Purpose/Background: managing grade iii/iV hemor- rhoidal disease with traditional excisional surg... more Purpose/Background: managing grade iii/iV hemor- rhoidal disease with traditional excisional surgery or stapled hemorrhoidopexy have been challenging undertak- ings considering the risks of non-negligible complications associated with invasive techniques. the aim of this study was to assess the safety and efficacy of mucopexy-recto Anal Lifting (murAL) in treating patients affected by grade iii and iV hemorrhoidal disease. Methods/Interventions: three hundred eighty-six patients affected by grade iii and iV hemorrhoidal diseasehave been enrolled in our study and underwent mucopexy- recto Anal Lifting (murAL) between may 2013 and November 2018. the method has already been described in detail by Pagano et al. [minerva chirurgica 2018 october; 73(5):469-74]. Arterial ligation and mucopexy involving progressive lifting have been performed at 6 positions, by following a standardized sequence (as outlined in the attached image). six longitudinal scars anchor perma- nently the mucosa and sub-mucosa to the muscular wall beneath. the follow-up examinations have been carried out by independent observers as follows: a digital explora- tion 3 weeks after the intervention, digital exploration and proctoscopy at 3 and 12 months, repeated at a 12-month interval. Patients not following strictly the postoperative clinical examination calendar have been excluded from the study. Primary outcome measure was the recurrence rate observed in patients who completed at least 12 months of follow-up. secondary outcome measures were: operative time, postoperative hospital stay, postoperative pain, post- operative symptoms and patient satisfaction score.Results/Outcome(s): murAL has been performed on 386 patients (59.6 % male, mean age 53.9, range 26-87); 297 (76.9%) with grade iii and 89 with grade iV hemor- rhoids. thirty-three (8.5%) patients had murAL as a revisional procedure of a previous intervention (17 stapled anopexy, 6 milligan-morgan, 5 murAL, 3 stArr, 2 tHd). mean duration of follow-up was 814 days (range 15-2007). the mean duration of the procedure was 23 minutes (range 13-45); 195 patients (53.0%) were discharged on the day of surgery and 163 (44.3%) had a one-day hospitalization; 10 patients treated with murAL required hospitalization > 1 day due to comorbidity. Pain Nrs score (0-10) on the first, second and third postoperative day was 3.8, 2.5 and 2.2 respectively. No major complications were observed. thirty-eight (10.3%) patients, all submitted to spinal anesthesia, had postop- erative acute urinary retention. transient fecal urgency was observed in 13 (3.4%) patients at the first follow-up. mean time to return to normal activity was 7 days (range 2-10). At one-year follow-up 89.5% of patients reported an excellent/good satisfaction score. operating time wassignificantly shorter, postoperative pain lower and tran- sient fecal urgency less frequent in patients with grade iii than in those with grade iV hemorrhoids. one-year recur- rence rate was evaluated in 279/386 patients (214 with grade iii and 65 with grade iV disease). recurrence was observed in 12 patients (4.3%): 7/214 (3.3%) with grade iii and 5/65 (7.7%) with grade iV hemorrhoids (P=0.12). two patients out of 28 (7.1%) had a second recurrence after murAL (1 previous mm, and 1 previous murAL). Conclusions/Discussion: in our experience, mucopexy- recto Anal Lifting (murAL) with its standardized proce- dure management approach, offers a safe and effective treatment solution of managing grade iii and iV symp- tomatic hemorrhoids with minimal invasivity, lowering the patient\u2019s risk of developing severe complications. the method does not cause tissue trauma, which permits to easily perform a redo-murAL in the event of recurrence
Benign tumors of the liver are rare, with an incidence of 0.4-7%. Cavernous hemangiomas represent... more Benign tumors of the liver are rare, with an incidence of 0.4-7%. Cavernous hemangiomas represent the most frequent benign solid liver masses, although the giant form (>4cm) is quite uncommon. In our series, in the period 1982-1992, 9 patients underwent resection for giant cavernous hemangioma (diameter between 9 and 21 cm). It concerned 7 women and 2 men, witha mean age of 52.5 years. Five of them were completely asymptomatic, while the others had symptoms related to the intraabdominal mass. Diagnostic inconclusion and the risk for rupture with severe hemorrhage of the larger hemangiomas were the main indications for resection in the asymptomatic patients. transverse upper abdominal laparatomy was performed more frequently. several kinds of hepatic resection were performed: 2 right trisegmentectomies, 2 lateral segmentectomies, 2 left lobectomies, 1 right lobectomy, 1 extended left lobectomy and 1 non anatomical wedge resection. We noted one severe intraoperative hemorrhage, solved by transfusion. The postoperative course was uncomplicated in every case. With a mean follo-up of 48 months (1-60) there was no evidence of recurrence
