USE OF INTRAPERITONEAL PTFE DUAL-MESH IN A GIANT INCISIONAL HERNIA AFTER RENAL TRANSPLANTATION: A CASE REPORT

Objectives: We evaluated the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair of a giant incisional hernia by intraperitoneal PTFE dual mesh. Patients and methods: We report our experience about an incisional hernia in a 55 years male after renal transplantation treated with an intraperitoneal dual mesh prosthesis. The cause of incisional hernia was probably due to an urinoma for a total necrosis of distal graft ureter that needed to reopen in 2sd day post transplant with primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia that rapidly became monstrous with migration of o…

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Despite undisputed improvements, prosthetics hernia repair continues to be affected by unacceptable rates of complications. Postoperative adverse events such as discomfort and chronic pain represent a subject of increasing concern among the surgical community. Poor quality biologic response, stiff scar plates, and mesh shrinkage, a typical effect of conventional static meshes and plugs, are all indicated as the main reasons for many of the complications related to inguinal hernia repair. Even the conventional concept of treatment based upon a supposed reinforcement of the groin consequent to the fibrotic incorporation of meshes, would appear to be inadequate in the light of the latest scien…

Acute appendicitis and situs viscerum inversus: radiological and surgical approach—a systematic review

Abstract Introduction Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies…

Laparoscopic management of cholecystocolonic fistula: A case report and a brief literature review

Highlights • Cholecystoenteric fistula is a rare and late complication of cholelithiasis. • We report a case of cholecysto-colonic fistula with hepatic flexure management by laparoscopic approach, a 64 years old male patients with fever of an unknown origins for two months and abdominal pain. • We performed laparoscopic cholecystectomy and repaired colonic wall with intra-corporeal sutures. • The laparoscopic management of cholecystoeneteric fistula is a feasible and safe procedure but the operative strategy should be individualized.

Fixation free inguinal hernia repair with the 3D dynamic responsive prosthesis ProFlor: Features, procedural steps and long-term results

Abstract Background Static and fixated meshes to repair mobile structures like the groin may seem a procedural incongruence. Inguinal hernia is described as a degenerative disease. Therefore, the objective of disease treatment should be the regeneration of wasted tissue. The fibrotic scar plate, a typical biologic response of conventional static meshes, does not represent tissue regeneration but rather a foreign body reaction. These contrasting aspects seem to be related to high complication rates of inguinal herniorrhaphy. Recent studies concerning the pathophysiology of the groin have led to the development of new concepts for repairing inguinal protrusions. A proprietary designed 3D dyna…

Duodenal perforation as presentation of gastric neuroendocrine tumour: A case report

Highlights • Gastric neuroendocrine neoplasms (g-NENs) represent the most frequent digestive NENs and are increasingly recognized thanks to diffusion of upper gastrointestinal endoscopy. • g-NENs can be sporadic or associated with multiple endocrine neoplasia type 1 (MEN-1) and present with a functional Zollinger-Ellison syndrome. • We described a case of a 60 years old Caucasian male came to emergency room with diffuse abdominal pain and leukocytosis on blood tests. • At the level of the pyloric portion we found irregularly thickened walls associated with a small fluid collection and bubbles of free air. On exploratory laparoscopy we found a large perforation (about 5 cm of size) in the fi…

Trattamento laparoscopico del Mielolipoma surrenalico: caso clinico e revisione della letteratura.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal …

Antibiotic Prophylaxis for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis

Objective: Although thyroid and parathyroid surgery is considered a clean procedure with a low incidence of surgical site infections (SSIs), a great number of endocrine surgeons use antibiotic prophylaxis (AP). The aim of this study was to assess whether AP is significantly effective in reducing the incidence of SSIs in this kind of surgery. Data Sources: A systematic literature search was performed with PubMed, Scopus, and ISI–Web of Science. Studies addressing the efficacy of AP in reducing the incidence of SSIs in thyroid and parathyroid surgery were included in the systematic review and meta-analysis. Review Methods: The random effects model was assumed to account for different sources …

Lipoma of the fossa femoralis mimicking a femoral hernia. Report of 2 cases

Highlights • Femoral lipoma can be mistaken with femoral hernia. • Differential diagnosis between femoral lipoma and femoral hernia can result challenging. • The occurrence of femoral pain can lead to misinterpretation of the symptoms.

La colecistectomia laparoscopica nel paziente uremico

The aim of this study was to evaluate the effectiveness of the laparoscopic cholecystectomy performed in two uremic patients with gallstones. From January to July 2004, 15 patients with gallstones underwent to laparoscopic cholecystectomy (LC). Two patients had chronic renal failure on haemodyalisis: a symptomatic fourty-two old woman, which had primitive hyperparathyroidism and primitive hyperaldosteronism, and asymptomatic transplant candidate fifty-five old man. No minor and major complications occurred and both patients were discharged 4 days after LC. Even in uremic patients the L.C. must be the gold standard for the treatment of gallstones both symptomatic and asymptomatic.

Is there an inguinal sphincter in the groin area? Is the impairment of this sphincter due to adhesional phlogosis leading to indirect inguinal hernia?

Confezionamento di fistola artero-venosa nativa per l’emodialisi

Malignant metastatic melanoma to the gallbladder: Report of a peculiar case

Highlights • Melanoma is one of the most aggressive and one of the fastest growing types of cancer. The gallbladder envolvement from a metastatic cutaneous malignant melanoma is a highly uncommon finding, usually associated with diffuse metastatic disease and observed during autopsy. • We report a case of a 35-years old Caucasian woman with isolated metastasis of gallbladder form cutaneous primary malignant melanoma underwent to laparoscopic cholecystectomy. • Malignant cutaneous melanoma is a skin cancer characterized by the highest mortality. Isolated metastasis of gallbladder are barely described and mostly present in a widespread metastatic disease. Surgical treatment is indicated consi…

Whipple's pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Abstract Introduction Pancreatic cancer is the fourth cause of death from cancer in Western countries. The radical surgical resection is the only curative option for this pathology. The prevalence of this disease increases with age in population. The causes of pancreatic cancer are unknown, but we consider risk factors like smoke and tobacco usage, alcohol consumption coffee, history of diabetes or chronic pancreatitis. In this study we report our experience in the treatment of resectable pancreatic cancer and periampullary neoplasms with particular attention to evaluate the evolution of surgical technique and the clinical postoperative outcomes. Methods In our Department between January 20…

The Septum Inguinalis: A Clue to Hernia Genesis?

Purpose: Double ipsilateral inguinal ("pantaloon") hernias and also the more advanced "combined" inguinal hernia involve disruption of the inguinal floor. In the case of pantaloon hernias, the medial boundary of the internal ring remains intact but in combined hernias this is fully disrupted, producing a single hernial protrusion. Deepening the pathophysiology of these hernias may be helpful in addressing hernia genesis, thus improving strategies for the treatment of this disease. Materials and Methods: A cohort of 22 patients who underwent inguinal hernia repair showed double ipsilateral (pantaloon) hernia, comprising distinct direct and indirect protrusions separated by a tissue septum. I…

Role of preoperative CT angiography with multimodality imaging reconstruction to perform laparoscopic Complete Mesocolic Excision (CME) and Central Vascular Ligation (CVL) in right-sided colon cancer: Is it really useful? A prospective clinical study.

Background: The concept of complete mesocolic excision (CME) and central vascular ligation (CVL) in right colonic resections appears to improve the oncological outcomes. The highest rate of complications reported in the literature in patients undergoing CME is related to difficult surgical manuevers and intraoperative bleeding due to the central vascular dissection. Methods: We used preoperative findings obtained with the CT angiography, multiplanar reformation (MPR), maximum intesity projection (MIP) and 3D volume rendering (VR) technique to verify if this preoperative radiological assessment had significant benefits regarding the difficulty of dissection of the embryological planes, the i…

Small bowel obstruction after laparoscopic gastrectomy: An atypical clinical presentation. Report of a case

Abstract Introduction Postoperative adhesions represent the most common cause of acute small bowel obstruction (80%) and are usually a consequence of abdomino-pelvic surgery performed with open technique. Presentation of case A 45-year-old black man arrived at the emergency room with abdominal pain and distension three months after laparoscopic distal gastrectomy with Roux-en-Y anastomosis performed for benign pyloric stenosis. CT abdominal scan revealed some air-fluid levels in the center of the abdomen with distension of proximal jejunal loops caused by intestinal adhesions. Laparoscopic adhesiolysis was performed to restore the intestinal transit. Discussion The formation of adhesions is…

Polipi neoplastici del colon –retto. Indicazioni e risultati preliminari della Polipectomia endoscopica.

Deep seroma after incisional hernia repair. Case reports and review of the literature.

