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Romano L, Fiasca F, Mattei A, Tersigni L, Gianneramo C, Schietroma M, Carlei F, Giuliani A. BJS-01 SARCOPENIA AND VISCERAL FAT IN PATIENTS WITH INCISIONAL HERNIA AFTER URGENT LAPAROTOMY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy.
Material & methods
Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-months follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups.
Results
From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years-old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant.
Conclusions
When surgery is performed in urgent settings it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease. In these patients a prophylactic mesh placement could be evaluated.
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Affiliation(s)
- L Romano
- DISCAB, university of l'aquila , l'aquila , Italy
| | - F Fiasca
- MESVA, university of l'aquila , l'aquila , Italy
| | - A Mattei
- MESVA, university of l'aquila , l'aquila , Italy
| | - L Tersigni
- DISCAB, university of l'aquila , l'aquila , Italy
| | - C Gianneramo
- DISCAB, san salvatore hospital , l'aquila , Italy
| | - M Schietroma
- DISCAB, university of l'aquila , l'aquila , Italy
| | - F Carlei
- DISCAB, university of l'aquila , l'aquila , Italy
| | - A Giuliani
- DISCAB, university of l'aquila , l'aquila , Italy
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Romano L, Mattei A, Fiasca F, Nervini A, Vicentini V, Schietroma M, Carlei F, Giuliani A. A monocentric retrospective analysis about the effects of COVID-19 pandemic on emergency general surgery consultations. Eur Rev Med Pharmacol Sci 2022; 26:4528-4534. [PMID: 35776054 DOI: 10.26355/eurrev_202206_29092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates. PATIENTS AND METHODS We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded. RESULTS In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery. CONCLUSIONS We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.
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Affiliation(s)
- L Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Romano L, Giuliani A, Pessia B, Mattei A, Fiasca F, Tonelli E, Carlei F, Schietroma M. The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score. Eur Rev Med Pharmacol Sci 2021; 25:6339-6348. [PMID: 34730215 DOI: 10.26355/eurrev_202110_27006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC. PATIENTS AND METHODS TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage. RESULTS In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort. CONCLUSIONS TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.
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Affiliation(s)
- L Romano
- General Surgery, Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
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Pessia B, Romano L, Carlei F, Lazzari S, Vicentini V, Giuliani A, Schietroma M. Preoperative sarcopenia predicts survival after hepatectomy for colorectal metastases: a prospective observational study. Eur Rev Med Pharmacol Sci 2021; 25:5619-5624. [PMID: 34604954 DOI: 10.26355/eurrev_202109_26781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The surgical approach to colorectal liver metastases has highly improved the survival rates in metastatic colorectal cancer patients. Since sarcopenia estimates the physiologic reserve of an individual patient, it is considered a surrogate marker of patient frailty, and the selection of appropriate candidates for LR could be crucial to maximize the benefits derived from surgery. The present study investigated the impact of sarcopenia as a prognostic factor after LR from CRLM. PATIENTS AND METHODS The study retrospectively analyzed 74 patients. Skeletal Muscle Mass at the third lumbar vertebra in the inferior direction was quantified using enhanced computed tomography scans. The patients were divided into two subgroups, with and without sarcopenia, based on median Skeletal Muscle Index. RESULTS The study included 48 Sarcopenic patients and 26 Non Sarcopenic patients. The median follow-up considered for the patients was 32 months. Median SMI was 39.3 and 52.7 cm2/m2, respectively. The OS rate was significantly different between the two groups. Preoperative sarcopenia resulted in worse OS up to 48 months. CONCLUSIONS Sarcopenia represents a negative prognostic factor as it is associated with poor postoperative OS. Future programs focused on remediating to the preoperative sarcopenic status of colorectal liver metastatic patients should be implemented.
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Affiliation(s)
- B Pessia
- Departement of Hepato-Bilio-Pancreatic Surgery, San Salvatore Hospital, L'Aquila, Italy.
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Romano L, Schietroma M, Giuliani A, Vicentini V, Carlei F. Correlation between neutrophil/lymphocyte ratio and postoperative infectious complications after pancreatoduodenectomy for carcinoma of the pancreas head. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leardi S, Pessia B, Mascio M, Piccione F, Schietroma M, Pietroletti R. Doppler-Guided Transanal Hemorrhoidal Dearterialization (DG-THD) Versus Stapled Hemorrhoidopexy (SH) in the Treatment of Third-Degree Hemorrhoids: Clinical Results at Short and Long-Term Follow-Up. J Gastrointest Surg 2016; 20:1886-1890. [PMID: 27601250 DOI: 10.1007/s11605-016-3220-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/20/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids. METHOD One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average). RESULTS At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery. CONCLUSION SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.
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Affiliation(s)
- S Leardi
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. .,Dipartimento Scienze Cliniche Applicate e Biotecnologie, Ospedale Civile San Salvatore, Università degli Studi di L'Aquila, Edificio Delta 6, 67100, L'Aquila, Italy.
| | - B Pessia
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - M Mascio
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - F Piccione
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - M Schietroma
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - R Pietroletti
- Department of Life, Health and Environmental Sciences MeSVA, University of L'Aquila, L'Aquila, Italy
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Woeste G, Juratli MA, Habbe N, Hannes S, El Youzouri H, Bechstein WO, Trombetta F, Moscato R, Ciamporcero T, Ghiglione F, Morino M, Tahir S, Baldjiev T, Goshev G, Pachoov N, Eftimov E, Kovachevski S, Smirnoff A, Roth JS, Wennergren J, Plymale MA, Zachem A, Davenport DL, Mangiante G, Passeri V, deManzoni G, Kaufmann R, Jairam AP, Mulder IM, Wu Z, Verhelst J, Vennix S, Giessen LJX, Jeekel J, Lange JF, Di Cerbo F, Ikhlawi K, Baladov M, Agha A, Iesalnieks I, Franklin M, Hernandez M, Glass J, Glover M, Gruber-Blum S, Fortelny R, May C, Glaser K, Redl H, Petter-Puchner A, Grossi J, Cavazzola LT, Tezza SLT, Nery LA, Zortea J, Roll S, Gorganchian F, Santa Maria V, Zuvela M, Galun D, Petrovic J, Micev M, Palibrk I, Bidzic N, Colozzi S, Clementi M, Cianca G, Giuliani A, Carlei F, Schietroma M, Amicucci G, Chung M, Cerasani N, Meyer J, Bulian DR, Heiss MM, Kocaay AF, Eker T, Celik SU, Akyol C, Cakmak A. Topic: Abdominal Wall Hernia - Abdominal wall closure. Hernia 2015; 19 Suppl 1:S198-205. [PMID: 26518800 DOI: 10.1007/bf03355349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Woeste
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - M A Juratli
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - N Habbe
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - S Hannes
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - H El Youzouri
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - W O Bechstein
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - F Trombetta
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - R Moscato
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - T Ciamporcero
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - F Ghiglione
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - M Morino
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - S Tahir
- University Surgical Clinic St. Naum Ohridski, Skopje, R. of Macedonia, European Union
| | - T Baldjiev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - G Goshev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - N Pachoov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - E Eftimov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - S Kovachevski
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | | | - J S Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - J Wennergren
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - M A Plymale
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - A Zachem
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - G Mangiante
- Upper Digestive Surgery, University of Verona, Verona, Italy
| | | | | | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A P Jairam
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - I M Mulder
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Z Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Verhelst
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - S Vennix
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - L J X Giessen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - K Ikhlawi
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - M Baladov
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - A Agha
- Klinikum Bogenhausen, Munich, Germany
| | | | - M Franklin
- Texas endosurgery Institute, San Antonio, USA
| | - M Hernandez
- Texas endosurgery Institute, San Antonio, USA
| | - J Glass
- Texas endosurgery Institute, San Antonio, USA
| | - M Glover
- Texas endosurgery Institute, San Antonio, USA
| | - S Gruber-Blum
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - J Grossi
- Brazilian lutern hospital, Canoas, Brazil
| | | | | | | | | | | | - F Gorganchian
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - V Santa Maria
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - M Zuvela
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - D Galun
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - J Petrovic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - M Micev
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - I Palibrk
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - N Bidzic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - S Colozzi
- Ospedale Civile San Salvatore, L'Aquila, Italy
| | | | | | | | | | | | | | - M Chung
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - N Cerasani
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - J Meyer
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - D R Bulian
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - M M Heiss
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - A F Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - T Eker
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - S U Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - C Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - A Cakmak
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Colozzi S, Schietroma M, Carlei F, Amicucci G. The effects of perioperative supplemental oxygen administration on the esophagojejunal anastomosis after total gastrectomy. A prospective randomized, double-blind study. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schietroma M, Giuliani M, Zoccali G, Carnei F, Bianchi Z, Gleni Z, Amicucci G. How does dexamethasone influence surgical outcome after laparoscopic Nissen fundoplication? A randomized double-blind placebo-controlled trial. Updates Surg 2010; 62:47-54. [DOI: 10.1007/s13304-010-0009-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 02/05/2010] [Indexed: 12/20/2022]
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Schietroma M, Cappelli S, Carlei F, Pescosolido A, Lygidakis NJ, Amicucci G. "Acute abdomen": early laparoscopy or active laparotomic-laparoscopic observation? Hepatogastroenterology 2007; 54:1137-41. [PMID: 17629056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomized controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation. METHODOLOGY From July 1993 to August 2004, 522 patients consecutively, admitted with "acute abdomen", were randomized to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of reproductive age, chest and/or abdominal radiograph if indicated clinically. RESULTS Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (P < 0.05). In the observation group 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopic group (P < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (P < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs. 7.3 days) (P < 0.01). Eight patients in group 1 required readmission (total readmission 46 days) compared with 58 patients in group 2 who stayed a total of 201 days (P < 0.05). CONCLUSIONS Early laparoscopy is valuable in the management of acute abdomen. It provides a significantly higher diagnostic accuracy and a better improvement in quality of life than the more traditional approach observation.
