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1.
Tech Coloproctol ; 22(7): 519-527, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30083782

RESUMO

BACKGROUND: Transanal irrigation(TAI) has been reported to be an inexpensive and effective treatment for low anterior resection syndrome(LARS). The aim of the present prospective study was to evaluate the use of TAI in patients with significant LARS symptoms at a single medical center. METHODS: Patients who had low anterior resection for rectal cancer between April 2015 and May 2016 at the Careggi University Hospital were assessed for LARS using the LARS and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) questionnaires 30-40 days after  surgery or ileostomy closure (if this was done). Quality of life was evaluated using a visual analog scale and the Short Form-36 Health Survey. All patients with LARS score of 30 or higher were included (early LARS) as were all patients with a LARS score of 30 or higher referred 6 months or longer after surgery performed elsewhere (chronic LARS) in the same study period. Study participants were trained to perform TAI using the Peristeen™ System for 6 months, followed by 3 months of enema therapy following a similar protocol. RESULTS: Thirty-three patients were enrolled in the study. Six patients stopped the treatment. The 27 patients (19 early LARS and 8 chronic LARS) who completed the study had a significant decrease in the number of median daily bowel movements [baseline 7 (range 0-14); 6 months 1 (range 0-4); 9 months 4 (range 0-13)]. The median LARS Score fell from 35.1 (range 30-42) (baseline) to 12.2 (range 0-21) after 6 months (p < 0.0001) and then rose to 27 (range 5-39) after 3 months of enema therapy. There was no difference in LARS score decrease at 6 months between the patients with early and chronic LARS (22.5 and 23.9 respectively; p=0.7) and there were no predictors of score decrease. Four components of the SF-36 significantly improved during the TAI period. The MSKCC BFI score significantly improved in several domains. Twenty-three patients (85%) asked to continue the treatment with TAI after the study ended. CONCLUSIONS: TAI appears to be an effective treatment for LARS and results in a marked improvement of continence and quality of life.  Patients may be assessed and treated for LARS early after surgery since the treatment benefit is similar to that observed in patients with LARS diagnosed  6 months or longer after surgery. The potential rehabilitative role of TAI for LARS is promising and should be further investigated.

2.
J Visc Surg ; 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30115586

RESUMO

PURPOSE: Robotics has shown encouraging results for a number of technically demanding abdominal surgeries including pancreaticoduodenectomy, which has originally represented a relative contraindication to the application of the minimally-invasive technique. We aimed to investigate the perioperative, clinicopathologic, and oncological outcomes of robot-assisted pancreaticoduodenectomy by assessing a consecutive series of totally robotic procedures. METHODS: All consecutive patients who underwent robotic pancreaticoduodenectomy were included in the present analysis. Perioperative, clinicopathologic and oncological outcomes were examined. In order to investigate the role of the learning curve, surgical outcomes were also used to compare the early and the late phase of our experience. RESULTS: A total of 59 patients underwent surgery. Median hospital stay was 9 days (5 - 110), with an overall morbidity and mortality of 37% and 3%, respectively. Of note, the rate of clinically relevant pancreatic fistula was 11.8%. R0 resections were achieved in 96% of patients and the 3-year disease-free and overall survivals were 37.2 and 61.9%, respectively. Overall, surgical outcomes did not vary significantly between the first and the late phase of the series. CONCLUSIONS: Robotic pancreaticoduodenectomy can be performed competently. It satisfies all features of oncological adequacy and may offer a number of advantages over standard procedures in terms of surgical results.

3.
Chirurg ; 88(Suppl 1): 12-18, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27380211

RESUMO

BACKGROUND: Laparoscopic gastrectomy for cancer is commonly considered a challenging procedure. The technical drawbacks of laparoscopy have been addressed by robotic technology, which can facilitate demanding reconstructions and fine dissection. These features confer potential advantages in the execution of lymphadenectomy. OBJECTIVES: Here, we illustrate our technique of robotic gastrectomy and discuss advantages and drawbacks by reviewing the current literature. MATERIALS AND METHODS: We describe our technique for robot-assisted distal and total gastrectomy for cancer and assess the current literature dealing with short-term outcomes, immediate oncologic measures, and long-term oncologic outcomes of robot-assisted gastrectomy, in comparison with conventional laparoscopic and open surgery. RESULTS: The robotic procedure seems to be as safe and effective as conventional gastrectomy for gastric cancer, with a longer operative time and decreased blood loss in comparison with laparoscopic gastrectomy. CONCLUSION: The technical advantages offered by robotics could help to standardize minimally invasive D2 lymphadenectomy and enable surgeons to perform this procedure routinely. Despite the scarcity of long-term data on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.


