Colon-proctological surgery
Colon-proctological surgery
Hemorrhoids or hemorrhoid pathology is the most frequently encountered proctological disease. It is estimated that about 50 percent of the population over the age of 50 in most industrialized countries suffer or have suffered from disorders related to hemorrhoidal disease (hemorrhoids).
The most innovative surgical procedure with regard to the treatment of hemorrhoids is THD (Transanal Hemorrhoidal Arterial Dearterialization), a method that is performed by means of an apparatus to which an anoscope, specially constructed for this use, is connected.
THD is a pioneering method in the treatment of hemorrhoids because it revolutionizes the surgical approach to hemorrhoid disease, ensuring maximum effectiveness of results and minimizing the levels of invasiveness, pain and stress for the patient.
The method that includes dearterization, that is, the selective identification and ligation of the terminal branches of the superior rectal artery, is mucopoxy, that is, the repositioning, thanks to submucosal stitches given from the point of ligation of the artery to the pectine line, of the pads in their natural anatomical location; all under local anesthesia with sedation, so that the patient can restore normal physiology and a rapid post-operative recovery, and without tissue removal. Therefore, in the postoperative period, discomfort for the patient is reduced compared to more invasive methods.
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Ankle surgery
Ankle surgery
Most patients who have an acute ankle injury benefit from physiotherapy, but if the condition persists, arthroscopic ligament repair is the most effective solution.
Ankle pain often results from impingement or cartilage injury. Hindfoot pain also results from impingement, cartilage injury, or Achilles tendon disorders. In turn, Achilles tendon pain results from tendinopathy or bursitis.
Although there are several treatment options for cartilage lesions and most of them are treated by arthroscopy, each patient is different and, therefore, each lesion requires a tailored solution.
Disorders treated:
- Achilles tendon
- Arthrosis
- Cartilage lesions and osteochondral defects
- Anterior and posterior ankle impingement
- Ankle instability
- Peroneal and posterior tibial tendon disorders
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Surgical phlebology
Surgical phlebology
VARICES OF THE LOWER LIMBS
Definition: varicose veins are a pathological dilatation of certain veins in the lower extremities and represent stage II Chronic Venous Disease. This disease is more frequent in the female sex (3:1 to 4:1), has a pronounced familial component, and other factors such as type of work activity, work environment, diet (importance of weight) and physical activity influence it.
Symptoms: They can cause complaints such as heaviness of the legs, edema (swelling) of the ankles, itching, tingling, pain, burning, and night cramps. In more severe cases and if present for a long time, thrombophlebitis of some of them, eczema (reddened and itchy lesions), skin dichromia associated with hardening of the skin (lipodermatosclerosis), and in even more severe cases ulcers may appear.
Types of intervention:
It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.
MICROSURGERY
Indications: all those patients at the early stage of the disease are candidates.
Type of Anesthesia: local
What the surgery consists of: using microincisions, varicosities are surgically removed. This type of technique, precisely because of its minimally invasive nature, does not involve cutting and therefore scarring; only sterile patches are applied after varicose veins are removed.
Post-operative course:after surgery, the patient walks immediately and after about 20 minutes can return to his or her activity.
TRADITIONAL SURGERY
Indications: All those patients in advanced stage of disease with excessive dilatation of the great saphenous vein or who have abnormalities in the course of the great saphenous vein and therefore cannot be subjected to endovascular treatments (LASER or Radiofrequency)
Type of anesthesia: local assisted
What the surgery consists of: a small cut (about 4-5 cm) is made in the groin, the diseased part of the great saphenous vein is removed, and the surgery is completed by removing the varicose veins present through microincisions (about 2-3 mm).
Type of hospitalization: Day Hospital
Post-operative course: about 15 minutes after surgery, ambulation is resumed, and after about 2 hours, the patient is discharged. The patient should wear an elastic stocking for about two weeks.
LASER OR RADIOFREQUENCED SURGERY
Indications:Candidates are those patients whose stage of disease is not advanced and whose great saphenous vein or small saphenous vein to be treated show specific ultrasound features.
Type of Anesthesia: local
What the procedure consists of: a micro-incision (about 2-3 mm) is made on the thigh or leg (the location varies from case to case), a LASER or Radiofrequency fiber is inserted inside the vein to be treated; an ultrasound-guided tumescent anesthesia of the venous axis is performed and the vein is obliterated. The procedure is completed with the removal of any varicose veins present using microincisions (approximately 2-3 mm).
Type of Hospitalization: outpatient
Post-operative course: The patient can ambulate about 10 minutes after surgery, and after about 30 minutes, he or she can be discharged. The patient should wear an elastic stocking for about two weeks.
