Biomedical subjects
Publications and source records attributed to P Lolli.
The authors maintain the opportunity of a mechanical and chemotherapeutical preparation of colon for the surgical operation, and illustrate the methods thereof. They report their clinical experience about the preoperative and peroperative cleaning, and confirm the importance of decompressive transversostomy as a protection of colorectal anastomoses.
The Authors study the statistics of the Verona Surgical Centre, concerning 5 cases of colovesical fistula. They support the two-time operation, that is, the colon resection with colo-colic anastomosis sheltered by a decompressive transversostomy and stitching of the vesical breach. They affirm the usefulness of the operation according to Hartmann in patients facing a greater operative risk.
The Authors describe 2 cases of anorectal melanoma, which underwent operation in the Surgical Clinic of Verona in the years 1981-83. They review the literature confirming the high malignancy of this neoplasm, the poor prognosis forecasting a demolishing surgical treatment only. They, at last, once again affirm the principle whereby the results of such surgery are proportional to the stage of evolution the neoplasm is caught in, and the difficulty to reach a precocious diagnosis is therefore one of the main reasons for the scanty remote results of such surgery.
The Authors, on the basis of the casuistry of the Verona Surgical Centre, concerning the interventions for Crohn's disease from 1973 up to 1983, and comparing the data of literature, study the problem of appendicectomy in Crohn's disease. They suggest the operation of appendicectomy both when there are signs of appendicopathy in course, joined to a pathology of the last ileum ansa, and in presence of apparently sound appendix and clear signs of ileum Crohn's disease. They think it opportune to avoid appendicectomy only in presence of clear signs of involvement of caecum by the morbid process.
The Authors face the problems involved in the colonic familial polyposis, with particular attention to the surgical treatment of subjects bearing neoplastic degeneration. They, moreover, report their clinical experience, and compare it with the experience of other centres.
The Authors show a case of rectal ampulla carcinoid, and review the literature thereabout. They suggest the removal through sphincter according to Mason, which technique, in their opinion, can ensure a satisfying radicalness when the diameter of carcinoid is shorter than 2 cm.
The Authors face the diagnostic and therapeutical problems involved in the tardy recognition of diaphragmatic breakages. On the basis of two clinical cases observed, they emphasize the relative frequency of this lesion, the variability of the clinical pictures, the limits of the clinical and radiological diagnostics, the utmost seriousness of the complications. They face the problem of the choice of the surgical way of approach and the techniques for repairing the diaphragmatic lacerations.
The authors show their experience about the surgical treatment of colonic perforations in course of neoplastic disease. Their casuistry is compared with those of other centres.
The authors report their experience in the surgical treatment of the cancer of splenic flexure. The neoplasiae arising in such place are usually diagnosed in a more advanced phase than in the other colon segments. This results in a survival at a shorter interval.
Personal experience of 135 operations on the left colon and the rectum, with simultaneous formation of decompressive transversotomy, is presented. According to the Authors, decompressive transversotomy is the sole method capable not of avoiding anastomotic dehiscences, but of ensuring that they do not become clinically manifest, and hence of reducing the mortality connected therewith. The doubts sometimes raised with regard to the method seem in the Authors' opinion to be linked to technical shortcomings in performance of the transversotomy itself.
The routine technique used by the Authors for performance of decompressive transversotomy in operations on the left colon and the rectum is described. The technique for extraperitoneal closure of the stoma is described in detail: the method is easy to perform and does not involve any noteworthy postoperative complications. Long-term follow-ups demonstrate that there are no functional disorders connected with adhesion of the organ to the abdominal wall.
The authors review the problems relating to the healing of colorectal anastomotic complications following anterior resection. They report on their own experience with 328 anastomoses, 281 of which constructed manually and 47 using a mechanical suturing gun. Following manual anastomosis, the reported incidence of clinical dehiscence was 1%, as against a 10.3% incidence of radiologically detectable dehiscence. In the cases of mechanically produced anastomoses the incidence of clinical dehiscence was 6.4%. In 2 cases stenosis developed as a result of the clinically manifest dehiscence following manual anastomosis. In the patients undergoing mechanical anastomosis, occlusion occurred in one case and stenosis in another, without any concomitant peri-anastomotic inflammatory processes; these complications were caused by a membrane extending between the margins of the anastomosis. The authors ascribe the greater incidence of clinically important dehiscence following mechanical anastomosis to a greater sensitivity of the mechanical suture to colonic contamination compared to the manual suture. According to the authors, the stenosis is attributable to inflammatory processes resulting from the dehiscence in the manual anastomosis cases and from the anastomotic structure in the mechanical-suture case.
The authors report on a case of leiomyosarcoma with intussusception of the large bowel. They stress the importance of the clinical suspicion in targeting preoperative instrumental instrumental investigations.
The authors report on a study population of extended operations for locally spread colon-rectum cancer in the Verona Surgical Clinic over the period from 1971 to 1987 (114 surgical demolitions for colon-rectum cancer out of a total of 1294 operations). They report an overall 5-year survival rate of 41% and a 3-year survival rate of 59% with a perioperative mortality rate of 1.75%. A number of aspects of such extended operations are discussed, and, in accord with most other reports in the literature, the authors confirm the validity of the choice of this type of surgery.
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Manometry is an important approach to anorectal function. In the haemorrhoids the evaluation of the anal resting tone, of the squeeze and of the sphincterial length is very useful to realize the best surgical treatment. Anorectal manometry is neither invasive nor expensive; it can be ready repeated and the results are reproducible. This examination must be considerated as essential part of the diagnostic routine of the anorectal diseases.
Indications and procedure of submucosal reconstructive hemorrhoidectomy (A.G. Parks hemorrhoidectomy) are described and discussed. This procedure is more difficult and time consuming than other techniques, but results are better in high degree hemorrhoids. Authors consider complications and sequelae on 278 patients operated in their Department.