Radiation enteritis

fib&acts

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77 TREATMENT IAPAROSCOPtC

HAL OF CHOLEDOC CHOLECISTECTOMY.

CYST

RADIATION WERITIS. Francesca Satma, Antonella Virdis, Mario Goddi, Gianfranco Fancello, Mario Trignano Istituto di Patologia Speciale Chirurgica, Univeniti degli Studi di Sassari. Abdomen and pelvic radiation therapy is administered to patients with digestive malignancy as palt of their treatment plan. Acute and chronic damage to the intestine occurs frequently, the bowel and mesentery are shortened with submucosal fibroses and mucosal ulceration. The bowel is compromised by endcmrteritis. In this study we report 8 clinical cases of radiation enteritis. Primary pathology was rectal cancer (4 patients underwent anterior resection; 3 Miles operation and 1 tramanal endoscopic microsurgery). A postoperative adiuvant radiation therapy was necessary for treatmen of residual disease; the mean radiation dose was 40-50 Gy. All patients experienced diarrhoea (as their predominant complaint:, radiation related probk?ms and intermittent small intestinal obstruction. Fibroses, adhesions, stenoses (or miscellaneous) were documented in recurrent obstruction. Lesions were located in the ileon. All patients present cachexia. We used parenteml support and liquid diet to correct denutrition. Parenteral nutrition and liquid diet were well tolerated but 5 of these patients required operations. We perform wide resection and anastomosis as the surgical procedure of choice. Postoperative complications were observed in 3 patients and 1 of them died. 1 patient presents recurrence of the original neoplasm. Radiation enteritis is a poorly predictable progressive disease. A clinical recurrence of symptoms is frequent. Surgical treatment allows improvement in quality of life but these bight risk patients become candidates for surgery only after a period of hyperalimentation; adeguate preparation is essential in achieving good operative results.

AFTER

Giorgio Coscarella (I), Stefano Msnfroni (2), Francesca Lirosi (I), Agostino Suxzarro (3), Alberto Garavello (2), Nicola Di Lorenzo (l), Alessandro Arturi (I), Francesco De Lisa (I), Donato Antonellis (2) (1) Scuola di Specialiione in Chirurgia ddl’Apparat0 Digerente ed Endosoopia Digestiva Chirurgica Universitri Roma 7or Vergata” (Dir. AL. Gaspari) (2) Dipartimento di Chirurgia Generaie Ospedale di Marino(3) Servizio di Gastroenterologia ed Endoscopia Digestiva Ospedale di Marino-Roma.

di Roma

Congenital dilatation of the extr-hepatic dud system is a very uncommon condition (l/200000 ). it is more common in the far east and its incidence is higher in wOrnen than in men. We have observed a woman of 42 years old with symptoms of a classic biliary colic, without jaundice or fever. She referred a previous laparowop ic cholecistectomy and also that during the intervention the surgeons didn’t find tha stone in the gallbladder showed during a pre-op US. Post-operatively an US showsd a dilatation of the choledocus , with a biliary stone, nothing to the intra and extra+epatic ducts, nothing to the pancreas. The patiint was admitted with a suspect of residual choledocic litiasis. The blood-test we in the range of normality. The patient were submitted to a ERCP. The procsdure demonstrated a dilatation of the choledoa~s for about 3 an. with a filling default of the contrast with stone. So ths patients was sent to the surgery with a suspect of a dstii dilatation of the choledo~s. After opening the biliary duct and cu!ting a part of the wall to make it homogeneous to the normal one, the last one was sutured without any drainage with Kehr’s tube. The patient was dismitted at the f&h day post-op. After six months, blood test were ncfmal and US didn’t show any palhologic sign.

