1,721,391 research outputs found
"Slim-Mesh" Technique for Giant Ventral Hernia
Full text linkBackground and Objective: We devised a sutureless "Slim-Mesh" technique to treat ventral hernias, including large-giant/massive ones, reduce intra- and postoperative complications, and lower operation time.Methods: Between September 1, 2009 and October 31, 2020, 43 patients with large (10 - 14.9 cm)-giant (15 - 19.9 cm) and massive( >= 20 cm) ventral hernia were operated at our Department with the above technique. This was a prospective (79%)-retrospective study.Results: This study comprised 22 males and 21 females. Mean age was 63 years. Large-giant and massive hernias were found intraoperatively in 37 and 6 cases respectively. Mean operation time for all hernias was 116 minutes, 104 for large-giant hernias, and 190 for massive. In 53.4% of cases, hernia-neck operative measurement was larger than preoperative size. In 25.5% of cases, laparoscopy found satellite hernias previously undetected by ultrasound- and/or computed tomography scan. A composite mesh and a non-composite mesh were used in 95% and 5% of cases respectively. For mesh fixation, titanium tacks and absorbable straps were used in 14% and 86% of cases respectively. Mean length of hospital stay was 2.3 days. Mean follow-up time was 3 years and 4 months. In our study, there were 5 early postoperative complications: 3 seromas, 1 trocar-site hernia, and 1 case of cystitis. We found 2 late small symptomless recurrences (4.6%).Conclusion: The sutureless "Slim-Mesh" technique facilitates intra-abdominal introduction, as well as the handling and fixation of giant and monster (36 x 26 cm) meshes. In our experience, "Slim-Mesh" is safe, simple, and fast, and economical even for large-giant/massive ventral hernia repair
Role of surgery in the treatment of bilio-pancreatic cancer. The European experience
No full textPancreatic cancer is the eighth most common cancer in Europe, accounting for 4.1% of cancer deaths in men and 4.8% in women. Standardized pancreatoduodenectomy and left pancreatectomy are the gold standard for routine surgical treatment of pancreatic cancer. Total pancreatectomy should be reserved for positive pancreatic resection margins or severe pancreatic anastomotic leak; mesenterico-portal vein resection should be performed only when it is the only reasonable way to obtain clear margins. Extended lymphadenectomies are recommended only in prospective, randomized studies. Ongoing efforts to standardize surgical procedures will facilitate comparison of selection criteria and trial data among different centers, and will also optimize the study design of ongoing/planned prospective trials using adjuvant and neoadjuvant chemoradiotherapy in pancreatic cancer
Ductal adenocarcinoma of the body and tail of the pancreas.
No full textBACKGROUND: Carcinoma arising from the body and tail of the pancreas is less frequent than pancreatic head cancer, and its prognosis is known to be worse. This aggressive behavior is reported by few large clinical studies.
STUDY DESIGN: We retrospectively reviewed our 24 years experience on adenocarcinoma of the body and tail of the pancreas and analyzed survival and longterm results after resection. Recent large series on cancer of the distal pancreas were also reviewed.
RESULTS: Among 148 patients observed, 109 were surgically treated. Resectability rate was 16%; ductal adenocarcinoma in 22% of patients who underwent surgery was resectable. Macroscopic radical resection was achieved in only 16 cases. Overall 5-year survival rate was 2%. In resected cancers the actual 5-year survival rate was 12.5%. Patients with unresectable cancers did not survive more than 17 months. All three patients who survived more than 5 years had a small tumor (T1 according to TNM staging). In the literature, among 360 evaluable resected patients, only 7 survived at 5 years (2%).
CONCLUSIONS: The prognosis for patients with adenocarcinoma of the distal pancreas is poor, even after resection of the tumor; however, the results are not substantially different for those reported after resection for pancreatic head carcinoma. Surgical resection can offer longterm survival for patients with localized cancer
Pancreaticoduodenojejunostomy for chronic pancreatitis presenting with an inflammatory mass in the head of the pancreas
No full textAn inflammatory mass in the head of the pancreas is reported in 18-50% of patients with chronic pancreatitis. When the clinical history is misleading, differential diagnosis between chronic pancreatitis and pancreatic cancer may be very difficult. Pancreaticoduodenectomy is considered the treatment of choice, if cancer is still suspected despite negative biopsy. From January 1987 to December 1992 we performed 42 pancreaticoduodenectomies, 36 for malignancies of the pancreaticoduodenal area and 6 for chronic pancreatitis suspected to have a pancreatic cancer. In three additional cases of chronic pancreatitis, we performed a pancreaticoduodenojejunal anastomosis after complete opening of the pancreatic duct and excision of the papilla of Vater. Frozen section and definitive histological examination of the pancreas and ampulla excluded malignance in all three patients. They are alive and well 60, 36, and 20 months after operation. With this procedure, frozen-section examination of the distal part of the pancreatic and biliary duct, the papilla, and the periductal pancreatic tissue can be performed, while this is impossible with the usual pancreaticojejunostomy. We can therefore reasonably exclude a small cancer of the periampullary area and perform a wider derivative procedure, instead of a pancreaticoduodenectomy, in patients with an inflammatory mass of the head of the pancreas
I fattori prognostici ed i markers tumorali nel follow-up dei pazienti sottoposti a resezione per carcinoma pancreatico
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