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U Fumagalli

Publications and source records attributed to U Fumagalli.

At least 19 recordsLinked to original sources
PubMed2006

Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy.

Minimally invasive techniques are increasingly being used for oesophagectomy. Diaphragmatic hernia is a rare complication of gastroplasty in open surgery. One of the advantages of the laparoscopic technique, the lack of peritoneal adhesions, may lead to an increased rate of this complication. We report two cases of diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy out of a series of 44 laparoscopic gastroplasties performed over 33 months. We discuss some technical aspects related to its occurrence. Prevention should include a limited crural division and fixation of the gastric tube to the diaphragmatic crura at primary surgery.

Adenocarcinoma↗
PubMed2004

Pre-operative endoscopic ultrasonography can optimise the management of patients undergoing laparoscopic cholecystectomy with abnormal liver function tests as the sole risk factor for choledocholithiasis: a prospective study.

BACKGROUND: Pre-operative endosonography has been proposed as a cost-effective procedure in the management of patients who undergo laparoscopic cholecystectomy having an intermediate risk of common bile duct stones. We prospectively evaluated the impact of pre-operative endosonography on the management of patients facing laparoscopic cholecystectomy with abnormal liver function tests as the sole risk factor for choledocolithiasis. METHODS: Among 587 consecutive patients scheduled for laparoscopic cholecystectomy, 47 (8%) patients having one or more abnormal liver function tests but a normal appearance of common bile duct at abdominal ultrasound, underwent pre-operative endosonography. In patients with endosonography-detected common bile duct stones, a pre-operative endoscopic retrograde cholangiography was performed, or an intra-operative endoscopic retrograde cholangiography was scheduled. In all endosonography-negative patients, an intra-operative trans-cystic cholangiography was performed. RESULTS: Endosonography detected common bile duct stones in nine patients (19%) but only in five of them stones were radiologically confirmed (PPV 0.55). Endosonography-detected stones were confirmed in four of four (100%) patients in whom cholangiography was performed within 1 week, but only in one of five (20%) patients in whom radiology was further delayed (P < 0.05). In three of four cases (75%), stones detected at endosonography but not confirmed at X-rays, were smaller than 2.0 mm. Among 38 patients with negative endosonography, common bile duct stones were found in two patients (NPV 0.95), whereas unplanned endoscopic stone extraction was needed only in one patient (NPV 0.97). CONCLUSIONS: Pre-operative endosonography can spare unnecessary pre-operative endoscopic retrograde cholangiography as well as inappropriate scheduling of intra-operative endoscopic retrograde cholangiography in patients undergoing laparoscopic cholecystectomy with abnormal liver function tests. To maximise the impact of endosonography on the management of these patients, the procedure should be performed immediately before laparoscopic cholecystectomy.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2001

Laparoscopic treatment of epiphrenic diverticula.

BACKGROUND AND PURPOSE: Epiphrenic diverticula are a rare disease probably caused by long-standing impairment of esophageal motor activity. Symptomatic disease, which may worsen clinically during follow-up even to severe symptoms, is usually considered an indication for surgical treatment. Surgery for epiphrenic diverticula consists of diverticulectomy, which traditionally is performed through a left thoracotomy; a myotomy and partial fundoplication are generally included in order to treat the underlying motor disorder and to prevent or correct reflux. The same principles of surgical treatment can be achieved through the laparoscopic transhiatal approach. The aim of this paper is to describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap to treat epiphrenic diverticula of the esophagus. PATIENTS AND METHODS: From January 1994 through May 2001, 11 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution. RESULTS: In all patients, the operation was completed through the minimally invasive access. The postoperative course was complicated in one patient (9%), who had a leak from the staple line, which was repaired through a thoracotomy. At follow-up, this patient had persistence of a small pouch at the diverticuletomy site. However, he was asymptomatic. All other patients were free of symptoms and without recurrence. CONCLUSION: Laparoscopy offers good access to the distal esophagus and the inferior mediastinum. Removal of the diverticulum, treatment of the motor disorder, and prevention of postoperative reflux can all be obtained through this approach. The immediate postoperative and long-term results are satisfactory.

