RESUMEN

Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth-5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.

Asunto(s)

RESUMEN

INTRODUCTION: Laparoscopy is rapidly emerging as the preferred surgical approach to a number of different diseases because it permits a correct diagnosis and accurate treatment; however, it is not yet being applied in a widespread manner in the management of benign or malignant colorectal disease. The aim of this work is to illustrate retrospectively the results of our experience of laparoscopic colorectal surgery carried out in a community hospital over the last 5 years to document its feasibility, safety, and benefits when carried out by general surgeons in this setting. MATERIALS AND METHODS: Between January 2003 and December 2007 a total of 628 patients underwent a colorectal procedure. Among them, 328 (52.2%) were operated on with a laparoscopic approach. RESULTS: In 12 cases, we had to convert to the open approach. Major complications occurred in 3.6% whereas minor occurrences occurred in up to 10%. CONCLUSIONS: Even if limited by its retrospective design, our experience exhibits that the laparoscopic may well be a safe and effective approach to colon pathology in a community hospital setting. Such features make laparoscopy a challenging alternative to open surgery in the approach to colon disease and it can be proven to be cost-effective without undue risk, as long adequate laparoscopic training is undertaken by the surgeon and proper preparation observed.

Asunto(s)

RESUMEN

OBJECTIVES: The laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair is well documented in numerous studies as an excellent choice when performed by an experienced surgeon. In this report we wish to evaluate our experience of TAPP laparoscopic inguinal repair performed in a Community Hospital over the last 5 years, focusing on the feasibility of the technique and the incidence of complications when performed by general surgeons in this setting. We also wish to report and discuss how our attitudes concerning inguinal hernia repair have changed since we adopted the laparoscopic approach. MATERIALS AND METHODS: Between January 2003 and January 2008 a total of 193 patients, at "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic inguinal hernia repair. The total hernias repaired were 362. RESULTS: The overall mean operative time was 45.58 min. (+/-15.2 min). All the procedures were performed in day surgery. There were no conversions to open repair or deaths in our series. We had 2 cases of small bowel occlusion and 5 relapsing hernias (1.3%), which we preferred to treat with an anterior approach. The mean follow-up was 30.4 (+/-5.6; range: 1 to 60 mo) months. No patients reported severe pain at 10 days, 7.2% (14 cases) reported mild pain at 3 months. There were no reports of night pain at 30 days. Approximately 90% of the patients had a return to physical-work capacity within 7 days, the remainder within 14 days. All patients were completely satisfied at 3 months. CONCLUSIONS: The analysis of the short-term postoperative outcomes of our experience enabled us to conclude that in the proper setting TAPP is feasible, effective, safe, and beneficial for patients and should be a routine part of any surgical practice providing adequate training has been undertaken and proper preparation observed.

Asunto(s)

RESUMEN

Two cases of pediatric acute abdomen owing to omental infarction are described in this paper, which were successfully treated laparoscopically. Owing to the objective rareness and absence of typical symptoms, the diagnosis was often neither made nor considered preoperatively. For other emergency situations, laparoscopy has been shown to be both a diagnostic and a therapeutic tool of a rare pathology found also in the pediatric patients.

Asunto(s)

RESUMEN

Laparoscopy is commonly used in the treatment of appendicular diseases and non-specific abdominal pain. Nevertheless, the role of day-case laparoscopic surgery in these cases is still debated. The aim of this study was to identify which cases of appendicitis or non-specific abdominal pain are most indicated for daycase laparoscopic surgery. From January 1 2000 to December 31 2005 at our institution 424 patients were treated laparoscopically for appendicitis or non-specific abdominal pain. 41 were operated on on a day-case basis. 81% of these (33 patients) were discharged from hospital within 24 hours of surgery. 2 patients could not be discharged because of persistent postoperative pain and 6 had a longer hospitalisation period for non-medical reasons. No major complications and no readmissions to hospital were observed in the 33 regularly discharged patients. Over the same period 61 patients were operated on by traditional "open" surgery for the same pathologies. Their postoperative hospitalisation was considerably longer. None of them were operated on on a day-case basis and none were discharged within 24 hours of surgery. 3 patients needed readmission to our institution within the first 30 postoperative days. Day-case laparoscopic. surgery is valid, safe and effective for the treatment of uncomplicated appendicitis and nonspecific abdominal pain. For successful laparoscopic day-case surgery it is of fundamental importance to ensure adequate preoperative patient selection and to pay proper attention to the treatment of postoperative pain.

