Adrenalectomies are growing worldwide because of the frequent diagnosis of incidentaloma and the use of minimally invasive surgery (MIS). The factors used to identify a malignant lesion and the best surgical technique are uncertain. In this context, the definition of high-volume center and expert surgeon is under debate. The Italian Society of Endoscopic Surgery and New Technologies (SICE) developed a nationwide survey to investigate the state-of-the-art of adrenal surgery in Italy. A web-based survey comprising 37 questions was developed and distributed to Italian surgeons involved in adrenal surgery. Two hundred forty-eight answers were analyzed. Consensus was reached among the survey participants regarding local infiltration (83%) and rapid growth of the lesion (81%) as markers of malignancy. Nearly 30% of the participants used MIS in case of malignant adrenal lesions. The lateral (50%) and anterior transperitoneal (44%) approaches were the most common among Italian surgeons. Approximately 40% of participants believe that 20–40 adrenalectomies/year are needed to define an expert surgeon and at least 20 procedures/year to define a high-volume center. Approximately half of participants performed < 10 adrenalectomies/year in centers with a median volume < 10 procedures/year . Based on participant feedback, this survey highlights local infiltration and rapid growth as the most significant markers of malignant adrenal lesions. While open adrenalectomy remains the gold standard for suspected malignant lesions, nearly 30% of the participants practice MIS even in these cases. The lateral and anterior transperitoneal approaches emerge as the most familiar for Italian surgeons. A substantial proportion of Italian patients with adrenal lesions undergo surgery performed by surgeons with an annual case volume < 10 procedures, at centers with a low annual volume of adrenalectomies. Moreover, there is a lack of standardized definitions for ‘expert surgeon’ and ‘high-volume center’ in this context.

BACKGROUND:Childhood obesity is a global health challenge linked to metabolic, cardiovascular, and psychosocial complications. While lifestyle interventions represent the key strategy for obesity management, metabolic and bariatric surgery (MBS) has emerged as a therapeutic option for severe obesity. This systematic review with meta-analysis assessed the effectiveness and safety of MBS and weight management devices in children and adolescents. METHODS:We included randomized and prospective controlled cohort studies assessing MBS or weight management devices in children and adolescents with obesity, searching PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry through January 2025. Critical outcomes included body mass index (BMI) and weight reduction, adverse events, and incidence or severity of obesity-related outcomes. RESULTS:Seven studies (three RCTs and four non-RCTs), all involving adolescents undergoing MBS, were included. No studies evaluated children or devices. Meta-analysis showed that compared with lifestyle intervention, MBS reduced BMI by 11.7 kg/m2 (95% CI: -13.2 to -10.1; two RCTs, n = 100) and 14.5 kg/m2 (95% CI: -15.7 to -13.3; three non-RCTs, n = 307), and weight by 20.9% (95% CI: -23.6 to -18.1; three RCTs, n = 152) and 31.2% (95% CI: -34.3 to -28.0; two non-RCTs, n = 173). Certainty of evidence was low. One non-RCT comparing Roux-en-Y gastric bypass and sleeve gastrectomy found similar outcomes. Both RCTs and non-RCTs reported improvements in obesity-related outcomes. CONCLUSIONS:Although MBS leads to substantial weight loss and health benefits in adolescents, the risk of complications underscores the need for careful patient selection, surgical expertise, and comprehensive postoperative care. TRIAL REGISTRATION:PROSPERO registration: CRD42023438469.

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.

Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline’s recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).

Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA). This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique." From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months. Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

The COVID 19 pandemic was declared on the 9th of March 2020. The health crisis affected the whole world with a very high and unexpected number of infected people. The situation forced the declaration of lockdown and a worldwide health system reorganization. Surprisingly, the social distancing laws caused a reduction of urgent hospital activities not COVID 19 related. The aim of this manuscript is to analyze the reasons why fewer emergencies were described during the 2020 Italian lockdown. The Data reporting urgent Emergency Room (ER) activity, during the first three weeks of the Italian lockdown (Group 1), were analyzed and compared with the same period in 2019 (Group 2). During the study period in 2020, there was a 46,5% reduction in ER activity compared to that in 2019. Nevertheless, the hospitalization rate was higher in the 2020 then in 2019 (p<0.05). The present data showed that almost half of the basic ER activity araised from mild health problems that could be followed by territorial health services. The strengthening of territorial medical services would allow hospitals to handle critical situations more easily and to focus activity by reducing the waiting list.

