Publications by authors named "Francesco Gabrielli"

Fistula in ano is a common anorectal disease in adults. Currently, surgery remains the definitive therapeutic approach, but in some cases, it can lead to serious complications as faecal or gas incontinence. Therefore, sphincter sparing treatments should be considered for complex fistulas.

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Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure.

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Article Synopsis
  • Acute left colonic diverticulitis (ALCD) in the elderly differs from younger patients in terms of clinical presentation, higher mortality rates during hospitalization and after surgery, and increased risk from geriatric comorbidities.
  • Despite these risks, elderly patients have a lower chance of recurrent episodes and less likelihood of needing urgent surgery if recurrence occurs.
  • A recent workshop in Italy involving various medical organizations sought to develop age-specific guidelines for diagnosing and treating ALCD in older adults, concluding with expert-approved recommendations on diagnosis, management, surgical techniques, and antibiotic treatment.
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Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation.

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Background And Aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes.

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The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis.

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Introduction: Since the 1970s, in the USA, we witnessed a progressive increase of one-day surgical procedures. This attitude soon gained ground in Europe as well. In proctology, this kind of clinical approach has always been limited by the acute sensitivity of the anal- perineal area and by difficulties in attaining a complete sphincter relaxation with local anesthesia.

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Introduction: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions.

Materials And Methods: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception.

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Article Synopsis
  • - Gallstone disease is prevalent, affecting 20 million people in the U.S., with higher incidence in women and older adults, highlighting a growing health concern as the elderly population increases.
  • - The guidelines from a consensus conference aimed to address the treatment of acute calculous cholecystitis (ACC) specifically in elderly patients, noting differences from the general population and evaluating study quality.
  • - Surgical decisions for elderly patients with ACC are complex; while laparoscopic cholecystectomy is recommended, the use of frailty and risk scores can improve clinical judgments, indicating that age alone shouldn't disqualify patients from surgery.
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Up to date, only a small number of carcinomas arising from a chronic anorectal fistula have been described in medical literature, especially in patients without Chron's disease. A 72-year-old man with a 6-year history of discharging perianal sinus without Crohn's disease arrived at our institution. He had previously undergone three surgical procedures in other institutions for incision and drainage of recurrent perianal abscesses.

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Introduction: Accordingly with the new physiopathologic insights of the 70s and 80s, hemorrhoidal disease appears to originate not much from venous hyperplasia but rather from a progressive deterioration of connective and support tissues with subsequent venous and mucosal prolapse. In the late 90s a new surgical technique for a more physiological treatment of hemorrhoids was introduced: stapled prolassectomy.

Materials And Methods: Between October 2017 and June 2018 we performed 50 hemorrhoidal stapled prolassectomies under local-regional anesthesia.

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Anal stenosis is a fibrous narrowing of the anal channel. It develops, in most cases, in the aftermath of proctologic surgical procedures with extensive anoderm excision or in the presence of chronic anal inflammation in patients with Crohn Disease. However rare, this condition is thoroughly debilitating for the patients.

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Introduction: The actual high hospitalization costs have encouraged a growing attention towards reducing hospital stay. Nowadays, many simple surgical procedures are carried out in a one-day surgery regimen . A shorter hospital stay brings many advantages for the patients: lesser inconvenience, a lower risk of hospital infection and an earlier return to work.

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Introduction: Inguinal hernia is one of the most common surgical entities and often poses technical dilemmas, even for the experienced surgeon. Amyand's hernia is an inguinal hernia; a protrusion of abdominal cavity content through the inguinal canal, with a vermiform appendix.

Case Report: A 77 years old Caucasian male was referred to our institution for the evaluation of a recurrent right inguinal hernia.

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Unlabelled: Hemorrhoidal disease is a very common condition requiring surgical management in approximately 10% of cases. Despite its long history and high prevalence, we are still trying to identify the best treatment. Earlier surgical approaches were soon abandoned and now only detain an historic significance.

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Background: Desmoid tumor is a rare soft tissues neoplasia characterized by local invasiveness and by a tendency towards local recurrence although not towards metastasization.

Discussion: Etiology is not clear. Desmoid tumors originate from the monoclonal proliferation of one mesenchymal cell and develop in the context of fascial, muscular and aponeurotic tissue.

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Background: The burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis.

Case Presentation: We present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis.

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The geomorphology of the Italian territory causes the incidence of many disasters like earthquakes and floods, with the consequent production of large volumes of waste. The management of such huge flows, produced in a very short time, may have a high impact on the whole emergency response. Moreover, historical data related to disaster waste management are often not easily accessible; on the other hand, the availability of data concerning previous events could support the emergency managers, that have to take a decision in a very short time.

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This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion.

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Background: We propose a new open mesh hernia repair procedure for the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia.

Methods: From September 2012 to August 2015, 250 consecutive patients were treated with "all in-one" mesh hernioplasty procedure in our Institution. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate.

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Background/objective: In the late's 90' a new surgical treatment, the stapled trans-anal rectal resection (STARR) was born to treat obstructed defecation syndrome (ODS). In this study we retrospectively analyze a series of 450 cases that underwent STARR in 10 years.

Methods: Between January 2001 to December 2011, 450 patients, diagnosed with ODS syndrome caused by rectocele or intussusception, underwent to STARR procedure.

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Introduction: Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues.

Case Report: We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy.

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Aim: To demonstrated the efficacy an safety of a perineal stapled approach to treat the protrusion of the entire layer of the rectum outside the anus in high morbidity patients.

Matherials Of Study: From February 2012 to april 2013, 7 patients (all female, mean age 74,2 years, range 48-88) were operated in our unit with perineal stapled prolapsed resection (PSPR) approach for a full thickness external rectal prolapse.

Results: The duration of hospitalization was 3 days and the follow-up period was 18 months.

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Background: The majority of patients with severe blunt chest trauma is successfully treated with supportive measures and thoracostomy tube; only few cases need urgent thoracotomy. Lung-sparing techniques are treatments of choice but major pulmonary resections are necessary in case of injuries involving hilar vessels or bronchi. Currently the mortality associated with pulmonary lobectomy performed for chest trauma is 40%.

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Background: The diffusion of cross-sectional imaging has recently permitted the detection of an increasing number of incidentalomas localized in the distal pancreas. Currently, there are no studies in the literature exploring the laparoscopic approach as treatment for left-sided pancreatic incidentalomas.

Methods And Results: We report a series of 20 incidentalomas localized in the body and tail of the pancreas treated with laparoscopic surgery over the period 2010-2014.

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