Wound-related complications are common after incisional hernia repair with mesh; seroma formation is the most frequent problem. The formation of a deep seroma has been rarely reported in the literature.In one year, September 2012-2013, 136 patients underwent surgery for incisional hernia repair, both elective and urgent.The following complications were observed: one dislocation of polypropylene prosthesis, a massive relapsed seroma and two deep seromas described in this article. A 63- years-old female underwent open incisional hernia repair with an intraperitoneal PTFE patch. She developed recurrent seroma under the mesh drained percutaneously, and finally the prosthesis was removed. A 72- …

Hemoperitoneum following mild blunt abdominal trauma: First presentation of Crohn's disease

Introduction: Inflammatory bowel diseases are heterogeneous in their presentation. Crohn's disease (CD) has been described as an unusual cause of massive lower gastrointestinal bleeding. We present a patient with CD whose first presentation was hemoperitoneum following mild blunt abdominal trauma Case presentation: A 54-year-old woman came to the emergency room with a blunt abdominal trauma. The patient underwent an abdominal CT scan with i.v. contrast medium injection, which showed hemoperitoneum with stenotic strictures of the small bowel and active massive bleeding from ileocolic artery. The rapid anemia onset and the CT report induced us to perform blood transfusion and an emergency exp…

Muscle degeneration in inguinal hernia specimens.

BACKGROUND: There are few articles in the literature reporting the histological changes of groin structures affected by inguinal hernia. A deeper knowledge of this matter could represent an important step forward in the identification of the causes of hernia protrusion. This study aimed to recognise the pathological modifications of muscular structures in autopsy specimens excised from tissues surrounding the hernia orifice. METHODS: Inguinal hernia was identified in 30 autopsied cadavers, which presented different varieties of hernia, including indirect, direct and mixed. Tissue specimens were resected for histological study from structures of the inguinal area surrounding the hernia openi…

RUOLO DELLA VIDEOLAPAROSCOPIA NELLE URGENZE PELVICHE: NOSTRA ESPERIENZA

Laparoscopic treatment for esophageal achalasia: experience at a single center

Background. Achalasia is a not frequent esophageal disorder cha- racterized by the absence of esophageal peristalsis and incomplete re- laxation of the lower esophageal sphincter (LES). Its cause is unknown. The aim of treatment is to improve the symptoms. We report the results of the treatment of this condition achieved in one center. Patients and methods. We conducted a retrospective study of pa- tients with esophageal achalasia. In the period 2010-2012 we observed 64 patients, of whom 19 were referred for medical treatment. Three of Introduction Achalasia is a not frequent esophageal motor disor- der that affects both the body of the esophagus and the lower esophageal sphincter (LES). It…

Il trattamento chirurgico delle lesioni nodulari tiroidee: nostra esperienza. Analisi di 462 casi.

Nodular thyroid lesions are the most frequent endocrine diseases in the general population. The surgical procedure is indicated for nodular thyroid tissue degeneration, or when the suppressive pharmacologic therapy is less efficient, even if sometimes both factors are associated. In Authors' study 462 patients were observed who underwent surgical procedures for thyroid diseases between January 1997-April 2003. In the thyroid pathology, either uninodular or multinodular, the surgical therapy adopted is total thyroidectomy, according to other Authors. The aim of total thyroidectomy is to avoid recurrence and simplify long term pharmacologic treatment. Although the question about the surgical …

Inguinal Hernia: Defect Obliteration with the 3D Dynamic Regenerative Scaffold Proflor™.

Prosthetic inguinal hernia repair presents significant challenges. Some of these, such as mesh fixation and quality of the biologic response, are still debated among surgeons. For example, there is no strong consensus regarding a specific condition that characterizes the surgical procedure during herniorrhaphy. This issue concerns management of the hernia defect, which in conventional hernia repair with flat meshes remains patent. However, a critical analysis of typical postoperative complications after inguinal hernia repair reveals that some of these adverse events are related to patency of the hernial opening. Postoperative discomfort, pain with specific movements and even hernia recurre…

Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings

Background Diverticular disease is increasingly prevalent in Western societies and is associated with significant morbidity. Objective Two-stage endoscopic device development for inversion and secured ligation of colonic diverticula; first, human cadaver studies were performed to measure forces required for diverticular inversion; second, a novel set of devices (elastic spiked O-ring with delivery system) was tested in animals. Design Prospective, observational study of human cadavers and prospective, interventional study of a porcine model. Setting University hospital pathology laboratory and animal facility. Intervention Full-thickness inversion of the colonic wall with a pipelike deliver…

Biologic Response of Inguinal Hernia Prosthetics: A Comparative Study of Conventional Static Meshes Versus 3D Dynamic Implants

Despite improvements in prosthetics and surgi- cal techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars—typical results with con- ventional static implants and plugs—may contribute to these adverse events. Recently, a new type of 3D dynami- cally responsive implant was introduced to the market. This device, designed to be placed fixation-free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic respo…

Imaging features of solid renal masses

The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign …

SURRENALECTOMIA LAPAROSCOPICA DESTRA PER MIELOLIPOMA, CASE REPORT

La colecistectomia laparoscopica nel paziente uremico

Acute appendicitis in a patient with situs viscerum inversus totalis: Role of laparoscopic approach. A case report and brief literature review

Highlights • Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. • The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis. • We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. • Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case. • Situs viscerum inversus and midgut malrotati…

Advantage of eradication therapy for Helicobacter pylori before kidney transplantation in uremic patients.

ABSTRACT From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the …

3D laparoscopic surgery: a prospective clinical trial

Since it's introduction, laparoscopic surgery represented a real revolution in clinical practice. The use of a new generation three-dimensional (3D) HD laparoscopic system can be considered a favorable "hybrid" made by combining two different elements: feasibility and diffusion of laparoscopy and improved quality of vision. In this study we report our clinical experience with use of three-dimensional (3D) HD vision system for laparoscopic surgery. Between 2013 and 2017 a prospective cohort study was conducted at the University Hospital of Palermo. We considered 163 patients underwent to laparoscopic three-dimensional (3D) HD surgery for various indications. This 3D-group was compared to a r…

Dedifferentiated retroperitoneal large liposarcoma and laparoscopic treatment: Is it possible and safe? The first literature case report

Highlights • We describe a case report of large retroperitoneal dedifferentiated liposarcoma totally treated by laparoscopic surgery. • In literature we found few cases of laparoscopic treatment only for Well-Differentiated liposarcoma. • To our knowledge this is the first description of Dedifferentiated liposarcoma completely treated with laparoscopic technique. • Literature review was performed to identify outcomes and advantages of laparoscopic approach for.

Nerve degeneration in inguinal hernia specimens

BACKGROUND: The histological study of the herniated inguinal area is rare in the literature. This report is focused on the detection of structural changes of the nerves within tissues bordering the inguinal hernia of cadavers. Their physiopathological consequences are hypothesized. MATERIALS AND METHODS: Primary inguinal hernia was diagnosed in 30 fresh cadavers. Tissue specimens from the inguinal region close to and around the hernia opening were excised for histological examination. A control of the data was achieved through tissue samples excised from equivalent sites of the inguinal region in 15 cadavers without hernia. RESULTS: The detected nerves in the inguinal area demonstrated path…

TRATTAMENTO MULTIDISCIPLINARE DELLA GANGRENA DI FOURNIER. CASE REPORT

Introduzione:Fournier ha descritto per la prima volta una fascite necrotizzante dei genitali e/o del perineo che può evolvere rapidamente in shock settico con mortalità fino al 67%1. Caso Clinico: Pz. maschio 50 a.a. con turbe psichiche e diabete mellito II sottoposto ad emorroidectomia. A 24 ore dolore distrettuale, iperpiressia, edema dello scroto, crepitio inguinale sottocutaneo bilaterale. Veniva effettuato drenaggio chirurgico urgente della regione inguinale bilateralmente e recentazione scrotale; nel post-operatorio NPT e terapia antibiotica e.v.(ertapenem sodico 1 gr/die e linezolidd 600 mg x 2/die). Doppia medicazione/die e curettage dei reliquati necrotici seguiti da lavaggi con be…

Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant.

Background: Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. Aims: In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. Methods: A tentacle-shaped flat mesh with a large central body and integra…

Valutazione delle possibilità e dei limiti del trattamento palliativo del carcinoma del retto mediante laser Nd-Yag versus colostomia

Ruolo della Colonscopia nella sorveglianza dei pazienti operati di cancro del colon rettale.

Histological findings in direct inguinal hernia

Abstract BACKGROUND: The study is focused on recognizing the histological changes of the structures close to and around the hernia opening in patients having direct inguinal hernia. METHODS: In 15 patients with primary bilateral direct inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, tissue specimens from the abdominal wall surrounding a direct hernia border were excised for histological examination. These findings in patients with direct inguinal hernia were compared with tissue specimens excised from the fossa inguinalis media of cadavers without hernia. RESULTS: Significant degenerative modifications such as fibrohyaline degeneration and fatty substitution of…

Achalasia Secondary to Submucosal Invasion by Poorly Differentiated Adenocarcinoma of the Cardia, Siewert II: Consideration on Preoperative Workup.

