La preparazione intestinale alla colonscopia. Esperienza personale e breve review della letteraura

Il posizionamento di protesi biliare per stenosi biliare post-operatorie. Nostra esperienza.

OBJECTIVE: To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000. BACKGROUND DATA: The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported. METHODS: Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operati…

Endoscopic treatment of pancreatic pseudocysts

Endometriosi intestinale: una causa oscura di rettorragia clinica

Prevenzione dell’occlusione delle protesi biliari mediante somministrazione di levofloxacina e acido ursodesossicolico.

One of the main advances in biliopancreatic endoscopic therapy has been the ability to palliate patients with biliary obstruction by placement of a stent during ERCP, but this is often complicated by clogging of the stent with subsequent jaundice and/or cholangitis. Stent clogging may be caused by microbiological adhesion and biliary stasis. Therefore, the use of antibiotics and choleretic agents such as levofloxacin and ursodeoxycholic acid has been investigated to see whether they prolong stent patency. Ninety patients with strictures of the biliary tract and untreatable macrolithiasis with endoscopically inserted stents were randomized into two groups: 49 subjects in group 1 (levofloxaci…

La tecnica del rendez-vous nel trattamento palliativo degli itteri neoplastici: nostra esperienza

Introduction: "Rendez-vous" technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation ("not fit for surgery"). Matherials and methods: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV. Results: 11/14 (79…

Non recurrent laryngeal nerve. Personal experience

Videolaparoscopic cholecystectomy: personal experience

Aim: Laparoscopic cholecystecomy (l.G) is now the gold standard for the treatment of gallstones, In this report were analyzed 153 IX ' performed by it single surgical team and, according to results, elaborated any technical recommendation. Mai i riai s and mi thuds: 153 IX. has been performed in Section of General and Thoracic Surgery of University' of Palermo, Sicily, by a single surgical team, since 2000. Indications for LC were all forms of calculous cholecystitis (biliary colic in 73.2%, acute cholecystitis in 4.5%, gallbladder polyps in 5.8%) or colecystocoledochal Hthiasis (9.8%). The mean age of patients was I9.-/6 years (range 18-78) and 6 2.7%) were female. The patients were studie…

Prevenzione delle complicanze in chirurgia tiroidea: la lesione del nervo laringeo ricorrente. Esperienza personale su 313 casi

Introduction: Thyroidectomy poses many challenges for the surgeon who undertakes endocrine surgery and iatrogenic injury of inferior laryngeal nerve (ILN) is one of the most serious (0-20%). We report our personal experience of a series of 313 thyroidectomy with intraoperative identification of ILN. Methods: 313 patients (253 females, 60 males, whose age was between 17 and 86 years, mean 41 years) had undergone thyroidectomy in our Operative Unit from January 2000 to January 2004. Among them, 259 patients underwent total extracapsular thyroidectomy, 38 subtotal thyroidectomy, 5 istmo-lobectomy and 11 were completions of thyroidectomy in patients who had previously undergone a first thyroid …

Probiotics, prebiotics and symbiotics in inflammatory bowel diseases: state-of-the-art and new insights

Inflammatory bowel disease (IBD) consists of two distinct clinical forms, ulcerative colitis (UC) and Crohn's disease (CD), with unknown aetiology, which nevertheless are considered to share almost identical pathophysiological backgrounds. Up to date, a full coherent mechanistic explanation for IBD is still lacking, but people start to realize that the pathogenesis of IBD involves four fundamental components: the environment, gut microbiota, the immune system and the genome. As a consequence, IBD development might be due to an altered immune response and a disrupted mechanism of host tolerance to the non-pathogenic resident microbiota, leading to an elevated inflammatory response. Consideri…

An uncommon complication of liver biopsy: obstructive jaundice from blood clots

Introduction: The AA. report on a case of one young woman who developed obstructive jaundice induced by hemo- bilia after percutaneous liver biopsy, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) Methods: An endoscopic sphincterotomy was performed with extraction of the clots Observations: Four weeks after ERCP the patient was healthy and asymptomatic, valuated as outpatient Conclusions: The role of ERCP in managing biliary sequelae of hemobilia is well established: biliary decompression is required if and intrabiliary lot causes obstructive jaundice and/or biliary colic. ERCP is feasible and leads to relief of symptoms in most cases, without the need of sur…

Acute pancreatitis during liver hydatidosis: treatment with ERCP and endoscopic sphincterotomy

