Background: The aim of this study was to define any benefits in terms of early outcome for laparoscopic colectomy in patients over 75 years old (OP) compared with the outcomes of a younger populations (YP). Methods: Forty elderly patients undergoing laparoscopic colectomy for colorectal cancer between 2007-2011 were studied, the patients are divided for gender, age, year of surgery, site of cancer, and comorbidity on admission and compared with 40 younger patients. Results and discussion: Mean (standard deviation) age was 81.3 in OP and 68.3 YP Conversion rate was the same between the two groups. There was no difference in operative mean time . The overall mortality rate was 0% percent. The surgical morbidity rate was the same but there was an increased in cardiologic e bronchopneumonia complications in older population. Patients treated with laparoscopic approach had a faster recovery of bowel function and a significant reduction of the mean length of hospital stay not age related. Laparoscopy allowed a better preservation of postoperative independence status. Conclusions: Laparoscopic colectomy for cancer in elderly patients is safe and beneficial including preservation of postoperative independence and a reduction of length of hospital stay.

Objectives: Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory. Methods: Registered data of 55 consecutive patients admitted to our center between January 2010 and December 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correlation to its clinical spectre. Results: Tobacco use was the most statistically significant (p 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as predictive factors of ITIN in multivariate analysis using logistic regression (OR 49.66 and p-value 0.0021). Conclusion: Our univariate and multivariate analysis identified multiple factors (Serum lactate levels ˃ 2mmol/L, Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Magnetic resonance imaging (MRI) is the gold-standard technique for evaluating muscle fatty infiltration and muscle atrophy due to its high contrast resolution. It can differentiate muscular from adipose tissue accurately. MRI can also quantify the adipose content within muscle bellies with several sequences such as T₁-mapping, T₂-mapping, spectroscopy, Dixon, intra-voxel incoherent motion, and diffusion tensor imaging. The main fields of interest in musculoskeletal radiology for a quantitative MRI evaluation of muscular fatty infiltration include neuro-muscular disorders such as myopathies, and dystrophies. Sarcopenia is another important field in which the evaluation of the degree of muscular fat infiltration or muscular hypotrophy is required for a correct diagnosis. This review highlights several MRI techniques and sequences focusing on quantitative methods of assessing adipose tissue and muscle atrophy.

BACKGROUND: High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery. OBJECTIVE: To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery. DESIGN: Retrospective analysis of a prospective database. PATIENTS: Adults (18 years or older) who underwent elective colorectal resection with anastomosis for benign and malignant disease. SETTINGS: Prospective enrollment in 78 centers in Italy from 2019 to 2021. INTERVENTIONS: All outcomes were measured 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed. After univariate analyses, independent predictors of the end points were identified through logistic regression analyses, presenting ORs and 95% CIs. MAIN OUTCOME MEASURES: Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event. RESULTS: An adverse event was recorded in 2321 of 8359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary end points were identified among patient- (age, ASA class, and nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage and reoperation) variables. Enhanced recovery pathway adherence of more than 70% independently reduced failure to rescue rates. LIMITATIONS: Clustering from multicenter data and unmeasured confounding from observational data. CONCLUSIONS: After elective colorectal resection, adherence of more than 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract. LA RECUPERACIÓN MEJORADA REDUCE DE FORMA INDEPENDIENTE LA POSIBILIDAD DE FRACASO EN EL RESCATE DESPUÉS DE UNA CIRUGÍA COLORRECTAL: ANTECEDENTES: La alta adherencia a la vía de recuperación mejorada después de la cirugía reduce las tasas de morbilidad y mortalidad después de la cirugía colorrectal electiva. OBJETIVO: Evaluar el efecto de la adherencia a la vía ERAS en las tasas de fracaso en el rescate después de la cirugía colorrectal electiva. DISEÑO: Análisis retrospectivo de una base de datos prospectiva. PACIENTES: Adultos (≥ 18 años) que se sometieron a una resección colorrectal electiva con anastomosis por enfermedad benigna y maligna. ESCENARIO: Inscripción prospectiva en 78 centros en Italia de 2019 a 2021. INTERVENCIONES: Todos los resultados se midieron a los 60 días después de la cirugía. Se analizaron varias variables relacionadas con el paciente, la enfermedad, el tratamiento, el hospital y las complicaciones para los resultados. Después de los análisis univariados, se identificaron los predictores independientes de los puntos finales a través de análisis de regresión logística, presentando razones de probabilidades e intervalos de confianza del 95%. PRINCIPALES MEDIDAS DE RESULTADOS: Fallo en el rescate después de cualquier evento adverso, definido como la relación entre el número de muertes y el número de pacientes que presentaron cualquier evento adverso; fallo en el rescate después de cualquier evento adverso mayor, con el denominador representado por el número de pacientes que presentaron cualquier evento adverso mayor. RESULTADOS: Se registró un evento adverso en 2321 de 8359 pacientes (27,8%), un evento adverso mayor en 523 pacientes (6,3%) y muerte en 88 pacientes (1,0%). Las tasas de fallo en el rescate fueron del 3,8% después de cualquier evento adverso y del 16,8% después de cualquier evento adverso mayor. Se identificaron predictores independientes de los criterios de valoración primarios entre las variables relacionadas con el paciente (edad, clase de la Sociedad Americana de Anestesiólogos, estado nutricional), el tratamiento (tipo de resección) y las complicaciones (fuga anastomótica, reoperación). La adherencia a la vía de recuperación mejorada > 70% redujo de forma independiente las tasas de fallo en el rescate. LIMITACIONES: Agrupamiento de datos multicéntricos y factores de confusión no medidos a partir de datos observacionales. CONCLUSIONES: Después de una resección colorrectal electiva, la adherencia > 70 % a la vía de recuperación mejorada disminuyó de manera independiente las tasas de fracaso en el rescate, junto con otros factores relacionados con el paciente o el tratamiento. (Traducción—Dr Osvaldo Gauto).

Purpose: Postoperative pain is a major concern for patients undergoing ultrasound scalpel-assisted hemorrhoidectomy, potentially exacerbated by delayed wound healing. This study aimed to evaluate the impact of an intimate cleansing gel containing chlorhexidine, hyaluronic acid, and other anti-inflammatory agents (Antroclean Fisioderm) on postoperative pain, itching, and wound healing in patients who had undergone this procedure. Methods: This multicenter observational case-control study involved a cohort of consecutive adult patients who underwent hemorrhoidectomy using an ultrasound device. The study compared 2 different postoperative wound management strategies over 1 month after surgery: washing with warm water twice per day (control group) versus a 2-minute topical application of intimate cleansing gel (Antroclean Fisioderm) followed by a warm water wash (intervention group). Results: The median postoperative pain score was significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). The percentage of patients reporting anal itching was also significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). All patients in the intervention group achieved complete wound healing 4 weeks after surgery, compared to 88 (82%) in the control group (P<0.01). No adverse events were reported. Conclusion: The topical application of intimate cleansing gel (Antroclean Fisioderm) twice daily for 1 month following ultrasound scalpel-assisted hemorrhoidectomy appears to be associated with faster healing, reduced pain, decreased itching, and improved quality of life, without any adverse effects. Further larger and prospective randomized trials are recommended to confirm these findings.