SCLEROTHERAPY / SCLEROFOAM
Indications:any type of patient can undergo this procedure. It is generally reserved for those who cannot cope with the previously described interventions (the result of which has a longer duration of time)
Type of Anesthesia: none
What the procedure consists of: a chemical substance in liquid or foam form (Scleromousse or Sclerofoam) is injected inside the vein to be treated;
Type of Hospitalization: outpatient
Post-operative course: the patient ambulates immediately and can, after about 30 minutes, be discharged. The patient should wear an elastic stocking for at least two weeks.
EMODYNAMIC TREATMENT (CHIVA or ASVAL)
Indications:any type of patient can undergo this procedure.
Type of anesthesia:local/local assisted
What the surgery consists of: This technique involves multiple surgeries scheduled a few months apart with the aim of facilitating the passage of blood flow from diseased superficial veins to deep veins. Small incisions (2-3 mm to 4-5 cm) are made in one or more places on the thigh or leg by which certain types of veins are ligated. There is no removal of present varices, which disappear independently over time.
Type of hospitalization: outpatient
Post-operative course: depending on the level at which surgery is performed, the patient ambulates immediately or after about 20 minutes and can be discharged after about 30 minutes. The patient should wear an elastic stocking for at least two weeks.
It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.
For information you can call the following address: +39 050 586217
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Hand surgery
Hand surgery
Hand Surgery intervenes to treat the following diseases:
- Compressive peripheral neuropathies of the upper limb (carpal tunnel syndrome, ulnar/radial nerve compression)
- Tenosynovitis (Trigger finger, De Quervain’s disease)
- Dupuytren’s disease
(Aponeurotomy for Dupuytren’s Disease and Lipofilling: minimally invasive treatment of Dupuytren’s Disease or retraction of the palmar aponeurosis: new surgery that avoids long incisions and allows faster healing [dott .ssa Grazia Salimbeni]) - Rhizoarthrosis, arthrosis of the hand and/or wrist
- Rheumatoid arthritis with related wrist and/or finger deformities
- Flexor/extensor tendon injuries, hammer toe, Segond
- Ulnar collateral ligament injury 1°mf (Stener’s lesion)
- Congenital malformations hand
- Hand tumors (epithelioma, xanthoma, schwannoma, lipoma, angioma, etc.)
- Complex hand and/or wrist trauma with tendon, nerve, and bone
- Reimplantations with microsurgical technique
- Post-traumatic hand outcomes, hand burn outcomes
Some more information
Carpal tunnel syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is the most common peripheral neuropathy and is due to compression of the median nerve at the wrist as it passes through the carpal tunnel. The carpal tunnel is a duct located at the wrist formed by several carpal bones over which the transverse carpal ligament (LTC), a fibrous ribbon that forms the roof of the tunnel, is stretched. Within this conduit runs the median nerve along with the 9 flexor tendons of the fingers. Surgical therapy of carpal tunnel syndrome is indicated in the presence of typical algic-paresthetic symptoms, after electromyographic (EMG) confirmation.
The traditional technique, which still remains, however, involves a 2-3 cm longitudinal incision to the hand, distal to the wrist crease, allowing the carpal duct to be opened by sectioning the LTC.
The endoscopic technique, used at the Casa di Cura San Rossore instead involves a small transverse incision at the level of the wrist crease that allows for the insertion of an endoscope connected to the camera system, which allows for perfect visualization of the inside of the carpal tunnel and related structures.
After correct positioning of the coaxial system, and under permanent visual control, a simple pressure on the button of the handpiece allows the ligament to be sectioned by retrograde action of the handpiece.
This innovative system with its minimally invasive surgery concept offers significant advantages to the patient in both resumption time, safety, and minimal scarring outcomes.
Snapping finger or Notta ‘s disease;
The snapping finger phenomenon is due to difficult sliding of the flexor tendons in the digital duct, an expression of an inflammatory process of the flexor tendons.
The snapping is often painful, and results in a fair amount of functional limitation of the hand, so puleggiotomy surgery is necessary, whereby the digital tunnel is opened and tendon sliding restored.
Immediate mobilization of the fingers is recommended, also favored by the rapid reduction of the pain picture.
De Quervain ‘s stenosating tenosynovitis;
It is an often very painful tendonitis of the wrist, brought on by inflammation of the abductor long and extensor short tendons of the thumb, which run in the first extensor duct.
It is called stenosing because it too is characterized by a conflict of the tendons with the duct walls, brought about either by an anatomical predisposition or by triggering factors, such as repetitive manual activities.
The main symptom is pain on the radial side of the wrist, exacerbated by particular hand movements (Finkelstein’s sign).
The most effective conservative treatment turns out to be local cortisone infiltration combined with the use of splints, but the ultimate solution is puleggioplasty surgery.
The operation consists of a small skin incision to widen the tunnel and remove the synovitis, quickly resolving the painful picture.
