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  1. Article ; Online: Implementing protocol-based relaparoscopy for severe complications in laparoscopic colorectal surgery.

    Puccetti, Francesco / Vallorani, Alessia / Cinelli, Lorenzo / Turi, Stefano / Gozzini, Lorenzo / Rosati, Riccardo / Elmore, Ugo

    World journal of surgery

    2024  

    Abstract: Background: Although laparoscopy has demonstrated growing applications for either primary colorectal resections or reoperations, no standardized criteria for implementing laparoscopy in revisional surgery have been reported. This study analyzes a single- ...

    Abstract Background: Although laparoscopy has demonstrated growing applications for either primary colorectal resections or reoperations, no standardized criteria for implementing laparoscopy in revisional surgery have been reported. This study analyzes a single-center series of major complications after laparoscopic colorectal surgery, undergoing laparoscopic (LR), or open reoperations in compliance with a hemodynamics-based institutional management.
    Methods: This study retrospectively analyzes a series of consecutive patients who primarily underwent either laparoscopic left colectomy or low anterior resection in a tertiary referral center between 2016 and 2021. Major complications requiring reoperation (MCR) were managed through an interdisciplinary protocol and submitted to reoperation according to patient hemodynamics and intra-abdominal contamination. A cohort analysis primarily assessed treatment failure rates (i.e., 90-day mortality and need for further surgery), while postoperative morbidity was secondarily examined.
    Results: Out of 1137 laparoscopic colorectal resections, 497 patients met eligibility criteria, while 45 (9.1%) developed MCRs were managed according to the standardized interdisciplinary protocol. Revisional surgery was performed through either LR (66.7%) or (33.3%). Treatment failure was 13.3% overall, including additional surgery (11.1%) and 90-day mortality (6.6%) after reoperation. In both overall and anastomotic leak-specific MCRs, relaparoscopy resulted in minimized length of hospital stay, postoperative morbidity, and intensity of care.
    Conclusions: Relaparoscopy for MCR preserves clinical benefits related to minimally invasive colorectal surgery. Further studies should investigate applicative determinants and impediments related to the center volume.
    Language English
    Publishing date 2024-05-08
    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 10.1002/wjs.12200
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  2. Article ; Online: ASO Author Reflections: Indocyanine Green Fluorescence to Optimize Lymphadenectomy in Gastric Cancer Surgery: Recommendations to Improve Radicality in D2 Lymphadenectomy.

    Puccetti, Francesco / Cinelli, Lorenzo / Elmore, Ugo / Rosati, Riccardo

    Annals of surgical oncology

    2022  Volume 29, Issue 9, Page(s) 5883–5884

    MeSH term(s) Fluorescence ; Gastrectomy ; Humans ; Indocyanine Green ; Lymph Node Excision ; Stomach Neoplasms/surgery
    Chemical Substances Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2022-06-14
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-022-11986-3
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  3. Article ; Online: Application of ERAS protocols in esophagogastric emergency surgery: is it feasible and does it make sense?

    Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

    Updates in surgery

    2022  Volume 75, Issue 2, Page(s) 383–387

    Abstract: Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple ... ...

    Abstract Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple factors enhancing patients' recovery after surgery worldwide. A further optimization would lead to the extension of the ERAS program to upper GI emergencies. This review provides a comprehensive collection of scientific basis, current supporting evidence, and potential applicative limitations.
    MeSH term(s) Humans ; Perioperative Care/methods ; Esophagectomy/methods ; Length of Stay ; Postoperative Complications
    Language English
    Publishing date 2022-08-31
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-022-01362-x
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  4. Article ; Online: Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study.

    Vignali, Andrea / Gozzini, Lorenzo / Gasparini, Giulia / Calef, Riccardo / Rosati, Riccardo / Elmore, Ugo

    International journal of colorectal disease

    2023  Volume 38, Issue 1, Page(s) 211

    Abstract: Purpose: The aim of the present study is to assess the impact of Echelon Circular: Methods: A single center cohort study was carried out on 552 consecutive patients, who underwent laparoscopic colorectal resection and anastomosis to the rectum ... ...

    Abstract Purpose: The aim of the present study is to assess the impact of Echelon Circular
    Methods: A single center cohort study was carried out on 552 consecutive patients, who underwent laparoscopic colorectal resection and anastomosis to the rectum between December 2017 and September 2022. Patients who underwent powered circular anastomosis to the rectum were matched to those who had a conventional stapled anastomosis using a propensity score matching. Main outcomes were anastomotic leak (AL) rate, anastomotic bleeding, and postoperative outcomes.
    Results: After adjusting cases with propensity score matching, two new groups of patients were generated: 145 patients in the PCS and 145 in the CCS. The two groups were homogeneous with respect to demographics and comorbidities on admission. Overall, AL occurred in 21 (7.3%) patients. No significant differences were observed with respect to AL (5.5% in PCS vs 9% in CCS; p = 0.66), fistula severity (p = 0.60) or reoperation rate (p = 0.65) in the two groups in study. A higher rate of anastomotic bleeding was observed in the CCS vs PCS (5.5% vs 0.7%, p = 0.03). At univariate analysis performed after propensity score matching, stapler diameter ≥ 31mm and age ≥ 70 years were the only variable significantly associated with anastomotic leak (p = 0.001 and p = 0.031; respectively).
    Conclusions: The powered circular stapler has no impact on AL, while it could affect bleeding rate at the anastomotic site.
    MeSH term(s) Humans ; Aged ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Rectum/surgery ; Cohort Studies ; Propensity Score ; Surgical Staplers/adverse effects ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Retrospective Studies ; Colorectal Neoplasms/surgery ; Surgical Stapling/adverse effects ; Surgical Stapling/methods
    Language English
    Publishing date 2023-08-10
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-023-04506-6
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  5. Article ; Online: Surgical Training for Transanal Total Mesorectal Excision in a Live Animal Model: A Preliminary Experience.

