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E Ancona

Publications and source records attributed to E Ancona.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Treatment of lymphocele following renal transplantation by laparoscopic surgery.

We describe a new technique for internal drainage of lymphocele following renal transplantation performed by laparoscopy. After induction of the pneumoperitoneum, using the cautery hook, a wide opening in the lymphocele peritoneal wall has been performed allowing the lymph flow to enter the peritoneal cavity. A portion of the omentum has been pushed inside the lymphocele cavity and fixed to the parietal peritoneum in order to avoid closure of the peritoneal window. A postoperative CT scan control has shown the complete disappearance of the fluid collection. Internal drainage of lymphocele performed by laparoscopy allows a radical treatment with minimal trauma for the patient and has therefore potential advantages over the other current procedures.

Adult↗
PubMedDate not supplied

[Limitations of the traditional manometric test and advantages of computerized manometry in the study of esophageal motility].

The analysis of esophageal motility tracings is laborious, time consuming and subject to reader variability. The motility traces of five patients were analyzed separately by five experienced readers, in order to assess the inter and intra observer variability. Later on, the manual analysis of the motility traces of five healthy volunteers and four patients was compared to the automatic analysis performed by a computerized system. The inter- and intra-observer variability (expressed as coefficient of variation) was high in the manual analysis, especially for the abdominal length of the lower sphincter and the duration of the esophageal body contractions (coefficient of variation ranging from 18 to 43%). On the contrary, automatic readings proved almost identical to the means obtained by manual analysis (Pearson factor 0.988 for amplitude and 0.89 for the duration of contractions). Moreover, the computerized automatic analysis gave a significant time gain in respect to manual readings and eliminated the inter and intra-observer variability.

Electronic Data Processing↗
PubMedDate not supplied

[Renal transplantation. 1st year's experience at a new center].

The initial activity in the field of organ transplantation always brings some organizational and medical difficulties. We describe the first year experience in the field of kidney transplantation at the Transplantation Unit of Padua University. Sixteen kidney transplants from cadaver donors have been performed. A double drug therapy (cyclosporine and steroids) as immunosuppression was used in 9 patients and a triple drug protocol (cyclosporine, steroids, azathioprine) was used in 7. Two patients also received monoclonal antibodies because of steroid resistant rejection. The technical problems we observed include one case of ureteral duplication corrected with uretero-ureteral anastomosis and one substenosis of an ureteral cystoanastomosis corrected with endoscopic dilatation. Among the complications related to immunosuppressive therapy we had one case of severe cyclosporine nephrotoxicity. Two patients died after few months with a functional graft because of pulmonary embolism and because of severe hepatitis complicated by pancreatitis. At an average of six months follow-up all the remaining patients have a good functioning graft.

Adolescent↗
PubMedDate not supplied

Esophageal strictures following nasogastric intubation.

Esophageal stricture is not reported to be a common complication of nasogastric intubation. Two patients who had a Levin tube inserted in the stomach for nutrition during a prolonged coma, and finally presented with a severe esophageal stricture were observed and treated. The clinical history of the patients suggests that the pathogenesis of this lesion is probably multifactorial, secondary to induced gastroesophageal reflux, impaired esophageal clearance, high gastric acid output, and use of steroids. Jejunostomy feeding, rather than nasogastric feeding, is probably a better means to provide nutritional support in comatose patients, thus averting the risk of such a serious complication. Esophageal replacement with left colon interposition appears the treatment of choice for these severe esophageal strictures.

Adolescent↗
PubMedDate not supplied

[Palliative treatment of cancer of the esophagus].

Personal experience in the treatment of patients with oesophageal cancer that cannot be radically operated is presented. The high incidence (50%) of this situation required the use of measures to improve survival conditions. Results speak in favour of prosthetic intubation of the oesophagus, preferably by the endoscopic route and in a carefully selected number of patients, in the course of major operations like palliative oesophago-gastroplasty.

Adult↗
PubMedDate not supplied

Esophagogastric anastomotic leakage.

Anastomotic leakage of esophagogastric anastomoses can be prevented by administering adequate preoperative nutritional support and by employing mechanical circular staplers. In a series of 299 intrathoracic anastomoses, 35 leakages were observed, 11 of which gave asymptomatic radiological findings. In a series of 46 cervical anastomoses, nine leakages were observed. In the majority of cases conservative treatment was adopted. This is based upon external drainage of septic collections, gastric emptying, antibiotics and intensive nutritional care. The mortality rate in cases of anastomotic fistulas was 1.74% (6 patients) in the patients with esophagogastric anastomoses.

Cardia↗
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A new technique for the treatment of esophageal bleeding in portal hypertension.

A new method to operate on patients with bleeding due to portal hypertension is presented. It consists of splenectomy, devascularization of the gastric corpus, fundus and distal esophagus, resection-anastomosis of the lower esophagus, selective vagotomy with pyloromyotomy, and antireflux cardioplasty. All these procedures are carried out through a laparotomy; the esophageal resection-anastomosis is performed using the American circular EEA mechanical stapler. The method was used on 15 patients; there was one postoperative death. As regards the varices, early results were optimal. No encephalopathy was observed. Endoscopic dilatation of the anastomosis was required in four cases. No recurrence of hemorrhage has yet been observed.

Esophageal and Gastric Varices↗
PubMedDate not supplied

The surgical treatment of cancer of the cervical esophagus: complications and preliminary results.

Out of 129 cancers of the cervical esophagus, 74 (57%) were resected. After laryngopharyngectomy and segmentary esophagectomy, the reconstruction was performed by substernal coloplasty in 18 cases and by free bowel autotransplantation in 18. When total esophagectomy was performed, pharyngogastroplasty was performed in 32 cases and pharyngocoloplasty in seven. The total postoperative death rate was 18.9%. In cases of segmentary resection the three-year survival rate was 14.34% and 15.87% in cases of total esophagectomy.