Secondary achalasia due to submucosal invasion of cardia by gastric cancer is a rare condition. We report a case of pseudoachalasia, secondary to the involvement of gastroesophageal junction by poorly differentiated gastric cancer, initially mistaken as idiopathic form. We focus on the difficulty to establish differential diagnosis only on the basis of routine exams and we stress the necessity of “second level” instrumental exams; EUS in routine workup in selected patients should be considered. We support that routine workup based on history, clinical presentation, radiological and endoscopic findings, and certainly manometry could be insufficient for a correct differential diagnosis betwee…

A New Prosthetic Implant for Inguinal Hernia Repair: Its Features in a Porcine Experimental Model

Even after more than 100 years of inguinal hernia repair, the rate of complications and recurrence remains unacceptably high. In the last decades, few effective advances in surgical technique and materials have been made. The authors see them as minor adjustments in the shape and materials of the prosthetic implants. Still, the underlying genesis of inguinal hernia remains undefined. Based upon this, it seems the surgical repair of inguinal protrusions cannot be based upon the pathogenesis because the etiology to date has not been addressed. Most hernia repairs are performed with some degree of point fixation (sutures/tacks) to stop the mesh from migrating and creating high recurrence rates…

Thyroid Surgery with "Ligasure"

Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review

Introduction: Diaphragmatic injuries are rare consequences of thoracoabdominal trauma and they often occur in association with multiorgan injuries. The diaphragm is a difficult anatomical structure to study with common imaging instruments due to its physiological movement. Thus, diaphragmatic injuries can often be misunderstood and diagnosed only during surgical procedures. Diagnostic delay results in a high rate of mortality. Methods: We report the management of a clinical case of a 45-old man who came to our observation with a stab wound in the right upper abdomen. The type or length of the knife used as it was extracted from the victim after the fight. CT imaging demonstrated a right hem…

Il gozzo nel paziente uremico cronico, Analisi della nostra esperienza nell'ambulatorio dei pazienti in lista d'attesa per trapianto renale

Laparoscopic near-total splenectomy. Report of a case

Highlights • We describe a case report of near total splenectomy managed by laparoscopy for a large lesion of the upper pole of the spleen. • When total splenectomy is performed, an increased risk of potentially lethal infections arises. Asplenia and impaired splenic function are related to the increase of morbidity and mortality from infectious complications. • The overwhelming post splenectomy infections (OPSI) are mostly represented by fulminating sepsis, meningitis or pneumonia. • laparoscopic near total splenectomy is an innovative partial splenectomy technique consisting on preserving a residual spleen volume. • The comparison between other spleen preserving techniques shows that LNTS…

Small bowel volvulus due to a large intestinal lipoma: A rare case report

Highlights • These are rare, benign, slow-growing mesenchymal tumors originating from adipose tissue in the bowel wall. Lipomas of mesentery, mesocolon, and antimesenteric side of intestine are extremely rare. • We describe a case of small bowel obstruction secondary to volvulus due to an antimesenteric ileal lipoma. • Mesenteric lipomas are rare clinical entity, with less than 50 cases described in English language literature. CT scan is the gold standard imaging modality for diagnosis of mesenteric lipoma and other lipomatous abdominal masses. • It shows homogenous tumor of adipose tissue, gives information about features of the small bowel and if there is evidence of ischemia and can dem…

Videolaparosurrenectomia: nostra esperienza preliminare

INTRODUCTION: In 1992, Gagner described the first laparoscopic adrenalectomy. Since then this technique has been more and more widely employed and several studies confirmed its advantages, comparing to the traditional approach, in terms of reduction of mean hospital stay and therefore of the health expense. PATIENTS AND METHODS: The Authors' preliminary experience spreads from March to November 2003 when 4 patients were studied and thus underwent a transperitoneal laparoscopic adrenalectomy: 2 of them were affected by Cushing syndrome, 1 by pheochromocytoma in MEN and 1 by an incidentaloma. The transabdominal access in lateral decubitus with 4 trocars was performed. RESULTS: No complication…

TWO STAGE TRANSPOSITION OF BRACHIO-BASILIC ARTERO-VENOUS FISTULA (BBAVF)BY ULTRACISION

LAPAROSCOPIC ADRENALECTOMY: SINGLE CENTRE EXPERIENCE.

Objective: Laparoscopic adrenalectomy is today considered the gold standard treatment for all benign adrenal tumors. The aim of this study is to evaluate the results of laparoscopic adrenalectomy in a single centre. Methods: We reviewed clinical data on 32 adrenalectomies performed at our istitution from 2009 to 2012. The average age of patients was 47 years (range 38-68); 18 were men and 14 women. For the clinical analysis, patients were divided into the nonfunctioning tumor group (n = 20) and the functioning tumor group (n = 12). All operations were performed via transperitoneal lateral access. Results: All laparoscopic adrenalectomy were finished successfully and no open surgery was nece…

Secondary Hyperparathyroidism and renal transplantation.

Pathological anatomy of hernia disease

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

Background: laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (< 5-6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (> 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods: at the University Hospital Policlinico "P. Giaccone" of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retr…

“Relaparoscopic” management of surgical complications: The experience of an Emergency Center

Background/aim: Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. Materials and methods: We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. Results…

Iperparatiroidismo terziario

Sequele nella chirurgia dell’iperparatiroidismo.

Single-incision laparoscopic cholecystectomy: Our experience and review of literature

Aim After the revolution in the surgery of gallbladder stones represented by the laparoscopic cholecystectomy, we tried a new technique that further maximize the aesthetic results and that at the same time is of easy learning for young surgeons. Patients and methods From January 2011 to December 2012 we performed at our department 320 cholecystectomy: 27 in laparotomy and 293 in laparoscopy. Of these, 88 underwent to Single Incision Laparoscopic Surgery (SILS), namely the Single Incision Laparoscopic Cholecystectomy (SILC), in recruited patients aged between 19-65 years; 56 patients were females and 32 were males. Results The laparoscopic cholecystectomy with the SILS methodology is a safe …

DUODENAL ADENOCARCINOMA: A CASE REPORT

Objective: Cancers of the small intestine are rare pathologies. They occur with vague and unspecific symptoms and cause many problems in differential diagnosis. Methods: A 64-years-old man, smoker, suffered inappetence, nausea and vomit over about 20 days until the presence of melena led to his admission to our hospital. His history included diabetes mellitus and moderate alcohol intake. The objective examination showed a hard-inelastic swelling in epi-mesogastric region. Laboratory data showed an increase of leukocytes and elevated level of CA 19-9. Esophagogastroduodenoscopy showed a duodenal vegetans neoformation, subjected to examination biopsy and bacterial culture. Computed tomography…

Ureteral injury during left colectomy for cancer: Laparoscopic management. A case report

Abstract Introduction Iatrogenic ureteral lesions may occur after any abdominal and pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of a lower third injury of the ureter during a laparoscopic left colectomy. Presentation of case An 81 year-old-man with left-sided colon cancer underwent laparoscopic left colectomy. During surgery there was a continuous full-thickness solution of the left ureter for which an end-to-end ureteral anastomosis was performed. In the postoperative period the patient underwent multiple urological and radiological interventional procedures due to …

Corrigendum to “Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience”

Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50-90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH stu…

External hernia of the supravesical fossa: Rare or simply misidentified?

Abstract Background External hernias of the supravesical fossa are considered rare, perhaps wrongly. Highlighting clinical and anatomical features could be useful for correct, preoperative diagnosis, thus avoiding the risk of complications such as incarceration. The study aims to demonstrate that the incidence of external protrusions of the supravesical fossa is higher that supposed. Probably, being mistaken for direct hernias, these hernia types are misidentified and not included in current classifications. This issue deserves attention due to the elevated risk of incarceration related to its distinctive structure. Material and methods 249 consecutive open anterior inguinal hernia procedur…

Fixation free prosthetic repair of large umbilical hernia granting a broad defect overlap

lntroduction: Umbilical hernia is a common surgical disease, accounting for l0-147o of all hernias and having many therapeutic options. Pure tissue repair is affected by a recurrence tp to 40Vo. Prosthetic mesh repair is now widely utilized with a decrease of recurrences up to 107o. Nevertheless, if large defect are present, assuring a wide overlap and a fixation-free technique still represent an issue. In this report we describe the outcomes of an umbilical hernia repair technique via a new implant with radiating straps at its boundary. Material and methods: A light weight, large porous polypropylene implant having a central body of 12x15 cm in diameter and eight radiating straps was used …

Neo-nervegenesis in 3D dynamic responsive implant for inguinal hernia repair. Qualitative study.

