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F Agresta

Publications and source records attributed to F Agresta.

At least 19 recordsLinked to original sources
PubMed2005

Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery.

BACKGROUND: Emergency laparoscopic exploration can be used to identify the causative pathology of acute abdominal pain. Laparoscopic surgery also allows treatment of many intraabdominal disorders. This report was prepared to describe the effectiveness of laparoscopic surgery compared to laparotomy or nonoperative treatment. METHODS: A panel of European experts in abdominal and gynecological surgery was assembled and participated in a consensus conference using Delphi methods. The aim was to develop evidence-based recommendations for the most common diseases that may cause acute abdominal pain. RECOMMENDATIONS: Laparoscopic surgery was found to be clearly superior for patients with a presumable diagnosis of perforated peptic ulcer, acute cholecystitis, appendicitis, or pelvic inflammatory disease. In the emergency setting, laparoscopy is of unclear or limited value if adhesive bowel obstruction, acute diverticulitis, nonbiliary pancreatitis, hernia incarceration, or mesenteric ischemia are suspected. In stable patients with acute abdominal pain, noninvasive diagnostics should be fully exhausted before considering explorative surgery. However, diagnostic laparoscopy may be useful if no diagnosis can be found by conventional diagnostics. More clinical data are needed on the use of laparoscopy after blunt or penetrating trauma of the abdomen. CONCLUSIONS: Due to diagnostic and therapeutic advantages, laparoscopic surgery is useful for the majority of conditions underlying acute abdominal pain, but noninvasive diagnostic aids should be exhausted first. Depending on symptom severity, laparoscopy should be advocated if routine diagnostic procedures have failed to yield results.

Abdomen↗
PubMed2005

Primary pulmonary nodular amyloidosis.

Primary nodular amyloidosis of the lung is an uncommon manifestation. The disease runs a benign course, but offers diagnostic problems due to non-specific radiological features entering the big field of the solitary nodule. We describe the case of a 60 year old man with multiple nodules on the left lung operated on diagnostic and therapeutic video-assisted thoracoscopy and discuss the possibilities, if any, of suspecting such a disease through radiologic characteristics along with findings from the patient's history, physical examination and laboratory tests.

Amyloidosis↗
PubMed2004

Direct trocar insertion vs Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective single-center study.

BACKGROUND: Nonobese patients undergoing laparoscopic procedures present a dilemma as to the correct mode of entry into the abdominal cavity because the Veress needle (VN) technique seems to be associated with a high risk of vascular and visceral injuries. Direct trocar insertion (DTI) has been reported as an alternative to the VN for creation of the pneumoperitoneum. METHODS: An open comparative randomized prospective study was conducted on the feasibility and safety of DTI vs the VN technique in nonobese patients of any age category referred for urgent or scheduled laparoscopic procedures. Exclusion criteria were obesity (defined as a body mass index [BMI] > 27 kg/m(2)), major abdominal distension, and two or more previous abdominal operations. The study endpoints were the feasibility and safety of the DTI and VN techniques. Results were evaluated on an intention-to-treat basis. Statistical analysis was carried out with the t-test for independent samples, the chi-square tests, and the Fisher's exact tests, as appropriate. The level of significance was 0.01. RESULTS: Since January 2002, a total of 598 nonobese patients have been entered into the current trial; 46% (mean BMI 21.6 A+/- 4.4 kg/m(2)) were randomly allocated to DTI, whereas 54% (BMI 21.1 A+/- 5.3 kg/m(2)) were allocated to the VN techniques. Demographic features and type of procedures were similar for the two groups. DTI was feasible in 100% of patients vs 98.7% in the VN group (p = NS). Minor complications were nil in the DTI group and 5.9% in the VN group (p < 0.01). The latter group consisted of 11 cases (3.4%) of subcutaneous emphysema and eight cases (2.5%) of extraperitoneal insufflation. Major complications were nil in the DTI group and 1.3% among VN patients (p = NS). These latter cases consisted of two (0.3%) hepatic lesions managed laparoscopically; one (0.3%) misdiagnosed ileal perforation requiring reintervention, and one (0.3%) mesenteric laceration treated conservatively. CONCLUSION: In thin and very thin patients of any age category with no more than one previous abdominal operation, DTI is a safe alternative to the VN technique and is associated with fewer minor complications. In terms of major complications, there is no difference between the two techniques. Either technique of access is acceptable Thin and very thin patients undergoing laparoscopy, on condition that the basic principles of laparoscopic surgery are complied with.

Adult↗
PubMed2002

Gallstone ileus as a complication of acute cholecystitis. Laparoscopic diagnosis and treatment.

