Updates in Surgery – serie

This comprehensive, multi-authored book covers all aspects of surgery on obese patients in emergency conditions. Obesity is a metabolic disease affecting a high percentage of world population..

In the past, liver resections and liver transplantations were performed by different surgical teams, with very little interplay between the two. However, the evolution toward more complex operations called for an increasingly intense interaction between these surgical techniques: split liver and living donor liver transplantation have become popular in the transplant community, utilizing the Coinaud segmental anatomy in a very sophisticated way, while portal and arterial resection and reconstruction have become indispensable methods for treating Klatskin tumors infiltrating the hepatic hilum.  This book offers a complete overview of the connections between liver transplantation and hepatobiliary surgery. It focuses on ex situ techniques for resection of tumors at the suprahepatic confluence, with or without venous reconstruction, and on total vascular exclusion of the liver with the aid of a venovenous bypass that should be a surgical option for referral centers in hepatopancreatobiliary surgery. By taking into consideration the development of minimally invasive liver surgery, it will introduce readers to a variety of new perspectives such as: vascular exclusion techniques with or without extracorporeal circulation, hemodynamic implications and lessons learned from liver transplant surgery, and technical details on pediatric transplantation and its informative role in modern biliary tract surgery.

In the last decade, the clinical management of melanoma has become more effective: basic clinical studies, randomized clinical trials, and new drugs have greatly improved the prognosis of patients, both in the initial and in the advanced stage of the disease.This book offers a wide and up-to-date overview of the multidisciplinary treatment of melanoma. Among the topics discussed, there are the role of sentinel lymph node biopsy and the radical dissection, following the results of international randomized clinical trials, in particular MSLT-II. The last chapters are focused on new medical treatments in adjuvant, neoadjuvant, and metastatic settings. The volume has been written for all the professionals involved in melanoma treatment, such as general surgeons, surgical oncologists, medical oncologists, dermatologists, radiotherapists, and nuclear medicine physicians.

The book offers a comprehensive review of the relations between volumes and outcomes in oncological surgery especially in Italian hospitals, based on national and regional data.

This book offers an overview of acute care surgery around the world, focusing on the four main branches of this novel subdiscipline: trauma, general emergencies, critical care, and rescue surgery. The book’s primary goal is to provide a general view of acute care surgery, while addressing the most important issues in depth.The content is divided into three parts, the first of which is dedicated to the general organization of trauma centers, including the composition of modern trauma teams. Protocols of activation and action for the trauma team, as well as damage control procedures both in the emergency room and in the surgical theatre, are described. The book also addresses the development of a trauma registry, together with the quality assessment process that can be applied.In turn, the second part describes the principal protocols for making diagnoses, with special attention to circumstances such as unstable hemodynamics, neurological deterioration, normal vital signs, and penetrating injuries. The book subsequently deals with the most important aspects of trauma to the abdomen, chest, and pelvis, with notes on both surgical and intensive care issues. Practical descriptions of how to treat principal injuries to various organs are also provided.Finally, the third part of the book is dedicated to the most frequent general surgical emergencies and rescue surgical approaches, and includes information on diagnostic support with point of care ultrasound and endoscopic advanced techniques. Presenting cutting-edge strategies, this book will be of interest to professionals involved in surgical and intensive care for emergency conditions, such as colonic perforations, obstructions, acute pancreatitis, biliary tree stones, and caustic injuries.

Twenty-five years ago, a monograph on gastric cancer was published by the Italian Society of Surgery: that book is recognized as a milestone in the management of these tumors in Italy.

This open access book describes the latest advances in the anal incontinence diagnostic and therapeutic processes. This volume will help the surgeons community to keep abreast of developments in diagnostics and treatment of this impairing condition.

This open access book offers a comprehensive review of hepatocellular carcinoma (HCC) with a particular focus on the pathobiology and clinical aspects of the disease, including diagnosis and treatment.

This open access book on thyroid surgery has been authored by an international team of contributors who present a comprehensive understanding of both benign and malignant thyroid disorders.