Severe rectal bleeding after transrectal US-guided prostate biopsy. Case report

CASE: The Authors report their experience about a case of severe rectal bleeding after transrectal ultrasound-guided prostate biopsy. INTERVENTION: After correct and sure diagnosis, the patient was submitted to resolutive endoscopic haemostatic treatment (failure of haemostatic mechanical manoeuvres, emergency colonscopy, haemostasis with sclerotherapy, heat bipolar probe and Argon Plasma Coagulation). RESULTS: Complete recovery (immediate stop bleeding). Follow-up (1 year) negative. CONCLUSIONS: Rectal bleeding after prostate biopsy is a important but rare complication of prostate cancer screening, potentially lethal. Best knowledge of causes and risk factors may improve the diagnosis and …

Common bile duct stones in cholecystectomized patients (chapt. 28) in Biliary lithiasis Basic science, current diagnostic and therapeutic approaches di C. Cordiano e G. Borzellino

The incidence of retained or primary stones is approximately 2-5% after LC and 5-15% after common bile duct exploration: in principle, these patients are in need of further intervention. Residual common bile stones are called secondary when they originate in gallbladder and later pass down through the cystic duct into the common bile duct.

Il trattamento chirurgico dell’idatidosi epatica: nostra esperienza e considerazioni diagnostico-terapeutiche

A rare complication of ERCP: Mallory-Weiss syndrome

OBJECTIVE: To describe the management and outcome after endoscopic treatment of hematemesis by Mallory-Weiss Syndrome (MWS) occurred after CPRE (suspected choledocolithiasis). Background data: Although cough and retching is common during EGD or CPRE, MWS resulting from endoscopy seems to be uncommon (0.0001-0.04%) and always self-limiting. Case report: The patient was submitted to CPRE with the suspicion of choledocholithiasis. Eight hours after CPRE the patient presented with hematemesis amd hypotension. With emergency EGD, the AA identified a small bleeding mucosal tear (visible vessel with spurting) just proximal to the esophagogastric junction. The patient was safely treated with endosc…

Corpi estranei gastrici: i bezoari. A proposito di due casi

Objective: The authors report their experience about the treat merit of two cases of gastric bczoar, treated in curative mode, the first endoscopically and the second with surgical intervention. Setting: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation. Policlinico, University of Palermo. Imerventaiion: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical frag- mentation of phytobezoar and fragments extraction via-over- tube), the second with surgical gastrotomy {stamp trichobezoar). There were no procedure- related complications. Results: the two patients were curative and radically tr…

Nutrition, malnutrition and dietary interventions in inflammatory bowel disease

Inflammatory Bowel Disease (IBD), which includes both Crohn's disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Diet, as a source of luminal antigens, is thought to be an important factor in the pathogenesis of IBD. often the nutritional status of patients is significantly compromised, particularly in CD. several factors, including drug-nutrient interactions, disease location, symptoms, and dietary restriction can lead to protein energy malnutrition and specific nutritional deficiencies. solid evidence regarding the accountability of certain dietary components in the etiology of IBD are lacking. With regard to malnu…

Surgical treatment of liver hydatidosis: our experience with diagnostic and therapeutic consideration

Objective: The Authors report on their experience in diagnosis and treatment of liver hydatidosis (LH). Materials and methods: From January 2000 to December 2003, we observed 24 patients (10 male = 42% and 14 female = 58%, male/female ratio 1:1.4, range of age 23 - 80 years, mean age 45.25 years). The most frequent initial symptom was hepigastric and hypocondriac pain (82.6%), meanwhile acute abdominal pain was only in 26.1%. In one half of cases performed radical surgery (total pericistectomy), in 35% of cases the AA subtotal pericistectomy and only in 17% the AA partial pericistectomy. Only one left hepatectomy during total pericistectomy we performed. Major complications were registered,…

Colecistectomia videolaparoscopica. Nostra esperienza

Regression of primary low-grade gastric mucosa-associated lymphoma by eradication of Helicobacter pylori infection: case report

Objective: the Authors report their experience in diagnosis and treatment of one case of primary low-grade gastric lymphoma of mucosa associated lymphoid tissue (MALT); recent international literature review. Experimental Design: complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of eradication therapy and short follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccotie" of Palermo. Intervention: treatment of H. Pylori infection (lansoprazole, amoxicillin and metronidazole twice a day for 14 days; after that, lansoprazole for another 4 weeks), according to international guide-lines. Results: H. Pylori wa…

