1,721,115 research outputs found
Intraoperative, Postoperative and Long-Term Complications of VATS Treatment of Pneumothorax and Bullous Disease. A Review
Full text linkIntroduction: Video-assisted thoracic surgery (VATS) is considered to be the standard approach in the treatment of pneumothorax and bullous disease, even if its impact on intraoperative and postoperative morbidity and long-term complications has not been totally evaluated yet. Analysing the author’s experience and the literature about this topic, this report aims to ascertain rational criteria to improve the outcomes through the knowledge of all the complications.
Materials and Methodology: At Thoracic Surgery Unit of S. Maria delle Croci Hospital of Ravenna (Italy) were performed 300 VATS procedures for pneumothorax or bulluous disease on 282 patients. All the patients were proposed for the resection of blebs or bullae. At the beginning pleurodesis was achieved by apical pleurectomy and then by talc poudrage.
Results: A pulmonary resection was performed on 289 cases. Apical pleurectomy was carried out in 97 cases, subtotal pleurectomy in 15 cases and talc poudrage in the remaining 198. 33 intraoperative complications occurred with a conversion rate of 2.0 %. Postoperative morbidity was 7.0 % including four cases in which re-operation was carried out.
Long-term complications included one Horner’s Syndrome and four severe intercostal neuritis. 178 patients were followed up for a mean period of 84 months and the recurrence was observed in six patients.
Conclusions: VATS is a very reliable approach in the treatment of pneumothorax and bullous disease. To further reduce intraoperative and postoperative morbidity it is necessary to perform the procedure with meticulous caution and to give special attention to secondary pneumothorax and to all cases of adhesions
Total gastrectomy with "over-D1" lymph node dissection: what is the actual impact of age?
No full textWe aimed to evaluate risk factors for postoperative complications after total gastrectomy with "over-D1" lymphadenectomy
Anatomic Laparoscopic Liver Resection in the Scenario of the Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
No full textAim:To assess the impact of the laparoscopic anatomic resections (LARs) on hepatocellular carcinoma (HCC) patients, analyzing the pooled short- and long-term outcomes of this technique and comparing it with the standard open approach [open anatomic resections (OAR)]. Material and Methods:A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning LAR for HCC. Results:After screening 311 articles, 10 studies with a total of 398 patients who underwent LAR for HCC were included. The pooled cohort included mostly male (76.6%), Child A (98.2%), with hepatitis B virus (HBV)-related disease (60.5%). The pooled conversion rate was 7.3%. The pooled overall complication rate was 10.2 with a mortality rate of 1.0%. In the pooled analyses of only comparative studies, LAR group included 378 versus 455 in OAR. Operative time was longer in the LAR group (329 minutes versus 248;P = .001). Blood loss (179 versus 331 mL;P = .018) was lower in the LAR group. The pooled mean length of hospital stay was 8.4 days in LARs and 11.3 in OARs (P = .002). The pooled rate of postoperative complications was higher in the OAR group (25.3 versus 13.8;P = .009), while mortality rates were similar. The LAR group had a pooled 3- and 5-year overall survival of 90.1 and 81.9 versus 83.5 and 80.7 of the OARs (P > .05), respectively. Conclusions:In conclusion, the LAR for HCC is safe and associated with decreased blood loss and length of hospital stay. Survival rates are comparable with those of the conventional open approach
Perivascular epithelioid cell tumor located retroperitoneally with pulmonary lymphangioleiomyomatosis: report of a case
No full textPerivascular epithelioid cell neoplasms, also known as "PEComas", are unusual mesenchymal tumors, exhibiting perivascular epithelioid cell differentiation and characterized by a mixed myogenic and melanocytic phenotype. "PEComas not otherwise specified" (PEComas-NOS) are especially rare; consequently, there are no published large series, but only case reports. These tumors are rarely located retroperitoneally, with only about 15 such cases reported. We report a case of pulmonary diffuse lymphangioleiomyomatosis with large retroperitoneal PEComa-NOS in a 66-year-old woman. Treatment consisted only of tumor resection, without additional adjuvant therapy. We emphasize the importance of correct immunohistochemistry diagnosis, initiation of recommended treatment, and surveillance of this unique family of tumors
Frail patients dropping out of neoadjuvant treatment: what should we do?
No full textPerioperative oncological treatment is currently the gold standard approach in Europe for Advanced Gastric Cancer patients. Unfortunately, patients dropping out due to worsening conditions has been frequently observed, but these data are seldomly considered and reported. To analyze frequency and propose solutions to support these patients, we reconsidered our results from the GASTRODOC randomized trial performed by [blinded for reviewers] and GIRCG on 91 patients. Thirty-four patients (37.4%) suspended chemotherapy and five (5.4%) did not reach surgery. Ten patients (11%) presented unacceptable toxicity related to gastrointestinal symptoms, six ended the treatment for investigator decision and six for progression, five patients withdrew their consent, five patients were excluded because of surgical complications and long hospitalization, and two patients died. Even though not significant, survival rates for patients who interrupted treatment in the whole trial were lower (5-year OS completed 64.6 vs. interrupted 41.8 p 0.07). Promptness in giving patient support for gastrointestinal symptoms, careful evaluation of anemia and patient nutritional status, and psychological programs from the beginning of the oncologic treatment may improve the final results
A very simple technique to repair Grynfeltt-Lesshaft hernia
No full textA very simple technique to repair a superior lumbar hernia is described. The location of this type of hernia, also known as the Grynfeltt-Lesshaft hernia, is defined by a triangle placed in the lumbar region
Impact of obesity on early surgical and oncologic outcomes after total gastrectomy with "over-D1" lymphadenectomy for gastric cancer
No full textThe purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with "over-D1" dissection for gastric cancer
Gastric splenosis mimicking a gastrointestinal stromal tumor: A case report
Full text linkIntramural gastric nodules are rare but all differential diagnoses must always be considered. If feasible, a preoperative fine needle aspiration can help the surgeon in selecting the best treatment option. Splenosis is uncommon in the general population but it must be considered in each patient with a history of splenectomy (especially after trauma). In this specific cluster it is reasonable to insist on ruling out splenosis even making a second histologic sampling after a first failur
Geophagia: An extraordinary cause of perforation of the sigmoid colon
No full textA case of large bowel perforation due to geophagi
Video-assisted thoracoscopic surgery for postoperative hemothorax
No full textThe aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in the treatment of postoperative bleeding after thoracic surgery
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