PubMed Health⌕ Search

Biomedical subjects

M Bortul

Publications and source records attributed to M Bortul.

At least 19 recordsLinked to original sources
PubMed2005

Transverse retubularized ileal vaginoplasty: a new application of the Monti principle--preliminary report.

OBJECTIVE: The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. Herein we present our successful experience with vaginal reconstruction by the use of a modified ileal segment according to the Monti principle. METHODS: Six patients aged from 23 to 41 years (mean 33 years) were referred to our institution for vaginal stenosis. In our series, ileum has been used to create the neovagina: the isolated segment has been longitudinally detubularized and transversally retubularized in order to configure the roof of the neovagina. RESULTS: The mean operating time was 220 min. No intra-operative complication occurred. The mean follow-up of this series was 16 months. At the latest follow-up, all patients had patent moist neovaginas, but excessive vaginal mucous was not a problem in any patient in our series. CONCLUSIONS: Neovaginal creation using isolated ileal segments according to the Monti channel principle provide excellent tissue for vaginal replacement, providing excellent patient satisfaction and relatively low morbidity. Cosmetic, functional and anatomical results were encouraging. In our opinion our technique may be indicated for all cases of vaginal absence: congenital abnormalities in the pediatric population, vaginal stenosis after treatment of pelvic tumors, severe vaginal scarring secondary to chronic inflammatory disease or in case of secondary correction after failure gender surgery.

Adult↗
PubMed2005

Laparoscopic mobilization of neovagina to assist secondary ileal vaginoplasty in male-to-female transsexuals.

OBJECTIVES: To describe 3 cases of successful laparoscopically assisted vaginal reconstruction using an ileal segment in patients with complete neovaginal stenosis. METHODS: We evaluated 5 male-to-female transsexual patients who required laparoscopic-assisted vaginal replacement for complete neovaginal stenosis after sex reassignment surgery. We performed complete laparoscopic vaginal isolation and mobilization, external configuration of the vagina, and laparoscopic-assisted vaginal anastomosis. RESULTS: No intraoperative complications occurred, and laparotomy conversion was not necessary. The mean length of the neovagina at the first postoperative visit was 13 cm. At a mean follow-up of 14 months, all patients were sexually active and completely satisfied with the operation. CONCLUSIONS: Our results have confirmed the feasibility of laparoscopic perineal neovagina construction by ileal colpoplasty. The cosmetic, functional, and anatomic results were encouraging. Isolated ileal segments provided excellent tissue for vaginal replacement, resulting in excellent patient satisfaction and relatively low morbidity. Furthermore, we report a modified surgical approach to conventional ileal vaginoplasty according to the Monti channel principle.

Adult↗
PubMed1998

Laparoscopic repair of a Morgagni-Larrey hernia.

The authors report a case of a large Morgagni hernia treated by laparoscopy. The patient complained of dyspnea, cough, and a sensation of tightness in the chest 1 month prior to admission. Preoperative diagnosis was made by chest x-ray, CT scan, and MRI, which showed a large right paracardiac mass consisting of an omentum and transverse colon. By reducing the hernial content, a 6 x 10-cm defect was revealed; the repair was performed with a Marlex mesh sutured by a hernia stapler. Postoperative recovery was uneventful, and 3 months after surgery the patient is well. Laparoscopic treatment of a Morgagni hernia provides an excellent view of the surgical field and ease of execution, joined with a minimal surgical trauma with rapid recovery for the patient.

Diaphragm↗
PubMed1997

Laparoscopic surgery for diverticulitis.

