Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Standardizing Elective Surgery in Diverticular Disease.
Mari G, Sassun R, De Carli SM … +10 more , Miranda A, Gerosa M, Di Fratta E, Santonocito M, Roufael F, Gianino M, Vignati B, Lasagna C, Maggioni D, AIMS Academy Research Network
Ann Ital Chir · 2025 Aug · PMID 41099121 · Publisher ↗
AIM: Diverticular disease (DD) is one of the most common benign gastrointestinal conditions in the Western world, with a range of clinical manifestations from uncomplicated symptoms to acute complications requiring surge...
AIM: Diverticular disease (DD) is one of the most common benign gastrointestinal conditions in the Western world, with a range of clinical manifestations from uncomplicated symptoms to acute complications requiring surgery. Elective sigmoidectomy is indicated in cases of Complicated Diverticular Disease (CDD) after recovery, Symptomatic Uncomplicated Diverticular Disease (SUDD), and Recurrent Diverticulitis (RD). This study aims to assess the short- and long-term outcomes of a standardized surgical approach for DD. METHODS: A retrospective analysis was conducted on 442 patients who underwent elective sigmoidectomy or left hemicolectomy for DD disease between January 2012 and March 2020. Different DD scenarios were included: 128 patients with SUDD (29%), 170 with RD (38.5%), 144 with CDD (34.0%). All patients had nearly 5 years of follow-up. Preoperative evaluations included computed tomography (CT) scans and colonoscopy. Surgical procedures followed a standardized protocol, including medial to lateral approach, inferior mesenteric artery preservation, distal resection at the level of the upper rectum with a 60 mm blue Endo Gia cartridge, an end-to-end Knight-Griffen anastomosis with a 29 mm circular stapler and Indocyanine Green (ICG) testing. Demographic data, type of DD, surgical technique, and postoperative outcomes were recorded. The primary outcome measures included intraoperative details, complication rates, recurrence rates, and quality of life (GastroIntestinal Quality of Life Index [GIQLI] scores) at 1 and 5 years post-surgery. RESULTS: The cohort included 240 males and 202 females with a median age of 50 years. The surgical procedure was standardized across all patients. The mean operative time was 121 ± 28 minutes, with a conversion rate of 5.2% and an overall complication rate of 16.1%. Major complications, including anastomotic leaks, were observed in 4.9% of patients. The mean hospital stay was 4 days. Diverticulitis recurrence occurred in 5.2% of patients, more frequently in those with a disease duration of more than 5 years (p = 0.028). Cox regression analysis revealed that the duration of DD greater than 5 years was the only significant risk factor for diverticulitis recurrence (Hazard Ratio [HR] 2.42, 95% CI 1.12 to 4.62, p = 0.028). GIQLI scores significantly improved 1 year after surgery (92.7 ± 9.5 vs 97.8 ± 8.5, p < 0.001) and continued to improve at 5 years (92.7 ± 9.5 vs 118.1 ± 10.6, p < 0.001). CONCLUSIONS: Elective sigmoidectomy for DD, using a standardized laparoscopic technique, is safe and effective, with low complication rates and significant long-term improvement in quality of life. The recurrence rate of diverticulitis is low, and surgery provides lasting relief, especially for patients with recurrent or complicated forms of the disease. Standardization appears essential to optimize safety and efficacy in DD management.
Survey of Physicians' Approach to Dyspepsia Management: Is Surgeons' Perspective Different?
Kayılıoğlu I, Şahin S, Akmeşe EB … +3 more , Dere Ö, Yazkan C, Özcan Ö
Ann Ital Chir · 2025 Sep · PMID 41099120 · Publisher ↗
AIM: This study aims to evaluate physicians' approaches to dyspepsia management, with a focus on the use of gastroscopy and Helicobacter pylori testing. METHODS: This cross-sectional survey study was conducted among phys...
AIM: This study aims to evaluate physicians' approaches to dyspepsia management, with a focus on the use of gastroscopy and Helicobacter pylori testing. METHODS: This cross-sectional survey study was conducted among physicians from different specialties, including general practitioners, internal medicine specialists, and surgeons. The questionnaire assessed approaches to diagnosing, management strategies, and adherence to clinical guidelines. RESULTS: A survey of 262 physicians revealed that 22.9% of them recommended gastroscopy for all dyspeptic patients, with the proportion increasing with patient age. The study also found that Helicobacter pylori testing was conducted in only 16.4% of new dyspeptic cases, suggesting a potential gap in clinical practice guidelines. Furthermore, general surgery specialists were found to be less likely to adhere to clinical guidelines, favoring a broader use of gastroscopy. The survey also revealed that most physicians (67.6%) prescribed proton pump inhibitors as an initial treatment, with varying treatment durations. CONCLUSIONS: This study highlights significant variability in dyspepsia management among physicians, which may stem from the lack of regional guidelines and insufficient postgraduate education. While surgeons' more frequent use of endoscopy reflects a heightened focus on diagnostic accuracy, it may inadvertently contribute to appointment system congestion, delaying gastric cancer diagnosis. Implementing region-specific guidelines alongside comprehensive postgraduate training presents a promising strategy for enhancing system efficiency.