Dupuytren’s disease
It is a typical pathology of the hand characterized by the occurrence of fibrous nodules in the palm of the hand, which slowly evolve into retracting chords of the digital rays, particularly at the level of the 4th/5th ray.
The disease often runs in families and predominantly affects the male sex, although with fair individual variability in severity and progression.
Selective aponevrectomy surgery is still the main corrective surgical technique, and it must be performed by experienced surgeons, given the vasculo-nervous structures in the palm and the need for skin plastics.
Postoperative physiotherapy treatment is always recommended.
The Rhizoarthrosis
The picture of arthrosis of the base of the thumb, which develops at the trapeziometacarpal joint, is thus defined. This joint allows opposability of the thumb to the long fingers, proving essential for the overall prehensile function of the hand.
The disease is part of a normal degenerative process of cartilage but can manifest with a local painful picture that is accentuated in prehension movements, leading to often severe functional limitation.
Treatment initially is conservative (use of specific braces, physical and drug therapies)
In cases of very severe pain, intra-articular infiltrations of hyaluronic acid or corticosteroids can be used, but the ultimate solution is suspension arthroplasty surgery, which involves removal of the trapezium and a tendon plastic.
This surgery does not involve the implantation of foreign material such as prostheses or synthetic means. It is necessary to maintain a small plaster shower for 3 weeks, and then begin a course of physical therapy.
Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disease of autoimmune origin that affects the joints, occurs most frequently between the ages of 30 and 50 years, preferring the female sex.
The disease is characterized by the proliferation of synovial tissue with erosive activity starting in the joints and then progressively affecting the bones and tendons.
The affected joints are initially those of the extremities, the small joints of the hands and feet, which become inflamed symmetrically causing stiffness, pain and swelling, and progressively impairing joint function. The course of rheumatoid arthritis is variable, generally characterized by periods of exacerbation and quiescence of the disease.
The consequences of the chronic degenerative process in the hand can be extremely varied, always expressing joint, capsular, tendon, and bone involvement, coming to shape the typical deformities of the disease over time.
To this end, experience in surgical therapy of the rheumatoid hand suggests early synovectomy, that is, a kind of cleaning of the joints and tendons in order to prevent more serious developmental complications.
Extra-articular complications are usually tendon ruptures, which can be treated with tendon solidarizations or tendon transfers, while surgery for bone and joint injuries usually involves prosthetic implants or arthrodeses.
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Facial nerve palsy surgery
Facial nerve palsy surgery
At Casa di Cura San Rossore, facial nerve palsy can be diagnosed, treated and cured.
What is facial nerve palsy?
Facial palsy results from interruption or compression of the facial nerve, with loss of function of the muscles responsible for facial expression. The patient with facial paralysis presents with characteristic symptoms: eye that does not close totally, upward rotation of the eyeball (Bell’s phenomenon), drooping of the angle of the mouth, difficulty making facial expressions and smiling.
Facial paralysis is a condition that can afflict patients of all ages.
How can the problem be solved?
If the nerve is damaged due to hemorrhage, compression, infection, trauma, but has not been disrupted, treatment begins with evaluation by the neurologist or otolaryngologist. Usually, before resorting to surgery, any spontaneous reinnervation is waited for.
On the other hand, when the facial nerve is interrupted or permanently damaged, depending on the site of the injury, the plastic surgeon, otolaryngologist, or neurosurgeon will perform the surgery. In the case of injuries on the face, the surgery will be referred to the plastic surgeon.
The main goals of surgical resuscitation are to restore oculopalpebral function and to restore functional and physiological smile.
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Mohs surgery
Mohs surgery;
Mohs surgery is a surgical procedure to remove skin tumors, carcinomas, of the face and body with intraoperative microscopic control of the margins.
Mohs micrographic surgery differs from traditional surgical techniques in its precision: the surgeon is able to verify during excision that the tumor has been completely removed. This surgical technique achieves very high probability of success, with minimal skin sacrifice, this gives obvious aesthetic and functional advantages, especially in the face.
Tumor removal with minimal amount of healthy skin
Section and mapping of the piece removed
Immediate histological examination and possible removal of other skin ONLY where necessary
Once total elimination of the tumor (radicality) is achieved, cosmetic repair of the surgical wound is performed in the same operating session. This means that the patient has completed the surgery, without the need to return to the operating room after several days with the wound open, as is the case with other techniques of “margin marking” or so-called “deferred” Mohs surgery.
Skin cancers that can be treated with Mohs chirurgi adi Mohs:
- Basal cell carcinomas (basaliomas), particularly recurrent or scleroderma of the face.
- Spinocellular carcinomas
- Dermatofibrosarcoma protruberans (DFSP)
- Bowen’s disease
- Extramammary Paget’s disease
- Eccrine porocarcinoma and other non-melanocytic malignancies.
- Lentigo Maligna of the face
- Skin cancers present at sites where saving the skin removed is important
TO BOOK A VISIT:
Clinic visit:
Call at +39 050 586319 and make an appointment at the clinic.