Aged↗
PubMed1999

Neoadjuvant chemotherapy for patients with locally advanced gastric carcinoma: effect on tumor cell microinvolvement of regional lymph nodes.

BACKGROUND: In a previous study the authors demonstrated, using immunohistochemical methods for epithelial antigens, that the regional lymph nodes of gastric adenocarcinoma contained individual tumor cells or small clusters of these cells (tumor cell microinvolvement [TCM]) in over 90% of cases. In the current study the authors used the same method to investigate a series of gastric adenocarcinoma cases treated with neoadjuvant chemotherapy prior to tumor resection; their aim was to determine the effect of chemotherapy on TCM in regional lymph nodes. METHODS: Resection specimens from 17 patients with adenocarcinoma of the stomach, resected after neoadjuvant treatment and classified by routine histology as ypN0, were included in this study. One section from each of the 622 lymph nodes dissected from these specimens was stained by immunohistochemical methods for cytokeratins and Ber-Ep4. RESULTS: Six patients (35%) and 25 of the 622 lymph nodes (4.0%) had TCM, compared with 93% of patients and 21.8% of lymph nodes in the previous study of patients treated with surgery alone. The lymph node response to chemotherapy correlated with the pathologic response of the primary tumor. Specifically, none of 5 patients with a complete or major pathologic response versus 6 of 12 (50%) patients with minor, partial, or no response had lymph node microinvolvement. CONCLUSIONS: In comparison to our previous study, this study indicates that chemotherapy has a marked effect on tumor cells in regional lymph nodes and that the extent of this effect can be correlated with the degree of pathologic response of the primary tumor to chemotherapy.

Adenocarcinoma↗
PubMed1998

Evaluating results of laparoscopic surgery for esophageal achalasia.

BACKGROUND: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure of choice to treat stage I-III esophageal achalasia. METHODS: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients underwent laparoscopic Heller-Dor for stage I-III achalasia. Conversion to laparotomy was done in three cases. All procedures were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative treatment). RESULTS: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year. After a mean follow-up (F.U.) of 21 months (1-62), clinical results range from excellent to good in 98.2%. One patient (1.7%) complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure reduced from 30.3 +/- 12.4 to 10.7 +/- 3.5 mmHg (basal) and from 14. 8 +/- 9.3 to 2.9 +/- 2.1 mmHg (residual). CONCLUSIONS: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous endoscopic dilations.

Adolescent↗
PubMed1998

Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula?

OBJECTIVE: To describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap for epiphrenic diverticula of the esophagus. SUMMARY BACKGROUND DATA: The epiphrenic diverticulum of the esophagus is a rare disease probably caused by a longstanding impairment of the esophageal motor activity. Although there is almost universal agreement to operate only on symptomatic patients, the optimal treatment is controversial. The best-accepted guideline is to treat the underlying motor disorder. This is generally done through a left thoracotomic approach that allows diverticulectomy, esophageal myotomy, and partial fundoplication. METHODS: From January 1994 through February 1996, 4 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution. A thorough preoperative study was done with barium swallow, esophagoscopy, and manometry in all patients; 24-hour pH monitoring was done in one case. RESULTS: No postoperative complications were observed. Short- and medium-term results are satisfactory. CONCLUSIONS: No theoretical objection should be made to this approach, because the principle of treatment of the diverticular pouch and the underlying motor disorder and the prevention of reflux is respected. Longer follow-up and a wider series are mandatory to substantiate these initially favorable results.

Diverticulum, Esophageal↗
PubMed1997

[The surgical correction of anterior rectocele. Our experience].

