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About me

Dr. Salvatore Cuccomarino

A passion born from childhood

I have always been curious and fascinated by everything around me. I was lucky enough to be born in a small town on the banks of the Ionian Sea, in Calabria. In the 1970s and 1980s, in places like that, children could grow up free, not only from the fears that cage kids in big cities today, but also - and perhaps above all - from the fake needs that are imposed on us by society today. Back then, being was more important than having.

Mine curiosity was very much alive, like that of all children; and nature, the landscape around me, continually gave me cues to inflame it further. Why do the waves move? Why is the sea one colour in the morning, another in the evening, yet another when it rains? How is it that beautiful flowers grow from a dry tree in spring?

I thought life was a splendid representation in which all parties, all actors, were dependent on each other, were all indispensable and in harmonyeach with its own role interconnected with those of others, and that I was one of those actors, like a small atom that becomes part of a much larger molecule, but without which the molecule would be completely different.

Arrived at theuniversityI became passionate about the disciplines that most represented this principle of uniqueness and indispensability in complexity: biochemistry, physics, anatomy, physiology... However, when it came time to face the reality of the hospital, I began to realise that there was something in the patients I saw as in-patients. deeply disharmoniousnot so much and not only the disease itself, but also the way of dealing with it.

I had decided early on to do the surgeonprecisely because the surgeon sees the disease with his own eyes and puts his own hands, as well as his own intelligence, at the service of the patient's care; but it disturbed me the invasiveness of surgery even when dealing with 'minor' problems, harassed my patient pain and the unwillingness of my mentors at the time to worry about it.

Those were the years when the first news came from France of ateam of surgeons from Lyonled by Philippe Mouretwhich had managed to realise a cholecystectomysurgery to remove the gallbladder by simply drilling four small holes in the patient's abdomen; this technique was called laparoscopyand had been developed thanks to the great technological advances of those years.

In our hospitals, on the other hand, with rare exceptions, to remove the gallbladder, incisions of around 30 cm were made, which caused patients an intense postoperative pain and forced them to stay in bed for a week. Laparoscopic surgery patients, on the other hand, went home a couple of days after the operation. What an extraordinary difference: surgery could therefore be 'kind'pain-free, respectful of the integrity of the patient's body and spirit.

After graduating with honours, I landed in Bologna to specialise in general surgery.

Upon entering the second specialisation school in General Surgery, I was assigned as a tutor an extraordinary man, a brilliant surgeon who would profoundly mark my professional history: the Professor Giovanni Ussiaa Calabrese like myself. Professor Ussia had studied in the United States and France and was one of the very few Italian surgeons of the time to master the minimally invasive laparoscopic techniques not only in surgery but also in uro-gynaecology. With him I began my learning path to minimally invasive abdominal surgeryincluding the laparoscopic repair of inguinal hernias. This process, I confess, puzzled me at first.

In fact, 'traditional' inguinal hernioplasty involves making a relatively small incision and allows the hernia to be repaired under local anaesthesia, with a simple technique and with discharge the same day as the operation. In contrast, laparoscopic hernioplasty access is much less invasive (one 10 mm incision and two 5 mm incisions), the technique is much more difficult and the anaesthesia is general, so the patient is discharged the day after the operation. When I would express my doubts to my professor, he would laugh and tell me: 'you are young Salvatore, you don't have experience yet, but you will soon understand that less is more". Less is more: I have heard him say it hundreds of times: less is more. Of course he was right: how much less the patient's body is surgically attacked, so many plus are the advantages for him: less pain, less bleeding, less convalescence, faster recovery, faster return to one's daily activities, to one's life. We could say that laparoscopic surgery 'gives life' to the patient.

In the wall surgery - therefore in the surgery of inguinal and abdominal hernias, laparoceles and diastasis of the rectus - this is even more true; for instance, chronic inguinal pain and skin sensitivity alterations are about half after laparoscopic inguinal hernia repair compared to open repair, and the probability of recurrence is reduced by 30-50%.

In the diastasewhen comparing REPA with abdominoplasty, post-operative pain is greatly reduced, recurrences from the 40% of abdominoplasty drop to about 3% of REPA, the risk of skin and navel necrosis is reduced from about 25 to 0%. Less invasiveness, more benefits for the patient. Always.

In the time since then, I have made it a point to offer my patients the 'plus' of less invasiveness in all possible interventions.