Asunto(s)

RESUMEN

The natural evolution of laparoscopy seems to be the use of miniature instruments and, where possible, a reduction of the number of trocars used. We report the results of our experience with all 5-mm instrument three-trocar cholecystectomy vs. the conventional laparoscopy approach. From July 2002 to July 2005 a total of 518 patients underwent laparoscopic cholecystectomy: 268 of them (51.7%) were operated on with a 5-mm three-trocar approach. The primary end point was the feasibility rate of the technique. Secondary end points were safety and the impact of the technique on the duration of laparoscopy. There were two conversions to laparotomy--one in each group--while a conversion to the classical approach for the three-trocar group was registered in 9.3% of the cases. Occurrence of minor complications was 3.6% (9 cases) with the conventional approach as against 3.7% (10 cases) with the three-trocar approach. The present experience shows that 5-mm three-trocar cholecystectomy is a safe, easy, effective and reproducible approach for gallbladder disease. Such features make the technique a challenging alternative to conventional laparoscopy in the treatment of cholecystopathy, in both the acute and elective setting.

Asunto(s)

RESUMEN

OBJECTIVE: An ideal mesh should produce slight foreign-body reactions and be compatible with the human organisms. Studies focusing on these aspects indicate that the use of mesh with less nonabsorbable material may reduce postoperative complications, insofar the web structure and its rigidity play an important role in compatibility. We evaluated retrospectively the patients of the past 1 year, who underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty (without the use any trocar and/or instrument of 10 mm in diameter) focusing attention on the feasibility of the technique and on the incidence of complications, especially those possibly related to the new type of mesh implanted. METHODS: Between June 2004 and September 2005, 76 patients have been operated on by using TAPP hernioplasty (bilateral or unilateral) without any 10 mm instrument/optic/trocar, and by applying a lightweight composite mesh fixed by "glues" (fibrin sealant and N-butyl 2-cyanoacrylate). RESULTS: The mean overall operative time was 55.57 (+/-15.2) minutes. All the procedures have been performed on a day surgery basis. We have registered any kind of major or minor morbidity (early or late), relapse, prosthesis rejection, and/or infection. We have registered no severe pain at 10 days; whereas a mild pain is still reported in 10.5% of our cases at a 3-month follow-up. The mean follow-up is 12.4 (+/-5.1; range 4 to 19) months. CONCLUSIONS: On the basis of this our initial experience, TAPP hernioplasty with a lightweight composite mesh is feasible, effective, and easy to perform by experienced hands, with good results. The well-known characteristics of a mini-invasive and gentle approach, together with the type of mesh implanted and its fixation of related glues, might explain the encouraging results of our experience.

Asunto(s)

RESUMEN

PURPOSE: Fibrin glue for mesh fixation has been proposed to prevent the risk of nerve injury in inguinal hernia repair. We retrospectively evaluated a series of 250 patients who underwent minilaparoscopic transabdominal preperitorneal (miniTAPP) hernioplasty (using trocars, optics, and instruments <10 mm in diameter) in whom mesh fixation was achieved using 2 mL of fibrin glue. We considered the feasibility of the technique and the incidence of complications, especially those possibly related to mesh fixation. We also compared the results with an earlier series of 245 patients in whom tacks were used to fix the mesh. MATERIALS AND METHODS: Between April 2004 and November 2005, 250 patients underwent bilateral or unilateral miniTAPP hernioplasty with instruments, optics, and trocars smaller than 10 mm and meshes fixed by fibrin glue. RESULTS: The mean overall operative time was 52.25 +/- 15.2 min. All the procedures were done as day surgeries. We registered one intraoperative bladder lesion and 15 cases of seroma. There were no relapses, prosthesis rejection, or infection. The mean follow-up was 13.2 +/- 6.1 months (range, 5-24 months). CONCLUSION: On the basis of our initial experience, miniTAPP hernioplasty with a fibrin glue is feasible, effective, and easy to perform in experienced hands, with good results without higher risk of recurrence. In addition, the fibrin fixation method seems to decrease postoperative neuralgia and reduced the incidence of postoperative seromas and hematomas.

