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ABSTRACT: Laparoscopic fundoplication to correct or avoid gastroesophageal reflux decreased Belsey Mark IV fundoplication (BMIV) dramatically worldwide. The purpose of this paper was to determine the role of BMIV and its current indications.
We reviewed all patients who underwent fundoplication between April 1997 and December 2001. All patients underwent a complete work-up included barium meal, endoscopy, 24-h pH-metry and manometry preoperatively.
Sixty-two consecutive fundoplications were performed. There were 23 males and 39 females. Forty-six patients were treated by laparoscopic approach (37 patients with total and nine patients with partial fundoplication). BMIV was preferred in 16 patients with the following indications: reoperations for failed oesophageal surgery (5), hiatal hernia fixed in the chest (4), epiphrenic oesophageal diverticula (3), diffuse oesophageal spam (2), hiatal hernia associated with bullous emphysema (1), leiomyoma of the oesophago-gastric junction (1). Excellent to good results were reported in 14 patients and poor in two. Follow-up was completed in all patients.
BMIV remains a valid fundoplication although the current indications are now limited. The technique is to be considered an additional, but necessary, weapon for thoracic surgeons with interest in oesophageal disease.
European Journal of Cardio-Thoracic Surgery 11/2003; 24(4):625-30. · 2.55 Impact Factor
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ABSTRACT: In thoracic surgery, the classic thoracoscope is used to perform simple maneuvers in the chest. We have devised a minimally invasive technique that requires only a single trocar. This technique is used in our department to diagnose and treat a wide range of thoracic pathologies.
Between October 1998 and August 1999, 37 patients underwent surgery prospectively for a thoracic disease through a single trocar. There were 19 men and 18 women with a mean age of 60 years (range, 40-85). The trocar was flexible or soft and had a diameter of 15-20 mm. A 2-cm skin incision was made in the planned intercostal space. The chest drain was always inserted under video control.
The mean operative time was 53 +/- 5 min. One patient developed intraoperative bleeding that required intubation and a 5-cm mini-thoracotomy. In one patient with stage II empyema, it was necessary to insert another trocar. Chest tubes were removed after 77.7 +/- 7 h. Hospital stay was 4 +/- 1 days (range, 2-14). Histologic examination revealed malignant disease in 26 cases and benign disease in 11. Two patients (5.4%) developed wound infections. None of the patients had port site metastasis. There were no hospital deaths.
Because of its simplicity, we recommend the use of this mini-invasive technique in place of the classic thoracoscope or video-mediastinoscope.
Surgical Endoscopy 09/2001; 15(8):899-901. · 4.01 Impact Factor
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The Annals of Thoracic Surgery 07/2000; 69(6):1990-1. · 3.74 Impact Factor
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ABSTRACT: Tight fundoplication is a well known complication of surgery for gastroesophageal reflux. We have noted, in clinical experience, that some patients operated for gastro-oesophageal reflux develop pharyngo-oesophageal dysphagia. This study was undertaken to elucidate, by comparing motility data in patients with and without tight fundoplication, the pathophysiologic characteristics of the swallowing mechanism and to clarify the cause of dysphagia in these patients.
Sixteen patients with postoperative persistent dysphagia following a fundoplication have been studied, of those 10 presented a lower oesophageal sphincter resting pressure above or equal to 30 mmHg (group A). Clinical work-up included a questionnaire, oendoscopy, manometry and barium meal or video-roentgenography. Oesophageal manometry was performed using a slow pull through technique while the stationary pull through technique was used for the pharyngo-oesophageal segment. The following parameters were evaluated: (a) amplitude of pharyngeal contraction; (b) upper oesophageal sphincter resting pressure; (c) amplitude of upper oesophageal sphincter contraction; (d) amplitude of oesophageal contraction; (e) lower oesophageal sphincter resting pressure. The results were compared to those of 21 patients who had a fundoplication with normal lower oesophageal sphincter pressure (group B).
in group A there were three males and seven females, with a mean age of 51 years (ranging from 28 to 60 years). Previous operations were Nissen in two and Nissen Rossetti in eight patients. Three out of 10 patients of group A presented pharyngo-oesophageal dysphagia. Mean lower oesophageal sphincter 36 versus 21 mmHg and upper oesophageal sphincter 86 versus 42 mmHg resting pressure, pharyngeal 147 versus 76 mmHg and oesophageal amplitude, upper oesophageal contraction 251 versus 103 mmHg were significantly higher in patients of group A versus group B. An increased number of repetitive contractions was also found in group A. The presence of a strong correlation was demonstrated between the pharyngeal amplitude and the closing tone of the upper oesophageal sphincter (R2 0.742 and R2 0.739) in both groups.
