[Video laparoscopy in abdominal emergencies]. / La videolaparoscopia nelle urgenze addominali.

BACKGROUND: Personal experience about the use of video laparoscopy (VL) in abdominal emergencies is reported. DESIGN: retrospective evaluation of patients observed in the last years. SETTING: General Surgery I. Policlinico, University of Palermo. SUBJECTS: 61 VL have been performed: 30 acute appendicitis, 21 acute cholecystitis, 4 perforated peptic ulcer, 1 haemoperitoneum by haemorrhaged luteal corpus, 2 pelvic inflammatory disease (PID), 1 terminal ileitis, 1 choledochal perforation after ERCP and 1 bleeding after CVL. INTERVENTIONS: the following interventions have been performed: 22 VL appendectomy, 8 VL-assisted appendectomy, 21 VL cholecystectomy, 1 VL duodenal suture, 3 minilaparotomic duodenal suture, 2 prophylactic VL-assisted appendectomy, in 1 patient with terminal ileitis and in 1 PID, 1 VL partial ovarian resection. In the case with choledochal perforation during ERCP a traditional cholecystectomy was performed with an outer biliary drainage. In the patient with bleeding after CVL the spontaneous haemostasis seen during VL was confirmed by laparotomy performed to exclude baro-haemostasis and to prevent from legal motivation. The procedure was only diagnostic in 1 patient with PID. MAIN OUTCOME MEASURES: the diagnostic and therapeutic value, versus traditional surgery have been valued. RESULTS: VL is useful both for a correct diagnosis and to lead a laparotomy if necessary, allowing an adequate peritoneal exploration and toilet without large incisions; the operation is therefore, in any case, less invasive. CONCLUSIONS: In our experience the usefulness of VL is clear in the suspect of acute appendicitis, acute cholecystitis, perforated peptic ulcer, haemoperitoneum and when diagnosis is not sure and in all other situations in which correct preoperative diagnosis is impossible. So this procedure is useful to make easy a correct diagnosis and to surgical treatment.

[Cervico-mediastinal goiter. Our experience]. / Gozzo cervico-mediastinico. Nostra esperienza.

BACKGROUND: Personal experience about substernal goiter is reported. Stressing laid on the importance of definition: a goiter that is totally or in the most part below the superior thoracic outlet, with normal vascularization. DESIGN: retrospective evaluation of patients observed in the last six years. SETTING: General Surgery I, Policlinico, University of Palermo. SUBJECTS: four hundred ninety-six thyroidectomies have been performed, 32 patients (6.5%) were found to have substernal goiters. The age was between 42 and 86 years (middle age 59). Male/female = 1/1.9. Asymptomatics were 8 (25%). More frequent symptoms were airway compression (34%), hoarseness (9%), pain (9%), thyrotoxicosis (9%) and dysphagia (3%). INTERVENTIONS: total thyroidectomies have been always performed. MAIN OUTCOME MEASURES: the incidence, symptoms, short and long term complication have been valued. RESULTS: There were no postoperative bleeding or lesion of recurrent nerves or definitive hypoparathyroidism. Postoperative hypocalcemia was observed in 9 patients (28%). Only one temporary hypoparathyroidism (two months) was observed. In 2 patients the histologic examination revealed a papillar carcinoma. There were no intraoperative deaths. CONCLUSIONS: In personal experience the presence of substernal goiter is an indication for total thyroidectomy. The reasons for treating substernal goiter surgically are the following: no effective medical treatment is available; respiratory compromise, thyrotoxicosis, dysphagia, or malignancy can develop in long-standing goiters; surgery, in skilled hands, presents minimal morbidity.

[Video laparoscopic appendectomy. Our experience]. / Appendicectomia videolaparoscopica. Nostra esperienza.

