Intraoperative radiofrequency ablation: intraductal cooling of the main bile ducts for the prevention of heat damage. A case report.

Intraoperative radiofrequency (RF) ablation has recently become a valid procedure in the treatment of liver primary or secondary malignancies in selected cases. This procedure can be used alone or in association with surgery in treating lesions not considered for curative surgery. Heat damage of the main bile ducts represents nowadays a limitation in the use of radiofrequency ablation of hepatic lesions. Up to now, in tumors proximal to a main bile duct or to the biliary bifurcation this procedure has been contraindicated. In order to preserve these structures from heat damage, a new technique consisting of intraductal cooling of the bile ducts has recently been introduced. We report a case of successful experience with this technique.

Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy.

The case is described of a 74-year-old woman who presented with an abdominal abscess 1.5 years after laparascopic cholecystectomy. CT and ultrasound showed the presence of gallstones within the abscess. Spillage of gallstones from perforation of the gallbladder is a well recognized complication of laparascopic cholecystectomy, although subsequent abscess formation is unusual especially after a long delay as in this case.

[Surgical treatment of extrahepatic biliary lithiasis and Kehr's tube. Indications]. / Terapia chirurgica della litiasi biliare extraepatica e tubo di Kehr. Indicazioni.

The paper outlines the indications for the use of Kehr's tube in the surgical management of extra-hepatic biliary lithiasis by reporting the authors' personal experience relating to the period 1988-1992. In line with data reported in the literature the paper emphasizes the value of Kehr's tube not only in those cases where it is necessary to prevent choledochotomy and radiological control, but above all were the postoperative possibility of removing any residual calculi using litholytic, endoscopic or lithotripsic methods, is of prime importance.

[Video laparoscopic cholecystectomy. An analysis of our initial experience]. / La colecistectomia videolaparoscopica. Analisi della nostra esperienza iniziale.

The paper analyses the authors' initial experience of video laparoscopic cholecystectomy, outing the difficulties and incidence of morbidity in the preliminary group of 38 patients. The details of complications and their pathogenesis are also reported.

[Recurrent inguinal hernia. The surgical procedure and technic]. / L'ernia inguinale recidiva. Tattica e tecnica chirurgica.

The authors describe two years and six months of personal experience in the treatment of recurrent inguinal hernia with polypropylene mesh. There was a follow-up with controls every 6 months with excellent results. From the data of the operation we programmed a further control 1'after 5 and 10 years. Considering the limited number of cases and the fact that the follow-up is not yet at completion, the information is provided as preliminary.

[Inguinal hernia repair with marlex mesh in a preperitoneal site using the classical inguinal access]. / La riparazione delle ernie inguinali con rete di marlex in sede preperitoneale mediante accesso inguinale classico.

Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis.

[Two cases of adrenal myelolipoma]. / A proposito di due casi di mielolipoma del surrene.

The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.

[The surgical treatment of biliary lithiasis in the patient of an advanced age]. / Il trattamento chirurgico della litiasi biliare nel paziente in età avanzata.

The paper reports the authors' experience in the treatment of biliary lithiasis in elderly patients. The indications for surgery are examined taking into account the possibilities offered by the introduction of new technologies, and in particular preoperative EPST.

[Diagnostic and therapeutic strategy in extrahepatic biliary lithiasis. Our experience]. / Strategia diagnostica e terapeutica nella litiasi biliare extraepatica. La nostra esperienza.

The paper describes the Authors' personal experience in the diagnosis and treatment of extrahepatic biliary lithiasis in 166 patients admitted to the Surgical Division of the International Evangelical Hospital. The basic tests for a correct diagnostic strategy are echotomography and ERCP in cases of jaundice and/or dilatation of the biliary tract with negative echographic results for lithiasis of the choledochus. The indications for surgery are also discussed and the new possibilities of pre- and post-operative PSTE are also taken into account.