Giacomo Sarzo

Publications (12)5.85 Total impact

• Article: Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?

  L Polese, M Vecchiato, A C Frigo, G Sarzo, R Cadrobbi, R Rizzato, A Bressan, S Merigliano
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  ABSTRACT: The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated. Patient characteristics, indications for surgery, surgical technique and postoperative complications were prospectively recorded. Stenosis was evaluated by rectoscopy at regular intervals, and patients were treated only if symptomatic. After at least 6 months following surgery, patients were asked to respond to the Short Form 36-item quality-of-life questionnaire during a telephone interview. Of the original 211 patients considered, 195 underwent a follow-up rectoscopy and were included in the study. Benign stenosis were found in 26 (13%), and 19 (73%) symptomatic patients were treated successfully (15 with endoscopic dilatation and four with radial diathermic surgical incisions). Risk factors for anastomotic stenosis according to univariate analysis were female sex, diverticulitis, mechanical anastomosis, and anastomosis located between 8 and 12 cm from the anal verge. The significant risk factors identified by multivariate analysis were diverticulitis (OR 5, P=0.002) and mechanical anastomosis (OR 9, P=0.04). The self-perceived quality of life of patients with stenosis was significantly worse compared with controls. Since diverticulitis and mechanical anastomosis are risk factors for anastomotic stenosis, surgeons should take this into account when they are considering what type of anastomotic technique to utilize.
  Colorectal Disease 09/2011; 14(3):e124-8. · 2.93 Impact Factor
• Article: Extensive anal condylomatosis: prognosis in relation to viral and host factors.

  G Sarzo, A Del Mistro, A Mistro, C Finco, H Frayle-Salamanca, F Marino, M Franzetti, R Ferrara, M Mistrangelo, S Savastano, M Vecchiato, S Merigliano
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  ABSTRACT: To evaluate the clinical course of extensive anal condylomatosis in relation to treatment modalities, patient comorbidity and immune function, and associated papillomavirus (HPV) sequences. Clinical data, treatment modalities and follow-up were recorded and analysed in relation to host and viral type. Histology, immunohistochemistry and molecular analyses for HPV search and typing were performed on formalin-fixed paraffin-embedded samples. Sixteen patients [14 males, median age 41.8 years (range 19-66)] affected by extensive anal condylomatosis [10 Buschke-Lowenstein Tumors (BLT) and 6 condylomatosis] treated in three different Italian institutions were included. There was associated preoperative anal intraepithelial neoplasia grade 3 (AIN3) in one and invasive carcinoma in three patients. After radical resection (n = 16) recurrence occurred in 4/10 (40%) BLT patients. Malignancy before or after treatment developed in 5/16 (31.25%) patients. HPV sequences were present in all the samples of 15 evaluable patients (types 6 or 11, 9 patients; type 16, 6 patients). A statistically significant association was found between presence of HPV type 16 and both malignancy and recurrence. Viral variant L83V was present in 3/4 HPV 16 positive recurrent cases. Radical resection resulted in a favourable clinical course. Typing of HPV sequences in the management of patients affected by extensive anal condylomatosis may be useful.
  Colorectal Disease 05/2009; 12(7 Online):e128-34. · 2.93 Impact Factor
• Article: Surgery for obstructed defecation in over 65 year old patients

  Silvia Savastano, Massimo Vecchiato, Giacomo Sarzo, Mario Gruppo, Roberto Cadrobbi, Elisa Marcellan, Isabella Mondi, Francesco Cavallin, Giuseppina Bazzolo, Stefano Merigliano
  BMC Geriatrics. 01/2009;
• Article: Anterior laparoscopic rectal resection for cancer in the elderly: long-term outcome, risk factors and health related quality of life

  Massimo Vecchiato, Silvia Savastano, Giacomo Sarzo, Roberto Cadrobbi, Mario Gruppo, Isabella Mondi, Francesco Cavallin, Giuseppina Bazzolo, Elisa Marcellan, Stefano Merigliano
  BMC Geriatrics. 01/2009;
• Article: Immediate and Long-Term Complications of Prolonged-Venous-Access Devices (PVAD): A Comparison Between Surgical Cutdown and Percutaneous Techniques

  Giacomo Sarzo, Cristiano Finco, Paolo Parise, Silvia Savastano, Giuseppe Portale, Massimo Vecchiato, Stefano Degregori, Stefano Merigliano
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  ABSTRACT: There is currently still no consensus regarding the best technique for implanting prolonged-venous-access devices (PVAD). One hundred ninety-six patients underwent surgical PVAD positioning using an all-surgical cutdown approach to the cephalic vein (CV). When surgical cannulation proved impossible, the patient was converted to percutaneous positioning. A retrospective analysis was performed on the difference between these two techniques. Among the 196 patients who underwent the surgical insertion of a PVAD, 23 (11.7%) were converted to percutaneous cannulation. For the surgical cannulation group, the median operating time was 35 minutes vs the 52.5 minutes needed for the percutaneous cannulation group. The median time of fluoroscopy amounted to eight seconds for the surgical cannulation group vs 18 seconds for the percutaneous cannulation group. Complications were observed in 23/196 patients (11.7%): 9/23 patients (39.1%) developed infections. Deep venous thrombosis was observed in 4/23 patients (17.4%). Pneumothorax and arterial hematoma developed in 5/23 patients (21.7%), all cases of percutaneous placement. PVAD malfunction was observed in 3/23 patients (13.0%). We concluded that surgical cutdown is faster than the percutaneous approach and safer for both patient and surgeon, involving a shorter time of exposure to radiation and reducing the risk of infection.
  International Journal of Angiology 11/2004; 13(4):203-209.
• Source

  Available from: Silvia Savastano

  Article: Laparoscopic-assisted resection is safe and effective for colorectal malignancies: a single-centre experience.

