Antimicrobial prophylaxis with ceftriaxone in laparoscopic cholecystectomy: a 7-year clinical experience involving 3,603 patients.

This study is one of the first in the literature with the aim of assessing the effectiveness of antimicrobial prophylaxis with a single preoperative dose of long-acting ceftriaxone in a retrospective analysis of 3,603 patients undergoing laparoscopic cholecystectomy. All patients who underwent laparoscopic cholecystectomy between October 1990 and December 1997 were reviewed. Antimicrobial prophylaxis with a single dose of ceftriaxone (1 g) was given intravenously at the induction of anesthesia. Patients were closely monitored for infections until 4 weeks after surgery. Postoperative infections occurred in 44 of the 3,603 patients undergoing laparoscopic cholecystectomy, with an infection rate of 1.22%. The infectious complications mainly comprised wound infections (n=13) but also included intra-abdominal abscesses (n=3), pneumonia (n=9), urinary tract infections (n=3) and other infections (n=16). The results of this retrospective and non-randomized study, show that a single-shot regimen containing ceftriaxone may be a cost-effective measure in preventing postoperative infections in patients undergoing laparoscopic cholecystectomy.

Experience with the Stentor endograft at four Italian centers.

PURPOSE: To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device. METHODS: Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.6 cm (range 4.2 to 7). Three (4.5%) of the 66 AAAs were anastomotic aneurysms. RESULTS: Sixteen (25%) tubular and 50 (76%) bifurcated endograft procedures were attempted; 4 (6.1%) were converted and 1 terminated owing to technical faults with the bifurcated graft's second limb. One tube graft was too short and failed to exclude an anastomotic aneurysm. Sixty (91%) endograft procedures were completed successfully. Six (9.1%) vascular complications occurred, three in one patient who subsequently died of pulmonary embolism 72 hours postoperatively (1.5% mortality). There were four (6.1%) proximal endoleaks; two sealed spontaneously in < 1 month, and a third was converted (7.6% conversion rate). The fourth is being observed. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 86.3% (57/66). In the 23-month follow-up of 57 eligible patients, 2 patients died of unrelated causes and 1 graft limb thrombosed, requiring a crossover femoral bypass. One patient was converted to surgical repair at 5 months postoperatively when increasing aneurysm size signaled an undisclosed endoleak (1.8% late conversion rate). Five other secondary endoleaks were treated with endovascular techniques. CONCLUSIONS: The Stentor was technically feasible in 10% to 40% of AAA candidates in this study, although deployment of the second limb was problematic in the bifurcated device. Introduction of the second-generation Vanguard endograft brought this study to an end.

Laparoscopic colorectal resection. A multicenter Italian study.

BACKGROUND: The aim of the present study was to evaluate retrospectively the experience of six surgical units currently performing laparoscopic colorectal surgery. METHODS: From November 1991 to January 1994, 200 patients (103 male, 97 female; mean age 62.5 years) were candidates for, and received, laparoscopic colorectal resection for benign (54) or malignant (196) lesions. All the units excluded patients with locally advanced organ tumors and all cases with suspected perforation and ascites. One center submitted to laparoscopic resection only stage I and IV adenocarcinoma. All surgeons considered obesity a relative contraindication. The following data were analyzed: indications, conversion rate to open surgery, operative time, morbidity and mortality, resumption of gastrointestinal function, number of lymph nodes harvested, hospital stay. RESULTS: Twenty-one out of 200 patients were converted to open surgery (10.5%); 37 patients had a complete laparoscopic procedure (17.1%); 137 had an assisted resection (68.5%); and the remaining 5 patients had a facilitated resection. The mean operative time was 208 min (90-480) for assisted resection and 275 min (54-550) for complete laparoscopic resection. The mortality rate was 1.7%; the overall morbidity was 19.6% (major complications 11.2%). All patients quickly became ambulatory and showed a prompt resumption of gastrointestinal functions, and less postoperative pain if compared with converted cases. The average number of lymph nodes was 12.1 (range 1-32). The mean hospital stay was 8.6 days (range 5-14.5). The mean follow-up was 16 months (range 6-24). The recurrence rate 11.7%. CONCLUSIONS: Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

Congenital choledochal cyst: video-guided laparoscopic treatment.

We report our first experience with a laparoscopic treatment of congenital choledochal cysts involving the total cyst resection and the reconstruction of the biliary and gastrointestinal tracts through a transmesocolic hepatic-jejunal Roux-en-Y loop anastomosis. The procedure was carried out in a 14-kg 6-year-old girl with a congenital choledochal cyst of the first type, according to the Alonso-Lej classification. The cyst was divided using a Multifire EndoGIA 30 stapler. Hepatic-jejunal and jejunojejunal anastomoses were made with 4.0 chrome catgut interrupted sutures. Intestinal recanalization occurred on the 2nd postoperative day and the postoperative course was uneventful. The laparoscopic approach affords several advantages: excellent intraoperative visualization of tiny structures and, therefore, great surgical accuracy; early resumption of peristalsis; no postoperative pain; no laparocele; prevention of adhesions; excellent esthetics; and quicker resumption of school and sports activities.