    Grieco, Michele / Elmore, Ugo / Vignali, Andrea / Caristo, Maria Emiliana / Persiani, Roberto

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2022  Volume 32, Issue 8, Page(s) 866–870

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Animals ; Cadaver ; Female ; Humans ; Laparoscopy/methods ; Operative Time ; Postoperative Complications/surgery ; Proctectomy/methods ; Rectal Neoplasms/surgery ; Rectum/surgery ; Swine ; Transanal Endoscopic Surgery/methods
    Language English
    Publishing date 2022-02-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1381909-4
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2021.0845
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    Zs.A 3246: Show issues Location:
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  6. Article ; Online: Transanal total mesorectal excision (TaTME): current status and future perspectives.

    Vignali, Andrea / Elmore, Ugo / Milone, Marco / Rosati, Riccardo

    Updates in surgery

    2019  Volume 71, Issue 1, Page(s) 29–37

    Abstract: Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through ... ...

    Abstract Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing to help overcome the steep learning curve related to the technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates when compared with conventional open or laparoscopic TME. Favorable short-term oncologic results have been reported: in particular, TaTME is associated with mesorectal specimen of a better quality and a longer distal resection margin that is established at the beginning of the procedure under direct view. Robotics, when available, will probably overcome the steep learning curve related to the complexity of TaTME. Long-term follow-up and ongoing RCT trials data are awaited regarding functional results, local recurrence and survival, and to facilitate the comparison with standard laparoscopic or robotic rectal resections. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, its indications, short- and long-term results and future direction in the application of TaTME.
    MeSH term(s) Anal Canal/surgery ; Digestive System Surgical Procedures/methods ; Digestive System Surgical Procedures/standards ; Digestive System Surgical Procedures/trends ; Humans ; Laparoscopy ; Organ Sparing Treatments/methods ; Patient Selection ; Rectal Neoplasms/surgery ; Rectum/surgery ; Risk ; Robotic Surgical Procedures ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2019-02-08
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-019-00630-7
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  7. Article ; Online: Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center.

    Talavera-Urquijo, Eider / Parise, Paolo / Carresi, Agnese / Cossu, Andrea / Barbieri, Lavinia / Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

    Updates in surgery

    2022  Volume 75, Issue 2, Page(s) 435–449

    Abstract: A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF ... ...

    Abstract A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
    MeSH term(s) Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Retrospective Studies ; Tertiary Care Centers ; Esophageal Neoplasms/surgery ; Esophageal Fistula/etiology ; Esophageal Fistula/surgery ; Anastomosis, Surgical/adverse effects
    Language English
    Publishing date 2022-08-22
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-022-01364-9
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  8. Article ; Online: Applicative Limitations of Indocyanine Green Fluorescence Assistance to Laparoscopic Lymph Node Dissection in Total Gastrectomy for Cancer.

    Puccetti, Francesco / Cinelli, Lorenzo / Genova, Luana / Battaglia, Silvia / Barbieri, Lavinia A / Treppiedi, Elio / Cossu, Andrea / Elmore, Ugo / Rosati, Riccardo

    Annals of surgical oncology

    2022  Volume 29, Issue 9, Page(s) 5875–5882

    Abstract: Background: Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not ... ...

    Abstract Background: Indocyanine green (ICG) fluorescence has been recently introduced as a novel imaging technique improving the accuracy of lymph node (LN) dissection in gastric cancer (GC) surgery, although procedure standardization and achievements have not been clearly defined. This study analyzed the feasibility and effectiveness of ICG-guidance for laparoscopic D2-lymphadenectomy during total gastrectomy for cancer.
    Methods: This study retrospectively analyzed a single-center series of patients who underwent laparoscopic total gastrectomy for cancer between April 2015 and August 2021. All patients underwent surgery with standard D2 LN dissection. Intraoperative ICG-fluorescence was institutionally implemented in April 2018 and was performed routinely afterward. Primary outcomes were LN harvest and ratio. Secondary endpoints included operative time and subgroup analysis to assess variables potentially affecting LN retrieval.
    Results: The study population included 102 patients, and ICG-fluorescence was applied in 38 (37.3%). ICG and no-ICG groups presented similar median age, gender proportions, ASA score and comorbidities (age-adjusted Charlson Comorbidity Index), body mass index, and advanced pathological stage. The median of LNs retrieved was significantly higher after the intraoperative ICG-guidance (44 vs. 32; p = 0.004), although this association was not significant after neoadjuvant therapy or among patients with positive LNs. Lymph node ratio and operative time were not significantly impacted by ICG fluorescence. Multivariate analysis identified the ICG-assistance as the only independent determinant for LN harvest (p = 0.029).
    Conclusions: ICG-guidance contributes to a significantly wider LN retrieval after laparoscopic D2-lymphadenectomy during total gastrectomy for cancer. However, neoadjuvant therapy and positive LN stage appeared to limit the procedural effectiveness to ICG-assisted LN identification.
    MeSH term(s) Gastrectomy/methods ; Humans ; Indocyanine Green ; Laparoscopy/methods ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Retrospective Studies ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery
    Chemical Substances Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2022-06-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-022-11940-3
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    Zs.A 4042: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  9. Article ; Online: Correction to: SICE national survey: current state on the adoption of laparoscopic approach to the treatment of colorectal disease in Italy.

