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L Montinaro

Publications and source records attributed to L Montinaro.

8 recordsLinked to original sources
PubMed2002

Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children.

BACKGROUND: Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux (GER) in children. We present the prospective experience and short-term results of eight Italian pediatric surgical units. METHODS: We included all the children with complicated GER, operated after January 1998 by single surgeons from eight different centers. Diagnostic aspects, type of fundoplication, and complications were considered. All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences. RESULTS: 288 children were prospectively included. Mean age was 4.8 years (3 m-14 y). Nissen fundoplication was done in 25%, floppy Nissen in 63%, Toupet in 1.7%, and anterior procedures (Lortat Jacob, Thal) in 10%. Gastrostomy was associated, if neurological impairment or feeding disorders were present. Mean follow-up was 15 months and reoperation was necessary in 3.8% of cases. CONCLUSIONS: This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden standard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach.

Adolescent↗
PubMed2002

The Lortat-Jacob operation by laparoscopic access to treat gastroesophageal reflux in pediatric patients. Preliminary results.

BACKGROUND: Even in the pediatric field, the technique most commonly used in the laparoscopic treatment of GERD is 360 degrees fundoplication (according to Nissen and variants), but this is not devoid of serious complications or sequelae, such as persistent dysphagia or the "gas bloat syndrome." In fact, there has been no lack of proposals of alternative techniques in literature aiming to reduce these negative postoperative events, especially in pediatric patients. At our pediatric surgical clinic at Bari University, the first choice technique is the Lortat-Jacob operation, used in traditional surgery for over 20 years and that has yielded excellent results both as regards control of GER and the complication and sequelae rate. Aim of this study, based on purely preliminary results, was to demonstrate the feasability of the Lortat-Jacob operation by laparoscopic access in pediatric patients, even younger than 1 year old. To our knowledge, there are no other references in literature to the use of this technique by laparoscopic access in pediatric patients. METHODS: Antireflux plasty sec. Lortat-Jacob by laparoscopic access was performed in 10 patients of ages ranging between 10 months and 11 years. The technique adopted took into account all the recognized principles of the traditional surgical approach. The most delicate stage was the extensive mobilization of the distal esophagus at the level of the mediastinum, owing to the risk of bleeding, and of pleural and vagal lesions. Mean operative time was 100' (80'-120'). All the operations were performed laparoscopically, and no intraoperative complications were recorded. The nasogastric probe was removed within 24 h postoperatively, and liquid feeding was recommenced within 36 h. All patients were discharged within 72 h. RESULTS: No complications or short or medium term sequelae were observed. Follow-up is still in the early stages, but the first radiological endoscopic, and pH monitoring controls have shown excellent results. CONCLUSION: The initial data on our recent, limited experience show that the Lortat-Jacob operation can be performed by laparoscopic access in expert hands, provided scrupulous attention is paid to the timing and principles laid down for the traditional surgical approach. Moreover, laparoscopic access allows even greater care to be taken to prevent damage to the vagal nerves during mobilization of the terminal esophagus at the mediastinic level, as they are easier to identify even in children under 1 year old, thanks to the magnification of the image. The good control of GER and absence of complications or short or medium term sequelae justify our choice to use this operation. However, our results are still preliminary and need to be confirmed by an increasing number of patients and longer term follow-up.

Blood Loss, Surgical↗
PubMed2002

Complications and conversions of pediatric videosurgery: the Italian multicentric experience on 1689 procedures.

