Background: Scientific events generate substantial educational content that remains largely confined to attendees, while formal congress proceedings have progressively disappeared. Modern artificial intelligence (AI) tools offer the technical possibility of converting recorded events into structured written knowledge, but their reliability depends on expert clinical supervision. We describe a clinician-led AI workflow designed to bridge this gap. Methods: We applied a four-stage tool-agnostic workflow to the diverticulitis module of the ACOI Bergamo 2026 Congress: (1) integral audio recording and slide collection; (2) parallel transcription with two independent AI systems and reconciliation; (3) AI-assisted structuring into a narrative article with human verification against the original audio; (4) AI-assisted reference retrieval and source verification. A clinician supervised every stage. Results: The workflow produced a structured clinical chapter in approximately three working days. The principal AI failure mode was the generation of speaker conclusions not actually stated in the recorded session—a phenomenon we provisionally refer to as “hallucinated synthesis”—corrected through audio relistening. The principal efficiency gains were AI-assisted reference retrieval and voice-based interaction with the model. Conclusions: The workflow appears reproducible by individual clinicians without dedicated technical staff. The critical component is the clinician supervisor, whose role shifts from primary writer to verifier and editor. By lowering the cost of converting scientific events into written outputs, this method may expand access to content currently confined to attendees.
Primary ovarian leiomyosarcomas are extremely rare tumors that comprise less than 0.1% of all ovarian malignancies. Their origin, etiology, histologic features, clinical behavior, and optimal treatment are still obscure. Malignant behavior is almost always associated with any two of coagulative necrosis, cellular atypia, and mitotic index greater than 10. Immunohistochemically, ovarian leiomyosarcomas are characterized by the expression of alpha-SMA and bcl-2. Traditionally, the International Federation of Gynecology and Obstetric (FIGO) staging and treatment of ovarian sarcomas have been the same as for epithelial ovarian carcinomas. Although surgery was performed for all cases, the extent of surgery is debatable. The benefit and modality of adjuvant therapy are controversial. The prognosis of primary ovarian leiomyosarcomas is extremely poor depending on tumor stage, tumor size, grade, and mitotic index and mostly recurs in abdomen and pelvis. We present a case of primary leiomyosarcoma of the ovary in a 48-year-old woman.
Background: Laparoscopic cholecystectomy in a day surgery setting (VLC/day surgery [DS]) has been recommended for several years, but this organizational model is slow to spread in surgical departments, often because of fear of complications in the first 24 postoperative hours. This retrospective study aimed to assess the feasibility and effectiveness of VLC/DS for uncomplicated symptomatic gallstones and to identify any factors that may influence delayed discharge. Methods: Perioperative variables of 102 subjects enrolled according to strict selective criteria were analyzed. Complications were defined and graded using the "Clavien-Dindo" classification system. Results: The mean operation time was 58.2 minutes. One laparotomy conversion was necessary because of bile duct injury. A subhepatic drainage was placed in four cases. There were no reported deaths. Postoperative morbidity was 12.7%. Active mobilization and oral intake resumed within scheduled times in 88 cases; pain was well controlled in 96% of cases. Eighty percent of patients were discharged within 7-10 hours of surgery. One patient required readmission for biliary leakage from the gallbladder bed. Only the duration of surgery was significantly related to late discharge, while the presence of drainage and complications were only confounding factors and therefore not causally valid in determining late discharge. Of the 71% of patients who responded to the satisfaction questionnaire, 93% judged the entire care pathway positively. Conclusions: The study demonstrates that the organizational model can be safely implemented in selected subjects and with a well-integrated and motivated surgical-anesthesiology team. Moreover, VLC/DS can combine patient satisfaction with cost-effectiveness.
