1,721,074 research outputs found
Endoscopic treatment of band erosion
No full textBackground. Band erosion is a major late complication of gastric banding, always requiring band removal; its frequency ranges from 0,5 to 3,8%. Different methods, laparotomic, laparoscopic or endoscopic, are currently used to remove the band.
Methods. 741 morbid obese patients underwent laparoscopic adjustable gastric banding in our Department since 1998. We observed 13 band erosions, 4 in our patients, and 9 in patients who were referred to our Center from other hospitals. In 2 patients we had to remove the band surgically, in one case for port-site infection associated with subphrenic abscess, in the other case for gallstone-related acute pancreatitis, associated with complete band migration in jejunum. In the other 11 patients we used an endoscopic approach with the Gastric Band Cutter, a device designed to cut the band (A.M.I. Agency for Medical Innovation GmbH, Götzis, Austria).
Results. We could remove the migrated band endoscopically in all cases except two: in one case a twisting of the cutting wire in the area of cardia required conversion to laparoscopy, in the other the band was successfully cut but was blocked in the stomach, and was then removed in laparotomy.
Conclusions. In nearly all cases the Gastric Band Cutter proved successful in cutting the band, even if not all bands could be removed endoscopically. In our experience this method seems to be the first choice for the treatment of band erosion. It is advisable to do it in the operating room for the possible complications of the procedure
Gastric Plication : una nuova procedura chirurgica
No full textBackground. La plicatura gastrica è un nuovo intervento bariatrico, i cui principali vantaggi sono:
• Via laparoscopica
• Non richiede resezioni/anastomosi gastriche
• Completamente reversibile
• Modificabile in caso di eccessiva riduzione del volume gastrico
• Effettuabile anche dopo altri interventi bariatrici (LAGB, Bypass biliointestinale...) per aumentarne l’ efficacia
• Effettuabile anche dopo interventi che impediscono il posizionamento di un bendaggio gastrico (fundoplicatio per MRGE)
Pazienti e metodi. Sono stati sottoposti a plicatura gastrica15 pazienti, di cui 12 già sottoposto ad altri interventi bariatrici e 3 in elezione. Sesso: F, età media 38 anni, BMI medio: 41 ± 5 Kg/m2.
Risultati. La %EWL a 1 mese è stata di 19 ± 17, a 3 mesi 23 ± 19, a 6 mesi 29 ± 27. Due complicanze postoperatorie: 1 reintervento per piccola lesione della parete anteriore dello stomaco, lontano dalla plicatura, risolto con sutura laparoscopica in 1° giornata. 1 reintervento per calibro troppo ridotto della plicatura, risolto con rimozione di 2 punti dalla regione antrale.
Conclusioni. Una percentuale del 15-20% dei pazienti portatori di bendaggio gastrico ha un calo ponderale insufficiente, e nel follow-up a lungo termine del bendaggio gastrico è riportato il 5-32% di revisioni chirurgiche (deconnessione del port, band slippage...). In questi casi nella nostra esperienza l’ associazione della plicatura gastrica al bendaggio si è dimostrata fattibile e sicura, con ripresa del calo ponderale e delle motivazioni del paziente
Dopo l’ immediato periodo postoperatorio, assenza di sintomatologia persistente riferibile a reflusso o a disfagia, e di complicanze maggiori. E’ necessario un follow-up più lungo per poter valutare i risultati a distanz
Virtual surgical education : experience with medicine and surgery students
No full textThe use of virtual reality simulation is currently being proposed within programs of postgraduate surgical education. The simple tasks that make up an operative procedure can be repeatedly performed until satisfactory execution is achieved, and the errors can be corrected by means of objective assessment. The aim of this study was to evaluate the applicability and the results of structured practice with the LapSim laparoscopic simulator used by undergraduate medical students. A significant reduction in operative time and errors was noted in several tasks (navigation, clipping, etc.). Although the transfer of technical skills to the operating room environment remains to be demonstrated, our research shows that this type of teaching is applicable to undergraduate medical students and in future may become a useful tool for selecting individuals for surgical residency programs
Didattica chirurgica virtuale: esperienza nell'ambito del corso di laurea in medicina e chirurgia
No full text
Impact of routine videothoracoscopy as the first step of the planned resectiona for lung cancer. Experience of 1306 cases
Full text linkWe have analyzed our experience of 1306 patients with NSCLC, submitted from November 1991 to December 2007 to routine videothoracoscopy exploration, as the first step of the planned procedure, in order to evaluate its validity in obtaining precise assessment of tumor extension, verifying thoracoscopic resectability and in decreasing the rate of unnecessary thoracotomies.
Thoracoscopy revealed inoperability in 58 patients (4.4%) mostly due to pleural dissemination (2.4%) or mediastinal infiltration (1.7%). Of the remaining 1248 (95.6%), 449 (34.4%) had thoracoscopic resection (230 lobectomies, 6 pneumonectomies, 230 wedge resections), 767 (58.7%) underwent open resection (592 lobectomies, 175 pneumonectomies), and 32 (2.4%) had an exploratory thoracotomy (ET). Among the 32 ETs, thoracoscopy had suspected unresectability in 7 (0.5%), had been incompletely carried out in 4 early cases (0.3%) and had been unfeasible in 21 (1.6%). In our previous series from 1980 to 1991 the E.T. rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy, the E.T. rate is 2.4% and the global rate of patients correctly staged, by thoracoscopy is 73.3%, significantly better than by CT. Video exploration resulted highly reliable in excluding conditions of unresectability with a negative predictive value (NPV) of 0.97.
We conclude that preliminary thoracoscopy is useful in obtaining correct staging, reliably evaluates resectability of the lesion and helps in decreasing unnecessary thoracotomies
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