RESUMEN
BACKGROUND: Although laparoscopic transabdominal preperitoneal polypropylene (TAPP) hernia repair is now a recognized procedure for groin hernia repair in patients undergoing elective surgery, there is a scarcity of data on TAPP repair in emergency situations such as those involving strangulated hernias. METHODS: Unless contraindicated, the authors' department considers laparoscopic TAPP repair the procedure of choice for all strangulated hernias. A prospective database of 1,532 consecutive hernia repairs performed between May 1998 and April 2004 was reviewed. RESULTS: A total of 28 irreducible strangulated hernias were observed and repaired through laparoscopic TAPP. There were three conversions (10.7%): one because of extensive adhesions and two because of bowel distention. Resection became necessary in 9 (36%) of the 25 cases involving effective TAPP repair of strangulated hernias. The mean operation time, with and without resection, was 103 and 55 min, respectively. The rate of postoperative morbidity was 4% because of one inguinal hematoma case. During a mean follow-up period of 340 days, there were no recurrences after TAPP repair. CONCLUSIONS: For selected patients, the TAPP approach appears to be a good therapeutic option for strangulated hernias.
Asunto(s)
Hernia Inguinal/cirugía , Laparoscopía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparoscopía/normas , Masculino , Persona de Mediana Edad , Polipropilenos , Estudios Retrospectivos , Mallas Quirúrgicas , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Several studies have shown the efficacy and effectiveness of the combined endoscopic-laparoscopic "rendezvous" technique for treatment of gallbladder and bile duct stones without complications, particularly pancreatitis. The so-called rendezvous technique consists of laparoscopic cholecystectomy standards with intraoperative cholangiography followed by endoscopic sphincterotomy (EST). The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. This method allows easier and faster cannulation, thus avoiding papillary edema and pancreatic trauma. The aim of this study was to evaluate whether this method is effective in eliminating ductal stones and to verify whether the risk of postprocedure pancreatitis is diminished. METHODS: From January 2002 to September 2004, we enrolled 256 patients with cholecystocholedolithiasis detected by transabdominal ultrasound and magnetic resonance cholangiopancreatography. One hundred and twenty of these had one or more patient-related risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, so they were randomized into two groups of 60 patients. In group A, the patients were treated in a single step with videolaparoscopic cholecystectomy, intraoperative cholangiography, and EST during the surgical procedure with the rendezvous technique. In group B, preoperative ERCP and EST were performed by using a traditional method of bile duct cannulation. RESULTS: No cases of post-ERCP pancreatitis were observed in group A, whereas six cases of acute post-ERCP pancreatitis occurred in group B (five mild and one moderate) (p = 0.0274). No procedure-related mortality was recorded. CONCLUSION: In cholecysthocholedocholithiasis, the combined laparoscopic-endoscopic approach prevents post-ERCP pancreatitis in cases with patient-related risk factors for this complication.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Colecistolitiasis/cirugía , Coledocolitiasis/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Esfinterotomía Endoscópica , Adulto , Anciano , Amilasas/sangre , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colecistectomía Laparoscópica , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pancreatitis/epidemiología , Pancreatitis/etiología , Pancreatitis/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Factores de RiesgoRESUMEN
For a long time, primary tumors arising less than 2 cm distal to the carina have presented a contraindication to surgical excision. Tracheal sleeve pneumonectomy technique allows carinal resection and reconstruction but still carries considerable postoperative complications. From 1983 to 1992 we performed 27 right tracheal sleeve pneumonectomies and one left. Fourteen patients had N0 nodes, nine had N1, and five had N2. No anastomotic complications, either fistula or stenosis, were observed. Successful outcome depends on meticulous attention to surgical details and careful anaesthetic management with a new ventilation tube. One patient died on the twenty-second postoperative day from myocardial infarction. Complications included pneumonia (one), vocal cord paresis (two), and pleural empyema without bronchial fistula (one). Conservative treatment allowed complete recovery from all complications. There are seven patients alive at 4 years after operation and one at 5 years. Six patients have been disease-free for between 1 and 32 months. Two patients died free of disease at 13 and 42 months. Two patients died of mediastinal recurrence and 10 of distant metastases within 6 and 54 months.
