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1.
Eur Rev Med Pharmacol Sci ; 25(23): 7204-7210, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34919218

RESUMO

OBJECTIVE: The role of antral resection (AR) in laparoscopic sleeve gastrectomy (LSG) is still a greatly debated topic in the literature. The aim of this study was to evaluate the results and complications of AR in LSG. PATIENTS AND METHODS: In this observational comparative study, 101 patients who underwent LSG were divided into two groups based on the extent of antral resection: 1 cm from the pylorus (1-DP group), or 6 cm from the pylorus (6-DP group). The %EWL (%Excess weight loss), resolution of T2D (Type 2 Diabetes Mellitus) and GLP-1 were investigated 48 hours before surgery and 3, 6 and 12 months after LSG. Postoperative complications in the first 30 days after surgery were also compared between the two groups using the Clavien-Dindo (CD) score. RESULTS: A significant difference in %EWL was observed at 3 and 6 months in favor of the 1-DP group (38.9% and 57.8%, respectively) compared to the 6-DP group (31.4% and 49.7%, respectively). No difference in T2D resolution was observed between two groups during the follow-up period, with similar changes in GLP-1. Statistically significant differences were found between 1-DP and 6-DP group for the reintervention rate (CD III, 7.7% and 1.9%, respectively; p = 0.02) and life-threatening complications requiring intensive care unit management (CD IV, 3.8% and 0%, respectively, p = 0.03). CONCLUSIONS: In LSG, sparing the antrum is associated with a significant reduction in the rate of postoperative complications, but the metabolic and weight results are comparable to those for antrum resection.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Gastrectomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Cirurgia Bariátrica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
2.
Eur Rev Med Pharmacol Sci ; 25(12): 4317-4324, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34227066

RESUMO

OBJECTIVE: The objective of our study is to investigate whether diabetes mellitus could adversely affect post-laparoscopic sleeve gastrectomy (LSG) weight loss. PATIENTS AND METHODS: A retrospectively recorded database of patients who underwent LSG from September 2018 to September 2019 in our Hospital in L'Aquila was analyzed. The post-operative weight loss was evaluated in terms of body mass index (BMI) variation, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL). The association between these parameters and diabetes was analyzed at 3 and 6 months of follow-up. RESULTS: The two groups (patients with and without diabetes) were considered comparable in terms of anthropometric and preoperative parameters. At 3 and 6 months of follow-up, the decrease in BMI resulted to be directly associated with the time and the group. The mean BMI at 3 and 6 months was higher in patients with diabetes. Changes in % EWL and % TWL were similar in both groups. CONCLUSIONS: It is rational to expect a lower weight loss in obese diabetic patients after LSG. This should not be considered as a contraindication to bariatric surgery that, being a metabolic surgery, has as main goal the resolution or improvement of co-morbidities.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Redução de Peso
3.
Ann Ital Chir ; 73(6): 647-9, 2002.
Artigo em Italiano | MEDLINE | ID: mdl-12820591

RESUMO

Ectopic pancreas is a rare congenital abnormality probably due to a derangement of embryologic development of digestive tract. Its frequency is reported in the literature between 0.5-14% predominantly distributed in the stomach, duodenum, jejunum. Such condition is extremely difficult to be diagnosed, in fact most of the case of ectopic pancreas are an accidental finding. We describe a case of ectopic pancreas located in the Meckel's diverticulum, resected at laparotomy performed for colonic disease. Although in retrospective review symptoms from ectopic pancreas are reported in up to 50% of the cases our patient was free of symptoms. In addition the finding of ectopic pancreas in Meckel's diverticulum has been described only seldom in the previous literature. Treatment however should always be resection in order to prevent complications that may occur, although rarely.


