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La proctocolectomia totale restaurativa nel trattamento chirurgico della rettocolite ulcerosa
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Immune system changes after laparoscopic and open cholecystectomy. A prospective and comparative study
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La chirurgia conservativa della malattia di Crohn: risultati a lungo termine
No full textINTRODUCTION: Patients with Crohn's disease (CD) receive one or more surgical interventions throughout their clinical history. Conservative surgery has recently been proposed as a safe and effective option for the treatment of complicated CD and for the prevention of short bowel syndrome and stoma. PATIENTS AND METHODS: One hundred nineteen patients affected by CD were treated with stricture plasty and mini-resection in our Department between January 1993 and January 1998. At admission, the prior complete clinical and surgical history of each patient was collected and then inserted in a prospectively maintained data base. Analysis of recurrence was made using the Kaplan-Meier function and the influence of certain variables on the risk of recurrence was analyzed using a Cox proportional hazard model. RESULTS: Perioperative mortality was nil, postoperative complications occurred in 8 patients (6.7%). Overall long term surgical recurrence at 5 years was 28%, 35% in patients operated on within one year and 15% in those treated after one year from the diagnosis (p < .05). CONCLUSIONS: Stricture plasty and minimal resections show lower perioperative mortality and postoperative complications similar to resective surgery. From risk factor analysis, a group of patients with high risk of surgical recurrence emerged. In this group and whenever technically possible, we consider stricture plasty and minimal resection the gold standard in the treatment of complicated CD
Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn's disease. A prospective study
No full textObjective: To evaluate in patients with Crohn's disease, using transabdominal ultrasound, the morphologic characteristics of the diseased bowel wall before and after conservative surgery and to assess whether these characteristics and their behavior in the postoperative follow-up are useful and reliable prognostic factors of clinical and surgical recurrence. Summary Background Data: Ultrasound is effective for evaluating the thickness of bowel wall, the most typical and constant finding of Crohn's disease. No data are currently available concerning the behavior of the diseased intestinal wall after conservative surgery and whether the preoperative characteristics of bowel wall or its behavior after conservative surgery may predict recurrence. Methods: In 85 consecutive patients treated with strictureplasty and miniresections for Crohn's disease, clinical and ultrasonographic evaluations were performed before and 6 months after surgery. Assessed before surgery were the maximum bowel wall thickness, the length of bowel wall thickening, the bowel wall echo pattern (homogeneous, stratified, and mixed), and the postoperative bowel wall behavior, classified as normalized, improved, unchanged, or worsened. Results: A significant correlation was found between a long preoperative bowel wall thickening and surgical recurrence. Bowel wall thickness after surgery was unchanged or worsened in 43.3% of patients; in these patients, there was a high frequency of previous surgery. Patients with unchanged or worsened bowel wall thickness had a higher risk of clinical and surgical recurrence compared with those with normalized or improved bowel wall thickness. Conclusion: With the use of abdominal ultrasound, the authors found that the thickening of diseased bowel wall may unexpectedly improve after conservative surgery, and this is associated with a favorable outcome in terms of clinical and surgical recurrence. In addition to its diagnostic usefulness, ultrasound also provides reliable prognostic information concerning clinical and surgical recurrence in patients with Crohn's disease in the postoperative follow-up
LA COLANGIODIGIUNOSTOMIA SUL DOTTO DEL TERZO SEGMENTO EPATICO SECONDO SOUPAULT E COUINAUD NEL TRATTAMENTO DELLE STENOSI NEOPLASTICHE NON RESECABILI DEL CONFLUENTE BILIARE
No full textPalliative management choice of neoplastic stenosis. at biliary carrefour is based more on evaluation of the patient's general condition than simple considerations about morbidity and mortality associated with the different technique used. The decision between a surgical or not surgical procedure should be guided to obtain best palliation in terms of quality of life. A series of nine patients affected by non resectable hilar cancer, still in good general condition, underwent operation to achieve a valid biliry drain through a biliary-jejunostomy on third intrahepatic duct segment. Our results are not only comparable to other surgical series reported in literature but also to data of non surgical ones and respect of the latter we obtained nevertheless a best comfort index. So, we consider biliodigestive anastomosis according to Couinaud and Soupault as palliative procedure of choice for non resectable cancer of biliary carrefour
Pancreasectomia totale vs pancreasectomia parziale nel trattamento chirurgico del carcinoma della testa del pancreas
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