OBJECTIVES Searching for retained bullets has always been crucial in war surgery. Aim of this pap... more OBJECTIVES Searching for retained bullets has always been crucial in war surgery. Aim of this paper is to briefly outline the history of retained bullet identification methods before X-rays discovery and describe the proliferation of the most significant methods of foreign body localization during WWI. METHODS Coeval medical journals, reference textbooks, dedicated manuals and documents have been searched and compared in multiple archives and on the internet. RESULTS Before radiologic era, probing the wound was the only way to detect the bullet and minimize the need of a large surgical incision (anaesthesia was walking its first tentative steps and antisepsis still to be conceived). Nelaton's probe, specifically designed to detect General Garibaldi's retained projectile, gained popularity. Application of electricity provided further rudimental aids to find retained metals. X-rays discovery made bullet detection easy, but exact localization to guide removal was still difficul...
The videolaparoscopic approach for appendectomy was suggested many years ago and it has spread wi... more The videolaparoscopic approach for appendectomy was suggested many years ago and it has spread widely around the world due to its advantages over the traditional technique. Moreover, the technology reached with the instrumentation makes this operation simple, safe and rapid with adequate training. From October 1991 to December 1993, in the Department of General Surgery of the S. Giuseppe Hospital - Cattedra di Chirurgia Generale of the University of Milan, we performed 250 videolaparoscopic appendectomies. The operating technique is similar to the other authors', but with personal variations. Great number of interventions, 177, were elective and 73 were in emergency. The operation was converted to open procedure in 10 cases (4%) and we had postoperative complications that required a reintervention only in one case (0,4%). All patients had a short postoperative course and an excellent cosmetic result. The videolaparoscopic compared with the laparotomic approach offers a better exploration of the abdominal cavity, allows for easier location of the appendix, reduces the period of inactivity, and also in 'difficult' appendectomies gives an excellent cosmetic result. These advantages are appreciable both in elective and in emergency operations
Background. We describe our experience in performing Videothoracoscopy as the first step of the o... more Background. We describe our experience in performing Videothoracoscopy as the first step of the operation in patients affected by lung cancer: we refer to this procedure as Videothoracoscopic Operative Staging (VOS). Methods. In 218 consecutive patients already proposed for curative surgical resection on the basis of the conventional staging, VOS was carried out in order to assess a conclusive assessment of resectability. Results, VOS discovered causes of inoperability in 15 patients (6.9%), thus lowering the rate of exploratory thoracotomies (ETs) to less than 3%. Furthermore VOS allowed us to assess operability of 10 patients in whom preoperative computed tomography (CT) had suggested suspect of unresectability but could not provide a definitive judgement. Morbility and mortality were absent. Conclusions. Based on their experience the authors conclude that VOS implies a minimal surgical trauma and is of remarkable validity to reduce to a minimum the number of ETs in patients with lung cancer
BACKGROUND This randomized study compared the medium-term results of stapled anopexy (SA) and tra... more BACKGROUND This randomized study compared the medium-term results of stapled anopexy (SA) and transanal hemorrhoidal dearterialization with anopexy (THD) in 4 homogeneous groups of patients, 2 with third- and 2 with fourth-degree hemorrhoids. METHODS Forty patients with third-degree and 30 with fourth-degree hemorrhoids were randomly submitted to SA (N.=20+15) and THD (N.=20+15), respectively. Clinical controls were done every 6 months from 1 to 42 months after the operation, with incidence of recurrent hemorrhoids as primary outcome measure. Operative time, complications, pain, time to return to normal activity, costs, Short Form-36, and overall patient satisfaction were also evaluated. RESULTS Frequencies of preoperative obstructed defecation symptoms and prolapse recurrence were higher in patients with fourth-degree hemorrhoids, and SA was more effective than THD in reducing the risk of recurrence at 36±6 months follow-up (P=0.049). Operative time, complications, pain, and time o...
