Chirurgia italiana
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Appendicitis is an acute disease requiring urgent surgical treatment. Acute appendicitis is the most common surgical emergency in children and young adults, with an incidence of about 100-140 cases per 100,000 people. In our study we analyse 501 consecutive appendectomies performed in our department. ⋯ Several studies have shown that laparoscopic appendectomy presents a number of advantages in terms of a shorter hospital stay, less postoperative pain and fewer wound infections. Some authors, however, have demonstrated that the laparoscopic approach for acute appendicitis is associated with increased operative times and risk of intra-abdominal abscesses (above all if the appendix is perforated). Our experience confirms that the routinely performed laparoscopic approach to treat acute appendicitis is associated with a low rate of abscess complications: in our series some of the complications could be attributed to the surgical learning curve.
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Perforation of peptic ulcer is a surgical emergency which still carries a risk of mortality. The main risk factors are delayed diagnosis > 24 hours, ASA-III or ASA-IV, age over 70 years, and associated cardiorespiratory pathologies. There is no unanimous consensus regarding the gold standard treatment of such complications. ⋯ One patient (2.56%) in the laparoscopic group and two (28.57%) in the open repair group presented morbidity in the postoperative period. One patient (ASA IV) in the open group died. Laparoscopic treatment in the emergency setting is a safe, reliable procedure, affording all the advantages of the minimally invasive approach.
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Abdominal abscess is a very important problem nowadays, being responsible for prolonged hospitalisation, because these infections still cause substantial morbidity and mortality. For many years, surgical drainage has been considered the best therapeutic option in abdominal abscesses but several studies have subsequently shown that the percutaneous approach is as effective as surgical drainage. ⋯ Abscess drainage was successful in 322/403 (80%) of postoperative abscess, in 16/18 (90%) of primitive abscesses, in 10/12 cases (85%) of acute cholecystitis, in 3/6 cases (50%) of intrahepatic abscess and in 12/12 cases (100%) of pyelonephritis. US-guided drainage is currently the gold standard in the treatment of simple abdominal abscesses.
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Adenocarcinoma of the gastro-oesophageal junction is progressively rising in western countries and, because of its poor prognosis, presents a real clinical challenge for the oncological surgeon. We evaluate our initial experience with wholly laparoscopic trans-hiatal extended total gastrectomy with the Or-Vil device for treating Siewert type II and III tumours of the gastro-oesophageal junction. Ten patients were enrolled in the present study; ASA score, stage of disease, length of surgery, estimated blood loss, number of lymph nodes harvested, length of proximal margin clearance, morbidity and mortality were analysed. ⋯ Neither anastomotic fistulas nor major dehiscence were observed. In our initial experience, wholly laparoscopic trans-hiatal extended total gastrectomy for treating Siewert type II and III tumours of the gastro-oesophageal junction is safe, effective and, according to our preliminary results, oncologically correct, but it remains a complex, advanced laparoscopic procedure, requiring major skills and adequate experience. Prospective, randomised trials--possibly multicentric--are required to establish its efficacy in terms of long-term oncological outcomes.
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Pericardial effusion may lead to cardiac tamponade sometimes requiring surgical treatment. The aim of the study was to retrospectively analyse a group of patients with cardiac tamponade treated with a modified video-assisted thoracoscopy technique. We treated 15 patients (8 males and 7 females; mean age 63 years; range 24-80 years) with cardiac tamponade. ⋯ There was no intraoperative mortality or perioperative morbidity. Drainage of the pericardial effusion was effective in all cases. The modified video-assisted thoracoscopic technique on the right chest using two trocars seems a feasible surgical technique for patients suffering from cardiac tamponade.