First Case of Internal Hernia After Revision of Biliopancreatic Diversion (Ceriani Procedure): A Case Report.
Panzera G
Ann Ital Chir · 2025 Sep · PMID 41099119 · Publisher ↗
AIM: To document the first known case of internal hernia following the Ceriani Procedure (CP) and evaluate its clinical and surgical management. CASE PRESENTATION: A 57-year-old female with a history of biliopancreatic d...
AIM: To document the first known case of internal hernia following the Ceriani Procedure (CP) and evaluate its clinical and surgical management. CASE PRESENTATION: A 57-year-old female with a history of biliopancreatic diversion (BPD) underwent CP for inadequate weight loss. She presented one year later with acute abdominal pain and fever. Diagnostic imaging and laparoscopy confirmed an internal hernia. Treatment involved lysis of adhesions, hernia reduction, and closure of mesenteric defects. The patient had an uneventful recovery and remained symptom-free during follow-up. RESULTS: The patient presented with acute abdominal pain and fever one year after undergoing the CP. Laboratory tests revealed elevated white blood cell count (11,780/mm) and lactate levels (3.6 mmol/L), with normal inflammatory markers. CT imaging showed signs of small bowel obstruction and a swirl sign consistent with internal hernia. Emergency laparoscopy confirmed herniation through an inframesenteric defect. The procedure was converted to open laparotomy for safe hernia reduction and mesenteric defect closure. The patient recovered without complications and was discharged on postoperative day three. At follow-up, she remained symptom-free. CONCLUSIONS: Internal hernia is a potential complication after CP, similar to Roux-en-Y reconstructions. Prompt diagnosis and surgical intervention are critical to avoiding severe complications like bowel infarction.
Digital Therapeutic Intervention for Venous Thromboembolism Prevention: Efficacy Evaluation of Telemonitored Ankle Pump System in Tibial Plateau Fracture Patients.
Ge Y, Xu L, Ye J … +4 more , Qu H, Fu H, Ru X, Huang X
Ann Ital Chir · 2025 Sep · PMID 41099118 · Publisher ↗
AIM: Deep vein thrombosis (DVT) is acknowledged as the primary complication associated with tibial plateau fractures (TPFs), necessitating the implementation of preventive measures such as physical exercise. While ankle...
AIM: Deep vein thrombosis (DVT) is acknowledged as the primary complication associated with tibial plateau fractures (TPFs), necessitating the implementation of preventive measures such as physical exercise. While ankle pump exercise (APE) is an effective preventive measure, challenges such as insufficient monitoring and a shortage of nursing staff have been identified. Therefore, our study aimed to evaluate the efficacy of the self-developed telemonitored APE compared to conventional APE. METHODS: The study was conducted in a randomized parallel-group design (Consolidated Standards of Reporting Trials (CONSORT)-compliant). We randomized 60 participants with TPFs into two groups for traditional APE (Group A) and telemonitored APE (Group B) separately. The study population was recruited from Zhejiang Hospital between December 2022 and June 2024. Evaluate the efficacy by four indices: diameter and flow velocity of the femoral vein and popliteal vein in the lower extremity, the increased value of postoperative calf diameter, visual analogue scale (VAS), and D-dimer. RESULTS: Following both telemonitored and traditional APE, statistically significant differences (p < 0.05) were detected between the two groups in at least one assessment period. Group B showed significantly lower VAS than Group A on postoperative day 7 (p = 0.001) and day 14 (p < 0.001). Group B had a lower D-dimer level on postoperative day 7 (p = 0.004). Group B showed a smaller calf diameter increment on day 7, p = 0.001). Group B had a significantly higher popliteal vein flow velocity after APE (p < 0.001). CONCLUSIONS: The remote monitoring ankle pump system is more effective than traditional methods in reducing postoperative pain, improving venous hemodynamics, and reducing thrombotic risk indicators, demonstrating its significant clinical value in the prevention and rehabilitation of lower extremity deep vein thrombosis in patients with tibial plateau fractures. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200065384).
Using Artificial Intelligence to Enable Safer Laparoscopic Cholecystectomy: A Step Toward a Standardized Critical View of Safety and Reduced Bile Duct Injuries.
Quarto G, Benassai G, Fernicola A
Ann Ital Chir · 2025 Sep · PMID 41099117 · Publisher ↗
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Transthoracic Echocardiographic Diagnosis of a Case of Aortopulmonary Window Combined With Pulmonary Artery Sling.
