Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery.

BACKGROUND: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. METHODS: A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. RESULTS: Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 +/- 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 +/- 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n = 11, 55%), cholecystocolic fistulas (n = 5, 25%), cholecystojejunal fistulas (n = 3, 15%), and cholecystogastric fistulas (n = 1, 5%); in the latter group, cholecystoduodenal fistulas (n = 8, 5.1%), and cholecystocolic fistulas (n = 4, 28.6) and cholecystojejunal fistulas (n = 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in either group. One patient in the LT group developed a bronchopneumonia postoperatively. Postoperative hospital stay was significantly longer in LT patients-17 +/- 4 vs 3+/-1 days (p < 0.001). CONCLUSION: Cholecystoenteric fistula is an occasional intraoperative finding during laparoscopic cholecystectomy. The results of this study, which are based on the collective experiences of 19 surgeons, illustrate the growing success of the laparoscopic approach to this condition, including a decreasing rate of conversion to open surgery over the last 3 years.

[Video-laparoscopic Nissen-Rossetti fundoplication]. / Nissen-Rossetti video-laparoscopica.

The authors describe the application of Nissen-Rossetti fundoplication for the treatment of hiatus hernia using a laparoscopic approach. They report excellent results both immediately after surgery and in the medium term.

Hydatid cyst of the lumbosacral spine with large pelvic mass.

A rare case of hydatid cyst of the lumbosacral spine, causing extensive destruction of the sacrum and a large pelvis mass, is reported; a cutaneous fistula from the pelvic cavity to the posterior lumbar region was also present. The patient was studied by computerized tomography and operated on by combined anterior and posterior approach. The sacral localization of the spinal hydatidosis and its extension into the pelvic cavity are unusual. CT and MR allow a good definition of the bone destruction and the abdominal and pelvic extensions. Radical removal of spinal hydatid cysts may be rarely accomplished, because of the extensive bone invasion, and multiple recurrences, requiring repeating operations, occur in most cases.

[Mucocele of the appendix. Some diagnostic features]. / Su un caso di mucocele appendicolare. Alcuni aspetti diagnostici.

The description of a case of mucocele of the appendix shows the difficulties of arriving at a preoperative diagnosis. Following an analysis of the diagnostic features it's possible to affirm that only surgery can confirm the diagnosis with the histological result. Careful surgical dissection is very important when a malignant tumor is suspected.

[An indirect hemagglutination study of total IgE and complement fractions C3c and C4 in patients with hepatic hydatidosis and undergoing therapy]. / Studio dell'emoagglutinazione indiretta, delle IgE totali e delle frazioni del complemento C3c e C4 in pazienti affetti da idatidosi epatica e sottoposti a terapia.

The trend of antibodies tested with indirect hemagglutination, of total IgE and complement fraction was examined in patients with liver hydatid disease, treated with surgery and benzoimidazoles.

Effects of total parenteral nutrition enriched with branched chain amino acid infusion on liver function and serum amino acid pattern in dogs undergoing hepatectomy.

In order to study effects of different total parenteral nutritional regimens on the recovery of liver function and on plasma amino acid pattern after major hepatectomy, twelve healthy mongrel dogs were submitted to 70% liver resection and randomly divided into three different groups: group I (control group) received only 10% glucose; group II received 10% glucose plus 8.5% Freamine; group III received 10% glucose plus 100% branched chain amino acid (BCAA) solution. Blood samples were analyzed for determining biochemical parameters, including plasma amino acid levels, before surgery and on 3rd and 7th postoperative day. The 'BCAA group', compared to other groups, showed higher values of plasma proteins (p less than 0.01) and prothrombin activity (p less than 0.05) on the 3rd postoperative day. The total concentration of plasma amino acids decreased after hepatectomy. Gluconeogenetic amino acids alanine and glutamine were markedly decreased in groups II and III, likely due to their increased consumption during gluconeogenesis. Aromatic amino acids were increased in all groups, due to the transient liver insufficiency. BCAA markedly increased in group III on 3rd postoperative day and returned to basal values on 7th postoperative day; possible explanations of such alterations are discussed. Our findings suggest that BCAA may represent a first choice substrate in the early phase after hepatectomy.

