Abstract:
AIM:Although many studies on laparoscopic surgery of the stomach have been conducted so far, yet they have not provided surgeons with criteria for gradual and safe training with this technique. The results of gastric surgery with 30 patients operated on by laparoscopic approach are hereby described. The aim of this issue is to provide surgeons with guide lines for progressive training, respectful to patients, complying with oncologic criteria and useful to reduce conversion rate or drawbacks at the start of the experience. METHODS:The Authors made a retrospective analysis on 30 patients affected by gastric lesions, 5 benign chronic ulcers and 25 neoplasms of the stomach. Our guide lines suggest that the training begin with the treatment of benign lesions, followed by early gastric cancer (EGC) and by advanced gastric cancer (AGC) of the antrum. Our experience started with 4 laparoscopic subtotal distal gastrectomies (LSGs) for benign ulcer; independent of the guidelines hereby proposed 1 laparoscopic total gastrectomy (LTG) was done after the intraoperative finding of a benign ulcer of the lesser curve penetrating into the left hepatic lobe. The beginning of training included also 1 LSG for distal stromal tumor (GIST). Subsequently 13 early gastric cancers (EGC) were operated on: echoendoscopy could demonstrate 12 T1 m and 1 T1 sm and no evidence of nodal involvement. The diameter of EGCs was 1,3 cm on average ( range 0,7-4 cm), all were marked by Indian ink to allow performance of 10 LSGs and 3 LTGs. Moreover, 8 LSGs for advanced gastric carcinoma (AGC) of the antrum were carried out. The training in malignancies progressed with LTG for 2 non-Hodgkin gastric lymphomas; 1 lymphoma required conversion to laparotomy due to infiltration of the diaphragmatic crus. A D2 lymphadenectomy was associated to gastrectomy in adenocarcinomas. RESULTS:The feasibility of laparoscopic gastric surgery was confirmed by this study, with operating time of 240 minutes (range 150-360), intraoperative blood loss was 180 ml (range 100-250), and only 1 patient required blood transfusion for postoperative bleeding. The specific morbidity rate was 10% owing to duodenal leakage in 3 cases in the early phase of this study (3/30): 1 required laparotomy. The mortality rate was 3% due to 1 serious postoperative bleeding and acute hepatic failure in a patient with post-alcoholic cirrhosis. The conversion rate was 3% (1/30). The nasogastric tube was removed on the 4(th) postoperative day, and the oral intake started on the 6(th) postoperative day after a barium follow-through examination. The mean postoperative hospital stay was 16 days (range 10-25). The number of nodes retrieved was 18 on average and it improved with the experience: from the minimum of 9 nodes in benign ulcers, it grew to 20 in EGCs and to 25 in AGCs, so that this data confirmed the guide lines proposed in this issue . The histologic examination of EGC confirmed the data of echoendoscopy about nodal status. CONCLUSIONS:Laparoscopic surgery is a safe and feasible procedure both for benign and for malignant lesions of the stomach. The results analysed hereby suggest that at the start of training be treated patients affected by benign lesions, followed by patients with EGC and then by patients with AGC. For gastric cancers, the average number of 18 nodes harvested from each patient was adequate, complying with the requirements suggested by the latest TNM classification. This choice of progressive selection of patients for training represents a good means to get an optimal performance level, especially in view of the oncologic requirements, and can prevent surgeons from elevated conversion rates and disappointing outcomes at the beginning of experience.
journal_name
Minerva Chirjournal_title
Minerva chirurgicaauthors
Pugliese R,Maggioni D,Sansonna F,Scandroglio I,Ferrari GC,Di Lernia S,Boniardi M,Costanzi A,Pauna Jkeywords:
subject
Has Abstractpub_date
2005-02-01 00:00:00pages
23-30issue
1eissn
0026-4733issn
1827-1626journal_volume
60pub_type
杂志文章abstract::Peri-inguinal and Para-inguinal hernias are included in the group of lateral ventral hernias and must be distinguished from Spigelian and intraparietal ascending inguinal hernias. Peri-inguinal hernia is very unusual in its location and development. Non one similar case has been reported in literature. ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1991-04-30 00:00:00
abstract::During the period March 1991-June 1992 5 single lung transplantations were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent regular fibrobronchoscopies within the context of a complex follow-up programme in order to monitor the resolution of the bronchial anastomosis and ide...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract::The biological and synthetic materials employed over the years for filling breasts after mastectomy or for congenital malformations are reviewed. At the start of the century, breast shape and volume were changed by adipose tissue grafts. In the 50s and 60s dermo-fibro-adipose grafts and later auto-grafts and grafts of...