Abstract Background Prosthetic repair of inguinal hernias is one of the most performed surgical procedures. Nevertheless, high rates of complications affect the surgical treatment. Implant fixation, poor-quality tissue ingrowth and mesh shrinkage seem to be involved in postoperative complications, discomfort and chronic pain following inguinal hernia repair. To address these issues a multilamellar shaped 3D dynamic responsive prosthesis has been developed. This new implant, positioned fixation-free to obliterate the hernia opening, thanks its inherent dynamic compliance during inguinal movements, has demonstrated to induce an enhanced biological response. The ingrowth of newly formed muscle…

Dynamic autostatic implant for inguinal hernia repair. Early results in an explorative cohort of patients

Acknowledging the need to further improve outcomes and reduce complications in inguinal hernia repair, our group has been developing new surgical implants for this condition. Our primary considerations are to reduce complications associated with invasive fixation, and improve the quality of the tissue ingrowth within the implant. We have developed a new type of 3D dynamic, self retaining implant to achieve these effects. This newly designed implant was previously experimentally tested in porcine model, showing excellent outcomes. Above all, the results concerning the quality of tissue ingrowth and the nearby absence of shrinkage in the long term were excellent. In this report we describe th…

The role of colonscopy in patient follow-up after surgery for colorectal cancer

Physiopathology of hernia disease

The genesis of inguinal hernia still represents a dilemma. Deryite innovation in surgical matenals and techniques, no care has lrccn eler concerning the etiology of hernia. Following a specific Erlnù tissue samples were excised in 30 fresh male cadavers with iÉr.l lsnias, from structures close to the hemia orifice. for histological study. 15 cadavers without hernia served as conffol. The tissue excised demonstrated several histological changes. Among these, fibrohyaline degeneration and fatty dystrophy of the myocytes. Besides limpho-histiocytic and plasmacellular clusters, we found also vein fibrosis and congestion. The arterial structrres showed thicken- ing of the media due to Lyperplade…

Laparoscopic treatment of mesenteric avulsion and intestinal perforation after blunt abdominal trauma: A report of a case

Highlights • Intestinal injuries are quite involved in non-penetrating abdominal trauma after liver and spleen. • The incidence of small bowel injury after blunt abdominal trauma has increased nowadays, since high-energy transfer impacts producing large abdominal wall displacements are more frequent, such as car crash. • We report a case of a 49-year-old Caucasian woman, victim of a violent car crash, resulting in multiple small bowel perforations and mesenteric avulsion treated with laparoscopic approach. • Laparoscopy is a safe and feasible tool in selected patients with blunt abdominal trauma, both for diagnosis and treatment. • The prerequisites for applying mini invasive approach are b…

Laparoscopic, three-port and SILS cholecystectomy: a retrospective study.

Introduction. The aim of this study was to compare the results of classic laparoscopic, three-port and SILS cholecystectomy. Materials and methods. We conducted a retrospective study of da- ta collected between January 2010 and December 2012 pertaining to 159 selected patients with symptomatic gallstones. 57 underwent lapa- roscopic cholecystectomy, 51 three-port cholecystectomy and 48 SILS cholecystectomy. We then compared the groups with respect to mean ope- rating time, intraoperative complications, postoperative pain, duration of hospitalization and final aesthetic result. Introduction The first laparoscopic cholecystectomy was carried out in 1987 in France by Philippe Mouret (1). The p…

Laparoscopic adrenalectomy for large adrenal masses: Single team experience

Abstract Introduction Laparoscopic adrenalectomy is today considered the standard treatment for benign small adrenal tumors. An open question is the use of laparoscopy for large adrenal masses because of technical limitations and increased risk of malignancy. In this study we report our experience in laparoscopic adrenalectomy for adrenal masses larger than 6 cm. Methods Between January 2010 and December 2013 we performed 41 laparoscopic adrenalectomy. Fourteen of 41 patients (34,1%) were submitted to laparoscopic adrenalectomy for lesion >6 cm in size. All patients were submitted routinely to radiological and hormonal tests to indentify tumors characteristics. Results The patients treated …

Terminal or truncal ligation of the inferior thyroid artery during thyroidectomy? A prospective randomized trial.

Abstract Introduction Thyroidectomy is a common procedure in general and endocrine surgery. The technique of ligation of inferior thyroid artery (ITA) has been invoked as a possible cause of appearance of postoperative hypocalcemia. Methods We performed a prospective randomized study involving 184 patients undergoing total thyroidectomy to evaluate the differences of truncal ligation versus distal ligation of ITA in terms of postoperative hypocalcemia, vocal fold palsy, voice and swallowing impairment. The patients were divided into group A (trunk ligation of ITA) and group B (terminal branches ligation of ITA). Results We evaluated postoperative PTH and calcemia (immediate, 6 and 12 months…

Laparoscopic drainage of liver abscess: case report and literature review.

Aim To evaluate the safety and efficacy of the minimally invasive surgical approach (laparoscopic drainage) of liver abscesses in selected cases. Case report Male, 58 years old, from a rural area, presented with epigastric abdominal pain, fever, weight loss, loss of appetite, a palpable mass in the epigastrium and neutrophilic leukocytosis. CT revealed a complex multiloculated liver abscess in segments 2-3. Systemic antibiotic therapy alone was ineffective; percutaneous drainage was excluded due to the characteristics of the lesion. Result Given the complexity of the lesion, a laparoscopic approach was chosen involving complete drainage of the abscess, debridement and irrigation; the cavity…

First-in-man permanent laparoscopic fixation free obliteration of inguinal hernia defect with the 3D dynamic responsive implant ProFlor-E®. Case report

Abstract Introduction In the case of inguinal hernia recurrence after primary anterior repair, international guidelines strongly suggest a posterior laparoscopic approach. The 3D dynamic-responsive prosthesis for inguinal hernia repair ProFlor-E® has recently been introduced to the market. The present report describes the results of the first-in-man laparoscopic inguinal hernia repair carried out with ProFlor-E®. Presentation of case A 71-year-old male Caucasian presented with recurrent inguinal hernia after primary anterior repair. A fixation free TAPP procedure with ProFlor-E® was planned. Implant delivery and placement to obliterate the defect was quick and safe. Postoperatively, startin…

Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study

Abstract Introduction Laparoscopic adrenalectomy is today considered the gold standard of treatment for adrenal tumors. The development of high definition cameras does not eliminate the major limitation of two-dimensional (2D) laparoscopy: lack of depth perception and loss of spatial orientation. Tree-dimensional (3D) HD laparoscopy was developed as an alternative to conventional 2D laparoscopy. Methods We report our experience with use of 3D vision system for laparoscopic adrenalectomy. Between January 2009 and March 2015 we performed a total of 52 laparoscopic adrenalectomies. In this case-control study we considered 13 laparoscopic adrenalectomies performed with three-dimensional (3D) vi…

Videolaparosurrenectomia . Nostra esperienza.

Systemic schistosomiasis and large bowel perforation: An unexpected surgical urgency. Report of a case and literature review

Key Clinical Message In the presence of suggestive clinical picture (high eosinophil count and multiple CT scan granuloma‐like lesions), schistosomiasis should be taken into account in case of suspected bowel perforation even if common risk factors are not identified through anamnesis.

Uterine Involvement in Klippel–Trenaunay Syndrome: A Rare But Relevant Event. Review of the Literature

IntroductionKlippel–Trenaunay syndrome (KTS) is a rare vascular congenital disorder characterized by the classical triad of port-wine stains, abnormal growth of soft tissues and bones, and vascular malformations. The involvement of the genitourinary tract and of the uterus in particular is extremely infrequent but relevant for possible consequences.MethodsWe performed an extensive review of the literature using the Pubmed, Scopus and ISI web of knowledge database to identify all cases of KTS with uterine involvement. The search was done using the MeSH term “Klippel–Trenaunay syndrome” AND “uterine” OR “uterus.” We considered publications only in the English language with no limits of time. …

Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review.

Several studies in the last years demonstrated the better surgical outcome of laparoscopic approach to adrenal gland. Laparoscopic surgery is more difficult to learn and requires different psychomotor skills than open surgery, especially with regard to complex maneuvers requiring precision and dexterity. The development of robotic platform with three-dimensional vision and increased degrees of freedom of the surgical instruments has the aim to overcome these problems. We performed a systematic literature review with meta-analysis to evaluate preoperative data and surgical outcomes of robotic adrenalectomy compared with laparoscopic technique. In September 2016 we performed a systematic lite…

Role and clinical importance of Helicobacter pylori infection in hemodialysis patients

Dyspepsia is an extrarenal symptom frequently found in hemodialysed patients; it is due to chronic renal failure, and uremic gastritis is a specific associated condition in chronic renal failure (CRF). On the other hand, in the general population, Helicobacter pylori infection is an important dyspepsia-related risk factor; its close connections with gastro-duodenal pathology are already known, above all the peptic disease in a really exclusive way. By observation of a dyalitic group of patients, opportunely matched with a no CRF group, we evaluated CRF-associated uremia and Helicobacter pylori infection which could eventually interact causing symptoms and lesions. A statistical analysis of …

A regenerative 3D scaffold for inguinal hernia repair. MR imaging and histological cross evidence. Qualitative study

Abstract Background Inguinal hernia is a degenerative disease occurring in a high motile surround. Stopping degeneration and promoting tissue regeneration should be the treatment goal. Groin hernias are conventionally managed with static flat meshes, mostly fixated to the delicate inguinal environment. Far from a regenerative effect, the biologic response of conventional hernia meshes is characterized by a foreign body reaction leading to a stiff/shrunken scar plate, which is often the source of unpleasant complications. Recently, a newly engineered 3D device for inguinal hernia repair – ProFlor-has been developed to produce a regenerative biological response. Unlike conventional hernia mes…

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by t…

Endoscopic screening of the upper and lower digestive tract of the patients with chronic renal failure on waiting list for renal transplantation

Adrenal gunshot wound: Laparoscopic approach. Report of a case

introduction: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating abdominal injury, it is also clear that certain stable patients may be managed without operation. Controversy persists regarding use of laparoscopy. PRESENTATION OF CASE: We report a case of gunshot wounds with bullet in left adrenal gland and perirenal subcapsular hematoma. The patients had no signs of peritonitis but in the observation period we noted a significative blood loss, so we performed an exploratory laparoscopy. DISCUSSION: We found the bullet in adrenal parenchyma. The postoperative period was regular and the patient was discharg…

Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a case-control study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico “P. Giaccone” and Ospedali Riu…

Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case

Highlights • Identify the preoperative radiologic features of adrenal hemangioma. • We examine the better surgical approach for adrenal tumors and adrenal hemangioma. • Controindication to laparoscopic adrenalectomy.

