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P Buccianti

Publications and source records attributed to P Buccianti.

At least 19 recordsLinked to original sources
PubMed1998

Trocar site tumor recurrences. May pneumoperitoneum be responsible?

BACKGROUND: Port site metastasis following laparoscopy for cancer is reported with increasing frequency and represents one of the most important limitations of the technique. METHODS: A scintigraphic model was utilized to evaluate a possible role of pneumoperitoneum in tumor cell dissemination. Labeled red blood cells (RBC) were injected at the level of the gallbladder bed during laparoscopic cholecystectomy (LC) performed for symptomatic cholecystolithiasis. LC was performed in two groups with standard CO2 pneumoperitoneum: in one group an endobag for retrieval of the specimen was utilized. In one group a gasless LC with endobag was performed. RESULTS: Radioactivity in the area of the trocar introduction was observed in almost all the patients who underwent standard (CO2) LC but represented a rare event in patients treated with the gasless method. The utilization of a protective bag for the extraction of the surgical specimen did not modify significantly the results. Moreover all patients treated with pneumoperitoneum demonstrated a wide intraperitoneal diffusion of the tracer not observed in gasless patients. CONCLUSIONS: The results of this study confirm that pneumoperitoneum may play an important role in the evolution of port site metastasis after laparoscopy for gastrointestinal cancer.

Cholecystectomy, Laparoscopic↗
PubMed1998

Adrenal masses in non-small cell lung carcinoma patients: is there any role for laparoscopic procedures?

Surgical treatment of adrenal metastases from non-small cell lung carcinoma (NSCLC) is a current and controversial issue. We analyze our experience with the laparoscopic treatment of NSCLC solitary adrenal metastases. In the last 4 years, six patients underwent laparoscopic adrenalectomy for suspected solitary NSCLC metastasis. A metastasis was removed in four patients and a cortical adenoma in two. Laparoscopy with intraoperative ultrasonography was demonstrated to be an excellent procedure for the diagnostic and therapeutic management of the patient affected by a solitary adrenal metastasis from NSCLC. Longer follow-up and a larger series are necessary to enable definitive conclusions to be drawn about the impact on survival of laparoscopic adrenalectomy for NSCLC metastasis.

Adenocarcinoma↗
PubMed1997

Traditional versus laparoscopic surgery in the treatment of pheochromocytoma: a preliminary study.

Laparoscopic removal of adrenal masses has been successfully accomplished by many authors, but some doubts still remain about the surgical treatment of pheochromocytomas by the laparoscopic approach. The outcome of 6 patients who had laparoscopic removal of pheochromocytoma, 1 of which bilateral, was compared with that of 20 patients with pheochromocytoma who underwent open surgery. The following parameters were evaluated: frequency of hypertensive crises, time required for surgery, total volume of infused fluids, severity of postoperative pain, hospital stay, wound suppuration, or occurrence of incisional hernia, persistence or recurrence of hypertension. Laparoscopic patients had shorter hospitalizations, less postoperative fever, less fluid infusion, and absence of scar complications. There was no evident difference in the frequency of intraoperative hypertensive crises between patients who were treated by laparoscopic versus those treated by open procedure. The laparoscopic approach seems to be as safe as the open approach. However, it causes less postoperative distress, better cosmetic results, and permits a faster recovery.

Adrenal Gland Neoplasms↗
PubMed1996

Single and double stapled anastomoses in rectal cancer surgery; a retrospective study on the safety of the technique and its indication.

Low anterior resection is commonly believed the main indication to double stapled (DS) technique, because placing the purse-string suture on the distal rectum is difficult or impossible. This study was designed to figure out the safety of the DS technique and to better define its role in rectal cancer surgery. The data of 34 patients that had a DS anastomosis were retrospectively compared to those of 43 that had a single-stapled (SS) anastomosis after anterior resection. Three deaths after SS (7%) and one after DS procedures (3%) were recorded (p = 0.62). Rates of clinical leaks were 12% (four cases) in the DS group and 14% (six cases) in the SS group (p = 0.41). The mean distance of the rectal tumour from the anal verge was significantly lower for DS (mean = 7.7 cm) respect to SS (mean = 12.7 cm) anastomoses (p < 0.0001) and the blood consumption at surgery was significantly greater in patients that had DS (mean = 375 ml) compared to SS-anastomoses (mean = 180 ml) (p = 0.028). Thus, the DS technique was mostly used in patients at high risk for leakage. The study shows that DS technique is a safe and reliable method to perform colorectal anastomosis after anterior resection for cancer. For cancers located in the upper rectum the routine adoption of the DS increases the cost of surgery and does not offer advantages over the SS technique with the exception of making feasible end-to-end mechanical anastomoses involving bowel segments having different diameters.

Aged↗
PubMed1996

Association between perioperative blood transfusion and dehiscence of anastomosis after rectal resection for cancer.

