Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results

Third segment cholangio-jejunostomy in the treatment of unresectable klatskin tumors

Background/Aims: Cholangiocarcinoma of the hepatic hilum is a seldom curable lesion when detected and several methods of palliation have been suggested. Bismuth has proposed an intrahepatic cholangiojejunostomy on the third segment of the liver, which in his experience obtains effective biliary drainage with better quality of life compared with other forms of palliation. Patients and Materials: We have used this technique in nine cases. We evaluate results, mortality and morbidity, in comparison with other authors' reported series. Results: In the early postoperative period one patient died, two patients suffered from immediate postoperative complications, and jaundice resolved completely in six patients. Long term survival was influenced by the underlying disease. Conclusion: Our findings support Bismuth preference for this technique of surgical palliation for non resectable tumors of the biliary tract

Policistosi epatica: indicazione al trattamento laparoscopico

La prevalenza della policistosi epatica nella popolazione \ue8 in aumento grazie alla diffusione della ecografia e della TAC. L'indicazione al trattamento chirurgico \ue8 limitata ai casi sintomatici; la chirurgia tradizionale impone interventi con ampie laparotomie, gravati di da un discreto margine di rischio operatorio per soggetti in scadute condizioni generali. L'utilizzo della metodica videolaparoscopica consente di evitare tali rischi, di ridurre la degenza ottenendo una buona risoluzione della sintomatologia, risparmiando al paziente una aggressione laparotomic

Trattamento laparoscopico della policistosi epatica

La prevalenza della policistosi epatica nella popolazione \ue8 in aumento grazie alla diffusione della ecografia e della TAC. L'indicazione al trattamento chirurgico \ue8 limitata ai casi sintomatici; la chirurgia tradizionale impone interventi con ampie laparotomie, gravati di da un discreto margine di rischio operatorio per soggetti in scadute condizioni generali. L'utilizzo della metodica videolaparoscopica consente di evitare tali rischi, di ridurre la degenza ottenendo una buona risoluzione della sintomatologia, risparmiando al paziente una aggressione laparotomic

L'ernioalloplastica con protesi preperitoneale per via inguinale anteriore in anestesia locale. Tecnica personale

Background. The most common surgical techniques for the repair of groin hernias need the positioning of a mesh over the fascia trasversalis or in the preperitoneal space. The advantages of Lichtenstein, Gilbert or Trabucco's anterior access techniques are essentially due to the simple execution, even in local anesthesia, and to the shorter and less painful postoperative course. Preperitonal techniques of Stoppa, Wantz and Rives are certainly more complex, but allow a complete reconstruction of the fascia trasversalis, since the mesh is positioned in the preperitoneal space. Methods. Trying to match the simplicity of the anterior repair techniques and the safety offered by a wide preperitoneal mesh, the authors described a new technique that allow preperitoneal hernioalloplasty by a classical anterior access. Results and conclusions. This method is different from the Rives' technique, since the shape, the size and the material of the mesh is different and it is performed under local anesthesia. These patterns allow a simple execution of the technique and a fast postoperative recovery with a better comfort, adding the advantages of the classic anterior repairs to those of the preperitoneal hernioalloplasties

[Total versus partial pancreatectomy in the surgical treatment of carcinoma of the pancreatic head]

This is a review of the recent advances in total pancreatectomy versus regional pancreatectomy for adenocarcinoma of the head of the pancreas. The rationale for total pancreatectomy comes from a tendency for pancreatic cancer to be multicentric, the absence of the pancreatico-enterostomy and the argument that total pancreatectomy is a better cancer procedure (wider lymphadenectomy and soft tissue resection). In spite of these theoretical advantages, any important impact on morbidity, mortality and ultimately on survival has not been realised. We analyse the principal metabolic and functional sequelae of total pancreatectomy, particularly highlighting the importance of glucagone hormone in maintaining correct blood glucose levels. The data suggest, a tendency to use total pancreatectomy in selected patients on the basis of pre- and intraoperative cytodiagnosis to prevent occult neoplasms in the pancreatic remnant