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Affiliation(s)
- M Schietroma
- Department of Surgery, University of L'Aquila, Italy.
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Schietroma M, Carlei F, Cappelli S, Pescosolido A, Lygidakis NJ, Amicucci G. Effects of cholecystectomy (laparoscopic versus open) on PMN-elastase. Hepatogastroenterology 2007; 54:342-5. [PMID: 17523270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND/AIMS Polymorphonuclear leukocytes (PMN) are well recognized as being the principal cells in inflammatory response reaction. During the surgical procedures there is a massive release of elastase (PMN-elastase) from the neutrophils, along with other proteinases. Therefore the measurement of the PMN-elastase might be a useful indicator of the degree of surgical trauma. Laparoscopic cholecystectomy (LC) is a so-called "mini-invasive" surgical procedure and on the basis of this consideration the aim of the present prospective, non-randomized study, is to examine (a) whether the serum levels of PMN-elastase concentration are modified and how, in patients undergoing LC compared to patients undergoing open cholecystectomy (OC), (b) whether these findings are indicative of an increased risk to develop infectious complications and therefore whether they are clinically significant. METHODOLOGY Plasma granulocyte elastase was determined photometrically, using an immune-activation immunoassay, in 86 patients (42 patients underwent OC and 44 LC). The levels of C reactive protein (CRP), an acute phase protein, were measured using a competitive CRP ELISA kit. Blood samples were collected from all patients a day before operation and at days 1, 3, 6 and 12 after operation. We established a reference range for elastase by measuring the serum elastase concentration in 68 normal control patients without gallbladder cholelithiasis or other diseases. RESULTS On day, 1, 3 and 6 after surgery, patients that underwent OC showed a significant increase (p < 0.05) in plasma elastase concentration, while it was almost unchanged in LC patients. The mean values of the serum CRP on p.o. days 1, 3 and 6 were also significantly lower in the LC group than those in OC group (p < 0.05). We recorded three cases (7.1%) of postoperative infections in the "open" group. The CRP concentration remained high for 1, 3 and 6 days and normalized 10-12 days after surgery while the PMN-elastase normalized after 13, 14 and 16 days. CONCLUSIONS The peripheral leukocyte function may be better preserved after LC in comparison to OC. Laparoscopic surgery, associated with a small skin incision and the avoidance of open laparotomy, can thus minimize surgical stress, and provide more favorable postoperative conditions for patients. Indeed excessive and prolonged post-injury elevations of PMN-elastase and CRP are associated with increased morbidity. Moreover, the PMN-elastase is a more sensible marker of inflammation in comparison to the CRP.
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Affiliation(s)
- M Schietroma
- Department of Surgery, University of L'Aquila, Coppito, Italy.
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Sozio A, Schietroma M, Franchi L, Mazzotta C, Cappelli S, Amicucci G. [Parathyroidectomy: bilateral exploration of the neck vs minimally invasive radioguided treatment]. MINERVA CHIR 2005; 60:83-9. [PMID: 15973213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIM In the therapy of primary hyperparathyroidism, the first surgical intervention, if efficacious, can remarkably reduce the incidence of persistence and relapses which are approximately about 5%. At present, the surgical approach of choice should involve the bilateral exploration of the neck. METHODS In the light of the high sensibility (91%) and specificity (98.8%) in the localization of parathyroid adenomas obtained by the parathyroid 99mTc-MIBI scintigraphy, we submitted, prospective and at random, between January 2001 and July 2004, 69 patients with primary hyperparathyroidism, to a conventional surgical treatment (bilateral exploration of the neck: 35 patients) or minimally-invasive approach (minimally invasive radioguided parathyroidectomy: 34 patients). This method consists of the injection of 50 mCi of 99mTc Sestamibi 2 h before the operation and the execution of parathyroid scintigraphy. When the adenoma is evident, we perform an incision of about 4 cm in the neck, 2 cm over the jugulum and the surgical dissection is guided by a probe showing the emission of gamma rays. RESULTS The parameters considered in order to compare the 2 groups, i.e. operating time, hospital stay and time of recovery were reduced in a significant way in the group submitted to the minimally invasive radioguided parathyroidectomy (MIRP). There were no complications in the 2 groups. In the follow-up we did not observe cases of persistence or relapses. CONCLUSIONS Therefore, we can confirm that the minimally invasive radioguided parathyroidectomy is a safe and efficacious method as well as the bilateral exploration of the neck. Moreover, cost reduction may convince many surgeons to consider MIRP the <<gold standard>> in the management of primary hyperparathyroidism.
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Affiliation(s)
- A Sozio
- Divisione di Chirurgia Generale, Dipartimento di Scienze Chirurgiche, Università degli Studi di L'Aquila, L'Aquila, Italy
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Amicucci G, Schietroma M, Rossi M, Mazzotta C. [Silicone occlusive sheeting vs silicone cushion for the treatment of hypertrophic and keloid scars. A prospective-randomized study]. Ann Ital Chir 2005; 76:79-83. [PMID: 16035676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Silicone gel and silicone occlusive sheeting are widely used at present for the treatment of hypertrophic and keloid scars. In recent studies the possibility was raised that static electricity generated by friction activated silicone sheeting could be the reason for this effect, and that it can, with time, cause involution of hypertrophic and keloid scars. Objective of this study was to test this hypothesis and to observe weather a continuous and also an increased negatively charged static electric field will shorten the treatment period. A silicone cushion was developed with the purpose of increasing a negative static-electric charge to accelerate the regression process. METHODS From November 2001 to June 2002 we studied in a prospective randomized study, 72 patients with hypertrophic an keloid scars. The trial extended over a 8-month period. 37 patients underwent silicone occlusive sheeting, the remaining 35 patients underwent silicone cushion (Clinicel). RESULTS Treatment with the silicone cushions yielded 74,2% cessation of itching and burning followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 25,7% had their scars resolved in up to 8 months of treatment. Four patients (11,4%) who add recalcitrant scars with little response to the use of the silicone cushion were given intralesional corticosteroid injections, in addiction to the use of the cushion, resulting in a fairly rayed resolution of these scars over a period of 2 months. Treatment with the silicone occlusive sheeting yielded 52,3% itching and burning cessation followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 22,1% had their scars resolved in up to 8 months of treatment. In conclusion by comparing the results of this trial using silicone cushions for the treatment of hypertrophic and keloid scars with those obtained using silicone gel or occlusive sheeting, a much faster response was demonstrated.