Assuntos
Pólipos Adenomatosos/patologia , Coristoma/patologia , Divertículo Ileal/patologia , Pâncreas , Idoso , Coristoma/cirurgia , Neoplasias do Colo/patologia , Humanos , Masculino , Divertículo Ileal/cirurgia , Neoplasias do Colo Sigmoide/patologia
4.
Ann Ital Chir ; 71(4): 519-23, 2000.
Artigo em Italiano | MEDLINE | ID: mdl-11109679

RESUMO

Intramural hematoma of the duodenum is a rare event which is usually associated with trauma. Because of the rarity of this problem, there has been little conformity of opinions as to diagnosis and treatment of this disease. The authors report on a case of intramural hematoma of the duodenum post-traumatically occurred in a young woman. Etiopathogenesis, diagnosis and treatment of hematoma of the duodenum are thoroughly examined in the present study. Plain abdominal radiography, oral barium study, ultrasound examination, CT and RNM are diagnostic tools in this disease. It appears that most patients with intramural hematoma of the duodenum would respond well to conservative management; surgery should be reserved for those cases that remain obstructed over seven days or have evidence of peritonitis. However surgery is mandatory in cases of uncertain diagnosis. The evacuation of hematoma is considered the most effective and safest surgical treatment.


Assuntos
Duodenopatias/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hematoma/diagnóstico , Traumatismos Abdominais/complicações , Adulto , Traumatismos em Atletas/complicações , Duodenopatias/etiologia , Duodenopatias/cirurgia , Duodeno/lesões , Duodeno/cirurgia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Laparotomia , Ferimentos não Penetrantes/complicações
5.
Ann Ital Chir ; 71(2): 233-7, 2000.
Artigo em Italiano | MEDLINE | ID: mdl-10920496

RESUMO

Hypocholesterolemia seems to represent a significant predictive factor of morbidity and mortality in critically ill patients. The authors, on the basis of recent literature data, aim to clarify the possible correlation between preoperative hypocholesterolemia and the risk of septic postoperative complications .205 patients undergoing to surgery for gastrointestinal diseases were the object of the study. Patients undergoing "minor" abdominal surgery or video-laparoscopic surgery and classified ASA III-IV were excluded. In all the patients, we considered retrospectively risk factors for postoperative septic complications as follows: preoperative blood concentration of cholesterol, malnutrition, obesity, diabetes, neoplasm, preoperative sepsis, type and duration of operations, antibiotics and regimen of use. Type and incidence of postoperative local or systemic septic complications were recorded. The patients have been stratified according to blood concentration of cholesterol and to the presence or absence of other risk factors. The incidence of postoperative sepsis was 35.1%. The highest incidence of postoperative septic complications (72.7%) was encountered, significantly (X2 = 7.6, p < 0.001), in the patients (11 cases, 5.9%) with cholesterol levels below 105 mg/dl). The results of this study seems to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.


Assuntos
Colesterol/sangue , Gastroenteropatias/sangue , Gastroenteropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sepse/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos
6.
Minerva Chir ; 55(11): 745-50, 2000 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-11265147

RESUMO

BACKGROUND: Melatonin induces sleep and modulates immune system. Aim of the paper is to show a possible relation between impaired rhythm of melatonin secretion and the onset of postoperative septic complications and insomnia in old patients undergoing surgery. METHODS: Fifty old patients, aged from 60 to 94 years, have been studied; 39.5% of the patients had neoplastic disease. Melatonin serum levels have been evaluated by ELISA technique at 12 p.m., 3 a.m. 8 a.m. immediately before operation. Postoperative clinical findings of insomnia and septic complications have been recorded. RESULTS: The melatonin serum mean values of all the patients were 16.3 pg/ml at 12 p.m., 22.4 pg/ml at 3 a.m. and 7.1 pg/ml at 8 a.m. Neoplastic patients showed the higher values of melatonin (26.696 pg/ml, 33.143 pg/ml, 9.185 pg/ml), long-lived patients (> 90 years) the lower. The melatonin secretion curve of the old patients with postoperative insomnia (19.961 pg/ml, 20.297 pg/ml, 9.378 pg/ml) or postoperative septic complications (20.695 pg/ml, 16.183 pg/ml, 6.036 pg/ml) was significantly different compared with that of other patients. The peak was advanced, lower and decreased slowly in the midnight. CONCLUSIONS: The study seems to show a possible correlation between impaired rhythm of melatonin secretion and postoperative insomnia and postoperative sepsis in old patients undergoing surgery.