Rectovaginal fistula (RVF) is an uncommon but highly morbid condition. Although most nonobstetric RVFs are related to inflammatory bowel disease, malignancy, radiation, or previous pelvic surgery, infectious causes should also be considered. Cytomegalovirus (CMV) usually causes gastrointestinal disease in immunocompromised hosts, but severe rectal involvement has also been described in elderly patients with diabetes or major intercurrent illness. We report the case of a 77-year-old woman admitted for metabolic derangement and urinary sepsis who, during hospitalization, developed rectal bleeding. Colonoscopy showed a circumferential destructive rectal lesion approximately 5 cm from the anal verge, with friable bleeding tissue and suspected fistulous involvement, initially raising concern for rectal cancer. Gynecologic assessment confirmed a rectovaginal fistula. Histopathologic examination of multiple rectal biopsies demonstrated CMV rectocolitis and excluded malignancy. Because of the fistula, recurrent infectious complications, the patient’s frailty, and her social vulnerability, combined medical and surgical management was adopted, including antibiotic therapy, valganciclovir, and fecal diversion by diverting loop colostomy, followed by subacute care and stoma management training. This case highlights two diagnostic pitfalls: CMV rectocolitis may mimic a rectal neoplasm, and fistulizing disease can occur even in patients without documented major immunosuppressive conditions. CMV infection should therefore be included in the differential diagnosis of destructive rectal lesions and rectovaginal fistula.
Introduction: Nontechnical skills (NTS) are cognitive and social resources critical for safe and efficient surgical performance, yet they are often overlooked in formal curricula. This study evaluates NTS awareness, knowledge levels, and training gaps among Italian surgeons to identify areas for institutional intervention. Materials and methods: A cross-sectional survey involving 331 surgeons was conducted via a 35-item questionnaire (nine NTS domains). Inclusion criteria targeted board-certified consultants and residents active in Italian surgical departments. Data were collected between January and March 2025 and analyzed using RStudio. Results: Of the 331 participants (79% consultants, 18% residents, 2% employed residents), 91% recognized the importance of NTS, but only 30.2% had received formal university training. Consultants demonstrated significantly higher NTS familiarity (94%) than residents (80%; P < 0.005). Seniority positively correlated with emotional awareness and stress regulation ( P < 0.01). However, residents reported significantly higher levels of ethical strain compared with seniors. Although mentorship was deemed essential by nearly all respondents, 35% reported a total absence of a dedicated mentor, highlighting a critical gap in professional development. Conclusions: While awareness is high, NTS acquisition in Italy remains largely informal and experience-dependent. To mitigate the “hidden curriculum” effect and reduce ethical strain among trainees, we recommend the mandatory integration of NTS modules into residency programs, the implementation of structured mentorship protocols, and the use of high-fidelity simulation to standardize these essential competencies across all career stages.
The Ileo Pouch Anal Anastomosis J-pouch is currently the standard of care for patients with ulcerative colitis undergoing total colectomy and who are candidates for restorative surgery. Surgical techniques and the management of this type of patient in referral centers have improved over time. Promptly and correctly identifying and treating complications from this type of surgery is essential to ensuring proper pouch function in a very young surgical population. These complications can sometimes be treated conservatively and medically. Cases requiring resurgical intervention must be thoroughly evaluated. Pouch revision surgery is a very delicate procedure, both technically and psychologically, and should be performed exclusively in referral centers. However, the recognition and management principles of pouch complications must be the prerogative of all general surgeons with the aim of preserving the functionality and quality of life of these patients.