Rectocele, or namely the protrusion of the anterior wall of the rectum into the vaginal lumen following the collapse of the rectovaginal septum, is the most common anatomic alteration observed in patients suffering from defecation disorders. The surgical treatment of this pathology is still controversial, particularly in the choice of the surgical approach. From 1992 to 1994 10 patients suffering from low type, symptomatic anterior rectocele associated with intrarectal intussusception underwent muscular plastic surgery of the rectocele and anterior mucosectomy. The aim of this study was to evaluate whether surgical muscular plastic of the rectocele using a transanal approach associated with anterior mucosectomy represents in selected symptomatic patients, a rational and elective therapeutic option. In spite of the small number of patients and the short postoperative follow-up, the authors state that, on the basis of the results obtained, the surgical technique used in this clinical series significantly improves symptoms with a lower incidence of complications compared to the transvaginal approach.

Adult↗
PubMed1997

[Video laparoscopic surgery and rectal prolapse. Our experience in rectopexy].

BACKGROUND: Laparoscopy is gaining an important role in the treatment of benign colorectal disorders. The aim of this study is the evaluation of clinical and functional results in 4 patients submitted to a laparoscopy rectopexy according to Wells. METHODS: Four females (22-76, mean 53.7 years) affected from a total rectal prolapse with fecal incontinence underwent this procedure from 1993 through 1995. Six months after surgery, at the end of a rehabilitation program consisting of kinesitherapy, bio-feedback and electrostimulations, all patients have been re-evaluated by means of a clinical exam, anorectal manometry, defecography. RESULTS AND CONCLUSIONS: Preliminary results seem satisfactory and may allow to prefer this approach instead of the traditional open one.

Adult↗
PubMed1996

Experimental oesophagogastric anastomosis: preliminary report of a new compression device that also fragments.

Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.

Anastomosis, Surgical↗
PubMed1996

Laparoscopic treatment of paraesophageal and large mixed hiatal hernias.

BACKGROUND: Laparoscopic treatment of large mixed hiatal hernias was attempted in eight patients. METHODS: One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the abdomen resulting from a shortened esophagus. One left pleural tear occurred intraoperatively and was repaired without further consequence. Median duration of the operation was 150 min (range 120-300 min). RESULTS: No postoperative complications were recorded. All patients are asymptomatic after a median follow-up of 14 months (range 7-15 months). Correct repositioning of the stomach was confirmed by radiological evaluation 1 month after surgery. Early functional results are good. (One asymptomatic gastroesophageal reflux was detected and medical treatment was undertaken). CONCLUSIONS: Laparoscopic crural repair and fundoplication are feasible even in paraesophageal and large mixed hiatal hernias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay. Nevertheless, long-term assessment is required to confirm the effectiveness of the laparoscopic approach in patients with large mixed hiatal hernias.

Esophagus↗
PubMed1996

A special instrument for a safe and effective laparoscopic esophageal myotomy.

The authors describe the use of particular endoscopic scissors that allow a safe and easy laparoscopic performance of Heller myotomy. Although originally designed for another use, these scissors are extremely useful for esophageal myotomy, their most important feature being the smooth and insulated protection of the lower jaw. This feature keeps the mucosa constantly away from the myotomy and allows the safe use of electrocautery, resulting in a perfect hemostasis.

Equipment Design↗
PubMed1995

Laparoscopic approach to esophageal achalasia.

Certain technical details are considered important to ease the laparoscopic performance of a Heller myotomy combined with a Dor antireflux procedure for esophageal achalasia. A special emphasis is given to intraoperative esophagoscopy combined with a mild balloon distension of the esophagogastric junction. These maneuvers prove helpful in identifying the esophagogastric region, easing the myotomy, and controlling its completeness.

Adolescent↗
PubMed1995

Surgical management of benign stricture from reflux oesophagitis.