Decreased blood perfusion at the anastomotic site increases the risk of anastomotic leakage (AL) following colorectal surgery. Indocyanine green near-infrared fluoroangiography (NIRF/ICG) is a technique that allows for the assessment of intestinal perfusion before and after the formation of an anastomosis. We aimed to compare the rate of AL after colorectal surgery conducted with NIRF/ICG assessing vascular anastomotic perfusion and without this support. The data of patients who underwent colorectal surgery from November 2014 to February 2019 were reviewed retrospectively. Left-sided hemicolectomy, sigmoid resection, and anterior rectal resection were included. Emergency resections were excluded. Procedures conducted with NIRF/ICG and without NIRF/ICG (no-NIRF/ICG) support were compared using Fisher’s and Mann–Whitney U test. Overall, 196 procedures were included, 98 were carried out with no-NIRF/ICG and 98 with NIRF/ICG. Patients’ clinical and intraoperative characteristics were similar in the two groups. In the NIRF/ICG, fluorescence was detected in 100% of the cases; following NIRF/ICG the planned site of transection was changed in eight cases, whereas in one case the anastomosis was re-performed. Overall, six patients (3%) developed an AL, 0% in the NIRF/ICG and 6% (n = 6) in the no-NIRF/ICG group (p = 0.029). Median hospital length of stay was shorter in the NIRF/ICG group [6 days (IQR 6–7) vs. 7 days (IQR 6–9), p < 0.001]. The results of this study suggest that the use of the NIRF/ICG was safe for colorectal surgery and decreases the risk of anastomotic leak. A randomized trial is required to confirm these preliminary data.

Differentiated thyroid cancers are the most common malignancies arising in thyroid gland.Papillary thyroid cancer presents a very favorable prognosis, while follicular type is slightly more aggressive, mainly for its attitude to hematogenous spreading with distant metastases.Papillary microcarcinoma (10 mm or less) has an excellent prognosis, largely demonstrated, and its management is changed in the last few years, reducing surgical procedure, role of radio iodine ablation (RAI) and TSH suppression.But no effective data are available for follicular thyroid microcarcinoma (mFTC); very few reports and studies are present in literature about mFTC, mainly for its low incidence.Aim of this paper is to review current literature to reach, in absence of evidence, some suggestion in managing mFTC.

The diagnosis is composed by the clinical signs mentioned above and a radiological image, that frequently consist on a cystography (Figure 1). As first attempt to solve the fistula, the patients undergoes a longer urinary catheterization, medical therapy and closure of the rectal wall damage. Only up to 46% of RUF [5] obtain the closure with this so called “conservative treatment”. In case of recurrent RUF, the first step is the reduction of the fistula “flow” through a double diversion: faecal diversion (colostomy) and urethral catheterization. At this point multiple approaches and surgical techniques have been proposed. Hechenbleikner EM et al. [6] has shown that patients affected by RUF undergoes up to 4 categories of repair with a 87,5% rate of fistula closure and with more than 10% rate of permanent fecal and/or urinary diversion. Techniques available can divided in 2 groups: trans-abdominal (open or laparoscopic) and perineal. In the trans-abdominal group the linkage closure is obtained suturing the rectal wall lesion with or without omentum patch, clips or glue. Unfortunately results are poor with low rate of fistula solution.

