ABSTRACT
Purpose : Preliminary evidences from the literature, together with our everyday clinical practice and patients reporting, led us to hypothesize that dry eye (DED) symptoms related to some COVID-19 mitigation measures might be a common problem and a relevant issue. We designed this study in order to assess and to monitor DED symptoms' changes from 2019 to 2021, in both DED patients and healthy subjects, and to investigate their relationship with homeworking and facemask wearing. Methods : We retrospectively reviewed the medical records of patients who, between November and December 2019 (V19), had undergone an eye exam including quantification of Ocular Surface Disease Index (OSDI) score at the Eye Clinic San Giuseppe Hospital, Milan. Between November and December 2020, we performed a telephone survey (V20) contacting these patients. The survey was repeated between November and December 2021 (V21). The telephone survey included the OSDI 12-items and a custom-made questionnaire exploring type of job or occupation, home working, screen time, type and average time of face mask-wearing, and recent onset and worsening of DED-related symptoms. We investigated the difference among V21, V20 and V19 DED symptoms, the rate of subjects with OSDI increase > OSDI minimal clinically important difference (MCID), and associations between DED symptoms, face masks wearing, VDT usage and home working. Results : Of 120 subjects with V19 OSDI≤12, 43 (36%) and 39 (32%) showed OSDI>12 at V20 and at V21, respectively. OSDI was significantly correlated with duration of face masks use (V20 r= 0.29;P<0.01. V21 r= 0.23;P<0.01) and heavy mask users had a significantly higher OSDI (P<0.05). V20 and V21 OSDI was significantly higher in home-workers (P<0.05) but we did not find a significant correlation between V21 OSDI and referred number of VDT use (r= 0.07;P=0.41). Of 70 patients with V19 OSDI>12, 18 (26%) and 24 (34%) showed symptoms worsening >MCID at V20 and V21, respectively. The percentage of OSDI worsening >MCID was significantly higher among heavy face masks users (73% vs 12%;P<0.01, Fisher test). The percentage of OSDI worsening >MCID was significantly higher in home workers at V20 but not at V21. Conclusions : Some COVID-19 mitigation strategies seem to have a significant role in triggering DED symptoms onset or worsening. This issue persisted during the second pandemic year, with weaker correlation to presumed trigger factors.
ABSTRACT
BACKGROUND: Minimally invasive Ivor Lewis esophagectomy (MIILE) provides better outcomes than open techniques, particularly in terms of post-operative recovery and pulmonary complications. However, in addition to requiring advanced technical skills, thoracoscopic access makes it hard to perform esophagogastric anastomosis safely, and the reported rates of anastomotic leak vary from 5 to 16%. Several minimally invasive esophago-gastric anastomotic techniques have been described, but to date strong evidence to support one technique over the others is still lacking. We herein report the technical details and preliminary results of a new robot-assisted hand-sewn esophago-gastric anastomosis technique. METHODS: From January 2018 to December 2020, 12 cases of laparoscopic/thoracoscopic Ivor Lewis esophagectomy with robot-assisted hand-sewn esophago-gastric anastomosis were performed. The gastric conduit was prepared and tailored taking care of vascularization with a complete resection of the gastric fundus. The anastomosis consisted of a robot-assisted, hand-sewn four layers of absorbable monofilament running barbed suture (V-lock). The posterior outer layer incorporated the gastric and esophageal staple lines. RESULTS: The post-operative course was uneventful in nine cases. Two patients developed chyloperitoneum, one patient a Sars-Cov-2 infection, and one patient a late anastomotic stricture. In all cases, there were no anastomotic leaks or delayed gastric conduit emptying. The median post-operative stay was 13 days (min 7, max 37 days); the longest in-hospital stay was recorded in patients who developed chyloperitoneum. CONCLUSION: Despite the small series, we believe that our technique looks to be promising, safe, and reproducible. Some key points may be useful to guarantee a low complications rate after MIILE, particularly regarding anastomotic leaks and delayed emptying: the resection of the gastric fundus, the use of robot assistance, the incorporation of the staple lines in the posterior aspect of the anastomosis, and the use of barbed suture. Further cases are needed to validate the preliminary, but very encouraging, results.