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78 CURRENT ROLE OF ERCP AND SPHINCTEROTOMY IN THE MANAGEMENT OF CHOLEDOCHOLITiASiS. Francesca Sanna, Fabrizio Scoanamillo, Maria Rosa Satta, Pietro Sore, Mario Trignano. Istituto di Patologia Chimrgica, Universiti degli Studi di Sassari. While laparoscopic cholecistectomy remains the treatment of choice for symptomatic cholelithiasis, the optimal treatment of ch&docholitiasis has not been deiined yet due to the fact that treatment options depends on each specialist’s level of expertise and experience. Endoscopic retrograde chotangiopancrcatography (ERCP) associated with sphincterotomy and endoscopic stone removal is a safer alternative to open surgery in the menagement of choledocholitiasis. Laparoscopic cholecystectomy is the standard operation for benign gallbladder disease and a single laparoscopic procedure for cholelithiasis and common bile duct stones would be the best approach but endoscopic procedures have shown favourable results in the treatment of common bile duct (CBD) stones and ERCP should be considered the procedure of choice in patients with pancreatitis and cholangitis. We performe preoperative ERCP when choledocholtiasis is documented from noninvasive tests (sonographically or radiologically) or in case of small stones in the gallbladder with a dilated bile ducts, liver chemistry abnormalities, history of jaundice, previous cholangitis or pancrcatitis and in cast of pancreatitis after uncomplicated cholecistectomy. In elderly debilitated patients with concurrent medical illness or during the immediate postoperative period, endoscopic sphincterectomy may he all that is necessary We followed-up patients with common bile duct stones with or without cholelitiasis (aged between 20 and 90 years) treated with sphincterectomy (and surgery, laparoscopic cholecistectomy or open cholecistectomy). When standard methods failed to a&eve reduction in stone size before removal, a mechanical lithotripsy was performed. Our data suggest a relatively low incidence of complications It has been of interest that about 80% of patients have a satisfactory result.

RESULTS OF ENDOSCOPIC POLYPECI’OMY OF THE COLON WITH A NEW HIGH FREQUENCY (HF) CURRENT GENERATOR WITH AUTOMATICALLY CONTROLLED SYSTEM (ENDOCUT) A. Gabbrielli, L. Petruzziello, 0. Hasaj, P. D’Alessio, M. Pandolfi and G. Costamagna Digestive Endoscopy - Libera Universiti Campus Bio-Medico _ Roma Background and aim: major complications of polypectomies arc bleeding and perforation with combined incidence of approximately 1.7% (perforation 0.04% to 2.1% and bleeding 0.3% to 2%). Recently, a new HF generator providing automatically controlled cut system (Endocut) showed good results in endoscopic biliary sphincterotomies, with reduced risk of bleeding. The aim of the study is to assess the effectiveness and safety of this new device in endoscopic colonic polypectomy. Material and methods: from Sept. ‘97 to May 2000, 337 consecutive polypectomies were performed in 201 patients (M 117, F 84, mean age 64.9. range 3 1 -90 years) with the newly developed HF surgery unit (Erbotom ICC 200 Erbe, Tubingen - Germany). The unit was set for Endocut, effect 3 (output limit 12OW). Polyps were located in the rectum n=64 (18.6%), sigmoid n=l IO (32%), descending n-33 (9.6%), splenic flexure n=9 (2.6%), transverse n=57 (16.6%), right flexure n=13 (3.8%), ascending n=46 (13.4%), cecum n=l 1 (3.2%), anastomosis n=l (0.3%). Poiyps were pedunculated n=80 (23.3%), sessile n=264 (76.7%). Histology showed: adenoma n=261 (tubular n=166, villous n=25, tubular-villous n=70), hyperplastic n=74, adenocarcinoma n=9 (in situ n=2). Mean diameter of polyps was 9 mm (range 3-40 mm). Twenty-nine polyps (8.4%) were > 2 cm. Results: No perforation and post-polypectomy coagulation syndrome were observed; bleeding rate was 1,7% (n=6). All bleeding could be treated endoscopically: APC n=4; regrasping with snare i APC=l; cpinephrine + endo-loop f APC=l. All but two bleedings were observed in polyps > 2 cm (4/29=13.8%; 4/315=0.6% p
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