Comment on a balanced approach to choledocholithiasis.
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Biomedical subjects
D R Iusco
Publications and source records attributed to D R Iusco.
The value of laparoscopy in the diagnosis and therapy of violin-string like perihepatic nonpostoperative adhesions.
We report three cases of Fitrz-Hugh Curtis syndrome (FHCs) that were diagnosed laparoscopically and showed microbiological or serological evidence of chlamydial infection. The case histories underscore the part played by abdominal right quadrant symptoms. In all three cases, right quadrant pain and tenderness constituted the presenting features. The patients were thought to have acute cholecystitis or acute appendicitis, but investigations proved negative. Laparoscopy was the key to the diagnosis, revealing the violin-string-like perihepatic adhesions typical of this syndrome. Lysis of the adhesions resolved the patients' symptoms of persistent severe abdominal pain. In the first case, the pain lessened dramatically only after the third operation, when the perihepatic adhesions were lysed. In the two other cases, the lysis was performed laparoscopically by fulguration and cutting. We consider this procedure to be an excellent therapeutic modality for the pain associated with FHCs.
Abdominal Pain↗
Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open, tension-free versus laparoscopic approach.
No randomized trial exists that specifically addresses the issue of laparoscopic bilateral inguinal hernia repair. The purpose of the present prospective, randomized, controlled, clinical study was to assess short- and long-term results when comparing simultaneous bilateral hernia repair by an open, tension-free anterior approach with laparoscopic "bikini mesh" posterior repair. Forty-three low-risk male patients with bilateral primary inguinal hernia were randomly assigned to undergo either laparoscopic preperitoneal "bikini mesh" hernia repair (TAPP) or open Lichtenstein hernioplasty. There was no difference in operating time between the two groups. The mean cost of laparoscopic hernioplasty was higher (P < 0.001). The intensity of postoperative pain was greater in the open hernia repair group at 24 hours, 48 hours, and 7 days after surgery (P < 0.001), with a greater consumption of pain medication among these patients (P < 0.05). The median time to return to work was 30 days for the open hernia repair group and 16 days for the laparoscopic "bikini mesh" repair group (P < 0.05). Only 1 asymptomatic recurrence (4.3%) was discovered in the open group. The laparoscopic approach to bilateral hernia with "bikini mesh" appears to be preferable to the open Lichtenstein tension-free hernioplasty in terms of the postoperative quality of life and interruption of occupational activity.
Adult↗
Surgery of abdominal aorta in octogenarians. Can indications be extended?
BACKGROUND: This paper describes the authors' experience with the management of the abdominal aorta in patients aged over 80 years. METHODS: Ten urgent procedures were performed on patients older than 80 years during a 2 year period. In 4 cases surgery was performed because of a ruptured aneurysm of the subrenal abdominal aorta, in 2 cases for active symptomatic aneurysms, in 3 cases for severe lower limb ischemia (occlusion of the iliac and femoral arteries) and in 1 case for a secondary aortoenteric fistula. RESULTS: The operative mortality rate was 20% (2 cases with a ruptured aneurysm). Five patients are still alive in good health conditions (one of them had been operated twice for two different diseases). Even if our findings refer to a small number of patients, although similar series on emergency operations found in the literature are not substantially larger, the results do not advise against operative treatment of the abdominal aorta in cases requiring a direct approach, even in patients over 80 years of age. CONCLUSIONS: If this treatment strategy is obviously adopted in emergency conditions, as with the patients we are reporting on, since the alternative to operation is usually death, it should also be carefully considered in elective circumstances, where alternative treatments such as endovascular stents did not to date obtain better results. In the elective scenario all the necessary biological and physical parameters as well as the patient's age should be taken into proper account in deciding whether to operate. This is specially true now that the average life spans of an individual is longer so that patients, who may incur serious problems if left untreated, may be offered a better quality of life.
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