RESUMEN
In December 2000, the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was formally launched under the auspices of the Italian Society for Endoscopic Surgery and New Technologies (SICE). The aim of this multicentre study was to analyse various aspects of the treatment that are still under discussion, such as the extension of the laparoscopic indications in cases of malignancy, independently of the associated splenomegaly, patient selection and operative techniques. A retrospective review of 379 patients undergoing laparoscopic splenectomy for haematological diseases from February 1, 1993, to September 15, 2005, was conducted. Data were collected from the 18 italian centres participating in the IRLSS. The mean length of surgery was 140 minutes (range: 25-420). Conversion was necessary in 25 cases (6.6%), and at least one accessory spleen was found in 30 patients (8%). The mean spleen weight was 1200 g (range: 85-4500). Perioperative death occurred in two cases (0.5%). There were no complications in 312 patients (82.3%), with a mean hospital stay of 5.5 days (range: 2-30). Morbidity occurred in 67 patients (17.8%), mainly consisting in transient fever (n = 22), pleural effusions (n = 16), and actual or suspected haemorrhage (n = 14), requiring re-intervention in 7 patients. This first study carried out on the IRLSS data shows that laparoscopic splenectomy may constitute the gold standard for haematological diseases with a normal-sized spleen. The low morbidity and mortality rates suggest that laparoscopic splenectomy can be successfully proposed also for splenomegaly in haematological malignancies.
Asunto(s)
Enfermedades Hematológicas/cirugía , Laparoscopía , Esplenectomía , Esplenomegalia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Enfermedades Hematológicas/mortalidad , Enfermedades Hematológicas/patología , Humanos , Italia , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos , Esplenectomía/métodos , Encuestas y Cuestionarios , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We describe the first experience in Italy with a new pre-cut composite polytetrafluoroethylene (PTFE)/expanded PTFE (ePTFE) prosthesis designed for the hiatal region. A 78-year-old female patient with a large paraesophageal hiatal hernia with migration of the left transverse colon inside the hiatal defect (type IV hernia) received laparoscopic repair by means of the composite V-shaped mesh. The procedure was completed laparoscopically and a partial fundoplication was performed. A favorable outcome was assessed by barium swallow radiograms performed on postoperative day 7. A complete resolution of the symptoms was noted at follow-up 1 month postoperatively. This report confirms the feasibility, effectiveness, and added advantages of the composite V-shaped mesh in tension-free repair of a large hiatal hernia.
Asunto(s)
Hernia Hiatal/cirugía , Mallas Quirúrgicas , Anciano , Materiales Biocompatibles Revestidos/uso terapéutico , Colon Transverso/patología , Colon Transverso/cirugía , Femenino , Fundoplicación/instrumentación , Humanos , Laparoscopía , Politetrafluoroetileno , Diseño de PrótesisRESUMEN
BACKGROUND: Surgical repair of large hiatal hernias is associated with a high recurrence rate when the repair is made by simple cruroplasty. The use of a mesh goes from a reinforcement of a simple cruroplasty to a tension-free repair. We discuss the evolution of this approach and evaluate the outcomes of 27 patients with type II (n = 9), type III (n = 16), and type IV (n = 2) hiatal hernias treated laparoscopically. METHODS: Between November 1999 and October 2003, 27 patients (18 women and 9 men) received laparoscopic repair of large hiatal hernias by means of an A-shaped polypropylene-polytetrafluoroethylene mesh. A total or a partial fundoplication was associated in all cases. The mean age was 60.1 years (range, 36-76 years). The patients presented with symptoms of 2 months to 10 years in duration. Preoperative assessment included an upper gastrointestinal endoscopy, esophageal manometry, 24 hour pH monitoring, and barium swallow. Concomitant esophagitis was found in 16 patients and impaired esophageal peristalsis in 2 patients. Four patients had concomitant gallbladder disease treated at the same time. RESULTS: No conversions occurred in our series. There was no perioperative mortality, and morbidity was low. Follow-up averaged 27 months (range, 6-46 months). There has been 1 recurrence (3.7%), prolonged dysphagia in 4 cases, and no mesh erosion. CONCLUSION: Early results confirm the feasibility of the tension-free repair of large hiatal hernias and the effectiveness of the composite A-shaped mesh. Long-term follow-up for all patients is necessary to determine the real incidence of recurrence.