Background: Protective diverting ileostomy is widely adopted to reduce the clinical impact of anastomotic leakage after rectal cancer surgery. Despite its protective role, prolonged stoma duration is associated with impaired quality of life, increased morbidity, delayed recovery, and higher healthcare costs. The optimal timing of ileostomy closure after laparoscopic anterior resection, particularly in patients receiving perioperative chemotherapy, remains controversial. Methods: Between September 1, 2024 and 2025, 30 elective laparoscopic anterior resections with total mesorectal excision were performed at two peripheral general surgery units in Calabria, Italy. Twenty patients with low rectal cancer (<= 6 cm from the anal verge) received a temporary protective ileostomy and were included in the analysis. Ileostomy closure was defined as early when performed within 30 days after primary surgery (n = 14) and late when performed after 30 days (n = 6). Outcomes analyzed included operative time for stoma closure, postoperative recovery, length of hospital stay, time to initiation of adjuvant chemotherapy, duration of stoma, and ostomy-related healthcare costs. Statistical significance was set at P < 0.05. Results: No significant differences were observed between groups regarding operative time, postoperative bowel function, or length of hospital stay. Early ileostomy closure was associated with a significantly shorter duration of stoma and a marked reduction in ostomy-related healthcare costs (P < 0.001). Time to initiation of adjuvant chemotherapy differed significantly between groups (P < 0.05), although the absolute difference was clinically modest and remained within acceptable oncological timeframes. Conclusions: Early ileostomy closure after laparoscopic rectal resection appears to be safe and effective in carefully selected patients. This strategy significantly reduces stoma burden and healthcare costs without adversely affecting postoperative recovery or causing clinically relevant delays in adjuvant chemotherapy. Further large-scale prospective and randomized studies are needed to validate these findings.
Objectives: Conservative mastectomies with preservation of the skin envelop allow for immediate reconstruction and have become most popular in recent years. Occasionally, the nipple-areolar complex needs to be removed for oncological reasons, and preservation of as much breast skin as possible is crucial to improve reconstructive outcomes. However, optimal skin incision and closure techniques remain debated, as they significantly impact both complication rates and aesthetic results. This study evaluates a reappraisal and modification of previous techniques that involve a five-pointed star design aimed at enhancing outcomes. In this paper, we present the surgical technique and a case series to support the safety of the proposed incision. Methods: We conducted a retrospective study involving 56 patients undergoing skin-sparing mastectomy with 58 breast reconstruction procedures, utilizing the five-pointed star incision. Complication rates and skin envelope viability were assessed. Results: The five-pointed star incision technique demonstrated adequate skin perfusion with an acceptable wound complication rate of 10.3%. Conclusions: The five-pointed star incision is a safe and effective alternative for skin closure when nipple-areolar complex involvement is present, and a skin-sparing mastectomy is required. It offers a simple technique with low complication rates, supporting its inclusion among standard options in breast reconstructive surgery. Further prospective studies are warranted to investigate the cosmetic result compared with other more common approaches.
Background:Botulinum toxin type A (BT-A) has recently emerged as a less invasive adjunct in abdominal wall reconstruction, acting as a chemical component separation tool. Despite encouraging evidence, its use remains off-label and highly heterogeneous, with no standardized protocols available.Methods:A nationwide cross-sectional survey was conducted among Italian surgeons between May and June 2025 through the official communication channels of the Italian Hospital Surgeons Association (Associazione Chirurghi Ospedalieri Italiani). The 32-item questionnaire addressed demographics, institutional activity, awareness, indications, technical details of BT-A administration, safety, adjunctive strategies, radiological protocols, and clinical impact.Results:A total of 160 responses were collected from 101 Italian hospitals. Although 87% of surgeons were aware of BT-A, only 30.1% reported direct clinical experience, mainly limited by regulatory barriers. Botox (62%; Allergan/Pharma Allergan) was the most frequently used formulation, followed by Dysport (36%). Injections were predominantly ultrasound-guided (86%), performed in an outpatient setting, with common dosages of 300-500 IU. Most respondents (77.4%) targeted all three lateral abdominal wall muscles, although literature suggests comparable outcomes with two-layer injection techniques. Administration was typically performed 30 days preoperatively, while 2% reported shorter intervals; novel rapid-onset formulations under investigation may broaden its use in urgent settings. Postinjection radiological assessment was performed in 70% of cases, mainly with computed tomography. Reported indications included hernia defects more than 10 cm, loss of domain, and cases requiring posterior component separation with transversus abdominis release. No adverse reactions were observed; literature similarly describes a favorable safety profile, with only rare reports of transient discomfort or systemic toxicity. Perceived clinical impact was significant: 41.6% believed BT-A helped avoid more invasive procedures, 14.3% considered it indispensable, while 24.7% reported no change in surgical strategy.Conclusions:This first nationwide Italian survey highlights a growing awareness and interest in BT-A use for complex abdominal wall reconstruction, but also substantial heterogeneity in its practical application. Standardized protocols regarding dosage, timing, target muscles, and radiological assessment are lacking. The findings emphasize the need for prospective multicenter studies to define optimal patient selection, validate clinical benefits, and explore emerging rapid-onset formulations for urgent scenarios.
