How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Background: We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.

Methods: A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment.

Impact of the new guidelines of the American Thyroid Association on the treatment of the differentiated thyroid tumor in an Italian center with medium-high volume thyroid surgery.

Background: The therapy for differentiated thyroid tumors is currently built upon two cornerstones: the stage of the disease and the new guidelines of the American Thyroid Association, jointly converging to lobohystmectomy for selected cases that meet certain criteria. The aim of the study was to relate these guidelines to the activity of an Italian center with a medium-high volume of thyroidectomies in a region with a high rate of endemic disease of the thyroid.

Methods: In order to conduct the analysis, the clinical records of the last 3 years, including 194 cases of total thyroidectomy and 3 lobohystmectomy, were taken into consideration.

Single-stage procedure for the treatment of cholecysto-choledocolithiasis: a surgical procedures review.

While laparoscopic cholecystectomy is generally accepted as the treatment of choice for simple gallbladder stones, in cases in which common bile duct stones are also present, clinical and diagnostic elements, along with intraoperative findings, define the optimal means of treatment. All available options must be accessible to the surgical team which must necessarily be multidisciplinary and include a surgeon, an endoscopist, and a radiologist in order to identify the best option for a truly personalized surgery. This review describes the different techniques and approaches used based on distinctive recommendations and factors, according to the specific cases treated and the results achieved.

Preoperative risk factors in total thyroidectomy of substernal goiter.

The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter.

Symptoms of obstructive defecation syndrome: functional outcome after stapled haemorrhoidectomy.

Background: Patients with haemorrhoids often present obstructive defecation symptoms. Preoperative they can be classified in three groups: slight, severe and mild symptoms. Aim of this study was to postoperatively evaluate functional outcome in patients who underwent stapled haemorrhoidectomy in mild obstructive defecation syndrome.

Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?

Patients with symptomatic gallstones present common bile duct stones in approximately 10% of cases. It is possible to resolve both gallbladder and bile duct stones with a single procedure. The aim of this study is to determine the effectiveness of a single stage procedure for gallbladder and bile duct stones in the elderly patients and to expose the differences between the various techniques.

Early biomarkers of hypocalcemia following total thyroidectomy.

Hypocalcemia is the most frequent major complication following total thyroidectomy (TT), delaying timely hospital demission. We prospectively evaluated the diagnostic utility of parathyroid hormone (PTH) measured one hour after TT and the delta (post-minus pre-surgery) PTH in order to determine which biomarker best predicted post-surgery hypocalcemia. Ninety-six consecutive patients, with either plurinodular goiter, Graves' disease or cervico-mediastinal goiter (22 (23%) men and 74 (77%) women, mean age 48.

Thyroid surgery with harmonic focus, ligasure precise and conventional technique: a retrospective case-matched study.

Background: New surgical technologies have been introduced in thyroid surgery, to achieve vessel sealing and hemostasis. The aim of the study was to examine their effectiveness and compare the outcome of total thyroidectomy using the Harmonic Focus™, the LigaSure® Precise and the conventional technique of suture ligation.

Methods: A retrospective case-matched study of all total thyroidectomies between October 2008 through May 2010 was conducted.

Efficacy and safety of ablative techniques in elderly HCC patients.

Background: This study was conducted to evaluate the efficacy and safety of ablative techniques in elderly patients with hepatocellular carcinoma (HCC).

Methods: From February 2004 to February 2009, 80 elderly patients (age > or = 70 years) affected by non-resectable HCC were treated with a regional palliative approach, trans-arterial-chemo-embolization and radio-frequency-thermal-ablation (TACE, RFA). Our approach includes a first treatment of TACE and then a control CT plan after a month.

[Comparison of conventional technique, Ligasure Precise and Harmonic Focus in total thyroidectomy].

The aim of this study was to compare the results obtained using an electrothermal bipolar vessel sealing system (Ligasure Precise), a harmonic curved shears (Harmonic Focus) and traditional technique in total thyroidectomy. We have enrolled 93 patients and assigned randomly to three groups of 31 pt: groups L (Ligasure Precise), F (Harmonic Focus) and C (traditional thecnique). Recorded data were demographics, preoperative serum calcium levels, operation time, length of hospital stay, weight of exported gland and pathology, postoperative calcemia at one and two days and recurrent laryngeal nerve paralysis.

Effective treatment of haemorrhoids: early complication and late results after 150 consecutive stapled haemorrhoidectomies.

