A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair.

BACKGROUND: The aim of this prospective, randomized, controlled clinical study was to compare laparoscopic transabdominal preperitoneal (TAPP) hernia repair with a standard tension-free open mesh repair (open). METHODS: A total of 108 low-risk patients with unilateral (primary or recurrent) or bilateral hernias were randomized to TAPP (group 1 = 52 cases) or open (group 2 = 56 cases). The outcome measures included operating time, complications, postoperative pain, return to normal activity, operating theater costs, and recurrences. RESULTS: The mean operative time was longer for the TAPP than for the open group only in unilateral primary hernias. At rest, the median Visual Analog Scale (VAS) score was higher for group 1 than group 2 at 48 h postoperatively. Mild to discomforting pain in the inguinal region after 7 days, night pain after 30 days, and inguinal hardening after 3 months were more frequent in group 2 than group 1. No significant differences were observed in return to normal activities between the groups. One hernia recurrence was observed after 1 month in group 1. TAPP was significantly more expensive than open. CONCLUSIONS: TAPP was associated with less postoperative pain than open. The increase in operating theater costs, however, was dramatic and was not compensated by shorter time away from work. TAPP should not be adopted routinely unless its costs can be drastically reduced.

[Percutaneous needle aspiration biopsy in intrathoracic lesions]. / Agoaspirato percutaneo nelle diagnosi delle lesioni intratoraciche.

The authors report their experience of transthoracic needle biopsy of the lung based on 68 consecutive cases from 1984 to 1990. In 55 cases significant data has been found: in 44 cases the diagnosis was exact, instead in other 11 cases it was only indicative. The overall complications were 11.7% and in particular were as follow: pneumothorax in 5 cases, hemoptysis in 2 cases and a temporary Horner syndrome in one case. The authors conclude by confirming the utility of transthoracic needle biopsy of intrathoracic tumors in which there is not other way to obtain a diagnosis. This technique is reliable and its complications can be disregarded.

[Treatment of spontaneous pneumothorax]. / Il trattamento del pneumotorace spontaneo.

Following an analysis of current treatment strategies for spontaneous pneumothorax and their surrounding controversies, the paper reports the Authors' personal experience. From 1 January 1984 to 31 December 1989 a total of 76 cases of spontaneous pneumothorax were treated, of which 3 were bilateral. The M:F ratio was 9:1 and the age of patients ranged between 16 and 77 years (mean age 39.2); 22 cases were relapses (27.8%). Conservative therapy was used in 12 cases (15.1%); pleural drainage was introduced in 54 cases (68.3%) for a mean of 7.5 days. Fourteen thoracotomies were performed in 13 patients (10.4%): bullectomy was performed 10 times with stapler, whereas pleurodesis was obtained in 9 cases using pleural abrasion and in 5 cases using apical pleurectomy plus pleural abrasion. Axillary thoracotomy at the 5th space was most commonly used. No major complications were observed during the postoperative period and, in spite of the minimum follow-up of 3 months, no cases of relapse were observed in operated patients.

[Prevention of colonic ischemia during surgery of the aorta]. / Prevención de la isquemia colónica durante la cirugía de aorta.

The authors report the results of 53 revascularizations of the Inferior Mesenteric Artery, performed during 315 aortic reconstructive procedures, in 19 (35.85%) cases out of a group of 102 aortic aneurysms and 34 (74.15%) cases in a group of 213 aorto-iliac obstructive lesions. The "Carrel patch" technique was always used for the aneurysms of the aorta abdominal cases, whilst this technique was always adopted for only 21 obstructive patients; in the remaining 13 a personal technique was used and is here described. The long term results show a good patency rate (63.7%) for the reimplanted artery, planted artery, but above all no case of colonic ischemia in this group to compare with the 3 cases occurred in the no reimplanted group.

[Esophago-jejunal anastomosis using an end-to-end anastomosis stapler. Clinico-radiologic study of early complications in 75 cases]. / L'anastomosi esofago-digiunale con E.E.A. Stapler. Studio clinico-radiologico delle complicanze precoci su 75 casi.

Personal experience with 75 consecutive cases of terminolaterale oesophagojejunal anastomosis by EEA Stapler is reported. A total of 6 intraoperative technical problems were encountered (8%) and consisted either of incomplete suturing of the anastomosis or stapling of the jejunal wall. Postoperative radiology revealed 5 dehiscences (6.6%) and 1 stenosis (1.33%). One patient with dehiscence died (1.33%) of septic complications. One dehiscence of the afferent jejunal stump and minor pleuropulmonary complications were observed in 3 cases. After a brief review of the literature, it is concluded that oesophagojejunal anastomosis by EEA Stapler produces a low incidence of postoperative complications such as the dehiscence, stenosis or bleeding.

Early gastric cancer: evaluation of diagnostic, clinicopathologic and therapeutic aspects in 60 cases.

A series of 60 patients with early gastric cancer (EGC) operated on from 1.1.1971 to 31.5.1983 is reviewed; since three cases had two and another case even had three synchronous primitive neoplastic lesions, a total of 65 EGC are reported. A prevalence of the "ulcerated" types, a large variability of lesion size and a prevalence of location along the lesser curvature and the antrum was observed; 38 EGC (58.46%) were confined to the mucosa (m), 27 (41.54%) also involved the submucosa; histologically, 53 EGC (81.54%) were of the intestinal type, and 12 (18.46%) were of the diffuse type. Associated lesions, above all chronic atrophic gastritis, intestinal metaplasia and adenomatous gastric polyps were often found. Clinical symptoms were not very specific (epigastric pain, abdominal distension, vomit, dyspepsia, GI hemorrhage) whereas x-ray and endoscopic evaluation had a very high diagnostic accuracy. Our policy is to perform curative resection for gastric cancer, in the form of partial or total gastrectomy with the removal of first level (n1) and second level (n2) lymph node groups and occasionally additional resection of enlarged lymph nodes in the tertiary (n3) group when metastases are suspected. All our patients have been followed up in order to detect any recurrences or metastases.

[Case contribution on intraoperative cholangiography]. / Contributo casistico per la colangiografia intraoperatoria di routine.

An assessment is made of the systematic application of intraoperative cholangiography in the light of a consecutive series gathered over a period of four years. The importance of employing this technique as a routine measure is clearly demonstrated by the results. If properly performed, it greatly reduces unnecessary choledochotomy, diminishes the incidence of overlooked calculi, and leads to the detection of papillo-oddian diseases.