PubMed Health⌕ Search

Biomedical subjects

A Gavelli

Publications and source records attributed to A Gavelli.

36 records · Page 2Linked to original sources
PubMed1994

The role of abdominal drainage after major hepatic resection.

The authors reviewed their recent experience with major hepatic resection in order to evaluate the role of abdominal drainage in the development and treatment of postoperative complications. Fifty-one patients underwent major hepatectomy with abdominal drainage; 44 of these patients (86%) for malignancy (average age at operation: 59 years). Drains were removed after a median period of 4 days. Major complications occurred in 16 patients (31%), and 3 patients (6%) had a fatal outcome. Twenty patients (39%) experienced minor complications, including 6 cases (12%) of ascitic leak from the insertion site. Considering the type and extent of liver resections reported in this series, these results suggest that abdominal drainage, if technically adequate and maintained for a short period, is not responsible for a high rate of postoperative complications. Its use, although questionable after limited resections, is, therefore, still recommended after difficult and extended hepatectomies.

Abdomen↗
PubMed1994

Bleeding pseudocyst of the pancreatic head. The role of omentoplasty and local hemostasis.

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.

Adult↗
PubMed1994

[Failure of the treatment of eventrations and hernias with the PTFE plate (111 cases)].

Patch repair using a PTFE prosthesis was performed in 111 patients over a 5-year period for treatment of incisional hernias (64 cases), inguinal hernias (41 cases, including 29 recurrences), umbilical hernias (4 cases), epigastric hernias (2 cases), lumbar hernias (1 case) and abdominal wall defects after resection for endometriosis (2 cases). The surgical technique was limited to simple patch closure of peritoneomuscular defects without myoplasty. Follow-up was evaluable for every patient and 84 cases have been reviewed clinically by 2 surgeons. 83 patients (86 patches) were followed for at least 1 year (74.8%). Post operative mortality was nil. Morbidity was 17.5% (20 cases, including 14 hematomas, 2 intraperitoneal bleedings, 3 cases of local sepsis, 1 hydrocele). Recurrence rate was 42.2% for incisional hernia repair (27 cases) and 14.6% after inguinal hernia repair. Three out of 4 umbilical hernias and 1 out of 2 epigastric hernias recurred. 14 patients underwent reoperation for recurrent hernia (11 incisional and 3 inguinal). Absence of fibrotic reaction around the PTFE prosthesis was noted in every case and appeared to be the main factor of recurrence. Our experience suggests that patch technique with PTFE prosthesis should be abandoned for the repair of abdominal wall defects.

Adult↗
PubMed1994

[Neoplastic thrombosis of the inferior vena cava involving the right atrium caused by adrenal cortical carcinoma. A new indication for vascular exclusion of the liver].

A large malignant adrenocortical carcinoma extending to the inferior vena cava and right atrium presented in the form of hemoptysis. Magnetic resonance imaging allowed precise evaluation without any other invasive procedure. Cardiopulmonary bypass is usually employed in these circumstances to remove the cavo-atrial thrombus. This approach may be advantageously replaced by the use of total vascular exclusion of the liver. The only unusual feature of the procedure is that the upper caval clamp is applied across the right atrium. Major collateral circulation due to caval thrombosis allows complete resection of the inferior vena cava up to the hepatico-caval confluence without the need for prosthetic replacement. After an uneventful postoperative course, malignant spread despite chemotherapy with op'-DDD led to death 4 months after surgery.

Adrenal Cortex Neoplasms↗
PubMed1994

Extended left hepatectomy with vascular exclusion.

Extended left hepatectomy represents the most extensive and difficult type of hepatic resection. The risk of hemorrhage during transection of the hepatic parenchyma and subsequently the risk of biliary complications may be minimized with use of hepatic vascular exclusion.

Adult↗
PubMed1994

Hepatic resection with ischemia of the liver exceeding one hour.