Asunto(s)
Carcinoma Broncogénico/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Adulto , Anciano , Carcinoma Broncogénico/mortalidad , Carcinoma Broncogénico/secundario , Humanos , Neoplasias Pulmonares/mortalidad , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Tasa de SupervivenciaRESUMEN
Mediastinal masses are generally excised through wide thoracotomies or median sternotomies. These lesions are often benign, usually asymptomatic, discovered incidentally, and relatively easy to resect. For these reasons, a minimally invasive approach is appropriate. Videothoracoscopy allows an optimal exploration of the pleural cavity and a panoramic view of the mass. Dissection is usually easy to perform, and the mass can be extracted from the thorax through a trocar incision or through a limited "utility thoracotomy." To avoid possible tumor seeding, the mass is inserted in a plastic bag before extraction. From September 1991 to January 30, 1994, 20 mediastinal masses (6 thymomas, 2 thymic cysts, 1 hyperplastic thymus, 1 fibrous tumor of the mediastinum, 2 pleuropericardial cysts, 2 thoracic teratomas, 2 large thoracic lipomas, 3 neurogenic tumors, and 1 bronchogenic cyst) were removed through such a minimally invasive approach. Eighteen patients had an uneventful postoperative course. Two patients hemorrhaged in the immediate postoperative period, and repeat thoracoscopy was done. In 1 patient, electrocoagulation of a bleeding intercostal artery controlled the hemorrhage. In the other, the source of bleeding could not be found, and removal of the clots and irrigation of the cavity stopped the hemorrhage. Further data and long-term follow-up are necessary, but videothoracoscopy offers a new, less invasive approach for the management of noninvasive mediastinal masses.
Asunto(s)
Neoplasias del Mediastino/cirugía , Toracoscopía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Toracostomía , Timoma/cirugía , Neoplasias del Timo/cirugía , Grabación en VideoRESUMEN
BACKGROUND: Bronchial fistula is one of the most serious complications of pulmonary resection. METHODS: We present an endoscopic treatment that consists of multiple submucosal injections of polidocanol-hydroxypoliethoxidodecane (Aethoxysklerol Kreussler) on the margins of the fistula using an endoscopic needle inserted through a flexible bronchoscope. RESULTS: From 1984 to 1995, 35 consecutive nonselected patients with a postresectional bronchopleural fistula were treated. All 23 partial postpneumonectomy or postlobectomy bronchopleural fistulas, ranging from 2 to 10 mm in diameter, healed completely. This did not occur in the 12 total bronchial dehiscences. No complications occurred due to the injection of the drug. CONCLUSIONS: In our opinion this treatment can be considered a valid therapeutic approach, as it is simple, safe, scarcely traumatic, and inexpensive, particularly considering that, in patients in stable condition, it can be performed as an outpatient treatment.
Asunto(s)
Fístula Bronquial/cirugía , Endoscopía/métodos , Fístula/cirugía , Enfermedades Pleurales/cirugía , Fístula Bronquial/etiología , Broncoscopía , Fístula/etiología , Humanos , Inyecciones , Neoplasias Pulmonares/cirugía , Enfermedades Pleurales/etiología , Neumonectomía , Polidocanol , Polietilenglicoles/administración & dosificación , Complicaciones Posoperatorias , Dehiscencia de la Herida Operatoria , Adhesivos Tisulares/uso terapéutico , Resultado del TratamientoRESUMEN
We report on our experience in 20 patients who underwent major thoracoscopic pulmonary resections between October 1991 and November 1992. These consist of 2 left pneumonectomies, 17 lobectomies, and 1 segmentectomy. The indications were strictly limited to benign pulmonary diseases and stage I (TNM) primary lung cancer. A hilar lymphadenectomy was performed in all cases of malignancy. Our surgical technique is described. Our findings demonstrate the feasibility of performing major video-assisted thoracoscopic pulmonary resections, even though the definite role of this procedure in the management of lung cancer must still be defined.
