Feasibility of laparoscopy for small bowel obstruction

<p>Abstract</p> <p>Background</p> <p>Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.</p> <p>Methods</p> <p>We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources.</p> <p>Results</p> <p>The feasibility of diagnostic laparoscopy is high (60–100%), while that of therapeutic laparoscopy is low (40–88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon.</p> <p>Conclusion</p> <p>Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.</p

Virtual colonoscopy in stenosing colorectal cancer

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Recurrent differentiated thyroid cancer: to cut or burn

[No abstract available

A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

<p>Abstract</p> <p>Background</p> <p>Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage.</p> <p>Methods</p> <p>We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.</p> <p>Conclusion</p> <p>The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.</p

La colecistectomia laparoscopica nel trattamento della colecistite acuta

Introduzione. Scopo di questo studio è quello di valutare fattibilità, convenienza e timing del trattamento laparoscopico nei pazienti con colecistite acuta. Pazienti e metodi. È stato eseguito uno studio retrospettivo su due gruppi di 70 pazienti (simili per età ed ASA) trattati entro 48 ore dall’ingresso in ospedale o dopo un periodo di terapia medica conservativa ed un intervallo di 8-12 settimane. Risultati. Nel 21,4% dei pazienti sottoposti a trattamento chirurgico differito è stato necessario eseguire un intervento chirurgico urgente. Tra i due gruppi la differenza più significativa è stata la durata della degenza ospedaliera: il gruppo di pazienti sottoposti ad intervento immediato ha presentato una più breve degenza totale (7 giorni) rispetto ai pazienti sottoposti ad intervento differito (13 giorni). Altre differenze sono state evidenziate nell’incidenza di conversioni laparotomiche (8,6% nel gruppo di pazienti sottoposti a trattamento immediato vs 12,7% nel gruppo di pazienti sottoposti a trattamento differito)e nella durata dell’intervento chirurgico (durata media 84 min nei pazienti del gruppo sottoposto a trattamento immediato vs 106 min in quelli del gruppo sottoposto a trattamento differito). Le complicanze post-operatorie sono comparse nel 6,3% dei pazienti del gruppo sottoposto a trattamento immediato vs 2,6% dei pazienti del gruppo sottoposto a trattamento differito. Conclusioni. Attualmente nei pazienti con colecistite acuta la colecistectomia laparoscopica rappresenta il gold standard del trattamento. Nella nostra esperienza l’’intervento intervento differito è tuttavia gravato da minore morbilità