SICE è una società da sempre attenta alla produzione scientifica diretta ed indiretta: questo per permettere a tutti i professionisti del settore medico, siano essi nostri soci o meno, di potere avere un valido supporto nello svolgimento della propria quotidiana attività, attraverso la stesura di documenti scientifici che non rappresentino singoli particolarismi, ma che siano invece espressione di un’unica voce da parte della comunità chirurgica italiana ed internazionale.
Ciò ha portato alla produzione – seppure non si tratti di vere e proprie Linee Guida – di Documenti di Consenso, che potete trovare di seguito elencati.
Sono attualmente in corso da parte della SICE ulteriori produzioni scientifiche in collaborazione con altre Società italiane e straniere (fluorescenza, diverticolosi e diverticolite, chirurgia dell’obesità).
In caso di necessità di ulteriori approfondimenti, non esitare ad inviare una e.mail con la tua richiesta alla nostra Segreteria (email@example.com), evidenziando in oggetto “Richiesta assistenza Linee Guida”.
La nostra conoscenza è a tua disposizione.
Gianluca Costa · Pietro Fransvea · Mauro Podda · Adolfo Pisanu · Francesco Maria Carrano · Angelo Iossa · Genoveffa Balducci · Ferdinando Agresta· the ERASO (Elderly Risk Assessment and Surgical Outcome) Collaborative Study Group
As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.
Emanuela Foglia, Lucrezia Ferrario, Chiara Gerardi, Umberto Nocco, Ferdinando Agresta, Gabriele
Anania, Alberto Arezzo, Gianluca Baiocchi, Alberto Biondi, Marco Augusto Bonino, Elisa Cassinotti,
Luca Cindolo, Roberto Cirocchi, Giuseppe Currò, Federico Davini, Ugo Elmore, Alessandra Marano,
Sarah Molfino, Beatrice Molteni, Rossella Onofrio, Riccardo Rosati, Wanda Petz, Karol Polom,
Michele Tringali, Luigi Boni, Gianfranco Silecchia, Nereo Vettoretto
Negli ultimi anni, importanti sono stati gli sviluppi della qualità di immagine in chirurgia
laparoscopica. L’uso di sistemi ad alta definizione e tridimensionali hanno migliorato le prestazioni
del chirurgo e la sicurezza del paziente (Kunert et al., 2013, Wilhelm et al., 2014). Grazie a questi
sistemi sempre più avanzati, si delinea la possibilità di avere immagini di alta qualità e
visualizzazioni da diverse angolazioni, capaci di ridurre ulteriormente i rischi legati agli errori
Proprio all’interno delle innovazioni tecnologiche destinate a un miglioramento della qualità
dell’immagine in fase intra-operatoria, recentemente, la tecnologia di visione e di orientamento
basata sull’iniezione di verde di indocianina (ICG), visualizzata mediante speciali filtri ottici, si sta
diffondendo come metodica vantaggiosa in diversi setting chirurgici, in tutta Europa (Schaafsma et
al,. 2011; Boni et al. 2017). Si tratta nello specifico di un mezzo di contrasto, iniettato in endovena,
sottomucosa, sottosierosa o intradermica, che, in seguito all’assorbimento di una fonte luminosa
NIR (700-900nm), diventa fluorescente emettendo radiazioni a lunghezza d’onda NIR (800nm).
Nonostante la sua comprovata efficacia, come strumento in grado di migliorare la qualità
dell’immagine, fornendo informazioni anatomiche dettagliate durante l’intervento chirurgico, con
conseguenti benefici in termini di outcome del paziente (Schaafsma et al., 2011; Verbeek et al.,
2014; Reinhart et al., 2015; Handgraaf et al., 2016; Boni et al., 2017), tuttavia manca una
validazione della tecnologia con valutazione e sintesi di evidenze in grado di definire la
sostenibilità e i vantaggi correlati all’utilizzo di ICG all’interno del contesto ospedaliero a 360 gradi.
Diviene prioritario quindi, comprendere non solo le evidenze, ma validarne la loro affidabilità e
replicabilità all’interno di contesti differenti, nonché comprendere l’utilizzabilità e applicabilità
della nuova metodica all’interno della pratica clinica quotidiana, definendo, attraverso un
approccio multidimensionale, impatti, vantaggi ed eventuali svantaggi, così da poter guidare al
meglio la scelta dei policy maker.
Tutti i Paesi Europei in questo momento, non solo il nostro contesto nazionale, hanno, come
obiettivo primario, quello di colmare questa area grigia della conoscenza, per attuare le adeguate
politiche di pianificazione sanitaria e comprendere l’esigenza e/o l’opportunità di poter investire
denaro pubblico, mettendo, così, in atto, uno switch tecnologico, ma basato su una metodica
adeguata alle richieste di sistema, non solo a livello nazionale, ma anche internazionale, nonché
rigoroso da un punto di vista scientifico.
Il fine ultimo è rappresentato dall’opportunità di generare delle informazioni consolidate e
validate da un punto di vista tanto scientifico, quanto operativo, per valutare l’effettiva validità
della tecnologia, ma soprattutto per esplicitarne il valore per la struttura ospedaliera e per il
paziente, informazione non ancora disponibile da un punto di vista generale.
Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo‑colic side‑to‑side anastomosis - Gabriele Anania1,2 · Ferdinando Agresta3 · Elena Artioli1,2 · Serena Rubino1,2 · Giuseppe Resta1,2 · Nereo Vettoretto4 · Wanda Luisa Petz5 · Carlo Bergamini6 · Alberto Arezzo7 · Giorgia Valpiani8 · Chiara Morotti8 · Gianfranco Silecchia9 · SICE CoDIG (Colon Dx Italian Group)
Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment
of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis.
The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with
the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes.
Methods One hundred and twenty-fve Surgical Units experienced in colorectal and advanced laparoscopic surgery were
invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic
characteristics, surgical technique and postoperative outcomes were collected through the ofcial SICE website database.
One thousand two hundred and twenty-fve patients were enrolled between March 2018 and September 2018.
Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled
in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA
and 50.7% for ECA; no signifcant diference was found according to patients’ characteristics and technologies used. Median
hospital stay was signifcantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was
signifcantly lower in ICA group.
Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently
adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study
confrmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain.
Trial registration Clinical trial (Identifer: NCT03934151).
Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT,Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE. European Hernia Society guidelines on prevention and treatment of parastomal hernias. 2017 Nov 13. doi: 10.1007/s10029-017-1697-5. [Epub ahead of print] Review. PubMed PMID: 29134456.
Hernia. 2018 Feb;22(1):183-198. doi: 10.1007/s10029-017-1697-5. Epub 2017 Nov 13.
European Hernia Society guidelines on prevention and treatment of parastomal
Antoniou SA(1), Agresta F(2), Garcia Alamino JM(3), Berger D(4), Berrevoet F(5),
Brandsma HT(6), Bury K(7), Conze J(8)(9)(10), Cuccurullo D(11), Dietz UA(12),
Fortelny RH(13), Frei-Lanter C(14), Hansson B(15), Helgstrand F(16), Hotouras
A(17), Jänes A(18), Kroese LF(19), Lambrecht JR(20), Kyle-Leinhase I(21),
López-Cano M(22), Maggiori L(23), Mandalà V(24), Miserez M(25), Montgomery A(26),
Morales-Conde S(27), Prudhomme M(28), Rautio T(29), Smart N(30), Śmietański
M(31)(32), Szczepkowski M(33)(34), Stabilini C(35), Muysoms FE(21).
(1)Department of General Surgery, University Hospital of Herakion, Crete, Greece.
(2)Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy.
(3)Nuffield Department of Primary Care Health Sciences, University of Oxford,
Oxford, Oxfordshire, UK.
(4)Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum
Mittelbaden/Balg, Baden-Baden, Germany.
(5)Department of General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium.
(6)Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK.
(7)Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk,
(8)Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany.
(9)Herniacenter Dr. Muschaweck/Dr. Conze, London, UK.
(10)Department of General, Visceral and Transplant Surgery, University Hospital,
RWTH Aachen University, Aachen, Germany.
(11)Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi,
Azienda Ospedaliera dei Colli, Naples, Italy.
(12)Department of General, Visceral, Vascular and Pediatric Surgery, University
Hospital of Wuerzburg, Wuerzburg, Germany.
(13)Certified Hernia Center, Department of General, Visceral and Oncological
Surgery, Wilhelminenspital, Vienna, Austria.
(14)Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
(15)Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The
(16)Department of Surgery, Zealand University Hospital, Køge, Denmark.
(17)National Bowel Research Centre, The Royal London Hospital, London, United
(18)Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
(19)Department of Surgery, Erasmus University Medical Center, Rotterdam,
(20)Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway.
(21)Department of Surgery, Maria Middelares Hospital, Ghent, Belgium.
(22)Abdominal Wall Surgery Unit, Department of General Surgery, Hospital
Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
(23)Department of Colorectal Surgery, Beaujon Hospital, Assistance
publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
(24)Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy.
(25)Department of Abdominal Surgery, University Hospitals Leuven, Leuven,
(26)Department of Surgery, Skåne University Hospital, Malmö, Sweden.
(27)University Hospital Virgen del Rocío, Sevilla, Spain.
(28)Digestive Surgery Department, CHU Nîmes, Nîmes, France.
(29)Department of Surgery, Division of Gastroenterology, Medical Research Center,
Oulu University Hospital, Oulu, Finland.
(30)Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter
Hospital, Exeter, UK.
(31)2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland.
(32)Department of General Surgery and Hernia Centre, District Hospital in Puck,
(33)Department of Rehabilitation, Józef Piłsudski University of Physical
Education in Warsaw, Warsaw, Poland.
(34)Clinical Department of General and Colorectal Surgery, Bielanski Hospital,
(35)Department of Surgery, University of Genoa, Genoa, Italy.
BACKGROUND: International guidelines on the prevention and treatment of
parastomal hernias are lacking. The European Hernia Society therefore implemented
a Clinical Practice Guideline development project.
METHODS: The guidelines development group consisted of general, hernia and
colorectal surgeons, a biostatistician and a biologist, from 14 European
countries. These guidelines conformed to the AGREE II standards and the GRADE
methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature
through OpenGrey were searched. Quality assessment was performed using Scottish
Intercollegiate Guidelines Network checklists. The guidelines were presented at
the 38th European Hernia Society Congress and each key question was evaluated in
a consensus voting of congress participants.
RESULTS: End colostomy is associated with a higher incidence of parastomal
hernia, compared to other types of stomas. Clinical examination is necessary for
the diagnosis of parastomal hernia, whereas computed tomography scan or
ultrasonography may be performed in cases of diagnostic uncertainty. Currently
available classifications are not validated; however, we suggest the use of the
European Hernia Society classification for uniform research reporting. There is
insufficient evidence on the policy of watchful waiting, the route and location
of stoma construction, and the size of the aperture. The use of a prophylactic
synthetic non-absorbable mesh upon construction of an end colostomy is strongly
Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M. Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference. Surg Endosc. 2015 Sep;29(9):2463-84.
1. Surg Endosc. 2015 Sep;29(9):2463-84. doi: 10.1007/s00464-015-4293-8. Epub 2015 Jul 3.
Laparoscopic ventral/incisional hernia repair: updated Consensus Development
Conference based guidelines [corrected].
Silecchia G(1), Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L,
Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M.
(1)Division of General Surgery and Bariatric Centre of Excellence, Department of
Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via
Faggiana 1668, 04100, Latina, LT, Italy.
Surg Endosc. 2015 Sep;29(9):2485.
BACKGROUND: The Executive board of the Italian Society for Endoscopic Surgery
(SICE) promoted an update of the first evidence-based Italian Consensus
Conference Guidelines 2010 because a large amount of literature has been
published in the last 4 years about the topics examined and new relevant issues.
METHODS: The scientific committee selected the topics to be addressed:
indications to surgical treatment including special conditions (obesity,
cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of
intraperitoneal meshes (synthetic and biologic); fixing devices
(absorbable/non-absorbable); abdominal border and parastomal hernia;
intraoperative and perioperative complications; and recurrent ventral/incisional
hernia. All the recommendations are the result of a careful and complete
literature review examined with autonomous judgment by the entire panel. The
process was supervised by experts in methodology and epidemiology from the most
qualified Italian institution. Two external reviewers were designed by the EAES
and EHS to guarantee the most objective, transparent, and reliable work. The
Oxford hierarchy (OCEBM Levels of Evidence Working Group*. “The Oxford 2011
Levels of Evidence”) was used by the panel to grade clinical outcomes according
to levels of evidence. The recommendations were based on the grading system
suggested by the GRADE working group.
RESULTS AND CONCLUSIONS: The availability of recent level 1 evidence (a
meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair
is an acceptable alternative to the open repair, but also it is advantageous in
terms of shorter hospital stay and wound infection rate. This conclusion appears
to be extremely relevant in a clinical setting. Indications about specific
conditions could also be issued: laparoscopy is recommended for the treatment of
recurrent ventral hernias and obese patients, while it is a potential option for
compensated cirrhotic and childbearing-age female patients. Many relevant and
controversial topics were thoroughly examined by this consensus conference for
the first time. Among them are the issue of safety of the intraperitoneal mesh
placement, traditionally considered a major drawback of the laparoscopic
technique, the role for the biologic meshes, and various aspects of the
laparoscopic approach for particular locations of the defect such as the
abdominal border or parastomal hernias.
PMID: 26139480 [Indexed for MEDLINE]
Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M; on the behalf of The Italian Surgical Societies Working Group. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg. 2015 Apr 8. [Epub ahead of print] PubMed PMID: 25850631.
Langenbecks Arch Surg. 2015 May;400(4):429-53. doi: 10.1007/s00423-015-1300-4.
Epub 2015 Apr 8.
Laparoscopic cholecystectomy: consensus conference-based guidelines.
Agresta F(1), Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P,
Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G,
Barlera S, Davoli M; Italian Surgical Societies Working Group.
Collaborators: Ricciardelli L, Belli F, Brandara F, Cantore F, Capizzi D,
Carlomagno N, Carrara A, Ciccorti L, Cillara N, Esposito MG, Feroci F, Fiume S,
Gilio F, Guercioni G, Indiani D, Lazzaro L, Luridiana G, Mannino L, Maglione V,
Masci E, Miranda G, Motter M, Nigro F, Perna F, Piccolo D, Prando D, Rizzuto A,
Sallustio P, Serventi F, Vadalà S, Virzì C, Rasi M, Arru A, Mutignani M,
Scaglione M, Scaramuzza G.
(1)Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard technique
for gallbladder diseases in both acute and elective surgery. Nevertheless,
reports from national surveys still seem to represent some doubts regarding its
diffusion. There is neither a wide consensus on its indications nor on its
possible related morbidity. On the other hand, more than 25 years have passed
since the introduction of LC, and we have all witnessed the exponential growth of
knowledge, skill and technology that has followed it. In 1995, the EAES published
its consensus statement on laparoscopic cholecystectomy in which seven main
questions were answered, according to the available evidence. During the
following 20 years, there have been several additional guidelines on LC, mainly
focused on some particular aspect, such as emergency or concomitant biliary tract
METHODS: In 2012, several Italian surgical societies decided to revisit the
clinical recommendations for the role of laparoscopy in the treatment of
gallbladder diseases in adults, to update and supplement the existing guidelines
with recommendations that reflect what is known and what constitutes good
practice concerning LC.
PMID: 25850631 [Indexed for MEDLINE]
Piccoli M, Agresta F, Trapani V, Nigro C, Pende V, Campanile FC, Vettoretto N, Belluco E, Bianchi PP, Cavaliere D, Ferulano G, La Torre F, Lirici MM, Rea R, Ricco G, Orsenigo E, Barlera S, Lettieri E, Romano GM; Italian Surgical Societies Working Group. Clinical competence in the surgery of rectal cancer: the Italian Consensus Conference. Int J Colorectal Dis. 2014 Jul;29(7):863-75. doi: 10.1007/s00384-014-1887-x. Epub 2014 May 13. Erratum in: Int J Colorectal Dis. 2014 Aug;29(8):1029. multiple author names corrected. PubMed PMID:
Int J Colorectal Dis. 2014 Jul;29(7):863-75. doi: 10.1007/s00384-014-1887-x. Epub
2014 May 13.
Clinical competence in the surgery of rectal cancer: the Italian Consensus
Piccoli M, Agresta F, Trapani V, Nigro C, Pende V, Campanile FC, Vettoretto N,
Belluco E, Bianchi PP, Cavaliere D, Ferulano G, La Torre F, Lirici MM, Rea R,
Ricco G, Orsenigo E, Barlera S, Lettieri E, Romano GM; Italian Surgical Societies
Collaborators: Sartori CA, Mele A, Casciola L, Corcione F, D’Annibale A, De
Manzini N, Doglietto GB, Leo E, Lezoche E, Marino I, Melotti G, Morino M,
Presenti L, Prete F, Pugliese R, Romano GM, Santoro E, Spinoglio G, Trompetto M.
(1)Department of General and Emergency Surgery, NOCSAE, Modena, Italy.
Int J Colorectal Dis. 2014 Aug;29(8):1029. multiple author names corrected.
BACKGROUND AND AIM: The literature continues to emphasize the advantages of
treating patients in “high volume” units by “expert” surgeons, but there is no
agreed definition of what is meant by either term. In September 2012, a Consensus
Conference on Clinical Competence was organized in Rome as part of the meeting of
the National Congress of Italian Surgery (I Congresso Nazionale della Chirurgia
Italiana: Unità e valore della chirurgia italiana). The aims were to provide a
definition of “expert surgeon” and “high-volume facility” in rectal cancer
surgery and to assess their influence on patient outcome.
METHOD: An Organizing Committee (OC), a Scientific Committee (SC), a Group of
Experts (E) and a Panel/Jury (P) were set up for the conduct of the Consensus
Conference. Review of the literature focused on three main questions including
training, “measuring” of quality and to what extent hospital and surgeon volume
affects sphincter-preserving procedures, local recurrence, 30-day morbidity and
mortality, survival, function, choice of laparoscopic approach and the choice of
transanal endoscopic microsurgery (TEM).
RESULTS AND CONCLUSION: The difficulties encountered in defining competence in
rectal surgery arise from the great heterogeneity of the parameters described in
the literature to quantify it. Acquisition of data is difficult as many articles
were published many years ago. Even with a focus on surgeon and hospital volume,
it is difficult to define their role owing to the variability and the quality of
the relevant studies.
PMID: 24820678 [Indexed for MEDLINE]
Hernia. 2013 Oct;17(5):557-66. doi: 10.1007/s10029-013-1055-1. Epub 2013 Feb 12.
Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the
first Italian Consensus Conference.
Cuccurullo D(1), Piccoli M, Agresta F, Magnone S, Corcione F, Stancanelli V, Melotti G.
(1)Department of Surgery, Monaldi Hospital, Naples, Italy.
PURPOSE: The laparoscopic treatment of ventral incisional hernias is the object
of constant attention and is becoming increasingly widespread in the
international scientific-surgical community; however, there is ample debate on
its technical details and indications. In order to establish a common approach on
laparoscopic ventral incisional hernia repair, the first Italian Consensus
Conference was organized in Naples (Italy) on 14-15 January 2010.
METHODS: The format of the Consensus Conference was freely adapted from the
standards of the National Institute of Health and the Italian Health Institute.
The parties involved included the followings: a Promotional Committee, a
Scientific Committee, a group of Experts, the Jury Panel and a Scientific
RESULTS: Eleven statements, regarding three large chapters on the indications,
the technical details and the management of complications were drafted on the
basis of literature references collected by the Scientific Committee, documents
developed by the Experts, reports presented and discussed during the Consensus
Conference, and discussion among the members of the Jury.
CONCLUSIONS: The laparoscopic approach is safe and effective for defects larger
than 3 cm in diameter; old age, obesity, previous abdominal operations,
recurrence and strangulation are not absolute contraindications. Ensuring an
adequate overlap, careful adhesiolysis and correct fixing of the prosthesis are
among the technical details recommended. Complications and recurrences are
comparable to, and in some cases, less numerous than with the open approach.
PMID: 23400528 [Indexed for MEDLINE]
Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2012 Aug;26(8):2134-64. doi: 10.1007/s00464-012-2331-3. Epub 2012 Jun 27. PubMed PMID: 22736283.
Surg Endosc. 2012 Aug;26(8):2134-64. doi: 10.1007/s00464-012-2331-3. Epub 2012
Laparoscopic approach to acute abdomen from the Consensus Development Conference
of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE),
Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia
(SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società
Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European
Association for Endoscopic Surgery (EAES).
Agresta F(1), Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M,
Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G,
Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D,
Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S,
(1)Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli
Etruschi, 9, 45011 Adria, RO, Italy. firstname.lastname@example.org
BACKGROUND: In January 2010, the SICE (Italian Society of Endoscopic Surgery),
under the auspices of the EAES, decided to revisit the clinical recommendations
for the role of laparoscopy in abdominal emergencies in adults, with the primary
intent being to update the 2006 EAES indications and supplement the existing
guidelines on specific diseases.
METHODS: Other Italian surgical societies were invited into the Consensus to form
a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other
stakeholders involved in abdominal emergencies were invited along with a
patient’s association. In November 2010, the panel met in Rome to discuss each
chapter according to the Delphi method, producing key statements with a grade of
recommendations followed by commentary to explain the rationale and the level of
evidence behind the statements. Thereafter, the statements were presented to the
Annual Congress of the EAES in June 2011.
RESULTS: A thorough literature review was necessary to assess whether the
recommendations issued in 2006 are still current. In many cases new studies
allowed us to better clarify some issues (such as for diverticulitis, small bowel
obstruction, pancreatitis, hernias, trauma), to confirm the key role of
laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific
abdominal pain, appendicitis), but occasionally previous strong recommendations
have to be challenged after review of recent research (such as for perforated
CONCLUSIONS: Every surgeon has to develop his or her own approach, taking into
account the clinical situation, her/his proficiency (and the experience of the
team) with the various techniques, and the specific organizational setting in
which she/he is working. This guideline has been developed bearing in mind that
every surgeon could use the data reported to support her/his judgment.
PMID: 22736283 [Indexed for MEDLINE]