Roberto Cirocchi

Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta‐analysis of short‐term outcome

Aim  The study aimed to compare robotic rectal resection with laparoscopic rectal resection for cancer. Robotic surgery has been used successfully in many branches of surgery but there is little evidence in the literature on its use in rectal cancer.

Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy

Single‐incision laparoscopic cholecystectomy (SILC) may offer advantages over conventional laparoscopic cholecystectomy (LC).

Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials

BACKGROUND The evidence regarding the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) has been mostly based on the data derived from nonrandomized studies. The objective of this study was to evaluate the outcomes of LSG and to present an up-to-date review of the available evidence based on the recent publications of new randomized, controlled trials (RCTs). METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched until November 2012 for RCTs on LSG. RESULTS Fifteen RCTs, comprising a total of 1191 patients, of whom 795 had undergone LSG, were included. No patient required conversion to open surgery for LSG, laparoscopic gastric bypass (LGB), or laparoscopic adjustable gastric banding (LAGB) procedures. There were no deaths, and the complication rate was 12.1% (range 10%-13.2%) in the LSG group versus 20.9% (range 10%-26.4%) in the LGB group, and 0% in the LAGB group (only 1 RCT). The complications included leakage, bleeding, stricture, and reoperation that occurred with rates of .9%, 3.3%, 0%, and 2.1%, respectively, in the LSG group and rates of 0%, 5%, 0%, and 4%, respectively, in the LGB group. The average operating time in the LSG group was 106.5 minutes versus 132.3 minutes in the LGB group. The percentage of excess weight loss (%EWL) ranged from 49% to 81% in the LSG group, from 62.1% to 94.4% in the LGB group, and from 28.7% to 48% in the LAGB group, with a follow-up ranging from 6 months to 3 years. The type 2 diabetes mellitus (T2DM) remission rate ranged from 26.5% to 75% in the LSG group and from 42% to 93% in the LGB group. CONCLUSIONS LSG is a well-tolerated, feasible procedure with a relatively short operating time. Its effectiveness in terms of weight loss is confirmed for short-term follow-up (≤ 3 years). The role of LSG in the treatment of T2DM requires further investigation.

Laparoscopic vs open resection for rectal cancer: a meta‐analysis of randomized clinical trials

Aim  Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short‐term morbidity and mortality, late morbidity and long‐term oncological outcomes.

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

High tie versus low tie of the inferior mesenteric artery in colorectal cancer: A RCT is needed

Nowadays left colon and rectal cancer treatment has been well standardized in both open and laparoscopy. Nevertheless, the level of the ligation of the inferior mesenteric artery (IMA), at the origin from the aorta (high tie) or below the origin of the left colic artery (low tie), is still debated. The objective of the systematic review is to evaluate the current scientific evidence of high versus low tie of the IMA in colorectal cancer surgery. The outcomes considered were overall 30-days postoperative morbidity, overall 30-days postoperative mortality, anastomotic leakage, 5-years survival rate, and overall recurrence rate. A total of 8.666 patients were included in our analysis, 4.281 forming the group undergoing high tie versus 4.385 patients undergoing low tie. Neither the high tie nor the low tie strategy showed an evidence based success, as no statistically significant differences were identified for all outcomes measured. Future high powered and well designed randomized clinical trials are needed to draw definitive conclusion on this dilemma.

Treatment of Hinchey stage III–IV diverticulitis: a systematic review and meta-analysis

BackgroundThis manuscript is a review of different surgical techniques to manage perforated colon diverticulitis.ObjectiveThis study was conducted to compare the benefits and disadvantages of different surgical treatments for Hinchey III or IV type of colon diverticulitis.MethodsA systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, and the Science Citation Index (1990 and 2011). A total of 1,809 publications were identified and 14 studies with 1,041 patients were included in the study. Any surgical treatment was considered in this review. Mortality was considered the primary outcome, whereas hospital stay and reoperation rate were considered secondary outcomes.ResultsPrimary resection with anastomosis has a significant advantage in terms of lower mortality rate with respect to Hartmann’s procedure (P = 0.02). The postoperative length of hospitalization was significantly shorter in the resection with anastomosis group (P < 0.001). Different findings have emerged from studies of patients with the primary resection with anastomosis vs laparoscopic peritoneal lavage and subsequent resection: overall surgical morbidity and hospital stay were lower in the laparoscopic peritoneal lavage group compared to the primary resection and anastomosis group (P < 0.001).ConclusionsDespite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a metanalytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.

A systematic review on robotic pancreaticoduodenectomy

BACKGROUND Robotic surgery might have several advantages in respect of the laparoscopic approach since might make more feasible the execution of a complex procedure such as pancreaticoduodenectomy (PD). The aim of the present systematic review is to evaluate the current state of the literature on robotic PD. METHODS A systematic literature search was performed, from January 1st 2003 to July 31st 2012, for studies which reported PDs performed for neoplasm and in which at least one surgical reconstructive or resective step was robotically performed. RESULTS Thirteen studies, representing 207 patients, met the inclusion criteria. The definition of the robotic approach was heterogeneous since the technique was defined as robotic, robotic-assisted, robot-assisted laparoscopic and robotic hybrid. Resection and reconstruction steps of robotic PD were also heterogeneous combining sequentially different approaches: totally robotic technique, laparoscopic-robotic resection and robotic reconstruction, laparoscopic resection and robotic reconstruction, hand port-assisted laparoscopic resection and robotic reconstruction, laparoscopic-robotic resection and reconstruction through mini-laparotomy. As regard the type of PD 66% were classic Whipple operations and 34% pylorus-preserving pancreatoduodenectomies. The management of pancreatic stump was a pancreaticogastrostomy in 23%, end-to-side pancreaticojejunostomy in 67%, and fibrin glue occlusion of the main pancreatic duct in 10% of cases. The overall procedure failure (rates of conversion to open surgery) was 14%. The overall morbidity rate was 58% and the reoperation rate was 7.3%. CONCLUSIONS There have been an increasing number of recent case series suggesting increased utilization of robotic PD over the past decade. The technical approach is heterogenous. For highly selected patient, robotic PD is feasible with similar morbidity and mortality compared to open or purely laparoscopic approaches. Data on cost analysis are lacking and further studies are needed to evaluate also the cost-effectiveness of the robotic approach for PD in comparison to open or laparoscopic techniques. The current state of the art analysis on robotic DP can be also useful in planning future trials.

Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review

Aim  A meta‐analysis of nonrandomized studies and one randomized trial was conducted to compare laparoscopic surgery with open surgery in the elective treatment of patients with diverticular disease.

Is laparoscopic right colectomy more effective than open resection? A meta‐analysis of randomized and nonrandomized studies

Aim  The aim of this systematic review was to compare laparoscopic and/or laparoscopic‐assisted right colectomy (LRC) with open right colectomy (ORC). Many randomized clinical trial have shown that laparoscopic colectomy benefits patients with improved short‐term outcomes and comparable overall survival in respect to the open approach. These results, however, could not be applied to right colectomy owing to its wide range of resection and more complicated vascular regional anatomy.