Direct trocar insertion for laparoscopy.

Background: The Veress needle (VN) technique for establishing pneumoperitoneum in laparoscopic surgery is widely used and yet is associated with slow insufflation rates and potentially life-threatening complications. Although these complications have been rarely reported, they represent a major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to open surgery. The open laparoscopy (OL) is an alternative to the VN technique, being relatively safer, even if considered cumbersome by many authors.

Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons' last five years experience over 932 cases.

Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique.

Inguinal-scrotal hernias in young patients: is laparoscopic repair a possible answer? Preliminary results of a single-institution experience with a transabdominal preperitoneal approach.

Objectives: The laparoscopic trans-abdominal preperitoneal (TAPP) approach to inguinal hernia repair is well documented as an excellent choice in numerous studies, especially when conducted by an experienced surgeon. Its full list of specific indications is still under debate. Generally, the repair of scrotal hernias demands a higher level of experience on the part of the surgeon, irrespective of the applied surgical technique.

Incarcerated internal hernia of the small intestine through a re-approximated peritoneum after a trans-abdominal pre-peritoneal procedure--apropos of two cases: review of the literature.

A description of two cases of internal herniation caused by a defect in the closure of the peritoneal flap during a trans-abdominal pre-peritoneal procedure is presented here. They were both successfully treated laparoscopically. This rare condition should be considered when patients who have had recent trans-abdominal surgery for inguinal hernia repair present with colicky lower abdominal pain--its aetiology may well be due to technical error.

Colorectal surgery in a community hospital setting: have attitudes changed because of laparoscopy? A general surgeons' last 5 years experience review.

Introduction: Laparoscopy is rapidly emerging as the preferred surgical approach to a number of different diseases because it permits a correct diagnosis and accurate treatment; however, it is not yet being applied in a widespread manner in the management of benign or malignant colorectal disease. The aim of this work is to illustrate retrospectively the results of our experience of laparoscopic colorectal surgery carried out in a community hospital over the last 5 years to document its feasibility, safety, and benefits when carried out by general surgeons in this setting.

Materials And Methods: Between January 2003 and December 2007 a total of 628 patients underwent a colorectal procedure.

Inguinal hernia repair in a community hospital setting--have attitudes changed because of laparoscopy? A review of a general surgeon's experience over the last 5 years.

Objectives: The laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair is well documented in numerous studies as an excellent choice when performed by an experienced surgeon. In this report we wish to evaluate our experience of TAPP laparoscopic inguinal repair performed in a Community Hospital over the last 5 years, focusing on the feasibility of the technique and the incidence of complications when performed by general surgeons in this setting. We also wish to report and discuss how our attitudes concerning inguinal hernia repair have changed since we adopted the laparoscopic approach.

Transabdominal laparoscopic inguinal hernia repair: is there a place for biological mesh?

Aim: An ideal mesh should produce minimal foreign-body reaction and be compatible with human tissue. Studies focusing on these aspects indicate that a biological mesh acts as a scaffold for hernia repair. In this paper, we retrospectively evaluate a consecutive series of patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty using a biological mesh-Surgisis-fixed with fibrin glue, focusing on the feasibility of the technique and the incidence of complications, especially those related to the type of mesh implanted.

Primary omental infarction: laparoscopic approach in two pediatric cases: a case review.

Two cases of pediatric acute abdomen owing to omental infarction are described in this paper, which were successfully treated laparoscopically. Owing to the objective rareness and absence of typical symptoms, the diagnosis was often neither made nor considered preoperatively. For other emergency situations, laparoscopy has been shown to be both a diagnostic and a therapeutic tool of a rare pathology found also in the pediatric patients.

Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures.

Background: Laparoscopy has rapidly emerged as the preferred surgical approach for a number of different diseases because it allows for a correct diagnosis and proper treatment. However, it is not being applied in a widespread manner for the management of benign or malignant colorectal disease. Its natural evolution seems to be the development of mini-instruments and optics (diameter, View Article and Find Full Text PDF

The laparoscopic approach in abdominal emergencies: has the attitude changed? : A single-center review of a 15-year experience.

Background: Laparoscopy has been practiced more and more in the management of abdominal emergencies. The aim of the present work was to illustrate retrospectively the results of a case-control 5-year experience of laparoscopic versus open surgery for abdominal emergencies carried out at our institution, especially with regard to whether our attitude toward use of this procedure has changed as compared with the beginning of our laparoscopic emergency experience (1991-2002).

Materials And Methods: From January 2002 to January 2007 a total of 670 patients underwent emergent and/or urgent laparoscopy (small bowel obstruction, 17; gastroduodenal ulcer disease, 16; biliary disease, 118; pelvic disease and non-specific abdominal pain (NSAP), 512; colonic perforations, 7) at the hands of a surgical team trained in laparoscopy

Results: The conversion rate was 0.

Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review.

Two cases of internal herniation through a defect in the broad ligament of the uterus are described. Both were successfully treated laparoscopically. This rare condition should be borne in mind when a middle-aged woman presents with colicky lower abdominal pain.

Laparoscopic cholecystectomy with a three-trocar 5-mm instrument approach.