Perioperative blood transfusion (PBT) has proved to increase the risk of sepsis after surgery. The hypothesis that PBT also might increase the occurrence of leak of rectal anastomoses has been tested. The data of 94 patients undergone low anterior resection for rectal cancer were reviewed. Thirty-nine of them (41%) received one or more packed red cells (PRC) units perioperatively. The total dehiscence rate was 14% (13 cases), and it was significantly lower in not-transfused (4%) compared to transfused patients (28%) (p < 0.005). The risk of dehiscence was increased by six-fold if up to two, and by fifteen-fold if more than two PRC units were given. These findings suggest that leakage of rectal anastomoses should be considered among the detrimental effects of PBT. The risk of dehiscence increases with the number of units transfused. A judicious administration of blood might contribute to reduce this complication.

Aged↗
PubMed1996

Laparoscopic compared with open appendicectomy for acute appendicitis: a prospective study.

OBJECTIVE: To assess the benefits of laparoscopic appendicectomy over open appendicectomy and to evaluate the impact of the severity of appendicitis and of peritonitis on the advantages of the laparoscopic approach. DESIGN: Prospective unrandomised study. SETTING: University hospital, Italy. SUBJECTS: 137 consecutive patients with acute appendicitis, 60 of whom were treated by open and 77 by laparoscopic appendicectomy. Patients were subdivided according to the severity of appendicitis and the presence of peritonitis. MAIN OUTCOME MEASURES: Duration of operation, consumption of analgesics, duration of hospital stay, overall complications, wound infection. RESULTS: Hospital stay (median 2.5 days, range 1-18 compared with 4, range 2-22 p < 0.0001). and wound infection (3/77 (4%) compared with 13/60 (22%), p 0.02) were significantly lower after laparoscopic operation. The incidence of wound infection was significantly lower when subgroups were analysed separately. CONCLUSIONS: Hospital stay and wound infection rates were significantly lower after laparoscopic appendicectomy. With the exception of the wound infection rate, the variables studied may differ depending on the severity of the appendicitis and the presence of peritonitis. Result of comparative studies should be carefully interpreted when the two groups are not stratified for these features.

Acute Disease↗
PubMed1995

Laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has already been described by various authors. The present series consists of 25 consecutive, nonselected cases operated on in the Department of Surgery, University of Pisa. All operations were carried out using a minimal access technique, and there were no conversions to open surgery. The mean operative time was 109 min. The median postoperative stay was 3 days (range 2-5). There were no complications, and none of the patients required blood transfusion. This technique proved to be as safe as open surgery and caused less distress and allowed more rapid return to normal activity. Increased experience and the development of new laparoscopic equipment are expected to further reduce operative time.

Adrenal Gland Neoplasms↗
PubMed1995

Laparoscopic sonography in screening metastases from gastrointestinal cancer: comparative accuracy with traditional procedures.

The wide use of operative and diagnostic laparoscopy has led to a greater use of the laparoscopic ultrasound (LUS) as a complementary procedure. A preliminary study was performed to evaluate the efficacy of LUS using a linear array laparoscopic probe characterized by double frequency, mechanical flexibility, and availability of Doppler analysis. LUS was performed in 36 patients with gastrointestinal neoplasms and compared with preoperative sonography, computed tomography, and with laparoscopy alone. LUS identified liver metastases with a sensitivity of 100% versus 60% for preoperative diagnostic means and laparoscopy. Nodal metastases were identified with a sensitivity of 96.1% and a specificity of 66.6%. Therapeutic planning was modified as result of LUS in 8 of 35 cases (22.9%). In patients with abdominal malignancy, LUS improves staging (cancer spread, nodal metastases, liver metastases), modifying therapeutic decisions. LUS represents a complementary, indispensable diagnostic method during laparoscopic surgery.

Bile Duct Neoplasms↗
PubMed1994

Echolaparoscopy: an indispensable procedure for laparoscopic surgery.

The widespread use of operative and diagnostic laparoscopy leads to growing use of laparoscopic ultrasound as a complementary procedure. A preliminary study was performed to evaluate the efficacy of laparoscopic ultrasound using a linear array laparoscopic probe characterised by double frequency, mechanical flexibility and availability of Doppler analysis. Twenty-five cases of cholecystolithiasis were evaluated during laparoscopic cholecystectomy in comparison with laparoscopic cholangiography: no differences were observed. Nine cases of gastrointestinal neoplasms (gastric, colon, pancreatic, and liver cancer) were evaluated in comparison with preoperative sonography and computed tomography. Laparoscopic sonography improves abdominal malignancy detection (cancer spread, lymph node metastasis, liver metastasis), thus modifying therapeutic decisions. The possibility of moving the probe in flexion extension movements allows a complete, multiplane exploration of operative fields. Laparoscopic sonography represents a complementary, indispensable diagnostic method during laparoscopic surgery.

Aged↗
PubMed1994

Intraoperative sonography of biliary tree during laparoscopic cholecystectomy.

