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Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula
No full textDear Author, I read with interest the letter by Deepak Batura about our paper entitled Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula. I thank the colleague for his accurate comments. I take this opportunity to clarify the following points: 1.All 7 patients reported in the original article underwent double diversion at least 2 months before the author's procedure. In this situation, no enteric preparation is necessary with a surgical field clean and ideal to use a mesh in a potential infected site. The biological mesh has a great capacity to progressively integrate itself; 2.All 7 patients we described underwent extensive clinical investigations during serial follow-up visits that excluded urethral stricture, signs of infections or urethral sequelae. That's way the patients did not undergo extra exams (endoscopic or bacteriological) once the stoma was closed; I hope this additional information will help to clarify up your querie
Three-Dimensional vs Two-Dimensional Minimally Invasive Surgery. A comparison of the visual work load and surgical outcomes
Full text linkBACKGROUND
Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been introduced to enhance depth perception and facilitate operations. The clear benefit of the 3D laparoscopy has never been tested. Some concerns emerged regarding the possible negative effects over the visual system in those surgeons who performed 3D surgery every day. 3D laparoscopy has been validated both in “in-vitro” and “in-vivo” (clinical) settings. All survey done in laparoscopic simulator comparing surgical exercise (suturing, peg transfer, cutting) performed with 2D or 3D system reported better results in
the second group, regardless the surgeon experience. Less data is disposable in the clinical setting, but with same conclusions. The use of 3D technology needs passive or active polarized glasses. Optometric tests, objective exams (RMN or EEG) and subjective questionnaires have been widely used to evaluate the alterations in the visual system utilizing the 3D technology. Each test concluded that 3D technology causes alteration in the EEG waves, but how long these alterations last is still unknown.
AIM
The aim of this study was to evaluate the possible benefit of using the 3D technology in terms of surgical outcomes (study 1) and to evaluate the alterations over the visual system operating in 3D laparoscopy (study 2).
MATERIALS AND METHODS
The study was a single-center prospective observational clinical trial, divided in two sub-study with a single patients-population. Participants included patients aged 18 years old and above, eligible for colorectal resections for neoplastic or inflammatory diseases. Four experienced surgeons in colorectal and laparoscopic surgery participated in the study. Each surgeon followed the standard laparoscopic
surgical rules performing the different type of colorectal resection, regardless the study subgroup. Data were collected at the pre-operative clinic, during surgery, during the hospitalizations and at the short term follow-up (30th days). For each study, there was a primary endpoint:
1. Primary endpoint for Study 1: incidence of Clavien grade 3, 4 and 5 postsurgical complications in patients undergone 3D colorectal resection;
2. Primary endpoint for Study 2: to grade the visual work load of surgeons operating with 3D screens and glasses.
At the end of each procedure (2D or 3D) the first surgeon had to fill in two different subjective questionnaire (the NASA task load index questionnaire and the Simulator Sickness questionnaire) to grade the visual sickness felt during the operation.
RESULTS
From January 2015 to September 2017, 313 patients were enrolled in the study: 82 in the 2D group, 231 in the 3D group.
STUDY 1: Colorectal cancer was the main indication for surgery (n 235, 75.1%), followed by colonic diverticulosis, benign polyposis and inflammatory bowel diseases (IBD), respectively 43 (13.8 %), 25 (7.9 %) and 10 (3.2 %). Age, sex, ASA score were comparable between the two groups. The median operative time showed no statistically significant difference between the 3D and 2D groups (p 0.611). Less drains were positioned at the end of the 3D operations comparing with 2D procedures (p 0.013). The stapled anastomosis was the most frequent performed over other techniques. The other intra-operative findings showed no significant difference between the two study groups. The median hospitalization and the reoperation rate showed no difference between the two groups.
STUDY 2: The statistical analysis done over all 313 cases divided in 2D and 3D did not reveled significant difference of the visual work scored by the NASA TLX. Data emerging from the SSQ questionnaire reveled no case of moderate or severe symptoms in both groups.