BACKGROUND The observation of a relatively high number of pulmonary aspirations (PA) among gastri... more BACKGROUND The observation of a relatively high number of pulmonary aspirations (PA) among gastric band (GB) carriers undergoing a second surgery, prompted us to modify our strategy for GB patients candidate to further operation under general anesthesia. MATERIAL OF STUDY AND RESULTS In January 2013, following the occurrence of PA at the induction of general anesthesia in 1 GB carrier undergoing a further operation, we reviewed our Data Base between January 2005 and 2013, to explore the rate of pulmonary aspiration in patients GB carriers undergoing a second surgery. Considering the rate (3/172 - 1.7%) too high in comparison with non-GB carriers, we decided to deflate the banding before any further surgery planned under general anesthesia. We then retrospectively reviewed the occurrence of PA after having changed the protocol. Since February 2013, through December 2016, 81 GB carriers underwent a second surgery and not a single episode of PA occurred (0/81). DISCUSSION The occurrenc...
AIM Aim of this study is to evaluate the validity of videothoracoscopic staging and treatment in ... more AIM Aim of this study is to evaluate the validity of videothoracoscopic staging and treatment in a twenty-year-long series of 286 VATS lobectomies for Clinical Stage I NSCLC. MATERIAL OF STUDY We retrospectively reviewed 1549 candidates to resection after conventional staging from November 1991 to December 2013, and routinely submitted to videothoracoscopy immediately before the procedure. Patients deemed operable at videoexploration were resected by thoracoscopy or thoracotomy. Out of 534 VATS resections 286 thoracoscopic lobectomies for clinical stage I cancers were performed with strict indications and standardized technique; more advanced tumours were converted even when thoracoscopically resectable. Impact of preliminary videothoracoscopy and and longterm Kaplan-Meier survival was analyzed. RESULTS AND DISCUSSION Out of 1549 patients, videothoracoscopy disclosed inoperability in 62 (4 %), mostly for pleural carcinosis (33pts.-2.1%) or mediastinal infiltration (22pts-1.4%). 534 ...
Purpose/Background: managing grade iii/iV hemor- rhoidal disease with traditional excisional surg... more Purpose/Background: managing grade iii/iV hemor- rhoidal disease with traditional excisional surgery or stapled hemorrhoidopexy have been challenging undertak- ings considering the risks of non-negligible complications associated with invasive techniques. the aim of this study was to assess the safety and efficacy of mucopexy-recto Anal Lifting (murAL) in treating patients affected by grade iii and iV hemorrhoidal disease. Methods/Interventions: three hundred eighty-six patients affected by grade iii and iV hemorrhoidal diseasehave been enrolled in our study and underwent mucopexy- recto Anal Lifting (murAL) between may 2013 and November 2018. the method has already been described in detail by Pagano et al. [minerva chirurgica 2018 october; 73(5):469-74]. Arterial ligation and mucopexy involving progressive lifting have been performed at 6 positions, by following a standardized sequence (as outlined in the attached image). six longitudinal scars anchor perma- nently the mucosa and sub-mucosa to the muscular wall beneath. the follow-up examinations have been carried out by independent observers as follows: a digital explora- tion 3 weeks after the intervention, digital exploration and proctoscopy at 3 and 12 months, repeated at a 12-month interval. Patients not following strictly the postoperative clinical examination calendar have been excluded from the study. Primary outcome measure was the recurrence rate observed in patients who completed at least 12 months of follow-up. secondary outcome measures were: operative time, postoperative hospital stay, postoperative pain, post- operative symptoms and patient satisfaction score.Results/Outcome(s): murAL has been performed on 386 patients (59.6 % male, mean age 53.9, range 26-87); 297 (76.9%) with grade iii and 89 with grade iV hemor- rhoids. thirty-three (8.5%) patients had murAL as a revisional procedure of a