Il reintervento per l'iperparatiroidismo renale persistente o recidivo

Giant subcutaneous lipomatosis in Myoclonic Epilepsy with Ragged Red Fibers syndrome: The first literature report of “laparoscopic” excision

Background MERRF (Myoclonic Epilepsy with Ragged Red Fibers) is a rare multisystem clinical disorder due to a pathogenic variant of the mitochondrial DNA. Rare symptoms of MERRF include multiple systemic lipomatosis with symmetric uncapsulated lipomas occurs generally on the posterior cervical region and upper back. Methods We report the clinical case of a 46 years-old Caucasian man with MERRF syndrome who presented with MSL on the right cervical region. We decided to perform a mini-invasive approach using laparoscopic instruments. We performed a 10-mm incision about 5 cm under the mass and conducted a blunt dissection of the subcutaneous plane. Then we positioned a 10-mm port and started C…

The colovescical fistula in diverticular disease: Laparoscopic approach in two different cases

Highlights • The colovescical fistula is one of the complications of diverticular disease. • It can cause typical symptoms like pneumaturia and fecaluria affecting the quality of life and sometimes leading to death, usually secondary to sepsis. • We studied two patients with clinical, radiological and endoscopic diagnosis of colovescical fistula as a consequence of diverticular disease. • We performed a totally laparoscopic treatment with colonic resection and closure of the fistula with intracorporeal sutures. • The presence of a colovescical fistula significantly increases the difficult of the laparoscopic colonic resection.

Fixation free femoral hernia repair with a 3D dynamic responsive implant. A case series report

Abstract Background To date, no gold standard for the surgical treatment of femoral hernia exists. Pure tissue repair as well as mesh/plug implantation, open or laparoscopic, are the most performed methods. Nevertheless, all these techniques need sutures or mesh fixation. This implies the risk of damaging sensitive structures of the femoral area, along with complications related to tissue tear and postoperative discomfort consequent to poor quality mesh incorporation. The present retrospective multicenter case series highlights the results of femoral hernia repair procedures performed with a 3D dynamic responsive implant in a cohort of 32 patients during a mean follow up of 27 months. Mater…

Terminal ligature of inferior thyroid arterhy branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels

Purpose: To evaluate the impact of truncal versus terminal branch ligature of the inferior thyroid artery (ITA) on postoperative calcium and PTH plasma levels in patients undergoing total thyroidectomy for multinodular goiter. Methods: A prospective randomized study was performed comparing a group of patients that underwent either truncal ligature of the ITA (group 1) or terminal ligature of ITA branches (group 2). Results: A series of 126 consecutive patients with non-toxic euthyroid multinodular goiter underwent total thyroidectomy. Truncal ligature of the ITA was performed in 63 patients (group 1) and terminal branch ITA ligature in 63 patients (group 2). Postoperative ionized serum calc…

Suture intradermiche totali

Two kind of total intradermal suture techniques are described in the present report. These procedures allow an effective reduction of post-operative pain of surgical wound, prevent infections, cut down tissutal trauma, achieve better aesthetic results, making easier postoperative patient''s management. From January 2001 to December 2007, 1,427 patients underwent surgical treatment and the wounds have been sewn with self-locking knots or intradermal skin closure with introflecting knots. This kind of procedures allow a sharp reduction of postoperative pain as well as the incidence of wound infections. Also the number of wound medication required after surgery is significantly reduced.

L'utilità della colonscopia nel follow-up dei pazienti operati per cancro del colon-retto. Analisi retrospettiva e revisione della letteratura

La colecistectomia con procedura mininvasiva open nei soggetti anziani ad alto rischio.

Intraoperative Parathyroid hormone monitoring during parathyroidectomy for renal hyperparathyroidism

Acute appendicitis and endometriosis: Retrospective analysis in emergency setting

Introduction. The aim of this study is to evaluate the incidence of appendiceal and pelvic endometriosis in a population with diagnosis of acute appendicitis in an emergency setting. Materials and methods. We carried out a retrospective study in the period between January 2010 and October 2013. We performed 429 appendectomy including 233 in female subjects (54.3%). In all patients of childbearing age, we did β-hCG urine test to rule out the presence of an extra-uterine pregnancy. Results. 127 of 233 patients received a laparoscopic approach (54.5%). The median age was 29 years-old (range 17-68). The diagnosis of appendiceal and/or pelvic endometriosis was performed in 10 patients (4.3%): 9 …

TRATTAMENTO ENDOSCOPICO DEI POLIPI DEL COLON-RETTO IN UN AMBULATORIO DI ENDOSCOPIA DIGESTIVA:NOSTRA ESPERIENZA

The aim of this report was to evaluate the effectiveness of the endoscopic treatment of colonic polyps to allow secondary prophylaxis in order to prevent the onset of cancer arising from adenomas. From October 2002 to January 2004 we performed 487 colonoscopies on a patient group with the following indications: screening prior to kidney transplant; screening for colorectal cancer (patients positive at faecal occult blood testing); follow-up of patients who had undergone colonic resections for colorectal cancer; patients with other diseases. Colorectal polyps were diagnosed in 15 males and 15 females, with a mean age of 63 years. All the neoplasms were resected during colonoscopy and specime…

Videolaparosurrenectomia.nostra esperienza

La chirurgia delle lesioni nodulari tiroidee: analisi di 592 casi

Totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation: The first case report in worldwide literature with a brief review

IntroductionBowel perforation is a relatively rare presentation of abdominal tuberculosis, whose diagnosis is challenging but fundamental to minimize morbidity and mortality. Laparoscopy is considered an effective modality for diagnosis, but its role in surgical treatment is still not established. We reported the first worldwide case of totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation.Case presentationA 30-year-old man with a history of weight loss, preceded by 2 years of nonproductive cough, was admitted to the Infectious Disease Department with a presumed diagnosis of tuberculosis. A microbiological culture test confirmed the diagnosis, and the …

New mesh shape and improved implantation procedure to simplify and standardize open ventral hernia repair: a preliminary report.

Introduction Issues in ventral hernia repair are represented by the need for mesh fixation and how to assure a sufficient mesh overlap of the defect. Aiming to resolve these problems, this study describes a modified technique for ventral and incisional hernia repair based upon a newly developed mesh with a special design. This new type of implant allows broader coverage of the abdominal wall and results in tension- and fixation-free repair. Materials and methods A unique geometrically shaped mesh consisting of a large central body and radiating arms was used to repair ventral or incisional hernia. The mesh was intended not to be point-fixated. The friction of the straps passing through the …

Fixation free open ventral hernia repair using a new mesh with integrated placement straps

Trattamento endoscopico dei polipi del colon in un ambulatorio di Endoscopia digestiva.

Enhanced angiogenesis in the 3D dynamic responsive implant for inguinal hernia repair ProFlor

Biologic response to hernia prostheses represents a continuous source of debate. Conventional hernia meshes, in their typical static, passive configuration have been used for decades to reinforce the herniated abdominal wall. These flat implants, mainly fixated with sutures or tacks, induce poor quality fibrotic ingrowth that shrinks the mesh. In groin hernia repair, flat meshes are applied in the delicate inguinal surrounding where uncontrolled development of a scar plate can impair movement and may incorporate the sensitive nerves crossing this area. Complications deriving from mesh fixation and nerve entrapment are frequent and unpleasant for patients. To remedy these problems, a multila…

Role and outcomes of laparoscopic cholecystectomy in the elderly.