From January 1976 to December 1994, out of 605 patients with reflux oesophagitis, 166 (27.4%) presented with an oesophageal stricture, and 68 of these (40.9%) underwent surgical therapy. Thirteen of the 68 patients (19.1%) had an associated Barrett's oesophagus. Oesophageal manometry revealed scleroderma in nine individuals (13.2%). The stricture was undilatable in 11 patients (16.1%) observed before 1985. An oesophageal-sparing operation was performed in the majority of patients: fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), and total duodenal diversion (n = 4). Oesophageal resection was performed in 15 patients (22%); 12 of these individuals were operated on before 1985. The mortality rate was 4.4%: two patients died of necrosis of the interposed colon and one of acute pancreatitis. The average follow-up time was 27 months (8-136). Oesophageal-sparing procedures significantly reduced the need for further endoscopic dilatation (P < 0.001). Standard fundoplication was successful in 30 out of 39 patients (77%). Reasons for a failed fundoplication were a long, hard stricture, an ineffective partial wrap in patients with unrecognized short oesophagus, or underlying scleroderma. Regression of Barrett's mucosa was not recorded with any of the conservative surgical procedures.

Adolescent↗
PubMed1994

Percutaneous alcohol sclerotherapy of simple hepatic cysts. Results from a multicentre survey in Italy.

The increased use of Ultrasonography (US) has led to increased detection of simple hepatic cysts. For symptomatic cysts treatment is necessary. Until some years ago surgery was the only therapy. We have treated a large number of patients with Percutaneous Alcohol Sclerotherapy (PAS) and evaluated retrospectively the efficacy of this approach. Data on 21 patients with symptomatic simple hepatic cysts were reviewed retrospectively. Cysts had a mean diameter of 9 cm (range: 7-15 cm). PAS was always performed under local anesthesia and US guidance. 25% of the volume was replaced with 95% ethanol and then completely aspirated after 20-30 minutes. No complications or deaths occurred. In all patients symptoms disappeared after treatment. In 15 out of 21 cases there was no evidence of residual cyst on US, computed tomography (CT) or magnetic resonance (MRI). In 6 patients with shorter follow-up, cysts showed a mean reduction in diameter of 50%. The mean follow-up was 18 months (range 6-60 months). We conclude that PAS is easy with low risk for the patients and with good long-term results; it should therefore become the procedure of choice for simple hepatic cysts.

Adult↗
PubMed1994

[Right adrenal adenoma: laparoscopic exeresis].

The authors report the case of a non functioning adrenal adenoma, incidentally diagnosed and excised through a laparoscopic approach. Indications to adrenalectomy for such a pathological condition and surgical technique are reviewed and discussed. In consideration of the relatively rare disease and of the scant literature on minimally-invasive approach to right adrenalectomy, it seemed worth reporting this case and the technical skills performed to ease this operation through laparoscopy.

Adenoma↗
PubMed1994

[Thoracoscopic techniques in treatment of esophageal diseases].

Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.

Carcinoma, Squamous Cell↗
PubMed1992

[Clinical use of a new compression surgical stapler in surgery of the large intestine].

The clinical experience with the use in colorectal surgery of a new compression anastomotic device developed by the Authors is reported. From May 1986 through June 1990, 95 patients underwent large bowel anastomosis using this device. Operations performed included 51 left hemicolectomies or anterior resections of the sigmoid and rectum, 23 left colon resections, 19 right hemicolectomies, and two total colectomies. Twenty-nine anastomoses were performed below the pelvic peritoneal reflection and 18.5% of them resulted less than 4 cms from the anal verge while 20% were located between 4.5 and 8 cms. Five (5.2%) intraoperative diverting colostomies were needed. The rings were evacuated postoperatively after a mean of 10.9 days with none or very little discomfort. Operative mortality was 1.0% (one patient died of myocardial infarction). Anastomotic complications included five (5.2%) clinical and four (4.2%) subclinical leakages. No haemorrhages or stenoses were observed. This initial clinical experience shows the anastomotic device is reliable and justifies further experimentation.

Adenocarcinoma↗