Biomedical subjects

Stefano Tursini

Publications and source records attributed to Stefano Tursini.

4 recordsLinked to original sources

PubMed2006

Laparoscopically assisted anorectal pull-through for high imperforate anus: three years' experience.

PURPOSE: We describe our three-year experience with the laparoscopically assisted anorectal pullthrough for high imperforate anus using laparoscopic muscle electrostimulation. MATERIALS AND METHODS: From March 2001 to January 2004, 7 patients with a diagnosis of high anorectal malformation underwent laparoscopically assisted anorectal pull-through. The patients, all males aged from 4 to 9 months (mean age, 5.8 months), presented with a rectourethral fistula. The associated malformations noted were sacral malformation, laryngeal stenosis, urethral duplication, multicystic kidney, nonpalpable testis, and esophageal atresia. All patients were treated with a colostomy in the newborn period followed by a delayed laparoscopically assisted anorectal pullthrough. Laparoscopy included stimulation of the puborectal muscle, using a modified Peña electrostimulator introduced through a trocar. All patients underwent a postoperative period of anal dilatation. RESULTS: In 6 cases the laparoscopically assisted anorectal pull-through was successful; there was 1 conversion to the open technique, due to strong tension from the colostomy. CONCLUSION: Although longer follow-up to evaluate continence is to come, laparoscopically assisted anorectal pull-through should be considered for the correction of the high imperforate anus and, according to our experience, it represents the gold standard. It offers the advantage of good visualization of the fistula and the surrounding structures and minimally invasive abdominal and perineal wounds. With the laparoscopic Peña stimulator the direct observation of the contraction of the puborectalis sling allows an evaluation of the functional contractility and an accurate colonic pullthrough in the center of the muscle complex.

Anus, Imperforate↗

PubMed2005

Congenital symptomatic intrahepatic arteriovenous fistulas in newborns: management of 2 cases with prenatal diagnosis.

BACKGROUND: Fetal and neonatal hepatic arteriovenous fistulas are rare and associated with a high mortality rate; they can be prenatally detected by ultrasonography. Management of these malformations can be a challenge for pediatric surgeons. METHODS: Two patients with a prenatal diagnosis of intrahepatic arteriovenous shunts were treated at our institution in the last 2 years. A hepatic complex arteriovenous malformation fed respectively by prominent branches of the hepatic artery and of the celiac trunk rising from dilated suprarenal aortae and draining into suprahepatic veins was detected. In the first case, an embolization was performed; in the second, the surgical resection of the vascular malformation was the treatment of choice. RESULTS: The first patient died after embolization and before surgery for hemodynamic complications. The second patient, at a follow-up of 16 months, is alive and doing well. CONCLUSION: Hepatic resection is the treatment of choice for localized intrahepatic arteriovenous malformation. Theoretically, embolization could be curative or reduce the size of a malformation, making consequent hepatic resection feasible. Results do not support this theory because of the high rate of complications recorded that brought in every case, ours included, to the death of the child.

Arteriovenous Fistula↗

PubMed2003

Treatment of ureterocele on duplex ureter: upper pole nephrectomy by retroperitoneoscopy in children based on a series of 24 cases.

OBJECTIVE: The objective of this study is to present the results of a preliminary series of 24 upper pole nephrectomies performed by retroperitoneoscopy in children between 1995 and 2000. MATERIAL AND METHODS: The patient was placed in the lateral supine position and 3-4 trocars were inserted. Parenchymal section was performed by ultrasound or unipolar scalpel. This series of 24 children consisted of 15 girls and 9 boys with a mean age of 22 months. RESULT: Three cases (12.5%) required open conversion. Nine intraoperative complications (37%) were observed and repaired intraoperatively. Five postoperative complications (20%) consisted of residual perirenal collections, requiring drainage under anaesthesia in only one case. The mean operating time was 2 hours 40 minutes. The mean hospital stay was 3.4 days. The mean follow-up was 32 months. No cases of secondary atrophy of the lower pole were observed. CONCLUSION: Overall, these preliminary results are comparable to those of conventional open surgery. The advantage of this method is a reduction of skin and musculo-aponeurotic scars.

Child↗

PubMed2002

[Treatment of ureterocele in ureteral duplication: upper pole nephro-ureterectomy by retroperitoneoscopy in children: 24 cases].

OBJECTIVE: The objective of this study is to present the results of 24 upper pole nephrectomies performed by retroperitoneoscopy in children between 1995 and 2000. MATERIAL AND METHODS: This series of 24 children consisted of 15 girls and 9 boys with a mean age of 22 months. The patient was placed in the lateral supine position and 3 to 4 trocars were inserted. Parenchymal section was performed by ultrasound or unipolar scalpel. RESULT: Three cases (12.5%) required open conversion. Nine intraoperative complications (37%) were observed and repaired intraoperatively. Five postoperative complications (20%) consisted of residual perirenal collections, requiring drainage under anaesthesia in only one case. The mean operating time was 2 hours 40 minutes. The mean hospital stay was 3.4 days. The mean follow-up was 32 months. No cases of secondary atrophy of the lower pole were observed. CONCLUSION: Overall, these preliminary results are comparable to those of conventional open surgery. The advantage of this method is a reduction of skin and musculo-aponeurotic scars.

Child, Preschool↗