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Affiliation(s)
- G Amicucci
- Dipartimento di Scienze Chirurgiche Università degli Studi di L'Aquila
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Agnifili A, Schietroma M, Carloni A, Mattucci S, Caterino G, Lygidakis NJ, Carlei F. The value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients. Hepatogastroenterology 2004; 51:1694-7. [PMID: 15532807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND/AIMS Anastomotic leakage is a major cause of mortality in colorectal surgery. Several methods have been evaluated in order to prevent anastomotic leakage. To decrease the rate and severity of anastomotic leakage, omentoplasty (OP) has been proposed by several authors on the basis of experimental and clinical studies. A prospective, randomized trial was designed to study the influence of omentoplasty on anastomotic leakage after colorectal resection. METHODOLOGY One hundred and twenty-six patients undergoing elective or emergency surgery for malignancy, benign tumor, diverticular disease and other were randomly assigned to omentoplasty (OP group) or not (NO group). The primary end point was the rate of clinical and radiological anastomotic leakage. Both groups were comparable in terms of demographic data, preoperative characteristics and intraoperative findings. RESULTS Eighteen patients (14.3%) had anastomotic leakage, 4 (6.4%) in the OP group and 14 (21.9%) in the NO group. Significant differences (P<0.05) between the two groups were also found in terms of repeat operation (3.2% vs. 14.1%) and deaths (3.2 vs. 7.8%). Other factors associated with anastomotic leakage were the distal site of anastomosis (<5 cm from anal verge) and the emergency. CONCLUSIONS Omental wrap, with its mechanical and biological properties, seems to be effective in lowering the rate and the severity of anastomotic leakage after colorectal surgery.
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Affiliation(s)
- A Agnifili
- Department of Surgery, University of L'Aquila, Coppito, Italy.
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15
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Schietroma M, Carlei F, Franchi L, Mazzotta C, Sozio A, Lygidakis NJ, Amicucci G. A comparison of serum interleukin-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Hepatogastroenterology 2004; 51:1595-9. [PMID: 15532785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND/AIMS Interleukin-6 (IL-6), a multifunctional cytokine, is expressed by various cells after many stimuli. This cytokine release is related, among other things, to the extent of the surgically-induced trauma. Laparoscopic cholecystectomy (LC) is a so-called "mini-invasive" surgical procedure and, on the basis of this consideration, the aim of the present prospective non-randomized study, is to examine (a) whether the IL-6 is modified and how, in patients after LC compared to patients undergoing open cholecystectomy (OC), (b) whether these findings are indicative of an increased risk to develop infectious complications and whether they are therefore clinically significant. METHODOLOGY Circulating IL-6 level was measured using a random access chemiluminescense-immunoassay system in 71 patients before the operation (time 0) and 1, 2, 3, 6, 24 and 48 hours after the beginning of the operation. Thirty-five patients underwent OC and 36 LC. RESULTS The increase in the serum IL-6 during LC was found to be significantly smaller than that during OC and resulted in a smaller extent of postoperative elevations for C-reactive protein. We recorded three cases (8.5%) of postoperative infections in the "open" group and IL-6 concentration normalized only 6 days after surgery. CONCLUSIONS An increase in the serum IL-6 level during LC is lower in comparison to OC and results in lower postoperative elevation in C-reactive protein. Laparoscopic surgery, associated with a small skin incision and the avoidance of open laparotomy, can thus minimize surgical stress, and provide more favorable postoperative conditions for patients. Indeed excessive and prolonged post-injury elevations are associated with increased morbidity.
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Affiliation(s)
- M Schietroma
- Department of Surgery, University of L'Aquila, Coppito, Italy.
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Agnifili A, Schietroma M, Carloni A, Mattucci S, Caterino G, Carlei F. [Omentoplasty is effective in lowering the complications of ano-rectal resections]. MINERVA CHIR 2004; 59:363-8. [PMID: 15278031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM The aim of this prospective, randomized study was to investigate the influence of omentoplasty on complications following colorectal resection, Hartmann's intervention and abdominoperineal amputation. METHODS One hundred and seventy-one patients undergoing elective or emergency surgery for malignancy, benign tumor, diverticular disease and others were randomly assigned to omentoplasty (OP group) or not (NO group). The primary goal was to evaluate the rate of clinical and radiological anastomotic leakage. The secondary goal was to assess the morbidity (mainly septic complications) following Hartmann's and Miles' procedures. RESULTS In colorectal anastomosis, 18 patients (14.3%) had anastomotic leakage, 4 (6.4%) in the OP group and 14 (21.9%) in the NO group. Differences between the 2 groups were also found in terms of repeat operations (3.2% vs 14.1%) and deaths (3.2% vs 7.8%). Other factors associated with anastomotic leakage were the distal site of anastomosis (<5 cm from anal verge) and the emergency. In Hartmann's and Miles' procedures, septic complications were reduced in the OP group. CONCLUSION Omental wrap, with its mechanical and biological properties, seems to be effective in lowering the rate and the severity of complications after colorectal and anal surgery.
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Affiliation(s)
- A Agnifili
- Dipartimento di Scienze Chirurgiche, Università degli Studi di L'Aquila, L'Aquila, Italy.
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Schietroma M, Carlei F, Mownah A, Franchi L, Mazzotta C, Sozio A, Amicucci G. Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy. Surg Endosc 2004; 18:1090-6. [PMID: 15136925 DOI: 10.1007/s00464-003-8819-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Accepted: 09/08/2003] [Indexed: 12/13/2022]
Abstract
BACKGROUND It has long been known that a hypercoagulability state develops after surgery. A surge in circulating cytokine levels is also commonly found in the postoperative period. These cytokines have all been shown to be capable of inducing a hypercoagulability state. Recently laparoscopic cholecystectomy (LC) has been introduced, and its advantages over the open procedure seem related to the reduced surgical trauma. LC is associated with a diminished acute-phase response compared with the open procedure. Our present knowledge on the influence of laparoscopic upon coagulation and fibrinolysis is incomplete and based on a few studies. METHODS The aim of this prospective, nonrandomized study was to investigate hemostatic system alterations in patients who undergo open and laparoscopic cholecystectomy. In addition we also measured the plasma cytokine profile to explore any relationship between changes in plasma cytokine levels and postoperative coagulation profile. Between September 1999 and April 2002, 71 patients were nonrandomly assigned to open (group 1) or laparoscopic cholecystectomy (group 2). All patients from group 1 were operated by a surgical team different from ours, who prefers the OC procedure. The patients with acute cholecystitis were excluded. Prothrombin fragment 1.2 (F1.2), thrombin-antithrombin (TAT), fibrinogen, soluble fibrin, antithrombin III (AT), protein C, plasminogen, and D-dimer levels were measured at baseline and at 1, 24, 48, and 72 h postoperatively. Serial serum levels of IL-1beta and IL-6 were measured by colorimetric enzyme-linked immunosorbent assay (ELISA). RESULTS Plasma levels of F1.2, TAT, fibrinogen, soluble fibrin, and D-dimer increased significantly in group 1. Plasma levels of AT, protein C, and plasminogen decreased in both groups. In the OC group, the serum IL-3 and IL-6 levels began to significantly increased as early as 1 h from the beginning of the operation, revealing a peak at the sixth hour. When IL-6 and IL-1 levels were markedly elevated also, F1.2, fibrinogen, and soluble fibrin levels were increased. CONCLUSIONS Only mild hypercoagulability was observed in patients who had undergone laparoscopic cholecystectomy. The cytokine surge was correlated with hypercoagulability. There was in fact a positive correlation between IL-6 level and hypercoagulability. The correlation between cytokine levels and coagulation activation may be related to the type of surgery performed. Further studies are required to investigate these issues.
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Affiliation(s)
- M Schietroma
- Department of Surgery, University of L'Aquila, Via Vetoio, Blocco 11, 67100 Coppito (AQ), Italy.
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Carlei F, Perata E, Schietroma M, Ventura T, Natuzzi G, Rossi M, Capperucci G, Lezoche E. [Histochemical assessment of immunoreactivity of thyroid peroxidase and its correlation with biochemical activity]. Ann Ital Chir 2002; 73:259-61. [PMID: 12404891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Peroxidase content has been recently evaluated in normal thyroid and in different thyroid disorders by biochemical, histochemical, ultrastructural and immunocytochemical methods Nevertheless immunocytochemical detection of thyroid peroxidase in thyroid samples conventionally processed for histology hes never been done using a commercially available antibody, neither its correlation with the biochemical activity on adjacent samples. METHODS In this study we have analyzed normal thyroid tissue (3 patients), follicular adenoma (2 patients) and multinodular goiter (2 patients) conventionally processed for histology and stiined by immunocytochemistry (Avidin Biotin System) using a polyclonal (rabbit) antibody for horseradish peroxidase (Serotec). Biochemical assay was performed on adjacent samples according to Hosoya method. RESULTS Normal thyroid showed peroxidase immunoresectivity in the majority of follicular celis; neoplastic cells of adenomas were variably stained. Biochemical assay showed positive correlation with ICC ranging from 20.4 mg/mg/prot a in multinodular goiter to 42.12 in normal thyroid, up to 122 of follicular adenoma. CONCLUSIONS Peroxidase content in the thyroid gland may be of clinical interest in several thyroid diseases, and in this study we have demonstrated that thyroid peroxidase can be detected by ICC in routinely processed thyroid samples using a commercially available antibody.
