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R Vecchio

Publications and source records attributed to R Vecchio.

At least 19 recordsLinked to original sources
PubMed2006

[Laparoscopic treatment of liver hydatid cyst: personal technique].

Treatment of liver hydatid cyst is still controversial. Besides medical treatment, interventional radiologic techniques and traditional surgery, recently the laparoscopic approach has been proposed. Laparoscopic treatment of liver hydatid cyst, however, has not been well defined so far and seems to be associated with a recurrence rate from 0 to 9%, in a 3-49 months follow-up. Disadvantages of the laparoscopic approach are difficult control of spillage, peritoneal dissemination of parasites and incomplete aspiration of high density fluid contents of the cyst. The authors have reviewed the literature and describe a personal technique to avoid this disadvantage and to reduce postoperative recurrence rate.

Echinococcosis, Hepatic↗
PubMed2002

Modifications of coagulation and fibrinolytic parameters in laparoscopic cholecystectomy.

BACKGROUND: The incidence of deep vein thrombosis and pulmonary embolism following laparoscopic surgery is unknown and studies on alterations of hemostasis after laparoscopy are inconclusive. METHODS: In this study we prospectively evaluated changes in prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (Fg), antithrombin III (ATIII), prothrombin fragment F 1 + 2, beta-thromboglobulin (betaTG) and D-dimer (D-D), preoperatively and 24 h after laparoscopic surgery in 16 patients. RESULTS: Comparing pre- and postoperative values, no statistical differences were observed in aPTT, F1 + 2, and ATIII measurements. Postoperative PT values increased slightly (p approximately 0.05) after surgery. Conversely, Fg, betaTG, and D-D values were statistically higher in the 24-h evaluation (p = 0.008, 0.01, and 0.045, respectively). CONCLUSIONS: These data suggest that laparoscopic surgery induces activation of coagulation and fibrinolytic pathways and, additionaly, betaTG elevation, which has never been reported and might account for postoperative platelet activation and a greater risk of thrombogenicity. Therefore, routine thromboembolic prophylaxis in patients undergoing laparoscopic surgery is recommended.

Adult↗
PubMed2002

Presacral myelolipoma. A case report.

Presacral myelolipoma is a rare benign tumour composed of fat and haemopoietic tissue. Ultrasound, computed tomography and magnetic resonance imaging are of help to achieve the diagnosis, but pathologic confirmation is mandatory. The Authors report an asymptomatic case whose diagnosis has been achieved by means of CT scan-guided percutaneous needle biopsy. Unnecessary surgical treatment was avoided in this case. Clinical approach and role of surgery are discussed.

Adrenal Gland Neoplasms↗
PubMed2001

Previous appendicitis may affect peritoneal overlap of the mesh in laparoscopic inguinal hernia repair.

Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation.

Appendectomy↗
PubMed2001

[Pancreatic pseudocysts. Our experience with 21 cases treated surgically].

Twenty-one consecutive patients with pancreatic pseudocyst have been reviewed. Nine cases have been treated with internal drainage, 9 with external drainage, while 3 patients have undergone distal pancreatectomy. No mortality was associated to the surgical treatment, while morbidity was of 9.5% due to pancreatic fistulas. Based on their own experience and literature review the Authors describe clinical, diagnostic and therapeutic features of the disease and point out the good results of cistojejunostomy with Roux-en-Y loop.

Adult↗
PubMed2000

History of laparoscopic surgery.