Asunto(s)
Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Toracoscopía , Femenino , Humanos , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Engrapadoras Quirúrgicas , Televisión , Resultado del TratamientoRESUMEN
Videothoracoscopy, routinely performed as the initial step of an operation, opens interesting opportunities for both the operative staging and treatment of lung cancer. Videosurgical maneuvers ensure thorough exploration of the cavity, thus avoiding unnecessary exploratory thoracotomies, confirming resectability of the lesion by open or, in selected cases, by a direct video-assisted approach. We report our experience of 155 patients submitted to videothoracoscopic operative staging between October 1991 and January 1994. Videothoracoscopic operative staging showed unresectability in 13 patients (8.3%) due to preoperatively unexpected (10 patients) or suspected conditions (3 patients). The remaining 142 patients were divided by staging of the lesion and general conditions into three groups. Group A consisted of 13 elderly patients with small peripheral tumor who could not tolerate lobectomy and who underwent thoracoscopic wedge resection. Group B consisted of 63 patients with peripheral clinical T1 N0 or T2 N0 tumor. Fifty-two lobectomies and 4 pneumonectomies were carried out thoracoscopically. Seven conversions to thoracotomy were necessary due to technical problems. The postoperative course was uneventful in 51, 5 had prolonged air leakage, and a bronchial fistula developed in 1 because of positive-pressure postoperative ventilation. Group C consisted of 66 patients with stage II or IIIa neoplasm. Thoracotomy after thoracoscopy proved unresectability in 4, whereas 62 were submitted to a radical pulmonary resection. In the literature the incidence of exploratory thoracotomies for conditions missed by preoperative staging still remains high. After adoption of videothoracoscopic operative staging we reported a 2.6% exploratory thoracotomy rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Estadificación de Neoplasias/métodos , Televisión , Toracoscopía/métodos , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Invasividad Neoplásica/diagnósticoRESUMEN
Fifty-six patients underwent large bowel anastomosis by the compression anastomotic device developed by the authors from May 1986 through December 1988. Operations performed were 40 left hemicolectomies or anterior resections of the sigmoid and rectum, 7 left colon resections, 7 right hemicolectomies, and 2 total colectomies. Twenty-one anastomoses were done on the extraperitoneal rectum, in 7 cases less than 4 cm from the anal verge and in 9 cases between 4.5 and 8 cm. Five intraoperative diverting colostomies were done (9%). The rings of the device were evacuated postoperatively after a mean of 11 days with little or no discomfort. Operative mortality was 1.8% (one patient died of myocardial infarction). Anastomotic complications were one (1.8%) clinical and one (1.8%) subclinical leak. Mean postoperative hospital stay was 14 days. This initial clinical experience shows that the anastomotic device is reliable.
Asunto(s)
Anastomosis Quirúrgica/instrumentación , Colon/cirugía , Recto/cirugía , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Diseño de Equipo , Femenino , Humanos , Tiempo de Internación , Masculino , Métodos , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
The Authors, on the base of their experience by the Institutes of Surgical Semeiotics at the Trieste University and of Surgical Pathology at the Padua University, report 30 cases of malignant neoplasms of the anus and the anal canal. 17 patients were males and 13 females. Pathological, clinical and diagnostic problems are discussed. The Authors stress the value of surgical therapy, consisting in a simple local excision or in a wide abdominoperineal resection in conformity with the distinctive features of every single neoplasm. The surgical strategy against nodal metastases is proposed, and the results which are obtained by combining surgery and irradiation are analysed. It is opinion of the Authors that surgical therapy is the most suitable approach for radical treatment of these neoplasms, even if early experience with multimodality therapy is promising to be a great success.
Asunto(s)
Neoplasias del Ano/cirugía , Adenocarcinoma/cirugía , Adulto , Anciano , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/patología , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
The authors describe their experience in performing Videothoracoscopy as the first step of the operation in patients affected by lung cancer: they refer to this procedure as Videothoracoscopic Operative Staging (VOS). In 286 patients, already proposed for curative surgical resection on the basis of conventional staging, VOS was carried out in order to reach a conclusive judgement of resectability. VOS discovered unsuspected causes of inoperability in 17 patients (5.7%), while 269 patients underwent surgical operation but in 9 of them this consisted in an exploratory thoracotomy (ET). Furthermore, VOS allowed us to assess the operability of 11 patients in whom preoperative computed tomography (CT) had suggested unresectability but without providing a definitive judgement. Based on their experience the Authors conclude that VOS should be performed in every patient affected by lung cancer in order to obtain a more detailed staging and to reduce to a minimum the number of ETs. By using VOS it was possible to decrease the rate of exploratory thoracotomies to less than 4%.