BACKGROUND: The aim of this study was to evaluate the incidence and management of complications of videosurgical procedures that occurred during a 4-year period in eight Italian pediatric surgery centers. METHODS: Between 1996 and 1999, 2305 videosurgical procedures were performed in 11 centers of pediatric surgery. The data from 3 centers, for a total of 616 procedures, were largely incomplete and were thus excluded from the study. We analyzed the data from 8 centers only, for a total of 1689 laparoscopic or thoracoscopic operations on patients aged between 15 days and 16 years. The type of operations performed ranged from basic videosurgical interventions, such as varicocelectomy and cryptorchidism, to advanced laparoscopic procedures, such as splenectomy, total colectomy, and esophageal achalasia. Each patient's file was examined for any complications that may have occurred during the surgical procedure and for a record of how these were managed. RESULTS: We recorded 79 complications (4.6%) in our series. In 57 cases (72.2%) the problem was solved by videosurgery. Twenty-two cases (27.8%) required conversion to open surgery. There was no mortality in our series. At a maximum follow-up of 4 years, all children were alive and had no problems related to the videosurgical complications. CONCLUSIONS: We believe that the routine use of open laparoscopy in pediatric patients is a key factor to avoiding complications related to the Veress needle and blind introduction of the first trocar. Moreover, the surgeon's laparoscopic experience, the correct indications for laparoscopic surgery, and the verification of the laparoscopic equipment before surgery are also important rules to follow to reduce the incidence of complications. In the beginning, it is preferable to have the assistance of an expert laparoscopic surgeon to decrease the complications related to the learning curve period.

Adolescent↗
PubMed2001

Results and complications of laparoscopic surgery for pediatric varicocele.

BACKGROUND: The aim of this study was to evaluate the results and complications of laparoscopic varicocelectomy in children. METHODS: Over a 36-month period, 211 children underwent laparoscopic treatment of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 (0.9%). In 195 patients the laparoscopic transperitoneal approach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicular veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. RESULTS: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. Testicular atrophy did not occur in any patient of this series. CONCLUSIONS: This preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. The ligation of testicular veins and artery is preferable to the ligation of the testicular veins alone. Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure.

Adolescent↗
PubMed2000

Laparoscopic treatment of pediatric varicocele: a multicenter study of the italian society of video surgery in infancy.

PURPOSE: We report preliminary results of a multicenter study of the Italian Society of Video Surgery in Infancy on the laparoscopic treatment of pediatric varicocele. MATERIALS AND METHODS: A total of 161 children 6 to 16 years old (median age 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surgery divisions. Varicocele was on the left side in 159 cases (98.7%) and bilateral in 2 (1.3%). Two boys had recurrent left varicocele. All children were treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7%). In 10 boys (6.2%) an additional procedure was done simultaneously, including closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. RESULTS: Average operative time was 30 minutes and hospitalization was about 24 hours. At followup there were 13 minor complications (8%), including left hydrocele in 9 children who underwent the Palomo technique, minor scrotal emphysema in 2 and umbilical granuloma in 2. In our series varicocele recurred in 1 boy (3.5%) who underwent ligation of the spermatic veins only and in 3 (2.2%) treated with the Palomo technique. CONCLUSIONS: Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.

Adolescent↗
PubMed1993

[Ambulatory pediatric anesthesia. Personal experience].

The authors critically examine the preoperative management, the various anaesthetic techniques, the perioperative undesired effects in eighty six ASA I-II paediatric patients (age 6 months-11 years) submitted to ambulatorial anaesthesia for minor surgery or endoscopy. The importance of the psychological approach to patients and parents is enhanced. The preoperative screening included physical examination, ECG and simple laboratory tests. Various anaesthetic techniques (tracheal intubation and muscle relaxation with mechanical ventilation or spontaneous breathing) and many variously combined anaesthetic drugs (propofol 2 mg/kg, ketamine 1.5 mg/kg, diazepam 0.15 mg/kg, thiopental 3-4 mg/kg, halothane 1-2 MAC, fentanyl 1 microgram/kg) were employed depending on the quality of the surgical procedure and the conditions and the age of the patient. The results show that arousal was always rapid and smooth. The residual analgesia was sufficient in 74 cases; the other patients received rectal paracetamol 250 mg. No major complication was observed and only 6 patients were discharged 1 day later on account of vomiting or low Steward score. In conclusion outpatient paediatric anaesthesia has no contraindication for ASA I-II patients, shows no major complication and is well accepted by the patients and their patients.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

[Echinococcosis: a persistent endemic].

Echinococcosis seems to be still endemic in Italy. Data from epidemiological studies in middle- south Italy indicates that this parasitosis is often a work- related disease. Our survey concerning findings among patients from surgical departments in Tuscany confirms the rsults of the studies. Echinococcosis is still endemic and dairy farming seems to be a risk factor.

Dairying↗