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World Journal of Gastroenterology 2006年第44期12卷 7165-7167页

作者： Girolamo Geraci Carmelo Sciumè Franco Pisello Francesco Li Volsi tiziana facella Giuseppe Modica University of Palermo Section of General and Thoracic Surgery via Carmelo Trasselli n. 16-90129 Palermo Sicily Italy

AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01). No mortality was registered. More vascular lesions were found in group B. CONCLUSION: The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.

关键词： Videolaparoscopy Minor vascular complications Trocars Prevention

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Secondary aortoduodenal fistula

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World Journal of Gastroenterology 2008年第3期14卷 484-486页

作者： Girolamo Geraci Franco Pisello Francesco Li Volsi tiziana facella Lina Platia Giuseppe Modica Carmelo Sciumè University of Palermo Section of General and Thoracic Surgery Operative Unit of Surgical Endoscopy Via Liborio Giuffrè 5 Palermo 90124 Sicily Italy

Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.

关键词： Aorto-duodenal fistula Surgery Dyspepsia Duodenotomy Explorative laparotomy

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麦当劳准则

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作者： (美)保罗·法赛拉(Paul facella) (美)阿迪娜·戈恩(Adina Genn)

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