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Affiliation(s)
- F Carlei
- P.O. Anagni Asl FR, Divisione di Chirurgia Geriatrica, Università degli Studi di L'Aquila
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Schietroma M, Carlei F, Liakos C, Rossi M, Carloni A, Enang GN, Pistoia MA. Laparoscopic versus open cholecystectomy. An analysis of clinical and financial aspects. Panminerva Med 2001; 43:239-42. [PMID: 11677417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The aim of this study is to assess the clinical and financial aspects of laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). METHODS Thirty-six patients treated with LC were prospectively, not randomized, compared with 35 patients that underwent OC. The data used were taken from local registers, patient-statistics and hospital accounting systems. We evaluated the costs, morbidity and mortality for both surgical procedures. RESULTS Significant differences were observed concerning the number of days that pain was suffered (mean 7.6 days in LC versus 18.5 days in OC), the duration of postoperative hospitalization (LC mean 2-3 days; OC 7-9 days), the extent of postoperative monitoring performed, and the number of days in order to return to normal activity (mean 4.4 days in LC; mean 7.6 days in OC). Calculation of the costs was based on the Diagnosis Related Groups (DRG). The profit for a DRG is the result of the difference between the reimbursement obtained from the execution of the operation and the cost in order to carry it out. The total cost for the execution of LC is Italian 3,332,632 pound sterling with a profit of Italian 1,208,807 pound sterling while for OC the cost is 4,007,359 pound sterling and the profit is 347,041 pound sterling. CONCLUSIONS The results of our study is that, clinically and financially, LC has obvious advantages over OC.
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Affiliation(s)
- M Schietroma
- Chair of Geriatric Surgery, Department of Surgical Sciences, University of L'Aquila, L'Aquila, Italy
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Schietroma M, Carlei F, Rossi M, Mattucci S, Gullà N, Lezoche E. Neutrophil-elastase in patients undergoing open versus laparoscopic cholecystectomy. Surgery 2001; 130:898. [PMID: 11685204 DOI: 10.1067/msy.2001.117374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Agnifili A, Schietroma M, Mattucci S, Carloni A, Caterino G, Rossi M, Pistoia MA, Carlei F. [Polyps (single or multiple) and juvenile polyposis]. MINERVA CHIR 2001; 56:507-18. [PMID: 11568727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The authors underline the important aspects of juvenile familial polyposis (JFP), a disease transmitted as an autosomal dominant trait. A case of JFP characterized by the presence of hundreds of polyps in the colo-rectal intestinal tract, is analyzed. The single juvenile polyp, multiple polyps (=/>5 polyps) and the sporadic form are examined. These are mucous hamartomas which can undergo neoplastic transformation (in carcinoma in 68% of untreated cases), a behaviour similar to that of adenomatous polyps. They differ from the later due to the following features: epidemiology (earlier appearance age), anatomopathology (stroma), clinical observation (self-recovery in some cases) and genetics (10q23.3-18q21, genetic mutations in a locus different those of adenomatous polyps). It is also necessary to determine its extension by means of colonoscopy, ileoscopy, gastroscopy and small bowel barium enema. Patients' screening through construction of the genealogical family tree is fundamental. Isolation of possible degenerative aspects of the polyps through biopsy is also fundamental. Single or multiple polyps are treated endoscopically, the juvenile polyposis is treated surgically (colectomy, total colectomy). A rigorous follow-up of the patients and their family members is recommended.
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Affiliation(s)
- A Agnifili
- Cattedra di Chirurgia Geriatrica, Università degli Studi, L'Aquila, Italy
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Schietroma M, Carlei F, Altilia F, Carloni A, Mattucci S, Agnifili A, Maira E, Antonellis M. The role of laparoscopic adhesiolysis in chronic abdominal pain. MINERVA CHIR 2001; 56:461-5. [PMID: 11568720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Intraperitoneal adhesions seem to be a possible cause of chronic abdominal pain, but reports of their etiological role are controversial. Laparoscopic adhesiolysis has been proposed as treatment of choice, even tough reports of success are contradictory. The aim of our prospective study, was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with pathological abdominal adhesions. METHODS Forty-five patients with chronic abdominal pain, lasting for more than 6 months, without abnormal findings other than pathological intraperitoneal adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. RESULTS Forty-one patients (91.1%) were available for follow-up after an average time interval of 18 months (range: 12-41 months): 24 patients (58.5%) were free from abdominal pain; 10 (24.4%) reported significant amelioration of pain, while 7 (17.1%) patients had no amelioration. CONCLUSIONS Laparoscopy is an efficient means of assessing patients with chronic abdominal pain, and laparoscopic adhesiolysis cures or ameliorates. Chronic abdominal pain in more than 80% of patients.
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Affiliation(s)
- M Schietroma
- Chair of Geriatric Surgery, Department of Surgical Sciences, Faculty of Medicine and Surgery, University of L'Aquila, L'Aquila, Italy
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Schietroma M, Carlei F, Perata E, Capperucci G, Perata A, Natuzzi G, Simi M. [Subcutaneous emphysema. Complication associated with pneumoperitoneum during videolaparoscopic cholecystectomy]. MINERVA CHIR 2001; 56:405-7. [PMID: 11460077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Diagnostic and therapeutic laparoscopy is a safe procedure, which, however, is not without complications. The rare occurrence of subcutaneous emphysema, as a consequence of pneumoperitoneum, following laparoscopic cholecystectomy, is reported. The mechanism for the development of this complication and its management are discussed.
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Affiliation(s)
- M Schietroma
- Divisione di Chirurgia Geriatrica, Università degli Studi, L'Aquila, Italy
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Schietroma M, Rossi M, Fraioli F, Liakos C, Carloni A, Mattucci S, Carlei F, Pistoia MA. [Inflammatory markers after laparoscopy versus laparotomy cholecystectomy]. Ann Ital Chir 2001; 72:477-82; discussion 482-3. [PMID: 11865703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The study is carried out to determine whether the level of IL-6 is altered and in what way after surgery as well as if such a change could be an indicator of increased morbidity after surgical treatment. MATERIALS OF THE STUDY: Chemiluminesence immunoeassay system was used in order to establish IL-6 level in blood samples of 71 patients that underwent abdominal surgery, 36 Laparoscopic Cholecystectomy (LC) and 35 Open Cholecystectomy (OC) at time 0 (before the operation), 1 h, 2 h, 3 h, 6 h, 24 h and 48 h after the operation. RESULTS Plasma IL-6 levels are significantly increased after OC; we observed 3 cases of post-operative infections, in which IL-6 returned to normal levels 6 days after surgery. Analogous variation to the IL-6 levels was noted for the C-reactive protein levels. DISCUSSION Laparoscopic cholecystectomy, a so called mini-invasive surgical procedure, is associated to a small increase of IL-6 serum levels and provides better post-operative conditions to the patients by reducing surgical stress and the infectious complications correlated to the surgical procedure. CONCLUSIONS During OC there is a significant higher elevation of IL-6 serum levels than after laparoscopic cholecystectomy. Variation of C-reactive protein serum levels after surgery is analogous to variation of IL-6 levels.