Background:Lipomas are benign tumors commonly presenting as soft-tissue masses. Lipomas exceeding 5 cm in diameter may pose a challenge regarding their potential malignancy.Methods:We analyzed 73 consecutive patients undergoing surgical excision for lipomas greater than 5 cm. Clinical, demographic, and histopathological data were reviewed. Tumor localization was categorized based on regions subject to high mechanical friction (neck, axillae, knees, and legs) compared with abdominal or low-friction areas.Results:Of the 73 cases initially diagnosed clinically as benign lipomas, histopathological analysis identified malignancy in 14 cases (19.2%), exclusively located in high-friction regions. Malignant cases predominantly comprised well-differentiated liposarcomas (n = 10), dedifferentiated liposarcomas (n = 3), and one case of pleomorphic liposarcoma. No malignancies were identified in abdominal (low-friction) locations.Conclusions:The significant association between tumor location in regions of high mechanical friction and the incidence of malignancy underscores the potential role of mechanical stress in malignant transformation.
Due to advances in endoscopic technology, surgery for duodenal ulcer bleeding has decreased, although it is still necessary for more complicated cases. The concept of damage control surgery has been established in the field of trauma, and a simple surgical approach may be preferable in serious cases, such as uncontrolled duodenal ulcer bleeding. We present a case of bleeding from an ulcer with a massive hematoma of the duodenum that was treated by a less invasive surgical approach, using the principles of damage control surgery.
Small bowel obstruction (SBO) is a common surgical condition frequently caused by adhesion (73.8%) and hernia (18.5%). SBO caused by bezoars is uncommon and accounts approximately for only 0.4-4% of the total. Phytobezoars are concretions of poorly digested fruit and vegetables that are found in the alimentary tract, and are mostly composed of indigestible cellulose, tannin, and lignin from ingested vegetables and fruits. Surgical intervention is often required in the management of small bowel phytobezoars. The operating technique provides three options: manual progression, enterotomy, and bowel resection. Here we report a case of SBO caused by phytobezoar in a young patient affected by opioid dependence undergoing opioid substitution treatment with methadone.
Abdominal muscle injuries after blunt trauma are rare but increasingly recognized. The overall incidence in all traumatic admissions is 0.2%–0.9%, which rises to 9.2% in patients who underwent abdominal/pelvis CT scan. The aim of this systematic review is to evaluate the incidence, type, management, and outcomes of abdominal wall injuries following blunt trauma. We performed a systematic review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to identify articles reporting abdominal wall injuries following blunt abdominal trauma. Only the papers focusing on abdominal wall injuries following abdominal trauma among the adult population were included. Preoperative variables and outcomes were analyzed. A total of 49 papers of the 568 initially identified were included for analysis. This represented a total of 759 patients, with the majority of papers being retrospective case reports/series. No prospective studies were retrieved. According to the Dennis et al. classification of traumatic abdominal wall injuries, type V (151) was the most common traumatic abdominal wall hernia, followed by type IV (71), type III (20), and type VI (9). Acute repair was performed in 333 patients (43.9%). As a whole, the use of mesh to repair the abdominal wall defect was specified in 183 patients. A minimally invasive approach was reported in eight papers. Patients with traumatic blunt injury to the abdominal wall are rarely reported and often overlooked by both radiologists and trauma surgeons. Nowadays, complex abdominal wall reconstruction has become a specific topic of interest for dedicated surgeons. In light of the five pillars of acute care surgery, we believe that a modern trauma team should include surgeons specifically trained in abdominal wall reconstruction techniques.