Assuntos
Gastrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Esôfago/cirurgia , Seguimentos , Gastrectomia/instrumentação , Humanos , Jejunostomia/instrumentação , Jejunostomia/métodos , Excisão de Linfonodo/instrumentação , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estadiamento de Neoplasias , Avaliação de Processos e Resultados (Cuidados de Saúde) , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Neoplasias Gástricas/patologia , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos
5.
Chirurg ; 87(8): 643-50, 2016 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-27371546

RESUMO

BACKGROUND: Laparoscopic gastrectomy for cancer is commonly considered a challenging procedure. The technical drawbacks of laparoscopy have been addressed by robotic technology, which can facilitate demanding reconstructions and fine dissection. These features confer potential advantages in the execution of lymphadenectomy. OBJECTIVES: Here, we illustrate our technique of robotic gastrectomy and discuss advantages and drawbacks by reviewing the current literature. MATERIALS AND METHODS: We describe our technique for robot-assisted distal and total gastrectomy for cancer and assess the current literature dealing with short-term outcomes, immediate oncologic measures, and long-term oncologic outcomes of robot-assisted gastrectomy, in comparison with conventional laparoscopic and open surgery. RESULTS: The robotic procedure seems to be as safe and effective as conventional gastrectomy for gastric cancer, with a longer operative time and decreased blood loss in comparison with laparoscopic gastrectomy. CONCLUSION: The technical advantages offered by robotics could help to standardize minimally invasive D2 lymphadenectomy and enable surgeons to perform this procedure routinely. Despite the scarcity of long-termdata on survival, immediate oncological measures (lymph node yield and margin status) are encouraging. Further studies investigating the long-term oncological outcomes are required.


Assuntos
Gastrectomia/instrumentação , Gastrectomia/métodos , Laparoscopia/instrumentação , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Instrumentos Cirúrgicos , Dissecação/instrumentação , Dissecação/métodos , Desenho de Equipamento , Esôfago/patologia , Esôfago/cirurgia , Seguimentos , Humanos , Excisão de Linfonodo/instrumentação , Excisão de Linfonodo/métodos , Duração da Cirurgia , Neoplasias Gástricas/patologia , Resultado do Tratamento
6.
Heart Lung Vessel ; 7(3): 231-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26495269

RESUMO

INTRODUCTION: Insufficient mesenteric perfusion is a dramatic complication in critically ill patients. Hydrogen sulfide, a newly recognized endogenous gaseous mediator, acts as an intestinal vasoactive agent and seems to protect against mesenteric ischemic damage. We investigated whether sodium hydrogen sulfide, a hydrogen sulfide donor, can improve mesenteric perfusion in an experimental model of pigs, both in physiological and ischemic conditions. METHODS: The study was conducted at Careggi University Hospital (Florence, IT). Fourteen male domestic pigs (≈10 Kg) were anesthetized and mechanically ventilated. Animals were randomized in control and ischemia groups. Mesenteric ischemia was induced with a positive end-expiratory pressure of 15 cmH2O. After mini-laparotomy, each animal received incremental doses of sodium hydrogen sulfide every 20 minutes. Perfusion of both the jejunal mucosa and sternal skin were measured by laser Doppler flowmeter, and systemic hemodynamic parameters were monitored. RESULTS: In the control group, sodium hydrogen sulfide was able to significantly improve the mesenteric perfusion, showing a 50% increase from the baseline blood flow. In the ischemia group, NaHS-induced a two-fold increase of the mesenteric post-ischemic perfusion with a recovery up to 70% of pre- positive end-expiratory pressure mesenteric blood flow. Sodium hydrogen sulfide did not directly or indirectly (by blood flow redistribution) affect the sternal skin microcirculation, heart rates, or mean arterial pressure, suggesting a tissue-specific micro-vascular action. CONCLUSIONS: In a porcine model, we observed a mesenteric perfusion recovery mediated by administration of hydrogen sulfide donor without affecting general hemodynamic.