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Affiliation(s)
- M Schietroma
- Facoltà di Medicina e Chirurgia Dipartimento di Scienze Chirurgiche Divisione di Chirurgia Geriatrica, Università degli Studi di L'Aquila
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Schietroma M, Carlei F, Lezoche E, Rossi M, Liakos CH, Mattucci S, Lygidakis NJ. Acute biliary pancreatitis: staging and management. Hepatogastroenterology 2001; 48:988-93. [PMID: 11490855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND/AIMS Acute biliary pancreatitis is a clinical entity with a high morbidity rate (15-50%) and mortality rate (20-35%). Early diagnosis has a primary importance for an appropriate treatment (75% of cases of idiopathic acute pancreatitis are of biliary origin). METHODOLOGY Diagnosis of acute biliary pancreatitis in 78 patients was based on careful clinical and instrumental assessment: ultrasonography (76.9% of cases) and laboratory tests in 23.1% of cases. In our study we used the Ranson and APACHE II scores and 24 of the cases (30.7%) were classified as severe, while 54 (69.2%) were mild. All patients with severe acute biliary pancreatitis underwent emergency endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy (within 24-48 hours) followed by laparoscopic cholecystectomy (10 days). Patients with mild acute biliary pancreatitis underwent laparoscopic cholecystectomy associated with intraoperative cholangiography, within 10 days. RESULTS In 19 patients with severe acute biliary pancreatitis operative endoscopy was curative. Subsequent laparoscopic cholecystectomy provoked subcutaneous emphysema only in one case but did not show any other serious morbidity. In the remaining 5 cases laparotomy was required because of necrosis, with a mortality rate of 60%. In all cases of mild acute biliary pancreatitis, laparoscopic cholecystectomy was successfully performed with a morbidity rate of 7.3%. Common bile duct stones were revealed with intraoperative cholangiography in 31.4% of the mild cases and in 75% of the severe cases. CONCLUSIONS In conclusion acute biliary pancreatitis treatment is always surgical; in almost all severe cases it is performed with minimally invasive procedures (endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy with laparoscopic cholecystectomy < or = 10 days) if surgery is carried out within 24-48 hrs, as well in the mild cases (laparoscopic cholecystectomy + intraoperative cholangiography) when surgery is performed within 10 days.
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Affiliation(s)
- M Schietroma
- Department of Surgery, University of L'Aquila, Aquila
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Perata E, Severoni S, Schietroma M, Rossi M, Perata A, Natuzzi G, Coiera F, Carlei F, Palmieri R, Capperucci G. [Post-partum vesicovaginal fistula: abdominal muscle strip treatment]. Minerva Ginecol 2001; 53:165-70. [PMID: 11395688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The Vesico-Vaginal Fistula (VVF) very often occur in tropical countries, but their treatment is usually not correct. METHODS A surgical treatment was carried put on 68 patients affected by VVF from March 1986 to December 19997 in the Nazareth Hospital (Nairobi). Their mean age was 22 years old; 27 patients (39.7%) underwent surgery for the first time, while for 41 patients (60.2%) the treatment was repeated. Fourteen patients (20.5%) had also Vesico-Rectum-Vaginal Fistula (VRV). The VVF was cured with a transvaginal treatment using a Martius strip for 32 cases. For 16 cases both vaginal and abdominal treatment was performed in the same time using an abdominal muscle strip, which was inserted in the space between the vagina and bladder. In VRV and VVF combined cases, the VVF was treated in the following way: first of all, during the same session, the VVF was cured by making a colostomy and then, after 2 months VRV was treated. RESULTS The follow-up took about 7.2 months; 62 patients (91.1%) recovered, for 6 cases treated only with transvaginal operation, it has been necessary a second surgical procedure owing to relapsing, and for 2 of them an abdominal muscle strip was used. CONCLUSIONS In conclusion, while the transvaginal repair is satisfactory treatment for little fistula never surgically treated before, on the other hand the transabdominal vaginal treatment is the best cure forge large or relapsing fistulas.
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Affiliation(s)
- E Perata
- U.O. Chirurgia Addominale e d Urgenza, P.O. Anagni, ASL, Frosinone, Italy
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Schietroma M, Carlei F, Lezoche E, Agnifili A, Enang GN, Mattucci S, Minervini S, Lygidakis NJ. Evaluation of immune response in patients after open or laparoscopic cholecystectomy. Hepatogastroenterology 2001; 48:642-6. [PMID: 11462893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND/AIMS Laparoscopic cholecystectomy is a so called mini-invasive surgical procedure, and on this basis, we investigated whether and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. METHODOLOGY In a prospective, nonrandomized trial, 35 patients underwent laparoscopic cholecystectomy and 31 open cholecystectomy. Immune activity (neutrophils, total lymphocytes, lymphocyte subpopulations, human leukocyte antigen (HLA-DR), interleukin 6, skin Multitest) was evaluated before surgery and respectively, 1, 3, and 6 days postoperatively. RESULTS One day after surgery, an increase in interleukin 6 (P < 0.01) was noted in patients who had undergone open cholecystectomy, while this parameter was almost unchanged in patients with laparoscopic cholecystectomy. Moreover, skin tests showed a hypo or anergic response in the majority (81.8%) of open cholecystectomy patients compared to laparoscopic cholecystectomy patients (10.5%), (P < 0.01). Finally, monocyte antigen HLA-DR was also reduced in open cholecystectomy patients (P < 0.05). In this group, we noted 2 cases (6.45%) of respiratory tract infection. CONCLUSIONS Even though laparoscopic cholecystectomy requires a longer surgery, it reduces postoperative pain, and hospitalization. It also facilitates rapid recovery, a return to normal activity, avoids postoperative immunosuppression and shows a better postoperative morbidity compared to open surgery.
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Affiliation(s)
- M Schietroma
- Department of Experimental Medicine, Universita degli Studi di L'Aquila, Via Vetoio, Blocco 11, Coppito, 67100 L'Aquila (AQ), Italy
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Schietroma M, Recchia CL, Carlei F, Rossi M, Enang GN, Pistoia MA, Orsini S, Simi M. [The general surgeon's experience in emergency gynaecological laparoscopy]. MINERVA CHIR 2001; 56:133-8. [PMID: 11353345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Early laparoscopy plays a very important role in the diagnosis and treatment of uncertain surgical diseases. Its use is not very clear, in part because it is a very new technique and secondly because its application in emergency surgery is very recent. The aim of this study is to evaluate the efficacy of this surgical approach. METHODS In the last six years, during emergency laparoscopy, we diagnosed various gynaecological diseases. We performed 4 ovarian cystectomies (25%), 2 salpingectomies (12.5%), 6 salpingo-oophorectomies (37.5%), 2 myomectomies (18.75%), 1 endocoagulation (6.25%). RESULTS Neither conversion in open surgery, nor major postoperatory complications were noted. Intervention time was shorter than that of the open technique. Return to normal activity was earlier. CONCLUSIONS The results of this study contribute to demonstrate that, in emergency surgery, laparoscopy constitute a valid and efficient diagnostic and therapeutic technique. It is indicated for the treatment of acute abdomen of unknown origin.
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Affiliation(s)
- M Schietroma
- Divisione di Chirurgia Geriatrica, Università degli Studi, L Aquila, Italy
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29
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Agnifili A, Rossi M, Pistoia F, Lombardi L, Schietroma M, Carloni A, Mattucci S, Carlei F, Pistoia MA. [Endoscopic diagnosis and treatment of juvenile solitary polyps, in the light of the unusual but proven neoplastic potential]. Ann Ital Chir 2001; 72:73-8. [PMID: 11464500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
For many years a neoplastic potentiality of the juvenile polyps has been denied. The authors performed a critical review of the international literature about the neoplastic transformation of the juvenile polyps. Each examined case had to respect three conditions: 1) exhaustive hystological findings certifying a clear neoplastic degeneration of a juvenile polyp; 2) clear evidence of single juvenile polyposis (< 5), presence in the colon and rectum only and absence of familiarity; 3) reliable diagnostic practice (endoscopic and/or hystological evidence). During the review we collected 271 cases of juvenile polyposis observed in 12 countries, 97 of which (35.79%) showed neoplastic transformation, adenomatous type in 50 (18.45%) and carcinomatous type in 47 (17.34%), and 13 cases of neoplastic degeneration of single juvenile polyps. The review shows clearly and strongly that the risk of cancer in the juvenile polyposis can reach the risk of the adenomatous polyposis. The neoplastic degeneration exists in the single juvenile polyps even if in a lower degree.
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Affiliation(s)
- A Agnifili
- Università degli Studi di L'Aquila Dipartimento di Scienze Chirurgiche I Divisione di Chirurgia Geriatrica
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30
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Schietroma M, Rossi M, Tinca CA, Liakos C, Mattucci S, Carlei F, Pistoia MA. [Structure, function, and levels of neutrophil elastase after laparoscopic cholecystectomy]. Chir Ital 2000; 52:567-72. [PMID: 11190551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Neutrophil elastase is a neutral proteinase present mainly in the azurophilic granules of segmented granulocytes, the main cells involved in the inflammatory response reaction. In our study we attempted to determine whether an enzyme such as neutrophil elastase produced by polymorpho-nuclear leukocytes could be an indicator capable of determining the degree of surgical trauma, comparing two surgical approaches, namely, laparoscopic cholecystectomy and open cholecystectomy. Plasma neutrophil elastase was determined photometrically, using an immune-activation immunoassay, in 66 patients (32 patients underwent open cholecystectomy and 34 laparoscopic cholecystectomy) 1 day before surgery and 1, 3, 6 and 12 days after surgery. We established a reference range for elastase by measuring the serum elastase concentration in 48 healthy control patients. A significant increase (p < 0.05) in plasma neutrophil elastase levels was observed on days 1, 3 and 6 after surgery in patients undergoing open cholecystectomy, whereas the levels of the enzyme were almost stable in patients undergoing laparoscopic cholecystectomy. We recorded two cases (6.2%) of respiratory tract infections in the "open" group. Neutrophil elastase is a good indicator for discriminating the severity of the surgical trauma, which is certainly more severe in laparotomy than in laparascopic cholecystectomy. Peripheral leukocyte function seems to be better preserved after laparoscopic surgery than after laparotomy.