Asunto(s)

RESUMEN

BACKGROUND: Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment - exploration to identify the causative pathology and performance of an appropriate operation - can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. METHODS: From January 1992 and January 2002 a total of 935 patients (mean age 42.3 +/- 17.2 years) underwent emergent and/or urgent surgery. Among them, 602 (64.3%) were operated on laparoscopically (of whom 112 -18.7% - with peritonitis), according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. RESULTS: The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat.) of cases, and 90.6% (87) of these patients were treated successfully by Laparoscopy. CONCLUSION: Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal peritonitis emergencies.

RESUMEN

INTRODUCTION: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. It seems to be moving toward the use of mini-instruments (5 mm or less in diameter). The aim of this paper is to illustrate retrospectively the results of an initial experience of minilaparoscopic transabdominal preperitoneal (miniTAPP) repair of groin hernia defects performed at two institutions. MATERIALS AND METHODS: Between February 2000 and December 2003, a total of 303 patients (mean age, 45 years) underwent a miniTAPP procedure: 213 patients (70.2%) were operated on bilaterally and 90 (28.7%) for a unilateral defect, with a total of 516 hernia defects repaired. The primary endpoint was the feasibility rate for miniTAPP. The secondary endpoint was the incidence of mini-TAPP-related complications. RESULTS: No conversions to laparoscopy or an anterior open approach were required. There were no major complications, while minor complications ranged as high as 0.3%. CONCLUSION: While limited by its retrospective design, the present study indicates that the minilaparoscopic approach to groin hernia repair is safe and effective, making miniTAPP a challenging alternative to laparoscopy in the approach to groin hernia repair.

Asunto(s)

RESUMEN

The aim of the study was to evaluate the practice of laparoscopic surgery in Italy. An audit on laparoscopic surgery was carried out through a written questionnaire sent to 600 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery over the last 10 years, surgery-related morbidity and mortality rates, indications, and impact on the day-to-day surgical work of the individual centres. A total of 64 institutions (10.6%) participated in the current audit. Laparoscopic surgery is performed in 96.8% of institutions, with cholecystectomy (98.3%) and appendectomy (72.4%) as the major surgical procedures performed with a laparoscopic approach. Laparoscopic procedures with miniaturised instruments (< or =3 mm) are performed by 15.5% of the surgeons interviewed. The low response rate of the present survey does not allow us to estimate the real extent of laparoscopic surgery in Italy, but only enables us to assess its use in centers routinely performing this kind of surgery. The impact of laparoscopy on day-to-day work is unquestionably positive and there is an increasing tendency by surgeons who become familiar with laparoscopy to use such an approach more frequently in different abdominal pathologies and in different situations (emergency/urgent and scheduled).

Asunto(s)

RESUMEN

Meckel's diverticulum is the most common of all the possible abnormalities that incomplete obliteration of the omphalo-mesenteric duct can produce. Often it is not sought during surgery performed for other abdominal diseases, e.g. cases of appendicitis. In these situations searching for and treating Meckel's diverticulum may be regarded as simply a waste of time or unjustified because its surgical treatment is not a completely safe procedure. In our opinion the systematic search for, and treatment of, Meckel's diverticulum during surgery performed for other abdominal conditions should always be performed. Elective resection of the diverticulum is characterised by fewer postoperative complications than emergency surgery. Laparoscopy would appear to be safe and effective in the treatment of this pathology, even in cases of severe diverticulitis. We report on our last five years' experience with the surgical treatment of this rare pathology, mainly occurring in previously appendectomised patients. One aim of this study was to demonstrate the possible benefits of the laparoscopic approach, focussing attention on the advisability of searching for and resecting Meckel's diverticulum when discovered incidentally during abdominal interventions performed for other pathologies.