BACKGROUND: Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and possibly a subset of patients who may benefit from a laparoscopic approach. METHODS: From August 1991 to December 1995, all patients with diverticular disease were classified according to a modified Hinchey classification system. The laparoscopic group included 18 patients who underwent a laparoscopic assisted colectomy, one with a loop ileostomy. The identical procedures were performed in 18 patients by laparotomy. The mean age of the two groups were 62.8 and 67.1 years, respectively (p = NS). RESULTS: Seven of 18 patients in whom laparoscopy was attempted (38.9%) had conversion to laparotomy. Six of seven (85.7%) conversions were directly related to the intense inflammatory process. Laparoscopic treated patients with Hinchey IIa or IIb disease had a morbidity rate of 33.3% and a conversion rate of 50% while all patients with Hinchey I disease were successfully completed without morbidity or conversions to laparotomy. However, after the first four cases, the intraoperative morbidity and postoperative morbidity rates were zero and 14.3% and after ten cases they were zero and zero, respectively. Furthermore, the median length of hospitalization for Hinchey I patients after laparoscopy was 5.0 days vs 7 days after laparotomy (p < 0.05). In Hinchey IIa and IIb patients, the median length of hospitalization was almost 50% shorter with a laparoscopic approach (6 days vs 10 days, p < 0.05). CONCLUSION: In conclusion, laparoscopic resection of diverticulitis can be performed without additional morbidity particularly in Hinchey I patients and with a reduced length of hospitalization in patients with class I or II disease. Patients with class I disease, and after initial experience even those with class II disease, can benefit from the reduced morbidity and length of hospitalization associated with laparoscopic treatment.

Adult↗
PubMed1997

[Surgical treatment of stomach cancer: analysis of our personal experience].

The "curative" treatment of gastric carcinoma includes the complete removal of the tumour and of the nodes involved without any macroscopic residual of disease (RO). Out of 326 patients with gastric cancer observed, a series of 114 consecutive patients underwent surgical resection (total gastrectomy or subtotal distal gastrectomy) with D2 or D3 lymphadenectomy. Overall operative mortality was 5.3%. Since 1988 no postoperative death occurred. Overall morbidity was 15.8%, specific morbidity 10.5%, reduced after 1988 to 6.6%. No significant differences in operative mortality and need of blood transfusions were recorded between D2 and D3 lymphadenectomy. Overall 5-year survival was 32%. Univariate and multivariate analysis showed that only T and N stages are significant prognostic factors, whereas tumour location, total or subtotal gastrectomy in antral cancers, extent of lymphadenectomy (D2 vs D3) and histology were not significantly related to survival. Since most studies have clearly shown that T and N stages are the most important prognostic factors in gastric cancer, the present aim should be to plan the extent of surgical resection according to the T and N stages characteristics of the neoplasm.

Adult↗
PubMed1996

Laparoscopic treatment or a nonparasitic splenic cyst: case report.

The authors describe a case of nonparasitic splenic cyst treated by laparoscopic fenestration. The patient complained of left upper quadrant pain that increased during the prior 3 months. Computed tomography scan revealed a large cyst of the inferior pole of the spleen. The patient was submitted to laparoscopic wide fenestration of the cystic wall. The postoperative course was unremarkable and the patient was discharged with complete relief of symptoms. Laparoscopic technique provides the same results in terms of effectiveness and safety as traditional surgery, linked to the benefits of the mininvasive approach; thus, the laparoscopic fenestration can be considered the ideal treatment of nonparasitic splenic cysts.

Cysts↗
PubMed1989

[Current problems in the surgical treatment of primary lymphoma of the stomach].

The surgical treatment of the primary gastric lymphoma (P.G.L.) presents some controversial aspects still. The authors discuss the problem on the basis of the most recent data published in the literature and on their own experience concerning 14 cases of P.G.L. They confirm that surgery maintains an important role, at first, in the determination of the diagnosis exactly. The incidence of preoperative diagnosis of P.G.L. is unsatisfactory still, although increasing with the appropriate technique of endoscopic biopsies and modern immunohistochemical analysis. Moreover, the surgical approach is necessary for the definitive staging of the disease, which at the laparotomy, must be performed with these modalities: gastrectomy, regional and extra-regional lympho-adenectomy, fine needle aspiration and surgical biopsy of the liver. The extension of the gastrectomy is based on the location of the tumor. In the P.G.L. localized in the middle and in the upper stomach a total gastrectomy must be performed; on the contrary in a neoplasm localized in the lower part, a subtotal gastrectomy could be considered as a curative treatment. Integrated with chemotherapy, surgery offers appreciable results in long term survival, much better than those obtained after surgical treatment of gastric cancer.

Aged↗
PubMed1989

[Results of the surgical treatment of gastric cancer. A retrospective study of 247 cases].

