Surgical management protocol during the COVID-19 pandemic in an Italian non-referral center.

BACKGROUND: In the surgical scenario, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion worldwide entails on the one hand the need to continue to perform surgery at least in case of emergency or oncologic surgery, in patients with or without COronaVIrus Disease 2019 (COVID-19); and on the other hand, to avoid the pandemic diffusion both between patients and medical and nursing team. The aim of this study was to report our surgical management protocol during the COVID-19 pandemic in an Italian non-referral center. METHODS: Data retrieved during the outbreak for the COVID-19 pandemic, from March 8 to May 4, 2020 (study period) were analyzed and compared to data obtained during the same period in 2019 (control period). RESULTS: During the study period, 41 surgical procedures (24 electives, 17 emergency surgical procedures) underwent surgery in comparison to 99 procedures in the control period. Stratifying the procedures in elective and emergency surgery, and based on the indication for surgery, the only statistically significant difference was observed in the elective surgery regarding the abdominal wall surgery (0 vs. 13 procedures, P=0.0339). Statistically significant differences were not observed regarding the colorectal and the breast oncologic surgery. All stuff members were COVID-19 free. CONCLUSIONS: The present protocol proved to be safe and useful to prevent SARS-CoV-2 infection before and after surgery for both patients and stuff. The pandemic was responsible for the reduction in number of procedures performed, anyway for the oncologic surgery a statistically significant volume reduction in comparison to 2019 was not observed.

PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial.

PURPOSE: This multicenter randomized study was designed to compare the clinical and functional results of stapled transanal rectal resection (STARR) performed with 2 staplers (PPH-01 vs. PPH-03) in the treatment of hemorrhoidal disease associated with a large internal rectal prolapse. METHODS: From a total of 937 patients, referred for hemorrhoidal disease in the 20 centers involved in the study, 425 (45.3%) with prolapsed hemorrhoids associated with a large internal rectal prolapse were randomized to undergo STARR with PPH-01 or PPH-03. Postoperative evaluation was made at 3, 6, and 12 months. RESULTS: The incidence of bleeding at the stapled line was significantly lower in the PPH-03 group than in the PPH-01 group (58/207 [28.0%] vs. 145/201 [72.1%]; P < .0001); the mean number of hemostatic stitches was significantly higher in the PPH-01 than in the PPH-03 group (3.2 ± 0.1 vs. 1.8 ± 0.8; P < .0001). The mean operative time was 25.1 ± 11.5 minutes in the PPH-03 group and 38.1 ± 15.7 minutes in the PPH-01 group (P < .0001). No major complications occurred in either of the groups. At 12-month follow-up, the success rate in the 2 groups was 94.5% in the PPH01 group and 94.2% in the PPH03 group. CONCLUSION: STARR performed for the treatment of hemorrhoidal disease associated with a large rectal prolapse is a safe and effective procedure. The use of the PPH-03 stapler instead of the PPH-01 guarantees a statistically significant reduction of intraoperative bleeding and a significant decrease of the operative time.

Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis. Clinical and instrumental study.

BACKGROUND/AIMS: Unsatisfactory functional results have been reported not only after coloanal anastomosis, but also after anterior resection with colorectal anastomosis. The aim of this study is to establish functional outcome predictive factors related to surgical technique and especially the real impact of residual rectum length to identify patients who could benefit from colonic pouch reconstruction. METHODOLOGY: Sphincter preservation was achieved in 214 of 327 patients who underwent surgery for rectal cancer. Patients have been subdivided according to the level of anastomosis measured by a rigid proctoscope from the anal verge. In 93 patients functional results have been assessed by clinical control and anorectal manometry. RESULTS: Functional alterations such as leakage (13%), incontinence (5%), urgency (5%) and difficulty in evacuation (10%) appeared in patients who underwent anterior resection with anastomosis 4 to 6 cm from the anal verge. Nevertheless, comparing anterior resection with anastomosis 6 to 8 cm and that with anastomosis 4 to 6 cm rectal compliance was the only parameter whose difference is statistically significant. CONCLUSIONS: This result makes us to believe that patients who undergo anterior resection with no more than 2-3 cm of residual rectum could benefit from a colonic pouch reconstruction.