OBIETTIVI Molti studi hanno evidenziato il beneficio della chirurgia laparoscopica 3D di ultima generazione rispetto ai sistemi ottici 2D. I reali effetti sul nostro sistema visivo nell'utilizzo di occhiali 3D non sono ancora stati valutati. Lo scopo principale di questo studio e stato quello di valutato lo stress visivo a cui il chirurgo viene sottoposto durante le procedure laparoscopiche in 3D. Obiettivo secondario e stato quello di valutare i risultati nell'impiego della tecnologia 3D HD comparando i risultati chirurgici del 2D vs il 3D nelle resezioni laparoscopiche colo-rettali per tumori del crosso intestino. MATERIALI E METODI Da Gennaio 2016 a Marzo 2017, 137 pazienti sono stati sottoposti a resezione colo-rettali per patologia neoplastica, di cui 64 mediante l' impiego di tecnologia 3d (gruppo 3d) e 71 mediante tecnologia 2d (gruppo 2d). Tra questi due gruppi sono stati confrontati dati intra-operatori e dati post-operatori. Al termine di ogni procedura chirurgica il primo operatore e stato invitato a rispondere a due questionari soggettivi per valutare il carico di lavoro visivo: il NASA task load questionnaire e il Simulator Sickness questionnaire (SSI). RISULATATI Tutte gli interventi sono stati completati mediante tecnica laparoscopica senza richiedere conversione in laparotomia. L'incidenza di procedure chirurgiche piu complesse come resezioni sec. Miles, colectomie totale e resezioni anteriore di retto e stata maggiore nel gruppo 3D. La durata dell'intervento e stata significativamente piu lunga nel gruppo 3D ( 177 ± 7 3D vs 157± 6 2D, P=0.03) mentre l' incidenza di complicanze post-operatorie e stata significativamente superiore nel gruppo 2D (26% 3D vs 9% 3D, P<0.01). Non sono emerse differenze significative tra i due gruppi per quanto riguarda il questionario SSI (vertigini, lacrimazione, nausea), mentre dal questionario NASA, lo sforzo mentale, fisico e visivo percepito dal chirurgo con la tecnologia 3D e superiore rispetto al 2D (p<0,001). CONCLUSIONI La laparoscopia associata alla tecnologia 3D risulta avere un'incidenza di complicanze postoperatorie inferiori rispetto ai vecchi sistemi 2D nell'eseguire interventi chirurgici complessi. Nonostante i disturbi determinati dalla visione 3D quali nausea lacrimazione e mal di testa risultino sovrapponibili alla laparoscopia 2d, lo sforzo visivo, mentale e fisico percepito dal chirurgo risulta superiore durante procedure 3D rispetto alla 2D.

Background: The value of surgical resection in the management of pancreatic neuroendocrine tumors (PNET) with liver metastases (LM) is still debated. The aim of this study was to evaluate the outcomes of surgery of PNET with LM. Methods: Patients with PNET with synchronous LM between 2000 and 2011 from 4 high-volume institutions were included. The patients were divided into 3 groups: curative resection, palliative resection, and no resection. Results: Overall, 166 patients were included. Eighteen patients (11%) underwent curative resection, 73 patients (43%) underwent palliative resection, and 75 patients (46%) underwent conservative treatment. The median overall survival (OS) from the time of diagnosis was 73 months. Patients who underwent curative resection had a significantly better median OS from the initial diagnosis compared with those who underwent palliative resection and those who were conservatively treated (97 vs. 89 vs. 36 months, p = 0.0001). The median OS from the time of diagnosis in those patients who underwent radical or palliative resection was 97 months, with a 5-year survival rate of 76%. On multivariate analysis, factors associated with OS from the time of diagnosis were the presence of bilobar metastases, tumor grading, and curative resection in a first model. On a second model, curative or palliative surgery was an independent predictor of OS. Among 91 patients who underwent surgery, the presence of pancreatic neuroendocrine carcinoma G3 was the only factor independently associated with a poorer survival after surgery (median OS: 35 vs. 97 months, p < 0.0001). Conclusions: Patients with LM from PNET benefit from surgical resection, although surgery should be reserved to well- or moderately differentiated forms.

Autoimmune pancreatitis (AIP) is a “one of a kind” inflammatory disease of the pancreas since it differs clinically, pathologically, and instrumentally from all other types of pancreatitis. Many papers have been published since the introduction of the term “autoimmune pancreatitis” by Yoshida et al. in 1995 [1], focusing mainly on the dramatic and quick response to steroid therapy.

Secondary neoplasms involving the pancreas are less common than primary neoplasms. The pancreas is rarely the only metastatic site and metastases can reach the pancreas by lymphatic or hematogenous routes. Several tumors have been demonstrated to metastasize to the pancreas; however, there are differences in the prevalence of the various tumor types that colonize the pancreas, depending upon the population considered (autopsy records vs. surgical specimens).

