Pudendal nerve block: a safe, simple and effective approach in surgical proctological patients.

BACKGROUND: Pudendal nerve block (PNB) is commonly used in pudendal neuralgia (PN) and, as anesthesiological technique, in obstetrical and urological procedures. The purpose of this retrospective study was to compare the efficacy of PNB with other anesthesiolocal techniques in proctological surgery. METHODS: A total of 362 patients were seen from a 22-month-time interval. Surgical indication was placed after a conservative therapy. Seventy-eight patients underwent surgery: 42 with spinal anesthesia with PNB and 36 with PNB alone according to their anatomical characteristics. All the patients underwent PNB in lithotomy position and with a perirectal approach. The success rate of PNB was evaluated in postoperative pain control with the VAS score, after the first and the second evacuation. The follow-up also included a third check on the seventh day after surgery. RESULTS: In postoperative period, the mean VAS score found after the first evacuation in patients undergoing PNB was 2.66, after the second evacuation was 1.55, while the VAS score on the seventh day was 0.38. The mean VAS score in the group who underwent spinal anesthesia and PNB were respectively 3.71 and 1.80 after the first and second evacuation. The VAS score calculated on the seventh day was 0.50. There were no statistically significant differences in the VAS score between the 2 groups (P>0.05). CONCLUSIONS: PNB may be a valid alternative to spinal anesthesia in proctological patients. PNB has proven to be both safe and effective technique.

Intestinal malrotation in one adult patient affected by SARS-CoV-2 infection: occlusion misdiagnosed as COVID gastroenteritis. Case report and literature review.

Malrotation of the gut is a rare occurrence, commonly diagnosed during childhood, but occasionally diagnosed in adults. In children, intestinal obstruction is the most common manifestation, whereas in adult patients, the diagnosis is more challenging since the symptoms are less specific with several episodes of abdominal pain and vomit. In a particular epidemic period, like the one we are going through, these generic symptoms may mislead to a wrong diagnosis. We present the case of a young man in which occlusion due to intestinal malrotation has been misinterpreted as gastroenteric symptoms of severe acute respiratory syndrome coronavirus 2 infection, and we also overview the correct Ladd's technique, commonly performed by pediatrical surgeon, but unusual operation for adult general surgeons.

Treatment of Acute Necrotising Pancreatitis and Its Complications: The Surgeon's Perspective.

Acute necrotising pancreatitis (ANP) is associated with high complication and mortality rates. It is still difficult for the surgeon to choose and schedule the most appropriate treatment. Compared to the past, the current minimally invasive "step-up" approach enables better outcomes in terms of morbidity/mortality, notwithstanding long periods of hospitalisation, and above all ensures better levels of residual pancreatic function. We hereby report the case of a patient hospitalised in our division for approximately 4 months with a diagnosis of ANP complicated by infection and late bleeding, handled with a sequential approach.

Appendiceal mucocele: three cases with different clinical presentation and review of literature.

Mucinous lesions of appendix are a rare clinical entity and may be neoplastic or non-neoplastic. The diagnosis is usual incidental during computed tomography scan or colonoscopy performed for general abdominal symptoms or occasional finding during operation for acute appendicitis. For this reason, initial treatment should be tailored to the situation, aiming at complete resection of the appendix with disease-free margins: this can be achieved by simple appendectomy or more extensive resection. The pathological examination of the specimen is the key to offer the patient a correct and complete treatment, and, if a neoplastic pathology is found, the case should be discussed in multidisciplinary group. We describe three cases with different clinical presentation leading to different surgical treatment: one elective case, in which the diagnosis was suspected preoperatively; and two urgent cases, one mimicking an intussusception and another one presenting as an acute appendicitis.

Possible impact of autologous blood towards elective open and laparoscopic surgery for colorectal carcinoma.

BACKGROUND/AIMS: An alternative approach to the allogeneic transfusion is patient's blood collection before the operation, using or not using the human recombinant erythropoietin. The aim of this study is to evaluate the percentage of people undergoing an elective operation for colorectal carcinoma who could avoid allogeneic blood due to blood predonation. METHODOLOGY: From January 1999 to April 2002, 249 patients (140 males and 109 females) underwent an operation for colorectal cancer. The most important parameter, used to estimate which patients are candidates for autologous blood predonation, is the before-treatment hemoglobin level. The other parameters we considered are the age of the patient, the absence of uncontrolled hypertension or clinically significant pathologies (except colorectal cancer), and the iron shortage. DESIGN: Retrospective cohort study. RESULTS: 36.5% of the patients satisfied every criterion to begin autologous predonation without using the human recombinant erythropoietin; instead, 23.7% of patients needed the administration of the human recombinant erythropoietin and additional iron. The valuation of the transfusional prospects, based on sex and cancer location is very interesting. CONCLUSIONS: Autologous blood predeposit in preoperational time turns out to be a method of increasing importance, thanks to the human recombinant erythropoietin.

[Recurrent groin hernia: a cognitive survey in Piedmont]. / Ernia inguinale recidiva: indagine conoscitiva in Piemonte.

The aim of this study was to analyze, using a cognitive survey, how recurrent groin hernia are treated in our region by surgical centres. A form was sent to 49 surgical centres in our region, considering the period 2002 -first six months of 2004, asking the number of primitive hernias treated, surgical technique, number of recurrent hernias treated, surgical technique, kind of anaesthesia and types of complications. We sent 49 forms, 41 (83.7%) were given back. During the considered period, 18 580 primitive hernias and 1102 recurrent (5.6% of all repair) were treated. The greatest part of it was performed with an open mesh technique tension free (77% of primitive hernias, and 62% of recurrent ones). Laparoscopic repair was performed in 0.2% of primitive hernias and 3.2% of recurrent ones. The operations were carried out mainly in spinal anaesthesia (722, 65.5%). Recurrence occurred in 34 cases (3.1%). In our region inguinal hernia repair both for primitive and recurrent groin hernia has been performed mainly by an open mesh technique, tension free and sutureless and, in greatest part, in spinal anaesthesia. Laparoscopic repair has not been used very much.