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L Sarli

Publications and source records attributed to L Sarli.

At least 19 recordsLinked to original sources
PubMed1992

[A critical review of the history of the systems for staging colorectal cancer].

A great debate is still open in literature about the available staging systems of colorectal cancer. Therefore, an historical analysis of the several systems suggested in the last decades was performed; pathological, clinicopathological and more recent score clinicopathological staging systems were evaluated. From this historical review it appears that subsequent modifications of various classifications allowed only for a poor improvement in predictivity. A more careful histopathological examination of surgical specimen and more exact information about involvement of other organs and tissues allow a correct classification of patients affected by colorectal cancer independently of the staging system used.

Colorectal Neoplasms↗
PubMed1992

Today's treatment of cholelithiasis: laparoscopic surgery.

The speed at which laparoscopic biliary tract surgery has been introduced to such a large number of surgeons is without precedent in modern surgical history. At least 4 factors work together to explain such a rapid success: 1) Laparoscopic cholecystectomy removes the diseased gallbladder and ensures permanent cure; 2) Laparoscopic approach allows a telescopic vision and dissections are very precise; 3) Laparoscopic cholecystectomy allows minimal wound pain with complete resolution within a few days, a short hospital stay and the ability of many patients to return to work within a week of operation; 4) There are economic advantages to the patient, his community and the healthcare provider. The procedure proved to be as safe and feasible to use as conventional surgery. Obviously adequate training and credentialing are important processes to faster good patient outcomes. There are some contraindications to laparoscopic surgery, the most part of them are depending upon the experience of the surgeon. The successful application of therapeutic laparoscopy changed the diagnostic approach to lithiasic biliary disease. Whereas the most popular method of documenting gallbladder abnormalities before performing conventional surgery is ultrasonography, most surgeons who have embraced laparoscopic surgery argue for routine cholangiography because of the necessity to document duct anatomy besides minimizing the incidence of retained GBDS.

Cholecystectomy, Laparoscopic↗
PubMed1992

[Laparoscopic surgery: planning program].

Performing laparoscopic surgery requires an initial training program. A well-planned organization is essential and the surgeon has to become first familiar with the new procedures; the choice of the necessary equipment is the second step. Upkeep of surgical instruments and a careful consideration of legal aspects are the next important steps. Several areas of a planning program are evaluated on the basis of the authors' experience.

Female↗
PubMed1992

[Anesthesia for laparoscopic cholecystectomy].

Alterations in the serological, pulmonary and cardiocirculatory parameters, potentially determined by CO2 pneumo-peritoneum during laparoscopic cholecystectomy, require careful intraoperative evaluation. With the aim of verifying the real entity of these alterations, an experience is reported relating to 76 of the 303 patients undergoing laparoscopic cholecystectomy during 14 months. During surgery, besides an obvious increase in pO2, a slight hypercarbia and a slight decrease in pH were observed, which required pharmacological intervention in only 5 cases. In no case did the respiratory and haemodynamic alterations observed necessitate the conversion into laparotomy. This initial experience gives us reason to conclude that careful monitoring of the respiratory parameters leads to an adequate anaesthesiological conduct, and thus facilitates the completion of laparoscopic procedures.

Adult↗
PubMed1992

[Reflection on 19 months of laparoscopic cholecystectomy].

The introduction of laparoscopic cholecystectomy (LC) has aroused enthusiasm on the part of the mass media and perplexity on the part of many medical workers. In an attempt to reconcile the two points of view, the video-laparoscopic activity in a surgical ambient was audited over 19 months. 450 LC were carried out during this period. The number of cholecystectomies performed by this method has risen significantly in the recent past thanks to the high esteem in which it is held by the public in general and by gastroenterologists in particular. The average age of patients is lower since young people accept more readily a type of surgery involving a lesser degree of traumatism, a relatively short convalescence and less aesthetic damage. After a brief initial period of scepticism, the method has also been received favourably by anaesthetist, and by operating theatre and ward nursing staff. Morbidity and mortality rates are not different from those noted after traditional cholecystectomy, which confirms the method as being safe and thus meriting the success it has widely achieved.

Cholecystectomy, Laparoscopic↗
PubMed1992

[The importance of preoperative study of cholelithiasis during the laparoscopic era].

Preoperative x-ray examination of the biliary tree has in the last decade been entrusted to ultrasonography. The diagnostic procedure was completed with an accurate evaluation of the main biliary tract by means of intra-operative cholangiography. However, recently-developed methods such as operative endoscopy and laparoscopic surgery require essential pre-operative information about the state of the biliary tract which ultrasonography is not able to provide. In our view, the most useful examination for this purpose is i.v. cholangiography; the results of this study, relating to 303 patients undergoing laparoscopic cholecystectomy, of whom 39 affected by cholecysto-choledochal lithiasis, would seem to confirm these view.

