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G Milito

Publications and source records attributed to G Milito.

16 recordsLinked to original sources
PubMed2003

Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation.

BACKGROUND: The STARR double stapling procedure (DSP), i. e. transanal anteroposterior rectotomy, has been recently reported as a low-morbidity and effective operation for the treatment of rectocele and internal rectal mucosal prolapse (R-IMP) causing obstructed defecation. We report the postoperative complications and recurrence of symptoms following this novel operation. PATIENTS AND METHODS: Fourteen chronically constipated women with RIMP, aged 36-72 years, presented with either severe complications or recurrence of symptoms following DSP performed by means of two circular staplers. All were followed for a median period of 12 months (range, 2-24) after DPS. RESULTS: Severe rectal bleeding occurred in two cases postoperatively. Persistent severe anal pain was reported by seven patients, all presenting with anxiety. Four of them were multiparous. Three patients had fecal incontinence, both had vaginal deliveries. R-IMP recurred in six, obstructed defecation in seven cases. Four patients needed reintervention, one for suturing the bleeding area, one excising the recurrent prolapse, one for colpocele and one for rectal stricture. Four patients required biofeedback training for non-relaxing puborectalis and two needed psychotherapy. CONCLUSION: Parity, spastic floor syndrome and psychoneurosis seem to be the risk factors predisposing to failure of DSP, which may be followed by severe complications and early recurrence of symptoms requiring reoperation.

Adult↗
PubMed2002

Complications after stapled hemorrhoidectomy: can they be prevented?

Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. A review of 1,107 patients treated with SH from twelve Italian coloproctological centers has revealed a 15% (164/1,107) complication rate. Immediate complications (first week) were: severe pain in 5.0% of all patients, bleeding (4.2%), thrombosis (2.3%), urinary retention (1.5%), anastomotic dehiscence (0.5%), fissure (0.2%), perineal intramural hematoma (0.1%), and submucosal abscess (0.1%). Bleeding was treated surgically in 24%, with Foley insertion 15%; and by epinephrine infiltration in 2%; 53% of patients with bleeding received no treatment and 6% needed transfusion. One patient with anastomotic dehiscence needed pelvic drainage and colostomy formation. The most common complication after 1 week was recurrence of hemorrhoids in 2.3% of patients, severe pain (1.7%), stenosis (0.8%), fissure (0.6%), bleeding (0.5%), skin tag (0.5%), thrombosis (0.4%), papillary hypertrophy (0.3%) fecal urency (0.2%), staples problems (0.2%), gas flatus and fecal incontinence (0.2%), intramural abscess, partial dehiscence, mucosal septum and intussusception (each <0.1%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. All hemorrhoidal thromboses were excised. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. Fissure was treated by dilatation in 57%. Most complications (65%) occurred after the surgeon had more than 25 case experiences of stapled hemorrhoidectomy. The most common complication in the first 25 cases of the surgeon's experience was bleeding (48%). Even though SH appears to be promising, we feel that a multicenter randomized study with a long-term follow-up comparing SH and banding is necessary before recommending the procedure. Most complications can be avoided by respecting the rectal wall anatomy in the execution of the procedure.

Adult↗
PubMed2002

Randomised trial comparing LigaSure haemorrhoidectomy with the diathermy dissection operation.

The study was designed to compare LigaSure haemorrhoidectomy with open haemorrhoidectomy performed by means of diathermy excision. Fifty-sixty consecutive patients with third- and fourth-degree haemorrhoids were randomly allocated to undergo either LigaSure haemorrhoidectomy (29 patients) or diathermy haemorrhoidectomy (27 patients). All patients were evaluated for operative time, pain, post-operative analgesic requirements, time to first bowel movement, length of hospital stay, wound healing period, time to return to work, and occurrence of early postoperative complications (such as urinary dysfunction, bleeding, soiling, seepage, continence disorders) and late complications (such as stenosis). A statistically significant advantage was observed in the patients who received the LigaSure technique as far as concerns length of operative time (9.2 vs. 12.2 min, p<0.001), post-operative analgesic requirements (14.1 vs. 16.8 administrations, p<0.001), wound healing period (16.3 vs. 37.5 days, p< 0.0001), and time to return to work (8.3 vs. 18.3 days, p<0.01). No significant difference was seen in the postoperative pain score, complications rate, first bowel motion or hospital stay. No recurrence was observed at the 6-month follow-up. In conclusion, our experience shows that the LigaSure haemorrhoidectomy offers definite advantages over the classic diathermy technique. This procedure is easier, safer, and more rapid to perform and is followed by a faster wound healing time, a significantly shorter hospital stay, less postoperative pain and faster wound healing.