Huang Z, Tian C, Yu H
Ann Ital Chir · 2025 Oct · PMID 41099116 · Publisher ↗
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Biomechanical Assessment in Calcaneal Fracture Management: Methods, Clinical Applications, and Future Directions.
Tang G, Zhou J, Wang K … +2 more , Sun J, Wu H
Ann Ital Chir · 2025 Oct · PMID 41099115 · Publisher ↗
This review explores the biomechanical evaluation of calcaneal fractures, utilizing techniques such as computed tomography (CT) imaging and finite element analysis to assess fracture stability, alignment, and load distri...
This review explores the biomechanical evaluation of calcaneal fractures, utilizing techniques such as computed tomography (CT) imaging and finite element analysis to assess fracture stability, alignment, and load distribution. These evaluations are essential for enhancing treatment approaches and improving patient outcomes. The review underscores the significance of quantitative metrics in linking biomechanical parameters with clinical outcomes, thereby facilitating personalized treatment planning. Future research advancements are anticipated to focus on integrating high-throughput biomechanical approaches, multimodal datasets, and artificial intelligence to enhance the precision of fracture evaluations and develop tailored interventions that foster better recovery and overall quality of life for patients with calcaneal fractures.
New Updates in Diagnostic Imaging and Treatment of Rectal Cancer.
Danti G, Santini D, Treballi F … +5 more , Anichini M, Giannessi C, Piccolo CL, Trinci M, Miele V
Ann Ital Chir · 2025 Oct · PMID 41099114 · Publisher ↗
Colorectal cancer (CRC) is the third most common tumour in men and the second most common in women. It ranks as the third leading cause of new cancer cases and cancer-related deaths in both sexes. Due to differences in e...
Colorectal cancer (CRC) is the third most common tumour in men and the second most common in women. It ranks as the third leading cause of new cancer cases and cancer-related deaths in both sexes. Due to differences in embryonic origin, rectal cancer (RC) is considered a distinct entity from colon cancer in terms of staging and treatment. Mortality rates in more developed countries are decreasing, largely due to increased screening and advances in the staging and treatment of rectal cancer. Current screening methods include faecal occult blood testing (FOBT) and rectosigmoidoscopy. For staging, the most commonly used imaging modalities are abdominopelvic magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) for locoregional evaluation, and computed tomography (CT), MRI, or positron emission tomography (PET) for detecting distant metastases. Traditionally, the standard treatment for rectal cancer has been total mesorectal excision. However, more recently, it has been observed that patients with non-advanced stages of the disease may benefit from neoadjuvant radiochemotherapy, which can allow for less invasive surgery at a later stage. In recent years, radiomic studies have emerged to identify predictive features of tumour progression, with the goal of personalising treatment according to each patient's characteristics.
Effect of Comprehensive Warming Measures on Reducing Limb Pain During Recovery From Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Study.
Zheng B, He H, Yan H … +1 more , Wu L
Ann Ital Chir · 2025 Oct · PMID 41099113 · Publisher ↗
AIM: This study aimed to explore the effect of comprehensive warming measures on reducing limb pain in patients undergoing laparoscopic cholecystectomy during recovery from anaesthesia. METHODS: The medical records of 13...
AIM: This study aimed to explore the effect of comprehensive warming measures on reducing limb pain in patients undergoing laparoscopic cholecystectomy during recovery from anaesthesia. METHODS: The medical records of 131 patients who underwent laparoscopic cholecystectomy in our hospital from June 2021 to June 2023 were retrospectively analyzed. According to the perioperative interventions administered, the samples were divided into a warming group (n = 62, in which comprehensive warming measures were applied, including preoperative forced-air warming, intraoperative use of warmed fluids and gases, and postoperative continuous warming) and a routine group (n = 69, in which routine management measures without active warming were applied, limited to maintenance of ambient room temperature, the use of standard draping and unheated fluids/gases). The Steward recovery score was used to evaluate the quality of anaesthesia recovery, and postoperative limb pain was assessed using the Visual Analogue Scale (VAS). Surgical indicators were also compared between the two groups. RESULTS: Baseline data, as well as operation time and blood loss, were not significantly different between the two groups (all p > 0.05). Infusion volume and length of hospital stay were significantly different between the two groups (p < 0.001). In terms of the quality of anaesthesia recovery, level of consciousness, level of airway patency, and limb movement in the warming group were significantly higher than those in the routine group (p < 0.05). The postoperative VAS score in the warming group was significantly lower than that in the routine group (p < 0.001). Incidence of complications was not significantly different between the two groups (p = 0.308). CONCLUSIONS: Comprehensive warming measures improved limb pain and recovery quality in patients undergoing laparoscopic cholecystectomy, highlighting their clinical value.
Comparative Analysis of Multi-Biomarker Diagnostic Models for Early Detection of Hepatocellular Carcinoma and Their Potential Implications for Surgical Decision-Making.