journal_title:Minerva chirurgica
pub_type: 历史文章,杂志文章
doi:
更新日期:1989-09-30 00:00:00
abstract:BACKGROUND:Utility of long term central venous accesses. METHODS:Personal experience in 173 long term central venous accesses (a.v.c.) performed from January 1990 to December 1997 in 172 patients mostly affected by neoplastic disease is reported. The device used was totally implantable in 102 cases (59%): 82 Port (80....
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1999-11-01 00:00:00
abstract::The Authors present a case of bile peritonitis due to a biliary fistula developed after T tube removal from the common bile duct. Highlighting poor clinical manifestations they report an alternative conservative treatment, by drainage of the bile leakage with culdocenthesis and successive endoscopic spincterotomy and ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1991-03-31 00:00:00
abstract::Reference is made to personal experience (421 lumbar sympathectomies in 1640 vascular operations carried out over the last ten years) and the results of an enquiry addressed to more than 200 Italian surgeons are cited for the proposition that the indications for this operation are still the subject of disagreement, wh...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1981-09-30 00:00:00
abstract::Angina-like chest pain, caused by alterations of esophageal function, is an increasingly common occurrence confronting cardiologists: advances in pathogenetic knowledge and in diagnostic possibilities in this field have in fact shed light on the prevalence of esophageal angina, which is present in approximately 60% of...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1991-04-15 00:00:00
abstract::Personal experience of short-term chemoprophylaxis with piperacillin in 261 consecutive "clean" and "non-contaminating" operations is reported. Piperacillin was employed in a dose of 2 g i.m. every 8 hours for a total of 48 hours, the first administration being carried out at the same time as pre-anaesthesia. Results ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract::Self-transfusion represents a clinical method used for the restoration of haematic losses that, in recent years has been employed more and more widely in the surgical ambit. The utilisation of this method has become increasingly frequent because of the high diffusion of haemotransmitted diseases, and of the incidences...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract::The rarity of benign primary neoformations in the parapharyngeal space associated with aspecific clinical symptomatology often leads to the identification of large size lesions with deformation of the lateral wall of the pharynx and homolateral hemiplate. The improved diagnostic specificity of radiological instruments...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:1998-06-01 00:00:00
abstract::Mechanistic reasoning suggests that since antireflux surgery treats the gastroesophageal reflux that is the major known risk factor for Barrett's esophagus, it should have a beneficial effect on the biology of Barrett's disease. Due to a lack of adequate data, whether this is the case remains uncertain. Most studies, ...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:2011-02-01 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::Carcinoma of the gastric stump in patients who have undergone resection for duodenal and gastric ulcer represents a rare event which poses considerable diagnostic and therapeutic problems. 7 personal cases are examined, particular attention being paid to the utility of endoscopy, together with sampling for cytological...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1978-09-30 00:00:00
abstract::The literature concerning accidents and complications of transcutaneous splenoportography is examined and compared with personal experience. The technique used is discussed and some of its advantages with respect to selective arteriography of the coeliac tripod are stressed. It is concluded transcutaneous that splenop...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1975-09-30 00:00:00
abstract::Examination of the rectum by pathologists is instrumental in the management of patients affected by rectal carcinoma. That role includes evaluation of multiple gross and microscopic features that convey prognostic implications. The analysis is based on the authors' experience handling rectal specimens along with revie...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:10.23736/S0026-4733.18.07739-8
更新日期:2018-12-01 00:00:00
abstract::Pancreatoblastoma is a very rare tumor of the pancreas, affecting children in the first decade of life. Ultrasound and CT scan may be useful but pre-operative diagnosis is often quite difficult. High level of seric alpha-fetoprotein could be suggestive of pancreatoblastoma. The definitive diagnosis is however made by ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1996-09-01 00:00:00
abstract::In Italy 250,000 subjects every year are affected by malignant tumors, causing 150,000 deaths/year. The global index (statistic prevalence) of oncological patients, either at first diagnosis, or restored to health or under treatment, aggregates 1 million and 500 thousand individuals. During his whole lifetime, every m...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:2003-04-01 00:00:00
abstract:AIM:This prospective study was done to evaluate the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano from a short follow up period (one year). METHODS:This randomized clinical trial of 26 patients was performed during the period from January 2012 to July 2012. Nineteen men...