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Affiliation(s)
- M Schietroma
- Divisione di Chirurgia Geriatrica, Facoltà di Medicina e Chirurgia, Università degli Studi di L'Aquila
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31
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Agnifili A, Schietroma M, Mattucci S, Rossi M, Carloni A, Caterino G, Pistoia MA, Carlei F. [Clinical assessment of juvenile polyposis with particular reference to the risk of neoplastic malignancy. Analysis of 412 patients reported in the international literature]. Chir Ital 2000; 52:393-404. [PMID: 11190530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors extensively review the international literature on juvenile polyposis, with particular reference to the risk of malignancy in the various forms of the disease (colorectal vs. generalized, familial vs. sporadic). Sixty-eight out of a total of 412 patients presented adenomatous changes in the polyps. In addition, 68 cancers were found. The rate of degeneration was analysed for all variants of juvenile polyposis, but no statistically significant differences were detected. The authors conclude that juvenile polyposis should be considered as being as challenging to the surgeon as familial polyposis syndromes and outline protocols for the screening, endoscopic and surgical treatment and follow-up of these patients.
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Affiliation(s)
- A Agnifili
- Divisione di Chirurgia Geriatrica, Dipartimento di Scienze Chirurgiche, Facoltà di Medicina e Chirurgia, Università degli Studi di L'Aquila, Via Vetoio, Blocco 11, Coppito, 67100 L'Aquila
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32
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Schietroma M, Lattanzio R, Risetti A, Rossi M, Carlei F, Cerimele M, Bellucci N, Pistoia MA, Simi M. [Diagnosis of severity as a basic parameter in the treatment of acute biliary pancreatitis]. MINERVA CHIR 2000; 55:421-9. [PMID: 11059236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish their severity in order to plan the appropriate treatment. METHODS 58 ABP patients were diagnosed by ultrasound (77.5%) or by laboratory findings (22.4%). Following Ranson and APACHE II scoring 17 cases (29.3%) were classified as severe, 41 (70.6%) as mild. All patients with severe ABP, had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. RESULTS In severe cases operative endoscopy cured pancreatic inflammation in 12 cases. Subsequent LC never showed serious morbidity, apart from subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 7.3% morbidity. IOC showed choledochal stones in 31.7% of cases, while in severe cases stones in the biliary tree were shown in 88.2% of cases. CONCLUSIONS In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days.
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Affiliation(s)
- M Schietroma
- Cattedra di Chirurgia Generale II, Università degli Studi, L'Aquila
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Schietroma M, Mattucci S, Rossi M, Agnifili A, Pistoia MA, Carlei F. [Is cell-mediated immunity affected by laparoscopic cholecystectomy?]. Chir Ital 2000; 52:271-7. [PMID: 10932372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
It is well known that surgery significantly decreases cell-mediated immunity. Laparoscopic cholecystectomy is a so-called minimally invasive surgical procedure, and on the basis of this consideration we investigated whether and how the immune system is modified in patients after laparoscopic cholecystectomy compared to those undergoing open cholecystectomy. Immune activity (neutrophils, total lymphocyte count, lymphocyte subpopulations, multiple skin tests) was evaluated in 82 patients on postoperative day 1 and on postoperative days 1, 3 and 6. Forty-two patients underwent open cholecystectomy and 40 laparoscopic cholecystectomy. On postoperative day 1 patients treated by open cholecystectomy showed a significant increase (P < 0.05) in plasma neutrophils, whereas this parameter was unchanged in patients undergoing laparoscopic cholecystectomy. Skin tests revealed a hypo- or anergic response in the majority of patients (81.8%) undergoing open surgery compared to those treated laparoscopically (10.5%). Total lymphocyte count and lymphocyte subpopulations were normal in the two groups. Four cases of respiratory tract infection (4.8%) were detected after open cholecystectomy. Laparoscopic cholecystectomy substantially reduces postoperative pain and hospitalisation, promotes an earlier recovery and return to normal activity and is not associated with postoperative immunosuppression, with a more positive postoperative morbidity profile compared to open surgery.
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Affiliation(s)
- M Schietroma
- Dipartimento di Scienze Chirurgiche, Facoltà di Medicina e Chirurgia, Università degli Studi di L'Aquila
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Carloni A, Perri S, Gola P, Lotti R, Caterino G, Altilia F, Schietroma M, Citone G. [Adenocarcinoma of the duodenojejunal flexure. A report of 2 clinical cases and a review of the literature]. Ann Ital Chir 2000; 71:133-8. [PMID: 10829536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The authors report two cases of adenocarcinoma of the duodenojejunal angle and remark the rarity of this pathology, the difficulty of making diagnosis peculiar to neoplasm of the small intestine and the difficulty of treatment peculiar to tumours of the duodenum. According to the literature the diagnosis was determined through X-ray films, after traditional endoscopy was inadequate. Surgical treatment is radical, with extensive exeresis procedures (unless the mesenteric upper vessels are infiltrated) since the prognosis of this tumours is good.
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Affiliation(s)
- A Carloni
- Dipartimento di Discipline Chirurgiche, Facoltà di Medicina e Chirurgia, Università degli Studi di L'Aquila
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35
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Schietroma M, Lattanzio R, Risetti A, Di Placido R, Carlei F, Leardi S, Mattucci S, Bellucci N, Pistoia MA, Simi M. [Treatment of acute biliary pancreatitis in the aged in the endolaparoscopic era]. MINERVA CHIR 1999; 54:677-84. [PMID: 10575889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish the severity in order to plan the appropriate treatment. METHODS In this study we have considered 61 patients divided into 2 groups. Group 1 had 29 ABP patients aging less than 65 years, group 232 patients aging more than 65 years; the diagnosis was made by ultrasound and serological values in 78.5% of cases, while in the remaining 21.5% was only serological. Following Ranson and APACHE II scoring 18 cases (29.5%) were classified as severe [6 (20.6%) in group 1; 12 (37.5%) in group 2: p < 0.01], 43 (70.4%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. RESULTS In severe cases operative endoscopy cured pancreatic inflammation in 13 cases. Subsequent LC never showed serious morbidity, apart subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 6.9% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 88.8% of cases. No significant differences were detected between group 1 and 2. CONCLUSIONS In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days, independently from the age of the patients.
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Affiliation(s)
- M Schietroma
- Dipartimento di Discipline Chirurgiche, Università degli Studi, L'Aquila
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36
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Carlei F, Schietroma M, Cianca G, Risetti A, Mattucci S, Ngome Enang G, Simi M. Effects of laparoscopic and conventional (open) cholecystectomy on human leukocyte antigen-DR expression in peripheral blood monocytes: correlations with immunologic status. World J Surg 1999; 23:18-22. [PMID: 9841758 DOI: 10.1007/s002689900559] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy (LC) is a "miniinvasive" surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity [neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen-DR (HLA-DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent "open" cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA-DR was reduced in patients with "open" cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the "open" group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with less p.o. morbidity compared to that seen with open surgery.
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Affiliation(s)
- F Carlei
- Department of Experimental Medicine, University of L'Aquila, Via Vetoio, Coppito 2, Coppito, L'Aquila, Italy
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Cutilli T, Schietroma M, Marcelli VA, Ascani G, Corbacelli A. Giant cervico-mediastinal lipoma. A clinical case. Minerva Stomatol 1999; 48:23-8. [PMID: 10356948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest X-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.