This is an open access book. Colorectal surgery is one of the most performed procedures in dedicated colorectal and general surgery units worldwide. In the last two decades, the minimally invasive laparoscopic approach has become very popular worldwide, attracting great interest among patients (lower risk of infection, less pain, and faster recovery) and demonstrating excellent oncological results.Technology is improving rapidly, offering revolutionary innovations, particularly with the advent of robotic surgery, which offers important advantages over laparoscopy for both surgeons and patients: improved ergonomics, wristed instruments, and a better vision. These advantages may be particularly useful for more complex and challenging situations (complete mesocolic excision, low rectal cancer, one-stage treatment of colorectal and liver metastases, etc.), translating into potential improved surgical and oncological results. Although several books have been published on the subject, the great interest in robotic surgery makes it mandatory, in our opinion, to have a general update in view of the latest technical innovations and the results of the most relevant and recent literature.The book is divided into chapters dealing with the different colorectal segments with their robotic surgical operations and specific technical variants. The new frontiers of benign and emergency colorectal diseases are also considered, as well as the new robotic platforms recently introduced in the healthcare market. Some of them, such as the da Vinci SP single port device, may represent a revolutionary approach for this surgery. Training and cost aspects were also considered.

Infections in surgery, commonly known as surgical site infections (SSIs), are complications that may occur after a surgical procedure. SSIs represent a serious problem leading to increased morbidity, mortality, and healthcare costs, highlighting the need for continued efforts to improve surgical practices and reduce their incidence.Several factors can contribute to the development of SSIs: patient-related factors (such as obesity, advanced age, diabetes, immunosuppression, pre-existing infections etc.); preoperative preparation-related factors (such as incomplete skin antisepsis or failure to administer appropriate antibiotic prophylaxis); microbial contamination (despite sterile techniques, microorganisms can infect the surgical site); surgical procedure-related factors (duration and complexity of the surgeries); postoperative care-related factors (such as inadequate wound care or infection control measures).To prevent SSIs, healthcare facilities implement various strategies, including: optimization of patients’ conditions before surgery; preoperative antibiotic prophylaxis; strict sterile technique; postoperative wound care; surveillance and monitoring to identify and address SSIs early, preventing their spread and complications.Despite the evidence supporting the effectiveness of best practices, many clinicians fail to implement them, and evidence-based practices that optimize both the prevention and treatment of SSIs tend to be underused, highlighting the importance of ongoing research and improvement in surgical techniques and infection control practices.This open access book provides a practical toolkit for surgeons and intensivists to improve their daily clinical practices in order to reduce the risk of SSIs.

Dissemination of knowledge is the best and only strategy capable of improving clinical management in rare and ultra-rare malignancies, including primary adrenal malignancies.

This is an open access book on the pathophysiology, diagnosis and surgical techniques of functional diseases of the esophagus. In the past, these diseases were only studied and treated in a few centres.

This open access book on Surgery in Uremic Patients is a comprehensive guide for general surgeons about the management of the most  prevalent surgical challenges and procedures in patients with renal failure. It covers preoperative assessment, anesthetic considerations, postoperative care, and specialized procedures. The book emphasizes understanding uremia's impact on organ systems for informed decision-making. It discusses anesthetic strategies tailored to uremic patients, postoperative complications, and preventive measures like managing infections and fluid imbalances. Specialized procedures such as dialysis access surgery are detailed, along with integrating technology into modern surgical practices. Common surgeries like appendectomy, hernia repair, and cholecystectomy are optimized to minimize complications. Upper and lower gastrointestinal surgeries, hepatobiliary surgery, urological surgery, transplant surgery, endocrinosurgery, bariatric surgery, geriatric surgery, and abdominal emergencies are thoroughly covered. The book concludes with key findings, clinical implications, and future research avenues, serving as a valuable resource for surgeons and students enhancing their approach to uremic patient care.

This open access book on Geriatric Surgery is an invaluable resource for healthcare professionals managing elderly surgical patients. It provides essential guidance to improve patient outcomes, optimize surgical decision-making, and enhance perioperative care. Older adults often have multiple comorbidities, altered physiological responses, and increased surgical risks. This manual equips surgeons and clinicians with evidence-based protocols to minimize complications such as infections, delirium, and poor wound healing. It also highlights best practices in prehabilitation, anesthesia considerations, and postoperative recovery strategies tailored to elderly patients.Surgical decision-making in geriatric patients is complex due to factors like frailty, cognitive impairment, and life expectancy. This well-structured manual outlines risk assessment models, such as the Frailty Index and Comprehensive Geriatric Assessment (CGA), ensuring a patient-centered approach that balances surgical benefits against potential risks. Modern geriatric surgery relies on collaboration between surgeons, anesthesiologists, geriatricians, physiotherapists, and dietitians. Our manual facilitates this teamwork by providing integrated care pathways, nutritional guidelines, and rehabilitation protocols to improve recovery and reduce hospital stays.For medical trainees and general surgeons, this geriatric surgery manual serves as an educational tool to understand the unique challenges of operating on older adults. It includes case studies, clinical algorithms, and practical recommendations that enhance their skills and decision-making abilities. By implementing best practices, hospitals can reduce complications, ICU admissions, and readmissions, ultimately cutting healthcare costs while improving patient quality of life. In summary, this geriatric surgery manual is crucial in providing structured, evidence-based guidance for optimizing surgical care in older adults, leading to better outcomes and more efficient healthcare delivery.

