[Fecal incontinence. Personal experience in direct sphincteric repair]. / Incontinenza fecale. Nostra esprienza nella riparazione sfinterica diretta.

BACKGROUND: Fecal incontinence is a disabling condition causing social isolation, whose real incidence is difficult to be exactly valued because patients are often reluctant to speak about it, even with their physician, or because they don't trust on surgical procedure. Aim of this study is report our experience in sphincteric reconstruction by direct sphincteric repair in patients suffering from post-traumatic fecal incontinence. METHODS: Seven patients suffering from fecal incontinence due to traumatic lesions of anal sphincterial apparatus were surgically treated between 1981-2000; in the first patient cause was an injury due to impaling, in the second a previous obstetrical lesion and in the last five a previous fistulectomy. Direct sphincteric reconstruction after finding and isolation of two retracted terminals of sectioned sphincter was performed in all the patients. Sphincteric reconstruction has been always accompanied by total parenteral nutrition for about two weeks during the postoperative period. A protective colostomy was never performed. RESULTS: In five cases the results were excellent: patients had continence total recovery and postoperative manometry recorded basal and voluntary contraction pressures normalisation. In the two remaining cases there was only a modest improvement because of concomitant pudendal neuropathy. No operative wound infection was observed. CONCLUSIONS: We hope that more attention is paid to fecal incontinence either regarding instrumental semeiotics or medical or surgical therapy. In particular, direct sphincteroplasty can restore a satisfactory continence in a strong number of patients with anal sphincterial apparatus single traumatic lesions without pudendal neuropathy, relieving them from a heavily disabling condition.

[Our experience in the transanal excision of tubulovillous adenomas of the rectum]. / Nostra esperienza in tema di escissione per via transanale degli adenomi tubulo-villosi del retto.

BACKGROUND: Personal experience on transanal excision of rectal adenomas without affecting sphincteric function is reported. METHODS: From 1985 to 1997, 27 patients suffering from rectal adenomatous polyps underwent surgery; the sites of lesions were within 3 to 10 cm from anal orifice in the whole series; the age of patients ranged from 30 to 81 years. Two different procedures were employed: the Parks' technique and the electroresection by traction flap technique according to Faivre. RESULTS: Any postsurgical complication such as hemorrhage, stenosis or incontinentia occurred; surgical mortality was absent. Histological examination disclosed severe dysplasia as well as in situ carcinoma in 6 patients (22.2%) and malignant polyps in 9 patients (33.3%). Only in a case a palliative excision was performed since the poor general conditions of this patient did not permit a more extended treatment; a local relapse of the tumour associated with liver metastases led the patient to death 22 months after surgery. Three patients were lost to follow-up and 2 patients died because of other causes, 6 and 8 years after surgical excision, respectively. CONCLUSIONS: The conclusions are is drawn that either Park's and Faivre's procedures are useful and safe for the surgical treatment of rectal villous polyps extended up to 8-12 cm from anal orifice, in spite of the presence of malignant foci within their mass. These surgical procedures are simple and relatively poor traumatic; for this reason they are more suitable than other transabdominal or abdomino-perineal approaches for older patients and other at risk-patients. It is underlined that the treated patients require a long-term follow-up aimed at the early diagnosis of possible relapses of adenomatosis.

[Our experience in internal medioposterior sphincterotomy with anoplasty]. / Nostra esperienza in tema di sfinterotomia interna mediana posteriore con anoplastica.

BACKGROUND: The technique of the posterior medial internal sphincterotomy according to Arnous is described and advice from personal experience reported. METHODS: From 1981 to 1995 posterior medial internal sphincterotomy with anoplasty was performed in 270 patients (132 males and 138 females) affected with chronic anal fissure, alone (112 cases) or associated with hemorrhoids (80 cases); moreover, the Arnous's operation was performed as well for hemorrhoids with posterior subsidiary packet and internal sphincter hypertonia (52 cases), relapsed hemorrhoids with postoperative anal stenosis (24 cases) and postoperative anal stenosis with painful fissure and residual internal sphincter hypertonia (2 cases). RESULTS: The results have been excellent; the average stay in hospital has been 7 days and the complete recovery occurred after 4-6 weeks without early or late complications. CONCLUSIONS: The importance of anorectal manometry for the preoperative valuation of the sphincteric hypertonia is emphasized: in this manner it is possible to modulate the sphincterotomy avoiding too economic sphincteric sections with next residue hypertonia or, in the contrary, too plentiful sphincteric section with problems of continence. Finally, the internal lateral-left sphincterotomy is mentioned, which is efficacious in the treatment of acute anal fissure. However, the proctological surgeon, on the basis of his experience, will propose the most convenient technique.

[Hemorrhoidectomy: Milligan and Morgan technique]. / L'emorroidectomia secondo Milligan e Morgan.

Milligan and Morgan and Arnous anoplasty procedures are described; their indications come from pathological features and associate pathology. Left internal sphincterotomy and posterior sphincterotomy and anoplasty are described and discussed on the basis of the Author experience about 523 haemorrhoidectomies. Internal sphincterotomy, when indicated, avoids pain, urinary retention, fissure and stenosis. Early and late complications are evaluated for both the procedures.

[Primary malignant tumors of the small intestine: the diagnostic and therapeutic considerations]. / I tumori primitivi maligni dell'intestino tenue: considerazioni diagnostiche e terapeutiche.

The authors report their experience in the management of five patients affected by small bowel neoplasms (2 adenocarcinomas, 1 carcinoid tumor, 1 leiomyosarcoma and 1 non-Hodgkin's lymphoma) operated from June '92 to September '93. Diagnostic and therapeutical aspects of this uncommon pathology are discussed.

[The surgical treatment of malignant neoplasms of the pancreas: resection or palliative intervention?]. / Trattamento chirurgico delle neoplasie maligne del pancreas: resezione o intervento palliativo?

The authors retrospectively evaluate their 10-year experience in the surgical management of pancreatic cancer, and analyze their results in terms of morbidity and long-term survival. The comparison between curative and palliative surgery shows, in this series, a better long-term survival and a better performance status for the patients in the curative group, although postoperative morbidity and mortality are higher. The difficulty of an early diagnosis as well as a correct preoperative staging is confirmed. Finally, the authors propose a personal, totally mechanic technique of digestive tract restoration after gastric resection during pancreatic surgery underlining this procedure is easy, safe, fast and functional.

[Rare primary hepatic neoplasms. Our experience in 2 cases: a primary lymphoma and a leiomyosarcoma of the liver]. / Neoplasie epatiche primitive rare. Nostra esperienza su due casi: un linfoma e un leiomiosarcoma primitivi del fegato.

In a review of personal experience of major liver surgery, 2 very rare cases of primary liver tumours, one lymphoma and one leiomyosarcoma are presented. The world literature on the subject is also reviewed and follow-up results are reported after indicating the surgical techniques adopted.

Treatment of aphthae with thalidomide.

We report our experience in the treatment of major and minor aphthae with thalidomide. With doses of 100 to 300 mg daily for 3 months, a cure was obtained in 34% of cases, and marked improvement was evident in the rest. The follow-up period varied from 1 to 8 years. Two patients experienced dysesthesias, which disappeared when the medication was stopped. Thalidomide cannot be prescribed to women of childbearing potential because of its teratogenic potential.