[Laparoscopic deroofing of non parasitic posterolateral liver cyst. Technical considerations]. / Fenestrazione laparoscopica di cisti non parassitaria posterolaterale del fegato. Considerazioni tecniche.

Laparoscopic deroofing of the solitary non parasitic cysts of the liver is a safe and effective procedure. This technique allows a wide access for surgical treatment of cysts localized in segments II, III, IVb, V, and VIII of the liver. On the contrary, the posterior segments, VI and VII, and the segment IVa, are difficult to approach laparoscopically. This report describes a laparoscopic technique used in treating 3 cases of symptomatic solitary cysts of the posterior segments of the liver. The patients were placed in the left lateral position. The fenestration treatment was easy and the mobilization of the right hepatic lobe was not required. At one year follow-up, neither postoperative complications nor recurring episodes were observed.

[Splenectomy for hematologic disease. Mini-invasive versus traditional technique]. / La splenectomia per malattie ematologiche. Tecnica mininvasiva e tradizionale.

BACKGROUND: This study aimed to compare the safety, efficacy and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with hematologic disorders. EXPERIMENTAL DESIGN: prospective study; SETTING: II Department of Surgery, Santa Maria Nuova Hospital, Reggio Emilia and III Department of Surgery, Santo Spirito Hospital Pescara; PATIENTS: 48 consecutive adult patients underwent splenectomy; 30 patients under-went LS and 18 OS. Perioperative characteristics, outcomes, complications and costs were comparatively analyzed. RESULTS: Mean age was 35.3 years in the LS group, and 40.8 in the OS group. Mean spleen size was 11.7 cm in the LS group and 15.2 cm in the OS group. Accessory spleens were found in 5 patients in the LS group and in 4 patients in the OS group; 4 conversions to laparotomy occurred in the LS group. A total of 4 complications occurred in 3 patients of the LS; 9 complications occurred in 5 patients of OS group. Mean surgical time was 141.5 minutes for LS and 89.7 minutes for OS (p<0.005). Mean postsurgical stay was 5.8 days in the LS group and 8.5 days in the OS group (p<0.005). Response rates were similar in both groups. CONCLUSIONS: LS is comparable to OS in terms of efficacy and safety and it is associated with a shorter hospital stay. LS should become the technique of choice for treatment of intractable benign hematologic disease.

[The nasojejunal tube in early postoperative nutrition]. / Il sondino naso-digiunale nella nutrizione postoperatoria precoce.

BACKGROUND: To verify the effectiveness of the nasojejunal tube inserted during operation as an alternative to jejunostomy to perform early enteral feeding. EXPERIMENTAL DESIGN: Prospective study. SETTING: Department of Surgery, General Hospital. PATIENTS: 27 patients undergoing laparotomy because of a gastric pathology. INTERVENTIONS: In 18 patients before construction of the distal jejunum anastomosis the tube was inserted by nasal route and advanced into the jejunum ansa until the end reached 15 to 20 cm down the anastomosis (group A); 9 patients underwent a jejunostomy according to Delany (group B). All the patients started enteral feeding 24 hours after operation and had the same polymeric diet, given to them using the same procedures. MEASURES: postoperative complications, tube intolerance, intestinal tolerance. RESULTS: The degree of non-acceptance of the tube was: absent in 3 patients of group A and in 7 patients of group B (p > 0.05); slight in 6 patients of group A and in 2 patients of group B (p > 0.05); medium in 9 patients of group A and in no one of the group B (p no measurable); high in neither groups. The intestinal tolerance was similar in both groups. CONCLUSIONS: Nasojejunal tube is an effective alternative to jejunostomy to perform early postoperative enteral feeding.

[Klippel-Trenaunay syndrome: clinical and surgical aspects]. / La sindrome di Klippel-Trenaunay. Aspetti clinici e chirurgici.

The Klippel-Trenaunay syndrome is a rare syndrome of uncertain etiology. The characteristic elements are flat angiomatosis, hypertrophy of soft tissue and bone tissue and alterations of the venous system, with the exclusion of hemodynamically significant arteriovenous fistulae. The authors report a clinical case and review the international literature. Treatment is conservative in the majority of cases; surgery is reserved for patients with disabling morphological and functional alterations.

[Leiomyosarcoma of the mesentery. A case report and clinico-diagnostic considerations]. / Il leiomiosarcoma del mesentere. Descrizione di un caso e considerazioni clinico-diagnostiche.

Leiomyosarcoma of the mesentery is a rare neoplasm. The clinical manifestation is non-specific and preoperative diagnosis is often late. Mitotic activity shows no significant correlation with the biological behavior of neoplasm. The surgical excision is the therapy of choice but local recurrence is high. The authors report a case of leiomyosarcoma which was treated by surgical removal and underline the diagnostic difficulties.

[Colon volvulus]. / Volvolo del colon.

The authors report a clinical case and review the international literature. After an analysis of the incidence and the predisposing factors causing this disorder, they focus attention on the question of therapy. In forms with vital loop non-surgical derotation must be attempted. In the event of the failure of non-invasive treatment and to prevent recidivation these forms are treated surgically, also using videolaparoscopy. In forms with non-vital loop, surgery consists of the section of the necrotic segment and preparation of anastomosis which may be immediate or deferred depending on general and local conditions.

[Biliary ileus. Case report and therapeutic considerations]. / Ileo biliare. Presentazione di un caso e considerazioni clinico-terapeutiche.

The authors, after having described, a case of biliary ileus, analyse the principal pathogenetic aspects of the disease, and underline the diagnostic and therapeutic difficulties. They believe that the simple enterolithotomy represents, initially, the best therapy, in particular with patients in poor clinical conditions.

[The effects of protein-energy deficiency in candidates for gastric resection]. / Gli effetti della carenza energetico-proteica nei pazienti candidati alla resezione gastrica.

The nutritional status of patients subjects to surgical operations represent an important element in determining the incidence of morbidity and mortality. We have examined 19 patients suffering both from benign and from malignant pathology subjected to a gastric resection and treated in the preoperative period for 7-8 days and in the postoperative period for 8-10 days with parenteral nutrition. Nutritional valuation was carried on at the time of admission, in the postoperative period and in proximity to discharge; an accurate observation of possible associated was also carried on. The comparison with the not treated with a nutritional support has shown a smaller incidence in complications of a general character and also in those connected with the operation and a reduction in the postoperative stay in hospital.