Background: Haemorrhoidectomy according to Longo potentially reduces post-operative pain and allows an early return to work. The aim of this study was to evaluate the efficacy of the technique, the early and especially late complications, and recurrences, in 150 patients.

Methods: Between January 2005 and December 2006, we performed 150 consecutive haemorrhoidectomies with the Longo technique: 82 for third degree haemorrhoids and 68 for fourth degree haemorrhoids.

Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factor analysis.

Aim: Incidence of common bile duct stones (CBDS) is approximately 10% in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy. Transcystic laparoscopic common bile duct exploration (TC-CBDE) is safe and efficient in achieving bile duct clearance from stones, with a success rate of between 85% and 95%. The aim of this retrospective study is the evaluation of risk factors and recurrence in patients treated with TC-CBDS.

[Preliminary results in the use of a new composite prosthesis in incisional hernia repair].

The repair of incisional hernias with the use of prosthetic biomaterials is the standard of care today. There are different prosthetic biomaterials that can be used to repair incisional hernias. These materials can be divided into products that are single component or a combination.

Minimally invasive approach of the most common complications after laparoscopic cholecystectomy.

Aim Of The Study: LC is now considered the gold standard in the treatment of cholelithiasis with a minimal incidence of complications, typically, bile peritoneum and hemoperitoneum.

Methodology: The Authors wished to verify the possibility of treating complications after LC with a minimally invasive approach. In 1100 LCs over 8 years, they treated 9 bile peritoneum and 4 hemoperitoneum.

[Laparoscopic cholecystectomy in acute cholecystitis: predictors of conversion to open cholecystectomy and preliminar results].

Inspite of increased technical difficulties and high incidence of conversion to open procedures and complications, laparoscopic cholecystectomy is a well established treatment for acute cholecystitis. In this study we reported our results in patients with acute cholecystitis undergoing laparoscopic cholecystecomy from 1998 to 2003. We found out that laparoscopic cholecystectomy was safe and was carried out with acceptable conversion rate and low morbidity.

Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia?

Hypocalcemia following parathyroid-sparing total thyroidectomy is frequent and can prolong hospital stay. We undertook this study to identify preoperative predictors of postoperative hypocalcemia useful in the postoperative management of these patients. We examined patients undergoing total thyroidectomy for benign disease with preservation of at least three parathyroids from January 2000 to January 2001.

[Ultrasound-guided trans-parietohepatic cholecystostomy in the critical patient: current indications].

The appearance of acute cholecystitis can make to complicate a natural history of cholelitiasis or post-operating time of patients that have concomitant predisposition factors. The best therapy is the cholecystectomy but somewhere for the critical general conditions is too much dangerous to make a surgical procedure. However we need to stabilize patients conditions, also for a short time.

Surgical controversies in the treatment of recurrent achalasia of the esophagus.

Background/aims: Surgery remains the first choice for achalasia of the esophagus with good results in 90% of cases.

Methodology: We studied the cause of failure for surgical treatment and the results of a second operation in 20 patients that were followed up for at least three years.

Results: The results were good in 70% of the cases.

[Classification of varices with Doppler ultrasonography mapping. Clinical and hemodynamic correlation].

The authors report their experience concerning the outpatient echo Doppler mapping of peripheral venous circulation in the lower limbs. Out of a total of 240 patients examined, 190 showed monolateral venous insufficiency and 50 bilateral. These results were correlated to the age of the patients and showed that saphenous pathology tended to affect the entire vein in elderly patients, whereas only partial damage was observed in young patients.

[Intraoperative ultrasonic evaluation of the residual thyroid weight in thyroidectomy in diffuse toxic goiter].

The amount of thyroid tissue to be ablated in unresponsive Basedow disease has mainly, until now, been empirically evaluated. An attempt has been made, using intraoperative ultrasonography, to evaluate the residual tissue. This method allows weight calculation of the thyroid lobe to be ablated through two sonographic measurements of the superior pole axes.

[Intraoperative echography as a therapeutic aid in the treatment of nephrolithiasis].

Intraoperative ultrasonography was performed in 24 patients with intrarenal pelvis or with recurrent or multiple stones. The stones were located by a 22 or 25 gauge needle, manually introduced under ultrasonography: they were then extracted through a small incision performed along the tract of the exploratory needle. This preliminary experience has shown that the real time B-mode intraoperative ultrasound can provide valuable results in urologic surgery.