previous intervention (17 stapled anopexy, 6 milligan-morgan, 5 murAL, 3 stArr, 2 tHd). mean duration of follow-up was 814 days (range 15-2007). the mean duration of the procedure was 23 minutes (range 13-45); 195 patients (53.0%) were discharged on the day of surgery and 163 (44.3%) had a one-day hospitalization; 10 patients treated with murAL required hospitalization > 1 day due to comorbidity. Pain Nrs score (0-10) on the first, second and third postoperative day was 3.8, 2.5 and 2.2 respectively. No major complications were observed. thirty-eight (10.3%) patients, all submitted to spinal anesthesia, had postop- erative acute urinary retention. transient fecal urgency was observed in 13 (3.4%) patients at the first follow-up. mean time to return to normal activity was 7 days (range 2-10). At one-year follow-up 89.5% of patients reported an excellent/good satisfaction score. operating time wassignificantly shorter, postoperative pain lower and tran- sient fecal urgency less frequent in patients with grade iii than in those with grade iV hemorrhoids. one-year recur- rence rate was evaluated in 279/386 patients (214 with grade iii and 65 with grade iV disease). recurrence was observed in 12 patients (4.3%): 7/214 (3.3%) with grade iii and 5/65 (7.7%) with grade iV hemorrhoids (P=0.12). two patients out of 28 (7.1%) had a second recurrence after murAL (1 previous mm, and 1 previous murAL). Conclusions/Discussion: in our experience, mucopexy- recto Anal Lifting (murAL) with its standardized proce- dure management approach, offers a safe and effective treatment solution of managing grade iii and iV symp- tomatic hemorrhoids with minimal invasivity, lowering the patient\u2019s risk of developing severe complications. the method does not cause tissue trauma, which permits to easily perform a redo-murAL in the event of recurrence
Benign tumors of the liver are rare, with an incidence of 0.4-7%. Cavernous hemangiomas represent... more Benign tumors of the liver are rare, with an incidence of 0.4-7%. Cavernous hemangiomas represent the most frequent benign solid liver masses, although the giant form (>4cm) is quite uncommon. In our series, in the period 1982-1992, 9 patients underwent resection for giant cavernous hemangioma (diameter between 9 and 21 cm). It concerned 7 women and 2 men, witha mean age of 52.5 years. Five of them were completely asymptomatic, while the others had symptoms related to the intraabdominal mass. Diagnostic inconclusion and the risk for rupture with severe hemorrhage of the larger hemangiomas were the main indications for resection in the asymptomatic patients. transverse upper abdominal laparatomy was performed more frequently. several kinds of hepatic resection were performed: 2 right trisegmentectomies, 2 lateral segmentectomies, 2 left lobectomies, 1 right lobectomy, 1 extended left lobectomy and 1 non anatomical wedge resection. We noted one severe intraoperative hemorrhage, solved by transfusion. The postoperative course was uncomplicated in every case. With a mean follo-up of 48 months (1-60) there was no evidence of recurrence
OBJECTIVES Searching for retained bullets has always been crucial in war surgery. Aim of this pap... more OBJECTIVES Searching for retained bullets has always been crucial in war surgery. Aim of this paper is to briefly outline the history of retained bullet identification methods before X-rays discovery and describe the proliferation of the most significant methods of foreign body localization during WWI. METHODS Coeval medical journals, reference textbooks, dedicated manuals and documents have been searched and compared in multiple archives and on the internet. RESULTS Before radiologic era, probing the wound was the only way to detect the bullet and minimize the need of a large surgical incision (anaesthesia was walking its first tentative steps and antisepsis still to be conceived). Nelaton's probe, specifically designed to detect General Garibaldi's retained projectile, gained popularity. Application of electricity provided further rudimental aids to find retained metals. X-rays discovery made bullet detection easy, but exact localization to guide removal was still difficul...