Laparoscopic surgery, whose development has been so impressive in the last decade, was initially introduced at the beginning of this century by Dimitri Ott, Georg Kelling and Hans Christian Jacobeus. Von Ott inspected the abdominal cavity of a pregnant women in 1901 and afterwards Georg Kelling performed a procedure, called "koelioscopie", closer to the definition of modern laparoscopy. In the same year Jacobeus published his first report of what he called "Laparothorakoskopie". In the following years several authors in Europe and in the United States performed laparoscopic procedures for diagnostic purposes. It was only with the introduction of the rod-lens optical system and of the cold light fiber-glass illumination that laparoscopy became more popular especially in the gynecologist departments. At this time laparoscopy in general surgery was mainly performed for the diagnosis of liver disorders and abdominal trauma, until the intuition of Lukichev in 1983 and Muhe in 1985 who performed their personal technique of laparoscopic cholecystectomy in humans. Their rudimental techniques did not receive the attention they probably deserved and increasing interest in laparoscopy among general surgeons developed only after the French gynecologist Mouret performed in 1987 the first acknowledged laparoscopic cholecystectomy by means of four trocars. Operative laparoscopy has advanced surprisingly in the last ten years. Several operative procedures have been performed by this new approach. After its tumultuous debut, laparoscopic surgery is now entering a phase of slower development and nowadays it is impossible to predict the immediate and long-term evolution of the technique.

Europe↗
PubMed1998

Bile duct injury after laparoscopic cholecystectomy. The United States experience.

BACKGROUND: Forty series reporting experience with laparoscopic cholecystectomy in the United States from 1989 to 1995 were reviewed. A total of 114,005 cases were analyzed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Intraoperative cholangiography (IOC) was attempted in 41.5% of the laparoscopic cholecystectomies and was successful in 82.7%. In major bile duct injuries, the common bile duct/common hepatic duct were the most frequently injured (61.1%) and only 1.4% of the patients had complete transection. METHODS: When reported, most of the bile duct injuries were managed surgically with a biliary-enteric anastomosis (41.8%) or via laparotomy and t-tube or stent placement (27.5%). The long-term success rate could not be determined because of the small number of series reporting this information. The management for bile leaks usually consisted of a drainage procedure (55.3%) performed endoscopically percutaneously, or operatively. RESULTS: The morbidity for laparoscopic cholecystectomy, excluding bile duct injuries or leaks, was 5.4% and the overall mortality was 0.06%. It was also noted that the conversion rate to an open procedure was 2.16%. CONCLUSIONS: It is concluded based on this review of laparoscopic cholecystectomies that the morbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore, bile duct injuries can be minimized by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-common bile duct junction.

Bile Ducts↗
PubMed1998

Bile duct injury: management options during and after gallbladder surgery.

Proper management of iatrogenic bile duct injuries is mandatory to avoid immediate or late life threatening sequelae. Results of surgery depend mainly on the type of injury, the detection of the injury, and the timing of the surgery. Lesions detected during cholecystectomy should be repaired immediately, preferably with an end-to-side biliary anastomosis, a Roux-en-Y bilio-enteric anastomosis, or by the insertion of a T-tube. Bile duct injuries detected in the postoperative phase require a multidisciplinary approach and an algorithm for treatment of each type of lesion is proposed. In bile peritonitis with biliary obstruction and/or transection and in tight long strictures, which develop several months after cholecystectomy, a Roux-en-Y hepatico-jejunostomy is the most commonly performed operation. Other surgical techniques include a "mucosal graft" procedure and intrahepatic biliary enteric anastomoses, which may be required in difficult high-biliary lesions. Endoscopy and/or interventional radiology offer the best treatment options in bile duct leaks and in short ductal strictures that involve less than 50% of the bile duct lumen. In these injuries, surgical management should be performed only in the failure of nonsurgical methods. Because these lesions involve complicated biliary surgery, therapeutic endoscopy, and interventional radiology, treatment should be performed where there is expertise in all three areas.

Algorithms↗
PubMed1998

[Preoperative treatment with interleukin-2 in colorectal carcinoma].

Thirteen surgical patients affected by colorectal cancer have been evaluated to study the effectiveness of a short-term preoperative therapy with interleukin-2 (IL-2). Seven patients have been treated for three days before surgery with subcutaneous administration of IL-2 (9.000.000 U.I. b.i.d.). Six patients have been treated with placebo and have been considered as control group. All the patients have been operated upon 36-48 hours after the last administration of IL-2 or placebo. The assays of CD-3+, CD-4+, CD-8+ e CD-56+ lymphocytes, evaluated preoperatively and 7 days after the operation, have showed a postoperative increase of CD8+ and CD56+ and a decreased ratio of CD4+/CD8+. The results of this study, although not conclusive, suggest a positive antitumoral response in patients treated preoperatively with IL-2. Further studies could be performed to evaluate the survival after such a treatment.