This open access book is a comprehensive and cutting-edge resource that provides a multidisciplinary, evidence-based approach to the management of complex abdominal wall defects. Offering a structured and practical guide to advanced surgical techniques, patient optimization, and emerging technologies, it is an essential reference for surgeons dealing with challenging cases.Organized into four sections, the book begins with fundamental principles, covering the pathophysiology of abdominal wall defects, risk stratification, and the role of prehabilitation in optimizing surgical outcomes. It then explores state-of-the-art surgical techniques, including robotic, laparoscopic, and component separation methods, as well as the use of biologic, synthetic, and hybrid meshes. Complex clinical scenarios such as infected mesh, enterocutaneous fistulas, and hernia repair in high-risk patients are addressed in detail. The final section delves into innovative technologies, including regenerative medicine and enhanced recovery after surgery (ERAS), highlighting future directions in the field.Designed for general and specialized surgeons, surgical trainees, and researchers interested in hernia repair and abdominal wall reconstruction, this book integrates practical surgical guidance with the latest scientific advancements. As part of the Springer Nature “Updates in Surgery” series, it ensures global accessibility, allowing a broad audience to benefit from the latest developments in complex abdominal wall surgery.

Incisional hernia surgery has witnessed an important progress over the last years, not only as far as the pathophysiological and etiopathogenetic aspects are concerned, but also from a technical point of view. Thanks to the recent findings on genetical disorders of the collagen, incisional hernia is today considered a true "disease of the abdominal wall". Surgeons need to be aware of all the different repairing techniques, in order to make an elective choice and to keep side effects and recidives under control. Today, on the basis of the most recent research on synthesis of collagen and collagenolysis, the treatment of the incisional hernia should not disregard the use of synthetic prostheses and of biomaterials, both in the routinal surgical practice and in the most complex clinical cases. Surgeons, surgical residents, and medical students will find this volume very useful in their daily practice.

In recent years the improvements in non- invasive diagnostic imaging modalities, a better understanding of liver anatomy, the improvements of preoperative optimisation of liver function (preoperative biliary drainage, portal vein embolization), the increased safety of liver surgery have gradually improved the outcome.

Pancreatic diseases are a crucial issue not only because of their epidemiological significance, and their anatomical and metabolic complexity, but also because of the different treatment options available and their implications for surgery. Due to the slow but steady increase in the incidence of pancreatitis and pancreatic cancer, these diseases are today a real challenge for the surgeon. This volume presents the state of the art of surgery in the treatment of inflammatory and neoplastic pancreatic diseases, describing in detail the different approaches and their most relevant technical aspects. Also described are conventional and interventional radiology, operative endoscopy and endoscopic ultrasonography (which has recently acquired a diagnostic role), and adjuvant and neoadjuvant therapy for treatment or palliation: for only a multidisciplinary approach can produce a global vision, a winning strategy for the optimization of results. Along with the texts, all written by experts, the volume includes color images and drawings. It will prove itself a very useful tool in clinical practice.

Surgery continues to be the most effective treatment of solid tumors in terms of recovery, while its combination with other treatments improves the survival curves especially in the advanced forms of the disease. The aim of my task first of all has been to provide readers with both the current and constantly evolving pathophysiologic knowledge required for building the foundation of a specific education enabling surgeons to meet the fundamental targets in surgical oncology. Secondly, this volume aims to present an update on the real possibilities offered by the cooperation between surgeon and pathologist and by chemotherapy, radiotherapy and gene therapy in the treatment of tumors in the light of the most recent scientific achievements. Lastly, the report presents the experiences and cases drawn mostly from our School regarding some of the major issues in oncologic surgery.This overview does not pretend to elucidate or to summarize all aspects of oncologic surgery, but rather to be the result of a general consideration on cancer surgery, on its rational bases, on its interaction with other treatment modalities, on its desirable and expected developments and on its probable future evolution.

