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Biomedical subjects

Luigi Roncoroni

Publications and source records attributed to Luigi Roncoroni.

31 records · Page 2Linked to original sources
PubMed2003

Long-term results of subtotal colectomy with antiperistaltic cecoproctostomy.

PURPOSE: To evaluate the clinical role of subtotal colectomy with cecorectal anastomosis (CRA) and its postoperative results, based on our surgical experience. METHODS: We retrospectively analyzed 26 patients who underwent subtotal colectomy with CRA during an 8-year period (1992-1999) in our university hospital. The indications for CRA were intractable constipation, colon tumors, diverticulitis, Crohn's disease, and postactinic colitis. CRA was performed using a new technique of end-to-end antiperistaltic anastomosis. Postoperative and late complications, and functional results, defined as the number of bowel movements per day and quality of life, were evaluated. RESULTS: None of the patients experienced postoperative or late complications. Two patients died from progression of colon cancer. The mean follow-up period was 4.5 years (range 1-8 years). By 1 month after surgery, 58% of the patients were passing frequent bowel movements, and by 1 year after surgery, only 23% of the patients were passing frequent bowel movements. The last follow-up revealed a mean 1.7 bowel movements per day, and only one patient was taking medication for diarrhea. All patients were satisfied with the results of their surgery and reported that their quality of life was good or improved, and even very good in six cases. CONCLUSIONS: Subtotal colectomy with our new CRA technique is appropriate for treating inflammatory diseases of the bowel, colon tumors, and intractable constipation in selected patients.

Adolescent↗
PubMed2003

The rationale for cecorectal anastomosis for slow transit constipation.

The most usual reconstruction after subtotal colectomy is ileo-rectal anastomosis, which requires the removal of the caecum. We propose the treatment of chronic slow-transit constipation with subtotal colectomy and antiperistaltic caecoproctostomy. The sparing of the caecum, the ileo-caecal valve and the distal ileal loop, leaving a physiologic reservoir, allowing the presence of colic bacterial flora which metabolizes the undigested starch and produces short chain fatty acids, should guarantee a normal stool consistency, normal absorption of water, sodium and vitamin B12 and the prevention of renal and gallbladder lithiasis. In 1992, we started a study on the outcome of 19 patients who had undergone subtotal colectomy and antiperistaltic caeco-rectal anastomosis for slow-transit constipation. The surgical procedure was carried out without any serious complications and without mortality. The mean clinical follow-up was 64 months (range 5-132). Six months after surgery, 13 patients reported normal bowel movements with solid stool consistency, 5 reported diarrhoea and the need for antidiarrhoeal agents, and one reported constipation easily controlled with laxatives. Fifteen patients considered their quality of life as having improved compared with that before surgery. Selection of patients justify such very satisfying results. It is well known that colic resection is effective only in the case of slow transit constipation, and thus a careful physiologic assessment is needed to rule out other causes of constipation, such as outlet obstruction syndrome.

Adult↗
PubMed2003

Functional outcome of total anorectal reconstruction: incontinence or constipation?

BACKGROUND AND AIMS: Besides incontinence, constipation is important after TAR. We aimed at evaluating their correlation and role in functional outcome. MATERIALS AND METHODS: 81 diaries in 16 patients (up to 8 years) were assessed, by a specific scoring system, regarding incontinence and evacuation. In the overall series and in three postoperative time groups, the correlation between the two items, their mean scores and relative score rates (% of the maximum possible scoring) were calculated. RESULTS: The Spearman correlation coefficient in all assessments was -0.128. According to timing, it was: 0.468 (short term), -0.036 (mean term) and -0.69 (long term). Incontinence was more disabling than evacuation; constipation occurred more frequently. Incontinence improved over time; constipation did not substantially change. CONCLUSIONS: Current criteria for functional assessment do not describe the true conditions after TAR and their variations over time. Profound consideration is necessary before announcing ultimate judgements on TAR.

Anal Canal↗
PubMed2002

A patient-rated, surgeon-corrected scale for functional assessment after total anorectal reconstruction. An adaptation of the Working Party on Anal Sphincter Replacement scoring system.

