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Endoscopy 01/2009; 40 Suppl 2:E263-4. · 5.21 Impact Factor
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ABSTRACT: The role of laparoscopic resection in the management of colon cancer is still a subject of debate. In this clinical study, we compared the perioperative results and long-term outcome for two unselected groups of patients undergoing either laparoscopic or open hemicolectomy for colon cancer.
This prospective nonrandomized study was based on a series of 248 consecutive patients operated on by the same surgical team using the same type of surgical technique for right (RHC) and left (LHC) hemicolectomy, excluding segmental resections; the only difference was the type of access, which was either laparoscopic or open. The choice of type of access was left up to the patient after he or she had read the informed consent form. Operative time, length of stay, complications, and long-term outcome for the two groups were compared. Follow-up time ranged between 12 and 92 months (mean, 42).
Between March 1992 and January 2000, 140 patients underwent a laparoscopic hemicolectomy (55 RHC and 86 LHC); at the same time, 107 patients (44 RHC and 63 LHC) were treated via an open approach. There were no conversions to open surgery in the laparoscopic RHC group, but six patients (7%) in the laparoscopic LHC group were converted. The mean operative time for laparoscopic surgery was significantly longer than the time for open surgery (190 vs 140 min for RHC, 240 vs 190 min for LHC,); however, with increasing experience, this time decreased significantly. The mean hospital stay for the patients who underwent laparoscopic procedures was significantly shorter in both the RHC and the LHC groups (9.2 vs 13.2 days for RHC, 10.0 vs 13.2 days for LHC). No statistically significant difference between the two laparoscopic and open groups was observed for the major complication rate (1.9% vs 2.3% for RHC, 7.5% vs 6.3% for LHC). The patient in the laparoscopic RHC group were lost to follow-up. The local recurrence rate was lower after laparoscopic surgery in both arms (5.4% vs 9% for RHC, 1.5% vs 7.5% for LHC), but the differences were not statistically significant. Two port site recurrences were observed in the laparoscopic groups, one after RHC (2.7%) and one after LHC (1.5%). Metachronous metastases rates were similar for the two groups (16.2% vs 15.1% for RHC, 4.4% vs 5.7% for LHC). Cumulative survival probability at 48 months after laparoscopic RHC was 0.865, as compared to 0.818 after open surgery, and 0.971 after laparoscopic LHC, as compared to 0.887 after open surgery.
These results suggest that laparoscopic hemicolectomy for colonic cancer can be performed safely, with morbidity, mortality, and long-term results comparable to those of open surgery.
Surgical Endoscopy 05/2002; 16(4):596-602. · 4.01 Impact Factor
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ABSTRACT: The authors report in a retrospective study their experience in the treatment of anal fistulas suggesting the total exercises of the fistula with primary closure of external and internal anal sphincters and rectal mucosa. In our department of surgery between 1987 and 1993, 36 patients (22 males and 14 females) with anal fistulas (17 intersphincteric, 15 trans-sphincteric and suprasphincteric) were treated with this technique. Postoperative in-hospital stay ranged between 2 and 5 days (mean 3.1) and surgical healing needed 12-15 days. A dehiscence of distal tract was observed in 3 cases (8.2%). in these cases secondary closure of the wound needed 24-28 days. All the patients controlled at follow-up (it lasted at least 1 year) did not show rectal incontinence for gas or stools. The authors conclude that total exeresis with primary closure is a safe procedure indicated in the treatment of anal fistula not associated to inflammatory bowel disease in consideration of earlier healing and minor costs.