Adult↗
PubMed2001

Parastomal hernia surgery: personal experience with use of polypropylene mesh.

Following stoma construction, parastomal hernia is the most frequent complication. Many surgical techniques have been postulated for these patients, and prosthetic surgery represents the first-choice treatment. We report our personal experience with 8 cases of parastomal hernia in patients submitted to abdominal perineal resection according to Miles, for carcinoma of the lower rectum. Polypropylene mesh was shaped according to the size of the fascial defects, characterized by a romboid incision about 4 cm in length. The mesh was placed in suprafascial position, after suturing the fascial tear. One case of wound infection occurred and, to date, none of the patients have presented with recurrence after a 3-year follow-up. In conclusion, the use of polypropylene mesh for parastomal hernia repair represents a safe and successful technique.

Aged↗
PubMed2001

Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy.

BACKGROUND: The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2). METHODS: One hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8-19) months patients were administered a standardized questionnaire by telephone. RESULTS: Postoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5.3 (range 0-19) days compared with 3.1 (range 0-10) days in group 2 (P = 0.01), while severe pain was present for 2.3 (range 0-24) days in group 1 but only for 1 (range 0-14) day in group 2 (P = 0.03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0.01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0.01), but after 30 days the continence score was better in group 2 (P = 0.04). CONCLUSION: Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.

Adult↗
PubMed2000

Glyceryl trinitrate for chronic anal fissure--healing or headache? Results of a multicenter, randomized, placebo-controled, double-blind trial.

PURPOSE: Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic anal fissure. METHODS: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients. RESULTS: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo (P = not significant). Pain score fell significantly in both groups, in addition to maximum anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate. CONCLUSION: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatment vs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic anal fissure.

Adult↗
PubMed1999

[The endorectal repair of rectovaginal fistulae].

BACKGROUND: Twenty-one patients who had simple rectovaginal fistulas were treated at the Surgical Department of "Tor Vergata" University from 1992 to 1996 all of whom were at the first approach. METHODS: The fistulas were treated with complete excision of the external tract and primary closure of the internal opening with advancement of a rectal mucosal flap, distal to the origin fistulas opening. The vaginal side is left open for drainage. RESULTS: Eighteen of the twenty-one patients had good results; three patients required reoperation for recurrences; all of them had satisfactory results. CONCLUSIONS: The advancement flap technique was very useful for simple rectovaginal fistulas with any sphincter damage, and it is very well tolerated by patients.

Adult↗
PubMed1998

Rhomboid flap procedure for pilonidal sinus: results from 67 cases.

Sixty-seven patients with chronic pilonidal sinuses were treated by excision and rhomboid flap transposition (RFT). Primary healing was obtained in all patients except two who developed a seroma and one who had a partial dehiscence of the surgical wound due to a hematoma, which necessitated drainage through the margin of the flap. The average stay was 5.3 days (range 1-16). All patients returned to normal activities within 2 weeks of surgery. No late recurrence occurred after a mean follow-up of 74.4 months (range 8-137).

Adolescent↗
PubMed1984

Clinical, endoscopic and histologic review in patients submitted to colectomy and ileorectal anastomosis for ulcerative colitis.

The main advantage of colectomy and ileorectal anastomosis performed in patients with ulcerative colitis is the preservation of the rectum and anal continence. However, it represents a high-risk condition for the development of carcinoma in the rectal stump. Thirty-five patients submitted to colectomy and ileorectal anastomosis for ulcerative colitis were interviewed and reviewed through endoscopic and histologic examinations of the rectum. Timing of the investigations varied according to the duration of the disease. Twenty-four patients who had the disease for less than 10 years (Group I) were examined every 12 months, whereas 11 patients (Group II) who had the disease for over 10 years were reviewed every 6 months. Endoscopic aspects of inflammation were graded as mild, moderate or severe. At histology, the disease was classified as quiescent, active or healed. Follow-up was 1-5.6 years. At one year, one patient of Group II presented persistent severe dysplasia on specimens taken from a flat area of rectal mucosa. Proctectomy was advised and performed. Anal complications arose in two patients: anal fissure (1) and anal fissure associated with an anal fistula (1). Endoscopic and histologic improvement of the rectal mucosa was observed in 45% and 54% of the patients in Group I and II respectively. At 5 years, endoscopic, histologic and clinical improvement was noted in 76%, 61% and 85% of the patients respectively. Colectomy and ileorectal anastomosis can be considered a valid procedure in a selected group of patients with ulcerative colitis, provided that regular endoscopic, histologic and clinical review is carried out to permit early detection of premalignant changes in the rectal stump.

