[The videolaparoscopic treatment of cholecystic common bile duct lithiasis: review of 827 cases]. / Il trattamento videolaparoscopico della litiasi colecisti-coledocica. Studio retrospettivo su 827 casi.

BACKGROUND: The aim of this retrospective study is to verify the progress of the results in 827 patients submitted to videolaparoscopic treatment for cholecysto-choledochus lithiasis during the period >March 1994 - September 2000. METHODS: All the patients had recurring biliary colic, dyspepsia and pain in the upper abdominal quadrants. All clinical forms of cholecystitis were treated. RESULTS: The laparotomic conversions in the case of lithiasis of the gallbladder alone were 8 (0.9%) and 13 (1.5%) as it occured simultaneously with lithiasis of the common bile duct. Mortality was null and morbidity was found in 4 cases, equal to 0.4%. CONCLUSIONS: On the basis of the results obtained cholecystectomy can be implemented on a large scale to include patients of all ages and those in the high risk groups provided that the operating team include expert and skilled surgeons in the laparoscopic method as well as the conventional methods.

[Laparoscopical marsupialization of symptomatic lymphoceles following kidney trans-plantation]. / Marsupializzazione videolaparascopica di linfocele sintomatico secondario a trapianto renale.

Personal experience in the laparoscopic treatment of a lymphocele following kidney transplantation and a review of the literature are presented. We have treated a symptomatic lymphocele, which occurred a month after renal transplantation. It compressed the iliac vessels and obstructed the urine flow. Physical examinations revealed it consisted of two chambers; it measured 12 x 8 x 6 cm. A US-guided puncture was performed and a drainage tube out in place. A continuous flow of lymphatic liquid derived, and therefore we decided on surgical intervention, which was conducted in laparoscopy. A puncture of blue through the drainage tube was performed; under US-guidance, we made an opening in the peritoneal wall and in the wall of the lymphocele. A cauterization of the edges was conducted. An immediate improvement in subjective and objective symptoms was achieved. A four-month follow-up showed minimal residual effusion, slowly disappearing. Literature data and clinical evolution of the patient show that the laparoscopic approach is to be considered the "gold standard" for the treatment of symptomatic lymphocele following kidney transplantation. The authors recommend the use of US-guidance to single out anatomic structures, particularly for surgeons not trained in this procedure.

[Iatrogenic ruptures of the stomach]. / Le rotture iatrogene dello stomaco.

A case iatrogenic rupture of the stomach due to gastric wash carried out to treat a child of 5 yrs who had swallowed antineuralgic tablets is reported. This is the first reported case. It is concluded that all instrumental techniques should be carried out with maximum caution and delicacy.