Asunto(s)

RESUMEN

INTRODUCTION: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. In abdominal emergencies, both components of treatment--exploration and surgery--can be accomplished via laparoscopy. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open surgery for abdominal emergencies performed at our institution. METHODS: From January 1992 to January 2002, 935 patients (mean age, 42.3+/-17.2 years) underwent emergent or urgent surgery, or both. Of these, 602 (64.3%) were operated on laparoscopically (small bowel obstruction, 28; gastroduodenal ulcer disease, 25; biliary disease, 165; pelvic disease, 370 cases; colonic perforations, 14) based on the availability of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than 2 previous major abdominal surgeries, or massive bowel distension were not treated laparoscopically. Peritonitis was not deemed a contraindication to laparoscopy. RESULTS: The conversion rate was 5.8% and was mainly due to the presence of dense intraabdominal adhesions. Major complications ranged as high as 2.1% with a postoperative mortality of 0.6%. A definitive diagnosis was accomplished in 96.3% of cases, and 94.1% of these patients were treated successfully with laparoscopy. CONCLUSIONS: Even if limited by its retrospective nature, the present experience shows that the laparoscopic approach to abdominal emergencies is as safe and effective as conventional surgery, has a higher diagnostic yield, and results in less trauma and a more rapid postoperative recovery. Such features make laparoscopy an attractive alternative to open surgery in the management algorithm for abdominal emergencies.

Asunto(s)

RESUMEN

OBJECTIVE: Notwithstanding its widely perceived advantages, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open appendectomy carried out at our institution. METHODS: Between January 1993 and November 2000, 555 patients (M:F = 210:345; mean age 25.2 +/- 15 years) underwent emergency or urgent appendectomy, or both. Of them, 322 (52%) were operated on laparoscopically, and 233 (48%) were treated via conventional surgery, according to the presence of a well-trained surgical team. RESULTS: The laparoscopic group conversion rate was 3.1% (10/322) and was mainly due to the presence of dense intraabdominal adhesions. Major intraoperative complications ranged as high as 0.3% (1/322) and 0%, respectively, in the laparoscopic and conventional groups (P=ns). Major postoperative complications were 1.6% (5/312) vs 0.8% (2/243), respectively (P=ns). Postoperative mortality was 0.3% (1/312) and 0.4% (1/243) in the laparoscopic and conventional subsets of patients. Reinterventions were 0.9% (3/322) in the laparoscopic patients versus nil in the open group (P=ns). Minor postoperative complications were observed in 0.6% (2/312) and 6.5% (16/243) of patients, respectively, in the laparoscopy and open surgery groups, and consisted mainly of wound infections (P=0.001). Flatus passage and hospitalization were significantly more rapid among the laparoscopic patients. The greater diagnostic accuracy of laparoscopy allowed the diagnosis of concurrent diseases in 12% (30/254) versus 1.5% (3/199) of patients with histology proven appendicitis treated via laparoscopy versus laparotomy (P<0.01). Similarly, among those patients without gross or microscopic evidence of appendicitis, or both gross and microscopic evidence, concurrent diseases were detected in 57.3% (39/68) of laparoscopic patients versus 8.8% (3/34) in the conventional ones (P<0.01). CONCLUSION: Even if limited by its retrospective nature, the present experience shows that laparoscopic appendectomy is as safe and effective as conventional surgery, has a higher diagnostic yield, causes less trauma, and offers a more rapid postoperative recovery. Such features make laparoscopy a challenging alternative to laparotomy in premenopausal women referred for urgent abdominal or pelvic surgery, or both.