Colon↗
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Laparoscopic treatment of gastro-esophageal reflux disease: indications and results.

This paper deals with the indications, techniques and results of laparoscopic total or partial posterior fundoplications (Nissen and Toupet procedures, respectively) performed in 41 patients with gastroesophageal reflux disease (GERD) failing to respond to medical treatment. Stationary manometry and 24-hour esophageal pH monitoring established the indications for surgery. Laparoscopy was attempted in all patients, even when giant mixed or para-esophageal herniations were present. The rate of conversion to laparotomy amounted to 12.2%. There were no intraoperative complications. Major complications were observed in 3 patients (8%) and included 2 cases of slipped Nissen and 1 of pneumonia. Four patients had persistent postoperative dysphagia; two of them were re-operated and two were treated with pneumatic dilatation. Reflux only recurred in 1 patient. Functional follow-p demonstrated an overall increase in LES resting pressure and length, with no abnormal gastro-esophageal reflux episodes, findings which tended to persist in the long term.

Adolescent↗
PubMedDate not supplied

[Myotomy of the esophageal body].

Extramucosal myotomy involving the external longitudinal and internal circular layers of the musculature of the esophagus represent the surgical therapy in patients with dysphagia and regurgitation or with angina-like chest pain secondary to functional abnormalities of the musculature of the esophagel body and sphincters. Surgery has a palliative function, because cures symptoms and complication such a diverticula, but not the disease. Modern surgical techniques also prevent recurrence of symptoms and complications are minimal with better long-term results than conservative therapy. Myotomy of the lower esophageal sphincter extended to the distal part of the esophageal body (Heller's operation) is performed as first choice or following insucces of dilatation in patients with primary achalasia of the esophagus, using a trans-abdominal or a trans-thoracic approach. Myotomy of the upper esophageal sphincter is indicated in patients with Zenker's diverticulum following diverticulectomy or diverticulopessy. Segmental myotomies are performed after diverticulectomy in patients with epiphrenic pulsion diverticula. Trans-thoracic "long" esophageal myotomy performed from the thoracic portion of the lower esophageal sphincter to the aortic arch is indicated in patients with diffuse esophageal spasm and nutcracker esophagus and sometimes in patients with aspecific abnormalities of the esophageal motor function associated with diverticula. Circular miotomies limited to the external longitudinal layer of the esophageal musculature can be performed at the level of anastomosis in order to gain tissue and reduce tissutal tension. The recent introduction of the endoscopic surgery allowed some of these operations to be performed through minimally invasive approaches. Therefore laparoscopic and thoracoscopic Heller's myotomy is feasible with clinical and functional results similar to those obtained with traditional open approach and with less postoperative discomfort and shorter hospital stay. This paper deals with the indications and surgical techniques of myotomies of the esophageal body both limited and extended to the lower esophageal sphincter.

Esophageal Diseases↗
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[Surgical treatment of acid gastroesophageal reflux].

Recently, it has been demonstrated that the surgical treatment of gastro-esophageal reflux disease is superior to the medical treatment. Further, the surgical treatment gained new popularity because of the introduction and diffusion of laparoscopic techniques. A careful definition of gastro-esophageal reflux disease, based on the underlying pathophysiological abnormality (i.e.: an increased exposure of the distal esophagus to the refluxed acid juice), and a proper selection of patients candidate to surgery must however be maintained, together with a proper surgical technique, in order to achieve satisfactory results. In this paper, the authors outline in this paper the general principles of anti-reflux surgery and review the most recent results obtained with Nissen fundoplication as well as with other antireflux procedures. They describe in detail the surgical technique of the Nissen fundoplication ("Floppy" Nissen) by a laparoscopic approach. They review their experience in this with 15 operations performed since June 1992, and report the results of an Italian multicentric survey study on laparoscopic surgery for gastro-esophageal reflux disease. Recent series appeared in Literature are also reviewed. In conclusion, the authors underline the need for careful prospective studies and long-term clinical and functional follow-up of patients undergoing laparoscopic anti-reflux surgery before drawing definitive conclusions on its efficacy. However, early results seem to be really promising.

Fundoplication↗
PubMedDate not supplied

Iatrogenic perforation of the esophagus.

The treatment of iatrogenic esophageal perforation is still today subject of discussion. The present work relates our experience on 16 cases seen between 1955 and 1976, and compares the results with the 1,310 collected by French and English literature. The etiology of perforation is: endoscopy (50.5%), dilatation (19.5%), foreign bodies (14%), surgery and other causes (16%). The mortality rate of cervical perforations is 14.5% (7.3% with medical treatment, 18% with drainage, 12.6% with suture). In the thoracic esophagus it is 32.5% (50% with medical treatment, 40% with drainage, 18% with suture). The data demonstrate that the best results are obtained with surgical treatment, that may be simple drainage when the perforation is cervical, but must be the suture in the thoracic esophagus. We must emphasize that the operation must be performed within 24 hours, because, in the cases operated on after 24 hours, the mortality rate is nearly double.

Adult↗
PubMedDate not supplied

[Cholecysto-colic fistula: laparoscopic treatment].

Cholecystocolic fistula is an unusual complication of biliary tract disease and it may defeat laparoscopic treatment. We recently was a patient who, while undergoing laparoscopic cholecystectomy, was found to have a fistula between the gallbladder and the transverse colon. The fistula was transected with a 3 cm endoscopic linear stapling device and uneventful laparoscopic cholecystectomy was performed. This report shows that, with increasing experience, no absolute contraindications exist to starting laparoscopic cholecystectomy by introducing the laparoscope.

Biliary Fistula↗