1,720,988 research outputs found
Technology spreading in healthcare: a novel era in medicine and surgery?
Full text linkSurgery and technological innovation have begun to move at the speed of light, with innovations and discoveries such as virtual reality, robotic systems, navigation surgery, and 5G networks radically revolutionizing the surgical world as well as the medical world in general, bringing significant benefits for healthcare professionals and patients alike. Technology will increasingly be a crucial element in surgical and medical development. This new therapeutic approach aims to enhance human–computer interaction by putting a new “patient” figure at its center. Multiple studies will be needed to demonstrate new advanced technological systems’ noninferiority to traditional patient approaches. Scientific societies, hospitals, and healthcare professionals cannot be found ill prepared for this revolution
Colouterine fistula treatment: when the patient chooses the steeplechase
Full text linkColouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition
Endoscopic management of multiple large antral hyperplastic polyps causing gastric outlet obstruction
Full text linkGastric hyperplastic polyps are often asymptomatic and are found incidentally at upper endoscopy performed for unrelated reasons. Although they are considered a benign lesion, all symptomatic polyps should be removed for a more reliable histological diagnosis, resolution of symptoms and to prevent potential malignant transformation. In fact, there are no significant difference between pure gastric hyperplastic polyps and gastric hyperplastic polyps with neoplastic transformation in the number, location, or gross appearance of polyps. If symptomatic, patients usually complain of dyspepsia, heartburn, abdominal pain or upper gastrointestinal bleeding leading to anaemia. Complete or incomplete gastric outlet obstruction with intermittent symptoms, may rarely be caused by gastric hyperplastic polyps. We described the management of a rare case of intermittent gastric outlet obstruction caused by a large hyperplastic antral polyp prolapsing through the pylorus. Using hydroxypropylmethylcellulose, a new lifting agent, firstly from pyloric side, we obtained a reliable long-lasting submucosal cushion under the lesion which allowed a stable repositioning of the polyp in the gastric lumen without making additional infiltration during the endoscopic mucosal resection. Innovative lifting agents could significantly reduce the procedure time, but additional studies should be performed on this area to confirm preliminary results. Endoscopic mucosal resection not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves symptomatic treatment
External hemorrhoidal thrombosis in the elderly patients. Conservative and surgical management
Full text linkBACKGROUND: External hemorrhoidal thrombosis is a common disease with an acute anal pain as the major symptom. It is astonishing the lack of studies which investigates the most effective treatment and there are not guidelines. Furthermore nobody has evaluated this peculiar condition in elderly people. METHODS: We have considered 87 patients aged >75 years who were visited and treated for this condition in our clinic, dividing them in three groups according the curative option chosen together with them after anamnesis and an interview: a conservative medical treatment (Group A), an immediate incision and evacuation of the thrombus (Group B) and the excision of hemorrhoid with the thrombus, with hemorrhoidectomy technique (Group C). The mean follow-up was 12,3 months. We analyzed immediate pain relief and time of remission of symptoms, bleeding, recurrences and major complications. RESULTS: The Group A presented a remission of symptoms in 11,8 days, Group B in 1,58 ad Group C in 7,8 days. The recurrence rate was very similar for the first two options (19,4% and 16,1 %) and lower in the excision group (no recurrence during follow-up). Bleeding is the common adverse event observed with a high frequency in the immediate incision and evacuation of thrombus, less common in hemorrhoidectomy, that did not present major complication. Surgical option is often refused by elderly patient evaluating comorbidities in the fear of adverse events. CONCLUSIONS: The surgical treatment for EHT in elderly is safe and effective, but not the most common choice for fear of complications. Medical treatment or immediate incision of thrombus can be preferred and well accepted by elderly even if followed by a higher rate of recurrences
Indocyanine Green Tattooing During Colonoscopy as a Guide to Laparoscopic Colorectal Cancer Surgery: A Literature Review
No full textBackground: Endoscopic tattooing of colorectal lesions has been performed employing several markers. The indocyanine green (ICG) that uses near infrared fluorescence technology, has been recently adopted in laparoscopic colorectal cancer surgery. This study aims to systematically review the international literature to validate the ICG in laparoscopic colorectal surgery, in order to include the ICG in the therapeutic protocol. Methods: Following AMSTAR 2 criteria, we performed a systematic review to evaluate the use of green indocyanine as a marker for preoperative endoscopic tattooing and for lymph nodes mapping. The study selection was conducted using the PubMed database from January 1989 to July 2022. Results: We identified 25 eligible studies. 13 based on fluorescent tumor localization in laparoscopic colorectal surgery using ICG while 12 of them reported the lymphatic road mapping and sentinel node identification by ICG using a near-infrared camera system. One study analyzed both topics. Conclusions: In laparoscopic colorectal cancer surgery indocyanine green can be used to localize fluorescent tumors and mapping fluorescence lymph node. The use of ICG appears to be a valid and safe technique that helps the surgeon to achieve a better oncological radicality. However, the protocols need to be clarified by further studies
1L Peg Bowel Preparation before Colonoscopy for Selected High-Risk Inpatients in a Pilot Study
No full textAIM - Adequate colonic examination is strictly associated with optimal
bowel preparation. Split-dose polyethylene glycol (PEG) based bowel preparation is considered the gold standard in
order to obtain an optimal mucosal visualization during colonoscopy. Inpatients are high-risk patient for poor bowel
cleansing and often need a quickly diagnosis. The rate of inadequate inpatient bowel preparation is high and
associated with a significant increase in hospital length of stay and costs. The timing of colonoscopy is essential to
obtain a correct diagnosis in the shortest time and to reduce the length of hospital stay. The aim of our pilot study was
to test the efficacy and tolerability of a new same-day low dose, 1 liter, PEG based bowel preparation in hospitalized
patients.
