2,692 research outputs found
Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade
No full textGastroepiploic arterial aneurysms (GEAA) represent a very rare disorder [1, 2]. The risk of GEAA rupture is high, and it is associated with a high mortality rate [3]. GEAAs are usually identified following rupture or are incidentally diagnosed. In emergency, an open surgical approach to treat GEAAs has been most frequently reported [4]. Alternatively, if the patient is hemodynamically stable, an angiography and embolization can be attempted. Herein we report the case of a patient presenting with two fissurated GEAAs that were successfully excised laparoscopically after failure of the endovascular approach
LAPAROSCOPIC MANAGEMENT OF VENTRAL HERNIA IN ACUTE PRESENTATION
No full textAlthough laparoscopic repair of incisional hernia is a well established practice, little is known about the role of laparoscopy when incisional hernia is complicated by acute bowel obstruction. Based on literature, no evidence for this topic can be drawn. However data from a few case series suggest that this approach does not seem to be associated with increased complication and recurrence rates compared to the same procedure performed electively. Facing emergency hernia repair, the use of minimally invasive surgery is strongly influenced by surgeon’s laparoscopic skill to carefully perform adhesiolysis, to safety reduce the herniated bowel into the peritoneal cavity, and to repair the wall defect in the presence of distended bowel loops. Main critical factors in decision-making process for a laparoscopic approach are: degree of bowel obstruction, intestinal viability, size and location of hernia defect and defect/hernia sac ratio. Keeping an uncontaminated abdomen is the key for a laparoscopic mesh repair and a successful outcome. Herein we present our experience about the laparoscopic management of incarcerated ventral hernia by highlighting tips and tricks to safety and effectively perform this top-challenging approach
Acute appendicitis complicating De Garengeot's hernia treated with combined laparoscopic-open technique: a case series and literature review
No full textAn acute appendicitis in the context of a De Garengeot's hernia is a very rare event and represents a hard challenge for surgeons. As only few cases have been reported in literature, there is no consensus about its optimal surgical strategy of treatment. Here we present two consecutive cases of female patients presenting an uncommon acute appendicitis in a femoral hernia treated with a combined laparoscopic/open technique
An unusual case of repeated splenectomy: traumatic rupture of an accessory spleen in a previously splenectomized patient
No full textThe traumatic rupture of an accessory spleen is a very rare condition and only few cases have been reported in the literature. We describe the case of a 51-year-old man undergone splenectomy for trauma several years before, who developed hemoperitoneum due to a laceration of a voluminous accessory spleen, following an accidental two-meter fall. As a conservative management of the injury was not possible, an accessory splenectomy was then required. Thus, a briefly review of the literature about this uncommon topic was perfomed
Laparoscopic armamentarium for common bile duct stones clearance: tricks and tips
No full textThe laparoscopic common bile duct exploration with cholecystectomy (LCBDE + LC) has been shown to be safe and effective for the treatment of choledocolithiasis. However, the use of LCBDE + LC is in decline, as almost replaced by the endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy. Should this trend continue, the laparoscopic approach to choledocholithiasis is at risk of disappearing from the armamentarium of the general surgeons. The aim of this video presentation is to explain the different types of LCBD exploration (transcystic vs transcholedochotomy), when to use them and how to perform them safely and efficiently. Furthermore, the authors explain the intraoperative situations in which a biliary tutor should be placed and how they can be properly managed
NEGATIVE PRESSURE WOUND THERAPY NELL’ OPEN ABDOMEN PER CAUSE NON-SETTICHE: UNO STUDIO RETROSPETTIVO SU 75 PAZIENTI
No full textObiettivi: L’open abdomen (OA) rappresenta una valida opzione
chirurgica nel trattamento di un ampio spettro di condizioni settiche
e non settiche. In letteratura, emerge che il tasso di successo della
procedura di Temporary Abdominal Closure (TAC) nei pazienti non
settici, dipende dal tipo di metodica adottata. Lo scopo di questo
studio è valutare se i sistemi di chiusura della ferita a pressione
negativa (NPWT) inuenzano l’outcome dei pazienti trattati con OA
per cause non settiche.
