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N de Manzini

Publications and source records attributed to N de Manzini.

At least 19 recordsLinked to original sources
PubMed2005

The treatment of inguinal hernia in the elderly: open technique or laparoscopic approach?

Well defined and shared quality standards characterize the ideal treatment of inguinal hernia: it should be the least traumatic as regards both the requested type of anaesthesia and the operative technique and the least expensive; it should have the least per-and post-operative morbidity. The chosen technique should be also the easiest to learn and to perform; and his positive results should be the most reproducible. While there are a lot of studies about the comparison between open and laparoscopic surgery, the number of the studies about the specific evaluation of the problem in the aged is very limited. Aim of the paper is to aid in evaluation of the problem in a group of patients, on the basis of the reports and on an initial departmental experience. In conclusion the laparoscopic repair is a complementary choice and not an alternative to the open surgery in the elderly patients.

Adult↗
PubMed1998

[Results of fundoplication by laparoscopic approach in the treatment of gastroesophageal reflux. Apropos of 224 cases].

STUDY AIM: The aim of this paper is to evaluate prospectively immediate and 2-year results of laparoscopic fundoplicature (LF) for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: Patients presenting GERD who had been previously submitted to a long-term medical treatment were included in this study. Preoperative workup included upper GI tract endoscopy, esophageal manometry and 24-hour pHmetry. Standard surgical procedure incorporated a Nissen-Rossetti 360 degrees fundoplicature. Short vessels division (Nissen operation) was performed in case of high strength of the wrap and a partial fundoplicature (Toupet 270 degrees) was performed when motility disorders of the esophagus were demonstrated by manometry. Postoperative morbidity and results were evaluated, with a clinical appreciation at 3 and 22 months, and by manometry and pHmetry at 3 months. RESULTS: Two hundred and thirty-five patients were observed, and 224 included in the study (143 men and 92 women). Nissen-Rossetti fundoplication was performed in 169 cases (80%), Nissen in 30 (14%) and Toupet in 13 (6%). In 12 cases (5%). LF was converted to an open Nissen-Rossetti procedure. There was no hospital mortality and complications were noted in three cases (1.5%): pneumonia (n = 2) and gastroplegia (n = 1). With a mean 22-month follow up, among the 103 patients who answered to a questionnaire, the rate of relapse of GERD was 14%, dysphagia was present in 2% and four patients had been reoperated on (one for a slipped Nissen, one for a stenosis of the esogastric junction and two incisional hernias). CONCLUSION: On the basis of this experience, LF for GERD is a safe and efficient operation, with 86% of good results at 2 years.

Adult↗
PubMed1996

[Immediate resection-anastomosis after intra-operative colonic irrigation in cancer of the left colon with obstruction].

In a consecutive series of 38 patients over 5 years, who required emergency surgery for obstructing left colonic carcinoma, 24 had primary bowel resection with immediate anastomosis, after intraoperative anterograde colonic irrigation. Complete colonic obstruction was present in all cases. There were 7 Dukes B tumors, 11 Dukes C tumors and 6 Dukes D tumors. The operative mortality was 8.3% (2 patients, with one from anastomotic leakage), anastomotic leakage rate was 4%. Superficial wound infection occurred in 4% of patients. The median postoperative hospital stay was 19.5 days. The Kaplan-Meier survival curve showed a 41% survival rate after 5 years. This technique was found to be safe and effective to perform a primary anastomosis, without requiring temporary colostomies, after emergency resection of selected left colonic carcinoma obstruction.

Aged↗
PubMed1996

[Tonometric monitoring of the viability of free transplants of the jejunum and the stomach after total circulary pharyngolaryngectomy].

A prospective study concerning the tonometric viability supervision of 9 digestive free autografts after total pharyngolaryngectomy was conducted. This technic is based on the Henderson and Hasselbalch's equation which calculates the intramucosal pH (pHi) in the graft using a tonometric catheter. When the pHi is under 7.10, there is a graft ischemia. This invasive technique seems to be sensitive and specific provided that minimally rigorous measurement procedures are used. Late graft necrosis is the major limitation of the technique.