Online remote visit:
Call +39 050 586319 to book an appointment online.
After receipt of the visit transfer, a link for online consultation will be sent.
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Endocrine surgery
Endocrine surgery
Endocrine surgery is a branch of general surgery that deals with the surgery of the endocrine glands.
In the experience of the Casa di Cura San Rossore, diseases of the thyroid, parathyroid and adrenal glands, and, finally, those of the endocrine part of the pancreas have been treated most frequently.
What has changed in thyroid surgery?
Stricter indications to perform thyroid gland surgery: as a result, fewer and fewer patients are being operated on. For example, the presence of nodules with benign features or small goiters are no longer an indication for surgery;
Less surgical aggressiveness in non-aggressive and non-locally advanced malignancies, resulting in a tendency to avoid unnecessary demolitive surgery;
Employment of new technologies in surgical dissection that make surgery more accurate and effective;
The possibility of using a device that allows monitoring of laryngeal nerves (Nerve Intraoperative Monitoring – NIM) with both intermittent and continuous technique, in order to prevent iatrogenic injury of nerve structures, a dreaded complication of thyroid surgery.
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Gastroenterological surgery
Gastrenterologic surgery
DIAGNOSTIC EXAMINATIONS LIST
- EGDS
- Rectosigmoidoscopy
- Pancolonoscopy
- Conventional esophageal pH-metry (with tube) 24/h
- Esophageal pH-metry with BRAVO capsule 24/h – 96/h
- Vital coloring
- Endoscopic magnification
- High-resolution esophageal manometry
- (Eco-Endoscopia)
- (Rx TD esophagus/stomach/duodenum with baryta m.d.c.)
LIST OF INTERVENTIONS GENERAL SURGERY
- Exploratory laparoscopy
- Laparoscopic gastro-enterostomies
- Inguinal hernia (open, laparoscopic)
- Abdominal wall hernias and Laparoceles
- Cholecystectomy (laparoscopic)
- Port-a-cath placement (for chemotherapy infusion)
- Laparoscopic dijunostomy placement
- Echo-guided placement of percutaneous drains (chest, abdomen)
LIST OF ESOFAGO-GASTRIC SURGERY OPERATIONS
- Fundoplicatio sec. Nissen, Nissen-Rossetti, Toupet, Dor (antireflux plastic for
Jatal hernia and gastroesophageal reflux disease) - Permagna jatal hernia (gastric volvulus, diaphragmatic hernias, etc.)
- Extramucosal myotomy sec. Heller-Dor (achalasia)
- Diverticulectomy (Zenker’s diverticulum, Epiphrenic diverticulum)
- Removal of leiomyomas/GISTs of the esophagus (laparoscopy, thoracoscopy)
- Laparoscopic gastroresection (neoplasms, GISTs, Leiomyomas)
- Esophagectomy for esophageal cancer
- Gastrectomy for gastric cancer
LIST OF OPERATIONAL ENDOSCOPE INTERVENTIONS
- Rigid, hydraulic, pneumatic dilatation (caustic stenosis, actinic, peptic,
Achalasia, scar rings, pylorus stenosis, anastomosis stenosis) - PEG, PEG-J (pull technique and introducer)
- Endoprosthesis placement esophagus, pylorus-duodenum, colon
- Mucosectomy (EMR, Endoscopic Mucosal Resection); early neoplastic lesions esophagus, stomach, duodenum, colon (up to 2 cm)
- Endoscopic Submucosal Dissection (ESD); early neoplastic lesions esophagus, stomach, duodenum, colon (> 2 cm)
- Radiofrequency Ablation (RFA). Treatment of dysplastic Barrett’s esophagus (BARRX)
- Treatment of fistulas and anastomotic dehiscences; perforations of esophagus and stomach (Prosthesis, OTSC-Ovesco, Apollo Endostich)
- (P.O.E.M., PerOral Endoscopic Myotomy for achalasia)
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General surgery
General surgery
Open surgery and laparoscopic surgery are performed at Casa di Cura San Rossore:
- Oncological surgery
- Gastroenterology
- Liver and biliary tract surgery
- Pancreas surgery
- Abdominal wall surgery (hernia and laparoceli, etc)
- Ambulatory surgery
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Maxillofacial surgery
Maxillofacial surgery
Facial nerve salvage surgery in parotid gland pathology, nerve grafts for reinnervation of the facial nerve territory, muscle transplants and transpositions in inveterate paralysis, and enrichment nerve grafts in congenital paralysis are performed at the Casa di Cura San Rossore. Synkinesias are treated, when there is an indication, either surgically or with botulinum toxin. Patients are followed up annually and can rely on careful follow-up as well as secondary surgery to touch up any morpho-functional problems related to age and previous surgery.
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