0000000001268634
AUTHOR
F. M. Accardo
Intraoperative cholangiography during laparoscopic cholecystectomy: What role?
Aim: Laparoscopic cholecystectomy has increased the number of iatrogenic lesion of the biliary tree. In this study, we evaluate the role of intra-operative cholangiography in prevention of biliary tree iatrogenic lesions and early identification of choledocolithiasis, during laparoscopic cholecystectomy. Material of study: 169 patients who underwent laparoscopic cholecystectomy, were evaluated by means of intra-operative cholangiography. Patients were divided into two groups basing on the risk to develop biliary tree lithiasis. Discussion: Patients with a higher risk of postoperative complications effectively showed cholangiographic anomalies, including duct stones, dilations, anatomical va…
Towards an improvement of hospital services and streamlining of health care costs: The DRG analysis in Italy
The term Diagnosis-related Group (DRG) refers to a classification system used to assess hospital services with the aim of a better management of health care costs and improving performance. The DRG system focuses on the utilization of resources, and is not concerned with the specific type of care provided to the patient. This system highlights any diseconomies and eventual critical aspects of the hospital system. This article, starting from the history of heath care financing in Italy and pointing out the difficulty to define the "quality" of health care services, describes the variables used to evaluate correctly hospital performance based on the DRG system. These include Average Length of…
Use of tailored intraperitoneal ePTFE dual mesh in permagna inguinal hernia
Here we report a case of a giant inguinoscrotal hernia in an elderly patients treated by means of an open positioning of intraperitoneal ePTFE dual mesh. In patients with giant inguinoscrotal hernia the forceful introduction of viscera in abdominal cavity and primary wall closure is burnened from respiratory complication, abdominal compartment syndrome, and defects in wound healing thus exposing the patients to further morbidity and mortality risk. The management of these patients is difficult because of the high occurrence of morbidity factors that affect the success on intervention independently of the technique of surgical repair. The tension- free technique we adopted consented us to ob…
Fentanyl and sufentanyl in fast track anaesthesia for major intra-abdominal surgery
Background and aim: Major intra-abdominal surgery is estimated to have high costs annually in Italy. In an attempt to decrease surgery costs and improve outcome for patients, fast-track programs have become popular. This is especially due both to the improvement of surgery and to the new anesthetic agents (regarding pharmacokinetic and pharmacodynamic) resulting in better care for patients. The aim of this study was to evaluate two different anesthetic protocols in patients undergoing scheduled anesthesia including the combination of two different opioids (fentanyl or sufentanil) with the same hypnotic and muscle relaxant. Material and Methods: 40 patients, with an American Society of Anest…
The management of postoperative pain after hemorrhoidectomy: Analysis of three methodics
Postoperative pain is one of the most common and disabling complications following hemorrhoidectomy. This study divided a total of 90 patients, undergone Milligan and Morgan hemorrhoidectomy, in three groups of 30 patient: Group A, undergone internal sphincterotomy after hemorrhoidectomy; Group B, treated with Diosmin 500 mg; Group C, treated with Paracetamol 1000 mg when required. The analysis of the median VAS score (Visual Analogic Scale) of postoperative pain, in every group pointed out a relationship between postoperative pain reduction and time at the three set checkpoints (1st, 3rd, 9th postoperative day) (R2= 0.9231 for Group A; R2= 0.9423 for group B; R2= 0.9423 for group C). Mean …