[Milligam-Morgan hemorrhoidectomy and stapled mucoprolapsectomy. Clinical comparison of the results]. / L'emorroidectomia secondo Milligan-Morgan e la mucoprolassectomia con stapler. Valutazione clinica comparativa dei risultati.

The aim of this retrospective study was to assess the results of treatment for hemorrhoids by Milligan-Morgan hemorrhoidectomy and by stapled mucoprolapsectomy in terms of operative time, postoperative pain, lenght of hospital stay, incidence of early and late complications, time to return to work and to normal social activities and patient satisfaction. Between January 2002 and December 2003, a total of 65 patients with hemorrhoids (35 men and 30 women with a mean age of 46.9 years) underwent surgical treatment: 41 patients underwent conventional hemorrhoidectomy and 24 patients stapled mucoprolapsectomy. All patients were contacted by phone or were reviewed in the outpatient clinic with a mean follow-up of 2 months (range 8-31). The Authors emphasize that it is difficult to make an objective comparison between hemorrhoidectomy and stapled mucoprolapsectomy because the two procedures are completely different in terms of rationale and technique; however, stapled circumferential mucosectomy in their experience causes less postoperative pain and bleeding and can be considered a valid therapeutic option for third- and fourth-degree disease.

[Self-expanding stents for the palliation of esophageal and gastric cardia cancer]. / L'impiego delle protesi autoespansibili nel trattamento palliativo del carcinoma dell'esofago e del cardias.

Twenty-one endoscopic tube implantations were carried out in 24 patients with malignant stenosis of esophagus and gastric cardia using self-expanding metallic stents. The indications to endoscopic intubation were advanced stage of the tumor in 17 cases and risk factors which made resection inadvisable in 7 cases. In 3 patients it proved impossible to implant a stent endoscopically because the Authors were not able to pass the guide wire through the stenosis, while correct stent placement was achieved in 21 patients. Functional results were good in 18 patients, while 3 patients did not have any improvement of symptoms. Complications occurred in 9 patients (42.85%): 2 bleedings, 3 neoplastic obstructions, 1 food obstruction and 3 distal dislodgements of the prostheses were observed, but could readily be corrected. No death occurred. The median survival time was 151 days (range 25-545). This study suggests that endoscopic placement of metallic self-expanding stents is safe and has to be preferred to plastic stents for easier implantation and lower morbidity.

[Iatrogenic biliary lesions and stenosis]. / Lesioni e stenosi biliari iatrogeniche.

Pathogenetic, diagnostic and therapeutic aspects of postoperative bile duct injuries are reviewed. Treatment options are discussed in relation to the time of diagnosis. Lesions detected during the same operation must be immediately repaired through an end-to-end biliary anastomosis or a bilioenteric anastomosis. In limited lesions of the bile duct a T-tube placement should be sufficient. Bile duct lesions recognized postoperatively can be managed through a multimodal surgical, endoscopic, and radiologic approach. In the early postoperative period, surgery is indicated when a complete section of the biliary tract or a severe peritonitis is recognized, or when endoscopic and radiologic treatment has failed. Surgery is also the treatment of choice in the late complete stenosis of the bile duct. Roux-en-Y hepatico-jejunostomy is the most common surgical procedure for the treatment of bile duct lesions and strictures. However, in high bile duct lesions, especially if the risk of anastomotic dehiscence is increased the Authors emphasize the Rodney-Smith technique for the reconstruction of the biliary tract.

[Congenital splenic cysts. Presentation of a clinical case]. / Cisti spleniche congenite. Presentazione di un caso clinico.

The authors describe a rare case of congenital splenic cyst, observed in a 22 year old female. Pathological and clinical aspects are discussed and the up-to-date diagnostic and therapeutic approach is presented.

[Transluminal esophagoplasty. Personal experience in the treatment of esophageal stenosis]. / Esofagoplasticatransluminale (TEP). Esperienza personale nel trattamento delle stenosi esofagee.

Personal experience in the treatment of four cases of oesophageal stenosis using a Gruntzig type balloon catheter under fluoroscopic control is reported. The technique is easy to execute and well tolerated. It offers better results than traditional techniques and there is less risk.