7.
Minerva Chir ; 70(4): 241-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25916194

RESUMO

Over the last decade, robotics has gained popularity and is increasingly employed to accomplish several abdominal surgical procedures. Nevertheless, pancreatectomies are regarded as demanding procedures for which the application of minimally-invasive surgery is still limited and its effectiveness has not been conclusively established. We aimed to investigate the current role of robot-assisted surgery to perform distal pancreatectomy. A systematic review of the English-language literature was conducted for articles dealing with robotic-assisted distal pancreatectomies. All relevant papers were evaluated on surgical and oncological outcomes. A total of 10 articles reporting on robotic distal pancreatectomies were finally considered in the analysis, including 259 patients. Mean operative time was 271 minutes (range 181-398); mean blood loss was 210 mL (range 104-361), in 11.6% of cases conversion to laparotomy occurred, spleen preservation was accomplished in 51.4% of procedures, mean time of postoperative hospital stay was 7 days. Overall, postoperative mortality and morbidity were 0% and 23.4% respectively, the mean number of lymph nodes harvested was 12.7. In all included series, no case of R1 resection was reported. Despite its relatively recent introduction in clinical practice, robotic-assisted surgery has been widely employed to perform distal pancreatectomy worldwide and it should be considered a safe and effective procedure. Both surgical and pathologic data support its application in the management of pancreatic lesions of the body and tail.


Assuntos
Tratamentos com Preservação do Órgão , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Procedimentos Cirúrgicos Robóticos , Baço , Humanos , Tempo de Internação , Duração da Cirurgia , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/tendências , Pancreatectomia/mortalidade , Pancreatectomia/normas , Pancreatectomia/tendências , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Procedimentos Cirúrgicos Robóticos/tendências
8.
Eur J Surg Oncol ; 41(8): 1106-13, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25796984

RESUMO

INTRODUCTION: Robot-assisted surgery for the treatment of gastric cancer is considered to be safe and feasible with early post-operative outcomes comparable to open and laparoscopic series. However, data regarding long-term oncological outcomes are lacking. Aim of this study is to evaluate long-term oncological outcomes of a cohort of gastric cancer patients treated surgically with the robot-assisted approach. MATERIALS AND METHODS: A prospectively collected database of robot-assisted gastrectomies performed for gastric cancer at the 'Misericordia Hospital' between September 2001 and October 2011 was retrospectively analysed. Data regarding surgical procedures, early postoperative course, and long-term follow-up were analysed. RESULTS: The study included 98 consecutive robot-assisted gastrectomies. Fifty-nine distal gastrectomies, 38 total gastrectomies, and 1 proximal gastrectomy. Open conversion occurred in seven patients (7.1%) due to locally advanced disease. Postoperative morbidity and mortality were 12.2% and 4.1% respectively. Post-operative staging showed 46 patients (46.9%) with stage I disease, 25 patients (25.5%) with stage II, 26 (26.5%) with stage III and 1 (1.02%) with stage IV. The mean follow-up was 46.9 months. Cumulative 5-year overall survival (OS) was 73.3% (95% CI: 62.2-84.4). Five-year survival by stage subgroups was 100% for patients with stage IA, 84.6% for stage IB, 76.9% for stage II, and 21.5% for stage III. The only patient in stage IV of this series died eight months after surgery. CONCLUSIONS: Robot-assisted gastrectomy for the treatment of gastric cancer is safe and feasible. It provides long-term outcomes comparable to most open and laparoscopic series. Further studies are necessary to better define its indication.


Assuntos
Gastrectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Robótica/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Prospectivos , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
10.
Chirurg ; 84(8): 651-64, 2013 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-23942961

RESUMO

Hepatobiliary surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive hepatobiliary surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant about the approach. On the other hand, gastric surgery is a very popular field of surgery with an extensive amount of literature especially regarding open and laparoscopic surgery but not much about the robotic approach especially for oncological disease. Recent development of the robotic platform has provided a tool able to overcome many of the limitations of conventional laparoscopic hepatobiliary surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon's movements, and high-definition three-dimensional vision provided by the stereoscopic camera, allow for steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive hepatobiliary and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted hepatobiliary and gastric surgery.The English full-text version of this article is available at SpringerLink (under supplemental).


