Abdominal surgery

As part of the Department of Surgical Sciences, the Abdominal Surgery Unit specializes in the treatment of oncological and functional diseases of the digestive system, offering both scheduled and emergency care.

Surgical interventions are performed using laparoscopic, robotic, and open techniques, supported by advanced equipment and cutting-edge technologies.

The Unit focuses on conditions affecting the stomach, colon-rectum, liver, pancreas, bile ducts, adrenal glands, and esophagogastric junction, leveraging the team’s extensive expertise in both traditional and minimally invasive surgical approaches.

For oncological diseases, the Unit adopts a multidisciplinary approach, ensuring patients receive a fully personalized program of diagnosis and treatment.

The Unit also manages other general surgical conditions, including hernias, incisional hernias, skin tumors, and proctological disorders.

Additionally, a Day Surgery Service is available, allowing certain procedures to be performed under local or regional anesthesia with same-day discharge. Procedures include: Inguinal hernia repairs, Abdominal wall hernia repairs, Treatment of proctological disorders, Excision of pilonidal sinus.

Main activities of the operative unit:

Colorectal Surgery

The Unit’s colorectal surgery program addresses both inflammatory conditions (e.g., diverticular disease) and colorectal cancer.

Most procedures are performed using minimally invasive techniques (laparoscopic or robotic), which provide: Reduced postoperative recovery times, Improved pain control, Superior cosmetic outcomes.

For patients with colorectal cancer, diagnostic and therapeutic pathways are developed through a multidisciplinary approach.

In cases of locally advanced mid-to-low rectal cancer, a neoadjuvant radiochemotherapy protocol is applied preoperatively to significantly lower the risk of local recurrence.

Hepato-Bilio-Pancreatic Surgery

The Hepato-Bilio-Pancreatic (HBP) surgery program focuses on the management of benign and malignant conditions of the liver, pancreas, and bile ducts, with a particular emphasis on: Metastases, Intrahepatic and extrahepatic cholangiocarcinoma, Hepatocellular carcinoma, Pancreatic ductal carcinoma, Pancreatic neuroendocrine tumors (PNETs).

Surgical procedures include: Typical and atypical liver resections, Pancreaticoduodenectomy (Whipple procedure), Spleen-preserving distal pancreatectomy, Intermediate pancreatic resections.

All cases are managed with a multidisciplinary approach, ensuring patients benefit from the highest level of medical expertise and the most advanced diagnostic and therapeutic technologies. For selected patients, minimally invasive techniques are employed to optimize outcomes and recovery.

Esophagogastric Surgery

Esophagogastric surgery focuses on the treatment of functional disorders of the esophagogastric junction (e.g., hiatal hernia) and oncological diseases. For oncological conditions, the procedures performed include atypical gastric resections (wedge resections) for gastrointestinal stromal tumors (GISTs), as well as total or subtotal gastrectomies and esophagectomies following the Ivor Lewis technique.

The majority of these interventions are performed using minimally invasive approaches (laparoscopic or robotic).

A multidisciplinary review of each case ensures that oncological patients receive precise preoperative staging and the most appropriate treatment plan, which may include neoadjuvant chemotherapy when indicated.

Surgery for Chronic Inflammatory Bowel Diseases

The program for chronic inflammatory bowel disease surgery is dedicated to the management of conditions such as Crohn’s disease and ulcerative colitis.

Many procedures are carried out using minimally invasive techniques to improve outcomes and recovery.

At Casa Sollievo, a dedicated multidisciplinary clinic for inflammatory bowel diseases (IBD Clinic) provides integrated care. Surgeons and gastroenterologists collaborate closely to deliver a comprehensive and personalized diagnostic and therapeutic program, tailored to the needs of each patient

Surgery for Rare Tumors and Peritoneal Diseases (HIPEC)

The Unit specializes in the surgical management of rare tumors and peritoneal diseases, focusing on the removal of large soft tissue tumors, such as sarcomas, which often require multivisceral resections.

Additionally, the Unit performs procedures for the treatment of peritoneal carcinomatosis, combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).

All cases are rigorously evaluated by a multidisciplinary team of oncologists and surgeons, ensuring that patients receive evidence-based care and access to the most advanced therapeutic options.

Abdominal Wall Surgery

Abdominal wall surgery includes procedures for a wide range of conditions, from small incisional hernias to complex abdominal wall defects (referred to as "abdominal wall disasters"). Repairs often involve the use of prosthetic materials and advanced reconstructive techniques, such as component separation, to restore the functionality and integrity of the abdominal wall.

For selected cases, minimally invasive techniques are employed for prosthetic repairs, such as TAPP (transabdominal preperitoneal repair) for bilateral inguinal hernias or recurrent inguinal hernias, providing optimal outcomes with reduced recovery times.

Adrenal Surgery

Adrenal surgery focuses on the removal of the adrenal gland, which regulates stress responses through the production of corticosteroids and catecholamines.

Surgical indications generally involve adrenal adenomas causing hormonal hypersecretion, often leading to hypertension. Less commonly, the intervention is required for adrenal tumors.

These procedures are predominantly performed using minimally invasive laparoscopic techniques, ensuring patient safety and reducing recovery time.

Scientific and Outreach Activities

The Unit collaborates with the Oncology Service and the Institute for Stem Cell Biology, Regenerative Medicine, and Innovative Therapeutics (ISBReMIT) at Casa Sollievo della Sofferenza to advance research on novel oncological targets.

Indicators

The C.O.U. of Abdominal Surgery performs approximately 300 colorectal surgeries annually, addressing both benign and malignant conditions. Of these, around 70% are conducted using minimally invasive techniques.

The Unit is equipped with the Da Vinci Xi Robotic Surgical System, which allows surgeons to perform complex surgical procedures using minimally invasive techniques. This system integrates high-definition 3D visualization, Endowrist instrumentation, and an intuitive control interface, enabling advanced procedures such as: Total or subtotal gastrectomies with D2 lymphadenectomy, Anterior rectal resections for tumors, Distal pancreatic resections.
Over the past 15 years, IRCCS Casa Sollievo della Sofferenza has become a benchmark center for liver, biliary tract, and pancreatic surgery in Puglia and Southern-Central Italy. This highly specialized field, developed within the Abdominal Surgery Unit, focuses primarily on neoplastic diseases of the liver, bile ducts, and pancreas. Since 2005, the Unit has conducted more than 1,000 liver surgeries and approximately 600 pancreatic resections, solidifying Casa Sollievo della Sofferenza as a leading center for liver and pancreatic diseases in the region.

In collaboration with the Anesthesia and Intensive Care Service I, the Unit has implemented the Enhanced Recovery After Surgery (ERAS) protocol, a modernized perioperative management program designed to improve outcomes for colorectal surgery patients by accelerating functional recovery.

The ERAS protocol includes specific goals, or "items," aimed at optimizing the patient experience and outcomes, such as: Reducing discomfort associated with bowel preparation, Promoting early postoperative mobilization, Enabling a faster return to normal postoperative feeding.