Assuntos
Melatonina/sangue , Neoplasias/sangue , Complicações Pós-Operatórias/sangue , Sepse/sangue , Distúrbios do Início e da Manutenção do Sono/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melatonina/fisiologia , Pessoa de Meia-Idade , Fatores de Tempo
7.
World J Surg ; 23(1): 18-22, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9841758

RESUMO

It is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy (LC) is a "miniinvasive" surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity [neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen-DR (HLA-DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent "open" cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA-DR was reduced in patients with "open" cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the "open" group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with less p.o. morbidity compared to that seen with open surgery.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia/efeitos adversos , Antígenos HLA-DR/sangue , Monócitos/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Colelitíase/imunologia , Colelitíase/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Resultado do Tratamento
8.
Ann Ital Chir ; 69(4): 499-503; discussion 503-5, 1998.
Artigo em Italiano | MEDLINE | ID: mdl-9835126

RESUMO

Simple anorectal surgery can be routinely employed on a one-day surgery (ODS) bases; however complications such as bleeding, urinary retention, and postoperative pain represent a limitation in this respect. In this paper we report preliminary results of our experience in surgery for haemorrhoids, anal fissures and fistulas, achieved in two years on 232 patients. Our protocol includes admission in the morning of the operation and preoperative evaluation by means of ECG, coagulation profile, assay of beta-HCG for female patients. The patients, prepared with a self-administered enema and perianal applications of prilocaine-lidocaine ointment, is taken in the operative room were a venous line is placed and an anaesthesiologist proceed to monitoring of ECG, blood pressure and oximetry. 211 patients were operated under locoregional anaesthesia performed by the surgeon by means of bilateral pudendal nerves blocking. Whereas the remaining underwent general or spinal anesthesia. With this approach we performed 106 haemorrhoidectomies, 96 sphincterotomies, 19 of which with posterior anoplasty and 30 fistulectomy or fistulotomy. 60 mg of ketorolac have been injected locally at the end of operation in order to improve postoperative pain control. Patients undergoing hemorrhoidectomy, anoplasty, fistulotomy or fistulectomy were discharged after 24 hours whereas those undergoing sphincterotomy went home the same day. We reported 4 early postoperative complications in the haemorrhoids group with an incidence of 1.7% (two bleedings, one urinary retention and one fever) treated conservatively. Postoperative pain resulted adequately controlled by a low dosage of NSAID (a mean of 3.7 doses of 30 mg ketorolac/patient). Our satisfactory results seem to suggest continuing the practice of one-day surgery in proctology.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Cirurgia Colorretal/métodos , Adulto , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anestesia/métodos , Anestesia/estatística & dados numéricos , Cirurgia Colorretal/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Medição da Dor , Fatores de Tempo , Resultado do Tratamento
9.
Minerva Chir ; 53(5): 359-62, 1998 May.
Artigo em Italiano | MEDLINE | ID: mdl-9780623

RESUMO

BACKGROUND: It is well known that surgery induces an acute inflammatory response associated with significant increase of interleukin-6 (IL-6) and C reactive protein (CRP). Laparoscopic cholecystectomy (LC) is a so called "mini-invasive" surgical intervention and on the basis of this consideration it has been investigated if and how serological markers of inflammation are modified in patients after laparoscopic cholecystectomy compared to patients undergoing open cholecystectomy. METHODS: The acute phase of inflammation (IL-6, CRP and body temperature) was evaluated in 53 patients one day before surgery and p.o. after 1, 3 and 6 days; 26 patients underwent "open" cholecystectomy and 27 LC. RESULTS: One day after surgery patients with open cholecystectomy showed significant increase (p < 0.05) of IL-6, CRP and body temperature, while these parameters were almost unchanged in patients with LC. In patients with "open" cholecystectomy, 2 p.o. complications (pneumonia) were observed. CONCLUSIONS: In conclusion, LC, although it requires longer operative time, strongly reduces p.o. pain, hospitalization, promotes earlier recovery and return to normal activity, avoiding the acute phase of p.o. inflammation with better p.o. morbidity compared to open surgery.


