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Biomedical subjects

R Russo

Publications and source records attributed to R Russo.

400 records · Page 23Linked to original sources
PubMedDate not supplied

Laparoscopic re-operation from gastro-oesophageal reflux.

Since 1994 until the present day, we have had to surgically re-operate in five cases of failure with laparoscopic operations aimed at correcting gastro-oesophageal reflux disease. Two of these cases came from our own patients and three came under our observation from other centers. We applied fundoplication according to Nissen-Rossetti in three cases and the Rossetti-Hell operation in the other cases. One case involved recurrent gastro-oesophageal reflux with a short oesophagus and fundoplication raised into the mediastinum. In one other case, there was recurrent hiatal herniation with a rotary as well as axial component and consequent mediastinal occupation. The other three cases featured persistent post-operative dysphagia caused, in one case, by an error in the creation of the anti-reflux valve (perigastric cuff) and, in the other two, by erroneous choice of the anti-reflux operation: post-operative manometry showed important oesophageal hypo-dyskinesia which should have indicated partial fundoplication. All the patients underwent laparoscopic exploration. The patient with the short oesophagus had to be converted for the performance of a total duodenal diversion, while the remaining four patients underwent a total laparoscopic operation. The patient with recurrent hiatal hernia had the hernia reduced in the abdomen and combined anterior and posterior hiatoplasty. In another three cases, total fundoplication was transformed into partial fundoplication according to Toupet. The post-operative course and clinical results were excellent in all five patients. Stress is placed on the importance of accurate morphological and functional assessment of the oesophagus in the pre-operative stage so as to select the most suitable operation and in the post-operative stage in order to evaluate the causes of failure, the advantages of laparoscopy in terms of exposure of the operative field, the importance of certain technical details that optimize the results of the operation, and the efficacy of the laparoscopic approach also for the correction of most failures that demand re-operation.

Fundoplication↗
PubMedDate not supplied

Diagnosis of low back pain: role of imaging studies.

The authors describe the benefits and limitations of standard radiography, bone scintigraphy, computed tomography, myelography, discography, and magnetic resonance imaging. They caution the physician to base decisions about obtaining imaging studies on whether the studies will influence patient management.

Diagnostic Imaging↗
PubMedDate not supplied

Laparoscopic colectomy: the absolute need for a standard operative technique.

BACKGROUND: The aim of this study is to review our experience performing laparoscopic colon surgery and to present the operative technique as used and standardized by us. METHODS: From April 1992 to December 1996, 158 consecutive patients underwent laparoscopic colon surgery. There were 92 females and 66 males, whose average age was 66.7 years (range 31-92); 134 patients (84.9%) were operated on for carcinoma, and the remaining 24 (14.1%) or benign disease. RESULTS: There were 117 procedures completed laparoscopically out of 158 patients (74%); 103 colon resections (18 for benign disease and 95 for malignant disease), 7 Hartmann procedures, 3 for reversal of Hartmann's procedures, 1 rectopexy, and 3 ileotrasversostomies. Conversions were required in 41 out of 158 cases (25.9%); 19 of these cases, however, were converted to a laparoscopic-facilitated procedure. The most common causes for conversion were the presence of bulky tumors and/or tumors that contaminated adjacent structures (16/158), adhesions due to previous operations (8/158) or patient obesity (5/158). There were 31 complications (19.6%), 9 of which required re-operation. There was only one recurrence (0.9%) that manifested 15 months after the procedure, at both trocar and drainage sites, and with peritoneal carcinomatosis. This occurred in a patient with rectal neoplasia who suffered a perforation of the rectum during dissection, with bowel spillage. The average number of lymph nodes harvested in resected specimens was 12.8 (range 1-41), whereas the mean distance of the tumor from the proximal margin of resection was 11.5 cm (range 5-35), and from the distal margin 7.5 cm (range 1-25). The average operative time was 165 minutes (range 40-360), and the mean hospital stay was 9.2 days (range 6-40). There were three mortalities out of 158 patients (1.9%). CONCLUSIONS: Laparoscopic colon resection for malignant lesions, performed with the highest respect for oncologic principles, has demonstrated that it is difficult to develop a barrier to wall and intraluminal recurrence. Recurrence, in our opinion, is caused by improper surgical technique. Therefore, neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers.

Adenocarcinoma↗