Abstract Introduction : Laparoscopic cholecystectomy is the standard of treatment for gallstones disease and acute colecystitis. The prevalence of this disease increases with age and the population is aging in industrialized countries. So, in this study we report our experience in the treatment of gallstone disease in elderly patients, particularly analyzing the outcomes of laparoscopic approach. Methods : Between January 2010 and May 2014 we performed a total of 1227 cholecystectomies. In this retrospective study age group was the primary independent variable: 351 patients were 65–79 years of age and 65 were 80 years of age or older. Results : Only 65 patients (5.3%) of all population had …

Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin

Background: Postoperative chronic pain caused by fixation and/or fibrotic incorporation of hernia meshes are the main concerns in inguinal herniorrhaphy. As inguinal hernia is a degenerative disease, logically the treatment should aim at stopping degeneration and activating regeneration. Unfortunately, in conventional prosthetic herniorrhaphy no relationship exists between pathogenesis and treatment. To overcome these incongruences, a 3D dynamic responsive multilamellar scaffold has been developed for fixation-free inguinal hernia repair. Made of polypropylene like conventional flat meshes, the dynamic behavior of the scaffold allows for the regeneration of all typical inguinal components: …

Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis

Anastomotic leakage is one of the major complications occurring after anterior resection of rectum. A defunctioning stoma is usually created routinely or on surgeons' discretion. The aim of this study was to investigate the usefulness of temporary ileostomy to prevent anastomotic leakage comparing the postoperative course of patients with and without defunctioning loop ileostomy.Patients that underwent anterior resection of rectum were recruited. 140 patients were enrolled and divided in two groups: patients without and with defunctioning loop ileostomy. Patients' characteristics and other useful data were recorded. A comparison between the two groups was made. The minimum follow-up was 11 …

Use of monitoring intraoperative parathyroid hormone during parathyroidectomy in patients on waiting list for renal transplantation.

This report describes the use of intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy for patients with secondary hyperparathyroidism on the waiting list for renal transplantation. The levels of ioPTH were determined among waiting list patients undergoing subtotal parathyroidectomy and tertiary hyperparathyroidism patients undergoing procedures. The levels of ioPTH were significantly reduced at 10 minutes by 59.7,3% among with secondary hyperparathyroidism and 68.9% among tertiary hyperparathyroidism. A 15 minutes it was 85% in secondary hyperparathyroidism and 89.7% in tertiary hyperparathyroidism. A decrement of 50% in basal values at 10 minutes and 85% decrement or m…

Colecistectomia mininvasiva open. Risultati su una casistica di 285 pazienti consecutivi non selezionati. Confronto con la VLC e la colecistectomia tradizionale.

Feasibility and Safety of Laparoscopic Complete Mesocolic Excision (CME) for Right-sided Colon Cancer

OBJECTIVE The aim of this prospective clinical study is to compare short-term outcome of laparoscopic right hemicolectomy using the Complete Mesocolic Excision (CME group) with patients who underwent conventional right-sided colonic resection (NCME group). SUMMARY BACKGROUND DATA Although CME with central vascular ligation in laparoscopic right hemicolectomy is associated with a significant decrease in local recurrence rates and improvements in cancer-related 5-year survival, there may be additional risks associated with this technique because of increased surgical complications. As a result, there is controversy surrounding its use. METHODS In this randomized controlled trial, several prim…

Histological findings of the internal inguinal ring in patients having indirect inguinal hernia

BACKGROUND: Aiming to deepen the understanding of the factors involved in the genesis of groin hernia, this study is focused on identifying the histological changes within the muscle fibers of the internal inguinal ring in patients having indirect inguinal hernia. METHODS: In eight patients with primary or recurrent bilateral indirect inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, a tissue specimen from the edge of the internal inguinal ring was biopsied and histologically examined. RESULTS: In all of the tissue samples, remarkable degenerative changes such as fibrohyaline degeneration of the muscle fibers, vascular congestion, and phlogistic infiltration thro…

Thyroid surgery with the system Ligasure.

Recurrent intussusception of small bowel in a young patient due to metastases from cardiac undifferentiated pleomorphic sarcoma: A first ever case report

Highlights • Metastatic undifferentiated pleomorphic sarcoma (Malignant Fibrous Histiocytoma) is a rare entity in the visceral organs. • We report a case of a metastatic primary cardiac undifferentiated pleomorphic sarcoma which presented with a recurrent small bowel intussusception in a young man. • Laparotomy by a small midline incision performed on the same day identified an intussusception of a 15-cm section of small intestine caused by a 4-cm intraluminal metastasis from undifferentiated pleomorphic sarcoma. • Metastasis intussusception in the small intestine is a very rare condition and they are part of differential diagnosis in patient with a history of tumor who present with intussu…

Causa rara di ostruzione delle vie aeree: linfoma tiroideo

GIANT INCISIONAL HERNIA IN THE ELDERLY PATIENT. A RAPID AND SIMPLE SURGICAL TREATMENT

Successful laparoscopic management of congenital diaphragmatic relaxation: A case report

Highlights • We describe a case report of congenital Diaphragmatic relaxation treated with totally laparoscopic plication of the left hemidiaphragm with nonresorbable sutures. • In our case report the diaphragmatic relaxation seemed to be congenital and the laparoscopic approach resulted the most appropriate technique to obtain the repositioning of abdominal organs and diaphragmatic placation. • A brief review of literature was performed to identify outcomes and potentially surgical advantages of laparoscopic approach for diaphragmatic relaxation. Laparoscopic approach can only be practiced in selected cases.

Intraoperative parathyroid hormone monitorino durino parathyroidectomy for renal hyperparathyroidism

Chirurgia laparoscopica ed Endoscopia nel paziente uremico

Combined inguinal hernia in the elderly. Portraying the progression of hernia disease

Abstract Introduction Identification of a combined hernia is a common occurrence in the course of inguinal hernia repair. This type of protrusion disease seems to affect the elderly, in particular. Very few investigations have been carried out to ascertain the structural changes that occur in the groin affected by this clinical condition. Method Analysis of intraoperative findings of combined inguinal hernias evidenced in the elderly, from the most recent 100 groin hernia repair procedures carried out by a single operator, represents the basis of the article. Protrusions that presumably represent the forerunner of this type of hernia were also analyzed: double ipsilateral inguinal hernias c…

Trattamento endoscopico dei polipi del colon retto.

Incidentaloma Surrenalico. Caso di Sindrome di Cushing subclinica.

The authors describe a case of adrenal incidentaloma that was the cause of subclinical Cushing's syndrome and take the opportunity to weigh up some of the clinical, diagnostic and therapeutic aspects. Besides the particular expression of the symptoms which were difficult to interpret before reaching a diagnosis, the authors describe the diagnostic work-up adopted, aimed at precisely identifying the type of tumour and the surgical procedure implemented laparoscopically, the outstanding validity of which is confirmed compared to traditional adrenalectomy techniques.

Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value &lt

Modified fixation free plug technique using a new 3D multilamellar implant for inguinal hernia repair: a retrospective study of a single operator case series.

Aim: Implant fixation, mesh shrinkage and poor quality of tissue ingrowth are unresolved issues in modern hernia repair. Many complications reported in the literature such as bleeding, nerve entrapment, hematoma, pain, discomfort, and testicular complications, are considered to be a direct results of implant fixation. This article describes the outcomes of a procedure carried out using a handcrafted implant that addresses the issues consequent to point fixation. Methods: This was a retrospective study on the short, medium and long-term results of placing a-modified, fixation free three-dimensional polypropylene implant in 61 patients who underwent inguinal hernia repair using a novel delive…

Screening endoscopico del tratto digestivo superiore ed inferiore del paziente uremico da sottoporre a trapianto renale.

Damage to the vascular structures in inguinal hernia specimens.

BACKGROUND: Few scientific reports to date describe the histological modification of structures outlining a hernia opening. This article is focused on the identification of the pathological changes in vascular structures in tissues excised from cadavers with inguinal hernia. A deeper comprehension of this topic could lead to essential improvements in the detection of hernia genesis. MATERIALS AND METHODS: Different kinds of hernia, including indirect, direct and mixed, were identified in 30 autopsied subjects. Tissue samples were resected for histological study from abdominal wall structures close to the hernia opening. Histological examination focused on the detection of structural changes…

I trapianti in rapporto ai mass media: dal trionfalismo alla ricerca esasperata della malpractice

I TUMORI DEL RENE: INQUADRAMENTO NOSOLOGICO, STAGING E FATTORI PROGNOSTICI

Incidenza di esofago di Barrett in una popolazione siciliana di pazienti reflussori sottoposti a EGDS.

Unusual giant chromophobe renal cancer totally managed with laparoscopic technique: Report of a case

Highlights • We describe a case report of giant renal cell chromophobe carcinoma totally treated by laparoscopic surgery. • The size of renal lesion represents a critical point in surgical approach because to perform a laparoscopic radical nephrectomy can be challenging even for skilled surgeons in giant renal tumors. • A brief review of literature was performed to identify outcomes and potentially surgical advantages of laparoscopic approach for retroperitoenal liposarcoma. • The possibility of the laparoscopic approach derives from from the preoperative identification of adipose cleavage, from the absence of invasion of major vascular axes, from the absence of distant metastatic lesions.