METHODS - A single-center prospective pilot study was conducted including all hospitalized patients scheduled to
colonoscopy from August 2015 and August 2016 with a consisting suspect of colic stenosis or unable to drink a
standard large volume of PEG due their clinical condition. All included patients were divided in two groups receiving:
1L PEG-based on the same day or 4L PEG split dose, performing colonoscopy within 4 hours after the last dose.
Patient demographics, medical history and Bristol Stool Scale type were acquired (Tab. 1). Endoscopic data as caecal
intubation, withdrawal time, adenoma detection rate and quality of colonic preparation, assessed by the Boston bowel
preparation scale (BBPS), were also recorded (Tab. 2).
RESULTS - 44 inpatients (male= 27; mean age 63.5 years; age range=20-94 ) were enrolled between August 2015
and August 2016. 22 patients received 1L PEG-based (Group A) and the others 22 received 4L PEG-based split dose
preparation (Group B). The bowel preparation was adequate in fourteen patients of the Group A and in twelve patients
of the Group B (Fig. 1). An optimal bowel cleansing was reached in 82% (Group A) and 71% (Group B) of patients.
The mean exploration time was 24 and 22 min respectively (caecal intubation rate=77% for both groups). The ADR
was 32% (Group A) and 18% (Group B) and ADK rate was 27% and 14% respectively.
CONCLUSION - Our data support that this schedule protocol allows a correct diagnosis in most of patients and show
the greater weight of the interval time between the end of the bowel preparation and the beginning of colonoscopy
compared to the volume of PEG administered. In our study there are no statistical differences between the two groups
in terms of diagnostic rate and successful bowel cleansing achieved. Therefore the same-day low dose 1L PEG-based
bowel preparation could be introduced in selected inpatient in order to improve tolerability and to reduce the waiting
time in hospitalized high-risk patients. The promising results obtained with our bowel preparation protocol require
more randomized trials
Intraoperative enteroscopy by standard colonoscope with a minimal contamination technique.
No full textTransperineal excision of malignant peripheral nerve sheath tumors of the ischiorectal fossa: Case report of a rare tumor in a frequently forgotten anatomical region
Full text linkIntroduction and importance: Malignant peripheral nerve sheath tumor is an aggressive tumor that arises from peripheral nerves. Frequently associated with neurofibromatosis, its common localization is in the extremities, trunk (with paravertebral regions), neck and head. Some cases have been found in the pelvis or uterus. In this case report we illustrate one of the rarest localization of this type of tumor in the ischiorectal fossa, with the full recovery of the patient after surgical excision and radiotherapy. Case presentation: A 61-year-old woman showed a lump near the anus which was initially diagnosed as a lipoma of the right ischiorectal fossa, by Computed Tomography scan. The tumor was completely removed with a minimal skin incision, and the patient had a complete recovery. Only the pathological examination determined the diagnosis of malignant peripheral nerve sheath tumor, in this unusual localization. In consideration of its high aggressiveness the patient underwent radiotherapy. After more than two years of follow-up there is no sign of recurrence. Discussion: In sites far from branches of nerves, malignant peripheral nerve sheath tumors can be considered episodic. Ischiorectal fossa is a rare localization, and the differential diagnosis from benign mesenchymal cell tumors can be challenging. When possible, a biopsy should be performed before surgery. Conclusion: Surgical excision of tumors in ischiorectal fossa should be always complete, in consideration of possible histological surprise
Stapled hemorrhoidopexy: “mucosectomy or not only mucosectomy, this is the problem”
Full text linkIntroduction: Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy. The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications.
Materials and Methods: We histopathologically analyzed surgical samples from patients who underwent stapled hemorrhoidopexy performed between 2014 and 2019. Patients were divided into three groups, according to the stapler used: Group A (single PPH®), Group B (double PPH®), and Group C (CPH34 HVTM). We evaluated the actual wall layers included in the stapled rectal ring. For every specimen, we reconstructed the history of the corresponding patient and the incidence of complications.
Results: Of the 137 histological slides available, 13 were only mucosectomies (9.5%), and 124 presented also the submucosa and muscularis propria (90.5%)−50/58 patients in Group A, 28/28 in Group B, and 46/51 in Group C. No statistically significant difference in the rate of complications was found when stratifying patients according to the thickness of the resection [mucosectomy (M) or “full thickness” (FT)].
Discussion: Stapled hemorrhoidopexy is not a simple mucosectomy but a resection of the rectal wall with almost all its layers. This concept defines the entity of the surgical procedure and excludes a direct correlation with an increased rate of complications
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