Materiali e metodi: Abbiamo analizzato in maniera retrospettiva
75 pazienti trattati con OA per cause non settiche (Abdominal
Compartment Syndrome, trauma ed ischemia intestinale) tra il
2001 e il 2015. In 40 pazienti (53%) la TAC è stata eseguita con
sistema NPWT (Gruppo A); in 35 (47%) con sistemi non a pressione
negativa (Gruppo B). Abbiamo analizzato e comparato i seguenti
parametri: durata media della TAC, tasso di chiusura de!nitiva
della laparostomia e mortalità. Il t-test di Student e il test corretto
di Fisher sono stati utilizzati per l’analisi statistica. Il valore di p <
0.05 è stato considerato signi!cativo.
Risultati: In totale, la durata media della TAC è di 2,46 giorni, il
tasso di chiusura de!nitivo 75% e la mortalità pari al 44%. Tra il
gruppo A e il Gruppo B, la durata media dell’OA è risultata 2.42 vs
4.82 giorni (p = 0,09), il tasso di chiusura de!nitivo 85% vs 65% (p
= 0.06) e la mortalità 40% vs 48.6% (p=0.49).
Conclusioni: Questo studio, seppur limitato dal confronto tra
differenti “periodi storici”, dimostra la superiorità, anche se non
signi!cativa, della TAC NPWT rispetto a quella non-NPWT in
termini di durata media dell’OA, del tasso di chiusura de!nitivo e
della mortalità nei pazienti sottoposti a OA per cause non settiche.
È verosimile che un ampliamento del campione analizzato possa
fornire una conferma signi!cativa ai dati riportati
THE ROLE OF THE EARLY GASTROGRAFIN TEST IN A DECISION-MAKING ALGORITHM FOR THE MANAGEMENT OF PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION (ASBO)
No full textIntroduction: The Gastrografin Test (GT) is a very useful tool for the management of ASBO without signs of peritonitis which facilitates the recognition of patients who will benefit from a surgical operation 1,2. The aim of this study is to analyze the results of GT protocol use and to identify failure predictive factors. Material and methods: During 2015-2016, 90 patients with overall 92 ASBO episodes were managed in our Unit using a decision-making algorithm. In 80 cases (87%), a conservative treatment with GT was adopted. We prospectively analyze patients’demographic data and diagnostic CT work-up (wall thickening [ 5 mm, mean small bowel maximum caliber, fluid collection and parietal pneumatosis). Results: 31 ASBO episodes (39%) were successfully managed with a conservative treatment with Gastrographin (group 1, G1). The remaining 49 episodes (61%) required a surgical exploration (group 2, G2). The incidence of intestinal wall thickening [ 5 mm was significantly higher in G1 (49% vs 19,4%, p = 0,015). The same was identified for the mean small bowel maximum caliber (4,35 cm vs 3,7 cm, p = 0,002). The latter parameter (p = 0,011; OR 2,6; IC 95%) and the wall thickening (p = 0,026; OR: 3,88; IC 95%) can be considered as predictive factors of GT failure Conclusion: GT is a safe and effective tool in the management of ASBO not requiring emergency surgery. It may be helpful in establishing whether or not to perform surgery. The mean small bowel maximum caliber and the intestinal wall thickening can be considered as predictive factors for GT failure. References: 1. Di Saverio S et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013; 8 (1): 42-51. 2. Azagury D et al. Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making and management J Trauma Acute Care Surg 2015; 79 (4): 661-668.