Bile Duct Diseases↗
PubMed1992

[Interaction between laparoscopic surgery and operative endoscopy. Results of an experience].

Nowadays it is possible to treat complex biliary disease such as cholecysto-choledochal stones with mini-invasive methods. In this field, laparoscopic surgeons and gastroenterologic endoscopists can collaborate not only in the planning of endo-laparoscopic sequential treatment of biliary stones but also in the successful treatment of complex cases having either surgical or endoscopic complications. Here are presented the results which 14 months of collaboration between laparoscopists and endoscopists have brought about in the diagnostic and therapeutic fields. In particular, the results are documented of the sequential endo-laparoscopic treatment of cholecysto-choledochal calculi proposed for 39 patients, of inverse laparo-endoscopy carried out in 2 cases, and of therapeutic procedure used to treat an iatrogenic perforation of the biliary tree by mini-invasive methods. The experience reported is an example of how technological progress is gradually pushing aside the barriers still existing between medicine and surgery.

Cholecystectomy↗
PubMed1992

[Tension-free laparoscopic hernioplasty].

Hernia recurrence after traditional "open" hernioplasty is an observed event. The tension undergone by anatomical structures of the area is believed to be responsible in large part for these failures. Thus, techniques involving "tension free" hernioplasty have been developed, some of which involve laparoscopic access. Here an experience is reported regarding laparoscopic hernioplasty carried out to repair groin hernias, first of all on an animal model (pigs: 7 cases) then in the clinical field. The technique chosen was the endo-peritoneal positioning of a PTFE prosthesis. The results revealed several advantages over the traditional methods, basically the possibility of reinforcing the entire inguinal floor at the same time as repairing the hernia, and the decrease in groin area discomfort and less time off from work for the patient.

Abdominal Muscles↗
PubMed1992

[Laparoscopic treatment of varicocele].

Varicocele is frequently a contributing factor in male infertility. We performed laparoscopic treatment of varicocele in 6 patients. This procedure can be carried out through three ports and allows not only ligation and excision of the dilated testicular veins, but those veins branching through the back of the inguinal canal lower down. It is a quick operative procedure and we completed it within 30 minutes. All the patients have gone home on the 2 days and, to date, there have been no complications. During a follow-up period of 3-6 months it was possible to observe the disappearance of varicocele. It is possible to conclude that the laparoscopic procedure is simple and effective as more traditional methods.

Adult↗
PubMed1992

[Elective and emergency diagnostic laparoscopy].

A report is presented concerning 31 patients treated by laparoscopic approach under both elective and emergency conditions. The mini-invasive approach to an abdominal disease allows both the making of a direct visual diagnosis and the carrying out of biopsy or actual therapy without the need for laparotomy. Elective diagnostic laparoscopy has proved efficacious in the screening of patients affected by abdomino-pelvic neoplasms, determining the extension of the latter, staging them and judging their operability. Under emergency condition this method lends itself in particular to the study and the treatment of some cases of traumatic haemoperitoneum, intestinal obstructions resulting from adhesions and peritonitis of dubious aetiology. Explorative laparoscopy thus constitutes a valuable diagnostic and therapeutic aid, its possibilities being destined to increase with the improvement of laparoscopic techniques.

Adolescent↗
PubMed1992

[Videolaparoscopy and conservative treatment of splenic injuries].

The treatment of lesions due to blunt abdominal trauma has changed considerably in the last decade. With a view to the prevention of immediate and later complications of splenectomy, conservative surgical technique have been put forward, or else, when the haemodynamic conditions of the patient permit, techniques of non-operative monitoring of splenic lesions. Laparoscopy today constitutes an approach to the diagnosis and treatment of blunt abdominal trauma which decisively favours conservative treatment. The experience presented bears witness to the potential usefulness of laparoscopy in these cases. Technological progress will widen the possibilities of this method and more detailed studies will define its exact indications.

Abdominal Injuries↗
PubMed1992

[Experimental intestinal laparoscopic resection].

At present, there is a debate in the literature regarding the possibility of extending the laparoscopic approach to intestinal resection. Some techniques have been developed, but certain imperfections and problems remain. This experimental contribution suggests answers to some technical problems arising in the course of a small-bowel laparoscopic resection on a pig.

Anastomosis, Surgical↗
PubMed1991

[Occult hepatic metastases from colorectal carcinoma: diagnostic and prognostic considerations].

