1,721,100 research outputs found
Duodenal perforation in course of endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy. Therapeutic considerations
No full textCommon bile duct lithiasis: therapeutic approach.
No full textINTRODUCTION: Treatment of cholecysto-choledocholithiasis has been revisited from the standpoint of either endoscopic or laparoscopic mini invasive approach. A standard diagnostic-therapeutic procedure has not been unanimously defined. PATIENTS AND METHODS: Since 1997 to 2011 we have treated 924 patients: 555 gallbladder lithiasis, 276 acute biliary pancreatitis and 93 choledocholithiasis (without pancreatitis). We have compared, by the review of the literature, our results of two stage endoscopic stones removal followed by laparoscopic cholecystectomy versus one stage laparo-endoscopic rendez vous technique/VLC and laparoscopic approach alone. RESULTS: In our experience endoscopic removal of stones have been performed in 82 patients (88.17%); 11 patients (11.82%),not elegible for endoscopic approach, have been submitted to laparotomic therapy. In sum preoperative ERCP/ES with CBD cleaning followed by VLC, not with standing the valid results of laparoscopic approach alone remains the strategy more frequently applied in clinical practice, because the good results. CONCLUSIONS: The results of the treatment of CBD lithiasis of sequential laparo-endoscopic approach (two or one stage) and of laparoscopic approach alone are roughly overlappable. Therefore the first has remained the treatment of reference and comparison in all the clinical evaluation of different procedure
Minimally invasive treatment of acute intrahepatic fluid collections with acute biliary pancreatitis.
No full textBACKGROUND: Peripancreatic fluid collection suggests the anatomical-clinical scenario of necrotizing acute pancreatitis. However, intrahepatic fluid collection is a rare occurrence with fewer than 30 cases being reported in the medical literature. We describe 2 cases of intrahepatic fluid collection in 2 patients with acute biliary pancreatitis and discuss the therapeutic possibilities.
CASE REPORTS:
The first case report is that of a 68-year-old female with a diagnosis of acute biliary pancreatitis with several necrotizing fluid collections and a large infected intrahepatic collection in the left lobe. The patient was successfully treated by percutaneous US/CT guided drainage. The second case report is that of a 72-year-old female with a diagnosis of acute biliary pancreatitis with several peripancreatic fluid collections and a voluminous intrahepatic fluid collection in the left lobe that caused epigastric pain. This patient was also successfully treated with percutaneous US/CT guided drainage.
CONCLUSION:
Intrahepatic fluid collection in the course of acute biliary pancreatitis is a rare occurrence. The therapeutic approach is the same as that for pancreatic and peripancreatic fluid collections. In case of infection, the patient undergoes percutaneous US/CT guided drainage. This therapeutic procedure can be added to the therapeutic program for necrotizing acute biliary pancreatitis together with ERCP/ES and videolaparocholecystectomy (VLC)
Are there differences between the right and left laparoscopic adrenalectomy? Our experience
No full textAIM:
The purpose of this study was to determine if there are different outcomes between the right and left laparoscopic adrenalectomy according to our experience.
MATERIAL OF STUDY:
From September 2010 to September 2015 forty-two LA were performed. Variables compared include age, body mass index (BMI), ASA score, operative time, estimated blood loss, conversions, gland size, tumor size, postoperative ambulation, postoperative hospitalization, perioperative and postoperative complications.
RESULTS:
Substantially there are no difference in postoperative results between right and left LA.
DISCUSSION:
We report difference in the operative time because left procedure is more complex. The difference in the blood loss due to two intraoperative bleeding in right side, can be considered a given accidental.
CONCLUSIONS:
It's important an adequate learning curve to improve intraoperative and therefore postoperative Outcomes
Laparoscopic adrenalectomy: transperitoneal lateral approach. Cases study.
No full textAIM OF THE STUDY:
To compare the results of the laparoscopic adrenalectomy achieved with the traditional laparotomic one.
MATERIAL AND METHOD:
In the period 1997-September 2004 we treated 17 patients with adrenal pathology: eight patients underwent to an open anterior transperitoneal adrenalectomy and nine patients underwent a laparoscopic adrenalectomy with lateral transperitoneal approach.
RESULTS:
Among the immediate results a longer operative time was evident in the laparoscopic approach and a greater blood loss in the open approach; there were no conversions to a laparotomic procedure. In the postoperative period there were some bronchopneumonic infiltrates and some infections of the laparotomy in the open group; in the laparoscopic group there was a parietal haematomas that cleared up spontaneously, in correspondence of a trocar access.
DISCUSSION:
Both procedures allow to achieve the complete resolution of the adrenal pathology if it is confined within the gland and no more than 8 cm. in size. The morbidity in the mininvasive approach is surely much lower than the open technique. The advantages of a laparoscopic approach can be found in a minor surgical stress. The evident datum that results from the literature analysis of the results of the the laparoscopic adrenalectomies, is the very rapid resumption of the normal activities in the postoperative course.
CONCLUSIONS:
The laparoscopic adrenalectomy with lateral transperitoneal approach is a safe and efficacious procedure. Therefore, the AA can believe that the laparoscopic approach is at present the gold standard in the treatment of all benign adrenal pathologies with a no more than 8 cm. size
Clinical considerations on malignant carcinoids: bronchial, gastric, ileocolic involvement
No full textTHERAPEUTIC APPROACH AND PREVENTION IN RECURRENT ACUTE BILIARY PANCREATITIS
No full textAim: Acute biliary pancreatitis (ABP) is caused by alteration of the papillary patency. The normal transpapillar flux and the cleaning of the common biliary duct (CBD) may prevent potentially avoidable recurrent pancreatitis.
Patients and Methods: In the period September 1997/december 2008 we have treated 224 ABP (34 severe, 190 mild/moderate): 162 (72,4%) with the first attack, 62 (27,6%) with recurrent ABP (second or further attack). The patients with recurrent pancreatitis had not undergone, in the previous hospital stay elsewhere, the evaluation and, if necessary, the treatment of the papillary obstacle and /or CBD stones, sludge, etc. In ours hospital all patients had undergone complete treatment of ABP: intensive therapy, clinical: instrumental control of the papillary patency, then ERCP/ES(180-80%) within 72 hours from the onset in all SAP, in mild/moderate with signs of papillary lithiasic obstacle (US/MRCP confirmation), in all recurrent pancreatitis, and videolaparocholecystectomy.
Results: In the follow-up of recurrent pancreatitis we have controlled, clinical and instrumental data, after 90 and 180 days, 35 patients (56%-27 lost): 21 SAP, 14 mild/moderate). Further recurrence only in 1 patients (2,8%); in the other controls recurrence of ABP are not reported; laboratory (amylases, cholestasis) and instrumental tests ( abdominal US) has been normal.
Conclusions: Recurrent ABP have been caused, in the patients discharged from the hospital without additional treatment, by persistent papillary obstacle (small stones, sludge, cholesterol crystals, etc.). Therefore we confirm therapeutic validity of the instrumental control (US/MRCP) and the possible treatment of papillary or biliary lithiasic obstacle for the prevention of recurrent ABP
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