Disclosure: No significant relationships
Biological prosthesis, platelet enriched plasma and bone marrow stem cells in complicated incisional hernia reconstruction in emergency surgery: a prospective case control study
No full textNumerous innovations have been aided by abdominal wall sur-gical repair. Abdominal wall surgery was drastically altered by synthetic materials. Tissue engineering was unquestionably first applied to biomaterials. The purpose of the present study is to com-pare different repeating approaches with rising tissue engineering complexity in repairing complex incisional hernia in emergency setting. Patients with complicated incisional hernia were prospec-tively included in the study and divided into 4 groups: DR (Direct Repair) group underwent direct reconstruction of the abdominal wall, BR (Biological mesh Repair) group underwent reconstruc-tion of the abdominal wall with biological mesh (retro-muscular), BPR [Biological mesh and Platelet Enriched Plasma (PEP), gel] group underwent reconstruction of the abdominal wall with Biological mesh (retro-muscular) and PEP, BPSR (biological mesh, PEP gel and Bone Marrow Stem Cells) group underwent reconstruction of the abdominal wall with biological mesh (retro-muscular), PEP and Bone Marrow Stem cells (BMSc). Forty patients were enrolled. Patients in the DR group experienced a higher rate of severe complication (p<0.05). Recurrence rates were 60% for DR patients, 20% for BM patients and 10% for the BM+PEP group (p<0.05). Median follow-up period was 64.6, 55.7 and 55.8 months (p<0.05). 7-and 30-days abdominal wall thick-ness is progressively increased by different techniques: BP, BP+PEP and BP+PEP+BMSc (p<0.05). No mortality was regis-tered. Tissue engineering techniques in abdominal wall reconstruc-tion showed promising results. They seem to reduce the recurrence rate without increasing complication one in complicated incisional abdominal wall hernia. Although many aspects are yet to be deter-mined and standardized, it seems extremely important to continue research and experimentation in this field
LAPAROSCOPIA PER DIVERTICOLITE HINCHEY II “NON RESPONDER”: SIGMOIDECTOMIA O LAVAGGIO PERITONEALE?
No full textObiettivi: In letteratura, non esiste un chiaro consenso riguardo al ruolo del lavaggio e drenaggio laparoscopico (LDL) rispetto alla sigmoidectomia laparoscopica (SL) nelle diverticoliti acute complicate di grado II Hinchey “non responder” al trattamento conservativo in quanto non drenabili per via percutanea nè controllabili con sola terapia antibiotica. Lo scopo di questo studio è confrontare i pazienti sottoposti a queste due procedure chirurgiche ed analizzare i risultati postoperatori.
Materiali e metodi: Abbiamo considerato nel periodo 2013-2016, 9 pazienti (Gruppo A) sottoposti a SL e 7 pazienti (Gruppo B) a LDL per diverticolite acuta di grado Hinchey II “non responder”.I seguenti parametri sono stati analizzati e comparati: età media, BMI, Mannheim Peritonitis Index (MPI), ASA Score, tempo medio operatorio, durata media della degenza post-operatoria, morbilità, tasso di re-intervento e mortalità. Il t-test di Student e il test corretto di Fisher sono stati utilizzati per l’analisi statistica. Il p <0,05 è stato considerato signi"cativo.
Risultati: Il gruppo A e il gruppo B non sono risultati significativamente differenti per età media (62 vs 60 anni; p =
0.80), BMI (25,82 vs 28,86 kg/m2; p = 0.31), MPI (9,66 vs 14,00; p = 0.26) ed ASA score (2,37 vs 2; p = 0.60). Anche il tasso di complicanze (11% vs 57%; p = 0.10), il tasso di re-intervento (0 vs 28%; p = 0,18) e la durata media della degenza post-operatoria (8 vs 13 gg, p = 0.09) non sono risultati signi"cativamente dissimili tra i due gruppi. In effetti, 2 pazienti inizialmente sottoposti a LDL hanno successivamente necessitato di SL per insuf"ciente
controllo dell’infezione. Il tempo operatorio medio è risultato signi"cativamente più lungo nel gruppo A (195 min vs 64 min; p < 0.05). Nessun decesso è stato identi"cato nei due gruppi.
Conclusioni: Sebbene retrospettivo e con una popolazione limitata, questo studio dimostra che l’ LDL può avere un ruolo nel trattamento delle diverticoliti acute di grado II Hinchey “non responder”. Questa procedura, in casi selezionati, può rappresentare un opzione ef"cace e sicura nel trattamento dell’infezione addominale diverticolare. L’eventuale insuccesso del LDL non pregiudica la possibilità di ricorrere successivamente ad
un intervento resettivo
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