Il nervo ricorrente che non ricorre

Pancreas aberrante: una causa rara di epigastralgia

Objective: The Authors report their experience about a case of aberrant pancreas that lead epigastralgia. Design: Report of 1 case and endoscopic treatment (upper endoscopy + EUS + endoscopic polipectomy + endoscopic biopsy of the base. Surgical effectiveness evaluation. Setting: Section of General and Thoracic Surgery. Department of General Surgery; Emergency and Organ Transplantation. Policlinico "Paolo GiacconePalermo. Intervention: After correct and sure diagnosis, the patient was submitted to endoscopic polipectomy with radical and curative intention. Results: Complete recovery. Hematochemical and endoscopic follow-up (1 months) negative. Conclusions: Diagnosis of aberrant pancreas is …

Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale

Il trattamento endoscopico delle pseudocisti pancreatiche.

Aim: the Authors report their experience about the endoscopic treatment of pancreatic pseudocysts (PP). Patients and methods: report of 10 cases; evaluation of effectiveness, morbidity and mortality of treatment. Setting: Section of General and Thoracic Surgery, AOUP “Paolo Giaccone”, University of Palermo. Procedure: endoscopic drainage was performed in all 10 patients, with 2 cysto-gastrostomy, 5 cysto-duodenostomy and 3 trans-papillary cystic drainage. Results: 100% successful; one case of bleeding post-procedure (10%), one case of sepsis (10%) and one case of stricture of fistula between PP and duodenum. Conclusion: endoscopic drainage of PP is a safe and simple treatment, with high rat…

La gastrectomia percutanea endoscopica (PEG) metodo pull: nostra esperienza

Una rara complicanza precoce delle anastomosi digestive meccaniche:l’emorragia.

Introduction: Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often self- limiting but potentially lethal if not evidenced intraoperatively or in the immediate postoperative. Material and methods: The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis (11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis, 2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment in emergency. Res…

Juxtapapillary duodenal diverticular bezor as an exceptional cause of biliary stent obstruction. Case report.

INTRODUCTION: we describe the first case in literature of biliary stent obstruction by bezoar impaction in a iuxtapapillary duodenal diverticulum. CASE REPORT: this case illustrates an juxtapapillary duodenal diverticulum and bezoar in it causing obstructive jaundice in subject with two biliary stents for cholangiocarcinoma (Klatskin's tumor) in the absence of bile duct stones. RESULT: successful treatment with endoscopic stent removal and diverticulum toilette. Obstructive jaundice was cured after endoscopic removal of the bezoar and stent substitution. DISCUSSION: the presence of a bezoar and its possible contribution to the pathogenesis of pancreatitis in the presence of periampullary ex…

La palliazione endoscopica dell’ittero ostruttivo da carcinoma inoperabile del pancreas. Nostra esperienza

Aim of the study: Few patients with pancreatic cancer are eligible for resection. In the remainder; estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to refer our personal experience about the palliation with endoscopic stenting in patients with unresectable pancreatic cancer. Methods: The Authors reviewed retrospectively 132 patients affected by unresectable pancreatic cancer who underwent palliative interventions with endoscopic stenting from 2000 to 2004. Results: Jaundice dramatically decreased in 86% of patients within 36 hours, in 12% within 48 hours and in 2% after two days. As c…

Endoscopic palliation of obstructive jaundice caused by inoperable pancreatic cancer: personal experience

Il gozzo cervicomediastinico

INTRODUCTION: Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG). MATERIALS AND METHODS: The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379 patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. RESULTS: The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA performed tota…

Intestinal endometriosis: an obscure cause of cyclic rectal bleeding

Complicanze in chirurgia tiroidea: ipoparatiroidismo sintomatico post-operatorio.Incidenza, note di tecnica chirurgica, prevenzione e trattamento.

Introduction: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia Materials and methods: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 …

Heterotopic gastric mucosa in the gallbladder: case report and literature review

Trattamento endoscopico di un caso di “gastric outlet syndrome” dopo gastroplastica verticale sec. Mason

Treatment of complications of hepatic hydatid disease by ERCP: our experience

What to do when endoscopic retrograde cholangio-pancreatography fails? Personal experience.

Linfangioma cistico mesenterico. Descrizione di un caso e revisione della letteratura.

Objective: The Authors report their experience in diagnosis and treatment of one case of mesenteric cystic lymphangioma; recent international literature review. Experimental Design: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of radical surgical treatment and follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. Intervention: Radical surgical treatment, according to international guide-lines. Results: Complete recovery with "restitutio ad integrum". No relapse were recorded at short follow up. Conclusions: Even when asymptomatic and discovered incidentally, LCM must be treated sur…