Zhang X, Wang T, Xu X … +4 more , Gao G, Cheng M, Lai X, Mao D
Ann Ital Chir · 2025 Oct · PMID 41099112 · Publisher ↗
AIM: Hepatocellular carcinoma (HCC) remains a significant global health concern, often diagnosed at advanced stages, limiting the efficacy of surgical interventions. Early and accurate diagnosis is critical for improving...
AIM: Hepatocellular carcinoma (HCC) remains a significant global health concern, often diagnosed at advanced stages, limiting the efficacy of surgical interventions. Early and accurate diagnosis is critical for improving surgical outcomes and reducing mortality. Traditional biomarkers, such as alpha-fetoprotein (AFP), des-gamma-carboxyprothrombin (DCP), and the lectin-bound fraction of AFP (AFP-L3), show limited sensitivity and specificity. Advanced diagnostic models, including GALAD, TAGALAD, and GAP_TALAD, offer a promising multi-biomarker approach but lack extensive evaluation in surgical contexts. METHODS: This retrospective study included a cohort of 267 untreated hepatocellular carcinoma patients and 231 control patients (with hepatitis or cirrhosis). We applied the predefined formulas for the TAGALAD, GAP_TALAD, and other models to the cohort data. The diagnostic performance of each model and individual biomarker for detecting HCC was assessed using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC), sensitivity, and specificity at optimal cut-offs. Additionally, key clinical subgroups, including pathologically confirmed HCC, clinically diagnosed HCC, early-stage HCC (TNM I+II), patients with complete data (no imputation), and hepatitis B virus (HBV)-related disease, were also analyzed. RESULTS: TAGALAD and GAP_TALAD demonstrated superior performance compared to the GALAD model and traditional biomarkers across all patient subgroups. Notably, TAGALAD achieved the highest diagnostic accuracy, with an AUC of 0.880, sensitivity of 0.760, and specificity of 0.861, followed closely by GAP_TALAD (AUC = 0.874). Both models demonstrated excellent performance in early-stage HCC detection (TAGALAD AUC = 0.860, GAP_TALAD AUC = 0.867), highlighting their potential in identifying candidates for surgical resection or transplant at an early curative stage. In HBV-related HCC, TAGALAD (AUC = 0.874) and GAP_TALAD (AUC = 0.857) showed superior diagnostic accuracy compared to GALAD (AUC = 0.731) and single biomarkers (AUC = 0.598-0.799). CONCLUSIONS: The TAGALAD and GAP_TALAD models offer a robust and reliable framework that supports early diagnosis of HCC. Their superior accuracy indicates a more reliable foundation for identifying candidates for curative surgical interventions, suggesting the potential to refine patient selection. Future research should focus on multi-center validation and the integration of novel biomarkers to further optimize these models for surgical decision-making and personalized treatment strategies.
Development of an Integrated Nomogram for Predicting Postoperative Deep Vein Thrombosis Risk in Trauma Patients: Combining Thrombosis Risk Assessment Profile Score and Thrombosis Biomarkers.
Jin X, Lin Y, Jin F … +1 more , Zhu Y
Ann Ital Chir · 2025 Oct · PMID 41099111 · Publisher ↗
AIM: This study aims to evaluate the effectiveness of combining the risk assessment profile for thromboembolism (RAPT) score with thrombotic biomarkers in predicting postoperative deep vein thrombosis (DVT) in patients w...
AIM: This study aims to evaluate the effectiveness of combining the risk assessment profile for thromboembolism (RAPT) score with thrombotic biomarkers in predicting postoperative deep vein thrombosis (DVT) in patients with traumatic fractures and to create a nomogram model for risk assessment. METHODS: This retrospective cohort study recruited 329 traumatic fracture patients from Shouxiang Community Health Service Center of Yinhu Street between September 2021 and September 2024. Patient data were randomly assigned to a training set (n = 230, 70%) and a test set (n = 99, 30%) for model development and validation. In the training set, patients were stratified based on DVT state into a DVT group (n = 110) and a non-DVT group (n = 120). The RAPT score and thrombotic biomarker levels were compared between the two groups. Multivariate logistic regression analysis was conducted to identify independent risk factors for postoperative DVT. Based on these factors, a nomogram model was developed, and its diagnostic performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and clinical decision curve analysis. RESULTS: The DVT group exhibited significantly higher levels of RAPT score (7.00 [5.00, 9.00] vs. 4.00 [2.00, 7.00]), D-dimer (D-D) (874.12 ± 77.16 vs. 841.37 ± 86.94), fibrinogen (FIB; 4.00 [3.90, 4.30] vs. 4.00 [3.70, 4.20]), and thrombin-antithrombin complex (TAT; 16.60 [14.43, 18.38] vs. 15.40 [14.10, 16.90]) relative to non-DVT group (p < 0.05). Multivariate logistic regression analysis identified the RAPT score, D-D, FIB, and TAT as independent risk factors for postoperative DVT, with odds ratios (ORs) of 1.209, 1.006, 3.625, and 1.246, respectively (p < 0.05). Using these factors, a nomogram model was constructed. In both the training and test sets, the fitting degree of this nomogram model was good. ROC curve analysis revealed that the area under the curve (AUC) of 0.7714 (0.7107-0.832) and 0.7066 (0.603-0.8103) for predicting the occurrence of lower extremity DVT in the training set and the test set, respectively. The calibration curve demonstrated excellent agreement between the predicted probabilities and the observed outcomes. Decision curve analysis (DCA) demonstrated that the nomogram yielded a higher net benefit than the "treat all" or "treat none" strategies across a threshold probability range of 0.055-0.755 in the training set and 0.095-0.805 in the testing set. CONCLUSIONS: The integration of the RAPT score with thrombotic biomarkers (D-D, FIB, and TAT) offers a feasible and effective approach for predicting postoperative DVT in patients with traumatic fractures, guiding targeted prophylactic strategies and enhancing perioperative management and patient outcomes.