Gallstone ileus accounts for 1-4% of all cases of intestinal obstruction, with its incidence rising with age of patients. There is often a long delay between onset of symptoms (usually abdominal pain, vomiting, and bowel distension) and proper treatment, with a simple enterolithotomy as the one of choice. We report a case of an atypical gallstone ileus presented as a complication of acute cholecystitis, treated with a laparoscopic guided enterolithotomy. A 67-year-old woman on the 5th p.o. day after a laparoscopic procedure for an empyematous cholecystitis (no sign of fistula or duodenal perforation and a "negative" intraoperative cholangiography) presented continuous vomiting as the only symptoms of a subileus (radiographic diagnostic images negative for intestinal obstruction or intraluminal gallstone or duodenal fistula). A laparoscopic diagnostic approach revealed a gallstone in the distal jejunum. Through a 5 cm midline incision the intestine, including the gallstone, was brought out extracorporally and the stone was removed by a simple enterolithotomy. The postoperative course was uneventful and the patient had no complaint at a 1-year follow-up. We consider the laparoscopic approach, in patients with "abdominal emergencies," feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities, as in the case of gallstone ileus we have reported.

Acute Disease↗
PubMed2000

Laparoscopic management of colonoscopic perforations.

Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation.

Abdomen, Acute↗
PubMed2000

Emergency laparoscopy: a community hospital experience.

BACKGROUND: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience). METHODS: Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach. RESULTS: The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy. CONCLUSIONS: We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach promises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.

Adult↗
PubMed2000

Gastric MALT lymphomas: the value of an endoscopic follow-up evaluation.

BACKGROUND: Findings have demonstrated the close association between primary gastric B-cell lymphomas originating from mucosa-associated lymphoid tissue (MALT) and Helicobacter pylori (HP) infection, with their regression after an HP eradication therapy in up to 70% of the cases. Endoscopic-biopsy diagnosis and endoscopic ultrasound are of major importance as decisive prognostic factors and therapeutic determinants. OBJECTIVES: We report 3 years of experience and follow-up evaluation in the management of MALT lymphomas. We also describe the guidelines strategy therapy used in our institution. METHODS: Since July 1996, nine patients with a histologic diagnosis of low-grade, HP-positive MALT gastric lymphomas, have been followed up. All patients had stage IE lymphomas (according to Musshoff classification). Eradication of HP was performed with triple therapy amoxycillin, clarithromycin, and omeprazole using over a 14-day period. The patients were seen for endoscopic follow-up assessment after 3, 6, 9, and 15 months, then twice a year. The actual median follow-up time was 30.4 months (range, 16-38 months). RESULTS: All the patients are now free of disease and asymptomatic. We have registered two cases of HP relapse (both after 1-year follow-up evaluation), positively treated with the same triple therapy, and three cases of disease relapse treated with single-dose chemotherapy (plus radiotherapy in one patient). CONCLUSIONS: In our experience the eradication of HP appears to be effective, and we consider it the first therapeutic option in patients with stage IE gastric low-grade MALT lymphoma, although long-term results are still needed. Prolonged follow-up evaluation (particularly by endoscopy) is necessary (and feasible in our experience) to determine whether these remissions are long-lasting. We recommend that HP be eradicated in these lymphomas before referral to other standard treatment.

Aged↗
PubMed2000

Small bowel obstruction. Laparoscopic approach.

BACKGROUND: This is a retrospective review of our experience using a laparoscopic approach in the treatment of acute and chronic small bowel obstruction (SBO). MATERIALS AND METHODS: Of 136 patients hospitalized in our institutions for acute (94 cases: 69.1%) and chronic (42 cases: 30.8%) SBO, from January 1994 to March 1998, 63 (46.3%) were approached laparoscopically. The etiology was accurately diagnosed in 58 cases (92%), and it was possible to treat it laparoscopically in 82.5% (52 of 63 cases). In the remaining 11 cases (17.4%), a formal laparotomy was needed for bowel resection, due to an ischemic small bowel or for malignant disease. RESULTS: Overall, 82.5% of our cases were successfully treated laparoscopically. CONCLUSIONS: We conclude that, in experienced hands, laparoscopy is an excellent diagnostic and, in the majority of cases, a therapeutic surgical approach in selected patients with acute or chronic SBO.

Acute Disease↗
PubMed2000

Perforated peptic ulcer: laparoscopic approach.

