Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
1.
G Chir ; 38(4): 181-184, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29182900

RESUMO

BACKGROUND AND AIMS: Bleeding and staple line leak are the most common postoperative complications of LSG. To prevent and/or to promptly identify such complications, conventional peri-operative protocols imply post-operative gastric decompression (NGT) and staple line drain (IAD). Our aim was to evaluate the role of naso-gastric tube (NGT) and intra-abdominal drain (IAD) in preventing and/or facilitating identification and treatment of post-operative complications after sleeve gastrectomy. PATIENTS AND METHODS: A retrospective observational study on two consecutive series has been undertaken to evaluate the real utility of routine placement of NGT and IAD at the end of a LSG to prevent (primary end-point), promptly identify (secondary end-point) and manage (tertiary end-point) bleeding and staple line leakage. Collected outcome data of all consecutive cases, which underwent primary LSG at our Department, were analyzed. The first 100 consecutive patients (group A) received the standard perioperative protocol and the other consecutive 100 (group B) received a fast track protocol (no NGT neither IAD). RESULTS: The two groups were not different in their outcome. Two bleeding occurred in Group A and were conservatively treated. One abscess developed in group B soon after surgery. It was diagnosed by an abdominal CT performed because patients presented fever, leucocitosis and tachycardia. It was successfully treated by percutaneous ultrasound-guided drainage. One fistula occurred in group B after discharge on 30th post-operative day. Fistula was suspected based on fever and tachycardia in absence of any abdominal discomfort and was confirmed by an abdominal CT. The patient was successfully treated in 40 days by endoscopic positioning of a gastric tube-prosthesis and percutaneous ultrasound-guided drainage of abdominal collection. A third patient in group B experienced bleeding suspected due to hemoglobin drop and confirmed by abdominal CT. He also was conservatively treated. CONCLUSIONS: In conclusion, placement of drains does not facilitate detection of leak, abscess, or bleeding after primary LSG.


Assuntos
Drenagem , Gastrectomia/métodos , Intubação Gastrointestinal , Laparoscopia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/terapia , Adulto , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritônio , Cuidados Pós-Operatórios , Estudos Retrospectivos
2.
Eur Rev Med Pharmacol Sci ; 18(2 Suppl): 2-5, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25535183

RESUMO

OBJECTIVE: To evaluate the clinical feasibility and safety of a new technique for liver resection using a new saline-coupled bipolar sealing device (Aquamantys®) that has shown high performance in the animal setting. PATIENTS AND METHODS: Twelve Child-Pugh A cirrhotic patients with hepatocellular carcinoma underwent partial hepatectomies using Aquamantys®. Our primary end-point was to observe occurrence of early specific surgical complications as bleeding, biliary leakage and abscess development. Our secondary end-point was to evaluate local recurrence along resection margin after a minimum follow-up of 1 year. RESULTS: One bisegmentectomy, five monosegmentectomies and six atypical resections were performed. Mean resection time was 45 minutes (range, 30-100 min). Mean blood loss was 20 mL (range 5-80 mL). Mean post-operative stay was 6 days (range 5-16 days). All specimens presented negative margins (R0) at pathological examination. No blood transfusion were required both intra-operatively and post-operatively. No mortality was observed within 30-days post-operatively. One fluid collection occurred after  6-7 bisegmentectomy and was successfully treated by ultrasound-guided percutaneous drainage. At 1 year follow-up two patients died: one because of new lesions into the liver and one because of distant metastases and multifocal new liver disease. Ten patient are alive disease free at 1 year follow-up. CONCLUSIONS: Liver resection using Aquamantys® is feasible and safe and allows to achieve almost bloodless parenchymal division with minimal necrosis and negative margins even in atipycal resection. Comparative trials are needed to confirm our preliminary results.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/instrumentação , Hepatectomia/métodos , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Feminino , Seguimentos , Hepatectomia/efeitos adversos , Humanos , Cirrose Hepática/patologia , Neoplasias Hepáticas/patologia , Masculino , Recidiva Local de Neoplasia/cirurgia
3.
Surg Endosc ; 15(9): 1042, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11605115

RESUMO

BACKGROUND: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are. CASE REPORT: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically. CONCLUSIONS: Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.


