[Intrahepatic cholangiojejunostomy on the third segment in non-operable neoplasms of the hepatic hilum]. / La colangiodigiunostomia intraepatica al III segmento nelle neoplasie inoperabili dell'ilo epatico.

The authors report their experience in 19 cases of primitive or secondary tumor of the hilus of the liver which couldn't benefit from radical operation. Palliative treatments--to resolve the jaundice (which is often the only responsible for a short-term exitus)--include surgical (intrahepatic bilio-digestive derivations) and non surgical procedures (PTDB, percutaneous transtumoral intubation). Considering the ephemeral results of the latter, the Authors take peripheral derivative operations into account and particularly the Soupault and Couinaud technique (intrahepatic colangiojejunostomy) performed in 7 patients with satisfying results. It is an easy and quick technique--because of constant anatomical situation of the left intrahepatic biliary distribution and of the superficial location of the duct of the III segment--which allows a lasting biliary decompression with a good residual life.

[Preliminary experience with the surgical treatment of inguinal hernias with the Shouldice procedure]. / Considerazioni sulla iniziale esperienza nel trattamento chirurgico delle ernie inguinali secondo la tecnica di Shouldice.

The authors report their recent experience on the surgical treatment of inguinal hernias according to Shouldice Canadian repair, used for the undiscussed advantages. The least pre-operational preparation, the early mobilization of the patient, the reduction of the hospitalization and the almost total absence of relapses, support the application of this technique of which we auspicate a wider use.

[The technical aspects of liver resection surgery: the authors' experience]. / Aspetti tecnici nella chirurgia resettiva epatica: contributo d'esperienza.

Based on their personal experience in hepatic resective surgery the authors dwell upon details of surgical technique which, well combined and sustained by advanced technological supports (ultrasonic dissector, laser-argon clotter, intraoperative echography), allow to perform wide parenchymal resections sheltered from dangerous complications. The safety achieved in such a surgery--now routinely performed--derives not only from improved diagnostic techniques (US, CT, MNR, angiography) and advances in anaesthesia-reanimation but, above all, from precise knowledge of organon segmental anatomy and close vascular correlations between the two hepatic hemisystems.

[Portal thrombosis: the diagnostic and therapeutic aspects and clinical cases]. / Le trombosi portali: aspetti diagnostico-terapeutici e contributo clinico.

The authors report their experience, from 1983 to 1992, in the treatment of portal vein thrombosis and discuss various aetiological factor of obstruction also underlining the frequent and important association with portal hypertension. The authors emphasize the crucial role of the modern diagnostic techniques such as endoscopy and imaging radiology (U.S., C.T., angiography). Although these techniques not always allow a conclusive evidence in relation to aetiology, however, it is possible to have a rationale for the treatment, i.e. medical, sclerotherapeutic or surgical. As related to the surgical procedures, the authors--based on their personal experience--believe the best are the non-derivative ones.

[The diagnostic and therapeutic strategies in neoplasms of the adrenal cortex: the authors' own experience]. / Strategia diagnostica e terapeutica nelle neoplasie della corteccia surrenalica: contributo d'esperienza.

The Authors report their limited series of neoplasms of the adrenal cortex, and underline the decisive role of the modern diagnostics based on imaging techniques (US--TC--NMR). These, in fact, often allow a good definition also in the non-functioning adrenal masses incidentally discovered (incidentalomas). The authors emphasize the high quality of such diagnostic methods offering a good reliability in discriminating the nature of the adrenal mass. These undeniable diagnostic advantages have a positive impact on the surgical strategy, allowing together with a careful morphological study of the lesion, to program in detail possible demolitive operations. The authors finally underline the importance of the surgical access: they are persuaded the best is the bilateral under-rib incision. This surgical approach assures a complete exploration of the abdominal and pelvic cavity; moreover, it allows to face every complication.

[Esophagogastric devascularization in bleeding esophageal varices due to portal hypertension: median-term results]. / La devascolarizzazione esofago-gastrica nelle varici esofagee sanguinanti da ipertensione portale: risultati a medio termine.

The authors report their personal experience in the treatment of bleeding gastroesophageal varices related to portal hypertension. The excellent results of the esophagogastric devascularization observed in the middle-term follow-up (5 years) reinforced authors' opinion on this surgical procedure as the most valid alternative to derivative surgery. Furthermore, they emphasize esophagogastric devascularization can often replace, on principle, derivative surgery.

[A right hepatectomy extended to segment IV for hepatocellular carcinoma. A case illustration]. / L'epatectomia destra allargata al IV segmento per HCC. Illustrazione di un caso.

The authors report their experience in the management of hepatocellular carcinoma, describing a right hepatectomy extended to the left medial segment (IV segment). They also emphasize the treatment of the remaining part of the liver and pay attention to the retrieval of blood.

[Internal biliary diversions in inoperable neoplasms of the biliary tract and pancreas]. / Le derivazioni biliari interne nelle neoplasie inoperabili delle vie biliari e del pancreas.

The authors report their experience with the treatment of mechanical jaundice in inoperable malignant neoplasms of the bile ducts and pancreas. They emphasize the importance of intrahepatic peripheral biliodigestive derivations (Soupault and Couinaud operation). After a review of the international literature, the authors consider the value of on accurate surgical strategy even in the presence of pathological and clinical features which may limit a radical choice.