Assuntos
Colecistectomia Laparoscópica , Interleucina-6/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Colecistectomia , Feminino , Febre/sangue , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade
10.
Endoscopy ; 28(3): 312-5, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8781799

RESUMO

The results with five pediatric patients (6-15 years) who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis are reported here. One patient had associated hematological disease (sickle-cell anemia). All five children were submitted to surgery using the laparoscopic technique. Intraoperative cholangiography was performed in two cases with uncertain ductal and vascular intraoperative anatomy. None of the operations was converted to open cholecystectomy, and there were no operative complications. The mean hospital stay was 2.2 days (range 2-3 days). All five children were able to return to normal activity within a week. No long-term complications were seen in any of the patients during an average follow-up period of 10.6 months (range 8-14). We believe that laparoscopic cholecystectomy in children is safe and effective, and that it is an important alternative to open cholecystectomy. However, prospective comparative studies of the procedure are necessary.


Assuntos
Colecistectomia Laparoscópica , Colecistectomia , Colelitíase/cirurgia , Adolescente , Criança , Feminino , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
Chir Ital ; 48(4): 21-5, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-9522095

RESUMO

Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial clearly assessing the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and establishing the severity in order to plan the appropriate treatment. Forty-nine ABP patients were diagnosed by ultrasound (75.5%) or by laboratory findings (22.5%). Following Ranson and APACHE II scoring, 15 cases (30.6%) were classified as severe, 34 (69.3%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hours) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. In severe cases operative endoscopy cured pancreatic inflammation in 11 cases. Subsequent LC never showed serious morbidity, but subcutaneous emphysema in one case. In 4 cases laparotomy was required since pancreatic necrosis was present, with 75% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 8.8% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 80% of cases. In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hours as well as in mild cases (LC + IOC) when surgery is done within 10 days.


Assuntos
Colecistectomia Laparoscópica , Colelitíase/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Pancreatite/cirurgia , Esfinterotomia Endoscópica , APACHE , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colelitíase/complicações , Colelitíase/diagnóstico , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/etiologia , Fatores de Tempo
12.
Chir Ital ; 48(4): 27-31, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-9522096

RESUMO

Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.


Assuntos
Colecistectomia Laparoscópica , Colecistectomia , Colecistite/cirurgia , Complicações Pós-Operatórias/imunologia , Doença Aguda , Adulto , Idoso , Colecistite/imunologia , Feminino , Antígenos HLA-DR/imunologia , Humanos , Interleucina-6/imunologia , Laparotomia , Contagem de Linfócitos , Subpopulações de Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Testes Cutâneos
13.
Minerva Pediatr ; 48(1-2): 21-7, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-9072661

RESUMO

Despite the exponentially increasing number of laparoscopic cholecystectomies on adults to date, there is a paucity of reports in the literature about this new technique in pediatric patients. From September 1992 to February 1995, 140 patients underwent laparoscopic cholecystectomy. Since July 1993, in our institution, five pediatric patients (three females and two males) with a diagnosis of cholelithiasis underwent laparoscopic cholecystectomy. The age of the patients ranged from 6 to 15 years (mean 8.8 years) and they weighed 18-58 kg (mean 28.4 kg). All five patients had biliary cholic and ultrasound evidence of cholelithiasis. One patient had associated hematological disease (sickle cell disease). All 5 children were operated using the laparoscopic approach technique. Operative cholangiography was performed in cases with ductal and vascular intraoperative anatomy unclear. No operation was converted to open cholecystectomy. Intraoperative cholangiography was performed successfully (100%). The mean time of surgery was 50.2 minutes (range from 38 to 68). There were no operative complications. The mean hospital stay was 2.2 days (range 2 to 3 days). All five returned to their activity within a week. No long-term complications were seen in all patients throughout an average follow-up period of 10.6 months (range 8-14). The benefits of laparoscopic cholecystectomy in children are clear and obvious. It is safe and effective and should now be the treatment of choice for cholelithiasis in pediatric patients.


Assuntos
Colecistectomia Laparoscópica , Gravação em Vídeo , Adolescente , Anestesia Geral , Criança , Colangiografia , Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Masculino , Ultrassonografia
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