[Bilateral splanchnicectomy according to the Dubois method in pain caused by chronic pancreatitis and by inoperable neoplasms of the pancreas]. / La splancnicectomia bilaterale second Dubois nelle algie da pancreatite cronica e da neoplasie inoperabili del pancreas.

The authors report a personal series of 12 p. undergoing splanchnicectomy through Dubois' transhiatal approach because of abdominal pain of pancreatic origin. They underline this technique produces immediately a total, lasting pain relief, improving quality of life of these patients.

[Results of the treatment of carcinoma of the thoracic esophagus with one-stage resection and esophagogastrostomy]. / I risultati del trattamento del carcinoma dell'esofago toracico mediante resezione ed esofagogastrostomia in un tempo.

Between november 1964 and december 1982, 102 patients were operated upon for the treatment of carcinoma thoracic esophagus. The philosophic objectives were to restore promptly the ability to swallow and to achieve a worthwhile survival period. To fulfill these requirements wide excision of the growth and immediate esophagogastrostomy were performed through a combined abdominal and right thoracic approach. In higher thoracic growths the Authors added a cervical phase. The resectability rate was 74% and the overall hospital mortality rate was 19,6%. Anastomotic leaks occurred in 10 patients (9,8%) with fatal outcome in 6. Pre- and postoperative care (particularly hyperalimentation and intensive respiratory therapy) and use of mechanical devices reduced the operative mortality rate to 8,1% between 1976 and 1982 without deaths in the last 16 patients. Very satisfactory palliation was achieved in 80% of the patients who survived the standard esophagogastrectomy. These patients enjoyed uncomplicated oral alimentation for the remainder of their lives. Despite there has been considerable improvement in operability and resectability rates and in survival of resection as compared to past years, long term results of treatment of carcinoma of the esophagus continue to remain disappointingly low. Overall survival rate at 5 years was 10,2% in this report. The stage of the disease influenced significantly survival: curative as opposed to palliative resections demonstrated a marked difference in 5-year survival (28,2% vs 2,8%). Long-term survival of patients with carcinoma of the esophagus will probably not improve until early diagnosis is possible. Therefore esophagogastrectomy should be the treatment of choice until other forms of therapy prove superior to it both in terms of palliation and long-term survival rate.

[Adenocarcinoma of the proximal stomach and cardia: problems of surgical strategy and technics]. / Adenocarcinoma dello stomaco prossimale-cardias: problemi di tattica e tecnica operatoria.

In a total of 142 patients with adenocarcinoma of the proximal third of the stomach and cardia, curative resection was carried out in 88 during the period 1960-1980. The patients were divided in two groups. I group included 32 patients with tumor distal to the esophagogastric junction. In II group (54 patients) the tumor involved the esophagogastric junction (adenocarcinoma of the gastric cardia). In I group, when the proximal border of the cancer was well defined and sufficient length was maintained between the proximal tumor border and esophagogastric junction, the abdominal approach was preferred and the operation performed was generally a total gastrectomy combined with splenectomy and celiac node dissection. Distal pancreatectomy was performed as necessary. In most patients of the II group, the operation was performed using separate abdominal and right-sided thoracic incisions. Two principally types of operation were used: extended total gastrectomy and extended proximal subtotal gastrectomy, depending on degree of gastric wall involvement, combined with extensive esophagectomy, splenectomy and regional nodes dissection in both cases. Distal pancreatectomy was not performed routinely but only as necessary. In this group of patients there was no significant difference in the overall cure rate between the extended total gastrectomy and the extended proximal subtotal gastrectomy. Operative morbidity and mortality rates were also comparable.

[Carcinoma of the common bile duct]. / Il carcinoma della via biliare principale.

