Background and Objectives: The use of oncoplastic techniques has spread widely in the last decade, with an expansion of the indications and demonstration of excellent oncological safety profiles. A ...potential downside may be the increased complication rates, which could influence the timing of adjuvant therapy. To date, there is increasing evidence that negative pressure therapy on closed wounds can reduce complication rates after surgery. From this perspective, we tested the use of portable negative pressure wound dressings (NPWDs) in oncoplastic surgery to minimize early post-operative admissions to the outpatient clinic and prevent surgical complications. Materials and Methods: An observational prospective cohort study was conducted on a population of patients who underwent quadrantectomy and wise-pattern reduction mammoplasty for breast cancer. The primary objective of the study is represented by the evaluation of the impact of NPWD on post-operative outcomes in an oncoplastic surgery setting. Patients enrolled between January 2021 and January 2023 were divided into two groups, the conventional dressing (CD) group and the NPWD group, by a simple randomization list. Results: A total of 100 patients were enrolled, with 52 in the CD group and 48 in the NPWD group. The use of NPWD significantly reduced the wound dehiscence rate (2.0% vs. 7.7% p = 0.002) and the number of one-month postoperative admissions to our clinic (3.8 ± 1.1 vs. 5.7 ± 1.3 p = 0.0009). Although not significant, it is possible to note a trend of reduction of clinically relevant postoperative total complications in patients treated with NPWDs. Conclusions: NPWDs may represent a useful tool in the post-surgical management of complex oncoplastic procedures, ensuring less wound dehiscence. Furthermore, the use of these dressings led to a significant reduction in admissions to the clinic, promoting a lower use of resources by hospitals and effective prevention of possible complications.
Abstract Background Acute appendicitis is the most common surgical diagnosis in young patients, with lifetime prevalence of about 7%. Debate remains on whether uncomplicated AA should be operated or ...not. Aim of this meta-analysis of randomized controlled trials was to assess current evidence on antibiotic treatment for uncomplicated AA compared to standard surgical treatment. Methods Systematic literature search was performed using PubMed, EMBASE, Medline, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated AA. Trials were reviewed for primary outcome measures: treatment efficacy based on 1 year follow-up, recurrence at 1 year follow-up, complicated appendicitis with peritonitis identified at the time of surgical operation and post-intervention complications. Secondary outcomes were length of hospital stay and period of sick leave. Results Five RCTs comparing AT and ST qualified for inclusion in meta-analysis, with 1.351 patients included: 632 in AT group and 719 in ST group. Higher rate of treatment efficacy based on 1 year follow-up was found in ST group (98.3% vs 75.9%, P < 0.0001), recurrence at 1 year was reported in 22.5% of patients treated with antibiotics. Rate of complicated appendicitis with peritonitis identified at time of surgical operation was higher in AT group (19.9% vs 8.5%, P = 0.02). No statistically significant differences were found when comparing AT and ST groups for the outcomes of overall post-intervention complications (4.3% vs 10.9%, P = 0.32), post-intervention complications based on the number of patients who underwent appendectomy (15.8% vs 10.9%, P = 0.35), length of hospital stay (3.24 ± 0.40 vs 2.88 ± 0.39, P = 0.13) and period of sick leave (8.91 ± 1.28 vs 10.27 ± 0.24, P = 0.06). Conclusions With significantly higher efficacy and low complication rates, appendectomy remains the most effective treatment for patients with uncomplicated AA. The subgroups of patients with uncomplicated AA where antibiotics can be more effective, should be accurately identified.
Introduction
Nipple-sparing mastectomy (NSM) is a surgical procedure increasingly performed for breast cancer or risk reduction surgeries. The site of skin incision seems to affect not only cosmesis ...but also technical ease in operating and vascular viability of the nipple. We present a series of patients who underwent a modified vertical surgical approach for NSM, which resulted to be safe, reliable, and with good esthetic results.
Materials and Methods
From December 2016 to February 2019, 27 “Hook Shape” incision NSMs were performed. All patients underwent an immediate subcutaneous muscle-sparing reconstruction with tissue expander covered by a titanium-coated polypropylene mesh, followed by a second surgical step with expander substitution and lipofilling on the definitive implant when indicated. Preoperative and postoperative BREAST-Q patient-reported outcomes measure was performed in all cases.
Results
Postoperative morbidity was evaluated: One patient developed seroma and another presented a systemic infection that resolved with intravenous infusion of antibiotics. One patient experienced vertical wound dehiscence, recovered after conservative treatment and without implant exposure. No implant loss was observed. Nipple–areola complex necrosis or ischemia rate was 0%. The BREAST-Q outcomes reported significant increases in the overall satisfaction with breast (
p
< 0.05), psychosocial well-being (
p
< 0.05), and sexual well-being (
p
< 0.05) sections. Scores in the physical impact of surgery section appeared to decline from preoperative to postoperative evaluations, with no statistically significant results.