Adult↗
PubMed1994

[Complicated colonic diverticulosis. Changes in treatment and results over 22 years].

OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease. METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females). RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%). CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.

Abscess↗
PubMed1994

[Pancreaticojejunal anastomosis by intussusception of an isolated loop in pancreaticoduodenectomy].

The most frequent and severe complication of pancreaticoduodenectomy is pancreatic fistula due to dehiscence of the pancreas anastomosis. The technique that uses a separate Roux en Y loop for pancreas anastomosis, to reduce the fatal risks of pancreatic fistula, has been described for more than 50 years. With the development of pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique, derived from those previously described allows a good intussusception of the pancreatic stump into the intestinal loop. This method was performed in 22 pancreaticoduodenectomies. There were 2 operative deaths unrelated to the pancreaticojejunal anastomosis and one pancreatic fistula, which healed under medical treatment.

Adult↗
PubMed1994

[Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy].

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.

Adolescent↗
PubMed1993

[1000 cases of cholecystectomy: 500 by laparotomy versus 500 by laparoscopy].

The authors report 1,000 cases of cholecystectomy for cholelithiasis, excluding all cases with associated common bile duct surgery. The aim of the study was to compare two groups of cholecystectomies, one of 500 laparotomic procedures, evaluated retrospectively, and one of 500 laparoscopic ones, evaluated prospectively. Sex ratio was the same in both groups, and mean age was higher in the second group (54 vs 60) (p < 0.05): acute cholecystitis ratio was similar in both groups (23% vs 19%; NS). During the laparoscopic period, 84 laparotomic interventions were performed (17%), with a 0% mortality and a 18% morbidity rate. Mean operating time was 69' in the first group vs 91' in the second one, with a mean hospital stay of 11 vs 4.5 days (p < 0.001). Mortality rate was 1% vs 0% (p < 0.03) for laparotomic and laparoscopic procedures, and morbidity rate was respectively 11% and 1% (p < 0.001). Conversion rate in laparoscopic surgery was 7%. Two cases (0.4%) in laparoscopic group had a common bile duct lesion diagnosed intraoperatively and 1 case (0.2%) had a residual stone in common bile duct. Laparoscopic surgery is at present the standard technique for the treatment of cholelithiasis and laparotomic cholecystectomy seems only indicated when laparoscopic procedure is contraindicated or impossible.

Adolescent↗
PubMed1992

[Value of a "floppy" Nissen in the treatment of gastroesophageal reflux. Apropos of 117 cases].

The Nissen fundoplication is the most widely used antireflux procedure. However this operation is associated with several specific complications. To prevent these complications, an alternative antireflux procedure ("floppy" Nissen) has been designed. This investigation was conducted to investigate the effects of the floppy Nissen performed on 117 patients, between 1978 and 1990. Indication for surgery was the endoscopic discovery of stage I and II oesophagitis (59 cases), III and IV oesophagitis (25 cases) or an associated disease (gallstones: 25 cases, duodenal ulcer: 8 cases), pH monitoring used preoperatively in 47 cases showed an important reflux in 33 cases (70%). Preoperative manometry exploration (71 cases) showed a low pressure of the low oesophageal sphincter (LOS) in 63 cases (89%). The "floppy" Nissen procedure was performed over a length 4 to 6 cm. The folds of the diaphragm were closed back behind the oesophagus in 40 cases. During the postoperative period the pH-data were restored to normal range in 73% (18/26 cases), and the value of the LOS was restored in 74% (19/26 cases). The mean duration of clinical follow-up study of 99 patients was 3.22 years. Improvement in clinical symptoms was noted for 86%; 13% had specific Nissen complications (9 gall-bloat syndrome, 4 intermittent dysphagia). Six patients had to be reoperated. This technique allowed good control of the reflux symptoms, with a low incidence of mechanical complications.

Adult↗
PubMed1991

[Liver injuries].

Explore the source record for details and available documents.

Abdominal Injuries↗
PubMed1991

[Mechanical trans-sutural colorectal anastomosis in the treatment of cancers of the rectum. Apropos of 70 cases].

