[Videolaparoscopic cholecystectomy in the obese patient]. / La colecistectomia videolaparoscopica nel paziente obeso.

The difficulties which arise when performing VLC in obese patients primarily concern the induction of pneumoperitoneum and the use of normal surgical instruments. This is due to the thickness of the abdominal wall and the scarce anchorage of the cutis and subcutis to the musculo-fascia level. Two technical variations of pneumoperitoneum are proposed in order to overcome the first problem, whereas with regard to the latter the authors suggest moving the trocar insertion points towards the site of the gallbladder.

[Transrectal polypectomy using a TEM (transanal endoscopic microsurgery) technique]. / Polipectomia transrettale con tecnica TEM (transanal endoscopic microsurgery).

The paper describes the removal of a broad-based tubulo-villous adenoma from the middle rectum using a transanal endoscopic microsurgical technique. This procedure, which was introduced by Buess, Thess and Hutterer in 1983, represents an alternative to the classic transanal technique, compared to which it is more accurate, and to the trans-sacral and transperitoneal methods compared to which it is less invasive.

[Proctological surgery in the day-hospital regimen]. / La chirurgia proctologica in regime di day-hospital.

567 haemorrohoidectomies 83 of which total haemorrhoidectomies for piles with surgical indications, were performed with recourse to day-hospital admission. The authors examine the results of this experience and advise this therapy and this type of admission for pathologies with different cost/benefit ratio.

[Scintigraphy using indium-111-oxine as an aid to transrectal echography in the diagnosis of perianal abscess]. / La scintigrafia con l'utilizzo di indio 111-oxina quale ausilio dell'ecografia transrettale nella diagnostica della patologia ascessuale perianale.

The paper describes the authors experience relating to the use of indium-111-oxine scintigraphy as an aid to transrectal echography in the diagnosis of difficult anal fistulas. This method has proved useful in locating otherwise undetected accumulations and in controlling the outcome of operations with a "slow resolution" of the surgical wound. The marker showed a good level of resolution in that, as already shown in the case of chronic inflammatory diseases, marked leukocytes are prevalently located on the site of infection.

[Carcinogenic perianal fistula]. / Fistola perianale cancerizzata.

The paper reports a case of anal fistula which led to the formation of a muco-secreting adenocarcinoma. The case is described in the context of other published case reports.

[First experiences with trans-rectal echotomography in perianal abscess pathology]. / Prime esperienze di ecotomografia trans-rettale nella patologia ascessuale perianale.

Trans-rectal ultrasound with a 5 MHz probe was used to examine 16 patients who had perianal fistulas and 5 of them underwent one or more surgical explorations. In 11 cases, all surgically checked, sonography was able to demonstrate a pararectal abscess and accurately image the site, size, extension and--in some cases--the fistula itself. It can be advised that, using high frequency probes (7 or 10 MHz), transrectal ultrasound could provide even more exact diagnostic information in anorectal pathology.

[Possibilities and limitations of cryohemorrhoidectomy]. / Possibilità e limiti della crioemorroidectomia

The cryonecrosis process of haemorrhoids and cryonecrosis of living organic tissues follow the same laws. On the basis of these observations and of personal experience, the cryohaemorrhoidectomy technique is described and its most important practical aspects underlined.