[Choledochoduodenal anastomosis by laparoscopy]. / L'anastomose cholédoco-duodénale par voie laparoscopique.

Eleven patients underwent choledochoduodenostomy under laparoscopic control: 5 for adenocarcinoma of head of pancreas, including 2 with extension into duodenum, 3 for chronic pancreatitis. 1 for gastric carcinoma with pancreatic infiltration 1 for carcinoma of ampulla and 1 for stenosing papillitis. Mean duration of operation was 97.9 minutes and mean hospital stay 7.8 days. No immediate or delayed postoperative complications were reported. The advantages of this method are the marked reduction in recovery time, especially in severely debilitated elderly patients, and the absence of postoperative pain.

[Laparoscopic cholecystectomy using argon bistoury]. / La colecistectomia laparoscopica con il bisturi ad Argon.

A total of 92 patients were submitted to laparoscopic cholecystectomy during the period Autumn 1990-Spring 1991. The dissection of the gallbladder from the hepatic bed was performed in 40 patients using the Argon beam coagulator, in 25 using the monopolar electrocoagulator and in 27 using the Holmio laser beam. In average, with the Argon beam coagulator time procedure was respectively 2.7 and 5.4 minutes shorter than monopolar electrocoagulator and Holmio laser. Only one complication (pneumomediastinum) was correlated with the use of the Argon beam coagulator.

[Mechanical duodenopancreatectomy]. / La duodenocefalopancreatectomia meccanica.

Pancreaticoduodenectomy with stapler devices is presented. Three patients affected by pancreatic malignant neoplasm were successfully treated, and the technique used is here reported.

[Primary gastric lymphoma: our experience (clinical contribution)]. / Il linfoma gastrico primitivo: nostra esperienza (contributo clinico).

The authors analyze a personal study population (11 cases) of primary gastric lymphoma. Whenever possible, more radical surgery was carried out even in severely debilitated patients. Polychemotherapeutic treatment was given after discharge. The mean postoperative survival was 35 months, and the 5-year survival rate was 27.2%.

[Biliary pathology in chronic pancreatitis]. / La patologia biliare nella pancreatite cronica.

The authors expose in a very accurate discussion the biliary pathology during chronic pancreatitis. They divide the biliary lesions into associated with pancreatitis and secondary to chronic pancreatitis. They emphasize the necessity to practise a detailed study of the biliary tract in all patients affected by chronic pancreatitis and the good results showed by a very simple surgical act.

[Carcinoma of the gallbladder. Clinico-statistical considerations]. / Il carcinoma della colecisti. Considerazioni clinico-statistiche.

The Authors shortly describe some essential aspects of the gall-bladder primitive cancer, and state their experience about 19 cases of malignant neoplasms observed out of 2280 operations on biliary duct. They confirm the extremely severe prognosis of such disease due to diagnostic delay. As a conclusion, they affirm the simple cholecystectomy is the choice operation in the precocious forms, and suggest the preventive cholecystectomy in the risk patients for such pathology.

[Usefulness of morphoscillography for the prognosis of the duration of aorta-femoral bypass in complex ilio-femoral arteriopathies]. / Utilità della morfoscillografia per la prognosi di durata dei by-pass aorto-femorali nelle arteriopatie complesse ilio-femorali.

The work has the purpose to draw some prognostic indications and therapeutical directions in the aorto-iliac arteriosclerotic disease, with reference to the preoperative arteriographic and morphoscillographic reports. In the 94 patients, corresponding to 140 limbs operated on, it was possible to remark the progression in worsening of the sphygmic activity in the limbs segments goes along with a deterioration of the surgical results, and the prognosis is particularly severe when the minimum values of total vascular caliber are remarked at thighs.

Postoperative chylothorax. Six cases in 2,500 operations, with a survey of the world literature.

We have systematically reviewed the literature concerning iatrogenic chylothorax and shall report our personal observations on the subject. Despite an increasing number of thoracic operations, injuries to the thoracic duct are infrequent. Cardiovascular and esophageal procedures are the most frequent causes of chylothorax. Malformations of the thoracic duct and other organs of the mediastinum have often been involved in lymphatic injury. Consequently, we believe that a complicating chylothorax may result from varied causes rather than solely from a surgical error.

[Intestinal lymphagiectasis of surgical interest]. / Linfangectasia intestinale di interesse chirurgico

Surgical management of a case of intestinal lymphangectasis with unusual features is reported. The view that the picture was one of early segmentary enteritis was supported by some aspects of the course and various anatomopathological features.