Clinical Efficacy and Risk Factors for Complications of Unilateral Biportal Endoscopy Treatment in Complex Spinal Stenosis: A Retrospective Study.
Niu Y, Chang H, Xu J
Ann Ital Chir · 2025 Oct · PMID 41099110 · Publisher ↗
AIM: This study aimed to evaluate the clinical efficacy of unilateral biportal endoscopy (UBE) technology in patients with complex spinal stenosis and to identify factors associated with postoperative complications to op...
AIM: This study aimed to evaluate the clinical efficacy of unilateral biportal endoscopy (UBE) technology in patients with complex spinal stenosis and to identify factors associated with postoperative complications to optimize individualized treatment strategies. METHODS: This single-center retrospective study included 146 patients with complex spinal stenosis, characterized by multi-segmental involvement and/or ligamentum flavum calcification, who underwent UBE between May 2020 and March 2023. Eligible patients had complete clinical and imaging data and a minimum follow-up of 6 months. Surgical variables (operative time, intraoperative blood loss, and length of hospital stay), perioperative information, and early mobilization protocols were collected. Primary outcomes included pain intensity (visual analog scale (VAS)), functional disability (Oswestry Disability Index (ODI)), and neurological recovery (Japanese Orthopaedic Association (JOA)). Secondary outcomes involved complication rates, recurrence, and patient satisfaction. Pre- and postoperative differences were assessed using paired t-tests, and multivariate logistic regression was performed to identify independent risk factors for postoperative complications. RESULTS: UBE significantly improved clinical symptoms, with VAS scores decreasing from 7.5 ± 0.9 preoperatively to 2.5 ± 0.8 postoperatively (p < 0.001), ODI scores decreasing from 55.8 ± 8.3% to 19.6 ± 6.4% (p < 0.001), and JOA scores increasing from 8.7 ± 1.9 to 19.8 ± 3.1 (p < 0.001). Imaging evaluations showed a significant increase in spinal canal area (p < 0.001). The overall complication rate was 19.9% (29 cases), with ligamentum flavum calcification identified as an independent risk factor (odds ratio (OR) = 3.414, 95% confidence interval (CI): 1.383-8.432, p = 0.008). The satisfaction score of 88.4% of patients is ≥4 points. CONCLUSIONS: UBE technology effectively improves clinical symptoms and imaging outcomes for managing complex spinal stenosis, with low complication and recurrence rates. However, the presence of ligamentum flavum calcification is a critical risk factor for complications, highlighting the need for tailored preoperative planning to optimize surgical outcomes and reduce risks.
Effects of Sugammadex Versus Neostigmine on Postoperative Oxygenation and Pulmonary Complications in Elderly Patients Undergoing Lower Abdominal Surgery.
Cheng Q, Song L, Huang L … +3 more , Yu G, Fang X, Xu C
Ann Ital Chir · 2025 Oct · PMID 41099109 · Publisher ↗
AIM: Neostigmine is a competitive inhibitor of acetylcholinesterase commonly used in neuromuscular blockade (NMB). Sugammadex is a new drug for rapid and reliable reversal of NMB. This study evaluated the effects of suga...