Assuntos
Insulinoma/cirurgia , Laparoscopia/métodos , Neoplasias Pancreáticas/cirurgia , Contraindicações , Endossonografia/métodos , Feminino , Humanos , Insulinoma/diagnóstico , Pessoa de Meia-Idade , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico , Resultado do Tratamento , Cirurgia Vídeoassistida/métodos
4.
Surg Laparosc Endosc Percutan Tech ; 11(4): 256-61, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11525371

RESUMO

The medical records of patients who had undergone splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic splenectomy for nontraumatic splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.5%) who underwent laparoscopic splenectomy and 24 patients (54.5%) who underwent open splenectomy. Various parameters were reported for open and laparoscopic procedures separately, including associated surgical procedures, spleen weight, postoperative mortality and morbidity rates, perioperative blood transfusions, use and length of abdominal drainage, accessory spleen removal, operative times, length of hospital recovery, and hematologic parameters on admission to and discharge from the hospital. Laparoscopic splenectomy was successfully completed in all 20 considered patients with no conversion to open splenectomy. The supine position and four trocars were adopted in all patients. Accessory spleens were found in four (9.0%) patients: two (4.5%) during open splenectomy and two (4.5%) during laparoscopic splenectomy. The postoperative mortality rate was 2.7% (a case of myocardial infarction). The morbidity rate was 9% (four patients), but no postoperative complications occurred after laparoscopic splenectomy. A significant statistical difference was shown by the increase in platelet counts after open versus laparoscopic splenectomy. The open and laparoscopic mean operative times (73.70 +/- 13.42 minutes and 78.42 +/- 14.63 minutes, respectively) were comparable. These times were comparable also considering patients who underwent only splenectomy. Mean recovery time was shorter after laparoscopic splenectomy (3.95 +/- 0.60 days) than after open splenectomy (7.0 +/- 1.68 days). After open procedures, however, the mean recovery time was shorter in uncomplicated cases (6.68 +/- 1.49 days) than in the open group as a whole. Authors conclude that many well-known advantages of the laparoscopic approach. especially those related to its low invasiveness, can be observed in patients requesting splenectomy for nontraumatic diseases of the spleen, without lowering the efficacy of this operation. They suggest that such advantages can be entirely displayed when selection criteria of the patients are applied.


Assuntos
Laparoscopia , Linfoma não Hodgkin/cirurgia , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos
5.
Chir Ital ; 53(2): 189-94, 2001.
Artigo em Italiano | MEDLINE | ID: mdl-11396066

RESUMO

Laparoscopic cholecystectomy is the suitable treatment for symptomatic cholelithiasis, even if the incidence of biliary lesions following this procedure may be up to threefold higher than that of open cholecystectomy. We report our experience concerning the incidence, aetiopathogenesis, diagnosis and treatment of complications in a homogeneous group of laparoscopic cholecystectomies. In a total of 492 laparoscopic cholecystectomies only three bile duct lesions were observed (0.6%); they were classified according to Bismuth and re-assessed according to Strasberg. They consisted in two biliary leakages and one bile duct stricture. All patients were evaluated by full blood test, ultrasonography and endoscopic retrograde cholangiopancreatography. Endoscopic treatment was successful in the two patients with biliary leakage, while the patient with a stricture required surgical therapy. In conclusion, we suggest that a correct knowledge of the aetiopathogenesis together with a multidisciplinary approach to the diagnosis appear to be the best method for the detection, complete classification and most suitable treatment of symptomatic cholelithiasis.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
6.
Surg Laparosc Endosc ; 8(5): 353-5, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9799143

RESUMO

Intraabdominal structures may be damaged during blind introduction of the first trocar for laparoscopic operations. In this study, 150 patients with gallbladder lithiasis who underwent laparoscopy were randomly assigned to two groups, a blind (V group) or an open (H group), in order to compare the results and the rate of complications. No mortality was observed. Major complications occurred in 3/75 (4%) patients of the V group and in 1/75 (1.3%) patient of the H group (p < 0.05). Minor complications occurred in 5/75 (6.7%) patients of either group. The achievement of pneumoperitoneum required 4.5+/-0.4 min in the V group and 3.2+/-0.2 min in the H group (p < 0.05). The open laparoscopic technique is safer and faster than the blind approach; therefore, it is proposed that this approach be routinely used in all laparoscopic procedures.


Assuntos
Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial
7.
Chir Ital ; 47(2): 58-61, 1995.
Artigo em Italiano | MEDLINE | ID: mdl-8768089

RESUMO

Acute necrotizing pancreatitis involves high mortality. When diagnosed, the disease implies a choice of suitable timing and proper technique of surgical approach. The experience on 16 patients with acute necrotizing pancreatitis, 9 males and 7 females, mean age of 54.7 +/- 3.3 years, is presented in this study. Necrosectomy and continuous local lavage of abdominal collections and pancreatic necrotic surfaces was the most appropriate surgical treatment. The method seems able to remove necrosis and active biological compounds and would appear to achieve a limited mortality and morbidity. Necrosectomy and postoperative local lavage represent a therapeutic effective procedure.


