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Robert N Cacchione

Publications and source records attributed to Robert N Cacchione.

5 recordsLinked to original sources
PubMed2005

Laparoscopic Heller myotomy for achalasia.

BACKGROUND: Achalasia is an uncommon illness affecting 1 per 100,000 patients yearly. There is evidence to suggest viral, autoimmune, and hereditary etiologies. There are many treatment options available including medications, botulinum toxin injection, pneumatic dilation, and surgical myotomy. METHODS: We present a retrospective review of patients undergoing laparoscopic-modified Heller myotomy at a large referral and surgical training center. RESULTS: There were 36 patients identified. Thirty patients had undergone prior treatment with botulinum toxin injection, pneumatic dilation, previous Heller myotomy, or esophageal stenting. Immediate complications included mucosal perforation (2), spleen injury (1), and trocar-site infection (1). There were no postoperative esophageal leaks. Three patients suffered reflux requiring the daily use of a proton pump inhibitor 9 months after surgery. Three patients suffered recurrent dysphagia. CONCLUSIONS: Presently, there are little data to suggest an ideal management strategy in patients with achalasia. Our patient population consists predominantly of failures of other treatment methods submitted for laparoscopic myotomy. Our data suggest that laparoscopic Heller myotomy can be safely undertaken in this population, without a higher than expected rate of recurrent symptoms or reflux.

Adolescent↗
PubMed2004

Techniques for repair of gastric prolapse after laparoscopic gastric banding.

Laparoscopic gastric banding is a valuable surgical option for treating morbidly obese patients. Its operative technique is continually being refined. Since its inception, many changes in technique have helped to reduce the complication rate. Currently, the major complications are obstruction, erosion, and band slippage. Band slippage requires surgical correction. Since each band costs approximately 3000 dollars, surgeons should attempt to preserve the band when facing patients with this complication. This paper discusses the techniques for the reduction of band slippage.

Gastroplasty↗
PubMedDate not supplied

Jaundice due to extrabiliary gallstones.

OBJECTIVE: Cholecystectomy is one of the most common general surgical procedures performed today. The laparoscopic approach is beneficial to patients in terms of length of stay, postoperative pain, return to work, and cosmesis. Some drawbacks are associated with the minimal access form of cholecystectomy, including an increased incidence of common bile duct injuries. In addition, when the gallbladder is inadvertently perforated during laparoscopic cholecystectomy, retrieval of dropped gallstones may be difficult. We present a case in which gallstones spilled during cholecystectomy, causing near circumferential, extraluminal common hepatic duct compression, and clinical jaundice 1 year later. METHODS: The patient experienced jaundice and pruritus 12 months after laparoscopic cholecystectomy. A computed tomographic scan was interpreted as cholelithiasis, but otherwise was normal (despite a previous cholecystectomy). Endoscopic retrograde cholangiopancreatography was performed and a stent placed across a stenotic common hepatic duct. RESULTS: The results of brush biopsies were negative. The stent rapidly occluded and surgical intervention was undertaken. At exploratory laparotomy, an abscess cavity containing multiple gallstones was encountered. This abscess had encircled the common hepatic duct, causing compression and fibrosis. The stones were extracted and a hepaticojejunostomy was tailored. The patient's bilirubin level slowly decreased and she recovered without complication. CONCLUSIONS: Gallstones lost within the peritoneal cavity usually have no adverse sequela. Recently, however, numerous reports have surfaced describing untoward events. This case is certainly one to be included on the list. A surgeon should make every attempt to retrieve spilled gallstones due to the potential later complications described herein.

Aged↗