CONCLUSIONS
3D laparoscopic surgery had the same postoperative results of the 2D standard laparoscopy. The more frequent intra-abdominal anastomosis in the 3D group might suggest a more safeness felt by the surgeon using the new technology. The NASA TLX and the SSQ questionnaire did not reveled significant difference of the visual work between 2D and 3D vision
Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO
No full textBACKGROUND: Patient and disease-related factors, as well as operation technique all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. AIM: To investigate the effect of pre- and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. METHOD: International prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. This study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien-Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, re-operation, surgical site infection and length of stay at hospital. Multivariable binary logistic regression analyses were used to produce odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Three hundred and seventy five resections in 375 patients were included. The median age was 37 and 57.1% were female. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36 95% CI 1.10-4.97)], urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13-3.55) and unplanned intraoperative adverse events (OR 2.30, 95% CI 1.20-4.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, CI [1.08-1.61]) and those who had urgent/expedited operations (OR 1.21, CI [1.07-1.37]). CONCLUSION: Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intraoperative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients. This article is protected by copyright. All rights reserved
Comparative evaluation of surgeon visual work load of 3d vs 2d colorectal resections
No full textOBIETTIVI Molti studi hanno evidenziato il beneficio della chirurgia laparoscopica 3D di ultima generazione rispetto ai sistemi ottici 2D. I reali effetti sul nostro sistema visivo nell'utilizzo di occhiali 3D non sono ancora stati valutati. Lo scopo principale di questo studio è stato quello di valutato lo stress visivo a cui il chirurgo viene sottoposto durante le procedure laparoscopiche in 3D. Obiettivo secondario è stato quello di valutare i risultati nell'impiego della tecnologia 3D HD comparando i risultati chirurgici del 2D vs il 3D nelle resezioni laparoscopiche colo-rettali per tumori del crosso intestino. MATERIALI E METODI Da Gennaio 2016 a Marzo 2017, 137 pazienti sono stati sottoposti a resezione colo-rettali per patologia neoplastica, di cui 64 mediante l' impiego di tecnologia 3d (gruppo 3d) e 71 mediante tecnologia 2d (gruppo 2d). Tra questi due gruppi sono stati confrontati dati intra-operatori e dati post-operatori. Al termine di ogni procedura chirurgica il primo operatore è stato invitato a rispondere a due questionari soggettivi per valutare il carico di lavoro visivo: il NASA task load questionnaire e il Simulator Sickness questionnaire (SSI). RISULATATI Tutte gli interventi sono stati completati mediante tecnica laparoscopica senza richiedere conversione in laparotomia. L'incidenza di procedure chirurgiche più complesse come resezioni sec. Miles, colectomie totale e resezioni anteriore di retto è stata maggiore nel gruppo 3D. La durata dell'intervento è stata significativamente più lunga nel gruppo 3D ( 177 ± 7 3D vs 157± 6 2D, P=0.03) mentre l' incidenza di complicanze post-operatorie è stata significativamente superiore nel gruppo 2D (26% 3D vs 9% 3D, P<0.01). Non sono emerse differenze significative tra i due gruppi per quanto riguarda il questionario SSI (vertigini, lacrimazione, nausea), mentre dal questionario NASA, lo sforzo mentale, fisico e visivo percepito dal chirurgo con la tecnologia 3D è superiore rispetto al 2D (p<0,001). CONCLUSIONI La laparoscopia associata alla tecnologia 3D risulta avere un'incidenza di complicanze postoperatorie inferiori rispetto ai vecchi sistemi 2D nell'eseguire interventi chirurgici complessi. Nonostante i disturbi determinati dalla visione 3D quali nausea lacrimazione e mal di testa risultino sovrapponibili alla laparoscopia 2d, lo sforzo visivo, mentale e fisico percepito dal chirurgo risulta superiore durante procedure 3D rispetto alla 2D
The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit
No full textAnastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable
Correction: Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey
No full textIn this article some authors name were missing from the CRISAL collaborative group. These authors are list. • Ugo Boggi • Riccardo Casadei • Massimiliano Fabozzi • Mario Guerrieri • Gabriele Materazzi • Gianluigi Moretto • Micaela Piccoli • Paolo Prosperi • Chiara Dobrinja The original article has been corrected
Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula
No full textPurpose: To report the author's experience on a miniinvasive technique using bioprosthetic plug and a rectal wall flap advancement in the treatment of recurrent rectourethral fistula. Materials and methods: Between 2013 and 2015, seven patients with recurrent recto-urethral fistula were referred to the Pederzoli Hospital, Peschiera del Garda, Verona,Italy. Intraoperatively all patients were found to have a rectal wall lesion and were treated with urinary and fecal diversion. For the persistence of the fistula, all the patients underwent a mini-invasive treatment consisting on placement of a bioprosthetic plug in the fistula covered by an endorectal advancement flap through a trans-anal and transurethral combined technique. Results: Median operative time was 48 min with a median blood loss of 30 ml. Median hospital stay was 3 days (IQR 1-3). No case of fistula recurrence or plug migration was described. None of the patients experienced fecal or urinary incontinence. All patients obtained complete fistula healing. Conclusions: Recurrent recto-urethral fistula is a challenging postsurgical complication for surgeons and urologists
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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