Tight fundoplication is, in our experience, always associated with total fundoplication. The appearance of pharyngo-oesophageal dysphagia in the postoperative period in patients operated on to correct gastroesophageal reflux using a total fundoplication, should not be under-estimated because it suggests an obstruction of the distal oesophagus.
European Journal of Cardio-Thoracic Surgery 10/1999; 16(3):266-72. · 2.55 Impact Factor
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Minerva chirurgica 04/1998; 53(3):115-9. · 0.77 Impact Factor
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ABSTRACT: The authors compare the efficacy of epidural morphine analgesia with continuous intercostal extrapleural block using bupivacaine 0.5% after thoracotomy. They affirm that antalgic treatment in thoracotomised patients is the most important factor in preventing the onset of major complications that may negatively influence the results of surgery. The efficacy of the analgesic techniques examined was evaluated using El-Baz's visual analogic scale of pain, through the analysis of spirometric values and on the incidence of postoperative complications. The authors demonstrate that the extrapleural continuous nerve block is a reliable method of post-thoracotomic analgesia.
Minerva chirurgica 04/1996; 51(3):103-7. · 0.77 Impact Factor
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ABSTRACT: Three patients with pleuropericardial cysts are reported. The authors accoding to what exists in literature confirm the congenital origin of this relatively rare pathology. It is benign and rapresents 6-19% of all mediastinal neoplasms. This lesion is more common in adults and prefer IV-VI decade of life. Usually this cyst constitute a casual radiological report because most of these tumours are asymptomatic. In our experience only one case was characterized by dyspnea. The authors, besides, consider CT of great help in diagnosis of pleuropericadial cyst in view of its high specificity. Thoracoscopy, result very important to diagnosis and exeresis of this neoplasm when doubts no persist as to the true nature of the lesion. Surgical treatment of pleuropericadial cyst is the only therapy. In our experience thoracotomy was preferred with excellent results and no postoperative complications or recurrences.
Minerva chirurgica 01/1996; 50(12):1057-63. · 0.77 Impact Factor
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ABSTRACT: Two observed cases of spigelian hernias in 54 years and 62 years old men leads to an analysis of the diagnostic clinical and therapeutic aspects of this rare abdominal pathology. It represents 1-2% of all abdominal hernias and can occur anywhere along the semicircular line of Douglas, but in 90% of cases its most frequent localization is from the level of the umbilicus to the inguinal area. Diagnosis can be difficult because of non-specificity of symptoms. Many times Spigelian hernia is masked by abdominal fat and the only symptom is pain. TAC plays a primary role in the diagnosis of spigelian hernia, infact with it, detailed characteristiques and location of the hernia, hernial content, other intra-abdominal pathology, are recognized. The only treatment of spigelian hernia is surgical; many times it is diagnostic and therapeutic. A pararectal skin incision permits an accurate exploration of the abdominal cavity and an cautious choice of aponeurosis to the plastic repair.
Minerva chirurgica 01/1996; 50(12):1099-103. · 0.77 Impact Factor
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ABSTRACT: An observed case of leiomyosarcoma of the stomach in a 67 year old man leads to an analysis of the diagnostic, clinical and therapeutical aspects of this myoid tumour in the digestive tract representing 50-60% of cases. Symptoms are aspecific and gastric bleeding is the most common sign (50%). leiomyosarcoma always presents considerable problems of diagnosis and represents the most important among the various examined diagnostic investigations but it is maintained that surgery many times plays a primary role in the diagnosis of this tumour. The accuracy of gastrofiberoscopic biopsy is limited by frequent false-negative cases. False negative cases are obtained because the tumour tissues are usually covered by gastric mucosa and so the biopsy with standard forceps is too small and too superficial. The ultrasonographic finding of a gastric leiomyosarcoma is variegated, in fact it can be hyperechoic or hypoechoic. Frequently we can see echo-free spaces due to liquefactive necrosis and in such a case, an echogenic rim is demonstrable. According to our experience ultrasonography is very important in post-operative follow-up. The TC study can be considered superior to the other diagnostic investigations, in fact with it, detailed characteristics and location of the tumour, invasivity, metastatic dissemination, are recognized. It is still controversial the criterium concerning the diagnosis of malignant smooth muscle tumour of the gastrointestinal tract. We believe that number of mitoses (having five or more mitotic figures x 10 high-power fields), cellularity, pleomorphism, atypicality, together with macroscopic aspects (size, bleeding, ulcerations, necrosis, invasivity) are the most reliable indicators of malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)
Minerva chirurgica 11/1993; 48(20):1211-7. · 0.77 Impact Factor
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ABSTRACT: Having observed 6 cases of benign tumours deriving from nerve sheaths, one of which was of exceptional size (19 x 11 x 10 cm), with an endothoracic localization over the past 5 years, the Authors analyse the etiopathogenetic problems, anatomo-clinical symptoms and the possible methods of treating these endothoracic tumours. Neurinomas represent between 60 and 70% of mediastinal neurogenic tumours which account for 20% of all cancers of the mediastinum. Their typical localization is the posterior mediastinum, along the paravertebral grooves, and the dimensions of these tumours vary between 3 and 8 cm, although on rare occasions they reach 15 cm. In all cases except that of the giant neurinoma, surgery took the form of straightforward enucleation. Follow-up has not revealed recidivation in any of the cases operated.
