[Current role of abdomino-perineal amputation]. / Ruolo attuale dell'amputazione addomino-perineale.

In Italy 6.5% of cancer deaths can be attributed to localized colorectal cancer of which rectal cancer alone accounts for 33%. The introduction of mechanical staplers and new techniques (colo-anal anastomosis) into colon surgery has led to a drastic reduction in indications for Miles' operation in favour of techniques which aim to conserve the sphincter. From October 1987 to March 1991 the Surgical Clinical of the Ospedale Maggiore in Novara operated 75 patients with rectal cancer. Twenty-eight patients underwent APA (abdominoperineal amputation) whereas 47 underwent conservative surgery, referred to as SSR (sphincter-saving resection). Of the 28 APA patients, 19 revealed a localisation in the lower rectum (0-5), 7 in the mid rectum (6-8) and 2 in the upper rectum (9-15). In the latter two cases the considerable size of the tumour mass and the extraparietal diffusion of the tumour led the authors to prefer APA rather than SSR. In SSR the minimum distal safety margin from the tumour was 2 cm, whereas the mean distance of the tumour from the anal margin in APP patients was 4 cm, and that in SSR patients 11 cm. The stage of cancer was not taken into consideration when choosing the type of surgery. Postoperative mortality was 3.5% for APA and 2% for SSR. The overall incidence of recidivation was 20%, equivalent to 11 patients. Recidivation was found to be more frequent in the lower rectum (6 cases) compared to the upper rectum (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastric surgery in morbid obesity. Apropos of 101 cases]. / Chirurgie gastrique dans l'obésité morbide. A propos de 101 cas.

The authors analyze the complications and the results of gastric surgery for morbid obesity, on the basis of their personal experience. After abandoning up jejunoileal by-pass because of its severe complications, they started to perform gastric by-pass and vertical banded gastroplasty according to Mason. The number of severe complications was low and the results on the weight loss were good, without any disturbance of metabolic and nutritional tests. Gastric by-passes and gastroplasties had similar results. The authors suggest that gastroplasty could be the technique of choice as it is a simple and quick operation, without anastomosis, which ensures a better respect of gastroduodenal physiology and the possibility of exploration of the distal gastric pouch.

[A rare complication in the suppression of a porto-systemic shunt in disabling encephalopathy]. / Considerazioni su una rara complicanza nella soppressione di shunt porto-sistemico per encefalopatia invalidante.

The authors describe an uncommon complication in a case of side-to-side portacaval shunt which was suppressed due to disabling portal-systemic encephalopathy; the patient was treated by esophageal transection with esophagogastric devascularization and nonoperative secondary occlusion of the shunt by external elastic traction on a Silastic catheter surrounding the anastomosis: a stenosis of the caval vein under traction required another operation in order to close the shunt.