Clinical Safety and Feasibility of Minimally Invasive Colectomy Under Neuraxial Anesthesia in Frail Patients: Preliminary Case Series.

General anesthesia is the most widely used anesthesia technique for major abdominal surgery, but it may have a longer recovery time, high cost, and environmental impact. In addition, general anesthesia may be contraindicated in some frail patients. Our study aims to evaluate the feasibility and safety of performing colorectal surgery with a minimally invasive technique in frail patients under spinal anesthesia.

Radiomics Beyond Radiology: Literature Review on Prediction of Future Liver Remnant Volume and Function Before Hepatic Surgery.

Post-hepatectomy liver failure (PHLF) is the most worrisome complication after a major hepatectomy and is the leading cause of postoperative mortality. The most important predictor of PHLF is the future liver remnant (FLR), the volume of the liver that will remain after the hepatectomy, representing a major concern for hepatobiliary surgeons, radiologists, and patients. Therefore, an accurate preoperative assessment of the FLR and the prediction of PHLF are crucial to minimize risks and enhance patient outcomes.

Comparison of Laparoscopic and Robotic Lateral Lymph Node Dissection for Rectal Cancer: A Systematic Review and Meta-analysis of Short- and Long-term Outcomes.

Aim: The importance of lateral lymph node dissection (LLND) for advanced low rectal cancer is still questioned, but selected patients might benefit from this procedure. The purpose of this study was to compare robotic LLND (R-LLND) versus laparoscopic LLND (L-LLND) to identify the safety, feasibility, and advantages of R-LLND.

Methods: PubMed, Scopus, and Cochrane databases were searched for studies assessing the benefit of R-LLND over L-LLND.

Radiological Assessment After Pancreaticoduodenectomy for a Precision Approach to Managing Complications: A Narrative Review.

Radiological assessment following pancreaticoduodenectomy is critical for the prompt diagnosis and management of postoperative complications, significantly influencing patient outcomes. Pancreaticoduodenectomy, or the Whipple procedure, is the standard surgical intervention for pancreatic and periampullary malignancies, but it involves notable risks, especially from complications like fistulas, bleeding, or leakage. Cross-sectional imaging, particularly contrast-enhanced computed tomography, serves as the primary diagnostic tool due to its rapid acquisition, high resolution, and effective delineation of postoperative anatomy and complications.

Machine Learning for Predicting the Low Risk of Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Toward a Dynamic and Personalized Postoperative Management Strategy.

Background: Postoperative pancreatic fistula (POPF) remains one of the most relevant complications following pancreaticoduodenectomy (PD), significantly impacting short-term outcomes and delaying adjuvant therapies. Current predictive models offer limited accuracy, often failing to incorporate early postoperative data. This retrospective study aimed to develop and validate machine learning (ML) models to predict the absence and severity of POPF using clinical, surgical, and early postoperative variables.

A Comparison of Machine Learning-Based Models and a Simple Clinical Bedside Tool to Predict Morbidity and Mortality After Gastrointestinal Cancer Surgery in the Elderly.

Frailty in the elderly population is associated with increased vulnerability to stressors, including surgical interventions. This study compared machine learning (ML) models with a clinical bedside tool, the Gastrointestinal Surgery Frailty Index (GiS-FI), for predicting mortality and morbidity in elderly patients undergoing gastrointestinal cancer surgery. In a multicenter analysis of 937 patients aged ≥65 years, the performance of various predictive models including Random Forest (RF), Least Absolute Shrinkage and Selection Operator (LASSO), Stepwise Regression, K-Nearest Neighbors, Neural Network, and Support Vector Machine algorithms were evaluated.

Management of high-surgical-risk patients with acute cholecystitis following percutaneous cholecystostomy: results of an international Delphi consensus study.

Background: The management of high-surgical-risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high risk, alternative treatment options, such as percutaneous cholecystostomy (PC), are available.

Quadruple Assessment of Colorectal Anastomosis after Laparoscopic Rectal Resection: A Retrospective Analysis of a Propensity-Matched Cohort.

Anastomotic leakage (AL) is one of the most feared complications in colorectal surgery, with an incidence of 12-39% and associated risk of mortality of 2-24%. The causes of AL and the ways to prevent it are currently under investigation. This study aims to verify if a quadruple assessment of colorectal anastomosis could reduce AL incidence.

A Green Lantern for the Surgeon: A Review on the Use of Indocyanine Green (ICG) in Minimally Invasive Surgery.

Indocyanine green (ICG) fluorescence imaging has revolutionized surgical practice across various medical and surgical specialties. This article reviews the clinical applications of ICG in abdominal, urological, thoracic, and gynecological surgery. ICG fluorescence imaging has been widely adopted in general surgery for various applications, including perfusion assessment, intraoperative visualization of the ureter, and tumor localization.

Evaluation of Short-Term Effects on Colorectal Surgery Elective Patients after Implementing a Patient Blood Management Program: A Multicenter Retrospective Analysis.

: Patients who undergo surgery may require a blood transfusion and patients undergoing major colorectal surgery are more prone to preoperative and perioperative anemia. Blood transfusions have, however, long been associated with inflammatory and oncological complications. We aim to investigate the effects of an optimal implementation of a patient blood management (PBM) program in our hospital.

Radiomics in Oesogastric Cancer: Staging and Prediction of Preoperative Treatment Response: A Narrative Review and the Results of Personal Experience.

Background: Oesophageal, gastroesophageal, and gastric malignancies are often diagnosed at locally advanced stage and multimodal therapy is recommended to increase the chances of survival. However, given the significant variation in treatment response, there is a clear imperative to refine patient stratification. The aim of this narrative review was to explore the existing evidence and the potential of radiomics to improve staging and prediction of treatment response of oesogastric cancers.

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches.

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity. Despite recent advances in medical IBD therapy, colectomy rates for ASUC remain high. A scoping review of published articles on ASUC was performed.

Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial.

Background: Protective stoma after rectal surgery has been associated with important complications. The most common is surgical site infection (SSI) high rates after stoma reversal reported in literature. Our study compared the rate of SSI of two skin closure techniques, linear closure, and purse string closure.

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture.

Peptic ulcers result from imbalanced acid production, and in recent decades, proton pump inhibitors have proven effective in treating them. However, perforated peptic ulcers (PPU) continue to occur with a persistent high mortality rate when not managed properly. The advantages of the laparoscopic approach have been widely acknowledged.

Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy.

Introduction: Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy.

Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines.

Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds.

Application of fluorescence-guided surgery in the acute care setting: a systematic literature review.

Purpose: Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in emergency setting. The present review critically summarizes currently available applications and limitations of indocyanine green (ICG) fluorescence in abdominal emergencies including acute cholecystitis, mesenteric ischemia, and trauma surgery.

Methods: A systematic review was performed according to the PRISMA statement identifying articles about the use of ICG fluorescence in the management of the most common general surgery emergency.

Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis.

Background: This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC).

Material And Methods: A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases.

Results: Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs.

The unrestricted global effort to complete the COOL trial.

Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed.

Good stability and mid-term subjective outcomes after repeated anterior cruciate ligament (ACL) revision surgery using allografts.

Purpose: To evaluate the mid-term clinical outcomes of a cohort of patients who underwent multiple ACL revision reconstructions. The hypothesis was that patients with pre-existing meniscal deficiency conditions, malalignment and cartilage degeneration would have obtained lower results.

Methods: All cases of multiple ACL revisions performed with allograft tissue at one single sport-medicine institution were extracted and patients with a minimum 2 years of follow-up were included.