The videolaparoscopic approach for appendectomy was suggested many years ago and it has spread wi... more The videolaparoscopic approach for appendectomy was suggested many years ago and it has spread widely around the world due to its advantages over the traditional technique. Moreover, the technology reached with the instrumentation makes this operation simple, safe and rapid with adequate training. From October 1991 to December 1993, in the Department of General Surgery of the S. Giuseppe Hospital - Cattedra di Chirurgia Generale of the University of Milan, we performed 250 videolaparoscopic appendectomies. The operating technique is similar to the other authors', but with personal variations. Great number of interventions, 177, were elective and 73 were in emergency. The operation was converted to open procedure in 10 cases (4%) and we had postoperative complications that required a reintervention only in one case (0,4%). All patients had a short postoperative course and an excellent cosmetic result. The videolaparoscopic compared with the laparotomic approach offers a better exploration of the abdominal cavity, allows for easier location of the appendix, reduces the period of inactivity, and also in 'difficult' appendectomies gives an excellent cosmetic result. These advantages are appreciable both in elective and in emergency operations
Background. We describe our experience in performing Videothoracoscopy as the first step of the o... more Background. We describe our experience in performing Videothoracoscopy as the first step of the operation in patients affected by lung cancer: we refer to this procedure as Videothoracoscopic Operative Staging (VOS). Methods. In 218 consecutive patients already proposed for curative surgical resection on the basis of the conventional staging, VOS was carried out in order to assess a conclusive assessment of resectability. Results, VOS discovered causes of inoperability in 15 patients (6.9%), thus lowering the rate of exploratory thoracotomies (ETs) to less than 3%. Furthermore VOS allowed us to assess operability of 10 patients in whom preoperative computed tomography (CT) had suggested suspect of unresectability but could not provide a definitive judgement. Morbility and mortality were absent. Conclusions. Based on their experience the authors conclude that VOS implies a minimal surgical trauma and is of remarkable validity to reduce to a minimum the number of ETs in patients with lung cancer
BACKGROUND This randomized study compared the medium-term results of stapled anopexy (SA) and tra... more BACKGROUND This randomized study compared the medium-term results of stapled anopexy (SA) and transanal hemorrhoidal dearterialization with anopexy (THD) in 4 homogeneous groups of patients, 2 with third- and 2 with fourth-degree hemorrhoids. METHODS Forty patients with third-degree and 30 with fourth-degree hemorrhoids were randomly submitted to SA (N.=20+15) and THD (N.=20+15), respectively. Clinical controls were done every 6 months from 1 to 42 months after the operation, with incidence of recurrent hemorrhoids as primary outcome measure. Operative time, complications, pain, time to return to normal activity, costs, Short Form-36, and overall patient satisfaction were also evaluated. RESULTS Frequencies of preoperative obstructed defecation symptoms and prolapse recurrence were higher in patients with fourth-degree hemorrhoids, and SA was more effective than THD in reducing the risk of recurrence at 36±6 months follow-up (P=0.049). Operative time, complications, pain, and time o...
BACKGROUND The observation of a relatively high number of pulmonary aspirations (PA) among gastri... more BACKGROUND The observation of a relatively high number of pulmonary aspirations (PA) among gastric band (GB) carriers undergoing a second surgery, prompted us to modify our strategy for GB patients candidate to further operation under general anesthesia. MATERIAL OF STUDY AND RESULTS In January 2013, following the occurrence of PA at the induction of general anesthesia in 1 GB carrier undergoing a further operation, we reviewed our Data Base between January 2005 and 2013, to explore the rate of pulmonary aspiration in patients GB carriers undergoing a second surgery. Considering the rate (3/172 - 1.7%) too high in comparison with non-GB carriers, we decided to deflate the banding before any further surgery planned under general anesthesia. We then retrospectively reviewed the occurrence of PA after having changed the protocol. Since February 2013, through December 2016, 81 GB carriers underwent a second surgery and not a single episode of PA occurred (0/81). DISCUSSION The occurrenc...
AIM Aim of this study is to evaluate the validity of videothoracoscopic staging and treatment in ... more AIM Aim of this study is to evaluate the validity of videothoracoscopic staging and treatment in a twenty-year-long series of 286 VATS lobectomies for Clinical Stage I NSCLC. MATERIAL OF STUDY We retrospectively reviewed 1549 candidates to resection after conventional staging from November 1991 to December 2013, and routinely submitted to videothoracoscopy immediately before the procedure. Patients deemed operable at videoexploration were resected by thoracoscopy or thoracotomy. Out of 534 VATS resections 286 thoracoscopic lobectomies for clinical stage I cancers were performed with strict indications and standardized technique; more advanced tumours were converted even when thoracoscopically resectable. Impact of preliminary videothoracoscopy and and longterm Kaplan-Meier survival was analyzed. RESULTS AND DISCUSSION Out of 1549 patients, videothoracoscopy disclosed inoperability in 62 (4 %), mostly for pleural carcinosis (33pts.-2.1%) or mediastinal infiltration (22pts-1.4%). 534 ...
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