Chirurgia italiana最新文献

Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as means of further minimising postoperative pain, allowing a rapid return to activity and work, and obtaining patient satisfaction and better cosmetic results. It is still debatable whether the three-port technique is comparably safe. Since 2001, 374 consecutive patients underwent laparoscopic cholecystectomy in elective and emergency surgery. Three ports were routinely positioned and the need for a fourth cannula was evaluated during the surgical procedure. Of the 374 consecutive cholecystectomies performed, 204 were completed with three ports and 161 needed a fourth port to be completed, while 9 required conversion to laparotomy. Patients who were operated on with just three ports were significantly younger and mostly female. Complications of procedures completed with three ports were negligible and those of procedures completed with four ports were in line with the recent literature. Our experience shows that the three-port technique is always a good initial option when performing laparoscopic cholecystectomy. It is safe and requires conversion to four-port placement in only a minority of cases overall.

Laparoscopic right hemicolectomy has developed less markedly than rectosigmoid resection, probably because of the more complicated regional anatomy and greater difficulty in performing an adequate regional lymphectomy. The aim of the present study was to analyse our 5-year experience with laparoscopic right hemicolectomy. Twenty patients were enrolled with non-metastatic, non-infiltrating right colonic cancer, treated laparoscopically and compared to a group well matched for age, sex, comorbidity and stage of disease, treated laparotomically. The duration of the laparoscopic procedures was slightly longer, but intraoperative blood loss, passage of flatus and hospital stay were reduced compared to the laparotomic procedure. Morbidity was similar and there was no 30-day mortality in either group. Specimen length and number of harvested lymph nodes were similar and the 5-year cumulative survival curves showed no statistically significant difference (72.5% versus 72.2%). Our experience shows that laparoscopic right hemicolectomy is a safe, effective and oncologically adequate procedure, comparable in all respects to open hemicolectomy, but with all the advantages of the minimally invasive technique. Yet, it remains a complex surgical procedure, requiring skill and a long learning curve. Further studies, possibly prospective and randomised, are necessary to define the exact role of this technique for the treatment of non-metastatic, non-infiltrating right colonic cancer.

Total mesorectal excision (TME) is the cornerstone of surgical treatment for extraperitoneal rectal cancer. The aim of the present study was to analyse our five-year experience with laparoscopic TME, evaluating the overall five-year and disease-free survival rates. Twenty-five patients with low-middle rectal cancer were treated with laparoscopic TME. Patients with advanced rectal cancer were treated preoperatively with neoadjuvant radiochemotherapy. Five-year overall survival and disease-free survival were calculated according to the Kaplan-Meier method. Twenty-three ultralow anterior resections with Knight-Griffen anastomosis and 3 abdominoperineal resections were performed. At 30 days mortality was zero, while morbidity was 20% (all minor complications). The mean follow-up period was 30.5 months. Five-year overall survival was 80.2%, and five-year disease-free survival 80.9%. Our experience shows that laparoscopic TME is a safe and oncologically correct procedure. Oncologic outcomes were comparable to those reported in all major international experiences, and the results were very similar to those obtained with the laparotomic approach. However, it remains a complex technique, requiring an adequate learning curve. More prospective, randomised trials are needed in order to define laparoscopic TME as the new gold standard for the treatment of extraperitoneal rectal cancer.

The Authors describe the reconstruction of an eyebrow, in a case of complete traumatic avulsion, using a scalp island flap based on the superficial temporal artery, in a young person aged 32 years. The lesion represented a serious aesthetic disablement capable of causing disturbed psychic equilibrium and individual relationships, in view of the fact that the eyebrows play a decisive role in the characterisation of the face and expressive gestures. The strategy of using a scalp island flap with a limited amplitude only slightly larger than that of the site in which it was inserted enabled optimal projection of the newly constructed eyebrow to be achieved during suturing.

Self-expanding biliary drains seem to allow long-term patency and prevent stent migration in peri-ampullary neoplastic lesions. We report two cases of duodenal occlusions due to the stent advancing towards the intestinal lumen in patients with tumours of the pancreatic head. The stents had been percutaneously positioned after an endoscopic papillotomy or palliative choledocho-jejunostomy and were impacted by alimentary debris, blocking the passage of food. Dislodgement of the metallic mesh, in conjunction with duodenal wall stiffness and reduced absorption ability due to the pancreatic cancer, can give rise to progressive intestinal occlusion.