Professional evolution

My business was actually born in 2008with my decision to leave Italy for the Spain. I had already been employed at the hospital for seven years with a permanent contract, but I could not tolerate the organisation of work, the pyramid system that still plagues the Italian public health service, due to which it is very difficult for a doctor and a surgeon in particular to evolve professionally.

In particular, even today in Italy abdominal wall surgery is considered a minor' surgerymore annoying than useful: nevertheless it represents about 30% of all surgery performed in a hospital each year and some of its surgical techniques, especially the minimally invasive ones, are of very high complexity. Moreover, minimally invasive procedures for the surgery of abdominal wall defects have experienced a far greater percentage increase than for other diseases, a clear sign of the complexity and technological evolution that this surgery has undergone in recent years - everywhere but in Italy. 

In Spain, I found a working environment that was completely opposite to the Italian reality: great freedom and autonomy for the doctor, meritocracy, very large space for minimally invasive surgery: an ideal terrain to cultivate my aspirations and ambitions.

He returned to Italy in 2012I tried to transfer the experience gained in Spain into my daily clinical practice. I opened my first freelance practicewhich, due to lack of resources, was for a couple of years located within the hospital where I worked. I began to apply the minimally invasive techniques I had learned in Spain, in the fields of proctology, hernia and laparocele surgery, and abdominal surgery.

Since colon and stomach surgery was at that time monopolised by the chief surgeon of the day, I decided to invest in a niche that was still free, the wall surgery indeed, and to super-specialise in minimally invasive techniques.

I continued to assiduously the Iberian and Latin American surgical environment and learning as much as I could from my foreign friends and colleagues.

In particular, I learned of the 'existence' of the diastasis recti as a pathological entity (in Italy, it has long been a 'forgotten' condition, considered only on the aesthetic side, without anyone ever bothering to investigate its pathological implications) and a new technique for its repair, the REPAdeveloped by Derlin Juarez Muasa brilliant Argentine surgeon my friend.

I tried to understand what exactly diastasis consisted of; and when I learned that it affects the 33% of women after childbirthan audience HUGE  of patients who were 'ripped apart' every year with abdominoplasty, with very poor functional results, I realised that this was the space I could and should occupy.

So I asked Derlin to teach me his technique step by step: it was early 2017. I began to explore the Italian environment, and discovered that in Italy, on the one hand, the vast majority of surgeons underestimated or ignored completely the existence of diastasis of the rectus; while on the other hand, communities of patients with the condition began to form and were very active on social media, spreading news - sometimes very wrong - about the condition.

I then decided to start interacting with these communities, telling them that it was not necessary to undergo major invasive surgery to resolve the diastasis - that, in short, even in this case less is more - and that the use of the network, which is 'compulsory' in REPA, would have greatly reduced recidivism. Thus the first patients began to arrive at the practice.

My work today

On 3 August 2017 I performed, for the first time in Europe, the REPA. Since then, by refining my technique and introducing some variations that have simplified the procedure, I have made some REPAs more than 350. I am, by all accounts, the surgeon who has the largest REPA caseload in the world today.

L'abdominoplasty continues to have its indications, in patients with adipose aprons / excess skin: but in all other cases it is foolish to propose such an intervention to a patient invasiveand with many postoperative complications to correct a diastasis of the rectus.

Today, diastasis of the rectus has also entered, as a topic, the congresses of scientific societies dealing with wall surgery and minimally invasive surgery; just as the idea of the importance of the postoperative physiotherapy in patients undergoing surgery for diastasis of the rectus and other large abdominal wall defects.

I had also 'stolen' this idea from Derlin: I was the first to introduce it in Italy and to develop, together with my physiotherapist, a postoperative functional recovery protocolbased on the hypopressive gymnastics by Marcel Caufriez (an advanced form of physiotherapy, virtually unknown in Italy in 2017 but which has since become very popular), a protocol that has been the first of its kind and which today is used by many colleagues all over the world.

But I did not stop there. 

Today my team, consisting of Surgeons, Anaesthetists, Pain Therapists, Physiotherapists, Nutritionists and Doctors with expertise in Antiaging Medicineproposes an integrated approach to what can, in fact, be described as aninsufficiency of theabdominal corewhich through the muscle preparation, the correction of dietary habits wrong, the prevention and treatment of postoperative painthe body fat remodelling and theuse of stem cells and growth factors contained therein, the study of genetic markers of ageing of tissues and organs and the integration of lifestyles that slow down the body's deterioration processes, addresses the issue of diastasis of the rectus and its consequences in a broader project for the recovery of the patient's overall physical and psychological well-being

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