G Romano

Publications (10)24.84 Total impact

• Article: Laparoscopic surgery for colorectal cancer: clinical practice guidelines of the Italian Society of Colo-Rectal Surgery

  C. A. Sartori, A. D’Annibale, G. Cutini, C. Senargiotto, D. D’Antonio, A. Dal Pozzo, M. Fiorino, G. Gagliardi, B. Franzato, G. Romano
  Techniques in Coloproctology 04/2012; 11(2):97-104. · 1.29 Impact Factor
• Article: A nationwide audit of the use of radiotherapy for rectal cancer in Italy.

  G Gagliardi, S Pucciarelli, C R Asteria, A Infantino, G Romano, B Cola, P De Nardi, M Brulatti, M Lambertini, E Contessini-Avesani, [......], F F Selvaggi, C Eccher, G D'Ambrosio, F Galeotti, E Jovine, I Demma, A Fianchini, G Ambrosino, L M Casentino, M Fiorino
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  ABSTRACT: There is good evidence that radiotherapy is beneficial in advanced rectal cancer, but its application in Italy has not been investigated. We conducted a nationwide survey among members of the Italian Society of Colo-Rectal Surgery (SICCR) on the use of radiation therapy for rectal cancer in the year 2005. Demographic, clinical and pathologic data were retrospectively collected with an online database. Italy was geographically divided into 3 regions: north, center and south which included the islands. Hospitals performing 30 or more surgeries per year were considered high volume. Factors related to radiotherapy delivery were identified with multivariate analysis. Of 108 centers, 44 (41%) responded to the audit. We collected data on 682 rectal cancer patients corresponding to 58% of rectal cancers operated by SICCR members in 2005. Radiotherapy was used in 307/682 (45.0%) patients. Preoperative radiotherapy was used in 236/682 (34.6%), postoperative radiotherapy in 71/682 (10.4%) cases and no radiotherapy in 375 (55.0%) cases. Of the 236 patients who underwent preoperative radiotherapy, only 24 (10.2%) received short-course radiotherapy, while 212 (89.8%) received long-course radiotherapy. Of the 339 stage II-III patients, 159 (47%) did not receive any radiotherapy. Radiotherapy was more frequently used in younger patients (P < 0.0001), in patients undergoing abdominoperineal resection (APR) (P < 0.01) and in the north and center of Italy (P < 0.001). Preoperative radiotherapy was more frequently used in younger patients (P < 0.001), in large volume centers (P < 0.05), in patients undergoing APR (P < 0.005) and in the north-center of Italy (P < 0.05). Our study first identified a treatment disparity among different geographic Italian regions. A more systematic audit is needed to confirm these results and plan adequate interventions.
  Techniques in Coloproctology 09/2010; 14(3):229-35. · 1.29 Impact Factor
• Article: Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study.

  A Infantino, R Bellomo, P P Dal Monte, C Salafia, C Tagariello, C A Tonizzo, L Spazzafumo, G Romano, D F Altomare
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  ABSTRACT: We report a multicentric prospective study which aimed to evaluate Doppler-assisted ligation of the terminal haemorrhoidal arteries (THD) for II and III degree haemorrhoids. A total of 112 patients from five colorectal units, including 81 men, mean age 48 +/- 13 years, with II degree (39) and III degree (73) haemorrhoids were treated by Doppler-guided transanal de-arterialization and anopexy using a new device (THD). The mean operative time was 33.9 +/- 8.8 minutes, and the mean number of ligatures applied was 7.2 +/- 1.5. Postoperatively, 72% of patients did not need analgesics and the other 28% used nonsteroidal antiinflammatory drugs 1-3 times/day for less than 2 days. All the patients were operated as a day case. Early postoperative complications included haemorrhoidal thrombosis (2 patients), bleeding (1) treated by haemostatic suture, dysuria (6) and acute urinary retention (1). After a mean follow-up of 15.6 +/- 6.5 months (range 6-32), 2/105 (20.9%) patients complained of minor bleeding, while mild pain was still present in 4/51 patients (7.8%). There were no statistically significant differences in the sample population regarding the gender or stage of the disease. Tenesmus was cured in 15/17 patients, dyschaezia in 20/22 patients and mucous soiling in 10/10 patients. No new cases of altered defaecation or faecal incontinence were recorded. Overall, 85.7% of patients were cured and 7.1% improved. Residual haemorrhoids were treated by elastic band ligation in nine (8%) patients and by surgical excision in further five patients (4.5%). Doppler-assisted ligation of the terminal branches of the haemorrhoidal arteries for II and III degree haemorrhoids is highly effective and painless. Complications are few and the technique can be performed as a day case.
  Colorectal Disease 05/2009; 12(8):804-9. · 2.93 Impact Factor
• Article: Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial.

