Papers by Massimo Arcerito
PubMed, Aug 13, 1999
The Authors report their experience on 76 patients managed for oesophageal achalasia from 1973-19... more The Authors report their experience on 76 patients managed for oesophageal achalasia from 1973-1997. 65 patients have been surgically treated with Heller miotomy (19 cases) or miotomy with antireflux procedures (46 cases); 11 patients underwent an endoscopic pneumatic dilation. 54 patients, 43 surgically and 11 endoscopically treated, have been followed for a mean length of time of 6 years and 6 months. Complete cure or significant improvement of symptoms have been noted in 86% and 72.7% of patients treated respectively with surgery or pneumatic dilatation. The results have been evaluated according to the recent data from the literature and diagnostic and therapeutic aspects of primitive achalasia are discussed.
Surgical Endoscopy and Other Interventional Techniques, May 1, 1997
Background: About 20% of patients with gastroesophageal reflux disease (GERD) have severely impai... more Background: About 20% of patients with gastroesophageal reflux disease (GERD) have severely impaired esophageal peristalsis in addition to an incompetent lower esophageal sphincter. In these patients a total fundoplication corrects the abnormal reflux, but it is often associated with postoperative dysphagia and gas bloat syndrome. We studied the efficacy of partial fundoplication in such patients. Methods: A partial fundoplication (240°-270°) was performed laparoscopically in 26 patients (11 men, 15 women; mean age 50.5 years) with GERD (mean DeMeester score: 92 ± 16) in whom manometry demonstrated severely abnormal esophageal peristalsis. Results: All operations were completed laparoscopically and the patients were dicharged an average of 39 h after surgery. The preoperative symptoms resolved or improved in all patients, and no patient developed dysphagia or gas bloat syndrome. Postoperative pH monitoring showed complete or nearly complete resolution of the abnormal reflux in every patient. Conclusions: Partial fundoplication is an excellent treatment for patients with GERD and weak peristalsis, for it corrects the abnormal reflux and avoids postoperative dysphagia.
American Journal of Medical Case Reports, May 23, 2022
American Journal of Surgery, Dec 1, 1995
American Surgeon, Dec 1, 2018
Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, r... more Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common clinical presentation. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery. Between March 2014 and August 2016, 50 patients (18 males and 32 females) underwent robotic fundoplication (17 sliding and 33 paraesophageal hernias). The mean age of the patients was 58 years. Biosynthetic mesh was used in 28 patients with paraesophageal hernia. The mean operative time was 115 minutes (90-132) in the sliding hiatal hernia group, whereas it was 200 minutes (180-210) in the paraesophageal hiatal hernia group. The mean hospital stay was 36 hours (24-96). Eight patients experienced mild dysphagia which resolved after four weeks. No postoperative dysphagia was recorded at 30-month median follow-up. We experienced one recurrence in the sliding hernia group and two recurrences in the paraesophageal hernia group, with two patients treated robotically. Robotic fundoplication in treating sliding hiatal hernia is feasible and safe but is more challenging in the large paraesophageal group. Improved patient outcomes hinge on the operative technique used and increasing surgeon experience. The increased dexterity that robotic surgery affords enables the esophageal surgeon to more adeptly apply the traditional principles of laparoscopic fundoplication.
Georg Thieme Verlag eBooks, 2018
Gastroenterology, Apr 1, 1995
Mucosal regeneration is essential for intestinal homeostasis but regulatory factors are obscure. ... more Mucosal regeneration is essential for intestinal homeostasis but regulatory factors are obscure. This study investigates the influence of epithelial/mesenchymal interactions on postnatal small intestinal epithelial regeneration, using a novel model. Methods: Postnatal rat small intestinal mucosa underwent enzymatic digestion to produce either (i) cell aggregates (CA) with intact epithelial/ mesenchymal interactions or (ii) single cell suspensions (SCS) in which these heterotypic cellular interactions were disrupted. Cell viability was assessed in epithelium of both groups immediately after isolation, while colony forming ability, proliferation and limited aspects of differentiation were evaluated in primary culture. The capacity for organotypic neomucosal morphogenesis was evaluated, after grafting of disaggregated epithelium of both groups to inbred recipients, in vivo. Results: Cell viability immediately after isolation was similar in both groups. CA formed more colonies per well than SCS (29±10 CA v 8±5 SCS p<0.001), by 24 hours in culture. By 96 hours, median cellularity was greater in colonies from CA (178 ±48 CA v 123±50 SCS cells/colony p<0.03). However, intestinal alkaline phosphatase was only identified in colonies from CA. After grafting, 32/40 CA regenerated small intestinal neomuoosa. Grafts of SCS were unsuccessful. Conclusion: Intact epithelial/mesenchymal interactions enhance postnatal small intestinal epithelial colony forming ability, proliferation and differentiation in vitro and capacity for mucosal regeneration in vivo. TRANSPLANTATION OF SMALL INTESTINAL STEM CELLS AFTER GENETIC MODIFICATION.