Purpose: The prognostic role of body mass index (BMI) on colorectal cancer (CRC) is unclear. The aim of this study is to assess the impact of BMI on stage-related survival in patients with CRC. Methods: Data of patients who underwent surgical resection for CRC between January 2008 and December 2013 were retrospectively analyzed. Patients were divided into two groups according to a BMI <30 (group A) or >= 30 kg/m(2) (group B), respectively. Overall and stage-related survival were analyzed at 5 and 10 years and compared between the two groups. Cancer-specific survival was analyzed only at 5 years. Results: A total of 377 patients were enrolled in the study, 316 in group A (83.8%) and 61 in group B (16.2%). Five-year survival was similar between the two groups in Dukes stage A (P = 0.5926) and B (P = 0.1842). Conversely, in stage C, obese patients showed a significantly higher 5-year survival when compared with nonobese patients (P = 0.0134). Furthermore, obese patients showed 10-year survival rates lower in stage A (P = 0.0492), similar in stage B (P = 0.8707), and higher in stage C (P = 0.0425). Conclusion: These results suggest that high BMI offers a paradoxical protective effect in advanced-stage CRC.
Contemporary cancer management often necessitates repeated venous access for therapeutic administration and blood sampling. Long-term central venous access devices, such as port-a-cath (PaC) systems, are routinely used to preserve peripheral venous integrity. Device removal or replacement is indicated after prolonged use or upon the development of complications. Although PaC retrieval is generally straightforward, resistance to removal may occasionally occur despite adequate traction, and excessive manipulation can lead to serious adverse events. We conducted a retrospective analysis of 94 consecutive PaC removal procedures performed at our center between 2009 and 2025, focusing on cases involving catheter retrieval difficulties. Three cases exhibited significant resistance to standard removal techniques. One was successfully managed through interventional radiology consultation. In a second case, a catheter fracture led to migration and pulmonary embolization, resulting in limited pulmonary ischemia. In the third case, catheter entrapment within the venous system necessitated abandonment of the retrieval attempt. Our findings highlight that difficult PaC removals, particularly in long-term implants, require a systematic approach that includes thorough preoperative planning, timely specialist consultation when complications arise, and rigorous postoperative monitoring to minimize the risk of serious complications.
Background:Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery optimize postoperative recovery and enable early discharge. Readmission rates are key indicators of healthcare quality, reflecting the adequacy of initial hospitalization and follow-up care.Method:This retrospective clinical audit analyzed a prospective database of 1427 patients undergoing elective colorectal resections under ERAS protocols from January 2008 to December 2022 at a single center. Patients were operated on under the leadership of a single chief surgeon, with progressive adherence to ERAS culminating in certification as a qualified ERAS center in 2021. Exclusions included emergency and palliative surgeries. Logistic regression was used to analyze predictors of 30-day readmission, with complications categorized using the Clavien-Dindo classification.Results:The median age was 70 years, and 34.6% of patients were classified as American Society of Anesthesiologists III-IV. The 30-day readmission rate was 7.6% (109 patients), with over half due to minor complications (Clavien-Dindo I-II). Independent predictors of readmission included chronic ischemic heart disease, diabetes, rectal resections, extended right colectomies, abdominoperineal excision, and splenic flexure resections. Progressive adherence to ERAS reduced median hospital stay from 4 to 2 days without significantly increasing readmission rates.Conclusion:This 15-year audit confirms that discharge under ERAS criteria is safe and should be considered "optimal" rather than "early." Targeted postdischarge strategies for high-risk patients and structured follow-up could further reduce unnecessary readmissions, especially for minor complications, improving recovery and healthcare resource utilization in colorectal surgery.