The use of routine cholangiography during laparoscopic cholecystectomy is still under debate. Previous reports have suggested that intraoperative sonography can replace cholangiography in the evaluation of common duct lithiasis during open cholecystectomy. The present study was performed to evaluate the possible role of sonography during laparoscopic cholecystectomy. Thirty patients underwent intraoperative sonography of the biliary tree during laparoscopic cholecystectomy. In cases with a diagnosis of common bile duct lithiasis, intraoperative cholangiography was performed. In 26 cases, sonography did not show the presence of stones; in three cases, stones were identified at both sonography and cholangiography; in one case, stones were diagnosed by sonography alone. In this last case, stones were confirmed on later review of cholangiogram. No complications related to the method were observed. We suggest that intraoperative sonography can represent an adequate substitute for intraoperative cholangiography as a screening procedure for stone identification during laparoscopic cholecystectomy.

Adult↗
PubMed1993

Scintigraphic evaluation of biliary leakage following laparoscopic cholecystectomy.

Three patients with biliary leakage following coelioscopic cholecystectomy after percutaneous drainage of abdominal collection underwent 99m Tc TRIMETHYL-BROMO IDA biliary scintigraphy. In all cases, scintigraphy showed the site of the leak with a good dynamic evaluation of tracer confirming the adequacy of percutaneous drainage. Two patients were treated conservatively; one underwent surgical repair of a common bile duct lesion because of the high output of bile despite nasobiliary drainage. Biliary scintigraphy provides useful information in case of suspicious biliary leakage after coelioscopic cholecystectomy.

Adult↗
PubMed1993

Outcome of surgical treatment for extrapancreatic gastrinomas.

Since the availability of the H2-receptor antagonists (1978), seven patients admitted to the Department of Emergency Surgery, University of Pisa, with Zollinger-Ellison syndrome (ZES) sustained by extrapancreatic gastrinomas underwent elective surgical treatment. There were four women and three men, with a mean age of 37.3 years (16 to 67 years of age). Preoperative localization studies included endoscopy of the upper part of the gastrointestinal tract, computed axial tomography, ultrasound, selective angiography and transhepatic portal vein sampling for gastrin and were effective in four patients. In the other three patients, the localization of the gastrinoma was made at laparotomy. Four patients had gastrinomas of the duodenal and jejunal wall. Three underwent excisional operations, whereas the remnant was treated with pancreatoduodenectomy. In three of the patients, the location of the gastrinoma was extrapancreatic and extraintestinal, and surgical treatment consisted of nodal excision (two patients) and hepatectomy. None of the patients had undergone a gastric operation in addition to tumorectomy procedures. Soon after excisional operation, ZES recurred in one patient and a second laparotomy with nodal excision resulted in a cure. On long term follow-up evaluation, ranging from 15 to 136 months (mean of 85.1 divided by 37.3 months), no patients showed a recurrence of ZES. The possibility of extrapancreatic gastrinoma should be suspected in patients with sporadic ZES. The need for emergency surgical treatment in these patients is minimized by the medical control of the gastric secretion that consents diagnostic studies for the preoperative localization of the gastrinoma. Even if only suspected, the site of the extrapancreatic gastrinoma has an increased chance to be identified at operation. This consents to remove gastrinomas mostly by a minimal excisional procedure resulting in the normalization of gastric secretion and the prevention of malignant evolution of these tumors.

Adolescent↗
PubMed1993

Eosinophilic gastroenteritis: possible role of sonography in diagnosis and follow-up.

Eosinophilic gastroenteritis (EGE) is a rare disease of unknown etiology. The clinical and radiological diagnoses have to be confirmed by histological examination of biopsy specimens. The authors now present a case of a 19-year-old man with recurrent epigastric pain and vomiting, whose sonographic features and eosinophilia suggested the diagnosis of EGE, which was subsequently confirmed by histology. Sonographic follow-up permitted an effective evaluation of the evolution of the disease under steroid therapy.

Adult↗
PubMed1992

Resection of liver gastrinoma leading to persistent eugastrinemia. Case report.

In a 30-year-old man with Zollinger-Ellison syndrome, the only detectable gastrinoma was in the right liver lobe. Removal of the lobe, without additional gastric surgery, was followed by normalization of the gastrin level. Long-term follow-up confirmed the good result. The usefulness of quick intraoperative gastrin assay is stressed.

Adult↗
PubMed1992

Subcutaneous implantation of liver metastasis after fine needle biopsy.

A 50-year-old woman underwent percutaneous ultrasonographic fine needle biopsy of a suspicious liver metastasis of colon cancer. A subcutaneous metastasis developed at the site of the puncture 20 days after biopsy. Tumor recurrence in the needle biopsy track is rarely reported in the literature. The possible causes of this complication are discussed.

Adenocarcinoma↗
PubMed1992

[The prevention of postoperative deep venous thrombosis with heparan sulfate per os. A controlled clinical study vs. heparin calcium].

The paper reports the results of a randomised study carried out on a pool of 100 patients undergoing surgery in order to assess the efficacy and tolerability of orally administered heparan sulfate versus heparin calcium in the prevention of postoperative deep-vein thrombosis. Despite the limits of oral administration, heparan sulfate is indicated in the pharmacological prevention of postoperative deep-vein thrombosis.

Administration, Oral↗