Asunto(s)

RESUMEN

Laparoscopy has gained widespread acceptance in common surgical practice as a diagnostic and therapeutic tool. Suspected appendicitis is still a diagnostic challenge to the general surgeon. A correct diagnosis is crucial because of the various diseases that may be responsible for the same symptoms, in order to plan the appropriate procedure or avoid an unnecessary laparotomy. Laparoscopy is the only minimally invasive technique to allow at the same time for adequate diagnosis, appropriate treatment and the best abdominal approach. Minilaparoscopy would appear to be a natural further step in the development of this technique. The aim of the present work was to illustrate retrospectively the results of an initial case-control study of minilaparoscopy vs. laparoscopy carried out at our institution. Between January and December 2002 a total of 86 patients underwent emergency and/or urgent appendectomy. Among them, 68 (79%) were operated on laparoscopically (37 [54.4%] with a minilaparoscopic approach and 31 with conventional laparoscopy), while 18 (21%) were treated by laparotomy, as performed by a well-trained surgical team. In the minilaparoscop group we registered no conversions to laparotomy and only one major postoperative complication (intra-abdominal abscess treated laparoscopically). As regards the postoperative period, generally speaking, the patients' conditions (analgesic treatment, flatus, diet, hospital discharge) were broadly the same as in the laparoscopic group. Though limited by its initial retrospective character, the present study shows that minilaparoscopic appendectomy is as safe and effective as classical laparoscopic surgery, and seems to be associated with less trauma and a more rapid postoperative recovery. Such features make minilaparoscopy a challenging alternative to conventional laparoscopy (and, of course, laparotomy) in patients referred for urgent abdominal and/or pelvic surgery.

Asunto(s)

RESUMEN

BACKGROUND: Retroperitoneal leiomyosarcomas (RLMS) are a challenging clinical entity. The vast majority of patients are operated on when tumors are advanced. We report herein a case of RLMS, mimicking acute appendiceal disease and treated successfully via laparoscopy. METHODS: A 37-year-old woman, para 1, was admitted to our department for right lower quadrant abdominal pain, fever, and leukocytosis. She had no changes in gastrointestinal and urologic function. A physical examination revealed the presence of abdominal guarding, rebound, and a tender mass in the right lower quadrant. The abdominal ultrasound showed an inhomogeneous ovoid mass (6 cm in diameter) located below the cecum, with no definite margins, and consistent with an appendiceal abscess. The patient was referred for laparoscopy. The procedure was performed with the aid of 3 ports: a 12-mm trocar in the umbilicus (open technique), a 10-mm trocar in the left iliac fossa, and a 5-mm one in the supra-pubic space. On inspection of the abdominal cavity, a retroperitoneal 6-cm mass was immediately found below the cecum and the appendix. Neither intraperitoneal seeding nor suspected lymph nodes were present. After dissection of the parietal peritoneum, the mass appeared to be encapsulated and well demarcated from all surrounding structures. It was eventually dissected and removed via a plastic bag. A standard appendectomy was also performed. The postoperative course was uneventful, and the patient was discharged on the 3rd day. The histology analysis of the resected specimen showed a totally excised G2 leiomyosarcoma. The appendix had no signs of inflammation. Postoperatively, the patient underwent a total-body CT-scan, which had no signs of residual or distant disease. No adjuvant therapy was necessary. At an 18-month follow-up, the patient was doing well and was disease free. CONCLUSION: Surgery represents the main therapeutic option for resectable RLMS. Laparoscopy is a useful diagnostic tool that allows safe resection of incidentally discovered, small and well encapsulated RLMS.