Two to three decades ago, multiple primary malignancies (MPM) were considered to be simply a clinical curiosity, with sporadic reports, mostly single case descriptions, found in the literature. While in the last few years, analyses of larger series have been published, the number of cases has still been relatively small and most of the reports have addressed a single type of primary tumor and its associations. With the improved prognosis and survival of cancer patients, MPM is becoming increasingly prevalent in this population, necessitating a better understanding of the characteristics and associations of the malignancies involved. Thus, as a prerequisite, a universal definition and an internationally accepted classification system, based on chronological, pathological, clinical, and other parameters, are needed. Moreover, much remains to be learned about the etiology of MPM, whether genetic, iatrogenic, or environmental.Several of the hereditary syndromes, such as familial adenomatous polyposis, hereditary non-polyposis colorectal cancer, hereditary breast-ovarian cancer, and multiple endocrine neoplasia, are already well-known and their characteristics in relation to MPM must be kept in mind.Nonetheless, along with these syndromes, there are sporadic and apparently casual associations between primary neoplasms that can involve almost any part of the body. This volume points out the clinical aspects of MPM and discusses the diagnostic and therapeutic problems that are encountered in treating these patients. "DNA-guided" surgery, currently confined to the treatment of patients with hereditary syndromes, will, along with other novel treatment strategies, no doubt play an increasingly greater role in the therapy of MPM. This work presents state-of-the-art information about MPM that is aimed at a broad range of medical specialists, including surgeons, endoscopists, oncologists, and geneticists,. The goal is to improve our understanding of this group of diseases as well the treatment of these patients.

Crohn's disease is an inflammatory bowel disease, whose symptoms are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis; it can therefore be difficult to diagnose. Its knowledge and understanding have increased considerably in the last years; new advances in genetics, medical and surgical management offer today new possibilities for patients suffering from an inflammatory bowel disease. However, Crohn's disease remains a difficult disease to deal with, both from a research and clinical point of view.This book provides general practitioners with a basic knowledge of the disease, offering in the same time an update on new facts about Crohn's disease to specialists. It can also be useful for residents willing to develop a deeper knowledge of inflammatory bowel diseases.

Oncological surgeons are often requested in their clinical practice to identify and manage uncommon and complex situations. It is therefore of the utmost importance that they are well aware of the most recent technological evolutions, in order to achieve the best possible results in term of oncological outcome, with a concern on quality of life and economical issues. Furthermore, new techniques can give a fundamental contribution in overcoming the limitations of standard approaches.An essential aim of this book is to underline the great importance and the need of an effective coordination of multi-disciplinary care among surgeons, medical oncologists, radiation therapists, plastic surgeons and ancillary services, in order to optimise patient outcome.

Pancreatic diseases are a crucial issue not only because of their epidemiological significance, and their anatomical and metabolic complexity, but also because of the different treatment options available and their implications for surgery. Due to the slow but steady increase in the incidence of pancreatitis and pancreatic cancer, these diseases are today a real challenge for the surgeon. This volume presents the state of the art of surgery in the treatment of inflammatory and neoplastic pancreatic diseases, describing in detail the different approaches and their most relevant technical aspects. Also described are conventional and interventional radiology, operative endoscopy and endoscopic ultrasonography (which has recently acquired a diagnostic role), and adjuvant and neoadjuvant therapy for treatment or palliation: for only a multidisciplinary approach can produce a global vision, a winning strategy for the optimization of results.Along with the texts, all written by experts, the volume includes color images and drawings. It will prove itself a very useful tool in clinical practice.

Surgery continues to be the most effective treatment of solid tumors in terms of recovery, while its combination with other treatments improves the survival curves especially in the advanced forms of the disease.The aim of my task first of all has been to provide readers with both the current and constantly evolving pathophysiologic knowledge required for building the foundation of a specific education enabling surgeons to meet the fundamental targets in surgical oncology. Secondly, this volume aims to present an update on the real possibilities offered by the cooperation between surgeon and pathologist and by chemotherapy, radiotherapy and gene therapy in the treatment of tumors in the light of the most recent scientific achievements. Lastly, the report presents the experiences and cases drawn mostly from our School regarding some of the major issues in oncologic surgery.This overview does not pretend to elucidate or to summarize all aspects of oncologic surgery, but rather to be the result of a general consideration on cancer surgery, on its rational bases, on its interaction with other treatment modalities, on its desirable and expected developments and on its probable future evolution.