Controversies still exist regarding the surgical treatment of gastric cancer. The therapeutic value of lymphoadenectomy (staging or curative) and the amount of the stomach exeresis for the lower third location are particularly debated. The authors discuss about their experience on 247 patients with gastric cancer of which 148 treated with exeresis (total and subtotal gastrectomy). In the greater number of patients (130 cases) a R2/R3 lymphadenectomy was performed. The global 5-years survival rate was 26.5%. Concerning the lower third localization the 5-years survival rate was 33.5% for total gastrectomy and 24.5% for subtotal gastrectomy with no significant difference (chi-square test: p = .6235). In 31 patients in which there was N2 involvement the 5-years survival rate was 19.2%. They conclude that this result confirm the opportunity to perform a R2/R3 lymphoadenectomy whose value can be considered curative in the cases with N2 involvement and of staging in the N3 positive. They underline that the possibility to perform a less aggressive lymphoadenectomy (R1/R2) in the early gastric cancer, must be considered after an objective evaluation of the depth of tumor invasion in the gastric wall.

Actuarial Analysis↗
PubMedDate not supplied

[Management of breast cancer in geriatric age; observations on 164 cases].

Progressive increasing of the life expectancy and the ever more frequent finding of breast cancer in elderly women have focused the attention on the treatment of this pathology in the elderly women. Today most studies support a more aggressive locoregional and systemic therapy in older patients in good physical condition. Authors analyze retrospectively a series of 164 women with breast cancer aged over 69 years treated with combined modality therapy regarding the stage of disease and the status of the patient. Survival by stage, tumor characteristics, node involvement have been compared with a series of patients less than 70 years treated on the same period. Survival curves were not significantly different between the two groups, except for T1 which showed a better survival in younger patients. Also survival according to node involvement did not show significant differences between the two groups. in conclusion, older women should be treated with the same surgical procedures, according to stage, of the younger patients, if they are not too frail to undergo surgery. Only the definitive results of prospective randomized trials will better define the indications and limits of a further reduction of the extent of surgical excision.

Age Factors↗
PubMedDate not supplied

[Leiomyosarcoma of the inferior vena cava: a case report].

Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare vascular tumour, with about 200 cases reported since 1871. The Authors report a case of leiomyosarcoma of the suprarenal inferior vena cava preoperatively diagnosed by ultrasonography and computed tomography. A surgical resection and venous wall reconstruction was performed. Complete surgical resection with a tumour-free margin (1 cm) is the treatment of choice. Neoadjuvant therapy may be given to downsize the tumour and increase resectability rate. When complete resection is not possible, debulking combined with radiation therapy provides good palliation.

Humans↗
PubMedDate not supplied

[Pancreatic cystadenoma: report of 2 clinical cases and review of the literature].

The Authors present two rare cases of pancreatic serous cystadenomas. Preoperative diagnosis of these neoplasms is very difficult despite the routine use of echotomography and CT, because the definitive diagnosis is provided only by histological examination of the surgical specimen. General agreement exists as to surgical indication. Surgical tactics depend on tumour localization: duodenocephalopancreatectomy for tumours of the head of the pancreas, and distal pancreatectomy for tumours located in the tail, as can be seen from a review of the recent literature. In both cases reported, the neoplasm was located in the pancreatic body. The treatment consisted in distal pancreatectomy. Splenectomy was necessary only in one of the two cases. During the follow-up the first patient died after 11 years without relapse. The second died 10 months postoperatively of an undifferentiated low rectal cancer. CT scans and sequential laparotomy showed no local relapse of the pancreatic tumours.

Aged↗
PubMedDate not supplied

[Indications for splenectomy in the surgical treatment of gastric cancer].

The extent of lymphadenectomy in the treatment of gastric cancer is still a matter of debate. Splenectomy, which has to be performed using the common surgical techniques to remove the lymph nodes of the splenic hilus, is part of this problem. The indications for splenectomy in the treatment of gastric cancer are examined, considering the results in terms of operative mortality and morbidity and long term survival. The Authors analyze a consecutive series of 129 patients who underwent total gastrectomy with D2 or D3 lymphadenectomy for gastric cancer. Forty-seven splenectomies were performed among 79 patients submitted to total gastrectomy. Splenectomy did not influence the perioperative mortality. Morbidity was higher in the patients who underwent splenectomy (33.3%) than in the patients without splenectomy (28.12%). This difference was not statistically significant. Five-year survival was higher in the group that did not undergo splenectomy (37.6% vs 27%) without any significant difference. Also considering the results in literature, splenectomy is associated with an increase in morbidity, and, for some authors, also in mortality, without any significant improvement in long-term survival. The indication for splenectomy in gastric cancer is based on an accurate evaluation of the localization and the depth of the parietal infiltration of the tumor.