Hepatico-jejuno-duodenoplasty for biliary stricture.

The authors present the results of their experience in the therapy of biliary strictures, using a jejunal loop interposed between the biliary tract and duodenum. This procedure allows extensive biliary discharge and aims to prevent the pathophysiologic disturbances of gastroduodenal functions, which result from Roux-en-Y anastomosis, and has the advantages of both Roux-en-Y and choledochoduodenostomy procedures. The authors report nine years positive experience with this technique. No gastroduodenal postoperative complaints are reported in their series, whereas an 8% incidence of duodenal ulcers is reported after Roux-en-Y anastomoses.

[Comparative experimental physiopathological evaluation of Roux-en-Y biliary shunt and choledocho-duodenal anastomosis with an interposed jejunal loop in dogs]. / Valutazioni fisiopatologiche sperimentali comparative fra la derivazione biliare ala "Roux-en-Y" e l'anastomosi coledoco-duodenale con ansa diciunale interposta nel cane.

The authors compare in an experimental study two biliary tract reconstructive procedures in dogs: Roux-en-Y hepatico-jejuno-stomy and hepatico-jejunoduodenoplasty. The former causes in increase of plasma gastrin and insulin and moreover a decrease of duodenal pH after alimentary stimules, whereas the latter, preserving biliary flux through the duodenum doesn't alter such parameters, and therefore should be preferred.

[Percutaneous punctures guided by echography]. / La puntura percutanea guidata dall'ecografia.

It is possible to carry out percutaneous injections of lesions in any organ under the direction of echography. This is particularly so in the liver, pancreas and kidney. The procedure has been used in 79 patients for diagnostic and/or therapeutic purposes and has provided very good and promising results. The technique is harmless, causes only minimum discomfort to the patient and, in many cases, enables the routine diagnostic approach to be short-circuited because more laborious, expensive techniques can be avoided.

Normal inferior vena cava: caliber changes observed by dynamic ultrasound.

A review of the literature revealed conflicting reports on the physiologic variations of the caliber of the normal inferior vena cava as seen by sonography. In this study, 25 normal volunteers were examined using dynamic scanning, and the upper parts of their inferior vena cavas were observed for changes during various phases of respiration as well a Valsalva maneuver. Optimum distension and, therefore, optimum visualization of the inferior vena cava were achieved after simple breath holding or at end expiration. Inspiration and Valsalva maneuver decreased the size of this vessel in most subjects, making if difficult to see.

[Liver transplantation: an experimental model with rats]. / Il trapianto di fegato: un modello sperimentale nel ratto.

In this report the Authors describe their surgical technique of liver transplantation in the rat. The operation has been performed on fifty rats of 400 gms of weight, stabulated in standard conditions. The surgical technique has been extremely simplified, requiring only two end-two-end vascular anastomoses and another anastomoses between common bile duct and duodenum. Under the surgical point of view results are excellent, as demonstrated by the normal macroscopic appearance of the new transplanted liver, indicating a good revascularization; pre- and post-operative surgical complications are very rare. However, during the immediate post-operative course the incidence of mortality is high, because the occurrence of electrolytes imbalance can be responsible of cardiac arrest, respiratory insufficiency and pulmonary edema.

[Personal experience with bilio-digestive anastomosis]. / La nostra esperienza in tema di anastomosi bilio-digestive.

The indications and contraindications for the various types of bilio-digestive anastomosis operations are assessed with due allowance for the physiopathological aspects of main bile way function. Careful analysis of the data obtained in pre- and intra-operative investigation permits a precise choice of the required intervention in all cases. The advantages offered by restoral of bile flow at duodenal level, as occurs in EDDP, are stressed.

[Treatment of hepatic metastases in tumors of the gastrointestinal tract. Considerations on 25 cases]. / Il trattamento delle metastasi epatiche nei tumori del tubo gastroenterico. Considerazioni su 25 casi.

Results with liver resection over a period of 3 yr in the treatment of metastases derived from tumours of the gastroenteric tube are reported. An account is given of the data and the techniques used by Italian and foreign workers for this purpose. A personal series of 25 cases is presented and its 2-yr survival figure is stated.