Biomedical subjects

P Tondelli

Publications and source records attributed to P Tondelli.

At least 19 recordsLinked to original sources

PubMed1995

[Initial results with laparoscopic fundoplication].

17 patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease not responding to medical treatment. Conversion to laparotomy was necessarily due to large paraesophageal hiatus hernia (3) or severe peri-esophagitis (1) in 4 patients. There was no perioperative morbidity or mortality. At 3 months all patients were symptom-free. Esophageal manometry revealed a rise in mean lower esophageal sphincter pressure from 4 mm Hg preoperatively to 11 mm Hg postoperatively, and lengthening of the high pressure zone from 2.3 to 3.3 cm. One patient needed reoperation one year after fundoplication due to wrap disruption with recurrent reflux disease. Laparoscopic fundoplication involves low perioperative morbidity and shortens the postoperative recovery time in selected patients.

Adult↗

PubMed1995

[Reflux disease following gastropexy for para-esophageal hiatal hernia].

From 1984 to 1992 28 patients with paraesophageal hiatus hernia underwent elective operation with crural repair and gastropexy. In the absence of severe reflux disease (6 patients had mild to moderate reflux symptoms) and of esophagitis at endoscopy, no antireflux repair was performed in these patients. Follow-up of 19 patients after 3 years (12-72 months) revealed reflux symptoms in 11 patients (58%) and moderate or severe reflux disease (need for medical treatment) in 6 (32%). 6 patients developed new reflux symptoms after operation. 3 patients had esophagitis at endoscopy. In elective cases, the repair of paraesophageal hernia should, regardless of the presence of reflux esophagitis, be combined with an antireflux procedure to avoid the high risk of postoperative reflux disease.

Adult↗

PubMed1994

[Results of surgical therapy in esophagus and cardia carcinoma].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in early stage of tumor. In the advanced stage of tumor palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed morbidity and mortality of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracic access, gastric interposition with thoracic anastomosis and extramucous pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) [1], 47% palliative (UICC stage III and IV) [1]. Perioperative 30-days mortality was nil, perioperative 30-days morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents either good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus or potentially curative therapy with low morbidity in early stage of tumor.

Adenocarcinoma↗

PubMed1994

[Sphincter-preserving surgery of trans-sphincteric anal fistulas].

The "laying open" technique is the standard method of treating fistulas-in-ano. Laying open transsphincteric (high anal) fistulas involves division of a part of the external anal sphincter and may result in incontinence. In 12 patients with high transsphincteric fistula (7 with previous surgery to attempt fistula healing) we have used a sphincter-saving surgical method: excision of the fistula tract and closure of the internal opening by suture of the internal anal sphincter. Fistulas were eradicated in 8 patients (67%) without incontinence. In 4 patients the fistulas persisted. It is concluded that transanal closure of the internal opening and perianal fistula excision can be an effective method of treating transsphincteric fistulas without sphincterotomy, thus avoiding the risk of incontinence.

Adult↗

PubMed1994

[Prognostic factors in resected stomach carcinoma].

Between January 1982 and December 1991, 232 consecutive patients (121 male, 111 female) with gastric adenocarcinoma were treated at our clinic. Resection of the tumors (resectability 73.7%) included lymphadenectomy of compartment I (D1 resection). The tumors were classified according to the Borrmann's and Laurén's criteria and according to the TNM system. 171 patients underwent resection of the tumor, 49 palliative surgery and 12 were treated nonsurgically. The operative morbidity in patients with resection and palliative operations was 20.5% and 10.2% respectively, and the mortality rate was 0.6% and 8.2% respectively. Follow-up data (median 6 years postoperatively) were available for 229 out of 232 patients (98.7%). After resection, the five year actuarial survival rate according to the method of Kaplan-Meier was 38.2%. The probability of survival increased to 47.5% after potentially curative resection. An univariate and a multivariate analysis by the proportional hazard model (Cox regression analysis) identified several significant prognostic parameters for survival (in order of their significance): tumor stage (TNM), N-stage, percentage of positive lymph node metastases among removed nodes, Borrmann criteria, T-stage, metastases in five and more lymph nodes, diameter of the tumor, serosal involvement, peritoneal and hepatic metastases, and patient's age. The following parameters did not have a prognostic value in our analysis: grading, Laurén classification, and localization of the tumor. We conclude that the identification of several prognostic factors allows us to estimate the probability of survival for each individual patient. In future these factors may influence decision-making on adjuvant treatment of gastric cancer.