Aged↗
PubMedDate not supplied

[The treatment of laparoscopic cholecystectomy for acute cholecystitis].

The aim of the study is to evaluate the results of early laparoscopic cholecystectomy for acute cholecystitis and to analyse the problems related to patients' selection and surgical timing. The authors report their personal experience of 45 laparoscopic cholecystectomies for acute cholecystitis. The diagnosis was based on clinical, blood test and US scan analyse findings. Technical surgical details were decompression of the gallbladder, use of endobag and abdominal dranage. We didn't perform and intraoperative cholangiography in absence of predictive factor for common bile duct stones. The mean time required for surgery was 120 minutes, conversion rate was 15% in early operations and 23.8% in operations delaied more than 72 h. Dissection difficulty is the main cause of conversion. Four patients underwent postoperative complications: one subphrenic abscess, one bile leakage (both recovered with nonsurgical therapy and two wound infections). In conclusion laparoscopic cholecystectomy is safe and effective as early treatment of acute cholecystitis in the first 72 hours due to easier dissection of the inflammed and oedematous tissue. This approach allows a reduction of the operative risk and the conversion rate with medical and economic advantages. Presence of bile duct stones is still now indication to conversion in open surgery.

Acute Disease↗
PubMedDate not supplied

[Emergencies in colorectal carcinoma: negative prognostic factor?].

The authors analyze a consecutive series of 219 patients affected by complicated colorectal cancer who underwent surgery in emergency. In hospital mortality, 5-year survival and recurrence's incidence in 104 of these patients who underwent curative treatment are calculated and compared with a series of 701 patients who underwent elective surgical treatment. There was no significative statistical difference between emergency and elective group. At the multivariate analysis only the stage of the tumor was an independent prognostic factor.

Colorectal Neoplasms↗
PubMedDate not supplied

[Preoperative transhepatic biliary drainage in the jaundiced patient: our experience].

The authors assessed the efficacy of PTBD in a group of 72 patients with obstructive jaundice due to lithiasis or malignant obstruction, that underwent preoperatively PTBD procedure. They analysed the early and late complications and its effectiveness in decreasing the bilirubin levels. The results, in agreement with the most recent reports, suggest the uselessness of the preoperative PTBD in the treatment of the patients with a jaundice due to a biliary lithiasis. Concerning the patients with a neoplastic jaundice, this procedure seems to be more effective in the patients with a biliary obstruction due to pancreatic head or distal choledochus carcinoma: in the patients with a far advanced cancer, the PTBD procedure could be the first step to the insertion of biliary endoprosthesis; on the other hand, in the patients that may undergo a curative treatment, PTBD could be useful preoperatively both to reach an adequate water-electrolyte [correction of hydroelectrolithic] balance and nutritional status both to complete the diagnostic procedure.

Aged↗
PubMedDate not supplied

[Therapeutic development in common bile duct lithiasis. Apropos of a 25-year experience].

Authors' experience in the treatment of common bile duct stones (LVBP), including 592, operated patients, is presented. During the years 1969-1983, the most used technique was transduodenal sphincterotomy, while after 1983 choledocotomy, mostly with associated external temporary biliary drainage, was the preferred one. Since 1985 endoscopic sphincterotomy (SE) has been used, firstly for high-risk patients, and then with increasing indications; at present the first choice in treatment of LVBP consists in sequential SE and laparoscopic cholecystectomy. Postoperative results of these techniques showed a specific mortality rate of 1.1% for ST, of 0% for CT and SE, and a specific morbidity rate of 4.6% for ST, of 6.9% for CT and of 5.6% for SE. At follow-up patients in I and II Visick group were 87% for ST, 91% for CT and 100% for SE. Even if a statistical analysis of such results is not proposable, the only existence of a specific mortality for ST made us to change our choice. At present the treatment of choice for LVBP is in our opinion the sequential SE and laparoscopic cholecystectomy, waiting for a complete evaluation of all laparoscopic procedure. Traditional surgery is now indicated for failures of sequential approach and, as a first choice, for treatment of "empierrement" of common bile duct, for intrahepatic lithiasis and for atonic megacholedocus.

Choledochostomy↗