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N Palasciano

Publications and source records attributed to N Palasciano.

9 recordsLinked to original sources
PubMed1999

Treatment of external anorectal mucosal prolapse with circular stapler: an easy and effective new surgical technique.

PURPOSE: The aim of this study was to demonstrate the feasibility, effectiveness, and reliability of a new technique for treating overt rectal mucosal prolapse using a stapler device. METHODS: Eighteen consecutive patients with overt rectal mucosal prolapse were selected for the study. Preoperative anal manometry and cinedefecography demonstrated no anal incontinence and the absence of full-thickness rectal prolapse. One or two purse strings were prepared 3 to 4 cm distally to the dentate line and tied on a 33 mm circular stapler introduced through the anus and then fired. RESULTS: The operation lasted an average of 15 minutes, and no local complications were recorded. Supplementary hemostatic sutures (2 to 6 stitches) were sometimes necessary. Seven patients did not require postoperative analgesia, whereas eight patients received one or two administrations of analgesics. Longer-lasting analgesic treatment (4 days) was necessary in only three patients. Sixteen patients were discharged after 48 hours, and only 1 after four days because of pulmonary infection. Patients resumed normal activities after a median period of three days. Median follow-up was 20 months. The prolapse was eliminated in all cases. No stricture was found at anal exploration, and no episodes of anal incontinence or bleeding were recorded. Postoperative manometry did not show significant changes compared with preoperative findings. CONCLUSIONS: This new surgical technique is safe, effective, and rapid, causing minimum or no postoperative pain and could be proposed to replace traditional surgery for this common condition.

Adult↗
PubMed1996

Vaginal repair of rectocele after dynamic graciloplasty for fecal incontinence due to imperforate anus.

A 35-years-old woman developed obstructed defecation due to a large (6 cm) non-emptying rectocele one year after successful electrostimulated gracilis neosphincter operation for correction of fecal incontinence after surgery for imperforate anus. Surgical correction of the rectocele was performed by a trans-vaginal approach due to the poor elasticity of the neoanus and avoidance of possible damage to the neosphincter. After physiological investigations, including defecography, the patient had a resection of the posterior vaginal mucosal wall, a double layer plication of the muscular wall with non-absorbable suture and a longitudinal mucosal suture. The postoperative course was uneventful. Defecography, performed 3 and 6 months later, showed a marked reduction of the rectocele (2 cm) which corresponded to clinical improvement. Occurrence of disabling rectocele can be considered a possible long term complication after successful electrostimulated neosphincter procedure in patients at risk for developing a rectocele; a successful repair can be obtained using trans-vaginal approach without the risk of neosphincter damage. Transvaginal repair of rectocele in similar clinical situations may be recommended.

Adult↗
PubMed1991

[Effect of the resection margin and the extrarectal spread on the recurrence following 2 types of surgical procedures in rectal cancer].

A prospective unrandomized clinical study was conducted to determine the incidence of local recurrences after radical surgery and to ascertain whether the anterior resection could be an effective approach in cases of the tumours of the rectum, also in presence of the unsatisfied distal clearance and the extraparietal spread. For this purpose the length of the rectum below the tumor, mesorectum included, was cut in little cubes of 1 square cm and 10 microslices/cm at random were histologically examined to locate the intramural diffusion and extraparietal spread. Sixty-one patients undergoing curative surgery for rectal cancer entered the trial. Thirty-seven of them have been operated on by anterior resections (AR) and twenty-four by abdominal-perineal amputation. Thirteen local recurrences (21.3%) have been recorded during a five-year follow-up: 9 after AR and 4 after Miles operation. Nine relapses were among the cases with distal clearance less than 3 cm an eight of these have undergone anterior resections. No recurrence was seen in cases with distal clearance greater than 5 cm. Spread was found in 11 (18%) patients. Five recurrences were recorded all belonging to the group with anterior resection. No statistical difference exists between conservative surgical procedure and abdominal-perineal operation. We have been able to demonstrate only the direct relationship between relapse and Dukes C stage after curative rectal surgery.

Actuarial Analysis↗
PubMed1990

Prediction of mortality by logistic regression analysis in patients with postoperative enterocutaneous fistulae.

The contrasting results of treatment of patients with postoperative enterocutaneous fistulae reflect the heterogeneity of the disease and depend on the patient's condition and the characteristics of the fistulae. For this reason, the use of a prognostic index, which enables such patients to be classified according to their risk of death, could be useful. In this study we propose a prognostic index based on a logistic regression analysis, obtained by using two (APACHE II score and serum albumin concentration) of the eight risk factors that have been retrospectively analysed in a series of 70 patients with postoperative enterocutaneous fistulae treated in our surgical department since 1981. The logistic regression equation indicates that patients with a probability of dying of less than 0.35 have a good prognosis, with a sensitivity of 90 per cent, a specificity of 90 per cent, a negative predictive value of 79 per cent, a positive predictive value of 96 per cent and an accuracy of 90 per cent. The predictive performance of the index has also been evaluated in a group of 17 patients studied prospectively, and this confirms the sensitivity and specificity of the model. This postoperative enterocutaneous fistulae index could be a helpful tool in clinical trials and surgical audit.

Adult↗
PubMed1990

Protective colostomy closure: the hazards of a "minor" operation.

A retrospective study of 87 patients, subjected to colostomy closure between 1976 and 1987, was conducted in order to evaluate the role of 8 potential risk factors on morbidity and mortality. Possible risk factors were age greater than 65 years, presence of hypoalbuminaemia (less than 3.0 gr%), anaemia (Hb less than 10 gr%), operative technique, duration of colostomy, site of colostomy, underlying disease and presence of subcutaneous drainage. Apart from hypoalbuminaemia, no clear risk factor was identified, although an interval of more than 90 days between construction and closure of colostomy appears to be safer than shorter intervals. A comparison was also made between two different periods from 1976 to 1982 and from 1983 to 1987 which resulted in important changes in patient management in the second period including: type of antibiotic prophylaxis, type of anastomosis and suture material, site of colostomy and mean duration of colostomy. Four post-operative deaths (4.6%) (two for myocardial insufficiency and two for sepsis), 11 major (13%) and 25 (29%) minor complications were recorded. The analysis of the two different periods showed a strong reduction in both mortality and morbidity in the second period, which could be related to a better management of this type of patient. In conclusion, the incidence of mortality and morbidity in colostomy closure cannot be underestimated and therefore the same skill and meticulous approach are required for this operation as for any major surgical procedure on the colon.

Adolescent↗
PubMed1988

[Peritonitis].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1983

Technical problems in pancreatoduodenectomy.

This paper reports on technical problems involved in pancreatoduodenectomy. Twenty cases of periampullary carcinoma underwent pancreatoduodenectomy. Pancreatic fistula developed in five cases: three of these patients recovered using simple drainage and TPN; one underwent a second operation in which a new pancreatico-jejunostomy was performed and another patient died (5% of the series) from sepsis and liver failure. After reviewing various techniques used in performing pancreatico-jejunostomy, it is concluded that the most suitable management of the pancreatic stump seems to be the duct-to mucosa anastomosis. But in cases in which this type of reconstruction is impossible, invagination yields satisfactory results.

Adult↗