Early Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors (patient caracteristics or surgical technique variations) affecting hypocalcemia following thyroid surgery. This studiy evaluates the role of several factors in postoperative hypocalcemia development. A retrospective study conducted on 2108 patients that underwent thyroid surgery in a single center (1669 women and 439 men). Postoperative early hypocalcemia was defined as serum calcium levels lower than 8,0 mg/dl measured 24 h after surgery. Following factors were evaluated in the study: sex, age, glandular hyperfunction, preoperative diagnosis, preoperative serum calcium levels, preoperative serum PTH levels, type of surgery performed (total thyroidectomy vs. lobectomy); minimally invasive video assisted thyroidectomy (MIVAT); number of parathyroid preserved in situ, postoperative serum calcium levels, changes in perioperative calcium levels (difference between preoperative values ​​and postoperative calcium levels), presence of carcinoma in the surgical specimen, presence of thyroiditis based on histopatology reports. Among evaluated factors only gender and surgical procedure revealed to be significantly correlated to early hypocalcemia development. In fact female patients experienced postoperative hypocalcemia in 42% (701/1669) of cases, which was signicantly higher than the 21.4% (94/439) identified in men. We also noticed a greater hypocalcemia incidence in patient undergoing total thyroidectomy (38.8%) than in patient undergoing lobectomy group (13.8%). Early hypocalcemia development didn’t appear to be related to preoperative serum calcium levels but it showed a statistically significant correlation with perioperative serum calcium level drop. This findings suggest that sex (female gender is a strong risk factor),surgical procedure and perioperative changes in serum calcium are the only factors (among all variables examined) that influence early hypocalcemia development.

The laparoscopic intraperitoneal onlay mesh repair (IPOM) approach has become the most widely adopted technique in the last decade. The role of laparoscopic IPOM in the last years has been resizing due to several limitations. The aim of the present study is to evaluate short- and long-term outcomes in patients who underwent laparoscopic IPOM. This retrospective single-center study describes 170 patients who underwent laparoscopic IPOM for ventral hernia at the General Surgery Unit of Parma University Hospital from 1 January 2016 to 31 December 2020. We evaluated patient, hernia, surgical and postoperative characteristics. According to the defect size, we divided the patients into Group 1 (Ø < 30 mm), Group 2 (30 < Ø < 50 mm) and Group 3 (Ø > 50 mm). A total of 167 patients were included. The mean defect diameter was 41.1 ± 16.3 mm. The mean operative time was different among the three groups (p < 0.001). Higher Charlson Comorbidity Index, obesity and incisional hernia were related to postoperative seroma and obesity alone with SSO. p < 0.001 Recurrence was significantly higher in larger defects (Group 3) and incisional hernia. p < 0.001. This retrospective study suggests that laparoscopic IPOM is a feasible and safe surgical technique with an acceptable complication rate, especially in the treatment of smaller defects up to 5 cm.

Hemobilia is an unusal cause of upper gastrointestinal bleeding and may be the result of the formation of an hepatic vessel pseudoaneurysm. This is a rare occurence after laparoscopic or open cholecistectomy. The most importants factor for pathogenesis are direct or indirect iatrogenic injuries during intervention and hepatic trauma. Clinical presentation may also be late and includes more frequently upper gastrointestinal bleeding due to pseudoaneurysm rupture, abdominal pain and jaundice secondary to bile duct compression. Therapies includes trans arterial embolization of feeding artery and percutaneous ingjection of embolic devices into the aneurysm. Surgery must be reserved for cathether based therapy failure. We report a case of a 66 year old man, presenting a month after cholecystectomy, complaining abdominal pain in the upper right quadrant and hematemesis. An EGDS exam showed hemobilia and computed tomography (CT) revealed a cistic artery pseudoaneurysm (PSA) wich have been successfully treated with hyperselective arterial embolization. Although this is a rare complication the surgeon must be aware of related symptoms and signs in order to sospect pseudoaneurysm as prompt recognition and treatment are essential. Untreated haemobilia may determine an immediate threat to life leading to acute haemodynamic instability We describe both diagnostic features and therapeutic strategies in comparison to the most recent literature. (www.actabiomedica.it).

Background Multifocality is usually detected afterwards surgery for papillary thyroid cancer (PTC) and has been reported in 18-87% of PTC. Methods This is a retrospective single-center study involving a series of 238 patients that underwent thyroidectomy or lobectomy after preoperative fine needle aspiration (FNA) diagnosis of Thyr 5 or Thyr 6, according to Bethesda classification, from January 2015 to December 2019 at the General Surgery Unit of the University - Hospital of Parma. We divided patients into two main groups: patients with multifocal papillary thyroid cancer at postoperative diagnosis and patients with unifocal papillary thyroid cancer. The aim of the study is to identify demographic or preoperative radiological risk factors for the presence of multifocal PTC and to verify the presence of cyto-histological features of greater aggressiveness in multifocal tumors than in unifocal ones. Results Out of our sample, 176 patients were females (73,9%) and 62 males (26,1%) with a mean age of 50,45 ±14,41. Preoperative cytological diagnosis resulted Thyr 5 in 47 cases (19,7%) and Thyr 6 in 191 cases (80,3%). Multifocal cancer was reported in 35,8% of the females and in 32,3% of the males. Older age was significatively related to the presence of multifocal papillary carcinoma (p<0.05). Preoperative bilateral thyroid nodules were associated with a higher finding of multifocal disease at histological examination (p<0.05). The presence of multifocal disease was related with a higher soft tissue invasion at the histological specimen (p<0.05). Tumor size was not related to multifocal PTC in our study. Conclusions Older age of patient and preoperative bilateral thyroid nodules are significantly associated to multifocal thyroid cancer. In add to this, multifocal disease is related to higher finding of perithyroidal tissue invasion at histological exam. In case of predictive factors for multifocal PTC, surgeons should take total/near-total thyroidectomy always into consideration.

In scientific literature there are numerous authors that have highlighted how the outcome of patients undergoing surgical treatment, such as intraoperative or postoperative complications, surgical time, mean hospital stay, is related to the surgeon's experience based on the number of cases treated per year for a specific disease. In our study we decided to verify if, in our clinical practice, there are significant differences in postoperative outcomes between procedures performed by a senior surgeon, a young specialist or a surgical resident, evaluating if surgical experience affects positively either on intraoperative complications such as bleeding, hypocalcemia, dysphonia, or on surgical time, mean hospital stay and postoperative complications. In this retrospective study we examined all cases of patients that underwent surgery for thyroid disease at our Operative Unit, from January 1, 2015 to December 31, 2019. The analysis of our data highlights how the surgeon's experience affects the surgical outcome of patients undergoing lobectomy or total thyroidectomy. Our conclusion was that a high volume center, like the one we are working in, with a correct selection of the patients, allows to train a surgical resident guaranteeing both the surgical training of the doctor and the patients safety.