfi, Alberto / Bona, Davide / Lipham, John C / Bonavina, Luigi

    Current obesity reports

    2024  Band 13, Heft 1, Seite(n) 183–185

    Mesh-Begriff(e) Humans ; Gastrectomy ; Laparoscopy ; Obesity, Morbid/surgery ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2024-01-03
    Erscheinungsland United States
    Dokumenttyp Letter
    ISSN 2162-4968
    ISSN (online) 2162-4968
    DOI 10.1007/s13679-023-00545-w
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  8. Artikel: Safety profile of magnetic sphincter augmentation for gastroesophageal reflux disease.

    Froiio, Caterina / Aiolfi, Alberto / Bona, Davide / Bonavina, Luigi

    Frontiers in surgery

    2023  Band 10, Seite(n) 1293270

    Abstract: Background: The magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated.: ... ...

    Abstract Background: The magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated.
    Methods: Retrospective study on a prospectively collected database. Patients who underwent MSA procedure between March 2007 and September 2021 in two tertiary-care referral centers for esophageal surgery were included. The trend of MSA explant, the changes in the sizing technique and crura repair over the years, the technique of explant, and the clinical outcomes of the revisional procedure were reviewed.
    Results: Out of 397 consecutive patients, 50 (12.4%) underwent MSA removal, with a median time to explant of 39.5 [IQR = 53.7] months. Main symptoms leading to removal were dysphagia (43.2%), heartburn (25%), and epigastric pain (13.6%). Erosion occurred in 2.5% of patients. Smaller (12- and 13-bead) devices were the ones most frequently explanted. The majority of the explants were performed laparoscopically with endoscopic assistance. There was no perioperative morbidity, and the median length of stay was 2.8 ± 1.4 days. After 2014, changes in sizing technique and crura repair resulted in a decreased incidence of explants from 23% to 5% (
    Conclusion: Oversizing and full mediastinal dissection with posterior hiatoplasty may improve the outcomes of the MSA procedure and possibly reduce removal rates.
    Sprache Englisch
    Erscheinungsdatum 2023-11-07
    Erscheinungsland Switzerland
    Dokumenttyp Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2023.1293270
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  9. Artikel ; Online: Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery.

    Bonavina, Giuseppe / Zackova, Monika / Bet, Luciano / Bonavina, Luigi

    Annals of surgery open : perspectives of surgical history, education, and clinical approaches

    2023  Band 4, Heft 1, Seite(n) e252

    Sprache Englisch
    Erscheinungsdatum 2023-03-15
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ISSN 2691-3593
    ISSN (online) 2691-3593
    DOI 10.1097/AS9.0000000000000252
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  10. Artikel ; Online: Short-term Outcomes of Different Techniques for Gastric Ischemic Preconditioning Before Esophagectomy: A Network Meta-analysis.

    Aiolfi, Alberto / Bona, Davide / Bonitta, Gianluca / Bonavina, Luigi

    Annals of surgery

    2023  Band 279, Heft 3, Seite(n) 410–418

    Abstract: Background: Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the ... ...

    Abstract Background: Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported.
    Purpose: Compare short-term outcomes among different GIC techniques.
    Materials and methods: Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrIs) were used to assess relative inference.
    Results: Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC versus noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC versus noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC versus noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC versus noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC versus AngioGIC in terms of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments.
    Conclusions: Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS.
    Mesh-Begriff(e) Humans ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Network Meta-Analysis ; Stomach/surgery ; Stomach/blood supply ; Ischemic Preconditioning/adverse effects ; Ischemic Preconditioning/methods ; Anastomotic Leak/surgery ; Anastomosis, Surgical/methods ; Ischemia/surgery ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/complications
    Sprache Englisch
    Erscheinungsdatum 2023-10-13
    Erscheinungsland United States
    Dokumenttyp Systematic Review ; Meta-Analysis ; Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000006124
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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