journal_title:Minerva chirurgica
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2014-08-01 00:00:00
abstract::Although successful short-term results have been achieved with the use of overlapping sphincteroplasty and primary end-to- end repairs to treat fecal incontinence due to sphincteric injury, long-term failure rates may reach as high as 50%. This disadvantage associated with tension repairs may be overcome by utilizing ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:2008-08-01 00:00:00
abstract::The authors report a case in which a PTFE prosthesis, used to treat a voluminous hiatal sliding hernia, dislocated inside the cardial lumen. Within two months the prosthesis had become decubitant and penetrated the cardial lumen, causing dysphagia, inappetence and weight loss. The use of radiological and tomographic i...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:2000-05-01 00:00:00
abstract::A 54 year-old man, without any remarkable medical history, was examined for recurrent episodes of colicky abdominal pain, over a period of nine months, with positive faecal occult blood test. Three months earlier he had undergone an extensive evaluation for a single episode of melaena, including upper gastrointestinal...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Numerous hypotheses are called to explain the beneficial effect on glucose metabolism after bariatric surgery. Some authors advocate for the secretion and release of various substances with endocrine functions for the explanation on this event. One of the substances most marked as effector, with contrasting ...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:10.23736/S0026-4733.18.07681-2
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:There is an increasing preference for early laparoscopic cholecystectomy (ELC) as compared to delayed LC (DLC) in the management of acute cholecystitis (AC). Conversion to open cholecystectomy (LOC) remains an important outcome. We aim to compare ELC and DLC outcomes and identify LOC predictors. METHODS:Ret...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:10.23736/S0026-4733.17.07412-0
更新日期:2017-12-01 00:00:00
abstract:AIM:The aim of this study was to assess retrospectively at 5 years the clinical outcome of bone regeneration in patients who underwent maxillary sinus lift with different equine-derived, enzyme-deantigenated equine bone grafts, and simultaneous placement of acid-etched surface implants. METHODS:Eighteen patients (10 m...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:2008-04-01 00:00:00
abstract::Blunt transhiatal esophagectomy is largely performed in selected cases of esophageal cancer following the experience of Mark Orringer. We have recently performed five consecutive video-laparoscopy-assisted transhiatal esophagectomies in order to help the esophageal dissection and to avoid injuries to mediastinal struc...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1997-06-01 00:00:00
abstract::Thoracic trauma occurs in an estimated 25% of all trauma victims, with approximately 50% of trauma mortalities attributable to these injuries. Only 4% of thoracic traumas involve injuries to thoracic vessels, including the aorta, innominate veins and artery, left carotid artery, internal mammaries, and pulmonary hilar...
journal_title:Minerva chirurgica
pub_type: 杂志文章,评审
doi:
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:This study is to evaluate the efficacy and adverse reaction of a combination therapy of chemotherapy and laser thermal ablation (LTA) on liver metastases from colorectal cancer. METHODS:Eighty-five cases colorectal cancer liver metastases were assigned to the treatment group (43 cases) and to the control gr...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:10.23736/S0026-4733.16.07204-7
更新日期:2017-02-01 00:00:00
abstract::A case of primary leiomyosarcoma of the mesentery is described. Only seven other cases have been reported in the literature, which means that this was an accidental finding. The histological features of the case are illustrated. It is suggested that this tumour originates in the muscle cells of the mesenteric vessels....
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1980-09-15 00:00:00
abstract::Postoperative infections are the most frequent complications in surgery and are the commonest cause of the lengthening of hospital stay. The purpose of this study is to prospectively evaluate the incidence and predisposing factors of postoperative infections in 1396 surgical patients admitted to our Institute from 198...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1992-07-01 00:00:00
abstract::The diaphragmatic hernia described by Morgagni in 1761 and by Larrey in 1829 is a rare diaphragmatic anomaly that may be considered nearly always congenital. It is called in so many ways, but the authors think that "anterior diaphragmatic hernia of Morgagni-Larrey" is the most correct name. Usually asymptomatic in the...
journal_title:Minerva chirurgica
pub_type: 杂志文章
doi:
更新日期:1994-11-01 00:00:00