Twenty-six hepatic resections were performed using vascular clamping lasting more than one hour. The average duration of continuous normothermic ischemia was 67.0 +/- 7.5 minutes (plus or minus standard error of the mean) (range of 60 to 85 minutes). Vascular occlusion consisted of simple portal triad clamping in 14 patients and of hepatic vascular exclusion in 12. Extensive hepatectomy was performed upon more than 80 percent of the patients. One postoperative death was recorded. Extensive complications occurred in eight patients, including one case of hepatic failure. Postoperative changes in hepatic function tests were mild and transient. The rate of postoperative complications was higher in the group of patients with chronic hepatic disease (77.8 versus 11.8 percent, p < 0.005). Prolonged hepatic ischemia should not be considered a risk factor in patients with normal livers, whereas morbidity and mortality rates are seriously affected by the presence of chronic hepatic disease.

Adult↗
PubMed1993

[Risk factors of hepatectomies: results of a multivariate study. Apropos of 113 cases].

113 consecutive elective liver resections were performed in 107 patients over a period of 8 and half years. The indication was a malignant tumor in 75.2% of cases and a benign lesion in 24.8%. The remnant liver was pathologic in 22.1% of cases (16 steatosis, 8 cirrhosis and 1 fibrosis). The extent of liver resection was major (> or = 3 segments according to Couinaud classification) in 60 cases and minor in 45 cases. No intraoperative mortality occurred. Hospital mortality was 4.4%. Major complications, including death, occurred in 36.3% of cases (41/113). Statistical analysis of various risk factors was performed, regarding age, type of liver disease, cholestasis, surgical approach, extent of resection, type of hepatic vascular clamping, liver ischemia, quality of the remnant liver, intraoperative hemorrhage and length of the procedure. Multivariate analysis demonstrated three major statistically significant risk factors: pre operative cholestasis (r = 0.373; p = 0.0012), extent of liver resection (r = 0.377; p = 0.0011), and intra operative blood transfusion (r = 0.364; p < 0.008) with a global correlation coefficient of 0.582 (p < 0.0001). These results should lead to better surgical selection for liver resection and reduced morbidity and mortality.

Abscess↗
PubMed1992

Technique of hepatic vascular exclusion for extensive liver resection.

Hepatic vascular exclusion, which includes clamping of the portal pedicle along with the inferior vena cava below and above the liver, may be a useful procedure for resection of liver tumors close to the hepatic veins or the vena cava that are usually considered unresectable by conventional techniques. Since complete caval exclusion is the key to good hemodynamic tolerance and a bloodless transection of the liver parenchyma, several technical aspects of the procedure must be accomplished and are detailed.

Constriction↗
PubMed1992

[Is ex situ surgery of the liver useful for difficult hepatic resections?].

Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited.

Adult↗
PubMed1992

Liver ischemia for hepatic resection: where is the limit?

BACKGROUND: A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported. METHODS: Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients). RESULTS: No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.

Bilirubin↗
PubMed1992

[Leiomyosarcoma of the inferior vena cava invading into the liver. Complete resection with venous reconstruction].

A case of leiomyosarcoma of the retrohepatic inferior vena cava associated with metastasis in the right liver lobe is reported. Resection included extended right hepatectomy, right nephrectomy, and tumor--containing inferior vena cava resection followed by polytetrafluoroethylene tube reconstruction. A comfortable survival was obtained before multifocal malignant spread led to death 42 months after surgery.

Blood Vessel Prosthesis↗
PubMed1992

[Minimal intestinal preparation before colectomy for cancer. Experience of 189 cases].

189 cases of colectomy for cancer have undergone limited bowel preparation by one or two enemas the day before surgery. The anastomosis has been performed manually with a continuous suture of resorbable material. Hospital mortality is 1.6% for the whole series and limited to 0.5% for elective resections despite the old age of the patients included (70.6 +/- 11 years, with 40.7% more than 75 years). Morbidity rate is 13.9% and of 2.6% for local septic complications. No clinical anastomotic dehiscence was demonstrated. From these results, poor local bowel preparation does not appear to be a risk factor of colectomy for cancer.

Adenocarcinoma↗
PubMed1992

[Is extracorporeal liver surgery useful for difficult hepatic resections?].

Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited.

