[Treatment of major iatrogenic lesions of the bile ducts]. / Trattamento delle lesioni iatrogene maggiori della via biliare.

BACKGROUND: The appropriate treatment of major bile duct injuries is mandatory in order to avoid serious complications, such as bile peritonitis or secondary biliary liver cirrhosis. In the last fourty years, surgical, endoscopic or radiologic techniques of cure have been proposed, but in our opinions, the preferred option is given by Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Creating an anastomosis on narrow bile duct could be difficult; in these really rare cases, the jejunal loop could be secured by a second suture to the hilar plate with satisfactory long-term results. PATIENTS AND METHODS: In the last four years, in our Institution, six patients underwent surgery for major bile duct injuries. A Roux-en-Y hepaticochojejunostomy was performed for all of them. Two patients had the jejunal loop secured to the hilar plate. RESULTS: Operative morality was nil, and long-term results at a mean follow-up of 20 months are encouraging. CONCLUSIONS: The prevention of major bile duct injuries remains the main target during cholecystectomy or surgery in the area of the hepatoduodenal ligament. In our experience, in general agreement with data from literature, bile reconstruction is best achieved by Roux-en-Y hepaticojejanostomy. In patients unsuitable for surgery, endoscopic balloon dilatation and stent positioning represent a satisfactory alternative.

[The use of prosthetic materials placed intraperitoneally in the repair of large defects of the abdominal wall, reflections on a limited case series]. / L'utilizzo dei materiali protesici in sede intraperitoneale nella riparazione dei grandi difetti di parete addominale, riflessioni in merito ad una limitata casistica.

To evaluate the best prosthetic material in direct contact with intestinal loops in the repair of large abdominal wall defects, four cases were reevaluated and an extensive review of the literature was undertake to point out the pathophysiology of prosthetic materials in abdominal wall surgery. For its intrinsic features, Gore-Tex represents the best prosthetic material to locate intraperitoneally, but the slow foreign body reaction is responsible for postoperative complications (e.g. hematoma, seroma, dehiscence). Marlex should not be used in direct contact with intestine because of the risk of multiple fistulas, very difficult to treat, while, the intense foreign body reaction rapidly integrate the mesh into the abdominal wall. To treat large abdominal wall defects are now been proposed mixed prostheses (Gore-Tex in intraperitoneal location, Marlex at the exterior) and dual mesh Gore-Tex (two textures at different microporosity on each side of the mesh). Preliminary studies have shown the safety and utility of these prostheses.

[Benign breast diseases: the surgeon's role in its treatment]. / La patologia mammaria benigna: ruolo del chirurgo nel suo trattamento.

INTRODUCTION: Surgery plays a key role in the diagnosis and treatment of breast diseases. Diagnostic answers and therapeutic solutions are offered thanks to surgery for both benign and malignant situations. PATIENTS AND METHODS: From January 1975 to August 1995 in our centre 1933 breast biopsy for benign breast diseases have been performed. In 98% of all cases the intervention has been performed under local anesthesia throughout the infiltration of 5 to 40 cc of Lidocaine or Mepivacaine. RESULTS: Mortality in our series was 0. Morbidity affected the 0.75% of all operated cases with hematomas or wound infections. DISCUSSION: Surgery becomes the solution in the diagnosis of breast diseases whenever previous diagnostic steps (Clinical examination+mammography+FNAB) or (Clinical examination+Ultrasonography+FNAB) or (Clinical examination+FNAB) fail to reveal a preoperative diagnosis. Of course surgery represents also the logical treatment of previously diagnosed lesions. The surgical excision of benign lesions must be meticulous due to the high recurrency rate that some of these lesions have (some histotype of fibrocystic disease or phyllodes tumors). Moreover surgery due to the benign nature of the lesions and to the fact that most part of the patients is represented by young women should always be as conservative and aesthetic as possible, by following anatomic lines and calibre sutures.