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Risultati della terapia chirurgica per via laparoscopica della MRGE. Esperienza di scuola
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Functional Evaluation at 1-Year Follow-Up of Laparoscopic Nissen-Rossetti Fundoplication
No full textLaparoscopic Nissen fundoplication is currently the gold standard for surgical treatment of gastroesophageal reflux disease. The aim of this study was to present our experience with this procedure at 1 year of follow-up. Forty patients were operated on between January 2006 and July 2007, and 30 underwent a 24-hour postoperative pH-metry study. Ninety-two percent of the patients were asymptomatic at a follow-up of 12 months. All pH-metric parameters improved. DeMeester and Johnson's score was reduced from 44.7 to 7.75; endoscopy with histologic samples revealed the healing of esophagitis in all patients; 4 (13%) patients complained of dysphagia, which resolved within 1 month after surgery. Twenty-seven (90%) patients were completely satisfied by their surgical results. One year after surgery, 24-hour ph-metric results show that laparoscopic Nissen fundoplication can completely control acid reflux with relatively few complications and a high degree of patient satisfaction
24H pHmetric Evaluation of GERD after Laparoscopic Nissen-Rossetti Fundoplication: 1 Year Follow Up. 21st National Congress of the Italian Polyspecialist Society of Young Surgeons (IPSYS). June 15-18, 2008, Perugia
No full textIntroduction: Laparoscopic Nissen Fundoplication is the gold standard for surgical treatment of GERD. Results 1 year after Nissen-Rossetti Fundoplication is reported. Material and Methods: 92 N-R performed, underwent to a pre and postoperative work-up including symptom quest, barium meal, endoscopy and 24-h pH-metry. 64 patients were considered. 92% of treated patients was asymptomatic. Results: 24-h pH-metry was positive in 3 cases: total number of reflux episodes decreased from 40,00 ± 4,5 to 8,79 ± 2,3; the duration of longest episode decreased from 98,73 mins to 11,50 mins; the percentage of time with esophageal pH<4 was 1,8% ± 0,7 for total time, 1,4% ± 1,3 for supine time and 1,88% ± 0,6 for erect time; DeMeester & Johnson’s Score decreased from 79,4 ± 1,0 to 13,2 ± 3,1; endoscopy with histological samples evidenced a strong improvement of esophagitis, a stationary aspect of Barrett’s Esophagus in 1 patients, a complete regression in 2 patients; 17 patients complained dysphagia spontaneously relieved within 1 month; there was no need of reintervention, only one patient recurred to PPI therapy and one to benzodiazepine administration, however 95% of patients were completely satisfied by surgical results. Conclusion: Based on our personal experience, laparoscopic N-R Fundoplication can totally control acid reflux after 1 year with relatively few complications and a high degree of patient satisfaction
[Intragastric balloon in bariatric surgery].
No full textGli Autori presentano la loro casistica sul palloncino intragastrico (BIB) nel trattamento dell’obesità. Il BIB è un dispositivo meccanico restrittivo, costitutito da un involucro in silicone che viene introdotto in cavità gastrica per via endoscopica, riempito con 500 cc di soluzione fisiologica colorata con blu di metilene e mantenuto in situ per 6 mesi. Nell’arco di 2 anni sono stati posizionati 98 palloncini intragastrici a 88 pazienti la cui età media era di 37.1 anni e l’indice di massa corporea (BMI) medio di 41.9; l’eccesso ponderale medio era 47,6 kg. Le complicanze registrate sono state l’intolleranza, il reflusso gastro-esfageo (RGE), la rottura e/o la desufflazione del palloncino e meteorismo. Il BIB è risultata una procedura efficace nel trattamento temporaneo dell’obesità potendo indurre un soddisfacente calo ponderale e un miglioramento a breve termine delle comorbilità. Intragastric balloon (BIB) is a mechanical restrictive device formed by a silicone wrapper inserted endoscopically in the stomach, filled with 500 cc of phisiological blue metilene solution and kept in situ for 6 months. In two years 98 intragastric balloon have been set in 88 patients at the average age of 37.1 years, of 41.9 of BMI and 47.6 kg of weight. Complications were intolerance, gastro-oesophageal reflux, break and/or deflation and meteorism. BIB is an effective procedure in obesity temporary treatment leading a satisfactory loss of weight and a short-term comorbility improvement
Laparoscopic combined Nissen-Rossetti fundoplication and cholecystectomy: our experience - [Plastica Nissen-Rossetti e colecistectomia in un unico tempo laparoscopico: esperienza personale]
No full textThe aim of this study is to valuate the opportunity to associate both laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in patients with gallbladder cholelithiasis and gastro-oesophageal acid reflux (endoscopically and pHmetrically assessed), considerating that the gallbladder removal makes duodenal-gastric reflux worse. From 2005 until 2007 we associated laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in 10 patiens, who presented surgical indications for gallbladder cholelithiasis and gastro-oesophageal reflux. Clinical data, surgical procedures and post-operative complications were compared to our esperiency on the singular procedure (laparoscopic Nissen-Rossetti fundoplication and cholecystectomy). Results were valuated at 3, 6 and 12 months after surgical interventions by clinical and instrumental follow up (24-pH-metry and oesophagus-gastro-duodenoscopy). The analysis of instrumental data of these associated procedures doesn't present significative differences between the singular surgical approach. In all the patients treated by combined procedure, the follow-up shows a normal pHmetric exam, a good control on the acid reflux by fundosplication, absence of distal oesophagitis and gastric reflux symptoms. The association of laparoscopic Nissen-Rossetti fundoplication and laparoscopic cholecystectomy is indicated in patients who present both pathologies and needs to be considerating in relations to the good results and the low postoperatoric morbidity
[Lung surgery in the elderly].
No full textLung surgery in the elderly, once considered a major risk, to be avoided if possible has become more popular in recent years as a result of many factors. First: lung cancer incidence has increased significantly in every age group but mostly in the elderly. Second: diagnosis at an early stage of the disease is higher in patients over 70 due to more frequent medical control in old subjects. Third: we now have more and more humans over 80 and a life expectancy increasing over the years. Fourth: preoperative, operative and postoperative medical supports are now safer and more reliable than previously. Operability criteria in the elderly are substantially the same as in younger group of patients for lung cancer. There are no reasons to refuse surgery in a subject over 80 because he is old. Lobectomy is the procedure of choice for lung cancer even in the elderly. Pneumonectomy must be avoided preferring a less radical procedure (wedge resection) so avoiding the risk of a postoperative respiratory failure that is often fatal for a patient with in border line functional respiratory tests, as often happens in the elderly. Thoracoscopic atypical resections must be considered in patients when a wedge resection is indicated preoperatively and almost always metastatic pulmonary lesion
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