Minerva chirurgica 05/1997; 52(4):377-81. · 0.77 Impact Factor
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ABSTRACT: Disturbances of anal continence and evacuation are frequent. Numerous techniques are now available to measure anorectal function. There is also a better understanding of the anatomy and physiology of the pelvic floor which has a major role in anorectal function. ANORECTAL MANOMETRY. Manometry of the anal canal is an index of the resistance of sphincters to the passage of faeces. Resting pressure is due mainly to the internal anal sphincter whereas voluntary contraction is due mainly to the external anal sphincter. Anorectal manometry is essential in measuring the length of the anal canal and in establishing the presence of the rectoanal inhibitory reflex. Several techniques are employed to evaluate anorectal manometry which is useful in the investigation of patients with faecal incontinence and constipation. PUDENDAL LATENCIES: Pudendal latencies are valuable in the study of the innervation of the external anal sphincter. Pudendal latencies are measured thanks to the stimulation of the S2-S4 nerves lying in the proximity of the ischial spine through the use of a special glove (St Mark's glove). Prolonged pudendal latencies are typical of neurogenic faecal incontinence but it can be brought about by childbirth, rectal prolapse, obstructed defecation and old age. ELECTROMYOGRAPHY. Electromyography is useful in the study of the function of the pelvic floor. This technique can be performed with single fibre needles which make it possible to measure the action potentials and the fibre density of the muscular fibres. Fibre density is raised in neurogenic faecal incontinence and the action potentials are polyphasic in this condition. Concentric needles are employed to map the anal sphincters and this is useful for evaluating the extent of the damage caused by traumatic events like a third degree tear. ANAL ENDOSONOGRAPHY. Anal ultrasound is very effective in the study of the morphology of the anal sphincters and it requires a rectal probe fitted with a 7-MHz transducer. It is as accurate as electromyography in evaluating the damage to the anal sphincters but it is not painful and it is more acceptable to the patient. DEFECOGRAPHY. This radiological test is a dynamic study of the pelvic floor during defecation. It is very useful for investigating the function and the morphology of the rectum and the pelvic floor during defecation. Important parameters like: the anorectal angle, the opening of the anal canal, the position of the pelvic floor and the descent of the perineum can be evaluated with this test. Defecography is useful in the study of patients with rectal prolapse and constipation. CONCLUSION. All these tests provide extremely useful information on the pelvic floor and are reproducible. They can be of great help in evaluating patients with pelvic floor disorders but they are no substitute for clinical judgement.
Minerva chirurgica 01/1995; 49(12):1187-93. · 0.77 Impact Factor
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ABSTRACT: In this study we evaluated the role of barium examinations and above all computed tomography and magnetic resonance imaging in the study of Crohn's disease. CT is most often requested for patients with suspected or known intraabdominal or pelvic abscesses. MR plays a very important role in the localization of perirectal and perianal abscesses.
La Clinica terapeutica 07/1994; 144(6):545-51. · 0.27 Impact Factor
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Minerva chirurgica 05/1992; 47(8):749-56. · 0.77 Impact Factor
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ABSTRACT: A group of 212 patients operated upon for Crohn's disease were studied and the early postoperative complications with related problems were assessed. The morbidity was 28.3 per cent, 60 patients had at least one complication, mainly of septic nature. The mortality was 3.3 per cent (7 patients), sepsis and deep vein thrombosis with pulmonary embolism were the most common causes of death. Postoperative complications were significantly higher (39.7%) (p less than 0.001) in patients with a pre-operative nutritional deficit and in those who had urgent surgery (44.4%) (p less than 0.001). Among patients with pre-operative sepsis, the morbidity was also higher (34.6%), but was not significant. Peri-anastomotic complications (dehiscence, abscess, fistula, bleeding) were apparently more frequent (45.4%) in patients with histological residual Crohn's disease at macroscopically free resection margins although this contrasts with previous series. A proper pre-operative diagnostic approach, adequate peri-operative protein-caloric repletion, antibiotic therapy, prevention of thromboembolism and elective surgery, are still the primary tools in reducing the morbidity and mortality after surgery for Crohn's disease.
The Netherlands journal of surgery 09/1990; 42(4):105-9.
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ABSTRACT: A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia 02/1989; 19(4):399-400.