AIM: Neostigmine is a competitive inhibitor of acetylcholinesterase commonly used in neuromuscular blockade (NMB). Sugammadex is a new drug for rapid and reliable reversal of NMB. This study evaluated the effects of sugammadex versus neostigmine on postoperative oxygenation and pulmonary in elderly patients undergoing lower abdominal surgery. METHODS: A retrospective analysis of 279 patients who underwent lower abdominal surgery in the Quzhou Affiliated Hospital of Wenzhou Medical University from July 2023 to February 2025 was performed. Patients were divided into two groups based on the NMB reversal agents used: the sugammadex group (129 patients) and neostigmine+atropine group (150 patients). The safety and effectiveness of sugammadex in patients undergoing lower abdominal surgery were evaluated in terms of postoperative saturation of peripheral oxygen/fraction of inspired oxygen (SpO/FiO) ratio, extubation time, post-anesthetic care unit (PACU) stay time, and length of postoperative hospital stay using independent sample t-test, Mann-Whitney U test and χ test. RESULTS: There was no significant difference in baseline characteristics between the neostigmine+atropine group and the sugammadex group (p > 0.05). Compared with the neostigmine+atropine, sugammadex could reverse deep NMB more quickly. The incidence of residual NMB at 10 min (sugammadex: 6.98%, 9/129; neostigmine+atropine: 52.00%, 78/150) and 20 min (sugammadex: 0%, 0/129; neostigmine+atropine: 16.00%, 24/150) was significantly lower in the sugammadex group compared to the neostigmine+atropine group (p < 0.05) post-operatively. Sugammadex also significantly improved postoperative oxygenation of patients, reduced the time to achieve Train-of-Four ratio (TOFr) ≥0.9, shortened the extubation time (p < 0.05), decreased the duration of PACU stay (p < 0.05), and lowered the incidence of postoperative pulmonary complications (p < 0.05), but has no effect on the length of postoperative hospital stay (p > 0.05). CONCLUSIONS: By effectively reversing NMB, sugammadex significantly relieves the symptoms of muscle relaxation, accelerates the recovery of respiratory function, shortens the time of TOFr ≥0.9, extubation time, PACU duration, and reduces pulmonary complications in elderly patients undergoing lower abdominal surgery.
Analytical Assessment of Perioperative Complications in Neurosurgical Procedures Performed in the Sitting Position.
Zhang K, Gu X, Xiang Y … +1 more , Zhao G
Ann Ital Chir · 2025 Oct · PMID 41099108 · Publisher ↗
AIM: This study aimed to investigate the incidence and risk factors of perioperative complications in two types of neurosurgical procedures performed in the sitting position: deep brain stimulation (DBS) electrode placem...
AIM: This study aimed to investigate the incidence and risk factors of perioperative complications in two types of neurosurgical procedures performed in the sitting position: deep brain stimulation (DBS) electrode placement and suboccipital craniotomy/craniectomy, with a focus on comparing their outcomes. METHODS: This retrospective analysis included 259 patients who underwent sitting-position neurosurgery (DBS electrode placement, n = 104; suboccipital craniotomy/craniectomy, n = 155) between January 2019 and June 2024. Complications, including venous air embolism (VAE), tension pneumocephalus, and hemorrhage, were analyzed separately for each group. Multivariate logistic regression and subgroup analyses were performed to identify independent risk factors specific to each procedure. RESULTS: The overall complication rate was higher in suboccipital craniotomy/craniectomy (14.19%) than in DBS (5.77%). For DBS, diabetes (odds ratio (OR) = 6.000, p = 0.039) was identified as a key risk factor. For suboccipital craniotomy/craniectomy, independent risk factors included age ≥60 years (OR = 2.152, p = 0.006), diabetes (OR = 3.412, p = 0.020), heart disease (OR = 3.262, p = 0.048), American Society of Anesthesiologists (ASA) grade III (OR = 2.346, p = 0.007), and prolonged operative time (OR = 1.983, p = 0.015). CONCLUSIONS: Neurosurgery in the sitting position demonstrates varying complication risks depending on surgical type and patient-specific factors. Strict perioperative monitoring and individualized positioning strategies are essential, particularly for elderly patients and those with comorbidities. These findings provide valuable insights for optimizing surgical safety and guiding future prospective studies.
Esophagojejunal Anastomosis After Totally Laparoscopic Total Gastrectomy: π-shaped Versus Reverse Puncture Device Anastomosis.
Le Z, Zhang Z, Zhou T … +1 more , Liu M
Ann Ital Chir · 2025 Oct · PMID 41099107 · Publisher ↗
AIM: This study aimed to compare the advantages of π-shaped anastomosis with reverse puncture device (RPD) anastomosis following totally laparoscopic total gastrectomy (TLTG). METHODS: Clinical data from 133 patients wit...
