[Comparison of Nd-Yag laser and strip biopsy in the treatment of extensive adenomas of the rectum]. / Confronto tra Nd-YAG laser e strip biopsy nel trattamento degli adenomi estesi del retto.

This prospective study was carried out in order to compare endoscopic laser therapy and strip biopsy for treatment of large sessile rectal adenomas. Between January 1990 and December 1991, 94 consecutive patients, referred to our Endoscopy Service because of extensive rectal adenoma have been allocated to laser therapy or strip biopsy. The effectiveness of the two techniques was statistically the same from many points of view: complete ablation (76.7% vs 71.4%), recurrence (35.4% vs 30.6%) need for surgical intervention (12% vs 16.6%) and complication rates. However, from our experience, the treatment period was significantly shorter for patients affected by an intermediate sized adenoma and treated with strip biopsy. In both groups, instead, complete, permanent ablation was difficult to obtain in the cases of extensive lesions and in particular if they were localized lower than 5 cm from the anus.

[Repair of splenic lesions with video-laparoscopy]. / Riparazione di lesioni spleniche in videolaparoscopia.

Conservative therapy of spleen injuries (non-operative treatment, partial splenectomy, autotransplantation, etc.) makes it possible to avoid the risk related to post-splenectomy hyposplenism. The videolaparoscopic approach makes the performance of such treatment possible achieving a clear reduction in surgical stress. The authors report two multiple injured patients showing spleen lesions, treated conservatively through videocoelioscopic procedure. Both patients (a 42-year-old woman and a 26-year-old man) presented hemorrhagic shock in hemodynamic compensation and hemoperitoneum. Abdominal ultrasonographic scanning proved the presence of spleen injuries. Both patients underwent a conservative surgical videolaparoscopic treatment using fibrin glue and omentoplasty. The resolution of the hemorrhagic shock and the restoration of the spleen lesions were achieved in both cases. The authors have already used the videocoelioparoscopic approach both in elective (biliary lithiasis, inguinal hernia, appendicitis, etc.) and in emergency surgery (acute cholecistitis, perforated ulcer, intestinal obstruction, etc.). They note the effectiveness of the method, also in the field of the mini-invasive conservative treatment of parenchymatous organ lesions (mainly in the case of spleen injuries, when the splenic function has to be preserved). So, it's possible to add the advantages of a conservative treatment to those of the minimal invasivity, provided by the videolaparoscopic procedure.

[Personal experience in the treatment of esophago-cardial stenosis with the Nd-YAG laser]. / Esperienza personale nel trattamento con Nd-YAG laser delle stenosi esofago-cardiali.

The authors analyze the results of treatment, by Nd-YAG laser. of benign and malignant esophageal and cardial stenoses. Particularly the personal technique, immediate and late complications and association with complementary techniques such as dilatation or intratumoral injection of polidocanol are evaluated.