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Leardi S, Altilia F, Pietroletti R, Risetti A, Schietroma M, Simi M. [DRG and gastrointestinal surgery]. Ann Ital Chir 1999; 70:45-9. [PMID: 10367506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The diagnosis-related-groups (DRG) is the cost-based system for hospital reimbursement. However, the proceeds does not coincide with the costs. Aim of the study was to identify the profit, which we could gained with 147, 155, 158, 162, 165, 198 gastrointestinal surgery DRG. 30 consecutive patients, undergone to surgery in Clinica Chirurgica of L'Aquila University, had been studied. We had calculated the daily costs of medical and nursing practice, diagnostic tests, drugs, hospitalization, surgical instruments for every patient's therapy. The DRG-proceeds had been correlated with the DRG-costs. The "major gastrointestinal surgery" had not profit (147 DRG: anterior resection of rectum = -354428 Pounds, Miles = -94020 Pounds; 155 DRG: total gastrectomy = -1920641 Pounds). On the contrary, "minimal surgery" had good profits (158 DRG: hemorroidectomy with local anestesia = 1469605 Pounds;162 DRG: sutureless groin hernioplasty = 1561200 Pounds; 198 DRG: videolaparochole-cystectomy: 1208807 Pounds). The study seems to demonstrate the disparity of the reimbursement system related to DRG. However, the surgeons, as managers, must employ warily the resources for producing DRG.
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Affiliation(s)
- S Leardi
- Dipartimento di Discipline Chirurgiche, Università di L'Aquila
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Schietroma M, Risetti A, Carlei F, Navarra L, Tozzi D, Simi M. [The influence of laparoscopic cholecystectomy vs laparotomy on the monocyte antigen expression (HLA-DR)]. Ann Ital Chir 1998; 69:619-23; discussion 623-6. [PMID: 10052213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
It is well known that surgery significantly decrenses immune responses. Laparoscopic cholecystectomy (LC) is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymfocytes count, lymphocytes subpopulations, HLA-DR) was evaluated in 53 patients one day before surgery and p.o. after 1. 3 and 6 days; 26 patients underwent "open" cholecystectomy and 27 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < = 0.05) of plasma neutrophils, while these parameters were almost unchanged in patients with L.C. Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (7.6%) of respiratory tract infection. In conclusion LC, strongly reduces p.o. pain, hospitalization, promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with better p.o. morbidity compare to open surgery.
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Affiliation(s)
- M Schietroma
- Dipartimento di Discipline Chirurgiche, Università degli Studi di L'Aquila
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40
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Carlei F, Schietroma M, Ventura T, Risetti A, Casciani G, Mattucci S, Baschieri I, Lezoche E, Simi M. Immunohistochemical assessment of peroxidase-like immunoreactivity in the thyroid gland and its correlation with biochemical assay. MINERVA CHIR 1998; 53:511-4. [PMID: 9774843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Peroxidase content has been recently evaluated in normal thyroid and in different thyroid disorders by biochemical, histochemical, ultrastructural and immunocytochemical methods. Nevertheless immunocytochemical detection of thyroid peroxidase in thyroid samples conventionally processed for histology has never been done using a commercially available antibody, neither its correlation with the biochemical activity on adjacent samples. METHODS In this study we have analyzed normal thyroid tissue (3 patients), follicular adenoma (2 patients) and multinodular goiter (2 patients) conventionally processed for histology and stained by immunocytochemistry (Avidin Biotin System) using a polyclonal (rabbit) antibody for horseradish peroxidase (Serotec). Biochemical assay was performed on adjacent samples according to Hosoya method. RESULTS Normal thyroid showed peroxidase immunoreactivity in the majority of follicular cells; neoplastic cells of adenomas were variably stained. Biochemical assay showed positive correlation with ICC ranging from 20.4 micrograms/mg/prot a in multinodular goiter to 42.12 in normal thyroid, up to 122 of follicular adenoma. CONCLUSIONS Peroxidase content in the thyroid gland may be of clinical interest in several thyroid diseases, and in this study we have demonstrated that thyroid peroxidase can be detected by ICC in routinely processed thyroid samples using a commercially available antibody.
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Affiliation(s)
- F Carlei
- Dipartimento di Medicina Sperimentale, Università degli Studi, L'Aquila
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41
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Schietroma M, Risetti A, Carlei F, Maggi G, Cianca G, De Santis C, Centi D, Iannucci D, Recchia CL, Mattucci S, Simi M. [Response of interleukin-6 in patients undergoing a laparoscopic or laparotomic cholecystectomy]. MINERVA CHIR 1998; 53:359-62. [PMID: 9780623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND It is well known that surgery induces an acute inflammatory response associated with significant increase of interleukin-6 (IL-6) and C reactive protein (CRP). Laparoscopic cholecystectomy (LC) is a so called "mini-invasive" surgical intervention and on the basis of this consideration it has been investigated if and how serological markers of inflammation are modified in patients after laparoscopic cholecystectomy compared to patients undergoing open cholecystectomy. METHODS The acute phase of inflammation (IL-6, CRP and body temperature) was evaluated in 53 patients one day before surgery and p.o. after 1, 3 and 6 days; 26 patients underwent "open" cholecystectomy and 27 LC. RESULTS One day after surgery patients with open cholecystectomy showed significant increase (p < 0.05) of IL-6, CRP and body temperature, while these parameters were almost unchanged in patients with LC. In patients with "open" cholecystectomy, 2 p.o. complications (pneumonia) were observed. CONCLUSIONS In conclusion, LC, although it requires longer operative time, strongly reduces p.o. pain, hospitalization, promotes earlier recovery and return to normal activity, avoiding the acute phase of p.o. inflammation with better p.o. morbidity compared to open surgery.
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Affiliation(s)
- M Schietroma
- Divisione di Discipline Chirurgiche, Cattedra di Chirurgia Generale II, Università degli Studi, L'Aquila
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42
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Schietroma M, Lattanzio R, Risetti A, Di Placido R, Carlei F, Cianca G, Cerimele M, Bellucci N, Pistoia MA, Simi M. [Acute biliary pancreatitis: mini-invasive treatment]. Chir Ital 1998; 48:21-5. [PMID: 9522095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial clearly assessing the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and establishing the severity in order to plan the appropriate treatment. Forty-nine ABP patients were diagnosed by ultrasound (75.5%) or by laboratory findings (22.5%). Following Ranson and APACHE II scoring, 15 cases (30.6%) were classified as severe, 34 (69.3%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hours) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. In severe cases operative endoscopy cured pancreatic inflammation in 11 cases. Subsequent LC never showed serious morbidity, but subcutaneous emphysema in one case. In 4 cases laparotomy was required since pancreatic necrosis was present, with 75% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 8.8% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 80% of cases. In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hours as well as in mild cases (LC + IOC) when surgery is done within 10 days.
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Affiliation(s)
- M Schietroma
- Dipartimento di Discipline Chirurgiche, Università degli Studi di L'Aquila
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Schietroma M, Risetti A, Carlei F, Cianca G, Mattucci S, Maggi G, Recchia CL, De Santis C, Simi M. [Acute cholecystitis: video-laparoscopic or laparotomic treatment? Role of the immune system]. Chir Ital 1998; 48:27-31. [PMID: 9522096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.
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Affiliation(s)
- M Schietroma
- Cattedra di Chirurgia Generale, Università degli Studi, L'Aquila
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44
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Carlei F, Lezoche E, Lomanto D, Schietroma M, Paganini A, Sottili M, Nardovino M. Cholecystoenteric fistula is not a contraindication for laparoscopic cholecystectomy: report of five cases treated by laparoscopic approach. Surg Laparosc Endosc Percutan Tech 1997; 7:403-6. [PMID: 9348621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors present five cases (three female, two male, mean age 50.8) of cholecystoduodenal fistula incidentally discovered during laparoscopic cholecystectomy and treated by laparoscopic approach. The laparoscopic technique adopted is described and all patients recovered promptly with no immediate or long-term post-operative complications. Discharge from the hospital was after 4.5 days, and after 6 months follow-up all patients were in good clinical condition. These results indicate that when the surgeon is skilled in advanced laparoscopic operative techniques such as duodenal mobilization and intracorporeal suturing and knotting, cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment.