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Hepatopatias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Robótica/instrumentação , Gastropatias/cirurgia , Neoplasias do Sistema Biliar/cirurgia , Desenho de Equipamento , Gastrectomia/instrumentação , Hepatectomia/instrumentação , Humanos , Imagem Tridimensional , Laparoscopia/instrumentação , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Software , Neoplasias Gástricas/cirurgia
11.
Int J Med Robot ; 7(1): 27-32, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21341360

RESUMO

BACKGROUND: The robotic approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy. We aimed to report our technique and outcomes of robot-assisted adrenalectomy (RAA). METHODS: From November 2000 to February 2010, all consecutive patients who underwent a RAA by the same surgeon were prospectively entered into a dedicated database. The data were reviewed retrospectively. RESULTS: During the study period, 21 right (50%), 20 left (47.6%) and 1 bilateral (2.4%) RAA were performed. Mean lesion size was 5.5 cm (max. 10 cm). Mean operative time was 118 ± 46 min and median blood loss was 27 ml. There were no conversions. The postoperative morbidity rate was 2.4%; mortality rate, 2.4%; median hospital stay, 4 days. CONCLUSIONS: RAA achieves good short-term outcomes and could be considered a valid option for the treatment of adrenal masses, with the potential to expand the limits of minimally invasive surgery.


Assuntos
Neoplasias das Glândulas Suprarrenais/mortalidade , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/mortalidade , Laparoscopia/mortalidade , Robótica/estatística & dados numéricos , Cirurgia Assistida por Computador/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
12.
G Chir ; 31(8-9): 394-6, 2010 Aug-Sep.
Artigo em Italiano | MEDLINE | ID: mdl-20843445

RESUMO

A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. This diagnosis may be very difficult and the optimal treatment remains controversial. We report the case of 80 years old female with calcific pancreatitis and severe intestinal bleeding due to a pseudoaneurysm of the splenic artery treated with interventional radiographic embolization.


Assuntos
Falso Aneurisma/complicações , Hemorragia Gastrointestinal/etiologia , Pancreatite Crônica/complicações , Artéria Esplênica , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Radiografia Intervencionista , Resultado do Tratamento
13.
G Chir ; 30(8-9): 377-84, 2009 Aug-Sep.
Artigo em Italiano | MEDLINE | ID: mdl-19735620

RESUMO

BACKGROUND: The objective of this study is in the critical analysis of the results of the lap and open surgery in the colorectal carcinoma, through the meta-analysis of the principal trials. PATIENTS AND METHODS: A systematic search of the comparative studies has been made among lap and open surgery in the colorectal carcinoma, using PubMed and Cochrane Library. Among these, have been selected perspective studies containing the description of the surgical techniques, the perioperative results and the oncological long term results. Statistic analysis has been performed with the program NCSS (Kaysville 2006, Utah). RESULTS: From the revision of the literature, 7 perspective studies have checked fit to a meta-analysis, for a total of 3580 patients. Among the operative outcomes, has been observed, with statistically significant, a reduction of the blood loss and of the morbidity, an earlier resumption to passing flatus and to normal diet, a reduction of the postoperative hospitalization for the lap; shorter operative time is releaved for the open surgery. Statistically significant differences have emerged neither on the other surgical outcomes (included mortality) nor on relapset of illness (regional or metastasis), crab-correlated mortality, long term survival. CONCLUSIONS: The laparoscopic can be considered a valid alternative to the traditional open surgery in the therapy of the colorectal carcinoma: the advantages consist in smaller trauma and reduction of morbidity and postoperative stay. The oncological results are the same of the open surgery.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Colectomia/métodos , Neoplasias Colorretais/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
Minerva Chir ; 56(4): 351-6, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11460071