Occult hepatic metastases (OHM) from colorectal cancer are those not evident to the surgeon at laparotomy. In this retrospective and "deductive" study the Authors evaluated the accuracy of hepatic CT scan and ultrasonography (US) to detect hepatic metastases. The CT and US accuracy rate was 78.4% and 79.8% respectively, and proved to be correlated to the intraoperative dimensions of the lesions. Sensitivity of these examinations, in the light of OHM identification, decreased to 69% and 69.2% respectively. This study shows that hepatic US and CT scan are not sufficient to identify OHM; the attempt to reduce the frequency of OHM by means of intraoperative ultrasonography could allow to obtain a more careful stadiation and prognosis of these neoplasms with possible therapeutic advantages.

Aged↗
PubMed1991

[Laparoscopic cholecystectomy as evolution of traditional cholecystec- tomy. Comparative evaluation].

Laparoscopic cholecystectomy (LC) is a minimally invasive method of removing the gallbladder that has become an accepted procedure all over the world. Authors performed 200 LC and compare the results of first 70 procedures with a matched group of patients who have undergone traditional cholecystectomy (TC) to evaluate its safety and efficacy. The average length of operation in the LC group was 64.5 +/- 26.3 min as compared to 68.5 +/- 22.5 min in the TC group. The difference between the incidence of postoperative complications in the 2 group was not statistically significant. The average length of stay in the LC group was 2.3 +/- 1.9 days versus 5.2 +/- 1.4 in the TC group. The difference is statistically significant. The comparison between the 2 methods shows less discomfort for LC patients during postoperative course. Pain was minimal, bowel evacuation was early and spontaneous, urinary retention only occurred in 2 patients versus 21 in TC group. The difference is statistically significant. Our results confirm laparoscopic cholecystectomy is a safe, effective and cost-efficient alternative to open cholecystectomy.

Adult↗
PubMed1990

[Current status of the surgical treatment in colorectal carcinoma].

The Authors take into consideration some topical subjects, with reference to their own experience. The percentage of patients diagnosed as having localized disease, despite improvement in diagnostic techniques, has not changed over the last decade. In local recurrences without distant metastases, surgery is the sole treatment which may improve the survival. Resection however has to be thought over, since surgery of local recurrences may be considered as curative only in a few cases and the probability of a poor result in survival and quality of life does not justify a surgical procedure when it is associated with a high operative risk. In cancers of the middle 3rd and lower rectum, staplers have favoured the choice of anterior resection, which does not show a high rate of recurrences, when compared to abdominoperineal excision. At last, progress in surgery, anaesthesiology and intensive care determined a different therapeutical attitude in the aged, either due to a lower incidence of postoperative complications, or because life expectancy in the elderly seems to justify, whenever possible, a curative procedure.

Age Factors↗
PubMed1989

Cholesterol microlithiasis: bacteriology, gallbladder bile and stone composition.

It is not known whether microcalculi possess structural differences compared with larger stones or whether they represent simply an earlier stage in stone disease. We carried out a controlled study on 10 patients affected by gallbladder cholesterol microlithiasis (CM). In all patients, samples from all parts of the stones were studied by X-ray diffraction and by infrared spectrophotometry. Bile analysis was carried out to determine cholesterol, phospholipid and total bile acid content. The cholesterol saturation indices (C.S.I.) were calculated. In all samples, bacterial bile culture was carried out. The results were compared with those of 10 patients who had undergone cholecystectomy for large cholesterol stones, and for 10 patients who had undergone abdominal surgery but without biliary pathology. Patients in these latter groups were matched with the first according to sex and age. Microcalculi proved to be layered (nucleus and external layer) in only 2 cases and larger stones in 9; cholesterol was seen to be the principal crystalline component in all cases. Traces of bilirubin were found in 7 CM and in the nuclei of 5 larger stones. These results show that the structural composition of microcalculi is similar to that of the nucleus of larger stones. No substantial differences exist, however, between the two groups of patients regarding the other parameters taken into consideration.

Adult↗
PubMed1989

[Iatrogenic biliary lithogenesis in surgery].

Iatrogenic biliary lithogenesis has been often observed in surgery. The authors, on the basis of the personal experience and literature, have tried to point out its etiologic factors and give a common interpretation to its different clinical manifestations observed in surgery. This study reports 19 patients who underwent total gastrectomy with truncal vagotomy and postoperative TPN and subsequently serial ultrasonographic scans to determine content and volume of the gallbladder. In 5 patients it was possible to take out a bile sample daily, using a naso-duodenal tube, for chemical analysis. In 10 out of 19 patients postoperative ultrasonography revealed the fast appearance of biliary sludge; 6 of the latter 10 developed microlithiasis. In all cases examined ultrasounds revealed a defect of the contractility of the gallbladder and the microscopic analysis of bile content showed pigment granules. The authors underline how different etiologic factors are involved in different clinical models. They conclude that gallstones observed in their experience are mostly pigmentary and are quickly formed owing to the interaction of many etiological factors. Finally prophylactic measures are discussed.

Cholelithiasis↗