OBJECTIVES: To examine the suitability of a laparoscopic approach for treatment of perforated peptic ulcer. DESIGN: Retrospective non-randomised study. SETTING: District Community Hospital. METHODS: 30 patients who presented with perforated peptic ulcers between November 1992 and October 1997 INTERVENTIONS: 16 patients were operated on laparoscopically, and 14 by open operation (as there was no surgeon available with laparoscopic experience). MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The laparoscopic operation was successful in all but one patient, whose operation was converted to an open procedure because we could not see the ulcer adequately. Duration of operation and postoperative nasogastric aspiration, analgesic requirements, hospital stay, morbidity, and mortality were similar in the two groups. CONCLUSIONS: Laparoscopic repair of a perforated peptic ulcer is safe in selected patients in whom a laparotomy should be avoided.

Adult↗
PubMed1999

[Emergency laparoscopic surgery: a hospital's experience].

BACKGROUND AND AIM: The wide diffusion and increasing use of laparoscopic surgery prompts the authors to broaden discussion to its validity and diagnostic-therapeutic use in emergency abdominal surgery. The aim was to evaluate the efficacy of laparoscopic surgery in the light of reports in the international literature and in relation to the situation in our hospital. METHODS: From April 1994 to May 1998, out of 1016 emergency abdominal operations performed at our hospital, 783 (77.5%) used a laparoscopic approach for diagnostic and therapeutic purposes: intestinal occlusion: 26 cases; gastrointestinal ulcer pathology: 15 cases; hepatobiliary pathology: 398 cases; "pelvic" pathology: 305 cases; colic pathology: 39 cases. These represent 24.4% of all laparoscopic procedures carried out during the same period. We preferred to use immediate laparotomic access in patients with the following characteristics: anamnesis of previous surgery for malignant pathologies; anamnesis of more than two major abdominal operations; massive intestinal distension; patients whose general conditions were a contraindication to a laparoscopic approach. RESULTS: The conversion rate was 6.2% (49 cases) with morbidity of 3.4% (25 cases) and a mortality rate of 0.2% (2 cases). A final diagnosis was made in 763 patients (97.4%) with the possibility of treating 719 of them (94.2%), again using a laparoscopic approach. CONCLUSIONS: It is right to regard the laparoscopic approach in emergency abdominal surgery as a feasible and safe model, offering a high potential for diagnosis and therapy if appropriately performed by an expert and well coordinated team. The increased experience of mini-invasive surgery and the improved range of instruments available make the laparoscopic approach a valid alternative to laparotomy, even in the event of emergency abdominal pathologies.

Acute Disease↗
PubMed1998

Thrombolysis with i.v. recombinant human tissue-type plasminogen activator in patients with bypass graft occlusion: a good adjunctive therapeutic mode (preliminary and case reports).

BACKGROUND AND METHODS: The authors report their experience with thrombolytic therapy in seven cases of graft thrombosis managed successfully with low-dose i.v. rt-TPA. In six patients the cause was an anatomical one and so, after the successful lysis, there was enough time to confirm a correct diagnosis and plan the "right" and "less extensive" surgical procedure, obviating it in one case with a "functional" cause of thrombosis. RESULTS: No complication directly attributable to rt-TPA infusion occurred, and no systemic fibrinogenolysis was registered in any cases. Judging from this experience, i.v. rt-TPA appears safe and effective in patients with graft thrombosis, proving to be a good adjunctive therapeutic mode. CONCLUSIONS: Further studies are needed do delineate more clearly safe indication and the validity of this method.

Aged↗
PubMed1996

[Femoro-distal bypasses with the saphenous vein in situ. Our experience].

The authors report their experience with the femoral-to-distal in situ saphenous vein bypass. Evaluation of the distal circulation, the adequacy of the saphenous vein, and routine follow-up after bypass, along with the operative procedure and technical problems (A-V fistulas, valvulectomy, etc.) are described. Overall the in situ saphenous vein bypass provides a natural, compliant endothelial-lined conduit that allows an optimal revascularization to below-knee arteries.

Aged↗
PubMed1994

[Pathophysiology of pancreatico-duodenectomy according to Traverso-Longmire. Clinical and instrumental study].

The authors report their experience with 9 patients, affected by pancreatic and periampullary carcinoma, treated using pancreaticoduodenectomy with pyloric preservation. They analyse the physiopathology of this technique, by the light of the international reports, and note the advantages that this technique allows about the nutritional status and the quality of life of the patients operated on.

Aged↗
PubMed1989

[Evaluation of prognostic factors in surgery of gastric cancer].

The prognostic role of some clinical and pathologic variables in patients with carcinoma of the stomach was evaluated. While for some of these (invasion of the gastric wall, nodal status) the prognostic value is widely accepted, for the others (age, sex, size and site of tumors, histologic type, surgical procedure) the prognostic significance has not been fully defined. Using univariate analysis, the best predictors of survival after curative resection were nodal status, histologic type and serosal involvement. As related to the last three, using a multivariate analysis, the serosal involvement was the most important prognostic variable.

Adult↗