BACKGROUND AND AIMS: To test current systems evaluating for fecal continence after total anorectal reconstruction (TAR) we adapted the incontinence plus evacuation scoring system proposed by the Working Party on Anal Sphincter Replacement (WPASR). PATIENTS AND METHODS: We examined 51 monthly diaries recorded by 14 patients after TAR or at yearly checks (up to 5 years). A form detailing all items and frequencies of the WPASR system was given to 12 patients who assigned a rating to each item in a frequency cell. The mean values of cells were rounded off, and a 0-20 scoring scale was obtained. We corrected the scores using previously defined criteria aimed at complying with an objective rating of severity while preserving the overall patient rating. Diaries were reevaluated by both patient-rated and surgeon-corrected scales, and the correlation was calculated to each other and to Jorge and Wexner's and the Williams et al. systems; correlations between incontinence and evacuation scores were also calculated. RESULTS: The surgeon-corrected system tended to have a lower mean score than the patient-rated one and was strongly correlated with it ( r=0.984), a significantly higher mean score than the Jorge and Wexner scale ( r=0.893), and a significantly lower mean score than the Williams et al. classification (quadrupled scores; r=0.857). No correlations between incontinence and evacuation were found. CONCLUSIONS: Although not validated, the patient-rated, surgeon-corrected adjustment of the WPASR system proved in our patients a reliable instrument for functional assessment. Its consensus administration to any given patient samples requires further research.

Aged↗
PubMed2002

Preoperative ultrasonographic assessment of the number and size of gallbladder stones: is it a useful predictor of asymptomatic choledochal lithiasis?

OBJECTIVE: To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. METHODS: Ultrasonographic data for 300 consecutive patients undergoing laparoscopic cholecystectomy were analyzed. Patients were divided into a group in which multiple small (< or = 5 mm) or multiple variably sized (both < or = 5 and > 5 mm) gallbladder stones were present ("positive" stones) and a group with multiple large (> 5 mm) or single gallbladder stones, considered "negative." The ultrasonographic description was compared with surgical findings; finally, the prevalence of asymptomatic common bile duct stones in the 2 groups was compared. RESULTS: Ultrasonographic classification of gallbladder stones was confirmed at surgery in 285 cases (95%). Asymptomatic common bile duct stones were diagnosed in 9.5% of patients with an ultrasonographic diagnosis of positive gallbladder stones and in only 2.3% of patients with a diagnosis of negative gallbladder stones (P < .05). CONCLUSIONS: Ultrasonography is able to accurately show gallbladder stones; the appearance of multiple small and variably sized gallbladder stones represent a risk factor for synchronous asymptomatic common bile duct stones.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Enterolith ileus complicating afferent loop syndrome simulating acute pancreatitis.

Afferent loop syndrome after Billroth II gastrectomy is usually caused by those events that impair the evacuation of the afferent duodenal loop. The formation of an enterolith in an afferent loop is a rare but dangerous event. We present a unique report of a patient in whom a huge enterolith developed in the afferent loop of a Billroth II anastomosis, which led to intestinal occlusion. This migration occurred after a laparoscopic procedure, so we hypothesized that this procedure could be the cause of enterolith migration.

Afferent Loop Syndrome↗
PubMedDate not supplied

[Prognostic significance of chromosome and microsatellite instability in colorectal cancer].

The prediction of recurrence and the prognosis of colorectal cancer have always been related to the stage of the disease. Clinical pathological classifications are unable to predict the individual risk of recurrence and the prognosis which would also appear to be linked to additional factors, which have yet to be properly assessed, such as the genetic endowment of the tumour. In this study we assessed how microsatellite and chromosomal instability may help us to stratify two classes of risk of recurrence in patients at the same stage. From July 1996 to June 1999 we prospectively collected data on 112 patients (59 male, 53 female) affected by colorectal cancer and undergoing surgery with a radical intent. Biopsies of normal and tumor tissue were submitted to DNA extraction and amplification to evaluate the presence of chromosomal instability (loss of heterozygosity) and microsatellite instability. Analysis of the data revealed that loss of heterozygosity in the long arm of chromosome 18 is associated, in patients with stage III colorectal cancer, with a higher risk of recurrence and therefore with a worse prognosis. Microsatellite instability proved to be associated with a better prognosis even in cases of recurrence.

Aged↗
PubMedDate not supplied

[Robotic fundoplication for gastro-oesophageal reflux disease].

