ABSTRACT
BACKGROUND: The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy.In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed.Functional evaluations performed on pre and post--surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier. METHODS: 45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with:⢠24 hours pHmetry,⢠esophageal manometry,The same evaluation was repeated 1 month and 6 months after surgical intervention. RESULTS: In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms. CONCLUSIONS: The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.
Subject(s)
Fundoplication/methods , Gastroesophageal Reflux/surgery , Laparoscopy/methods , Aged , Aged, 80 and over , Esophageal pH Monitoring , Female , Follow-Up Studies , Gastroesophageal Reflux/diagnosis , Humans , Male , Manometry , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.Morphological evaluations performed on serial pre and post - surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ. METHODS: 62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:⢠dyspeptic symptoms questionnaire,⢠gastric endoscopy with body, antrum, and fundus random biopsies,⢠histo-pathological analysis of samples and elaboration of bile reflux index (BRI).The same evaluation was repeated at a 6 months follow-up. RESULTS: In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori's gastric colonization nor on the induction of gastric precancerous lesions. CONCLUSIONS: Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.
Subject(s)
Cholecystectomy, Laparoscopic , Duodenogastric Reflux/etiology , Gallstones/surgery , Gastritis/etiology , Postoperative Complications , Aged , Aged, 80 and over , Duodenogastric Reflux/diagnosis , Duodenogastric Reflux/epidemiology , Female , Follow-Up Studies , Gastritis/diagnosis , Gastritis/epidemiology , Helicobacter Infections/diagnosis , Helicobacter Infections/epidemiology , Helicobacter Infections/etiology , Helicobacter pylori/isolation & purification , Humans , Incidence , Male , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Precancerous Conditions/diagnosis , Precancerous Conditions/epidemiology , Precancerous Conditions/etiology , Prospective Studies , Stomach Neoplasms/diagnosis , Stomach Neoplasms/epidemiology , Stomach Neoplasms/etiologyABSTRACT
BACKGROUND: Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD's impact on budget and activity in hospitals. METHODS: The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals.Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds. RESULTS: A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was 1.656.802 or 0.2% of the total budget of the hospital. 1.346.218, were attributable to the department of general surgery, 0.9% of the department's budget . CONCLUSIONS: The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department.