Assuntos
Necrose/cirurgia , Pancreatite/cirurgia , Lavagem Peritoneal , Doença Aguda , Adulto , Idoso , Drenagem , Estudos de Avaliação como Assunto , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/mortalidade , Cuidados Pós-Operatórios
8.
Minerva Chir ; 49(9): 767-71, 1994 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-7991189

RESUMO

Seventeen consecutive patients with rectal cancer underwent surgery at our institution between January 1988 and December 1990. The aim of this study was to assess the urogenital symptoms after radical resection of the rectum. Ten of these patients were suitable for the study, 9 of whom had an Anterior Resection (with colorectal anastomosis in 7 cases and with coloanal anastomosis in 2) and 1 a Miles operation. We observed urogenital disturbances in 2 patients (20%), 1 male with urinary tract dysfunction and 1 female with difficulties of sexual activity. The disease-free interval, at 36 months, was 100%. We suggest that curative surgery for rectal cancer can be associated, in overall cases, with a low incidence of urogenital disturbances. This allows the improvement of quality of life without evidence of loco-regional recurrence. A resective approach of rectal cancer, able to preserve nervous fiber of pelvic plexus but providing at the same time a radical excision of the tumor, seems to be a determining factor.


Assuntos
Carcinoma/cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Transtornos Urinários/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo
9.
Presse Med ; 22(28): 1307-12, 1993 Sep 25.
Artigo em Francês | MEDLINE | ID: mdl-8248056

RESUMO

In a sample population of 49 subjects (7 normal, 42 with various liver diseases), the parameters of the activity/time curve of trimethylbromo-iminodicetic acid (TBIDA) biliary scintigraphy were compared with the clearances of bromosulfophthalein (BSP) and indocyanine green (ICG). Correlation between T1/2 and P2 BSP slope was r = 0.50 (n = 33; P < 0.01). Correlation between Tmax TBIDA and fractional ICG clearance (P ICG) was r = 0.65 (n = 44; P < 0.001). In 23 cases of chronic cholestasis correlations remained significant (T1/2-P2 BSP: r = 0.53; n = 17; P = 0.02; Tmax-P ICG: r = 0.59; n = 17; P < 0.01). A prospective study of 11 cases of chronic intrahepatic cholestasis (primary biliary cirrhosis 8, primary sclerosing cirrhosis 3) showed that these two types of tests varied concordantly. Biliary scintigraphy, therefore, seems to be an accurate method to explore hepatocellular mass (degree of hepatic insufficiency) and cholestasis. The validation of biliary TBIDA scintigraphy as hepatobiliary functional exploration method and the possibility to study intrahepatic "regions of interest" defined a priori would make it possible to obtain a functional estimate of hepatic segments or lobes, for example before wide liver excision.


Assuntos
Colangite Esclerosante/diagnóstico por imagem , Colestase Intra-Hepática/diagnóstico por imagem , Cirrose Hepática Biliar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Colangite Esclerosante/tratamento farmacológico , Colangite Esclerosante/urina , Colestase Intra-Hepática/tratamento farmacológico , Colestase Intra-Hepática/urina , Doença Crônica , Feminino , Humanos , Verde de Indocianina/análise , Cirrose Hepática Biliar/tratamento farmacológico , Cirrose Hepática Biliar/urina , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Sulfobromoftaleína/análise , Ácido Ursodesoxicólico/uso terapêutico
10.
G Chir ; 14(4-5): 239-41, 1993.
Artigo em Italiano | MEDLINE | ID: mdl-8343351

RESUMO

Twenty-four patients operated on for breast carcinoma with associated axillary node dissection were randomly assigned to two protocols. In the first group fibrin glue was applied intraoperatively, in the second group no complementary treatment was accomplished. The aim of the study was to evaluate the effect of fibrin glue in reducing postoperative axillary sero-lymphatic secretion. In the fibrin glue group a significant reduction of postoperative axillary secretion was observed.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Avaliação de Medicamentos , Feminino , Humanos , Excisão de Linfonodo , Linfocele/prevenção & controle , Mastectomia Radical , Mastectomia Segmentar , Complicações Pós-Operatórias/prevenção & controle
11.
Ann Ital Chir ; 64(1): 29-33, 1993.
Artigo em Italiano | MEDLINE | ID: mdl-8328758

