[Laparoscopic approach versus laparotomy for suspected acute appendicitis]. / Approccio laparoscopico versus laparotomia per sospetta appendicite acuta.

Acute appendicitis is one of the most common surgical disease but, in spite of the progression diagnostic imaging, a definite diagnosis is frequently difficult and often is based in essentially clinical grounds. The Authors retrospectively analyze the results of conventional laparotomic appendectomy (CLA) and videolaparascopic appendectomy (VLA) as performed by two teams of their Department of Surgery. Between January 2000 and November 2001, 156 patients, age ranging from 3 to 67 yrs, underwent surgery because suspected acute appendicitis; 96 patients underwent VLA and 60 patients underwent CLA; a diagnosis of acute appendicitis was confirmed in 142 cases (91%). The patients who had a confirmed diagnosis of acute appendicitis were grouped according to clinical-pathologic criteria into follicular, gangrenous and complicated appendicitisi; operating time, complications and length of hospital stay were compared among the three groups. VLA resulted superior to CLA in terms of diagnostic performance: among the patients with suspected acute appendicitis, VLA allowed to establish a different diagnosis in 41% as compared to 13% with CLA. In two cases (2.08%) VLA was turned into CLA. There were non differences between VLA and CLA in terms of surgical operating time and hospital stay. A significantly higher incidence of surgical complications, such as wound infections and pelvic abscesses, was observed in the CLA group as compared to VLA. The Authors conclude that VLA allows a complete exploration of the abdomen, a better localization of the appendix and an easier diagnosis of unexpected conditions or pathologic processes associated with the clinical appendicitis; further, VLA is gravated by fewer complications.

[Varicocele. Ligation of the internal spermatic vein using laparoscopic approach]. / Varicocele. Legatura della vena spermatica interna per via laparoscopica.

It is now unquestionable that varicocele represents one of the main causes of male infertility, and thus requires appropriate surgical treatment. Inguinal and retroperitoneal methods have for some time been the most widely used. However, a significant postoperative morbidity and relatively long convalescence have prompted the search for alternative surgical techniques, such as percutaneous sclero-embolisation and microsurgery. Laparoscopic treatment of varicocele is a relatively recent surgical technique. The first studies by Sanchez de Badajoz date back to 1988 and to date a relatively small number of cases have been reported. The authors analyse the results in 54 patients treated over a period of two and a half years; 13 cases also presented inguinal hernia pathology which was treated during the same operation by applying a polypropylene graft again using a laparoscopic approach; the latter method has been routinely applied since 1992 in over 1000 cases with excellent results. The internal spermatic artery was always identified and preserved. No peri- or postoperative complications were observed. A follow-up was performed at 10 months after surgery and showed results which although referred to a relatively small series, were certainly better than those reported in the literature using traditional surgical techniques; in addition, this method also reveals interesting possibilities for the treatment of associated pathologies during the same operation, with obvious advantages in terms of costs and patient compliance.