  Paolo Parise, Giacomo Sarzo, Cristiano Finco, Silvia Savastano, Massimo Vecchiato, Stefano Degregori, Stefano Merigliano
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  ABSTRACT: The aim of the study was to evaluate laparoscopic-assisted colorectal resection for malignancies in terms of effectiveness, safety and medium-term survival, comparing our results with those reported in literature. From November 2000 to March 2004, 78 patients with colorectal malignancies underwent laparoscopic-assisted resection. All anastomoses were performed extracorporeally. Where indicated, patients underwent pre- or post-operative chemo-radiotherapy. All patients were followed up at regular intervals for a mean period of 18 months (2-42). The conversion rate was 14.1% and mean intraoperative blood loss was 120 cc. The post-operative morbidity rate was 15.3%. The mean number of lymph nodes removed was 12 (3-38) and all resection margins were clear and adequate. The observed overall and "disease-free" survival rates were similar to those reported in literature. Although the body of evidence needs to be increased, our findings and the data in the literature suggest that laparoscopic-assisted resection for colorectal malignancies is safe and effective, also in the medium and long term.
  Chirurgia italiana 56(6):811-6.
• Article: Insertion of prolonged venous access device: a comparison between surgical cutdown and percutaneous techniques.

  Giacomo Sarzo, Cristiano Finco, Paolo Parise, Silvia Savastano, Massimo Vecchiato, Stefano Degregori, Stefano Merigliano
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  ABSTRACT: The use of totally implantable prolonged venous access devices (TIPVAD) in chemotherapy for oncological patients is now consolidated practice, whereas the choice between surgical cutdown and the percutaneous technique is still a controversial matter. The aim of this study was to retrospectively evaluate the validity and safety of the surgical approach by comparison with percutaneous techniques. Over a period of 17 months, 106 patients (mainly oncological cases) underwent surgical cutdown for TIPVAD placement in the cephalic vein. During a mean follow-up of 8 months (range 1-21), we evaluated the surgical and management complications and compared them with reported results obtained with the percutaneous technique. We observed a lower incidence of pneumothorax, 2 cases of malfunction due to kinking, and no catheter fractures, while management complications were similar to the findings in the literature. In expert hands, the surgical approach is a fast, safe technique with a lower rate of intraoperative complications than the percutaneous approach and less discomfort for the patient. Adequate training of medical and paramedical staff is the most important factor in making TIPVAD reliable and safe in the long term.
  Chirurgia italiana 56(3):437-42.
• Article: Role of transperineal Doppler and ultrasound in evaluating anal sphincter injury after stapled haemorrhoidopexy.

  Giacomo Sarzo, Cristiano Finco, Paolo Parise, Silvia Savastano, Stefano Degregori, Filippo Marino, Francesco Candiani, Stefano Merigliano
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  ABSTRACT: The stapler treatment first described by Longo is considered by some authors to be a good technical solution for mucohaemorrhoidectomy. The aim of the present prospective study was to assess the function and morphology of the internal and external anal sphincters preoperatively and one month after surgery by means of a clinical examination, anorectal manometry and transperineal ultrasound. Ten patients (6 M, 4 F) underwent rectal mucosal prolapsectomy according to Longo. Anoscopy, anorectal manometry and transperineal ultrasound were performed in all patients preoperatively and again one month after surgery. The thickness and integrity of the internal and external anal sphincters were ascertained and colour Doppler was performed to assess the presence, quantity and size of any haemorrhoid swellings. All anatomical specimens underwent histological examination in search of smooth muscle fibres. Anorectal manometry revealed no postoperative sphincter tone defects. Transperineal ultrasound detected no postoperative sphincter lesions and the presence of venous swellings (always present at preoperative colour Doppler) never persisted at postoperative follow-up. The mean follow-up was 52.7 days (range: 31-151). Transperineal ultrasound proved useful in demonstrating the lifting of the mucohaemorrhoid prolapse within the ampulla of the rectum one month after surgery. The Longo procedure, in our albeit limited experience, caused no sphincter lesions.
  Chirurgia italiana 56(1):99-105.
• Article: Giant condyloma acuminatum of the anorectum (Buschke-Lowenstein tumour): a case report of conservative surgery.