Sir, Growing interest in splenic immunological function has led surgeons to perform distal pancreatectomy with spleen preservation (DPSP) for benign tumours in the pancreatic body and tail. This can be performed either by preserving the splenic vessels or by resecting them as in Warshaw's technique (WT),1.Warshaw A.L. Conservation of the spleen with distal pancreatectomy.Arch Surg. 1988; 123: 550-553Crossref PubMed Scopus (470) Google Scholar relying on the blood inflow through the short gastric vessels. Several authors have demonstrated the feasibility and safety of WT and have reported lower intraoperative blood loss, shorter operative time, reduced hospital stay and a lower complication rate with normal splenic perfusion at 30 days after the operation.2.Rodríguez J.R. Madanat M.G. Healy B.C. Thayer S.P. Warshaw A.L. Fernandez-del Castillo C. Distal pancreatectomy with splenic preservation revisited.Surgery. 2007; 141: 619-625Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Only Miura et al.3.Miura F. Takada T. Asano T. Kenmochi T. Ochiai T. Amano H. Haemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein.Surgery. 2005; 138: 518-522Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar have evaluated the haemodynamic consequences of WT in longterm follow-up, reporting a high risk for the development of perigastric varices, but a low risk for bleeding; they found only one case of bleeding among 150 patients reported in the literature. It should be appreciated that WT is often performed for benign pancreatic tumours (neuroendocrine and cystic tumours) and that the majority of patients in this context are young females with long life expectancies. Three of six patients who underwent a WT procedure at our institution developed perigastric varices at ≥1 year after the operation.4.Butturini G. Inama M. Malleo G. Manfredi R. Melotti G.L. Piccoli M. Perioperative and longterm results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.J Surg Oncol. 2011; PubMed Google Scholar In this context, we strongly believe that although it is important to establish whether WT is safe and feasible, it is at least as important to evaluate whether it results in longterm complications such as left-side portal hypertension (LSPH) with perigastric varices, which are potentially troublesome and may require pharmacological therapy. While we await further data, we will continue to perform DPSP whenever possible, although, as Yoon et al.5.Yoon Y.S. Lee K.H. Han H.S. Cho J.Y. Ahn K.S. Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy.Br J Surg. 2009; 96: 633-640Crossref PubMed Scopus (63) Google Scholar and our recent paper4.Butturini G. Inama M. Malleo G. Manfredi R. Melotti G.L. Piccoli M. Perioperative and longterm results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.J Surg Oncol. 2011; PubMed Google Scholar both highlight, spleen preservation per se represents a risk factor for LSPH.

Background. Poorly differentiated, resectable pancreatic ductal adenocarcinoma is associated with early recurrence and may benefit from neoadjuvant treatment. The aim of this study was to evaluate clinicopathologic characteristics and survival of patients with resectable pancreatic ductal adenocarcinoma according to histologic grading.Methods. A total of 502 patients who underwent resection for pancreatic ductal adenocarcinoma between. 1990 and 2008 were analyzed via the use of different histologic grading.Results. Well-differentiated (G1), moderately differentiated (G2), and poorly differentiated (G3) pancreatic ductal adenocarcinomas were found in 23 (4.5%), 310 (62%), and 169 (33.5%) patients. Adjuvant therapy, N status, grading, and R status were independent predictors of disease-specific survival for the entire cohort, with 1- and 5-year disease-specific survival rates of 81% and 21%, respectively. Only the presence of symptoms was a significant clinical predictor of G3 status (P = .035). G3 neoplasms were characterized by a greater rate of lymph node metastases, microvascular/perineural invasion, and R2 resections. Median disease-specific survival was 77, 26, and 20 months for G1, G2, and G3 neoplasms (P < .0001). Median disease-free survival was 63, 14, and 9 months for Cl, G2, and G3 pancreatic ductal adenocarcinoma (P < .0001). Adjuvant therapy improved disease-specific survival in G2 (P < .04) and G3 (P < .0001) pancreatic ductal adenocarcinoma, with a greater survival benefit for G3 neoplasms (hazard ratio: 1.334 vs 2.116).Conclusion. G3 pancreatic ductal adenocarcinoma is associated with a lesser rate of disease-free survival after resection and with the presence of other poor prognostic factors. The benefit of adjuvant therapy is greater in G3 than in G1 and G2 neoplasms. On the basis of these findings, patients with resectable G3 PDAC can be considered as possible targets for neoadjuvant treatment. (Surgery 2012;152:S112-9.)

Laparoscopic spleen‐preserving distal pancreatectomy can be performed with or without splenic vessels conservation. The formation of perigastric varices is the main long‐term complication and represents the area of major concern among surgeons. Aim of this paper was to evaluate the outcomes of patients who underwent spleen‐preserving distal pancreatectomy (with or without splenic vessels conservation) at our institution.