Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device.

BACKGROUND: Restoration of intestinal continuity in patients with ileostomy after total colectomy or with colostomy after Hartmann's procedure is a major operation. Herein we illustrate the validity of gasless laparoscopically assisted reversal using abdominal wall lifting. METHODS: The operation was performed on 10 patients from February 1997 to May 1999. Seven of them had a left iliac stoma after a Hartmann resection, and three had an ileostomy after total colectomy. RESULTS: The laparoscopic reversal was completed in eight patients; the two others were converted to an open procedure. Three major complications occurred (30%). There were no deaths. The average operation time was 192 min (range, 125-265). Time of discharge from surgery averaged 9.5 days. Mean follow-up of these patients was 12 months and negative. CONCLUSIONS: Laparoscopically assisted ileo- or colorectal anastomosis without pneumoperitoneum and using a laparotenser can be considered for the reversal of patients with ileostomy or colostomy. Even taking the high rate of intraoperative or postoperative complications into consideration, the advantages that make such a laparoscopic approach suitable include reduced trauma related to a second major abdominal operation, reduced postoperative pain, and fewer cutaneous tissues exposed to bacterial contamination. Moreover, the use of a laparotenser makes it possible to operate on elderly patients with cardiovascular diseases. In the absence of pneumoperitoneum, it becomes possible to use traditional instruments, with a consequent reduction in costs.

[Spigelian hernia: an up-to-date]. / Attualità dell'ernia di Spiegel.

Nine cases of Spigelian hernia occurred and surgically treated in the years 1992-1997 are reported. Spigelian hernias were observed in 5 females and 3 males with mean age of 62.1 years (range 49-70). In 5 cases prosthetic repair has been done with preperitoneal mesh and a very good outcome. In a 61 years old obese female spigelian hernia was bilateral. Her left sided hernia needed an emergency operation for strangulation. Hernia has been repaired by simple suture and recurred early. For the diagnosis of Spigelian hernia it is essential to remember it inside the "Spigelian belt". The satisfactory results obtained at present by prosthetic repair are underlined.

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

[The long-term results of mechanical anal sphincteroclasis]. / Risultati a distanza della sfinteroclasia anale meccanica.

BACKGROUND: The long-term results of 36 patients operated of manual dilatation of the anus are presented. Chronic anal fissure or benign anal stricture have been treated by this procedure in the years '80s. METHODS: Patients have been in part clinically examined and the other called up by phone interview. Average follow-up is 78 months. RESULTS: Nobody has been re-operated for the same cause, but 2 patients underwent sphincter sparing operation for rectal cancer. Twenty-five patients (72%) completely recovered, 5 (12.5%) complain sometimes from sudden anal pain and 3 (8%) report minor incontinence problems. CONCLUSIONS: These long-term results do not confirm disastrous conclusions reported by other authors in the literature, even if the incidence of continence disorders is higher than in anal sphincterotomies.

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

[Stoppa's intervention. The complications nd results]. / L'intervento di Stoppa. Complicanze e risultati.

The authors report their experience with the giant prosthetic reinforcement of the visceral sac (Stoppa procedure), developed in the last 6 years operating 126 cases. Postoperative period was regular for two third of the patients, but only in 4 cases we can consider complication severe: 2 cases of preperitoneal haemorrhage with haematoma formation and subsequent recurrence; one sepsis of the preperitoneal space around the prosthesis, cured with drainage and conservative measures without recurrence, and then one peritonitis in a morbid obese individual. There was no mortality. 93.3% of the patients has been clinically controlled after over 6 months (average 27 months; range 6-67 months): 8 recurrences have been observed (3.6% of the hernias operated). 7 required reintervention. Therefore it is possible to affirm that 91% of the operated patients had good results.

[Prosthetic repair of inguino-crural hernia using Rives technique]. / La riparazione protesica dell'ernia inguino-crurale con la tecnica di Rives.

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected.