Carlo de Werra | Università degli Studi di Napoli "Federico II" (original) (raw)
Papers by Carlo de Werra
Journal of Clinical Medicine, Aug 26, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Surgical Endoscopy and Other Interventional Techniques, Aug 11, 2020
Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gall... more Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures. Keywords Cholecystectomy • Critical view of safety • Laparoscopy • Bile duct injuries • Intraoperative bleeding • Laparoscopic training Laparoscopic cholecystectomy (LC) is currently and worldwide considered the gold standard for the treatment of gallbladder lithiasis. Since its introduction, in the early 1990s, this procedure has gained a remarkable consensus until becoming a routine surgical procedure. LC is characterized by a reduction in postoperative pain, hospital stay, and recovery times to normal daily activities, which translates into reduced costs for the national healthcare systems (NHS) [1]. However, this procedure comes with an increased incidence of bile duct injuries (BDI), compared to open cholecystectomy (OC): 0.3% and 0.8% vs 0.2% [2-7]. LC-related BDIs include minor injuries up to complex hilar injuries, as classified by Strasberg et al., in which the and Other Interventional Techniques
Annali Italiani Di Chirurgia, 2023
Digestive and Liver Disease, 2005
The involvement of oesophagus in pemphigus vulgaris is still debated. The aims of this study were... more The involvement of oesophagus in pemphigus vulgaris is still debated. The aims of this study were to evaluate the prevalence of oesophageal involvement and the gastro-duodenal mucosa appearance before and after high-dose corticosteroid therapy in a group of patients with oral pemphigus vulgaris. We prospectively studied 28 consecutive patients with oral pemphigus by oesophageal symptom standardised questionnaire, upper gastro-intestinal endoscopy, exfoliative cytology and histological biopsy. After clinical remission, all patients underwent new endoscopy. The prevalence of oesophageal symptoms was 57.1%. Endoscopic examination revealed oesophageal involvement with different degrees of severity in 67.8% of patients. After corticosteroid therapy, endoscopy showed normal oesophageal-gastro-duodenal mucosa. No examination-related exacerbations of the oesophageal lesions were seen. The upper gastro-intestinal endoscopic examination, in oral pemphigus vulgaris patients with oesophageal symptoms, is safe in skilled hands technique and a useful diagnostic tool prior to starting therapy.
Gallbladder - Anatomy, Pathogenesis, and Treatment [Working Title]
Gallbladder carcinoma is a form of cancer that develops in the gallbladder, an organ located bene... more Gallbladder carcinoma is a form of cancer that develops in the gallbladder, an organ located beneath the liver. This condition poses a clinical challenge due to its late diagnosis and aggressive tumor behavior. Risk factors include the presence of gallstones, advanced age, and obesity. Diagnosis of gallbladder carcinoma requires the use of various diagnostic techniques such as ultrasound, computed tomography, and magnetic resonance imaging. Cholecystectomy, the surgical removal of the gallbladder, is the primary treatment for gallbladder carcinoma. However, management and treatment may require a multidisciplinary approach, which can also involve chemotherapy, radiation therapy, and targeted therapies. Increased awareness of this disease is necessary to improve early diagnosis and treatment options, ultimately enhancing survival rates and improving the quality of life for patients with gallbladder carcinoma.
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2009
Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in ab... more Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14.6% of all infections observed in hospitalised patients and 38% of those observed among surgical patients. Strategies for the prevention of SSIs also include surveillance which has proved very effective. The most recent surveillance study carried out at a national level in Italy is Kir-Nos, a multicentric study sponsored by GlaxoSmithKline and performed between April and June 2002 in 32 different General Surgery Units for a total of 2972 surgical patients enrolled. Results emerging from the study clearly indicate that many patients receive inappropriate antimicrobial prophylaxis, especially in terms of drug choice, route and timing of administration. Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to ...
Surgical Endoscopy, 2001
Background: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of t... more Background: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. Methods: A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. Results: Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 ± 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 ± 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n ס 11, 55%), cholecystocolic fistulas (n ס 5, 25%), cholecystojejunal fistulas (n ס 3, 15%), and cholecystogastric fistulas (n ס 1, 5%); in the latter group, cholecystoduodenal fistulas (n ס 8, 5.1%), and cholecystocolic fistulas (n ס 4, 28.6) and cholecystojejunal fistulas (n ס 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in
Irish Journal of Medical Science, May 28, 2022
99° Congresso della Società Italiana di Chirurgia, 1997
COJ Nursing & Healthcare, 2020
Background: Counselling is the psychological aspect and an adequate and sympathetic communication... more Background: Counselling is the psychological aspect and an adequate and sympathetic communication with the patient. It consists in making more comprehensible to the patient his situation and to facilitate him to manage it with the greatest possible autonomy. Purpose: The purpose of our study was to evaluate the effect of the pre-operative nursing counselling in anxiety management, particularly among patients undergoing mutilating surgery. Methods: We selected 80 patients, 43 males and 37 females, who were scheduled for either a radical colorectal or breast cancer surgery. We used a two groups comparative design with an intervention group and a control group. STAI-Y1 test was administered to both groups. We used it to evaluate the pre-and post-operative anxiety and to evaluate the effect of the counseling intervention. Result: We calculated the preoperative and postoperative STAI-Y1 test average score for each group. There was a reduction of postoperative average score compared to preoperative one in both groups. In the intervention group, that received nursing counselling, the reduction of the postoperative average score is greater than in the control group. Conclusion: The analysis of our data shows that nursing counselling has a very important role to reduce anxiety in the surgical patient. We hope that counselling will be a teaching subject during the nursing degree curriculum. Further studies are needed to confirm our data.
Healthcare
Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As the... more Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is usually preferred for cysts extending to the third sacral vertebral body. Conversely, a transabdominal approach is preferred for lesions extending upward to achieve an optimal view of the surgical field and avoid injuries. Case report: Here, we report a case of a 48-year-old man suffering from perianal pain and constipation. Digital rectal examination and magnetic resonance imaging revealed a presacral mass below the third sacral vertebral body. A laparoscopic transabdominal presacral tumor excision was performed. The final histological diagnosis was a rare primary neuroendocrine tumor arising from a tailgut cyst. The postoperative course was uneventful, and no signs of recurrence were...
Journal of Clinical Medicine, Aug 26, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Surgical Endoscopy and Other Interventional Techniques, Aug 11, 2020
Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gall... more Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures. Keywords Cholecystectomy • Critical view of safety • Laparoscopy • Bile duct injuries • Intraoperative bleeding • Laparoscopic training Laparoscopic cholecystectomy (LC) is currently and worldwide considered the gold standard for the treatment of gallbladder lithiasis. Since its introduction, in the early 1990s, this procedure has gained a remarkable consensus until becoming a routine surgical procedure. LC is characterized by a reduction in postoperative pain, hospital stay, and recovery times to normal daily activities, which translates into reduced costs for the national healthcare systems (NHS) [1]. However, this procedure comes with an increased incidence of bile duct injuries (BDI), compared to open cholecystectomy (OC): 0.3% and 0.8% vs 0.2% [2-7]. LC-related BDIs include minor injuries up to complex hilar injuries, as classified by Strasberg et al., in which the and Other Interventional Techniques
Annali Italiani Di Chirurgia, 2023
Digestive and Liver Disease, 2005
The involvement of oesophagus in pemphigus vulgaris is still debated. The aims of this study were... more The involvement of oesophagus in pemphigus vulgaris is still debated. The aims of this study were to evaluate the prevalence of oesophageal involvement and the gastro-duodenal mucosa appearance before and after high-dose corticosteroid therapy in a group of patients with oral pemphigus vulgaris. We prospectively studied 28 consecutive patients with oral pemphigus by oesophageal symptom standardised questionnaire, upper gastro-intestinal endoscopy, exfoliative cytology and histological biopsy. After clinical remission, all patients underwent new endoscopy. The prevalence of oesophageal symptoms was 57.1%. Endoscopic examination revealed oesophageal involvement with different degrees of severity in 67.8% of patients. After corticosteroid therapy, endoscopy showed normal oesophageal-gastro-duodenal mucosa. No examination-related exacerbations of the oesophageal lesions were seen. The upper gastro-intestinal endoscopic examination, in oral pemphigus vulgaris patients with oesophageal symptoms, is safe in skilled hands technique and a useful diagnostic tool prior to starting therapy.
Gallbladder - Anatomy, Pathogenesis, and Treatment [Working Title]
Gallbladder carcinoma is a form of cancer that develops in the gallbladder, an organ located bene... more Gallbladder carcinoma is a form of cancer that develops in the gallbladder, an organ located beneath the liver. This condition poses a clinical challenge due to its late diagnosis and aggressive tumor behavior. Risk factors include the presence of gallstones, advanced age, and obesity. Diagnosis of gallbladder carcinoma requires the use of various diagnostic techniques such as ultrasound, computed tomography, and magnetic resonance imaging. Cholecystectomy, the surgical removal of the gallbladder, is the primary treatment for gallbladder carcinoma. However, management and treatment may require a multidisciplinary approach, which can also involve chemotherapy, radiation therapy, and targeted therapies. Increased awareness of this disease is necessary to improve early diagnosis and treatment options, ultimately enhancing survival rates and improving the quality of life for patients with gallbladder carcinoma.
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2009
Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in ab... more Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14.6% of all infections observed in hospitalised patients and 38% of those observed among surgical patients. Strategies for the prevention of SSIs also include surveillance which has proved very effective. The most recent surveillance study carried out at a national level in Italy is Kir-Nos, a multicentric study sponsored by GlaxoSmithKline and performed between April and June 2002 in 32 different General Surgery Units for a total of 2972 surgical patients enrolled. Results emerging from the study clearly indicate that many patients receive inappropriate antimicrobial prophylaxis, especially in terms of drug choice, route and timing of administration. Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to ...
Surgical Endoscopy, 2001
Background: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of t... more Background: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. Methods: A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. Results: Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 ± 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 ± 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n ס 11, 55%), cholecystocolic fistulas (n ס 5, 25%), cholecystojejunal fistulas (n ס 3, 15%), and cholecystogastric fistulas (n ס 1, 5%); in the latter group, cholecystoduodenal fistulas (n ס 8, 5.1%), and cholecystocolic fistulas (n ס 4, 28.6) and cholecystojejunal fistulas (n ס 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in
Irish Journal of Medical Science, May 28, 2022
99° Congresso della Società Italiana di Chirurgia, 1997
COJ Nursing & Healthcare, 2020
Background: Counselling is the psychological aspect and an adequate and sympathetic communication... more Background: Counselling is the psychological aspect and an adequate and sympathetic communication with the patient. It consists in making more comprehensible to the patient his situation and to facilitate him to manage it with the greatest possible autonomy. Purpose: The purpose of our study was to evaluate the effect of the pre-operative nursing counselling in anxiety management, particularly among patients undergoing mutilating surgery. Methods: We selected 80 patients, 43 males and 37 females, who were scheduled for either a radical colorectal or breast cancer surgery. We used a two groups comparative design with an intervention group and a control group. STAI-Y1 test was administered to both groups. We used it to evaluate the pre-and post-operative anxiety and to evaluate the effect of the counseling intervention. Result: We calculated the preoperative and postoperative STAI-Y1 test average score for each group. There was a reduction of postoperative average score compared to preoperative one in both groups. In the intervention group, that received nursing counselling, the reduction of the postoperative average score is greater than in the control group. Conclusion: The analysis of our data shows that nursing counselling has a very important role to reduce anxiety in the surgical patient. We hope that counselling will be a teaching subject during the nursing degree curriculum. Further studies are needed to confirm our data.
Healthcare
Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As the... more Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is usually preferred for cysts extending to the third sacral vertebral body. Conversely, a transabdominal approach is preferred for lesions extending upward to achieve an optimal view of the surgical field and avoid injuries. Case report: Here, we report a case of a 48-year-old man suffering from perianal pain and constipation. Digital rectal examination and magnetic resonance imaging revealed a presacral mass below the third sacral vertebral body. A laparoscopic transabdominal presacral tumor excision was performed. The final histological diagnosis was a rare primary neuroendocrine tumor arising from a tailgut cyst. The postoperative course was uneventful, and no signs of recurrence were...