Actuarial Analysis↗

PubMed1994

[Cholecystectomy today. A prospective study].

Between 13 June 1990 and 12 June 1993, we performed 1145 consecutive cholecystectomies. 127 patients who had undergone additional surgery were excluded from the prospective study. Of the remaining 1018 patients, 806 (78.2%) underwent laparoscopic cholecystectomy. The conversion rate to open procedure was 11.2% (90/806). The operative morbidity associated with laparoscopic cholecystectomy was 2.1% (17/806) and with open surgery 1.9% (4/212); mortality was 0.12% (1/806) and 0.47% (1/212) respectively. The reoperation rate after laparoscopic cholecystectomy was 0.6% (5/806). Reoperation was performed for lesions of the common bile duct, bleeding, and abscess formation. If the indications for open cholecystectomy are respected the morbidity and mortality were low for both laparoscopic and conventional cholecystectomy.

Adolescent↗

PubMed1994

[Results following resection in early stomach carcinoma].

The results of surgical resection in early gastric cancer were analyzed retrospectively. These operations were performed between 1982 and 1991 on 52 consecutive patients (29 women, 23 men; average age 64 [35-85] years). The tumours were resected by total gastrectomy in 11, by subtotal gastrectomy in 31, and by Billroth I resection in 10, followed by limited lymphadenectomy of the perigastric group of lymph-nodes (D1 dissection). There was one operative death (1.9%). The tumor was confined to the mucosa in 36 patients (69%), while submucosal infiltration was present in 16 (31%) and metastases to the regional lymph-nodes in seven (13%). Follow-up examination took place in all patients, after an average period of observation of 6.1 years. For the total group the 5-year survival rate, including operative mortality, was 83.7%. It correlated with the depth of penetration of the tumour and nodal involvement. 5-year survival rate for mucosal tumour was 90%, with submucosal infiltration 66.7% (P < 0.03), without lymph-node metastasis 86.4%, with it 68.6% (P < 0.05). The extent of resection and the tumour classification (according to Laurén--intestinal or diffuse) did not influence survival.--Early gastric cancer, contrary to that in the advanced stages, has a very good prognosis. But it is significantly altered by the depth of penetration of the tumour and nodal metastasis.

Adult↗

PubMed1994

Acute and chronic presentation of intestinal nonrotation in adults.

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.

Abdomen, Acute↗

PubMed1994

[Laparoscopic and open cholecystectomy in 954 patients. A prospective evaluation].

In 2 1/2 years we performed at the St. Clara Hospital in Basel 954 cholecystectomies; 661 were done laparoscopically. In the laparoscopic group we observed a morbidity of 2.3%, a reoperation rate of 0.6% and a mortality of 0.15%. In the group with open cholecystectomy the morbidity was 9.9% and the mortality 1.3%. In all 954 patients who had a cholecystectomy the morbidity was 4.6%, reoperation rate 0.4% and mortality 0.5%. Because of negative patient selection a comparison with the open cholecystectomy in our series is not possible. In summary we can say that the laparoscopic procedure has a low morbidity and low mortality. With the lesser operative trauma it allows a shorter hospital stay. We believe that laparoscopic cholecystectomy with good indication will replace open cholecystectomy as the gold standard therapy of symptomatic gallstone disease.

Adult↗

PubMed1994

[Intestinal obstruction with invagination caused by an inflammatory fibroid polyp of the small intestine].