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ABSTRACT: A technique that allows a safer use of the pursestring applicator in stapled esophagojejunostomy is described. By means of five stitches, all esophageal layers are incorporated in the stapled line. Thus, missing a segment of esophageal mucosal layer is avoided. No clinical or radiologic leak was observed in 48 patients who underwent total gastrectomy using this technique.
Surgery, gynecology & obstetrics 01/1989; 167(6):525-6.
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ABSTRACT: Seven patients with non advanced cancer of the lower third of the rectum underwent sphincter-saving resection through a combined abdominoperineal approach. In this procedure not only coloanal anastomosis, but also bowel transection were performed through the anus. All the patients had cancer located between 3.5-5.5 centimeters from the anal verge. The main advantages of the technique are precise lines of bowel transection with desired distal clearance of tumor, and easier and safer mobilization of the distal end of the rectum during the abdominal phase of the procedure. No mortality was observed; morbidity was comparable to low anterior resection. The mean follow-up is 8 months and all patients are free of recurrence and continent.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia 02/1988; 18(2):121-5.
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ABSTRACT: A combined abdominoperineal approach is described in which not only coloanal anastomosis but also bowel transection were performed through the anus. It is most suitable for cancer located 4 to 6 cm from the anal verge. The main advantages of the technique are precise lines of bowel transection with desired distal clearance of tumor, and easier and safer mobilization of the distal end of the rectum during the abdominal phase of the procedure.
Diseases of the Colon & Rectum 09/1987; 30(8):641-3. · 3.13 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the results of transduodenal papillostomy as a routine procedure in managing choledocholithiasis in treating common bile duct (CBD) stones. From 1973 to 1978, 117 patients underwent transduodenal papillostomy for CBD lithiasis. The operation was carried out in standard manner, and all patients had preoperative telecholangioscopy, cholangiography, and biliary manometry. The mean age of patients was 53.7 years, and women predominated in a ratio of 4.5:1.0. Papillostomy was performed together with cholecystectomy for CBD stones in 111 patients (group 1). In five patients, we had to perform a choledochotomy to remove the stones after an unsuccessful papillostomy (group 2). Eight patients who previously had cholecystectomies underwent papillostomy for retained or recurrent stones (group 3), and three patients had a choledochoduodenostomy for recurrent stones after a previous cholecystectomy and papillostomy (group 4). Complications included two deaths in group 1 (1.9%). No mortality was observed in groups 2 and 4. Moreover, the overall morbidity was due to six cases of wound infection, one case of postoperative bleeding, one case of phlebitis, and three cases of cholangitis. The mean length of hospital stay was 12.9 days, considering all the groups. Lack of confidence with this procedure may explain the different results reported in the literature for transduodenal papillostomy, which on the basis of this study has been shown to ba a valid alternative to supraduodenal choledochotomy in treating CBD stones.
Archives of Surgery 08/1982; 117(7):875-7. · 4.24 Impact Factor
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ABSTRACT: Laparoscopic cholecystectomy is a so called mini-invasive surgical procedure, and on this basis, we investigated whether and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy.
In a prospective, nonrandomized trial, 35 patients underwent laparoscopic cholecystectomy and 31 open cholecystectomy. Immune activity (neutrophils, total lymphocytes, lymphocyte subpopulations, human leukocyte antigen (HLA-DR), interleukin 6, skin Multitest) was evaluated before surgery and respectively, 1, 3, and 6 days postoperatively.
One day after surgery, an increase in interleukin 6 (P < 0.01) was noted in patients who had undergone open cholecystectomy, while this parameter was almost unchanged in patients with laparoscopic cholecystectomy. Moreover, skin tests showed a hypo or anergic response in the majority (81.8%) of open cholecystectomy patients compared to laparoscopic cholecystectomy patients (10.5%), (P < 0.01). Finally, monocyte antigen HLA-DR was also reduced in open cholecystectomy patients (P < 0.05). In this group, we noted 2 cases (6.45%) of respiratory tract infection.
