Automatic stapling devices in the surgical treatment of esophageal diverticula.

Experience is presented of 18 patients in whom surgical treatment of esophageal diverticulum included use of an automatic stapling device. Ten diverticula were pharyngoesophageal, three mid-esophageal and five epiphrenic. One-stage diverticulectomy with myotomy was performed in all cases. Postoperative follow-up was 6-66 months. The results were excellent, without early or late complications or recurrence.

Twenty-one-year survival after hepatic resection for primary hepatocellular carcinoma. A case report and review of the literature.

Hepatocellular carcinoma still presents a very low long term survival rate. Scintiscan, ultrasonography, computer tomography, celiac arteriography as well as AFP monitoring have contributed to early diagnosis, better staging and surgical approach. Despite this progress, very few cases in the literature are reported to survive more than ten years. For this reason, a case of a patient who underwent hepatic resection for primary hepatocellular carcinoma twenty-one years ago, is presented. The parameters which at present are known to influence long term survival are discussed. However, it is suggested that other, unknown factors may play a major role in prolonged survival after resection for hepatocellular carcinoma. The literature on the subject is reviewed.

Surgical management of postvagotomy syndrome.

The purpose of the present report is to demonstrate the results of conservative surgical treatment in twelve patients with postvagotomy syndrome (PVS). The reconstructive operation performed in each case depended on the preexisting drainage procedure. Out of eight patients who had undergone vagotomy and gastrojejunostomy (GJ) four suffered from bile reflux and vomiting, four from dumping (DU) and four had diarrhea. All underwent closure of GJ and two of them duodenoplasty for coexisting duodenal stenosis. The results were very good (Visick grade I and II) in all patients except for one complete failure. Out of four patients who had undergone vagotomy and pyloroplasty, three had DU, two diarrhea and two bile reflux and vomiting. Pyloric reconstruction was performed in all subjects. Symptoms were relieved in all cases. In one patient radioisotopic control showed mild G/O and D/G reflux. Conservative surgical operations give satisfactory results in the treatment of PVS. Furthermore they have lower morbidity and mortality than radical surgery.

Large Brunner's glands adenoma. A case report.

A rare case of a large Brunner's glands adenoma is reported. Usually, these neoplasms are small, exceeding 1 cm only in a few cases. Although the tumor was considerably large (6.5 cm), it did not cause obstruction of the upper digestive tract and bleeding was the first clinical symptom. Diagnosis was established after endoscopy with biopsies, which excluded malignancy. Local surgical excision of the neoplasm, which is the treatment of choice in such cases, was successfully performed.