The use of a new kind of low profile retractor for arteriovenous fistula procedure simplifies and speeds up the intervention

Purpose The aim of this study was to demonstrate the effectiveness of a new kind of disposable surgical retractor in arteriovenous fistula (AVF) procedures in order to achieve an easier, faster and safer surgical intervention. Methods Between January and June 2008, 22 AVF procedures were performed using the 3PAWS ReeTrakttrade; (Insightra Inc. - Irvine, Ca., USA) a self-retaining, low profile retractor. An equivalent patient sample, in which an AVF was performed using conventional retraction devices, was considered for comparison of the intra- and post-operative results. Results In all of the 22 AVF procedures performed, the ReeTrakt™ system has simplified the performance of the surgical te…

Topic: Inguinal Hernia - Joined guidelines.

Goals of Care in Emergency Abdominal Surgery in the Elderly and Frail Patient

Elderly and frail patients are often those at highest risk during surgical procedures both in terms of intraoperative complications and postoperative outcome. It is clear that the best therapeutic result in the elderly and frail patient can be obtained through multidisciplinary management of the problem. In the management of elderly and frail patients undergoing to emergency surgery, we can make a series of considerations that guide our decision-making process. First, correct diagnosis can be difficult because of the impaired cognitive and physical status of the patient or other clinical conditions and medications that mask signs and symptoms. Second, the choice of the treatment to be carri…

Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients

Introduction: Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism. The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism. Material and methods: Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPT…

Difficult laparoscopic cholecystectomy and preoperative predictive factors

AbstractLaparoscopic cholecystectomy (LC) is the standard technique for treatment of gallbladder disease. In case of acute cholecystitis we can identify preoperative factors associated with an increased risk of conversion and intraoperative complications. The aim of our study was to detect preoperative laboratory and radiological findings predictive of difficult LC with potential advantages for both the surgeons and patients in terms of options for management. We designed a retrospective case–control study to compare preoperative predictive factors of difficult LC in patients treated in emergency setting between January 2015 and December 2019. We included in the difficult LC group the surge…

Inguinal Hernia: Crossfire Between the Meshes.

Prosthetic strap system for simplified ventral hernia repair. Its results in a porcine experimental model.

Abstract: Introduction Aiming to achieve a simplified ventral hernia repair, a proprietary shaped mesh was experimentally tested in the porcine model. The mesh is structured with a large central body and radiating straps. The friction of the straps passing through the tissues are hypothesized to be adequate to maintain the mesh in place during tissue ingrowth, avoiding classic point fixation while ensuring a wide coverage of the abdomen. Methods The mesh, having 6 radial straps, was placed using a sublay preperitoneal technique in 4 pigs. All straps were passed laterally through the abdominal wall and exteriorized from the skin. The straps were trimmed at the level of the skin, allowing the…

Use of intraoperative parathyroid hormone in waiting list and kidney transplant patients

Vantaggi e limiti dell'approccio laparoscopico nell'addome acuto

INTRODUZIONE ED OBIETTIVI Le condizioni patologiche che possono insorgere con un quadro di addome acuto sono molto numerose ed il loro riconoscimento, nonostante l’affinamento delle procedure diagnostiche, rappresenta sempre una difficile prova anche per il chirurgo più esperto. Grazie alla standardizzazione delle procedure e all’impiego dell’alta tecnologia la laparoscopia trova oggi sempre maggiori indicazioni per risolvere dubbi diagnostici, anche in urgenza. MATERIALI E METODI Viene riportata la nostra esperienza di approccio laparoscopico su 147 pazienti, tutti emodinamicamente stabili, ricoverati con una diagnosi di ingresso di addome acuto. RISULTATI Nel 59% dei casi il trattamento l…

Splenic lymphoma with complex gastro-spleno-diaphragmatic fistula: 3D laparoscopic multivisceral resection. The first literature case report

Abstract Introduction Gastrosplenic fistula is a rare disease involving stomach and spleen that can lead to dangerous complications like massive gastrointestinal bleeding. Diffuse large B-cell lymphoma (DLBC) is the principal pathological cause of gastrosplenic fistula. Case report We report a case of A 76-year-old caucasian woman came to the emergency room with fever for two week and gravative pain in left upper quadrant of the abdomen. CT scan of thorax and abdomen demonstrated an inhomogeneous hypodense large lymphomatous mass (10 × 6 cm) of upper pole of the spleen deformating medial profile and infiltrating gastric fundus and left diaphragm. with the diagnosis of complex gastro-splenic…

La chirurgia dell'uremico

APPROCCIO MULTIDISCIPLINARE AL GOZZO RECIDIVO CON GRAVE STENOSI TRACHEALE: UN CASO CLINICO

INTRODUZIONE Il reintervento per patologia a carico della ghiandola tiroidea è raro, ma risulta spesso indicato nelle ricomparsa di patologia nodulare dopo interventi parziali. La ricorrenza della patologia multinodulare si aggira infatti intorno al 12% di tutti gli interventi sulla tiroide. Questi interventi di totalizzazione possono talvolta richiedere la collaborazione di equipe chirurgiche con diverse specialità in successivi steps temporali. MATERIALI E METODI Il caso clinico riguarda una donna di 72 anni sottoposta 40 anni prima ad intervento di tiroidectomia parziale che riferisce la comparsa di voluminosa tumefazione in sede sottojoidea nell’arco di 2 mesi accompagnata da crisi resp…

Day Surgery ed Endoscopia

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery.

BACKGROUND: The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). METHODS: Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. RESULTS: There …

Valutazione endoscopica del paziente uremico il lista d’attesa per trapianto renale.

Tentacle-shaped mesh for fixation-free repair of umbilical hernias

Purpose: Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal wall. The study describes the results of umbilical hernia procedures carried out with the tentacle-shaped implant and the related surgical technique. Methods: A proprietary tentacle-shaped flat mesh having a central body with integrated radiating arms at its edge was used to repair large umbilical hernias in 62 patients. The implant was placed in preperitoneal sublay. The friction of the straps, crossing the abdominal wall thanks to a special n…

Linfagioma cistico addominale: un’origine dibattuta.

Combined endo-laparoscopic treatment of large gastrointestinal stromal tumor of the stomach: Report of a case and literature review

Highlights • We report a case of 75-year-old Caucasian men with unknown voluminous gastric GIST, who came to our attention complaining melena. We decided to perform a laparoscopic-endoscopic combined surgical approach. • Intraoperative endoscopy identified gastric GIST and confirmed the submucosal origin and the integrity of the capsule. A 10 cm laparoscopic gastrotomy was carried out along the gastric found in order to realize a laparo-endoscopic rendez-vous technique. • Laparoscopy has rapidly become a preferable approach for gastric GISTs surgical treatment. The magnified view and the lesser invasiveness of laparoscopic technique allow the surgeon to perform a more meticulous dissection,…

Informed consent in high-risk renal transplant recipients.

Abstract Before performing a clinical, diagnostic, and/or therapeutic action, the doctor is required to provide the patient with a bulk of information defined as informed consent. This expression was used for the first time in 1957 during a court case in California and the two words— informed and consent —are used together to underline the fact that the patient cannot give his or her true consent without first receiving correct information concerning the medical act in question. With regard to the medicolegal aspects governing organ transplants, despite the bulk of detailed work performed by health service workers involved in this surgical field with the aim of preparing adequate informed c…

VALUTAZIONE ECO-COLOR-DOPPLER DEL RENE TRAPIANTATO. REVIEW DELLA CASISTICA E VALUTAZIONE CRITICA

Un caso complesso di calcificassi associata ad iperparatiroidismo secondario (IPTII) con coesistenza di sindrome emolitico uremica SEU) in paziente già sottoposta a trapianto di rene

Introduzione La calcificassi è l’estrema complicanza potenzialmente letale dell’iperparatiroidismo IPT spesso di tipo II. La sua patogenesi è dubbia in quanto concorrono variabili di tipo individuale legate ad una complessa reazione di ipersensibilità in presenza di PTH, vitamina D ed ipercalcemia.Una non sempre correlazione tra gravità dei segni clinici ed alterazioni laboratoristiche ed anatomo-patologiche rende difficile la prognosi. Il sodio tiosolfato e.v. può ridurre la precipitazione di calcio e disostruire le arterie migliorando il quadro clinico rappresentando oltre alla paratiroidectomia (PTX) l’unica terapia capace di ridurre l’elevato rischio di mortalità Materiali e metodi: Il …

INQUADRAMENTO ED ASPETTI FISIOPATOLOGICI DELL'ITTERO OSTRUTTIVO

Use of the monitoring of intraoperative parathyroid hormone during parathyroidectomy in waiting list for renal transplantation patients

ENDOTRACHEAL STENT IN A CASE OF SEVERE TRACHEAL STENOSIS FROM RELAPSING GOITER

Objectives:The surgical approach for tracheal complications in thyroidectomy sometimes requires tracheotomy in urgency for supporting the airways flow (especially in presence of giant goiter). Nevertheless, tracheotomy, even if necessary to guarantee the restoration of respiratory function, it can not be considered as definitive therapy in presence of alterations of trachea (i.e. stenosis) susceptible to heal. An useful help in clinical management comes by tracheal prosthesis as we showed in a case of a giant relapsing multinodular goiter. Materials and methods: A 72 yr old woman, affected by giant relapsing goiter rapidly growing, came to our observation with severe orthopnea, due to steno…

