RESUMEN
BACKGROUND: Surgeon's position during open cholecystectomy operation has been standardized since more than 100 years, being traditionally fixed at the right side of the patient. Only a few French authors adopted the "left location" just for the time requested for the common bile duct exploration. METHODS: In this paper a critical evaluation of the optimal visual angle of the Calot's triangle elements is carried out. Laparoscopic experience has taught to those who practice it to forcefully adopt the "left position" thus approaching the anatomic structures from an internal-external point of view (opposite to the usual one). The authors have compared, on the basis of videotaped material, the "right" approach (adopted in conventional open surgery) and the "left" approach (coming from the laparoscopic experience). RESULTS: From the comparative evaluation performed, a conclusion comes out that the left position allows a more accurate observation of the triangle of Calot and a more precise estimate of the "safe limit" from the hepatic artery and the common bile duct. Moreover it is observed that from this point of view the gallbladder infundibulum does not obstruct the vision of the hylus which is best evaluated in his third dimension thus attributing to each structure the right plane. CONCLUSIONS: In conclusion from the data obtained in this paper the authors suggest to adopt the "left position" to approach the gallbladder surgery, particularly in the hylar dissecting phase.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Humanos , PosturaRESUMEN
The Authors report a case of endometriosis of the surgical scar following caesarean section. The patient, arrived at surgical observation for a doubtful foreign body granuloma, underwent a diagnostic biopsy of the lesion. Histological examination confirmed the endometriosis nature of the lesion. Before surgical removal, adjuvant therapy based on GnRH analog was performed with the aim to reduce the volume of the lesion. After removal a cycle of therapy with GnRH analog was performed in oder to exclude possible residual pathologic microscopic lesions.
Asunto(s)
Músculos Abdominales , Cesárea , Endometriosis/etiología , Complicaciones Posoperatorias/etiología , Músculos Abdominales/patología , Músculos Abdominales/cirugía , Adulto , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Enfermedades Musculares/etiología , Enfermedades Musculares/patología , Enfermedades Musculares/cirugía , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Embarazo , Factores de TiempoRESUMEN
The video laparoscopic cholecystectomy, a new technique recently introduced in surgical surgery, includes, among other complications, also the dimension of stones. Our intention in the present work is to remove this limitation using an ultrasound lithotripter to reduce the dimension of lithiasic formations, avoiding, after all, to resort to minilaparotomy or to the use of dilators which are in contrast at least with two of the principles of methodology, the aesthetic and functional one for the patient.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Litotricia/métodos , Televisión , Colecistectomía Laparoscópica/instrumentación , Colelitiasis/cirugía , Terapia Combinada , Humanos , Litotricia/instrumentaciónAsunto(s)
Enfermedades del Esófago/diagnóstico , Gastropatías/diagnóstico , Anciano , Endoscopía , Femenino , Humanos , ProlapsoRESUMEN
The medical treatment of gastric ulcers is essentially based on the administration of H2 antagonists such as cimetidine and ranitidine and antacids. A case of gastric bezoar which developed forty-five days after medical treatment for gastric ulcer of the smaller curvature is described.
Asunto(s)
Antiulcerosos/efectos adversos , Bezoares/inducido químicamente , Úlcera Péptica Hemorrágica/tratamiento farmacológico , Úlcera Gástrica/tratamiento farmacológico , Estómago , Anciano , Antiácidos/uso terapéutico , Antiulcerosos/uso terapéutico , Cimetidina/uso terapéutico , Humanos , Masculino , Ranitidina/uso terapéuticoRESUMEN
A case of biliary ileus in association with successfully operated cholecystoduodenal fistula is reported. The importance for prognosis of preoperative diagnosis of the condition is emphasised. The diagnostic importance of echotomography in cases where there is a history of cholelithiasis is underlined.
Asunto(s)
Colelitiasis/complicaciones , Obstrucción Intestinal/etiología , Anciano , Fístula Biliar/complicaciones , Colecistografía , Colelitiasis/diagnóstico , Colelitiasis/diagnóstico por imagen , Colelitiasis/cirugía , Duodeno , Femenino , Humanos , Fístula Intestinal/complicaciones , UltrasonografíaRESUMEN
After focusing the high surgical morbidity and mortality of icteric patients, the Authors describe their technique of insertion of percutaneous bile drainage after percutaneous transhepatic cholangiography. They insert drainage via the epigastric region, usually in the left hepatic duct. One case is described where the Authors associated percutaneous transhepatic drainage to regional chemotherapy through the catheter used for bile drainage. After for cycles of chemotherapy with 5-FU both intravenously and in the catheter, the Authors obtained the patency of the main bile duct which was previously obstructed by a methastases of stomach cancer.