Asunto(s)

RESUMEN

Mucosal stomal prolapse is a frequent complication of end colostomies. We describe here an original mucosal colostomy prolapse repair technique using a circular stapling device. This technique stems from the recent introduction of stapled muco-haemorrhoidectomy and was employed on a 68-year-old male patient who had undergone a Miles abdominoperineal excision 17 years earlier. On clinical inspection the patient presented a 5-cm. mucosal stomal prolapse on straining. The surgical procedure was performed under i.v. sedation with midazolam and propofol. After draping the abdomen, the stomal mucosa was gently everted with the aid of three Allis forceps, and a 1.0 prolene purse string suture was created 4-6 cm. cephalad to the cutaneous rim of the stoma. The head of a 33-mm circular stapler was introduced and the purse string suture was tied. The mechanical stapler was prepared and fired, thus obtaining a resection anastomosis of the prolapsed stomal mucosa. No bleeding occurred. A 24-F bladder catheter was placed cephalad to the stapled line and removed on postoperative day one. The patient was discharged from hospital the day after surgery. During a 16-month follow-up neither complications nor relapses have so far been observed. Our technique appears to be simple and safe. We believe it is indicated only for mucosal stomal prolapses, while full-thickness stomal prolapses should be managed by conventional techniques. A larger cohort of patients is needed to confirm our preliminary results.

Asunto(s)

RESUMEN

Para-oesophageal hiatus hernia, a condition in which the fundus and part of the body of the stomach wrapped in a peritoneal sac herniate into the mediastinum, is a relatively uncommon entity. It tends to grow progressively and may become so large as to lead to symptoms of intrathoracic organ compression. In some exceptional cases, the entire stomach together with other abdominal viscera might herniate through the hiatus into the thorax. Paraesophageal hiatus hernias are characterised clinically by vague symptomatology, absent gastro-oesophageal reflux, and possible onset of gastric volvulus, generally without consequent incarceration of the portion of the herniated organ. Such an event is uncommon but dangerous and life-threatening. These cases often require resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundoplication. The authors report on the case of a patient presenting with acute abdomen as a result of incarcerated and perforated para-oesophageal hiatus hernia.

Asunto(s)

RESUMEN

The authors report their experience with the treatment of hemorrhoid disease and circumferential mucosal rectal prolapse with the use of a mechanical suturing device, according to the Longo technique. Over the period from March 98 to December 2000, 106 patients were treated with the above-mentioned procedure (100 patients for haemorrhoids and 6 for circumferential prolapse). Twenty-one patients had grade 4, 77 grade 3 and only 2 grade 2 disease. One hundred patients were followed up over a median period of 16.5 months (for the group with haemorrhoids) and 19 months (for the prolapse group). In 81% of cases the procedure was one-day surgery. Mucohaemorrhoidectomy with a stapler was well tolerated in terms of severity of postoperative symptomatology: in 42% of the patients operated on there was no need for any analgesic treatment. The time to return to work was 9.9 days for self-employed subjects and 15.6 days for the others. Refinement of the procedure and better patient selection may improve the results achieved with this technique. Stapled haemorrhoidectomy may be regarded as a sound technique that should be part of the surgeon's armamentarium. We suggest an "eclectic" approach whereby the stapling procedure may be included among the possible therapeutic options, with a view to optimising the choice of therapy for each individual patient.

Asunto(s)

RESUMEN

The authors present the results of a fact-finding survey on the state of the art of laparoscopic appendectomy in North-Eastern Italy. Over the period from 1991 to 2000 a total of 10,451 laparoscopic procedures were performed. Despite the extensive and increasing use of minimally invasive surgery, only 58% of the surgeons surveyed adopt laparoscopy in the management of suspected acute appendiceal disease. Thirty-six percent of surgeons indicate laparoscopy for all patients, while 60% reserve laparoscopic appendectomy for female patients. Forty-seven point one percent of procedures are performed in an emergency setting (within 6 hours of admission to hospital). The mean conversion rate is 4.9% and is mainly due to the aftermath of inflammation. Major intraoperative complications are of the order of 0.08%, while major postoperative morbidity is 0.6%. Wound infections are reported in 2% of patients. The mean hospital stay is 3 days. The majority of surgeons remove the appendix even in the absence of macroscopic inflammation and convert the procedure in the presence of suspected neoplastic disease found incidentally at surgery. The high diagnostic potential of the laparoscopic approach may well explain the infrequent use of preoperative imaging techniques.

Asunto(s)