Abstract:
BACKGROUND:The incidence of perforative diverticulitis of the left colon is steadily increasing. Today the decision is generally taken to perform two-stage surgery: segmentary resection without (Hartmann's operation) or with anastomosis, but protected by a colostomy ("limited intervention"). This study aimed to examine standard colectomy performed in a single operation ("ideal intervention"). METHODS:Left colectomy with primary ligature of the lower mesenteric artery and vein at the source and outlet, en bloc removal of the colon-mesocolon and immediate transverse colorectal anastomosis. Anastomosis protected by the omentum which is also used to peritonise the retroperitoneum and to wrap around the anastomosis, and anastomosis also protected by the author's three-way lavage and active aspiration tube in either a trans- or subanastomosis and transanal position. Urgency is essential for this single-stage operation, together with massive dose antibiotic treatment limited to the pre- and postoperative stages, but above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres, but only used 500 ml at a time. Of these 65 cases, 40 (62%) were purulent localised peritonitis and 25 (38%) were generalised (14 purulent, 4 fecaloid and 7 fecal). 8 cases (12.3%) underwent surgery in three stages and 16 (24.6%) underwent sigmoidectomy in one or two stages ("limited intervention"), 41 cases (63%) (1985-95, when Gullino's three-way tube became available) underwent standard colectomy in a single stage. RESULTS:Morbidity in 10 cases/65 (15%) and septic mortality in 5 cases/65 (7.7%) (limited to generalised peritonitis alone) only affected patients undergoing "limited interventions", but none of the 41 patients undergoing "ideal intervention". Mortality was significantly influenced by age: 50% of over 80 year-olds, none below 60. Postoperative hospitalisation was 17.1 days (in the first stage) of "limited interventions" and 9.7 days for "ideal interventions". CONCLUSIONS:The results argue clearly in favour of the "courageous" ideal colectomy with peritoneal lavage and protection of the colorectal anastomosis using Gullino's three-way tube.
journal_name
Minerva Chirjournal_title
Minerva chirurgicaauthors
Gullino D,Giordano O,Lijoi C,Masella M,De Carlo Akeywords:
subject
Has Abstractpub_date
1998-12-01 00:00:00pages
1059-67issue
12eissn
0026-4733issn
1827-1626journal_volume
53pub_type
杂志文章abstract::The results obtained in 10 patients suffering from complicated diverticulitis are reported, stress being laid on the seriousness of the pathology and proposing that emergency surgery be carried out. ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1989-03-31 00:00:00
abstract::A case of volvulus of ectopic spleen mistaken for twisted ovarian cyst is described. Attention is drawn to six points: 1) the rarity of the condition; 2) the persistent uncertainty concerning its aetiopathogenesis, even though over a century has passed since the first case was reported; 3) the mechanism leading to twi...
journal_title:Minerva chirurgica
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abstract::Reference is made to a personal case in an examination of the more controversial aspects of segmentary necrosis of the main bile pathway. Attention is drawn to the leading features of the pathogenetic evolution of this lesion. Bearing in mind the almost insurmountable difficulty of formulating a preoperative diagnosis...
journal_title:Minerva chirurgica
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更新日期:1979-05-31 00:00:00
abstract::Gastro-intestinal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. Its increasing incidence and multiple and non-specificity of symptoms and signs require special attention to establish a prompt diagnosis and not to delay treatment. The authors describe on case of colonic TB presentin...
journal_title:Minerva chirurgica
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更新日期:1995-10-01 00:00:00
abstract:BACKGROUND:Soft tissue defects are mostly managed surgically by free microvascular flaps. The progressive development of techniques and the availability and reliability of new different and free flaps encouraged this surgical approach. Thus, there is a constant need of free flap models to reproduce in laboratory. The e...
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pub_type: 杂志文章
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abstract:AIM:This study reports a series of 7 patients who experienced small-bowel obstruction (SBO) after laparoscopic gastric bypass (LGBP). METHODS:Between July 2001 and June 2004, 211 patients underwent surgery for morbid obesity in 2 different institutions and 7 of them required reoperative laparoscopic surgery or laparot...