Even though laparoscopic cholecystectomy requires a longer surgery, it reduces postoperative pain, and hospitalization. It also facilitates rapid recovery, a return to normal activity, avoids postoperative immunosuppression and shows a better postoperative morbidity compared to open surgery.
Hepato-gastroenterology 48(39):642-6. · 0.66 Impact Factor
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F Fiocca,
A Santagati,
V Ceci,
G Donatelli,
M J Pasqualini,
M G Moretti,
V Speranza,
M Di Giuli, S Minervini,
G Sportelli,
S Giri
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ABSTRACT: Acute biliary pancreatitis (ABP) is a serious complication of biliary stones disease and is associated with significant morbidity and mortality. The role of ERCP in the management of ABP has been the focus of discussion in recent years. In this report, we evaluated a protocol of emergency Endoscopic retrograde Cholangiopancreatography (ERCP) (within 24 hours) and early ERCP (within 72 hours). From July 1997 to July 2000, were observed 45 patients (19 man and 26 women) with acute biliary pancreatitis. Mean age of patients was 63.4 years (range 21-87 years). Diagnosis of ABP was based on anamnesis and clinical assessment and was confirmed by specific laboratory data (hyperamylasemia, hyperlipasemia, total and fractionated bilirubinemia, gamma-GT, transaminase, alkaline phosphatase, hypocalcemia, hyperglycemia, leukocytosis). Ultrasound scanning within 24 h of admission was performed in 45 patients (100%) and it revealed gallbladder stones and muddy bile in 39 patients (87%). Computed tomography (CT) performed in all patients, showed a severe acute pancreatitis in the second or subsequent week following admission. The severity of acute pancreatitis was established by Glasgow's criteria and by clinical details of patients. ERCP and Endoscopic Sphinterotomy (ES) was performed in all 45 patients with acute biliary pancreatitis. Twenty-six patients (57%) were classified as having a severe attack (> 4) 19 as having a mild attack by Glasgow's criteria. ERCP associated with ES was performed within 24 hours in 22 patients (49%), 11 (50%) showed a severe attack and 11 (50%) showed a mild attack. A total of 2 complications (4%) occurred and the mortality was of 2 patients (4%). In 23 patients (51%) ERCP and ES was performed within 72 hours after conservative therapy, 8 (35%) showed a mild attack and 15 (65%) showed a severe attack. A total of 5 complications (9%) occurred and the mortality was of 3 patients (6%). Our study showed that ERCP with endoscopic sphincterotomy can be performed safely by skilled endoscopist, without adverse consequences soon after the onset of acute biliary pancreatitis even within the first 24 hours and it showed that is better than ERCP within 72 hours after conservative therapy.
European review for medical and pharmacological sciences 6(1):13-7. · 1.04 Impact Factor
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Annali italiani di chirurgia 65(3):275-8. · 0.23 Impact Factor
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Annali italiani di chirurgia 65(3):299-304. · 0.23 Impact Factor
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Annali italiani di chirurgia 65(3):289-91. · 0.23 Impact Factor
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Annali italiani di chirurgia 65(3):293-7. · 0.23 Impact Factor
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ABSTRACT: A series of 12 cases of esophageal anastomotic leakage following esophageal surgery observed from 1969 to 1989 is retrospectively analyzed. In the period 1969-1975 6 patients were treated in emergency and the mortality rate was 66.6%, while the remaining 6 patients observed from 1975 to 1989 were treated conservatively with total parenteral nutrition (sometimes associating adequate surgical drainage): the mortality rate was 16.6%. In conclusion, not only in the treatment of anastomotic leakage, but also in its prevention, artificial nutrition has a crucial role. The outcome of thoracic and abdominal fistulas depends mainly on adequate drainage, not necessarily surgical. Cervical fistulas heal in 2-4 weeks, but strictures arise frequently and respond to endoscopic dilatation.
Il Giornale di chirurgia 12(6-7):385-8.