RESUMO

The surgical goal of gastroesophageal reflux treatment is to restore the ability of antireflux barrier. The basal tone and the length of lower esophageal sphincter are commonly considered the most important factors in the assessment of gastroesophageal reflux symptoms. However, reflux symptoms may also occur after surgical correction of sphincter incompetence. In the present study, 20 patients were evaluated pre- and postoperatively by 24 hours pH monitoring, esophageal manometry, endoscopy and analysis of gastric emptying of solids, in order to verify surgical results and connected functional changes. Preoperative data suggested to perform a partial fundoplication in 12 patients and a total fundoplication in 8 cases. Our results can indicate that fundoplications are able to significantly control reflux symptoms, to improve the competence of lower esophageal sphincter and finally to normalize gastric emptying of solids. This study emphasizes the value of normalizing a delayed gastric emptying to assure a satisfactory clinical outcome. The postoperative impaired gastric emptying rates in fact appear to associate with persistent symptoms.


Assuntos
Esofagite Péptica/cirurgia , Adulto , Idoso , Esofagite Péptica/epidemiologia , Esofagite Péptica/fisiopatologia , Esôfago/fisiopatologia , Esôfago/cirurgia , Feminino , Seguimentos , Fundo Gástrico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica
13.
Minerva Chir ; 47(1-2): 11-7, 1992 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-1553047

RESUMO

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis.


Assuntos
Esofagite Péptica/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Tono Muscular/fisiologia , Adolescente , Adulto , Idoso , Transtornos de Deglutição/fisiopatologia , Feminino , Esvaziamento Gástrico/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Azia/fisiopatologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade
14.
Minerva Chir ; 45(17): 1089-91, 1990 Sep 15.
Artigo em Italiano | MEDLINE | ID: mdl-2177859

RESUMO

In this study the incidence, the treatment and the survival of 7 patients with bilateral metachronous breast cancer have been evaluated. From this experience, the value of careful follow-up of mastectomized patients in order reach an early diagnosis of bilateral breast cancer is stressed.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Tempo
15.
Ann Ital Chir ; 60(6): 531-5, 1989.
Artigo em Italiano | MEDLINE | ID: mdl-2639610

RESUMO

Superior mesenteric artery syndrome is an uncommon clinical condition. A case of duodenal vascular compression and a review of the literature are reported in order to clarify the pathophysiology of the disease. Diagnostic values of hypotonic duodenography and angiography are emphasized. Although, the significance of long-term pH monitoring and gastric emptying for preoperative study and its importance in follow-up after the surgical treatment are evaluated.


Assuntos
Obstrução Duodenal , Síndrome da Artéria Mesentérica Superior , Adulto , Anastomose Cirúrgica , Obstrução Duodenal/complicações , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/patologia , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Seguimentos , Determinação da Acidez Gástrica , Humanos , Jejuno/cirurgia , Masculino , Síndrome da Artéria Mesentérica Superior/complicações , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/patologia , Síndrome da Artéria Mesentérica Superior/cirurgia
17.
Gastroenterol Clin Biol ; 10(10): 656-61, 1986 Oct.
Artigo em Francês | MEDLINE | ID: mdl-3792740

RESUMO

Delayed gastric emptying has been assumed to play an important role in the pathogenesis of gastroesophageal reflux (GER), even though this relationship has not been definitely established. Eleven patients with symptomatic GER were studied by esophageal manometry, endoscopy, gastroesophageal scintiscanning and gastric emptying of a mixed meal. Nine healthy subjects served as controls. Gastric emptying of solids (evaluated both as emptying half-time and emptying index) in GER patients was significantly slower than in controls. In comparison with a "normal" range previously established in 50 healthy subjects, only 2 of 11 (18.2 p. 100) of GER patients had a normal emptying rate. In addition, a significant correlation was found between the emptying half-time and the degree of esophageal lesions. These results suggest that impaired motor function of the gastric antrum could influence the natural history of GER disease and especially the appearance of esophagitis. The lack of esophageal lesions in the only two patients with "normal" emptying strongly supports this hypothesis.


Assuntos
Esvaziamento Gástrico , Refluxo Gastroesofágico/fisiopatologia , Adulto , Esôfago/diagnóstico por imagem , Feminino , Gastroscopia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Cintilografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...