Ultrasound-assisted lipolysis of the omentum in dwarf pigs.

Successful surgical treatment of medium degree obesity by subcutaneous liposuction has been reported in the literature. In obesity, most adipose tissue is visceral, mainly omental, and the resection of omentum is a mutilating procedure for the intestinal tract. Because of this, we planned to reduce omental adipose tissue by an apparently conservative approach: ultrasound-assisted lipolysis. The purpose of this study was to assess the feasibility and safety of this procedure in an animal experimental model, drawing clinical and autoptic patterns. We chose pigs because they are functionally analogous to humans, although they store less fat in the omentum, whose structure looks like a veil. Four male dwarf pigs were fed, since weaning, with hyperlipidic fodder. When they were eight months old, they were operated on under general anesthesia in our laboratory for experimental surgery. After laparotomy, the omentum was delivered and treated with ultrasound for 1 hour. Before and just after the sonication, biopsies were drawn from omentum and processed for histologic findings. After 50 days, the surviving animals were sacrificed and autopsied; specimens from omentum, liver, and spleen were histologically processed. Two animals died during the operation, while the two surviving animals were in good general condition. Macro and microscopic observations demonstrated that the ultrasound can liquefy omental fat, sparing its fibrous network in the immediate time; during the postoperative period, an intense inflammatory reaction developed; macroscopic observation evidenced fibrous adhesions of the omentum to the surrounding organs; the connective tissue network was thickened and the whole omentum was twisted on itself. The high mortality rate could be due either to the surgical learning curve or to casualty or to lethal effects of ultrasound on the cardiac conductive system; the inflammatory peritoneal reaction could be specifically due to ultrasound or to surgical handling

UN CASO DI LIPOMATOSI SIMMETRICA BENIGNA TRATTATO MEDIANTE ULTRASONICAZIONE

Descrizione del trattamento mininvasivo di un caso di lipomatosi mediante UAL (Ultrasound Assisted Lipectomy

Plastic surgery in a day-care public hospital unit

Background. The authors describe the advantages and disadvantages of plastic surgery performed in a day-care public hospital unit. Methods. A retrospective study was made of the day-surgery activities over 16 months (1998-1999) as part of a centralized system. Data were compared to day-surgery activities undertaken in 1997 using a non-centralized system. The study was based in the Macchi Foundation Hospital in Varese. A total of 179 patients were treated from all age group whose clinical, intellectual and social characteristics enabled them to be treated using a day-hopital regime. The pathologies treated can be classified into six groups: benign skin pathologies, malignant skin pathologies, scar pathologies, hand disorders, burns and others. All operations were performed as planned under general, local or regional anesthesia with the help of an anesthetist. Results. The centralized system has a number of advantages of a social and technical kind; there are few disadvantages, mainly consisting in the impossibility of using this approach for emergency surgery and its overall rigidity. Conclusions. This form of surgery provides a service that stands out for its quality, organisational efficiency and low cost