1,721,563 research outputs found
Surgery or antibiotics for acute appendicitis? Take care about study's design and methodology!
No full textProspective randomized, double-blind, controlled trial comparing Lichtenstein's repair of inguinal hernia with polypropylene mesh versus Surgisis gold soft tissue graft: preliminary results
No full textINTRODUCTION: Although polypropylene mesh are the preferred
prosthesis materials for the tension-free hernioplasties because
they handle well and become quickly integrated, having reduced
the recurrence rate below 1\%, some problems with their use are
still to be addressed (postoperative pain, long-term discomfort,
infections, intestinal obstruction and fistulization). In order
to answer to these disadvantages, a new degradable and
reabsorbable material, the porcine small intestinal submucosa
(SIS mesh gold, Surgisis), has recently been used in humans for
laparoscopic hernia repairs. Aim to our study is to evaluate the
safety and efficacy of the Lichtenstein's hernioplasty using the
Surgisis gold soft tissue graft, as a mesh, and to compare it
with the traditional Lichtenstein procedure performed with
polypropylene mesh. METHODS: A prospective, randomised,
double-blinded comparison of Lichtenstein's repair of inguinal
hernia with polypropylene mesh versus Surgisis ES soft tissue
graft was carried out at the Department of Emergency Surgery of
St Orsola-Malpighi University Hospital with the participation of
4 surgeons who accept to standardise the Lichtenstein's
procedures with the two different types of meshes. RESULTS: From
july 2002 up to now 20 patients submitted to Lichtenstein's
repair of inguinal hernia using Surgisis gold mesh with a 6 month
minimum follow-up were enrolled. 12 subjects were treated with
Surgisis ES mesh, while 8 were treated polypropylene mesh. There
were not intraoperative or postoperatively complications. No
recurrences and wound infections were observed. The
post-hernioplasty acute and chronic pain/discomfort (tested with
visual analogue scale and simple verbal scale) and
parenteral/oral analgesic consumption were lower in Surgisis ES
group. CONCLUSIONS: Lichtenstein's hernioplasty using the
Surgisis gold soft tissue graft has a promising safety and
efficacy
Thoracic complications from retained abdominal gallstones after laparoscopic cholecystectomy: is it always mandatory a thoracic approach?
No full textBACKGROUND: Thoracic complications from retained abdominal
gallstones are quite rare and the incidence rate ranges between
0.08\% and 0.3\%. Diagnosis and treatment of these complications
are challenging due to the uncommon presentations and the
debated role of the thoracic approach. This review of all cases
reported in literature aims to discuss the best practice of this
rare condition. METHODS: A comprehensive literature search was
performed for articles from January 1993 to May 2019 using
PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words
were used: 'cholelithopthysis', 'thoracic', 'gallstones'
'retained', and 'spilled'. All cases of thoracic complications
from retained gallstones after laparoscopic cholecystectomy were
extrapolated. RESULTS: Twenty-four patients were included in
this study. The most common symptoms were fever, hemoptysis and
lithoptysis. Symptoms after laparoscopic cholecystectomy were
presented after a mean time of 9.814.2 months (range from
one week to 60 months). Delayed diagnosis was found in fourteen
patients (58.4.\%). Only four subjects were treated successfully
with antibiotic therapy alone (16.7\%), whereas 20 patients
needed surgery or interventional radiology (83.3\%). Seven
patients (29.2\%) were successfully managed with an abdominal
approach. Three patients were managed using thoracentesis,
thoracoscopic-thoracotomic drainage (12.5\%). Right lung
decortication and pulmonary wedge resections were necessary for
ten patients (41.6\%). CONCLUSION: Clinicians always must
inquire about the previous cholecystectomy for cholelithiasis
related diseases in all patients suffering from recurrent
right-sided pleural/lung affections, to improve diagnostic
delay. The escalated approach must be performed: empirical
antimicrobial therapy followed by targeted therapy as soon as
microbiological data are available; afterwards, abdominal
surgery is effective in approximately 30\% of patients while the
remaining patients have to be submitted to a thoracic approach
Duodeno-Pancreatic and Extrahepatic Biliary Trauma
No full textDuodeno-pancreatic and extra-hepatic biliary trauma are rare traumatic lesions that often occur in the context of major multi-organ lesions and can require multidisciplinary management. Endoscopists, radiologists, and gastronterologists are essential in the early diagnosis and management, in nonoperative management (NOM), and in the treatment of complications. Mortality increase enormously with time in these traumas, and the management should be as early and quick as possible. The American Association for the Surgery of Trauma (AAST) has proposed a grading system for duodenal, pancreatic, and extrahepatic biliary tree injuries indicating degree and description of the lesions. Recently, the World Society of Emergency Surgery (WSES) revised the guidelines and proposed a classification in four classes considering both the AAST classification and the hemodynamic status. Penetrating trauma or hemodynamic instability often require surgical exploration, and in this context control of bleeding is crucial. E-FAST may suggest the presence of a perforation, but, in a hemodynamically stable patient, CT-Scan remains the gold-standard exam to evidence the degree of the lesion. In minor traumas, stable patients, and isolated injuries, NOM may be considered, but, when multiple organs are involved or in severe injuries, surgical management becomes unavoidable
Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review
Full text linkComplications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years
Severe adhesive small bowel obstruction
No full textAdhesive small bowel obstruction is a frequent cause of hospital
admission. Water soluble contrast studies may have diagnostic
and therapeutic value and avoid challenging demanding surgical
operations, but if bowel ischemia is suspected, prompt surgical
intervention is mandatory. A 58-year-old patient was operated
for extensive adhesive small bowel obstruction after having had
two previous laparotomies for colorectal surgery, and had a
complex clinical course with multiple operations and several
complications. Different strategies of management have been
adopted, including non-operative management with the use of
hyperosmolar water soluble contrast medium, multiple surgical
procedures, total parenteral nutrition (TPN) support, and
finally use of antiadherences icodextrin solution. After 2 years
follow-up the patient was doing well without presenting
recurrent episodes of adhesive small bowel obstruction. For
patients admitted several times for adhesive small bowel
obstruction, the relative risk of recurring obstruction
increases in relation to the number of prior episodes. Several
strategies for non-operative conservative management of adhesive
small bowel obstruction have already addressed diagnostic and
therapeutic value of hyperosmolar water soluble contrast.
According to the most recent evidence-based guidelines, open
surgery is the preferred method for surgical treatment of
strangulating adhesive small bowel obstruction as well as after
failed conservative management. Research interest and clinical
evidence are increasing in adhesions prevention. Hyaluronic
acid-carboxycellulose membrane and icodextrin may reduce
incidence of adhesions
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