  Paolo Parise, Giacomo Sarzo, Cristiano Finco, Filippo Marino, Silvia Savastano, Stefano Merigliano
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  ABSTRACT: Giant condyloma acuminatum of the anorectum (Buschke-Lowenstein tumour) is a rare interesting infectious disease caused by the papillomavirus serotypes 16 and 18. In January 2002 a 47-year-old heterosexual male presented with Buschke-Lowenstein tumour and reported having had the disease for 12 years. The patient underwent thorough screening for sexually-transmitted diseases (which proved negative), abdominal CT, transanal US-endoscopy, inguinal ultrasound, chest X-ray and anorectal manometry, which revealed only localized disease. He was treated conservatively with radical local excision of the lesions. No postoperative complications were observed. Twelve months after surgery, there has been no local or remote recurrence and faecal continence is normal. The treatment of choice for Buschke-Lowenstein tumour is controversial; there is no evidence to support the need for demolitive surgery or chemo- and/or radiotherapy. The majority of authors prefer abdominoperineal amputation, but in our opinion conservative surgery is the best choice, especially in terms of the patient's quality of life.
  Chirurgia italiana 56(1):157-61.
• Article: [Advantages of surgical treatment of hemorrhoids with mechanical sutures].

  Cristiano Finco, Giacomo Sarzo, Paolo Parise, Silvia Savastano, Stefano Merigliano
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  ABSTRACT: The use of circular staplers for the treatment of haemorrhoids is a new technique that makes for better correction of the physiopathology of the condition, affords greater patient comfort and reduces health-care expenditure. This technique, which was invented by A. Longo in 1993, pulls up the haemorrhoidal cushions into their anatomical position, reduces or avoids postoperative pain, sparing the sensitive fibres of the anal canal, avoids anal canal stenosis and is not complicated by faecal incontinence. The authors present their experience in 41 patients affected by symptomatic haemorrhoidal prolapse and treated with a mucosal rectal prolapsectomy using a circular stapler. Each patient was followed up for 6 months to assess the incidence of complications and the degree of patient satisfaction. The results were compared with those reported in the literature, obtained using the Milligan-Morgan procedure. The Longo technique, which can be performed in the one-day surgery setting, allows very good relief of postoperative pain, rapid functional recovery and an early return to work, with a saving in health-care expenditure as compared with conventional treatment.
  Chirurgia italiana 54(6):835-9.
• Article: Selection criteria for surgery in patients with obstructed defecation, rectocele and anorectal prolapse.

  Cristiano Finco, Barbara Luongo, Silvia Savastano, Francesca Polato, Giacomo Sarzo, Valentina Caruso, Franca De Lazzari, Stefano Merigliano
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  ABSTRACT: The aim of this study was to evaluate the impact of applying strict selection criteria to patients with symptoms of obstructed defecation, rectocele and rectal prolapse who were candidates for surgery. From June 2001 to September 2003, 20 patients underwent surgery in our clinic for symptomatic rectocele and anorectal prolapse. They were evaluated prospectively using a dedicated questionnaire (KESS), a proctological and gynaecological examination, colpo-cysto-defecography and anorectal manometry before surgery and 6 months postoperatively. Strict selection criteria were used for surgery. After 6 months the questionnaire showed an important improvement in symptoms. The symptoms of obstructed defecation and vaginal bulging improved significantly. The average KESS score dropped from 17.65 preoperatively to 5.8 six months after surgery. In the treatment of pelvic floor disease, it is important to evaluate both the uro-gynaecological and the proctological symptoms with the utmost care, obtaining an accurate clinical picture with the aid of dedicated questionnaires and a thorough clinical examination. Evaluation of the effectiveness of surgery for constipation necessarily includes assessing the strength of the indications for surgery, irrespective of the surgical technique adopted, but there is currently no standardised test method for recording and comparing the symptoms of constipation.
  Chirurgia italiana 59(4):513-20.
• Article: Colitis cystica profunda of the rectum: report of a case and review of the literature.

  Giacomo Sarzo, Cristiano Finco, Paolo Parise, Massimo Vecchiato, Silvia Savastano, Barbara Luongo, Stefano Degregori, Paolo Bocus, Filippo Marino, Alessandro Poletti, Franca De Lazzari, Stefano Merigliano
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  ABSTRACT: Colitis cystica profunda is a rare intestinal lesion. Because of its clinical expression (rectorrhagia, mucorrhea and abdominal pain) and the way it appears to current imaging techniques this disease presents features which can be associated with colon neoplasm. Its diagnosis has to be confirmed histologically, and its etiology remains unclear. The following is a case report of colitis cystica profunda recurring 20 years after a first episode in a white woman, who had had an anterior resection of the sigmoid colon and upper rectum to deal with a colitis cystica profunda-induced stenosis of the sigmoid colon and at 41 underwent the transanal removal of a polypoid lesion. A review of 20 cases in the literature showed that colitis cystica profunda has a predilection for the male and generally affects the medial and lower rectum and the sigmoid colon. The literature also confirmed the association with ulcerative rectocolitis, Crohn's disease and rectal prolapse. The type of treatment varies from surgical, medical, and endoscopic to no treatment at all.
  Chirurgia italiana 57(6):789-98.