1,721,045 research outputs found
Hernioplasty and simultaneous laparoscopic cholecystectomy: a prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair
No full textRapid antigen tests for large-scale diagnostic campaigns: A case study from North-Eastern Italy
No full textLaparoscopic subtotal pancreatectomy: the right edge of the distal resection
No full textCase
We report a case of an obese (BMI 30.) 48 year-old male patient who presented with recurrent upper abdominal pain. He was found to have a symptomatic cystic mass in the neck of the pancreas.. US demonstrated a 5 cm hypoechoic cystic mass of the pancreatic isthmus. Serum CA 19-9 was slightly elevated. CT and MRI findings were consistent with a mucinous cystoadenoma/cystoadenocarcinoma. EUS-FNAB diagnostic of a cystic lesion with no evidence of malignant cells. A 6-month follow up MRI scan demonstrated the lesion had increased in size, strengthening the suspicion for mucinous cystoadenocarcinoma. The patient underwent a laparoscopic subtotal pancreatectomy and splenectomy. The pancreatic transection was extended to the left side of the gastroduodenal artery. The surgical procedure was technically demanding due to the patient’s visceral obesity and the anatomical location of the lesion. The postoperative course was complicated by a grade B pancreatic leak, managed conservatively. The pathology report demonstrated a pancreatic lympho-epithelial cyst which was resected with a clear surgical margin.
Conclusions
Laparoscopic distal pancreatectomy and splenectomy for a pancreatic neck lesion can be extended to the left side of the gastroduodenal artery in order to obtain a clear resection margin. Even if obesity increased the techinical difficulty, it should not be considered a contraindication to laparoscopic approach
Staged hepatectomy and whipple procedure in metastatic gastroenteropancreatic endocrine carcinoma: report of a case.
No full text
Prospective comparison of laparoscopic incisional ventral hernia repair and Chevrel technique.
No full textPURPOSE:
Laparoscopic incisional hernia repair has become an attractive and widely adopted alternative to open procedures. The Chevrel technique is still frequently performed, owing to its safety and effectiveness. Our study prospectively compares the new and the old technique.
METHODS:
We prospectively collected data from laparoscopic and open incisional ventral hernia repairs performed from January 2006 to December 2008. Twenty-one patients were ultimately enrolled in the open and 20 in the video-laparoscopic (VL) group for the statistical analysis.
RESULTS:
Open and VL groups were homogeneous for demographics and size of parietal defect. No differences were observed in operating time and postoperative pain, although in the VL group, we found a tendency toward shorter hospital stays and higher postoperative quality of life. We reported a significantly higher rate of wound complications in the open group (7 vs. 1; P=0.03).
CONCLUSIONS:
Both techniques proved to be effective, although Chevrel presented a high rate of wound complications
Laparoscopic gastric bypass with remnant gastrectomy in a super-super obese patient with gastric metaplasia: a surgical hazard?
No full textThe endoscopic inaccessibility of the gastric remnant after Roux-en-Y gastric bypass (RYGBP) for morbid obesity represents an important issue for patients with familiar history of gastric cancer (GC) or affected by premalignant lesions, such as intestinal metaplasia. If a different bariatric procedure is contraindicated, RYGBP with remnant gastrectomy represents a reasonable alternative, significantly reducing the risk of GC but potentially increasing postoperative morbidity. For this reason, only few cases have been reported in the recent Literature and none regarding a super-super obese patient. We present the case of a 55-year-old super-super obese man with a family history of GC and antral gastritis with extensive intestinal metaplasia at preoperative upper endoscopy, who underwent laparoscopic RYGBP with remnant gastrectomy
Internal Hernias and Angina Abdominis After Laparoscopic Gastric Bypass: The Challenging Management of an Underestimated Problem
No full textIntroduction:. Internal hernia represents one of the most common late complications of Roux-en-Y gastric bypass (RYGBP), with an estimated incidence varying from 0.7% to 3.25%, reaching 6% considering only procedures with transmesocolic alimentary loop [1-2-3]. Such incidence only account for complicated hernias, while a greater part of internal hernias occur (si manifesta) as a recurrent episode of postprandial colic pain (angina abdominis). Those latter cases are probably the most challenging to diagnose, to treat and to prevent..
Case series: we present a video of four cases of laparoscopic exploration in patients with recurrent, not complicated, postprandial abdominal pain (angina abdominis) after RYGB. All the patients were mid age (mean age 39.5) females, previously submitted to an antecolic RYGB; mean EWL was 83%. Preoperative study revealed in all cases a partial or complete twist of the mesenteric axis at CT san. None presented with an acute syndrome (occlusion, leucocytosis, shock) and they were all operated on a not urgent setting.
A Petersen non complicated hernia was detected in three patients, and reduction with stitch fixation was performed, while an adhesion to an intraperitoneal mesh with loop rotation was detected in the last case, and treated by a laparoscopic adhesiolysis.
Postoperative course was uneventful for all the patients (mean hospital stay 2.5 days), and abdominal pain resolution was achieved at follow-up.
Conclusions: Laparoscopic exploration yields a sure diagnosis and a safe and effective treatment of non complicated internal hernias after RYGBP
Computed tomography volumetric fat parameters versus body mass index for predicting short-term outcomes of colon surgery.
No full textBACKGROUND: At present, the impact of obesity on short-term outcomes of general surgery remains controversial, especially in the field of laparoscopy. Most studies on the subject have used the body mass index (BMI) to define obesity without distinguishing between visceral and subcutaneous storage. Computed tomography (CT) volumetric analysis permits accurate evaluation of site-specific volume of adipose tissue. The purpose of this study was to compare CT volumetric fat parameters and the BMI for predicting short-term outcomes of colon surgery.
METHODS: A retrospective analysis was conducted of 231 consecutive patients undergoing elective colon resection, with open or laparoscopic technique, from January 2007 to April 2009. CT volumetric quantification of abdominal visceral and subcutaneous adipose tissue was performed. Intraoperative and perioperative data were collected.
RESULTS: A total of 187 patients were enrolled. BMI showed a direct correlation with fat volumetric parameters but not with the visceral/subcutaneous fat ratio. Operating time was correlated with subcutaneous fat storage and BMI in the laparoscopic right colectomy subgroup. No associations were found with the conversion rate. Length of the hospital stay was correlated with the visceral/subcutaneous fat ratio in the laparoscopic left colectomy subgroup. Whereas the overall postoperative complication rate and mortality were not associated with fat parameters, the postoperative surgical complication rate was associated with visceral volumetric parameters in the laparoscopic left colectomy subgroup.
CONCLUSIONS: Short-term outcomes of colon surgery are better predicted by fat volumetric parameters than by the BMI. This study has provided new elements for discussion on the impact of visceral and subcutaneous adiposity in laparoscopic and traditional colon surgery
- …