Presented as a possible "second" revolution in general surgery after the introduction of laparoscopy during the last few years, the robotic approach to mini-invasive surgery has not yet witnessed wide, large-scale diffusion among general surgeons and is still considered an "experimental approach". In general surgery, the laparoscopic treatment of gastrooesophageal reflux is the second most frequently performed robot-assisted procedure after cholecystectomy. A review of the literature and an analysis of the costs may allow a preliminary evaluation of the pros and cons of robotic fundoplication, which may then be applicable to other general surgery procedures. Eleven articles report 91 cases of robotic fundoplication (75 Nissen, 9 Thal, 7 Toupet). To date, there is no evidence of benefit in terms of duration of surgery, rate of complications and hospital stay. Moreover, robotic fundoplication is more expensive than the traditional laparoscopic approach (the additional cost per procedure due to robotics is 1,882.97 euros). Only further technological upgrades and advances will make the use of robotics competitive in general surgery. The development of multi-functional instruments and of tactile feedback at the console, enlargement of the three-dimensional laparoscopic view and specific "team" training will enable the use of robotic surgery to be extended to increasingly difficult procedures and to non-specialised environments.

Animals↗
PubMedDate not supplied

[Diagnostic and therapeutic management of choledocholithiasis associated with gallstone disease: nine years' experience].

Different approaches are described in the literature for the detection and treatment of common bile duct stones in patients undergoing laparoscopic cholecystectomy (pre-, intra- or postoperative treatment; combined endoscopic and laparoscopic or total laparoscopic management). No particular "gold standard" treatment can be identified, since too many variables and too many techniques need to be compared. Since it is impossible to establish any single protocol, the reviewing of different large experiences is useful to identify the pros and cons of each procedure. We present the evolution of our own experience over the period 1991-2000 in 1741 patients treated by laparoscopic cholecystectomy for gallbladder stones. We have chosen to assess and treat patients with symptomatic common bile duct stones preoperatively, whereas in the asymptomatic cases we have adopted a protocol that has been modified over the years, consisting first in routine intravenous cholangiography and then in the use of a scoring system which, with the aid of ultrasound data, has allowed us to assess the risk of choledocholithiasis and to administer selective preoperative treatment for common bile duct stones.

Case-Control Studies↗
PubMedDate not supplied

Calf metastasis of colorectal cancer: report of a case.

Colorectal cancer metastases rarely develop outside liver, lungs and lymph nodes, and only exceptionally in skeletal muscle. The very low incidence of such metastasis sites may be due either to underestimation of the problem or to their intrinsic rarity. We report a case of metastasis from colorectal cancer that developed in the left calf and manifested itself as a painful non-fluctuating mass. The relevant literature is also reviewed.

Adenocarcinoma↗
PubMedDate not supplied

Hypovolemic shock caused by a true aneurysm of the pancreatico-duodenal artery: case report and review of the literature.

True pancreatico-duodenal artery aneurysm (PDAA) is a rare condition that since 1973 has been described in only 54 cases. It is frequently associated with celiac axis stenosis and often present with rupture. Even if most PDAAs that are not ruptured are asymptomatic and are diagnosed during investigation for other diseases, they may have some symptoms, such as chronic abdominal discomfort and an abdominal pulsating mass, that can be helpful for diagnosis. The treatment of this condition has evolved in time from a merely surgical one to an angiographic noninvasive approach. We present a case of a PDAA that manifested with sudden hypovolemic shock requiring an emergency operation, and through a review of the literature, we discuss the different diagnostic/therapeutic protocols to use in different situations.

Aneurysm↗
PubMedDate not supplied

Staged hepatectomy and whipple procedure in metastatic gastroenteropancreatic endocrine carcinoma: report of a case.

Because of their extremely variable and often indolent natural course, therapeutic management of neuroendocrine tumors is still controversial. Hepatic metastases, especially for gastro-entero-pancreatic-endocrine neoplasms, are common and often responsible for symptomatology onset. Although it has not been clearly shown, liver resection probably represents the best treatment of hepatic metastases, in terms of symptom palliation and survival prolongation. We present a case, to our knowledge the first in the recent literature, of a 60-year-old patient submitted to a pancreatico-duodenectomy for a pancreatic endocrine carcinoma 20 months after a right hepatectomy for an isolated symptomatic metastasis.

Gastrointestinal Neoplasms↗