OBJECTIVE: Personal experience with the use of VL in the treatment of acute appendicitis (AA) is reported. The main advantage of this method is its high diagnostic reliability. SETTING: Chirurgia Generale I. Dipartimento di Discipline Chirurgiche e Anatomiche. Policlinico Università Palermo. SUBJECTS: The VL method has been used in 36 patients with diagnosis of suspect acute appendicitis. INTERVENTIONS: In the cases in which the diagnosis has been confirmed, a VL appendectomy with endoabdominal technique according to Semm has been performed in 23 cases, and an assisted VL appendectomy, trough a minimal and guided laparotomy, in 8 cases. In order to avoid vascular and visceral injuries, an "open" laparoscopy technique is always used. RESULTS: The diagnosis has been confirmed in 31 cases, 21 women and 10 men. The diagnosis has not been confirmed in 5 cases, a man of 74 years with sigmoidal diverticulitis and 4 women with terminal ileitis in a case, torsion of right ovarian cyst in another and, finally, pelvic inflammatory disease in 2. CONCLUSIONS: From this brief experience it is evident the diagnostic advantage of VL particularly in the female and in elderly patients. Other advantages of this method are the excellent aesthetic result, light postoperative pain, the rapid functional resumption, the small impact of adherences, wound infection, and incisional hernia, and the lower cost, when staplers are not used. The disadvantages are the extension of the operative time, using the "open" laparoscopy technique, and the difficulty to find Meckel diverticulum.

[Long-term central venous access. Our experience]. / Accesso venoso centrale a lungo termine. Nostra esperienza.

Prolonged venous access devices (PVAD) represent a useful tool for many patients with chronic diseases. In the last 3 years 50 PVAD have been placed. Polyurethane catheters with a subcutaneous tunnel > 6 cm, have been used. There were no complications related to catheter insertion. The average life of PVAD was 95 days (range 7-425).

[Mirizzi's syndrome]. / La sindrome di Mirizzi.

Two cases of Mirizzi's syndrome are reported. The syndrome consists of: external compression of the common bile duct due to a benign lesion (Type I)--presence of a cholecystobiliary fistula with impacted stones and partial or total obstruction of the hepatic duct (Type II). Clinical signs are non-specific and suggest at first sight an obstructive jaundice. Ultrasonography shows dilatation of the upper biliary tract with narrowing of the biliary tract below the dilatation. ERCP often proves mandatory for diagnosis. Therapeutical procedures are reported.

[Diverticula of the right colon. The diagnosis and treatment of complications]. / Diverticoli del colon destro. Diagnosi e trattamento delle complicanze.

BACKGROUND: Diverticula are localized in the right colon with a rate of 6.7-14% in Western countries. Two types of diverticula have been described in the right colon, on the basis of etiologic and pathological features: multiple diverticula and solitary diverticulum of the caecum. The most common clinical presentation of the right-sided colonic diverticula is an acute inflammatory complication, which is difficult to distinguish from other causes of right iliac fossa pain. METHODS: A survey of the literature is presented and personal experience relative to 4 cases of acute diverticulitis of the right colon observed over a 10-year period is described. RESULTS: In all the patients the preoperative diagnosis was acute appendicitis. In two cases the poor clinical conditions of the patients were associated with the free perforation of a solitary caecal diverticulum and diffuse faecal peritonitis. A temporary caecostomy was therefore required. In two cases a localized inflammatory mass was found around a perforated solitary diverticulum of the caecum. An ileocaecal resection was performed. CONCLUSIONS: The purpose of this study is to emphasize the epidemiological, etiologic and clinical features of right-sided colonic diverticula, and the diagnostic and therapeutic management of their complications.

[Hemobilia. Etiopathogenic, clinical, and therapeutic considerations]. / Emobilia. Considerazioni eziopatogenetiche, cliniche e terapeutiche.

The authors present a case report of hemobilia resulting from the rupture of a cystic artery pseudoaneurysm into the biliary tract. They analyse the international literature and stress aethiology, pathogenesis, clinical presentation, diagnosis and therapeutic aspects.