PubMed, 1995
The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy pe... more The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy performed through a left thoracotomy gives better results than pneumatic dilatation, the fear of an operation with the associated postoperative pain and disability has kept patients away from this form of treatment. Minimally invasive surgery allows the same results obtained with open surgery, with a short hospital stay, minimal postoperative discomfort, and a fast recovery time. A thoracoscopic or laparoscopic Heller's myotomy should be considered today the primary form of treatment for esophageal achalasia.
American Journal of Medical Case Reports
European congress of Thoracic Surgery, 2002
The American Surgeon, 2018
Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, r... more Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common clinical presentation. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery. Between March 2014 and August 2016, 50 patients (18 males and 32 females) underwent robotic fundoplication (17 sliding and 33 paraesophageal hernias). The mean age of the patients was 58 years. Biosynthetic mesh was used in 28 patients with paraesophageal hernia. The mean operative time was 115 minutes (90–132) in the sliding hiatal hernia group, whereas it was 200 minutes (180–210) in the paraesophageal hiatal hernia group. The mean hospital stay was 36 hours (24–96). Eight patients experienced mild dysphagia which resolved after four weeks. No postoperative dysphagia was recorded at 30-month median follow-up. We experienced one recurrence in the sliding hernia group and two recurrences in the paraesophageal hernia group, with two patients treat...
Annales chirurgiae et gynaecologiae, 1995
The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy pe... more The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy performed through a left thoracotomy gives better results than pneumatic dilatation, the fear of an operation with the associated postoperative pain and disability has kept patients away from this form of treatment. Minimally invasive surgery allows the same results obtained with open surgery, with a short hospital stay, minimal postoperative discomfort, and a fast recovery time. A thoracoscopic or laparoscopic Heller's myotomy should be considered today the primary form of treatment for esophageal achalasia.
Digestive Diseases and Sciences, 1999
Until recently, pneumatic dilatation andintrasphincteric injection of botulinum toxin (Botox)have... more Until recently, pneumatic dilatation andintrasphincteric injection of botulinum toxin (Botox)have been used as initial treatments for achalasia, withmyotomy reserved for patients with residual dysphagia. It is unknown, however, whether thesenonsurgical treatments affect the performance of asubsequent myotomy. We compared the results oflaparoscopic Heller myotomy and Dor fundoplication in 44patients with achalasia who had been treated withmedications (group A, 16 patients),
The American Journal of Surgery, 1998
Little attention has been paid to nonobstructive dysphagia (dysphagia in the absence of an esopha... more Little attention has been paid to nonobstructive dysphagia (dysphagia in the absence of an esophageal stricture) in patients with gastroesophageal reflux disease (GERD). The objectives of this study were to assess (a) the incidence of nonobstructive dysphagia in patients with GERD; and (b) the effects of laparoscopic fundoplication on nonobstructive dysphagia. Esophageal manometry and pH monitoring identified 666 patients with GERD. Two hundred and eight patients (31 %) without esophageal strictures complained of dysphagia in addition to heartburn and regurgitation. Forty-nine (24%) of these patients underwent laparoscopic fundoplication. Esophageal function tests were repeated postoperatively in 12 patients (25%). Main outcome measures were effects of laparoscopic fundoplication on symptoms and esophageal motor function. Dysphagia resolved postoperatively in 44 patients (90%), and improved in 2 patients (4%). Postoperative esophageal manometry showed a significant increase in the length and pressure of the lower esophageal sphincter, without changes in its ability to relax in response to swallowing. About one third of GERD patients without strictures experienced dysphagia; and dysphagia resolved in about 90% of such patients following a laparoscopic fundoplication.
Surgical Endoscopy, 1999
It has been said that a Heller myotomy cannot improve dysphagia in achalasia when the esophagus i... more It has been said that a Heller myotomy cannot improve dysphagia in achalasia when the esophagus is markedly dilated or sigmoid shaped. Those who hold this belief recommend esophagectomy as the primary treatment in such cases. This study aimed to compare the results of laparoscopic Heller myotomy combined with Dor fundoplication in 66 patients with and without esophageal dilatation, all of whom had achalasia. On the basis of the maximal diameter of the esophageal lumen and the shape of the esophagus, the patients were placed into four groups: group A (esophageal diameter &lt;4.0 cm; 26 patients), group B (diameter 4.0-6.0 cm; 21 patients), group C1 (diameter &gt;6.0 cm and straight esophageal axis; 12 patients), and group C2 (diameter &gt;6.0 cm and sigmoid-shaped esophagus; 7 patients). All patients underwent a laparoscopic Heller myotomy and Dor fundoplication. The duration of the operation and the length of hospital stay were similar among the four groups. Excellent or good results were obtained in 88% of group A, 100% of group B, 83% of group C1, and 100% of group C2. No patient in this consecutive series ultimately required an esophagectomy. In patients with achalasia who have esophageal dilation, a laparoscopic Heller myotomy and Dor fundoplication (a) took no longer and was no more difficult, (b) was associated with no more postoperative complications, and (c) gave just as good relief of dysphagia. We conclude that esophageal dilation by itself should rarely serve as an indication for esophagectomy rather than myotomy as the initial surgical treatment.
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Papers by Massimo Arcerito