Minerva chirurgica 01/1993; 47(23-24):1827-33. · 0.77 Impact Factor
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ABSTRACT: The paper reports a case of intrathoracic hemangiopericytoma localised in mediastinum which was brought to the authors attention and treated surgically. Having analysed the tumour's macro- and microscopic histological and biological features and the most suitable methods of diagnosis, the authors stress that, in line with international literature, radical surgery extended to the surrounding tissues is the elective surgical treatment for hemangiopericytoma in a mediastinal site.
Minerva chirurgica 12/1991; 46(21-22):1205-15. · 0.77 Impact Factor
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ABSTRACT: The authors take the opportunity of 11 cases of pulmonary hamartomas observed during the last 10 years, to specify the clinical and diagnostic problems and the therapeutic possibilities of this rare pulmonary neoplasm. The hamartochondroma is found mainly in the male sex, between the age of the fifth and sixth decades of life; the size of the neoplasm varies from 2 to 4 cm, rarely exceeding 10 cm. In 8 cases the operation was the simple enucleation of the hamartochondroma or its removal by atypical resection: in only one case, become of the conspicuous dimensions of the neoplasm, was it necessary to perform a typical lobectomy. The follow-up did not demonstrate any relapse, or the appearance of carcinoma of the lung in any of the cases under observation and surgically treated.
Minerva chirurgica 11/1991; 46(19):1019-25. · 0.77 Impact Factor
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Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 02/1990; 10 Suppl 30:17-24. · 0.86 Impact Factor
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Minerva chirurgica 10/1984; 39(18):1205-10. · 0.77 Impact Factor
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Minerva chirurgica 05/1984; 39(7):481-7. · 0.77 Impact Factor
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Minerva chirurgica 12/1981; 36(21):1433-40. · 0.77 Impact Factor
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ABSTRACT: The Authors examine the various types of breast discharge concentrating in particular on the secretions due to inherent pathology. After having studied origin, they concentrate on the diagnostic significance and the limits of exfoliative cytology and contrast mammography. The Authors conclude by presenting an original protocol of treatment of the afflicted breast illustrating in addition, the various surgical techniques proposed for the cure of the sicknesses of intramammary origin that cause abnormal discharge.
Chirurgia italiana 03/1981; 33(1):107-21.
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ABSTRACT: The Authors describe their experience in the resections of pulmonary tissue performed with the use of American automatic staples TA and GIA after having illustrated the surgical techniques allowed by them, and in most use, the Authors conclude by reviewing the numerous advantages, both operatory and clinical, of the metallic suture applied by the staplers, which confirm the validity of their use in pulmonary resections.
Chirurgia italiana 03/1981; 33(1):135-40.
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ABSTRACT: The Authors review their criteria of choice in 95 operations for plain goiter. The explain the parameters used in the evaluation of the various surgical procedures represented in this series, and give an account of long-term results in patients completing the followup period.
Chirurgia italiana 09/1979; 31(4):588-95.
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ABSTRACT: The Authors describe 5 cases of Bochdalek's posterolateral diaphragmatic hernia in terms of their clinical, diagnostic, and therapeutic aspects. They also explain their criteria in the choice of surgical approaches and describe reconstruction methods used in the repair of large hernias. Finally, they propose a special schedule of postoperative management to be used in connection with neonatal surgery, where surgical mortality is still high.
Chirurgia italiana 09/1979; 31(4):435-45.