Colectomy↗
PubMed1983

Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation.

Seventy-five dialysis patients awaiting renal transplantation were studied. Investigations included single contrast barium meal, serum gastrin assay, gastric acid studies, and fiberoptic gastroduodenoscopy with multiple biopsies. Radiological studies revealed five duodenal ulcers and one gastric ulcer. Endoscopy showed gastroduodenal lesions in 57 patients (49%). Superficial gastritis was present in 50 patients (66.7%), atrophic gastritis in 11 (14.6%), and duodenitis in 30 (40%). Hypergastrinemia was observed in 48 patients (64%). Maximum acid output was markedly elevated in 33 patients. Acid hypersecretion was found to be correlated with the presence of endoscopic lesions and histological evidence of gastritis. Nine of the 11 patients with atrophic gastritis were acid hyposecretors and had low gastrin levels. Pretransplant gastric assessment identified a relevant number of gastroduodenal lesions in these patients. The increased risk of severe posttransplant ulceration justifies thorough gastric assessment and prophylactic antiulcer therapy in all renal transplant candidates.

Adolescent↗
PubMed1983

Subcutaneous lateral internal sphincterotomy in the treatment of chronic anal fissure.

One hundred and seventeen patients with chronic anal fissure were submitted to subcutaneous internal lateral sphincterotomy. Immediate pain relief was observed in all patients except two, in whom sphincterotomy was incomplete. One hundred and ten patients had their first painless bowel movement 24 to 48 hours after the operation. Temporary incontinence to flatus was reported by 38 patients, whereas fecal incontinence was never observed. Healing time of the wound was six days, that of the fissure four weeks. In the 98 patients followed at six months and one year, no complications or recurrences were reported. If particular technical precautions are taken, this type of operation presents several advantages over other procedures, namely posterior midline sphincterotomy and anal stretching.

Adult↗
PubMedDate not supplied

[Surgical treatment of complicated diverticular disease of the colon].

The present study analyzes the results obtained by the AA with the different types of surgery adopted in the treatment of the complicated diverticulosis of the colon, highlighting, on the basis of data available in literature, the possible treatments in the different clinical settings. A retrospective study analyzing type of complication, the surgical technique adopted, Hinchey stage, mortality and morbidity rates and average hospital stay correlated with the kind of intervention has been carried out on 83 surgical interventions performed between 1984 and 1988. The results show that 43 R.A.P. (R.A.P. = primitive anastomosis resection) (32 cases at the I-II stage and 11 cases at the III-IV stage), 27 Hartmann (11 at the I-II and 16 at the III-IV), 9 colostomies (2 at the I-II and 7 at the III-IV), 2 esteriorizations and 2 simple drains have been carried out on a total of 44 intestinal perforations, 16 recurrent diverticulitis, 13 intestinal occlusions, 2 fistulae, 5 abscesses and 3 hemorrhages. The total mortality rate amounts to 10.6%; the morbidity rate of the R.A.P. interventions to 14.4 (I-II stage-related morbidity = 15.6%, III-IV stage = 63.6%), Hartmann's to 9.6% and that of the colostomies to 3.6%. Furthermore, in this work, we have considered the cases of riconversation after Hartmann interventions (9 cases): in the second operations the mortality and morbility rate amounts to 0 and the hospital stay to 9 days. The AA analyze on the surgical technique adopted in the different cases and the of choice criteria. According to the data obtained and to current literature, it results that the primitive anastomosis resection represents the first choice intervention at the I-II stage, although, in selected cases, it can be carried out also at the III-IV stage. Hartmann surgery confirms its effectiveness while simple colostomy is no longer accepted in literature.

Adult↗
PubMedDate not supplied

[Treatment of hemorrhoidal peduncles with diathermy probe].

Diatermy hemorrhoidectomy, without suture of hemorrhoidal pedicles, is a variant of the classical Milligan and Morgan operation. This procedure, if correctly performed, reduces postoperative pain and complications; results are good. Great care is reserved to internal sphincter; it must not be involved in coagulation. Evaluation concerning 100 personal cases are referred.

Diathermy↗