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journal_title:Minerva chirurgica
pub_type: 杂志文章
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abstract::A recently observed personal case of spontaneous cholecystospontaneous fistula is reported. Factors leading to the relative infrequency of this form in recent years are described, and its rarity is demonstrated by the fact that the case reported was the first to be noted in about 1000 operations on the bile ducts. A b...
journal_title:Minerva chirurgica
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更新日期:1981-02-15 00:00:00
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journal_title:Minerva chirurgica
pub_type: 杂志文章
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journal_title:Minerva chirurgica
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更新日期:1995-12-01 00:00:00
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journal_title:Minerva chirurgica
pub_type: 杂志文章
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更新日期:1996-07-01 00:00:00
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journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1990-10-15 00:00:00
abstract::A new system has been developed for transanal endoscopic microsurgery (TEM), which allows all the conventional surgical techniques within the rectal cavity. The main indication is the removal of sessile adenomas. "Early rectal carcinomas" are also suitable for local excision. We perform local excision of advanced canc...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1992-06-30 00:00:00
abstract::Clinical, radiological and endoscopic results at follow-up about 1-5 yr after surgery in a series of 62 patients subjected to Billroth I resection are compared with those in the literature. Recurrence of ulcers was observed in 8% (as opposed to 5% with the Billroth II). In addition, there was a marked reduction in the...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1980-07-15 00:00:00
abstract::A retrospective series of 30 (2.8%) cases of cholelithiasis out of 1064 abdominal aortic aneurysmectomies is presented. 21 subjects underwent aneurysmectomy and prosthetic grafting combined with cholecystectomy. Complications related to the combined operation, early or late (6 months to 8 years follow-up was available...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract::The ultrasonic scalpel has been used for some time in surgery in tissue with a predominantly cellular component since it can be used selectively on the parenchymatous component while respecting the vasculo-stromal component. On the basis of their earlier experience and using a versatile ultrasonic device currently uti...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract:AIM:The aim of this article is to present a new method for treating spontaneous pneumothorax, the one window plus puncture method (1WP) in which a thin endoscope is used. METHODS:With the patient in the lateral position and under one-lung ventilation, a one-window working port was created on the ventral side. An intro...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:2008-12-01 00:00:00
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journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1997-12-01 00:00:00
abstract::The authors evaluate the incidence of varicocele after having examined 18,800 healthy white men members of the Italian Army Corps born in 1966 and visited in 1985. They found a varicocele in 775 patients (4.12%), in 5 was present bilaterally, and in 770 in the left side. In 45 patients the surgical treatment was alrea...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1990-03-31 00:00:00
abstract:INTRODUCTION:One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. EVIDENCE...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:10.23736/S0026-4733.18.07844-6
更新日期:2019-04-01 00:00:00
abstract::Anaplastic carcinoma of the thyroid is a highly aggressive neoplasm with quickly total course. It is characterized by an average survival of 4-12 months. It infiltrates precociously into the windpipe, oesophagus, vessels of the neck and gives distant metastases in 10-48% of cases. In 30.8 to 80% of cases, this carcino...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
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journal_title:Minerva chirurgica
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doi:
更新日期:1989-05-31 00:00:00
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doi:10.23736/S0026-4733.20.08497-7
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journal_title:Minerva chirurgica
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更新日期:2001-08-01 00:00:00
abstract::This article addresses emergent endoluminal technologies currently available for the treatment of gastroesophageal reflux disease (GERD) and compares it to the laparoscopic Nissen fundoplication. To date the mainstay of GERD therapy has been achieved with either open or laparoscopic fundoplication or life-long medical...
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更新日期:2004-10-01 00:00:00
abstract::Thymoma is the most common primary neoplasm of the tymus. The majority of thymomas are encapsulated masses and exhibit benign behavior. Less frequently they may be invasive, or rarely they may metastasize to distant sites. The usual clinical presentation is that of an anterior mediastinal mass found accidentally in an...
journal_title:Minerva chirurgica
pub_type: 杂志文章
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更新日期:1996-09-01 00:00:00
abstract::The authors describe their experience of the aneurysm popliteal artery. They analyze the symptomatology, the diagnostic way and the therapy of such disease. ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract:BACKGROUND:The past years have seen the development of outpatient treatment and surgical procedures for the treatment of hemorrhoid disease in an attempt to reduce postoperative pain on the one hand and execution and hospitalisation times on the other. METHODS:This retrospective study compares the results obtained in ...
journal_title:Minerva chirurgica
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更新日期:2001-02-01 00:00:00
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journal_title:Minerva chirurgica
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更新日期:1991-05-31 00:00:00