Giuseppe Giuliani

Promptness of diagnosis is the main prognostic factor after colonoscopic perforation.

Aim  The authors present their experience of colonoscopic perforation and its management, with an analysis of factors affecting outcome.

Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence

The aim was to assess the effects of percutaneous tibial nerve stimulation (PTNS) in the treatment of faecal incontinence (FI) by means of an RCT.

Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery

BackgroundPostoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery.MethodsPubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3.ResultsA total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13).ConclusionsAlthough minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.

Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice

SummaryBackgroundSeveral surgeries are available to treat pilonidal disease.MethodsWe analysed the relative effects of conventional excision with primary midline closure compared with the cleft lift procedure on the clinical outcomes of recent published reports.ResultsA total of 14 studies containing 2089 patients were included in the analysis. At pooled analysis of available data, the cleft lift procedure showed significantly lower rate of recurrence, shorter time to complete wound healing and faster return to daily activities.ConclusionsThe quality of available inherent evidence is not sufficient to draw definitive conclusions. Although the clinical heterogeneity among studies represents a valid concern, the quantitative synthesis of the recent literature seems to support the use of the cleft lift over conventional excision with primary midline closure.

Repair of transperineal recto-urethral fistula using a fibrin sealant haemostatic patch.

Recto‐urethral fistula (RUF) is a rare complication of radical prostatectomy. We report a transperineal approach using a fibrin sealant haemostatic patch.

Robotic-Assisted Abdominoperineal Resection

In 1908, Sir Ernest Miles reported his first attempt to develop a radical operation for rectal cancer, publishing his experience with abdominoperineal resection (APR).

Minimally invasive versus open pancreatic enucleation. Systematic review and meta-analysis of surgical outcomes

Parenchymal sparing procedures are gaining interest in pancreatic surgery and recent studies have reported that minimally invasive pancreatic enucleation may be associated with enhanced outcomes when compared with traditional surgery. By meta‐analyzing the available data from the literature, minimally invasive surgery is not at higher risk of pancreatic fistula and offers a number of advantages over conventional surgery for pancreatic enucleation.

A Meta-Analysis of Randomized Controlled Trials on the Use of Suction Drains Following Rectal Surgery

Background: Anastomotic leakage is one of the most feared complications of rectal resections. The role of drains in limiting this occurrence or facilitating its early recognition is still poorly defined. We aimed to study whether the presence of prophylactic pelvic drains affects the surgical outcomes of patients undergoing rectal surgery with extraperitoneal anastomosis. Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials comparing drained with undrained anastomoses following rectal surgery. We evaluated possible differences on the relative incidences of anastomotic leakage, pelvic collection or sepsis, bowel obstruction, reoperation rate, and overall mortality. A meta-analysis of relevant studies was performed with RevMan 5.3. Results: A total of 760 patients from 4 randomized controlled studies were considered eligible for data extraction. The use of drains did not show any advantage in terms of anastomotic leak (OR 0.99), pelvic complications (OR 0.87), reintervention (OR 0.84) and mortality. Contrariwise, the incidence of postoperative bowel obstruction was significantly higher in the drained group (OR 1.61). Conclusions: The routine utilization of pelvic drains does not confer any significant advantage in the prevention of postoperative complications after rectal surgery with extraperitoneal anastomosis. Moreover, a higher risk of postoperative bowel obstruction can be of concern.

Pelvic Organ Prolapse (POP) Working Group (SICCR): Doubts and Evidence for a Practical Guide

Pelvic Organ Prolapse (POP) can be defined as a downward descent of female pelvic organs, including the bladder, uterus, post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vaginal walls, uterus, or both. The International Continence Society includes also rectal prolapses. POP development is multifactorial.

Clinical outcomes of ERCP-related retroperitoneal perforations

Endoscopic retrograde cholangiopancreatography (ERCP)-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medically treated ERCP-related retroperitoneal perforations. From MEDLINE/PubMed databases 137 patients with retroperitoneal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty-four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbidity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require surgery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.