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Affiliation(s)
- F Carlei
- Dipartimento di Medicina Sperimentale, Universita degli Studi di L Aquila, Italy
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45
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Schietroma M, Carlei F, Ciuca B, Risetti A, Iannucci D, Leardi S, Muzi F, De Santis C, Di Placido R, Recchia CL, Maggi G, Simi M. [Video laparoscopic cholecystectomy in acute cholecystitis: when,how and why?]. MINERVA CHIR 1997; 52:515-22. [PMID: 9297138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute cholecystitis has been previously considered as contraindication for laparoscopic cholecystectomy (LC), but recently, several studies have demonstrated that the laparoscopic approach can also be effective in such cases, although iatrogenic lesions of the biliary tree have been increasingly reported. Aim of this study was to verify the effectiveness of LC in patients presenting with acute cholecystitis on the basis of preoperative and intraoperative findings, postoperative mortality and morbidity, in order to assess those conditions which still can be considered as contraindications for LC. From September 1992 to January 1995, 133 patients have been consecutively admitted and operated for LC. 46 cases (36.5%) had histologically proven acute cholecystitis. Moreover we have compared preoperative date (clinical history, laboratory findings, Rx and ultrasound evaluation) with intraoperative findings to assess a correlation with intraoperative difficult conditions evaluated according to De Manzini score. Our results demonstrate that clinical data significantly correlate with intraoperative difficult situations. Hepatobiliary ultrasound also has shown good correlation between the thickness of gallbladder wall and difficult operations (73.9 sensibility-70.1 specificity). Therefore, in patients with clinically severe acute cholecystitis, and thickened gallbladder demonstrated by ultrasound it is very likely that the surgeon will experience difficult in intraoperative situations. In these conditions laparoscopy may be considered mainly as a diagnostic procedure in order to evaluate the entity of inflammatory changes considering the possibility of an open conversion that must be done before any iatrogenic lesion occur. This policy has allowed us to avoid in our series postoperative complications such as lesions of the biliary tree. In conclusion we believe that LC for acute cholecystitis should be considered as a therapeutical option only for selected cases.
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Affiliation(s)
- M Schietroma
- Clinica Chirurgica, Università degli Studi di L'Aquila
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46
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Del Cimmuto P, Schietroma M, Capanna A, Carlei F, Muzi F, De Berardinis O, Saragani G, Prosperi A, Recchia CL. [Digestive endometriosis: an isolated case localized in the ileum and occlusive course]. MINERVA CHIR 1996; 51:701-5. [PMID: 9082235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors starting from the description of a clinical case of intestinal endometriosis, who underwent emergency surgery for acute intestinal obstruction, take into consideration the incidence, the pathogenesis and the pathological characteristics of intestinal endometriosis. They attempt to define it while accepting that the indications for resection should be extremely limited from both gynecological and intestinal points view.
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Affiliation(s)
- P Del Cimmuto
- Clinica Chirurgica, Università degli Studi di L'Aquila
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47
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Simi M, Schietroma M, Carlei F, Iannucci D, Cianca G, Leardi S. Is laparoscopic cholecystectomy a safe alternative to open cholecystectomy for pediatric patients with cholelithiasis? Endoscopy 1996; 28:312-5. [PMID: 8781799 DOI: 10.1055/s-2007-1005462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The results with five pediatric patients (6-15 years) who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis are reported here. One patient had associated hematological disease (sickle-cell anemia). All five children were submitted to surgery using the laparoscopic technique. Intraoperative cholangiography was performed in two cases with uncertain ductal and vascular intraoperative anatomy. None of the operations was converted to open cholecystectomy, and there were no operative complications. The mean hospital stay was 2.2 days (range 2-3 days). All five children were able to return to normal activity within a week. No long-term complications were seen in any of the patients during an average follow-up period of 10.6 months (range 8-14). We believe that laparoscopic cholecystectomy in children is safe and effective, and that it is an important alternative to open cholecystectomy. However, prospective comparative studies of the procedure are necessary.
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Affiliation(s)
- M Simi
- Surgical Clinic, University of L'Aquila, L'Aquila, Italy
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48
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Schietroma M, Risetti A, Carlei F, Santirocco MV, Muzi F, Maggi G, De Santis C, Recchia CL, Iannucci D, Rampa R, Simi M. [Chronic abdominal pain: role of video-laparoscopic adhesiolysis]. Chir Ital 1996; 48:43-46. [PMID: 9522099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Adhesions have been suggested as a possible cause of chronic abdominal pain, but the reports of their etiological role conflict. Lysis of adhesions has been proposed as the therapeutic modality of choice, although the reports of success are controversial. The aim our prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-one patients with chronic abdominal pain lasting for more than 6 months, but with no abnormal findings other than adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. 37 patients (90.2%) were available for follow-up after a median time interval of 18 months (range: 12-41 months). Twenty-two patients (59.4%) were free from abdominal pain and 9 (24.3%) patients reported significant amelioration of their pain. Six (16.2%) patients had no amelioration. In conclusion the laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures of ameliorates chronic abdominal pain in more than 80% of patients.
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Affiliation(s)
- M Schietroma
- Cattedra di Chirurgia Generale, Università degli Studi, L'Aquila
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49
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Schietroma M, Carlei F, Iannucci D, Leardi S, Cianca G, Risetti A, Muzi F, De Matteis F, Simi M. [THe video laparoscopic experience of the general surgeon in cholecystectomy in childhood]. Minerva Pediatr 1996; 48:21-7. [PMID: 9072661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Despite the exponentially increasing number of laparoscopic cholecystectomies on adults to date, there is a paucity of reports in the literature about this new technique in pediatric patients. From September 1992 to February 1995, 140 patients underwent laparoscopic cholecystectomy. Since July 1993, in our institution, five pediatric patients (three females and two males) with a diagnosis of cholelithiasis underwent laparoscopic cholecystectomy. The age of the patients ranged from 6 to 15 years (mean 8.8 years) and they weighed 18-58 kg (mean 28.4 kg). All five patients had biliary cholic and ultrasound evidence of cholelithiasis. One patient had associated hematological disease (sickle cell disease). All 5 children were operated using the laparoscopic approach technique. Operative cholangiography was performed in cases with ductal and vascular intraoperative anatomy unclear. No operation was converted to open cholecystectomy. Intraoperative cholangiography was performed successfully (100%). The mean time of surgery was 50.2 minutes (range from 38 to 68). There were no operative complications. The mean hospital stay was 2.2 days (range 2 to 3 days). All five returned to their activity within a week. No long-term complications were seen in all patients throughout an average follow-up period of 10.6 months (range 8-14). The benefits of laparoscopic cholecystectomy in children are clear and obvious. It is safe and effective and should now be the treatment of choice for cholelithiasis in pediatric patients.
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Affiliation(s)
- M Schietroma
- Dipartimento di Discipline Chirurgiche, Cattedra di Chirurgia Generale II, Università degli Studi, L'Aquila
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50
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Schietroma M, Giri S, Valente A, Carlei F, Di Domenico S, Simi M, Speranza V. ["Occult" carcinoma of the thyroid: clinical, morphological, and biologic characteristics for a correct therapeutic regime]. MINERVA CHIR 1995; 50:199-208. [PMID: 7659253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The "occult" carcinoma of the thyroid is still a highly controversial topic. The controversies not only regard its diagnosis, treatment, natural history and, therefore, its biological potential, but also aspects of a nosological nature in that there is still no unequivocal acceptance of its originality, thus leading to discussions focused on its precise definition. On the basis of our experience and other published data, we have reached the following conclusions: a) the term "occult" carcinoma of the thyroid must be used to describe a neoplasia which does not exceed 1.5 cm in diameter, irrespective of the presence or otherwise of laterocervical adenopathy, and leaving aside the fact that it can be identified using clinical and instrumental tests; b) high-resolution echography and echo-guided FNA are fundamental instruments for a correct and early preoperative diagnosis; c) the clinical, morphological and, above all, biological (a very slowly evolving neoplasia) characteristics make the occult carcinoma of the thyroid seem to be a tumour with its own nosological identity; d) on the strength of the latter, and in particular in view of its natural history, conservative surgery (lobectomy with isthmectomy), in the differentiated forms, might play a primary role in the treatment of occult carcinoma of the thyroid in the very near future. However, at present complete thyroidectomy represents the treatment of choice even in differentiated forms, whereas lobectomy is only reserved for incidental cases of occult carcinoma discovered during the final histological test; e) lymphadenectomy is indicated in the event of lymph node involvement, not to achieve a longer survival rate but to reduce the incidence of recidivation in the form of lymph node metastases. In these cases, even the mere removal of macroscopically damaged lymph nodes is sufficient to ensure the virtual absence of recidivation on which, it is worth noting, metabolic radio-iodotherapy is efficacious in the large majority of cases.
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Affiliation(s)
- M Schietroma
- Clinica Chirurgica, Università degli Studi, Aquila
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