Asunto(s)
Biopsia/instrumentación , Endoscopios , Neoplasias Pulmonares/patología , Toracoscopios , Grabación en Video/instrumentación , Humanos , Neoplasias Pulmonares/cirugía , Estadificación de Neoplasias , Neumonectomía , Pronóstico , Sensibilidad y Especificidad , Instrumentos Quirúrgicos , ToracotomíaRESUMEN
After the great success of laparoscopy in the field of abdominal surgery, the mini-invasive approach has opened interesting new possibilities in the field of thoracic surgery too. At present, in many centres, thoracoscopy is the surgical approach of choice for the treatment of recurrent pneumothorax, giant bullous lung disease, peripheral benign lesions. In very few centres a new phase is now starting, having the objective of verifying the validity of more complex thoracoscopic surgical operations. The authors describe their experience in performing major thoracoscopic operations such as excision of mediastinal masses and major pulmonary resections. The series includes 36 patients submitted to thoracoscopic excision of mediastinal masses and 113 patients submitted to video-thoracoscopic major pulmonary resections. Every kind of mediastinal lesion as well as every kind of major pulmonary resection was performed; the evidence of no intra-operative deaths confirms the possibility of a useful employment of the mini-invasive approach in this kind of surgery.
Asunto(s)
Endoscopía , Enfermedades Pulmonares/cirugía , Neoplasias del Mediastino/cirugía , Neumonectomía/métodos , Toracoscopía , Adenocarcinoma/cirugía , Adolescente , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Timoma/cirugía , Neoplasias del Timo/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grabación en VideoRESUMEN
Colonic anastomoses made both by a new Compression Anastomotic Device (CAD) and by a traditional stapler (Autosuture CDEEA) were evaluated in impaired anastomotic healing induced by systemic cortisone in the dog. Twenty dogs were given daily i.m. hydrocortisone (25 mg/kg) starting one month before surgery and then until sacrifice. Eight untreated dogs served as controls. Surgery consisted of colonic transection and anastomosis done with CAD-25 in half the cases and with CDEEA-25 in the remaining half. The dogs were sacrificed six and 13 days after surgery. Macroscopic assessment, bursting pressure test, and histology were performed on the anastomosis. One dog died from peritonitis due to anastomotic dehiscence. No other clinical complications were observed. Although the number of observations was too small to attain statistical significance, CAD anastomoses appeared better than stapled ones as regards peri-anastomotic adhesions, anastomotic index, and histology. This preliminary study suggests that compression is as reliable as the stapler in the construction of colon anastomosis even in such situations of delayed anastomotic healing. Further experience is required to substantiate this conclusion.
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Colectomía/métodos , Hidrocortisona/farmacología , Cicatrización de Heridas , Anastomosis Quirúrgica/métodos , Animales , Colon/patología , Perros , Proyectos Piloto , Engrapadoras Quirúrgicas , Factores de Tiempo , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Personal experience of 42 videothoracoscopic operations is reported. From September 91 to May 92 we performed 10 major lung resections (1 pneumonectomy, 8 lobectomies, 1 segmentectomy) 9 wedge lung resections, 4 excisions of pulmonary bullae, 12 pleurectomies with or without apicectomy, 6 excisions of mediastinal masses (3 thymomas, 2 mediastinal cysts, 1 thoracic disembryoma), 1 removal of esophageal leiomyoma. No major complications occurred. Except for one patient submitted to bullectomy with pleurectomy who required a second thoracoscopy due to postoperative bleeding, all patients had excellent p.o. course. We describe technical details employed in different videothoracoscopic operations and discuss personal results and principles of videothoracoscopic approach. Different fields of videoendoscopic chest surgery are examined. Present data seem to advocate videothoracoscopic treatment for many thoracic diseases and also for major lung resections, due to its minimal trauma and little functional impairment. Nevertheless this still remains avant-garde surgery. Further improvement in endoscopic instrumentation is necessary and may lead to future extensions of videothoracoscopic surgical possibilities.