The clinical courses of 18 patients with extrahepatic bile duct carcinoma operated on between 1960 and 1979 are reviewed retrospectively. The preoperative and intraoperative diagnostic difficulties due to marked peritumor sclerosis are pointed out. The location of the lesion appeared to bear the most important relationship to prognosis: the lesions located in the upper and middle thirds of the extrahepatic biliary system are often invasive of adjacent vascular structures and, hence, unresectable, necessitating a proximal biliary-enteric anastomosis or intubation to alleviate jaundice and pruritus. A more aggressive operative approach, however, will result in a higher survival rate, as shown in personal experience for lower third lesions resected by Whipple's procedure.

[Pancreatic injuries]. / I traumi pancreatici.

Twenty patients were operated on for pancreatic trauma from 1960 to 1980. 8 (40%), without ductal lesions, were treated by drainage alone; 4 (20%) by distal resection; 3 (15%) by duodenal diversion; 1 by pancreatoduodenectomy and 1 by an anterior Roux-en-Y pancreatojejunostomy. Penrose and sump drains was used in all patients. Mortality rate was 20% (4 p.). Pancreas related complications occurred in 7 p. (35%). Particular emphasis is placed on general principles of management of pancreatic injuries to decrease mortality and morbidity.

[Comparative analysis of manual and mechanical sutures in the surgery of neoplasms of the esophagus and the cardia]. / Analisi comparativa tra suture manuali e meccaniche nella chirurgia delle affezioni neoplastiche dell'esofago e del cardias.

The authors analyse 50 sutures by hand and 50 by stapling device in oesophagocardial surgery, and compare them as to time of performance, number and quality of complications and influence on the protraction of stay in hospital after operation. The conclusions indicate the sutures by device as the most reliable and safe, susceptible to supplant, although not totally, the techniques by hand.

[Treatment of bleeding esophageal varices by esophago-gastric devascularization and esophageal transection with EEA stapler]. / Il trattamento delle varici esofagee sanguinanti mediante devascolarizzazione esofago-gastrica e transezione esofagea con suturatrice meccanica EEA.

The authors report their experience in the urgency surgery of oesophageal varices on a range of 24 patients operated in the years 1979 and 1980. In consideration of the utter seriousness of this pathology, they consider the direct operations of resection-anastomosis and devascularization of thoracic oesophagus and gastric bottom the most suitable to face the problem. Such operations, burdened by a relatively low mortality (12.5%), get the immediate step of hemorrhage and, 3 years after the first operations performed, gave good remote results. Such assertion expects a further confirmation from a longer follow-up.

[The surgical consequences of topographical variations of the implantation of the papilla in the duodenum]. / Le conseguenze chirurgiche delle variazioni topografiche dell'impianto della papilla nel duodeno.

The Authors underline the importance of anatomical variations concerning the location of the duodenal papilla. In roughly 75% of cases this structure pierces the duodenal mucosa at D2 and at the level of the lower flexure, in 20% at D3 and in about 6% at D1. Intraoperative cholangiography is most useful to spot the papilla, its position is fundamental from an anatomo-surgical point of view both when this structure is placed at a high level (when performing a gastro-duodenal resection), and when located at D3 level, if sphincterotomy is required. In this latter case the usual incision at 12 hours should be carried out at 9 hours instead in order to avoid surgical damage to the canal of Wirsung running vertically and along the common bile duct.

[Our experience in the preservation of the rectum in the surgical treatment of ulcerative rectocolitis]. / La nostra esperienza in tema di conservazione del retto nel trattamento chirurgico della rettocolite ulcerosa.

The Authors report a personal series of 42 cases of Ulcerative colitis seen over a 12 year period. (1969-1980). These patients underwent total colectomy with preservation of the rectum. Intestinal canalization was restored by means of an ileo-rectal anastomosis performed either with colectomy or at a later stage. Results are satisfactory as an improvement of general conditions occurred. Normalization of the intestinal function was observed in 85% of cases. Rectal lesions, periodically kept under control with endoscopy and hystologic examination, improved noticeably. In a few cases a total recovery was attained with an adequate, postsurgical, topic therapy. No cancer onset in the rectal stump had been recorded thus far among these patients. In the light of the Author's experience, total colectomy with rectal preservation represents a sensible solution for the surgical treatment of Ulcerative colitis.