    Elmore, Ugo / Vignali, Andrea / Rosati, Riccardo / Valeri, Andrea / Silecchia, Gianfranco

    Updates in surgery

    2019  Volume 72, Issue 1, Page(s) 229

    Abstract: The surname and given name of author Riccardo Brachet Contul was incorrectly published. ...

    Abstract The surname and given name of author Riccardo Brachet Contul was incorrectly published.
    Language English
    Publishing date 2019-10-15
    Publishing country Italy
    Document type Journal Article ; Published Erratum
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-019-00685-6
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  10. Article ; Online: Human seminal plasma stimulates the migration of CD11c+ mononuclear phagocytes to the apical side of the colonic epithelium without altering the junctional complexes in an

    Baratella, Marco / Iannone, Valeria / Cavarelli, Mariangela / Foglieni, Chiara / Viganò, Paola / Moog, Christiane / Elmore, Ugo / Nozza, Silvia / Alfano, Massimo / Salonia, Andrea / Dispinseri, Stefania / Scarlatti, Gabriella

    Frontiers in immunology

    2023  Volume 14, Page(s) 1133886

    Abstract: Introduction: Human immunodeficiency virus type 1 (HIV) transmission mostly occurs through the genital and intestinal mucosae. Although HIV-1 transmission has been extensively investigated, gaps remain in understanding the initial steps of HIV entry ... ...

    Abstract Introduction: Human immunodeficiency virus type 1 (HIV) transmission mostly occurs through the genital and intestinal mucosae. Although HIV-1 transmission has been extensively investigated, gaps remain in understanding the initial steps of HIV entry through the colonic mucosa. We previously showed that HIV can selectively trigger mononuclear phagocytes (MNP) to migrate within colonic epithelial cells to sample virions. Mucosal exposure to human seminal plasma (HSP), rich in pro- and anti-inflammatory cytokines, chemokines and growth factors, may as well induce alterations of the colonic mucosa and recruit immune cells, hence, affecting pathogen sampling and transmission.
    Methods: Here, we studied the role of HSP on the paracellular intestinal permeability by analyzing the distribution of two proteins known to play a key role in controlling the intestinal barrier integrity, namely the tight junctions-associated junctional adhesion molecule (JAM-A) and the adherents junction associated protein E-cadherin (E-CAD), by immunofluorescence and confocal microscopy. Also, we evaluated if HSP promotes the recruitment of MNP cells, specifically, the CD11c and CD64 positive MNPs, to the apical side of the human colonic mucosa. At this scope, HSP of HIV-infected and uninfected individuals with known fertility status was tested for cytokines, chemokines and growth factors concentration and used in an
    Results: HSP showed statistically significant differences in cytokines and chemokines concentrations between the three groups of donors, i.e. HIV infected, or uninfected fertile or randomly identified. Nevertheless, we showed that in the
    Discussion: In conclusion, even if HSP did not perturb the integrity of the human colonic mucosa, it affected the migration of a specific subset of MNPs that express CD11c towards the apical side of the colonic mucosa, which in turn may be involved in pathogen sampling.
    MeSH term(s) Humans ; Cadherins/immunology ; Cytokines/immunology ; Epithelium/immunology ; HIV Infections/immunology ; HIV Infections/transmission ; HIV Infections/virology ; Junctional Adhesion Molecules ; Phagocytes/immunology ; Semen/immunology ; Monocytes/immunology ; CD11c Antigen/immunology ; Intestinal Mucosa/immunology ; Intestinal Mucosa/virology ; Colon/immunology ; Colon/virology ; HIV-1/immunology ; Cell Movement/immunology ; Virus Internalization ; Host-Pathogen Interactions/immunology
    Chemical Substances Cadherins ; Cytokines ; Junctional Adhesion Molecules ; CD11c Antigen ; F11R protein, human ; FCGR1A protein, human
    Language English
    Publishing date 2023-03-22
    Publishing country Switzerland
    Document type Clinical Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2606827-8
    ISSN 1664-3224 ; 1664-3224
    ISSN (online) 1664-3224
    ISSN 1664-3224
    DOI 10.3389/fimmu.2023.1133886
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