Papers by Salomone Di Saverio
Abstract Background: Adherential pathology is the most common cause of small bowel obstruction. L... more Abstract Background: Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.
The CIAO Study is a multicenter observational study currently underway in 66 European medical ins... more The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012). This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified. The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality. White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.
Appendicitis is the most common cause of intra-abdominal surgical emergency in the Western world,... more Appendicitis is the most common cause of intra-abdominal surgical emergency in the Western world, 1 and its differential diagnosis is often challenging because of several other conditions causing right iliac fossa pain. Ultrasound has a limited sensitivity (ranging from 74% to 83%) and better specificity (89% to 94%) 2,3 compared with CT scan. However, although CT guarantees higher sensitivity rates (94%), it does carry the potential risks of radiation exposure.
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World Journal of Surgery, 2010
Background The Damage Control Surgery (DCS) approach to massive intraperitoneal hemorrhage has be... more Background The Damage Control Surgery (DCS) approach to massive intraperitoneal hemorrhage has been shown to significantly reduce the morbidity and mortality in severely injured trauma patients. We applied the same principles to patients who developed a massive hemorrhage and the “lethal triad” (acidosis, hypothermia, coagulopathy) during a surgical procedure in order to assess feasibility and efficacy of DCS on nontraumatic grounds. Methods A retrospective analysis of eight consecutive cases was performed aimed at collecting information on laboratory parameters, fluids requirements, operative times, APACHE II score, damage control surgery procedure, angioembolization, morbidity, mortality, and need for repacking. Results Average APACHE II score was 25.5 (predicted mortality rate = 54%); overall and early mortality in the nontraumatic group was nil, while the intra-abdominal septic (packing-related) complication rate was 12.5%. Conclusions Intra-abdominal packing was shown to be feasible, safe, and effective for patients with intra-abdominal nontraumatic massive hemorrhage, and the application of the principles of DCS may improve survival in cases of surgical hemorrhage with development of the lethal triad.
Total mesorectal excision (TME) of the rectum has been advocated as the gold surgical treatment o... more Total mesorectal excision (TME) of the rectum has been advocated as the gold surgical treatment of the middle and low third rectal cancer. Laparoscopy has gained acceptance among surgeons in the treatment of colon malignancies, while scepticism exists about laparoscopic TME in term of safety, and its oncological adequacy. To evaluate the impact of laparoscopic TME on surgical and oncological outcome in a group of consecutive unselected patients. 226 unselected patients with rectal cancer underwent laparoscopic TME from January 1998 to August 2007. Patients staged cT3/4 cTxN+ were submitted to neoadjuvant treatment. Postoperative complications and oncological outcome were registered. Mean distance of the tumour from the anal verge was 6.2+/-2 cm. 48.6% of patients were enrolled in "long-course" neoadjuvant chemo-radiotherapy (partial and complete response rates 72.4% and 20.1%, respectively). Surgical procedures were 202 anterior and 24 abdominal-perineal resections. Mean operative time 245.3+/-58.4 min, mean blood loss 203+/-176 mL. Conversion rate 6.1%. Thirty-days morbidity rate 31.8% without mortality. Anastomotic leaks rate was 16.8%. Reoperation rate 6.6%. Gastrointestinal recovery rate was 3.1+/-1.4 days and hospital stay 10.4+/-4.6 days. Concerning adequacy of oncologic resection, mean distance between tumour and margin of resection was 2.7+/-2 cm with a nodal sampling of 14.4+/-4.6. Six patients (2.6%) had a R1 margin. With a mean follow-up of 39.8 months non port-site metastases occurred. Local recurrence rate was 6.1%. Five years cumulative overall survival was 81% and disease-free survival was 70% (Kaplan-Meier method). Laparoscopic approach for rectal tumour is a technically demanding procedure, but it is safe and it has the feature of an oncologic procedure.