We observed the rare case of a 50-year-old man with intestinal obstruction due to an inflammatory fibroid polyp (IFP) of the jejunum. Here, we report its clinical and pathological characteristics, and its histologic appearance. Limited small bowel resection led to complete recovery of the patient. In a short review of the literature, possible pathogenetic mechanisms as well as diagnostic and therapeutic means are discussed. Although rare, IFP should be considered in the differential diagnosis of small bowel obstruction.

Anastomosis, Surgical↗

PubMed1993

[Results of esophagectomy in carcinoma of the esophagus and cardia].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in the early stage of the tumor. In the advanced stage of tumor, palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed mortality and morbidity of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracal access, gastric interposition with thoracal anastomosis and extramucosal pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) and 47 palliative (UICC stage III and IV). Perioperative 30-day mortality was nil, and perioperative 30-day morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus.

Adenocarcinoma↗

PubMed1993

Primary carcinoma of the gallbladder: operative experience during a 16 year period.

OBJECTIVE: To evaluate the results of operations for primary carcinoma of the gallbladder during the 16 year period 1975-1990. DESIGN: Retrospective study. SETTING: University affiliated hospital in Switzerland. SUBJECTS: 55 consecutive patients with primary carcinoma of the gallbladder. INTERVENTIONS: Resection with curative and palliative intent was done in 34 (62%) and in 10 (18%), respectively. Thirty nine (62%) had simple cholecystectomy and two (4%) radical resections; the remaining 14 (25%) had palliative operations. RESULTS: 23 Patients (42%) had early tumours (confined to the gallbladder wall, TNM stages I and II), and 32 (58%) had late tumours (TMN stages III and IV). A tumour of the gallbladder was suspected from preoperative ultrasonography in 20 of 37 examined patients (54%); 17 (31%) had occult lesions. Five patients died during the 30 day postoperative period (9%), and the overall median survival was 8.6 months. One and five year survival rates were 40% and 7%, respectively. Only four patients had long term cures after cholecystectomy alone. CONCLUSION: There was a high incidence of locoregional recurrence among patients with stage II disease, and this group benefit from more radical resections. For advanced tumours, palliation alone is preferable.

Aged↗

PubMed1993

[Perioperative morbidity and mortality in colon resection for colon cancer].

The operative risk of colon resections was evaluated by a retrospective analysis of 231 according patients who were operated on between 1984 and 1988. Mean age of the patients was 70 years with a range from 37 to 91 years. Colonic resection consisted of ileocecal resection in 3 cases, right hemicolectomy in 144 cases, segmental resection of transverse colon in 10 cases, left hemicolectomy in 22 cases, resection of sigmoid colon in 77 cases and 5 times a subtotal colectomy was performed. In two patients (0.9%) an anastomotic leak occurred. Three patients were reoperated on: one due to an anastomotic disruption, two others due to a mechanical small bowel obstruction. Two patients (0.9%) died due to systemic complications without any evidence of anastomotic or wound problems. Thus a low morbidity and mortality of colonic resection is documented in our study. Factors contributing to these results are a standardized bowel preparation, perioperative antibiotics and modern anaesthetic techniques.

Adult↗

PubMed1993

[The incidence of ileus after resection for rectal cancer with and without radiotherapy].

Between 1984 and 1989 240 patients had radical abdominal resection of a rectal carcinoma. Out of 201 patients surviving 12 months or more postoperatively, two groups are surveyed. The first group presents patients undergoing adjunctive radiation therapy (n = 47), the second group did not undergo postoperative radiation therapy (n = 134). Mean follow-up time postoperatively is 39 months. Within the irradiation group, the incidence of ileus was found to be 23% (11/47), in the non-irradiated group 8% (11/134). Subsequent reoperations in order to clear intestinal obstruction were performed on 4% (5/134) of non-irradiated patients and on 21% (10/47) of the irradiated group. Considering the increased risk of postoperative ileus after rectal resection for rectal carcinoma, serious reflection should be given to assessing the appropriateness of adjunctive radiation therapy.

Adult↗

PubMed1993

[Cancer of the gastric stump. An independent disease picture? Consequences for follow-up].