A NEW KIND OF DISPOSABLE AUTOSTATIC SURGICAL RETRACTOR IN INGUINAL HERNIA REPAIR

Objectives: The aim of this study is to demonstrate the effectiveness of a new kind of disposable autostatic surgical retractor in hernias procedures in order to achieve an easier, faster, and safer surgical intervention. Material and Methods: Between January and March 2008, 42 inguinal hernioplasty procedures have been performed using the 3PAWS model of ReeTrakt™ a self-retaining, low profile retractor. Equivalent patients samples, in which operations were performed using conventional retraction devices, were considered for comparison of the intra and postoperative results. Results: In all of the 42 inguinal hernioplasty procedures performed, the ReeTrakt™ system has simplified the perform…

SUCCESFULLY TREATED HEMOLITIC UREMIC SYNDROME (HUS) BY PLASMA APHERESIS AFTER KIDNEY TRANSPLANTATION

Objectives: The HUS is a rare disease; it exists a kind related to acute toxicity by Cyclosporine on the short time following kidney transplantation. Although the causes of this syndrome are still unclear, data from the literature show that patients with high levels of Reactive Antibodies (PRA test), Alport syndrome (as primitive renal disease), or which have history of HUS present a higher risk of HUS after renal transplantation. Materials and Methods: We report a case of a 58 yr old woman whose cause of uremia we did not know dependent on an episode of HUS. The patients underwent renal transplantation from deceased donor and treated with Cyclosporine, Mycophenolate Mofetil and steroids as…

UTILIZZO DI RENI MARGINALI: NOSTRA ESPERIENZA

Introduzione La scarsa disponibilità di organi e l’incremento del numero dei pazienti trapiantabili ha condotto all’utilizzo di graft provenienti da donatori anziani o marginali. Lo scopo del presente studio è quello di analizzare i risultati di pazienti sottoposti a trapianto renale da donatori anziani o marginali. Metodi Tra gennaio 1996 e settembre 2007 abbiamo eseguito 137 trapianti renali. 39 da donatori marginali (gruppo A) e 98 da donatori ideali (gruppo B). Dopo un follow-up di 18 mesi abbiamo analizzato i risultati ottenuti in termini di complicanze mediche e chirurgiche e di sopravvivenza dell’organo. Risultati L’analisi dei dati ha dimostrato nel gruppo A un tasso di complicanze …

L’INDICE DI RESISTENZA (IR) QUALE FATTORE PROGNOSTICO NELL’OUTCOME DEL TRAPIANTO DI RENE

Introduzione Il valore diagnostico dell’’indice di resistenza renale (IR) nel post trapianto è ormai indiscusso. Nel seguente lavoro ci si propone di correlare i valori medi di indice di resistenza renale a carico dei tratti distali delle arterie interlobulari alla funzionalità renale, quale fattore prognostico nella valutazione della sopravvivenza del graft. Metodi La popolazione sottoposta a studio comprende 100 pazienti trapiantati dal gennaio 2001 al dicembre 2008, durante un follow-up medio di 12 mesi, mediante una valutazione ecodoppler del graft e del tratto distale delle arterie interlobulari.Tali dati sono stati messi a confronto con alcuni parametri di funzionalità renale quali il…

USE OF HARMONIC SCALPEL FOR BRACHIO-BASILIC VEIN TRANSPOSITION IN AUTOGENOUS PROXIMAL ARTERIOVENOUS FISTULA

Objectives: This study evaluates the effectiveness and helpfulness of ultrasonic surgical device for atraumatic surgical dissection and hemostasis in brachio-basilic vein transposition. Since prosthetic grafts have been reached poor results and high costs, the primary use of autogenous AVF is recommended. Materials and Methods: From March 2004 to March 2009 67 cases (61 F ; 6 M; mean age 52 years) of brachio-basilic arteriovenous fistulae (BBAVF) were fashioned; in second stage, after vein maturation (about 30 days), we performed a superficial transposition of arterialized basilic vein by harmonic scalpel (UltracisionTM).. Results : On 67 cases of transposition of BBAVF 2 cases failed after…

Giant incisional hernia in the ederly patient. A Rapid and simple surgical technique

Objectives The aim is to obtain a) a safe procedure to repair the large abdominal defect and reinforce the fragile zones around; b) a simple and rapid technique to reduce the operation time. Materials And Methods Retrospective review of medical records of 72 elderly patients in whom intraperitoneal mesh placement was used between January 1988 and June 2005. Results No intraoperative complication occurred. In the postoperative stage 7 seromas, 4 haematomas, 2 infections occurred, all solved with conservative treatment. Conclusion The incidence of incisional hernia (IH) vary between 1% and 15 %, with increasing risk of recurrence in relation to the age of patients, wound infection, obesity an…

FUNZIONALITA' RENALE E INDICE DI RESISTENZA (IR)

INTRODUZIONE La valutazione dell’indice di resistenza renale (IR) nel post trapianto è stata largamente dibattuta e nonostante mostri valori differenti nei vasi iterlobulari rispetto a quelli interlobari il suo valore diagnostico è ormai indiscusso. Nel seguente lavoro i risultati dei valori medi di IR renale valutati nei tratti distali delle arterie interlobulari sono stati correlati alla funzionalità renale. METODI Da gennaio 2001 a maggio 2007 in 55 pazienti sottoposti a trapianto renale abbiamo eseguito, durante un follow-up medio di 6 mesi, una valutazione ecodoppler del graft e del tratto distale delle arterie interlobulari. Tutti gli esami sono stati condotti dallo stesso esaminatore…

Trattamento chirurgico di un caso di fibroistiocitoma maligno del mesocolon trasverso

INTRODUZIONE: I fibroistiocitomi (MFH) sono dei sarcomi che originano dai tessuti molli, solitamente si localizzano nelle estremità dell’organismo nel tronco e nel retroperitoneo; la localizzazione dei MFH primitivi a livello addominale e/o intestinale è molto rara, infatti non più di 40 casi sono stati descritti a tutt’oggi in letteratura. CASO CLINICO: Paziente donna di anni 80 nella quale è stata osservata una tumefazione localizzata a livello della regione epigastrica e dell’ipocondrio di destra, di consistenza teso elastica, ricoperta da cute integra e associata a sintomatologia dispeptica. Gli esami di laboratorio erano nella norma eccetto l’Emoglobina di 8,2 gr/dl, i Globuli Rossi di…

The use of a tailored mesh with special design for ventral hernia repair. Preliminary report

Introduction: The study describes a modified technique for ventral hernia repair based upon a tension free, fixation free, and dynamic compliant implant. Material and methods: A unique geometrical shaped light weighted, large porous polypropylene mesh was created consisting of a large central body and six radial arms, designed to pass through the tissues and hold the mesh in place without tension. We used the mesh in a small exploratory cohort of patients with ventral hernia. The mesh was placed sublay by taking each of the six straps and passing from below the muscle, through the muscle allowing the fixation free strap to sit with friction within the tissues. This was designed to give a te…

USO DEL BISTURI AD ULTRASUONI IN UN CASO DI DISSEZIONE "DIFFICILE" DEI VASI ILIACI IN CORSO DI TRAPIANTO DI RENE

Introduzione: La preparazione “difficile” dei vasi iliaci nel ricevente causata da uno stato di fibrosi serrata periavventiziale con linfoadenomegalia satellite a volte è gravata da complicanze nel post trapianto ( linfocele, sieroma ed ematoma). Le aderenze tra l’asse vascolare iliaco e soprattutto la linfoadenomegalia sono spesso dovute al cateterismo femorale. Materiali e metodi: Il caso clinico riguarda una paziente di 60 anni, da circa 4 anni in dialisi per insufficienza renale cronica di n.d.d. con fibrosi periavventiziale dell’asse iliaco e linfoadenomegalia satellite da cateterismo femorale bilaterale. In corso di trapianto di rene la preparazione dei vasi iliaci è stata effettuata …

USO DELLA PROTESI INTRAPERITONEALE IN PTFE IN UN GRANDE LAPAROCELE DOPO TRAPIANTO RENALE : CASE REPORT

Introduzione Il caso riguarda il trattamento chirurgico con l’utilizzo di protesi intraperitoneale dual mash PTFE di un laparocele in un paziente di 55 aa sottoposto a precedente trapianto di rene. Tale complicanza derivava da un urinoma per la necrosi massiva dell’uretrere distale del graft; per cui il pz. è stato sottoposto a reintervento in 2 giornata post trapianto con ricostruzione del piano del muscolo aponeurotico. A circa un mese dal trapianto comparsa di tumefazione in sede incisionale, che rapidamente si è evoluta fino a raggiungere le caratteristiche del grande laparocele.Gli esami strumentali evidenziavano la presenza dell’omento e del piccolo intestino nel sacco erniario. Mater…