The reduction in the acceptable length of distal margin below the tumor makes low anterior resection more suitable for rectal cancers. The technical difficulties of low anastomosis are reduced by performing stapled colorectal anastomosis through the suture. Seventy patients were submitted to this procedure. There was no operative mortality, while the reported morbidity was 14%. Sixteen patients underwent preoperative radiotherapy of 30 Gy without any subsequent leakage. This technique is discussed in relation to the hand-sewn colo-anal anastomosis.

Adenocarcinoma↗
PubMed1990

[Criteria for selection and contra-indications of ambulatory surgery].

Ambulatory surgery means to us the scheduled surgery and investigations carried out under various modes of anaesthesia in patients who are admitted in the morning and discharged in the evening. Now the strictness and guarantees required and the essential conditions of safety and efficiency can only be achieved if a number of selection criteria and contraindications are complied with. The authors first study the lesions for which ambulatory treatment is possible, as well as the criteria regarding both the patient and the attending physician responsible for the follow-up at home. Since a close co-operation between the anaesthesist and the surgeon proves to be essential, the criteria of anaesthesia must also be dealt with. The contraindications are connected to the type of surgery, to the type of anaesthesia, to the patient, to the patient's circle, to the medical team, and finally to the equipment and organization of the unit in which ambulatory surgery is performed. These many aspects of the problem are analyzed and discussed.

Ambulatory Surgical Procedures↗
PubMed1990

[Severe acute intestinal hemorrhage. Value of investigation tests].

Episodes of intestinal bleeding likely to endanger vital functions require detailed etiological and topographical examination before surgical intervention. Forty-two cases of serious haemorrhage of the lower digestive system in adults were studied retrospectively. The origin of the bleeding was localized preoperatively in 37 cases (88%). Four exploratory laparotomies were carried out after etiological examination including at least digestive arteriography. Hence it was always possible to localize the source of bleeding. We found it convenient to establish the order of the complementary pretherapeutic tests by taking into account two symptoms, acute active bleeding (AAB) and haemorrhage with acute anemia (HAA).

Acute Disease↗
PubMed1990

[Cancer of the anus. Current role of surgery].

70 cases of carcinoma of the anus are described in a retrospective study. All patients had been operated, since surgical treatment was regarded as the method of choice at that time. Our work therefore consists in assessing the role of surgery in the treatment of such carcinomas. In the initial forms, extended sphincter saving exeresis allowed excellent results (100% survival over a 1- to 10-year follow-up). In more advanced lesions, treated with abdominoperineal resection, the survival rate was 50% after 5 years. The same figure was obtained in case of extension to the female genital organs (the invasion of which is not a pejorative sign), while the prognosis was considerably worsened for the patients who had had lymph node resection due to invasion of inguinal nodes (20% survived after 5 years). Local surgical exeresis currently is as valuable as radiation therapy, but the latter is clearly indicated for advanced carcinomas, for which mutilating surgery has not demonstrated its superiority.

Adenocarcinoma↗
PubMed1989

[Injuries of the spleen: conservative treatment or exeresis?].

The authors report their experience with splenic preservation in a series of 36 patients. 77 patients with splenic injury were seen during the period from 1982 to 1987. In 41 cases splenectomy had to be carried out. This was for splenic contusions secondary to road traffic accidents in 36 cases and iatrogenic per-operative lesions in 5 cases. Intra-omental splenic autotransplantation was performed in 4 cases. In 36 other patients, the spleen was able to be preserved. Hemostasis was fairly obtained using infra-red photocoagulation (24 cases), splenorrhaphy (8 cases), surrounding the spleen with a resorbable mesh (3 cases) or by partial splenectomy (1 case). Only 1 case of transient and moderate secondary hemorrhage was seen and did not require further surgery. The authors define the legitimacy of splenic preservation and its indications and also stress its limitations. They insist on the following contraindications: preexisting splenic disease, subject on anticoagulants, labile blood pressure, multiple intra-abdominal lesions, presence of intra-peritoneal infection, severe cranio-encephalic lesions, age over 70 years. Study of this series shows that conservative treatment is most often justified for splenic trauma. Nevertheless, in view of the real but rare risk of OPSI, it is better to have a correct splenectomy than an incorrectly preserved spleen.

Aged↗