Asunto(s)
Enfermedades Pulmonares/cirugía , Enfermedades del Mediastino/cirugía , Televisión , Toracoscopía/métodos , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Cirugía Torácica/métodosRESUMEN
As the high risk of sepsis after splenectomy is well recognized, reliable conservative surgical techniques in splenic surgery are widely advocated. Among these, segmental splenectomy carries specific and increasing indications. The use of linear staplers makes this operation quicker and safer. On the basis of a personal observation, Authors examine the anatomical features on which this operation is based, the surgical technique and the technical details to be followed using these devices. The advantages offered by staplers in this surgery allow to widen the indications to partial splenectomy, so as to yield a true primary prophylaxis of the post-splenectomy sepsis.
Asunto(s)
Esplenectomía/métodos , Engrapadoras Quirúrgicas , Adolescente , Quistes/diagnóstico por imagen , Quistes/cirugía , Femenino , Humanos , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The Authors report on the use of a videothorascopic approach in the treatment of a patient with intralobar bronchopulmonary sequestration. The latter is a rare malformation which more often than not manifests itself in young patients with hemophthisis, recurrent infection and cough. The condition is difficult to diagnose and is often diagnosed intraoperatively. The treatment is surgical resection. The videothorascopic approach was used in a young patient presenting a lesion of the left inferior lobe with polycyclic contours suspected of being an intralobar bronchopulmonary sequestration, along with medical history findings of cough and hyperpyrexia. The approach permitted identification of the lesion in the context of the left inferior lobe, safe identification and section of the abnormal systemic vessel supplying the lesion and subsequent inferior lobectomy. The postoperative course was uneventful and the patient was discharged on postoperative day 5 with an excellent esthetic and functional outcome. The videothorascopic approach should be taken into consideration for the diagnosis and treatment of intralobar bronchopulmonary sequestrations.
Asunto(s)
Secuestro Broncopulmonar/cirugía , Cirugía Torácica Asistida por Video , Adulto , Humanos , MasculinoRESUMEN
Clinical application in surgery of the large bowel of a compression anastomotic device developed by the Authors is described. The device consists of three plastic rings carried by an instrument that assembles the rings while the bowel is being joined. The rings remain by the anastomotic site until complete healing of anastomosis, then fall into the intestinal lumen and are evacuated with the feces. Sixty-nine patients underwent large bowel anastomosis using this device in our department from May 1986 through June 1989. Forty percent of the anastomoses were located at less than 8 cm from the anal verge. Five intraoperative diverting colostomies were performed (7.2%). The rings were evacuated in average 11 days after the operation, with no or very little discomfort. Operative mortality was 1.4% (one patient died of myocardial infarction). Anastomotic complications were: two (2.8%) clinical and two (2.8%) subclinical dehiscences. This initial clinical experience shows that the anastomotic device is reliable.
Asunto(s)
Intestino Grueso/cirugía , Engrapadoras Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Colon/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recto/cirugíaRESUMEN
The clinical experience with the use in colorectal surgery of a new compression anastomotic device developed by the Authors is reported. From May 1986 through June 1990, 95 patients underwent large bowel anastomosis using this device. Operations performed included 51 left hemicolectomies or anterior resections of the sigmoid and rectum, 23 left colon resections, 19 right hemicolectomies, and two total colectomies. Twenty-nine anastomoses were performed below the pelvic peritoneal reflection and 18.5% of them resulted less than 4 cms from the anal verge while 20% were located between 4.5 and 8 cms. Five (5.2%) intraoperative diverting colostomies were needed. The rings were evacuated postoperatively after a mean of 10.9 days with none or very little discomfort. Operative mortality was 1.0% (one patient died of myocardial infarction). Anastomotic complications included five (5.2%) clinical and four (4.2%) subclinical leakages. No haemorrhages or stenoses were observed. This initial clinical experience shows the anastomotic device is reliable and justifies further experimentation.