Adenocarcinoma↗
PubMed1997

[The physiopathological and therapeutic aspects of esophageal diverticula].

The authors reviewed 23 surgical cases of symptomatic oesophageal diverticula. In Zenker's diverticula (7 cases) the surgical treatment consisted of extramucosal cricopharyngeal myotomy and diverticulectomy (6 patients) or diverticulum suspension (1 patient). The operations in epiphrenic (15 patients) and mid-thoracic (1 patient) diverticula were as follows: diverticulectomy, longitudinal extramucosal myotomy and antireflux surgery (11 cases); myotomy and antireflux surgery (4 cases); myotomy alone (1 patient). There was no operative mortality. Postoperative complications occurred in 3 patients (13%). 15 patients were followed for an average time of 60 months. None of them developed postoperative dysphagia. Pathogenesis, diagnostic methods and surgical options are discussed.

Adult↗
PubMed1996

[Our experience in the surgical treatment of pharyngoesophageal diverticula].

The authors review a consecutive series of 7 pharyngo-oesophageal diverticula surgically treated from 1979 to 1994. In their opinion, surgery of diverticula to be effective must be preceded by dynamic and functional studies to outline the motor impairment often associated. Surgical indications and the different surgical techniques are also emphasized.

Aged↗
PubMed1996

[Mixed-type pancreatoblastoma. Report of a clinical case].

Pancreatoblastoma is a very rare tumor of the pancreas, affecting children in the first decade of life. Ultrasound and CT scan may be useful but pre-operative diagnosis is often quite difficult. High level of seric alpha-fetoprotein could be suggestive of pancreatoblastoma. The definitive diagnosis is however made by histologists when an organoid structure, well encapsulated, consisting of acinar cells with zymogen-like granules and squamoid corpuscle is demonstrated, sometimes associated with mesenchymal tissue (mixed-type pancreatoblastoma). Immunohistochemical studies may help in differentiating pancreatoblastoma from papillary cystic tumors, acinar cell carcinomas and endocrine pancreatic tumors of the pancreas. We report a case of mixed-type pancreatoblastoma in a 12-year-old female patient, located in the head of the pancreas. The treatment has been surgical, consisting of a duodeno-cephalo-pancreasectomy. Neither radiotherapy nor chemotherapy has been performed. The patient is alive, without recurrence, four months after the operation. Diagnostic, therapeutic and prognostic aspects are discussed.

Child↗
PubMed1995

Aberrant biliopancreatic duct. A probable cause of acute pancreatitis?

Abnormal biliopancreatic ducts are very uncommon in adults with the exception of those associated with abnormalities of either the pancreatic or the bile ducts. The case presented herein is unique in that a biliopancreatic connection occurred proximal to the papilla of Vater and the patient was symptomatic because of the aberrant connection. The surgical therapy consisted of cholecystectomy and ligation of the aberrant duct, with complete relief of severe, debilitating symptoms. This interesting clinical observation is discussed in the light of Opie's theory of biliary reflux into the pancreatic duct as a pathogenetic mechanism for acute pancreatitis.

Acute Disease↗
PubMed1995

[Role of thymopentin in the prevention of post-splenectomy infections].

The Authors evaluated the efficacy of thymopentin in the prevention of post-splenectomy infections. 14 splenectomized patients treated by thymopentin (50 mg s.c. every other day in the 4 weeks following splenectomy) were compared with 14 splenectomized control patients. Clinical evaluations and measurement of CD4 and CD8 lymphocyte subpopulations were made preoperatively and then after 3 and 6 months from splenectomy. Hyperthermia (37.5-38 degrees C) "sine materia", which disappeared spontaneously in 4-5 weeks, was observed in the post-operative phase in 4 control patients and in 1 patient treated by thymopentin. No statistical difference was demonstrated comparing pre- and post-operative percentages of CD4 and CD8 lymphocytes in the treated and control groups.

Adolescent↗