AIM: This study aimed to compare the advantages of π-shaped anastomosis with reverse puncture device (RPD) anastomosis following totally laparoscopic total gastrectomy (TLTG). METHODS: Clinical data from 133 patients with gastric cancer who underwent TLTG between 1 January 2020 and 1 January 2024, in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Bengbu Medical University were retrospectively analyzed. Patients were categorized into a π-shaped group (67 patients) and an RPD group (66 patients) according to the esophagojejunal anastomosis method. The median follow-up duration was 6 months (95% CI: 5.2-6.8 months). Baseline characteristics, postoperative conditions, and postoperative complications were compared and analyzed between the two groups. RESULTS: There were no significant differences between the groups in intraoperative bleeding volume, total lymph node dissection number, first flatus time, hospitalization time, or the incidence of postoperative non-anastomotic complications (all p > 0.05). Compared with the RPD group, the π-shaped group demonstrated shorter anastomosis time, smaller main incision length, and a lower incidence of anastomotic complications (all p < 0.05). Conversely, the RPD group has a significantly longer esophageal resection margin compared to the π-shaped anastomosis group (p < 0.05). CONCLUSIONS: Both RPD and π-shaped anastomosis are safe and effective for esophagojejunal reconstruction after TLTG. The π-shaped anastomosis is recommended as the preferred anastomosis for totally laparoscopic total gastrectomy, and the RPD anastomosis can be applied to gastroesophageal junction cancer with a higher tumor location.
Lipoma With Inverted Meckel's Diverticulum Causing Intestinal Intussusception and Anemia: Report of a Case.
D'Amata G, Musmeci L, Florio G … +6 more , Caporilli D, Di Filippo AR, Demoro M, Antonellis F, Palmieri I, Mastrogiulio MG
Ann Ital Chir · 2025 Jul · PMID 40955198 · Publisher ↗
Meckel's diverticulum (M.D.) is the most frequent congenital anomaly of the gastrointestinal tract. Inverted Meckel's diverticulum is a rare clinical condition, and intussusception caused by M.D. inversion is even more u...
Meckel's diverticulum (M.D.) is the most frequent congenital anomaly of the gastrointestinal tract. Inverted Meckel's diverticulum is a rare clinical condition, and intussusception caused by M.D. inversion is even more uncommon. We present a case report of an inverted Meckel's diverticulum with associated lipoma as a cause of unexplained anemia and acute intestinal obstruction in a young man, and a brief literature review. The patient presented to the emergency room with acute abdomen. A computed tomography (CT) scan revealed ileo-ileal intussusception with a suspected intraluminal lipoma. Surgical resection of the intussuscepted ileal segment was performed, with an uneventful postoperative course. Histopathology showed an inverted Meckel's diverticulum with a lipoma associated. Inversion of a Meckel Diverticulum with an associated lipoma causing intussusception is extremely uncommon, and emergency abdominal surgeon could face it in differential diagnosis and treatment of acute abdomen. Surgical resection with primary anastomosis is the treatment of choice of this rare finding, with a high percentage of good results.
Global Research Trends and Disparities in Cesarean Section-Related Placenta Accreta Spectrum Disorders: A 93-Year Bibliometric Analysis.
Huang Q, Xu Y, Li H … +1 more , Zhang T
Ann Ital Chir · 2025 Jul · PMID 40955197 · Publisher ↗
AIM: Placenta accreta spectrum disorders (PASD) complicate 1 in 2500 deliveries globally, with incidence rising parallel to a 31% increase in cesarean section (CS) rates over three decades. This bibliometric analysis map...
AIM: Placenta accreta spectrum disorders (PASD) complicate 1 in 2500 deliveries globally, with incidence rising parallel to a 31% increase in cesarean section (CS) rates over three decades. This bibliometric analysis maps 93 years (1933-2025) of CS-PASD research to identify collaboration gaps and prioritize solutions focused on equity. METHODS: Articles concerning CS and PASD from 1933 to early 2025 were retrieved from the Web of Science Core Collection. A bibliometric analysis was conducted using VOSviewer, CiteSpace, and R- Bibliometrix to evaluate co-authorship networks, institutional collaborations, and keyword co-occurrence patterns. RESULTS: A total of 758 articles were identified, with an average annual growth rate of 2.64%. Contributions came from 57 countries/regions and involved 3814 authors, with the USA and UK leading in citations. Notable institutions included Sichuan University and University of California System. Key journals included the American Journal of Obstetrics and Gynecology and Obstetrics & Gynecology. Key contributors included Takahashi Hironori (9 articles) and Liu Xinghui (highest collaboration frequency, Total Link Strength (TLS) = 24), with emerging networks centered on Chinese and European institutions. Key keywords included "placenta accreta spectrum", "prior cesarean section", "ultrasound diagnosis", and "Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) guidelines", reflecting major research themes in PASD management. Trends highlighted advancements in diagnostic standardization, such as artificial intelligence (AI)-enhanced placental magnetic resonance imaging (MRI), multidisciplinary care models, and AI-driven risk stratification. Additionally, disparities in global resource allocation underscored the need for equitable healthcare interventions. CONCLUSIONS: Research on CS-PASD has evolved into a multidisciplinary issue, facilitated by advancements in imaging technologies and collaborative efforts. Future investigations should prioritize the integration of AI diagnostics, the development of cost-effective preventive strategies, and the establishment of standardized protocols to enhance maternal safety and mitigate healthcare inequities.