Adult↗
PubMed1991

[Is ischemia of the liver, lasting longer than an hour, a severity factor in hepatectomies? Apropos of 19 cases].

Nineteen hepatic resections with continuous liver ischemia exceeding one hour (60 to 85 min, m = 68 +/- 8 min) are reported. Surgery was undertaken for 15 malignant tumors, mainly metastatic, and 4 benign tumors. In 16 out of 19 cases, a major hepatic resection was necessary to remove massive and central lesions. Vascular clamping was a Pringle maneuver (9 cases), associated with inferior vena cava clamping-complete hepatic vascular exclusion (10 cases). 2050 +/- 2000 ml of packed red cells were infused peroperatively. No operative nor hospital mortality was recorded. Major complications developed in 6 patients: 3 intraperitoneal haemorrhages leading to complementary hemostasis of the raw surface of the liver in the first 24 hours, 1 erosive gastritis, 2 subphrenic abscesses treated by percutaneous drainage. Severe liver failure developed after left trisegmentectomy on a steatotic liver and led to emergency transplantation on the 17th day with success. Except this case, biochemical liver tests demonstrated slight and transitory alteration. Magnetic resonance imaging confirmed the rapidity of the regenerative process and liver biopsies at 6 and 12 months did not show any late changes. There is no relation between the duration of liver ischemia in the limits of this study and post operative morbidity rate, which is more influenced by the magnitude of the resection and the quality of the liver remnant.

Adult↗
PubMedDate not supplied

Early MR follow-up of partial hepatectomy.

Twenty-seven patients were studied with MRI between 3 and 40 days following partial liver resection. Twenty-four patients had undergone major hepatectomy (three to six segments) and three had undergone minor hepatectomy (tumorectomy, one; bisegmentectomy, two). Indications for surgery were as follows: metastases (n = 16), hepatocellular carcinoma (n = 5), hemangioma (n = 3), focal nodular hyperplasia (n = 2), and cholangiocarcinoma (n = 1). A total of 36 MR examinations were performed using a 1.5 T superconducting unit. Three patients were studied three times and three patients were studied twice. The MR images were evaluated to detect and to characterize liver parenchymal abnormalities and intraabdominal fluid or blood collections as well as to assess vascular and/or graft patency. The MR images showed hepatic ischemia in two cases and allowed differentiation between intraabdominal hemorrhagic (n = 30 and nonhemorrhagic (n = 4) fluid collections. Gradient echo images allowed assessment of polytetrafluoroethylene graft patency as well as demonstration of iliac vein (one case) and portal vein (one case) thrombosis. The presence of surgical clips at the resection margins did not affect image quality.

Adult↗
PubMedDate not supplied

[Emergency colonic surgery. Value of intervention in delayed emergency].

OBJECTIVES: Currently, there is a trend towards emergency colectomy in patients requiring immediate care for lesions involving the large bowel. However, the therapeutic indications have not been fully identified. We therefore retrospectively evaluated our experience with 123 emergency situations. METHODS: Among 745 cases requiring colonic surgery from January 1985 to August 1992, 123 were seen in emergency for intestinal obstruction (n = 69; 56.1%), peritonitis (n = 41; 33.3%) or haemorrhage (n = 13; 10.6%). The mean age of the patient was 71 years and 50% were over 75. The left colon was involved in 76.4% of the cases. Diverticulitis was seen in 43.1% and 39% had cancer of the colon. RESULTS: Emergency resection and anastomosis was performed in 55 cases (44.7%) without colostomy. In 62 patients (50.4%) a colostomy was created; 46 were later removed. In 61 cases, the patients underwent emergency surgery within 24 hours and in the other 62, delayed surgery was performed after one day of hospitalization. Overall hospital mortality was 11.4% (14/123), 20% for patients over 75 and 3.2% for those under 75. Mortality after delayed operations was lower (6.5%) than after emergency surgery (17.2%). There was also a higher rate of colon resections without colostomy in delayed procedures (62.9% vs 26.2%). CONCLUSIONS: Our experience leads us to recommend delayed surgery whenever possible in order to decrease operative mortality and number of operations.

Adult↗