  D F Altomare, G Milito, R Andreoli, F Arcanà, N Tricomi, C Salafia, D Segre, G Pecorella, A Pulvirenti d'Urso, N Cracco, G Giovanardi, G Romano
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  ABSTRACT: Milligan-Morgan hemorrhoidectomy using radiofrequency dissection (Ligasure) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure and conventional diathermy hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients. Patients with Grades III and IV hemorrhoids were randomized to two groups: Ligasure hemorrhoidectomy and conventional diathermy. Postoperative anal pain was measured by the Visual Analog Scale (VAS) and the analgesia required. Postoperative complications, wound healing, and return to working activities also were evaluated as secondary outcomes. A total of 273 patients, well matched for age, gender, working activity and grade of hemorrhoids, were randomized to two groups: Ligasure 146, and diathermy 127. The severity of postoperative anal pain was significantly less in the Ligasure group when measured at least 12 hours after defecation (P < 0.01), whereas it was similar at the time of defecation. The Ligasure group had significantly lower requirements for painkiller pills. There were no significant differences in early and late complications. Return to work and normal activities was significantly faster in the Ligasure group. Ligasure hemorrhoidectomy is an effective procedure for Grades III and IV hemorrhoids and facilitates a faster return to work and normal activities by reducing postoperative pain.
  Diseases of the Colon & Rectum 06/2008; 51(5):514-9. · 3.13 Impact Factor
• Source

  Available from: Antonio Sommariva

  Article: Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery.

  C R Asteria, G Gagliardi, S Pucciarelli, G Romano, A Infantino, F La Torre, F Tonelli, F Martin, C Pulica, V Ripetti, [......], E Veronese, S Mancini, G Pescio, G L Occelli, S Bracchitta, M Castagnola, T Pontillo, G Cimmino, U Prati, R Vincenti
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  ABSTRACT: The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies.
  Techniques in Coloproctology 06/2008; 12(2):103-10. · 1.29 Impact Factor
• Article: Ligasure™ Precise vs. Conventional Diathermy for Milligan-Morgan Hemorrhoidectomy: A Prospective, Randomized, Multicenter Trial

  D. F. Altomare, G. Milito, R. Andreoli, F. Arcanà, N. Tricomi, C. Salafia, D. Segre, G. Pecorella, A. Pulvirenti d’Urso, N. Cracco, G. Giovanardi, G. Romano, on behalf of the Ligasure™ for Hemorrhoids Study Group
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  ABSTRACT: PurposeMilligan-Morgan hemorrhoidectomy using radiofrequency dissection (Ligasure™) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure™ and conventional diathermy hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients. MethodsPatients with Grades III and IV hemorrhoids were randomized to two groups: Ligasure™ hemorrhoidectomy and conventional diathermy. Postoperative anal pain was measured by the Visual Analog Scale (VAS) and the analgesia required. Postoperative complications, wound healing, and return to working activities also were evaluated as secondary outcomes. ResultsA total of 273 patients, well matched for age, gender, working activity and grade of hemorrhoids, were randomized to two groups: Ligasure™ 146, and diathermy 127. The severity of postoperative anal pain was significantly less in the Ligasure group when measured at least 12hours after defecation (P < 0.01), whereas it was similar at the time of defecation. The Ligasure™ group had significantly lower requirements for painkiller pills. There were no significant differences in early and late complications. Return to work and normal activities was significantly faster in the Ligasure™ group. ConclusionLigasure™ hemorrhoidectomy is an effective procedure for Grades III and IV hemorrhoids and facilitates a faster return to work and normal activities by reducing postoperative pain.
  Diseases of the Colon & Rectum 04/2008; 51(5):514-519. · 3.13 Impact Factor
• Source

  Available from: Filippo Pucciani

  Article: The ProTect device in the treatment of severe fecal incontinence: preliminary results of a multicenter trial.