RESUMO

BACKGROUND: This study is aimed at contributing to defining a correct therapeutic management of pancreatic pseudocysts (PPCs): indications for treatment, operative timing and technical approach. METHODS: A retrospective analysis of 28 patients affected by PPC, 22 males (78.5%) and 6 females (21.5%), with a mean age of 52 years (range 17-76) has been performed. The diagnosis was realised by clinical assessment and US (ultrasonography) or CT (computerized tomography) scanning. The treatment consisted in surgical drainage (internal or external) or percutaneous drainage with US guidance: the cystojejunostomy with a Roux-en-Y loop was the first choice technique. RESULTS: Twenty-two patients (78.5%) under-went a surgical procedure: 19 cystojejunostomies with a Roux-en-Y loop and 3 external drainages. The mean interval between acute pancreatic event and elective surgery was 9 weeks (range 5-21). Perioperative morbidity and mortality was respectively 22.7% (5/22) and 13.6% (3/22). In 4 cases a percutaneous drainage with US-guidance, without morbidity and mortality was performed, but 2 patients required a successive surgical operation for lack of resolution of the PPC. The last 2 patients of this series recovered spontaneously. CONCLUSIONS: Currently the cystojejunostomy with a Roux-en-Y loop remains the first choice technique for an elective and definitive treatment of PPCs: other techniques (endoscopic internal drainage, surgical or percutaneous external drainage) should be limited to complicated PPCs or to high surgical risk patients. A waiting period of 4-6 weeks following the acute pancreatic event is considered the minimal time necessary before the elective treatment.


Assuntos
Pseudocisto Pancreático/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Int Angiol ; 20(4): 351-3, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11782704

RESUMO

Mortality due to the surgical treatment of ruptured abdominal aortic aneurysms (RAAA) is high, more than 40%, especially in elderly patients. The literature concerning RAAA in very elderly patients is analyzed by Internet research (Medline). Only rare examples of emergency surgical management in nonagenarian patients are reported, and even fewer reports of successfully operated patients. A case report of a successful surgical repair of RAAA in a nonagenarian is presented. After ultrasound (US) and CT scans, the patient (in good condition as regards blood pressure, respiratory, cardiac and renal function) underwent uneventful aneurysmectomy and reconstruction of the aorta and common iliac arteries by means of a bifurcated prosthesis. The length of hospitalization was 30 days and the patient is still alive and in good condition four years and two months after the operation. The advisability of emergency surgical repair in these patients, questionable because of the excessive surgical risk and poor survival benefit, is discussed. However many other factors affect the outcome of emergency repair (mainly cardiac, respiratory and renal function), independently of age. The authors conclude that age per se does not limit the indication for or success of surgery in very elderly patients.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/complicações , Feminino , Humanos , Indução de Remissão
16.
Minerva Anestesiol ; 66(4): 201-6, 2000 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-10832269

RESUMO

BACKGROUND: It is a current opinion that local anesthesia (LA) is the primary choice in surgical treatment of the inguinal region, particularly herniorrhaphy. The LA technique personally used for herniorrhaphy is described: it consists of iliohypogastric, ilioinguinal and genito-femoral nerve blocks, and incision line anesthetic infiltration. METHODS: From January 1998 to April 1999, 95 patients underwent inguinal herniorrhaphy employing LA: 77 (81%) in elective surgery, 18 (19%) in emergency; 2 cases with bilateral hernia (97 total LA procedures). RESULTS: Partial success was obtained in only 8 cases (8.4%), which required an association with a hypnotic drug ("blended anesthesia": propofol or midazolam): there were no cases of conversion to general anesthesia. Specific complications of local anesthetic drugs infiltration developed in 8 cases on 97 LA procedures (8.2%), but none required reoperation: 6 inguinal hematomas, 1 female external genitalia hematoma, 1 hematocele. CONCLUSIONS: In conclusion, it is stressed that LA is the technique of choice in herniorrhaphy and surgery of other inguinal pathologies, associating high success rates, rare complications and rapid dismissal: this allows for easy management of the patients and a very important reduction of sanitary costs. The association of LA-hypnotic drugs (blended anesthesia) represents another important resource, since it avoids general anesthesia in many cases and allows a rapid psychophysical recovery.