Conclusion
The mastectomy incision pattern can burden the surgical challenge, impact vascular viability of the nipple and significantly affect the aesthetic outcomes in breast reconstruction. We report our experience with an alternative approach for NSM, which appears a safe, practical, and reproducible method for patients with small- to medium-sized breasts and little/medium ptosis (grade I or II).
Level of evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
Background
Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on ...the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity.
Methods
Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher’s exact test, and data were considered significant when
p
< 0.05.
Results
Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically,
p
= 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %;
p
= 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26–75 % of cases (14.0 vs. 29.7 %;
p
= 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %;
p
= 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice.
Conclusions
The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.
Background
Prepectoral implant-based breast reconstruction has gained popularity in the last years, thanks to the development of accurate and tissue-sparing mastectomies together with the ...introduction of implant-covering devices as synthetic meshes and acellular dermal matrixes. Along with its diffusion, legitimate doubts on prepectoral reconstruction’s feasibility and oncological safety started raising. To date, there are no available data concerning oncologic outcomes following mastectomy and prepectoral breast reconstruction.
Methods
Electronic search in PubMed, Cochrane Library, and Web of Sciences databases was performed with no language restrictions. First articles’ identification was obtained through title and abstract descriptions and by full text visualization subsequently. Inclusion criterion was the report of outcomes assessment for oncological safety; thus cancer recurrence and incidence of systemic metastasis were recorded. Retrieved citations were screened by two reviewers, and inconsistencies were resolved by a third reviewer.
Results
Nine articles met the inclusion criteria and were included in the current review. Four studies presented control groups with submuscular reconstructions, and no statistical differences in terms of local or systemic recurrences were evidenced.
Conclusions
Taking into account the scarce number of articles at disposal, oncological safety of prepectoral breast reconstruction appears equal to the submuscular procedure. Further studies are needed to validate these data.
Level of evidence: Not gradable.
ACOI Surgical Site Infections Management Academy (ACOISSIMA) Sartelli, Massimo; Cortese, Francesco; Scatizzi, Marco ...
Il Giornale di Chirurgia - Journal of the Italian Association of Hospital Surgeons,
08/2022, Letnik:
42, Številka:
2
Journal Article
Recenzirano
Background:
Surgical site infections (SSIs) are the most common cause of healthcare-associated infections in surgical patients. Many SSIs may be preventable if simple measures are respected. Despite ...evidence supporting the effectiveness of evidence-based practices in Infection Prevention and Control, many surgeons fail to implement them.
Methods:
To clarify the key issues in the prevention of SSIs, an expert panel designated by the board of directors of Associazione Chirurghi Ospedalieri Italiani—Italian Surgical Association (ACOI) convened in Rome, Italy, on 16 December 2021, for a consensus conference.
Results:
The expert panel approved 11 evidence-based statements regarding the prevention of SSIs. A article was drafted and reviewed by the expert panel, finally obtaining this document that represents the executive summary of the consensus.
Conclusions:
The document aims to disseminate best practices among Italian surgeons and summarizes the ACOI recommendations for the prevention of SSIs.
Patient blood management (PBM) is defined as the timely application of evidence-based medical and surgical concepts designed to maintain a surgical patient’s hemoglobin concentration, optimize ...hemostasis, and minimize blood loss in an effort to improve the outcomes. PBM is able to reduce mortality up to 68%, reoperation up to 43%, readmission up to 43%, composite morbidity up to 41%, infection rate up to 80%, average length of stay by 16%–33%, transfusion from 10% to 95%, and costs from 10% to 84% after major surgery. It should be noticed, however, that the process of PBM implementation is still in its infancy, and that its potential to improve perioperative outcomes could be strictly linked to the degree of adherence/compliance to the whole program, with decoupling and noncompliance being significant factors for failure. Therefore, the steering committees of four major Italian scientific societies, representing general surgeons, anesthesiologists and transfusion medicine specialists (Associazione Chirurghi Ospedalieri Italiani; Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva; Società Italiana di Emaferesi e Manipolazione Cellulare; Società Italiana di Medicina Trasfusionale e Immunoematologia), organized a joint modified Delphi consensus conference on PBM in the field of major digestive surgery (upper and lower gastrointestinal tract, and hepato-biliopancreatic resections), whose results and recommendations are herein presented.
Purpose
Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the ...conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan.
Methods
All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures.
Trial registration
Clinicaltrials.gov
ID: NCT03080103
Introduction: Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people ...undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinico-pathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of "Sapienza" University of Rome, Italy.
Methods and analysis: The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system will be used to categorize complications. Secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and the predictive value for morbidity and mortality of several frailty and surgical risk scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02825082).
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