In a retrospective study we analysed the clinical course of 13 patients from the St Clara's Hospital who had a gastric-stump cancer between the years of 1975 and 1989 and compared our figures with the literature. Our figures showed the average age of the patient at their first operation for the gastric ulcer was 35 and, at the second operation for gastric cancer the average age was 68.8 patients were male and 5 were female. When the tumour was discovered it was already advanced. 11 patients had a Grade 3 or 4 tumour. Out of our 13 patients, 7 had to undergo a total removal of the gastric remnant. 1 patient underwent a partial gastrectomy and, 3 patients had a gastrostomy or jejunostomy performed. For 2 patients the tumour was seen to be so advanced that no palliative procedure could be undertaken. When this study was undertaken only 1 patient remained alive and this patient had survived 7 years after removal of the gastric remnant. Because the likelihood of cancer occurring in the gastric stump is four times more frequent than expected we recommend that the patient is endoscoped 20 years after the initial operation and then again regularly every 3 to 5 years after this.

Adult↗

PubMed1992

[Perioperative morbidity and mortality of colon resection in colonic carcinoma].

An analysis of the local and systemic perioperative complications is conducted to explore the risk of resection of colon cancer. In a retrospective study we analyzed 231 consecutive patients operated on between 1984 and 1988. The mean age was 70 (37-91) years. The operations consisted in 3 ileocecal resections, 144 right hemicolectomies, 10 resections of the transverse colon, 22 left hemicolectomies, 77 resections of the sigmoid colon and 5 subtotal colonic resections. 2 patients (0.9%) had a clinical leakage of the anastomosis. 3 patients were reoperated: one because of anastomotic leakage and two because of ileus due to small bowel adhesions. 2 patients with uncomplicated local healing died within 30 days after the operation from systemic complications (mortality 0.9%). It is concluded that with standardized preoperative bowel preparation, prophylactic perioperative antibiotics and modern anesthesia, the resection of colon cancer is today possible with minimal perioperative risk.

Adult↗

PubMed1992

[Laparoscopic cholecystectomy. Initial experiences and results in 278 patients].

Of 467 cholecystectomies (performed between 13. 6. 1990 and 12. 9. 1991) 278 were done by laparoscopy (196 women, 82 men; mean age 53 [18-86] years). Contraindications to a laparoscopic procedure were acute cholecystitis, severe chronic cholecystitis with adhesions, abnormal clotting and suspected gallbladder carcinoma. In 31 patients (11.1%) the initial laparoscopic cholecystectomy was continued as a conventional cholecystectomy, usually because of unclear conditions in severe chronic cholecystitis. Mean duration of hospital stay was 6.3 days for the laparoscopic procedure compared with 11.5 days for the conventional one. Complications occurred in four patients (in 12 with the conventional method): one occlusion (by clip) of the common bile duct, one bile leak, one bleeding and one pneumothorax, requiring re-operation in three patients. There were no deaths (compared with two in the conventional group). Assuming correct indications, laparoscopic cholecystectomy is a sparing method for the treatment of cholecystolithiasis.

Adolescent↗

PubMed1992

[Incidence of ileus following rectum resection in rectal carcinoma with or without radiotherapy].

Between 1984 and 1989 240 patients underwent radical abdominal resection of a rectal carcinoma. Out of 201 patients surviving 12 months or more postoperatively, 2 groups are surveyed. The first group presents patients undergoing adjunctive radiation therapy (n = 47), while the second group did not undergo postoperative radiation therapy (n = 134). Mean follow-up time postoperatively is 39 months. Within the irradiation group, the incidence of ileus was found to be 23% (11/47), and in the non-irradiated group 8% (11/134). Subsequent reoperations to clear intestinal obstruction were performed in 4% (5/134) of non-irradiated patients and 21% (10/47) of the irradiated group. Considering the increased risk of postoperative ileus after rectal resection for rectal carcinoma, the appropriateness of adjunctive radiation therapy should be carefully assessed.

Adult↗