Assuntos
Anestesia Local , Hérnia Inguinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Minerva Chir ; 55(4): 221-5, 2000 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-10859955

RESUMO

BACKGROUND: The aim of this study is to define the actual role of surgical therapy in severe acute necrotizing pancreatitis. METHODS: A retrospective analysis has been carried out on the surgical treatment of severe acute pancreatitis at the Institute of General Surgery and Surgical Specialties, University of Siena (Italy). From January 1980 to December 1997, 230 patients affected by acute pancreatitis were admitted to institution: 24 patients affected by severe disease (necrotizing pancreatitis: clinical and radiological diagnosis, by CT-scan) was choosen for this study. Of 24 patients, 15 were males and 9 females, with mean age of 55 years (range 30-80). In all cases, surgical procedure consisted in pancreatic necrosectomy, multiple abdominal and retroperitoneal drainage and closed management; operated patients with biliary pancreatitis underwent colecystectomy and, if necessary, common biliary duct drainage. RESULTS: The patients underwent surgical procedure, but the remaining 14 were treated by intensive medical care: mortality in these two groups was respectively 40% (4 cases) and 21% (3 cases). CONCLUSION: The conclusion is drawn that intensive medical care is the first therapeutic approach in severe acute pancreatitis, reserving surgery only to selected cases, as those affected by pancreatic infectes necrosis or those who get worse despite of conservative therapy. As to surgical technique, closed procedures vs open or semiopen, and conservative surgery (necrosectomy, multiple drainage and abdominal washing) vs anatomical resection are preferred.


Assuntos
Pancreatite Necrosante Aguda/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
18.
Minerva Chir ; 55(7-8): 505-12, 2000 Jul-Aug.
Artigo em Italiano | MEDLINE | ID: mdl-11140104

RESUMO

BACKGROUND: Currently, pancreatic exocrine carcinoma presents high mortality, poor survival after curative surgery and poor resectability rates at the time of diagnosis. The factors which mostly influence prognosis and therapeutic management (curative surgery or palliative treatments) of the patient affected by pancreatic carcinoma, particularly the peroperative stage, are analyzed and discussed in this article. METHODS: From 1969 to 1997, 142 patients with pancreatic ductal carcinoma were admitted to our Department: at the time of diagnosis only 32 patients (22.5%) were considered resectable, and 30 pancreaticoduodenectomies (PD), 1 distal pancreatectomy (DP) and 1 total pancreatectomy (TP) were performed. RESULTS: Postoperative morbidity and mortality was 53.1% and 12.5% respectively; the survival at 1, 3 and 5 years was 45.5%, 36.4% and 17.6% respectively. The worst prognosis was seen in N+ and T4 patients, with a mean survival of 9 and 10 months. CONCLUSIONS: On the basis of these results and of the literature, the indications for curative surgery, the operative strategy and the lymphoadenectomy extension are discussed: these problems are still open and not resolved definitively. The authors conclude by indicating the need for curative surgery for T1/2 N0 M0 tumors: for T3/4 and/or N+ tumors a careful evaluation of single case is necessary, because of high risk/benefit rate. Pancreatic resections (PD, DP) and standard lymphoadenectomy (D1) are performed by the authors, rather than total pancreatectomy and radical lymphadenectomy (D2-3).


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pancreatectomia/métodos , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
19.
Clin Hemorheol Microcirc ; 21(3-4): 409-14, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10711778

RESUMO

The aim of this study was to investigate the behaviour of circulating ET-1 in patients with carotid atherosclerosis, before and after carotid thromboendarterectomy (TEA), to test the hypothesis that plasma ET-1 decreases after removal of atherosclerotic lesion. Plasma immunoreactive ET-1 levels were determined in 17 patients with symptomatic and/or hemodynamically significant carotid atherosclerosis on the day before TEA, 48 h and 72 h after surgery and, in 11 of them, also after 8 h and 24 h. Compared to controls, ET-1 levels were significantly higher both before and after TEA; after carotid revascularisation (8 h) ET-1 increased; then, from the 24th h, ET-1 gradually decreased and at the 48th h and 72th h the decrease was significant in front of basal values. The increase of plasma ET-1 in the acute postoperative phase may reflect the degree of surgical stress and manipulation in diseased blood vessels; the following decrease may indicate the improvement of vascular dysfunction in the involved carotid site; the persistence of high ET-1 levels 72 h after surgery could suggest the presence of residual ischemia in the involved district and/or the involvement of other sites in ET-1 production.


Assuntos
Arteriosclerose/sangue , Arteriosclerose/cirurgia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Endotelina-1/sangue , Idoso , Arteriosclerose/fisiopatologia , Doenças das Artérias Carótidas/fisiopatologia , Feminino , Humanos , Masculino
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