In 2006, when my colleague Andrea Renda proposed multiple primary malignancies (MPM) as the subject of the Biennial Report to the 2008 Congress of the Italian - ciety of Surgery, I, together with the Steering Committee, quickly agreed. Recent progress in our understanding of the etiopathology of these neoplasms has led to - novative and significant progress on the clinical level. Importantly, the incidence of the onset of two or more tumors in the same patient suggests a more than casual - lationship. Furthermore, the occurrence of MPM derives from several different me- anisms—viral, iatrogenic, immunologic, environmental, and hereditary—such that any form of treatment must take into account the etiology of these tumors. After an epidemiological introduction, this monograph analyzes various aspects of multitumoral syndromes based on the experience of the Department of Surgical Sciences, along with that of other clinical departments of the University Federico II of Naples. In the discussion of inherited tumors, reference is made to the series of patients treated at the Department of Surgery at the University of Siena. The many topics that comprise this volume range from carcinogenesis to diagnostic strategies, and from epidemiology to innovations in imaging and endoscopic techniques. Among the clinical aspects, particular emphasis is given to sporadic and hereditary syndromes, as these patients are frequently treated by general surgery departments.

The 20th century has finished, the century when surgery took huge steps forward thanks to progress in technology. Now we have entered the "century of biotechnologies", which will not only generate progress in surgery, but also lead to a real "cultural revolution" that will completely change approaches to solving different problems in medicine. The aim of this book is to bring surgeons closer to biotechnologies and to overcome the cultural gap dividing them from these new approaches. Biotechnologies are already proposed and used at different levels in surgical practice: in diagnostic technique, enabling practitioners to identify diseases at an early stage and follow their molecular modification over time; and in tissue engineering, where the use of "smart scaffolds" offers a possible answer to increasing demand for biocompatible tissues and organs in transplantation surgery. This volume focuses on the emerging field of stem cells, analyzing both their role as possible players in originating and perpetuating cancer – "cancer stem cells" – and, conversely, their extraordinary therapeutical potential. An additional section is dedicated to the evaluation and application of derived molecular factors that can enhance the physiological processes that are fundamentally important in surgery, such as hemostasis and wound healing. Surgeons have always been technologists, in the sense that since surgery began they have always needed technology, beginning with a scalpel and surgical instruments. They have always cooperated with technologists. However, in the new century, the first one of the millennium, a rapid increase in knowledge that is outside the realm of the surgeon’s traditional technological training is imposing itself – hence the aim of this book. It is now urgent to encourage surgeons to embrace this knowledge (biotechnology) with confidence. By its very nature, biotechnology is completely different from the technologies used so far, because it escapesthe senses of sight and touch, which up to now have been the essence of the surgeon’s work. The cellular and molecular dimensions of biotechnologies are still far removed from most of the recent advances in modern surgical techniques. A common language between surgeons and biotechnologists will create further, revolutionary, progress in surgical sciences in the twenty-first century.

Surgery is the gold standard treatment of colorectal liver metastases. Patients management had a dramatic evolution during the past years: more accurate diagnostic tools and more effective chemotherapy regimens have been introduced and surgical indications have been widely broadened. A multidisciplinary treatment is now mandatory, involving oncologists, radiologists an gastroenterologists. However, many topics are still debated. In the present book all aspects of surgical treatment of colorectal liver metastases are analyzed based on a systematic, updated analysis of the literature. Aim of this book is to provide surgeons, oncologists and radiologists a clear overview of the state-of-the-art of treatment of colorectal liver metastases.

This is the first time a book about laparoscopy in emergency abdominal surgery has been published. Numerous articles have been published in specific surgical journals, but, until now, there has not been a book that collates all the aspects of this little-known field. The aim of this volume is to achieve a complete and easy presentation of all the implications associated with laparoscopy in emergency abdominal surgery. The book should be a manual that can be easily consulted by digestive, general, and specialized surgeons, especially in an emergency. The authors’ contributions are founded on evidence-based medicine, which give the book scientific credibility, but this is coupled with their experience of daily practice, which adds an important complementary dimension to evidence-based medicine. This is balanced by an emphasis on clarity and accessibility, because the ultimate aim of the book is educational. We hope this book will be frequently consulted, in depth, not only by specialistpractitioners, but also by undergraduate students, new graduates and surgeons in training.