  P Giamundo, D F Altomare, M Rinaldi, P De Nardi, V D'Onofrio, A Infantino, F Pucciani, G Romano
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  ABSTRACT: Patients suffering from severe fecal incontinence (FI) in whom surgical treatment has either failed or is inappropriate due to high operative risks and those who refuse to undergo surgery are condemned to living with their embarrassing symptoms, often responsible for progressive social isolation. ProTect is a new, relatively simple, medical device intended for selected patients suffering from severe FI. It consists of a pliable, silicone catheter with an inflatable balloon that seals the rectum at the anorectal junction, acting like an anal plug. The proximal part of the catheter incorporates two contacts that monitor the rectum for the presence of feces. The patient is alerted to an imminent bowel movement and, hence, a potential fecal accident, through a beeper. A multicenter trial has been set up to assess the reliability of the device in preventing episodes of FI and to evaluate its impact on quality of life. Patients with significant FI (CCF>10) were prospectively entered into this 14-day study. Two quality of life questionnaires and a daily log of bowel activity and incontinent episodes were completed before and during the study. Currently, the study enrolled 17 patients and 11 patients (9 women, 2 men) with a mean age of 66 years (range, 46-85) completed the trial. In these 11 subjects, there was an overall significant improvement in the quality of life (p<0.05) and a significant reduction in incontinence scores (p<0.001) while using ProTect compared to baseline. The ProTect is a safe non-surgical device that is able to prevent episodes of FI. It is unique because it can be used according to a patient's needs without interfering with activities of daily living.
  Techniques in Coloproctology 12/2007; 11(4):310-4. · 1.29 Impact Factor
• Article: Laparoscopic surgery for colorectal cancer: clinical practice guidelines of the Italian Society of Colo-Rectal Surgery.

  C A Sartori, A D'Annibale, G Cutini, C Senargiotto, D D'Antonio, A Dal Pozzo, M Fiorino, G Gagliardi, B Franzato, G Romano
  Techniques in Coloproctology 07/2007; 11(2):97-104. · 1.29 Impact Factor
• Article: Disappointing long-term results of the artificial anal sphincter for faecal incontinence.

  D F Altomare, G A Binda, G Dodi, F La Torre, G Romano, M Rinaldi, E Melega
  British Journal of Surgery 11/2004; 91(10):1352-3. · 4.61 Impact Factor
• Article: Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for severe faecal incontinence.

  D F Altomare, G Dodi, F La Torre, G Romano, E Melega, M Rinaldi
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  ABSTRACT: A new prosthetic device, the Action artificial anal sphincter, has recently been introduced for treating severe faecal incontinence. The results of this procedure in 28 patients are presented. The patients underwent operation for severe faecal incontinence in four Italian university hospitals and patients were reviewed after a median follow-up of 19 (range 7-41) months. Early infections occurred in four patients, requiring removal of the device in three. Dehiscence of the perineal wound occurred in nine patients. After activation of the device, the cuff had to be removed in a further four patients (for rectal erosion in two, anal pain in one and late infection in one). The cuff was accidentally broken in one patient. A new anal cuff was repositioned successfully in two patients. Overall, five patients had complete removal of the device and two removal of the cuff only. Twenty-one patients available for long-term evaluation had a major improvement in faecal continence. Median resting anal pressure increased from 27 mmHg before surgery to 32 mmHg after operation. Preoperative squeeze pressure was 42 mmHg while maximum postoperative anal pressure with the activated device was 67 mmHg. The median American Medical System incontinence score decreased significantly from 98.5 to 5.5 (P < 0.001). Similar figures were observed using the Continence Grading Scale (from 14.9 to 2.6; P < 0.001). Twelve patients developed symptoms of obstructed defaecation while two patients complained of anal pain. Improved continence was achieved after neosphincter implantation in three-quarters of the patients. Early infection and rectal erosion, together with difficulty in evacuating, are still major concerns with this technique.
  British Journal of Surgery 12/2001; 88(11):1481-6. · 4.61 Impact Factor