The natural evolution of laparoscopy seems to be the use of miniature instruments and, where possible, a reduction of the number of trocars used. We report the results of our experience with all 5-mm instrument three-trocar cholecystectomy vs. the conventional laparoscopy approach.

Day-case laparoscopic surgery for appendicitis and non-specific abdominal pain.

Laparoscopy is commonly used in the treatment of appendicular diseases and non-specific abdominal pain. Nevertheless, the role of day-case laparoscopic surgery in these cases is still debated. The aim of this study was to identify which cases of appendicitis or non-specific abdominal pain are most indicated for daycase laparoscopic surgery.

The misdiagnosis of ruptured abdominal aortic aneurysm: an ancient problem always present. Report of an atypical case.

The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients. Sometimes many of these signs can lack and, as a consequence, the diagnosis might be very difficult.

Lightweight partially absorbable monofilament mesh (polypropylene/poliglecaprone 25) for TAPP inguinal hernia repair: initial experience.

Objective: An ideal mesh should produce slight foreign-body reactions and be compatible with the human organisms. Studies focusing on these aspects indicate that the use of mesh with less nonabsorbable material may reduce postoperative complications, insofar the web structure and its rigidity play an important role in compatibility. We evaluated retrospectively the patients of the past 1 year, who underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty (without the use any trocar and/or instrument of 10 mm in diameter) focusing attention on the feasibility of the technique and on the incidence of complications, especially those possibly related to the new type of mesh implanted.

Preliminary experience using fibrin glue for mesh fixation in 250 patients undergoing minilaparoscopic transabdominal preperitoneal hernia repair.

Purpose: Fibrin glue for mesh fixation has been proposed to prevent the risk of nerve injury in inguinal hernia repair. We retrospectively evaluated a series of 250 patients who underwent minilaparoscopic transabdominal preperitorneal (miniTAPP) hernioplasty (using trocars, optics, and instruments <10 mm in diameter) in whom mesh fixation was achieved using 2 mL of fibrin glue. We considered the feasibility of the technique and the incidence of complications, especially those possibly related to mesh fixation.

Impulsivity and compulsivity in patients with trichotillomania or skin picking compared with patients with obsessive-compulsive disorder.

To compare impulsivity and compulsivity, we performed a case control study comparing a group of 20 patients with obsessive-compulsive disorder with a group of 20 patients with skin picking and/or trichotillomania (SP/T). The instruments used were Structured Clinical Interview for DSM-IV Axis I Diagnosis, Yale-Brown Obsessive-Compulsive Scale, Schalling Impulsivity Scale, and Hamilton Anxiety and Depression Inventories. A Multidimensional Impulsive-Compulsive Spectrum Assessment Instrument was designed for this particular study.

Clinical features associated to refractory obsessive-compulsive disorder.

Unlabelled: Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature.

Methods: To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD.

Peritonitis: laparoscopic approach.

Background: Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment - exploration to identify the causative pathology and performance of an appropriate operation - can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach.

[Laparoscopy. State of the art in Italy: the surgeon's point of view].

The aim of the study was to evaluate the practice of laparoscopic surgery in Italy. An audit on laparoscopic surgery was carried out through a written questionnaire sent to 600 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery over the last 10 years, surgery-related morbidity and mortality rates, indications, and impact on the day-to-day surgical work of the individual centres.

Primary pulmonary nodular amyloidosis.

Primary nodular amyloidosis of the lung is an uncommon manifestation. The disease runs a benign course, but offers diagnostic problems due to non-specific radiological features entering the big field of the solitary nodule. We describe the case of a 60 year old man with multiple nodules on the left lung operated on diagnostic and therapeutic video-assisted thoracoscopy and discuss the possibilities, if any, of suspecting such a disease through radiologic characteristics along with findings from the patient's history, physical examination and laboratory tests.

Is minilaparoscopic inguinal hernia repair feasible? A preliminary experience.

Introduction: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. It seems to be moving toward the use of mini-instruments (5 mm or less in diameter). The aim of this paper is to illustrate retrospectively the results of an initial experience of minilaparoscopic transabdominal preperitoneal (miniTAPP) repair of groin hernia defects performed at two institutions.

Direct trocar insertion vs Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective single-center study.

Background: Nonobese patients undergoing laparoscopic procedures present a dilemma as to the correct mode of entry into the abdominal cavity because the Veress needle (VN) technique seems to be associated with a high risk of vascular and visceral injuries. Direct trocar insertion (DTI) has been reported as an alternative to the VN for creation of the pneumoperitoneum.

Methods: An open comparative randomized prospective study was conducted on the feasibility and safety of DTI vs the VN technique in nonobese patients of any age category referred for urgent or scheduled laparoscopic procedures.

Meckel's diverticulum: a neglected (or deliberately ignored) entity.

Meckel's diverticulum is the most common of all the possible abnormalities that incomplete obliteration of the omphalo-mesenteric duct can produce. Often it is not sought during surgery performed for other abdominal diseases, e.g.

The laparoscopic approach in abdominal emergencies: a single-center 10-year experience.

Introduction: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. In abdominal emergencies, both components of treatment--exploration and surgery--can be accomplished via laparoscopy. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open surgery for abdominal emergencies performed at our institution.