Mixed neuroendocrine–nonneuroendocrine neoplasms (MiNEN) are rare neoplasms. Comprising of two distinct entities, a neuroendocrine and a nonneuroendocrine component, usually an adenocarcinoma, they are highly aggressive neoplasms with a poor prognosis. We report the case of a 62-year-old Caucasian woman with duodenal and ampullary MiNEN. A computed tomography scan unveiled a neoplastic lesion involving the ampulla of Vater. Subsequently, the patient underwent a surgical intervention (modified Whipple procedure) with an initial diagnosis of adenocarcinoma of the ampulla of Vater and the head of the pancreas. After resection, histological examination revealed MiNEN, originating from the duodenum and ampulla of Vater with the presence of an adenocarcinoma and a neuroendocrine tumor (NET G2). The final histological staging was pT4N2. The primary objective of this case report, which presents a duodenal ampullary MiNEN, is to contribute to the management of this rare disease through a detailed literature review.
This article, a result of the 41st National Congress of the Italian Hospital Surgeons Association in 2023, presents critical findings on the alignment of surgical training with legal requirements, the authentic experience of trainees, and the personal and professional effects of job satisfaction on surgeons under 45. By analyzing survey data, we aimed to understand the reasons behind the declining number of young general surgeons in Italy.
Background:The aim of this study was to investigate the effectiveness and safety of the combination of diosmin, extract of Vitis vinifera, Ruscus aculeatus, and Melilotus officinalis (Viviven (R)), in addition to standard of care, as conservative therapy of hemorrhoidal disease (HD). Methods:Prospective, multicenter, observational cohort study, nested analysis of the VIVI2022/01/VIVALDI study, on adults with symptomatic Goligher grade I-II-III HD. The primary study endpoint was the improvement in the R & oslash;rvik hemorrhoidal disease symptoms score (HDSS). Secondary endpoints of effectiveness were bleeding entity, measured through the Giamundo score, quality of life, using the Short Health Scale adapted for HD (SHS-HD), Goligher grading, satisfaction with treatment, and the change in strategy. Patients and all scores were evaluated at baseline (VO) and at day 30 (V2). Results:Thirty-five people, 80% males, median (Q1, Q3) age 50 (37, 59) years, affected by HD since 3 (0, 7) years, were enrolled. The mean (standard deviation) HDSS decreased from 8.29 (4.4) at baseline to 4.09 (3.4) at day 30 (P < 0.001). At day 30, 51.4% of participants had no bleeding versus 5.7% at baseline (P < 0.001), and 34.3% showed a Goligher grade downstaging. The mean (standard deviation) SHS-HD score decreased from 12.2 (4.6) at baseline to 7.89 (3.6) at day 30 (P < 0.001). Treatment was deemed satisfactory by 74.3% of participants, with none discontinuing within day 30. Conclusion:The combination of diosmin, extract of V. vinifera, R. aculeatus, and M. officinalis, was safe and effective. Clinical improvements in signs and symptoms were found in people suffering from Goligher grade I-II-III HD.
Background: This study aims to investigate the prognostic value of lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in patients with locally advanced, nonmetastatic (Stage II-III) triple-negative breast cancer (TNBC). Methods: In this observational, monocenter, retrospective study, patients who underwent breast surgery for locally advanced TNBC were analyzed. Clinical-pathological features of interest were collected. The log-rank statistics method and the Cox proportional hazard analysis were used to identify prognostic factors. Disease-free survival (DFS) and overall survival (OS) curves were evaluated by the Kaplan-Meier method, using the log-rank test to compare survival between groups. Results: Between 2011 and 2016, 82 patients were included in the study. The median follow-up was 33 months. Cox's univariate analysis showed that T stage, positive lymph nodes, LODDS, and LNR were statistically significant prognostic factors for DFS (P < 0.05). In the Multivariate Cox analysis, LNR was the only independent prognostic factor for DFS (P < 0.0001). Conclusions: LNR and LODDS can provide additional prognostic value for DFS and OS in locally advanced TNBC. Moreover, LNR had a better prognostic value compared with LODDS. These data should be considered in the overall care strategy of these patients, especially in the decisions on possible adjuvant therapy.