Evaluation of SYNTAX 2 Score and Visceral Adiposity Index in Patients Undergoing Isolated On-Pump Coronary Artery Bypass Grafting.
Duman B, Özsin KK, Engin M … +3 more , Sanrı US, Toktaş F, Yavuz Ş
Ann Ital Chir · 2025 Aug · PMID 40955196 · Publisher ↗
AIM: We aim to investigate the relationship between the synergy between percutaneous coronary intervention and cardiac surgery (SYNTAX) scoring system created with coronary angiographic and clinical parameters and the Vi...
AIM: We aim to investigate the relationship between the synergy between percutaneous coronary intervention and cardiac surgery (SYNTAX) scoring system created with coronary angiographic and clinical parameters and the Visceral Adiposity Index (VAI), which includes anthropometric parameters and blood lipid values and is to evaluate their predictive power complications after coronary artery bypass grafting (CABG). METHODS: This prospective observational clinical study was conducted between 15 August 2023 to 1 December 2023. A total of 173 patients who underwent isolated CABG were included. SYNTAX 2 scores, VAI results, and complications occurring in the postoperative period were recorded. All patients were divided into two separate groups, low and high, according to the median value of the SYNTAX 2 score and VAI. Postoperative complications were compared between groups, and correlation and predictive analyses were performed. RESULTS: Intra-Aortic balloon pump (IABP) use and low cardiac output were more frequent in the group with a high SYNTAX 2 score. However, this difference was significant for IABP use but not for low cardiac output (LCO) (p = 0.011 and p = 0.109). A positive correlation was observed between VAI and intensive care unit stay and postoperative respiratory complications (p = 0.018 and p = 0.035). There was no statistically significant correlation between SYNTAX 2 score and VAI value (p = 0.540). In Receiver Operating Characteristic (ROC) analysis, it was determined that VAI could predict respiratory complications and SYNTAX 2 score could predict IABP requirement [area under the curve (AUC): 0.639, 95% CI: 0.531-0.746, p = 0.036 and, AUC: 0.799, 95% CI: 0.678-0.920, p = 0.001]. CONCLUSIONS: In our study, no correlation was found between SYNTAX 2 score and VAI. However, we found that high VAI can predict postoperative respiratory complications and that a high SYNTAX 2 score is associated with postoperative IABP requirement. These parameters can be taken into account in risk assessments.
Greening the Operating Room: A Narrative Review of Global Frameworks for Sustainable Surgical Practice.
Mastronardi M, Fracon S, Ahuja M … +3 more , Ngo VQJ, Westwood E, Yiasemidou M
Ann Ital Chir · 2025 Aug · PMID 40955195 · Publisher ↗
AIM: Climate change is a major global health threat, and healthcare contributes 4-5% of global greenhouse gas emissions. Operating rooms (ORs) are particularly resource-intensive, producing high levels of waste and emiss...
AIM: Climate change is a major global health threat, and healthcare contributes 4-5% of global greenhouse gas emissions. Operating rooms (ORs) are particularly resource-intensive, producing high levels of waste and emissions. Sustainable surgical practices are essential to reduce the environmental impact of healthcare. This review aims to summarise and compare key international initiatives that promote sustainability in the OR. METHODS: A narrative review was conducted between January and March 2025. Resources were identified through searches of PubMed, Google Scholar, and professional society websites. Inclusion criteria included publication or endorsement by recognised academic or professional bodies, availability in English, and provision of practical guidance on surgical sustainability. No formal quality assessment was performed due to the heterogeneity of sources. RESULTS: Four major frameworks were identified: the Intercollegiate Green Theatre Checklist, which offers actionable perioperative recommendations including reusable equipment, waste reduction, and energy savings; the European Association for Endoscopic Surgery (EAES)/the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Taskforce, which focuses on leadership, education, and international collaboration; the Harvard Climate in Obstetrics, Anaesthesia and Surgery Team (COAST) Group, which promotes equity-focused, low-cost, and scalable solutions suitable for varied healthcare settings; the World Federation of Societies of Anaesthesiologists (WFSA) Global Consensus, which outlines sustainable anaesthetic practices and education. These frameworks align with the "5R" model-Reduce, Reuse, Recycle, Rethink, and Research-and highlight the OR as a key area for intervention. CONCLUSIONS: Despite implementation barriers, these frameworks provide practical, scalable strategies for surgical teams to reduce emissions. Embedding sustainability in surgical practice is critical for achieving healthcare decarbonisation and improving planetary health.
The Value of the Donated Body: Why Cadaveric Training Remains Irreplaceable in Surgical Education.
Diaz R, Fregatti P, Mantica G
Ann Ital Chir · 2025 Sep · PMID 40955194 · Publisher ↗
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