[Double-breasted alloplasty in the treatment of a midline laparocele]. / Alloplastica a doppio petto nel trattamento del laparocele mediano.

The authors describe a new original surgical technique in repairing midline incisional hernias with polypropylene mesh, considering technical and functional advantages. Twenty-six cases are presented as well as early and late postoperative complications after 12 months follow-up.

[The rational use of prosthesis in laparocele]. / L'impiego razionale delle protesi nei laparoceli.

The Authors report their cases of incisional hernias observed from 1990 to 1995 involving 142 patients treated either in emergency or under normal conditions. A guideline in the choice of prosthetic materials of current use, considering the relative chemo-physical characteristics, the biocompatibility and the costs is outlined. Although not entering into the merit of the surgical technique some general criteria that should guide the surgeon facing the incisional hernial pathology are ruled out.

[Gallbladder and common bile duct calculi: treatment with laparoscopy vs laparotomy. Costs and benefits]. / Litiasi colecisto-coledocica: trattamento laparoscopico vs. laparatomico. Costi-benefìci.

The cost-benefit ratio of laparoscopy vs laparotomy was evaluated comparing 2 groups of patients: 500 operated using traditional laparotomy and 500 operated via laparoscopy. The first parameter considered was the average hospital stay, which was 8.4 days (min. 3, max. 22 days) in group I (laparotomy) (Fig. 1) against 4 days (min. 2, max. 13 days) in group II (laparoscopy). Even more interesting were the results related to the average postoperative hospital stay: 5 days for laparotomy, 2 days for laparoscopy. Currently, 90% of patients submitted to laparoscopic cholecystectomy is discharged in the first postoperative day. The cost of the surgical procedure is 1,100,000 It. Lit. for laparotomic cholecystectomy and 2,130,000 It. Lit. for laparoscopic cholecystectomy. However, considering the cost of the daily hospital stay and adding the cost of the surgical procedure we already save 50% with the laparoscopic method. Furthermore, if we consider the time occurring between patients' discharge and return to work a 50% reduction of the postoperative recovery time is obtained. The conclusions of the Authors are the following: Laparoscopic cholecystectomy performed by skilled surgeons presents an incidence of complications comparable to traditional cholecystectomy. The operating time is almost the same for both methods. Operative costs are higher for the laparoscopic technique. Postoperative hospital stay is drastically reduced with the laparoscopic procedure. Return to work is assured in a shorter time after laparoscopy.