The case of a 58-year-old man with a large midthoracic oesophageal diverticulum and a left diaphr... more The case of a 58-year-old man with a large midthoracic oesophageal diverticulum and a left diaphragmatic relaxation who presented with night regurgitations, abdominal bloating, epigastric burning and a sensation of fullness after meals is reported. The patient underwent a successful thoracotomic diverticulectomy with left diaphragmatic plicature. The postoperative course was uneventful. To our knowledge this is the first reported case of an association between midthoracic oesophageal diverticulum and left diaphragmatic relaxation. Moreover, we hypothesised that the diverticulum was caused by a pulsion mechanism due to obstruction of the distal oesophagus secondary to diaphragmatic relaxation.
An 82-year-old woman, with previous history of hiatal hernia, cholecystectomy and depression, has... more An 82-year-old woman, with previous history of hiatal hernia, cholecystectomy and depression, has been admitted for worsening diffuse abdominal pain with constipation and vomiting for 4 days. She lived alone, without signs of dementia or cognitive impairment. The abdomen was distended and tender in middle quadrants. Abdominal x-ray revealed concentric distension of bowel loops. CT scan confirmed mechanical small bowel obstruction with a transition point in the right iliac fossa. At laparotomy, the obstruction was caused by an intraluminal mass. After enterotomy, a 5.5 cm large phytobezoar was extracted; immediately after, a small live insect jumped out from the vegetable mass crawling onto the surgical area. The specimen was sent for parasitology and identified as a crustacean isopod, terrestrial arthropod, classified in the phylum Arthropoda, subphylum Crustacea and order Isopoda. They usually live in humid, moist conditions, obtaining their nourishment from decomposing vegetable matter. They often colonise in greenhouse pot plants. No cases of parasitisation in vertebrate species have been reported to date.
ABSTRACT Abdominal compartment syndrome (ACS) is defined as an increase of intra-abdominal pressu... more ABSTRACT Abdominal compartment syndrome (ACS) is defined as an increase of intra-abdominal pressure (IAH) to values higher than 20 mmHg, associated with reduced perfusion and organ dysfunction. There is a classification of open abdomen which stratifies patients according to the natural history of improvement or clinical deterioration. The aim of treatment is to maintain the open abdomen at the lowest level and to prevent progression to a more complex level. Surgical treatment essentially consists in abdominal decompression by leaving the abdomen open. Analysis of the literature shows that negative pressure increases the rate of primary fascial closure; entero-cutaneous fistulas are seen in a minority of cases, without seeming consequence of the application of the dressing. Open abdomen management consists of three treatment stages: acute (24-48 hours), intermediate (from 48 hours to 10 days) and late or reconstruction (from 10 days to the final closure). It's important to recognize patients at risk of IAH and the first signs of ACS and intervene early with abdominal decompression if this will establish itself. Management of the open abdomen is now facilitated by negative pressure devices, which positively affect the morbidity and mortality of patients with ACS. Abdominal compartment syndrome, Negative pressure devices, Open abdomen management.
World journal of emergency surgery : WJES, 2014
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging fr... more Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
Ospedali d'Italia - chirurgia
World journal of emergency surgery : WJES, 2014
The journal of trauma and acute care surgery, 2014
S urgical practice is continuously evolving mainly because of technologic developments and better... more S urgical practice is continuously evolving mainly because of technologic developments and better-performing instruments. Recent evolution of technology has dramatically changed the range of available instruments and, subsequently, the therapeutic options that can be offered to patients needing surgical interventions and eventually even emergency surgery.
The Annals of thoracic surgery, 2014
We herein report a case of a 45-year-old white male who referred to the emergency department for ... more We herein report a case of a 45-year-old white male who referred to the emergency department for a right pneumothorax. A chest tube was emergently placed. Due to incomplete lung reexpansion, the patient underwent a right thoracoscopy disclosing the presence of several kinky vessels consistent of localized pleural angiomatosis, and a talc pleurodesis was performed. Computed tomographic scan and angiography confirmed an anomalous vascular connection between systemic and pulmonary circulation. Thus, a vascular percutaneous transcatheter embolization of the abnormal vessel was successfully executed and the patient was discharged without consequence.
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Papers by Salomone Di Saverio