Anorectal and perineal injury due to a personal watercraft accident: case report and review of the literature.

We report a case of a 28-year-old male with an anorectal trauma sustained while he was riding as a passenger on a personal watercraft. Management, treatment and outcome of the case are described. A brief analysis of the literature is discussed.

Rare cause of biliary obstruction by ascariasis associated with choledocholithiasis.

Ascariasis, the most common parasitic infestation of the gastrointestinal tract, is typical of tropical and subtropical countries. Migration of the worm to the bile ducts is rare and has been exceptionally observed in developed countries. This study reports a case of biliary ascariasis associated with gallbladder and common bile duct lithiasis observed in Italy in a 60-year-old woman originating from Senegal. The patient was treated with endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy, and antihelminthic therapy. In particular, ERCP allowed the diagnosis and the extraction of the parasite from the papilla of Vater. After a 6-month follow-up, the patient is in good condition, without signs of cholestasis in laboratory values and no dilatation of the biliary tree at abdominal ultrasound. Although biliary ascariasis is rare in Western countries, the increase in population migration makes it necessary for clinicians world-wide to consider this difficult diagnosis and to determine how to treat it in the most conservative way.

[Incisional hernia repair in the region of Brescia and in Lombardy: results of a survey and discussion]. / Il trattamento del laparocele in provincia di Brescia e in Lombardia. Risultati di un'inchiesta e loro discussione.

This paper reports the results of a survey on the surgical therapy of incisional ventral hernia in the county of Brescia (19 surgical wards) compared with the results in Lombardy. Using epidemiological data on open and laparoscopic surgery we investigated the recent trends in this kind of surgery, addressing aspects that are not yet supported by evidence-based data in the literature. Laparoscopic repair is performed in about half of the surgical wards, and in the majority (85%) of Lombardy hospitals that replied to the questionnaire. It is also performed in a small number of primitive ventral hernias. The creation of a pneumoperitoneum is accomplished both by the Verress and the Hasson techniques, without significant differences. Composite meshes have proved most interesting, and fixation by titanium spiral tacks is most commonly used. We found rapid discharge and low morbidity rates, similar to the published data. The preferred open technique is still the Rives-Stoppa submuscular mesh repair. It is generally agreed that there will presumably be a major diffusion of laparoscopic repair, in spite of the fact that it is nowadays performed only by surgeons familiar with advanced laparoscopic techniques and is still more expensive than open repair, which, however, is offset by the distinct benefit afforded by the patient.

[Multilevel atherosclerotic lesions of the lower limbs. Simultaneous surgical and endovascular approach. A case report]. / Lesioni aterosclerotiche "multi-level" dell'arto inferiore. Approccio terapeutico simultaneo, chirurgico ed endovascolare. Caso clinico.

Surgical treatment of femoro-popliteal atherosclerotic occlusion usually consists in a femoro-distal bypass. However, the associated presence of proximal lesions that reduce prosthesis inflow, or of distal lesions that increase resistances may be decisive factors in determining the outcome of the revascularisation. Frequently, an iliac or common femoral artery stenosis can be treated with an endovascular technique prior to surgery, thus increasing the bypass inflow that is going to be created. On the contrary, in the case described here, the stenosis was distal to the femoropopliteal bypass and was treated with PTA + stenting, thus increasing the run-off and the theoretical long-term patency. Therapeutic indications and technical options are discussed in the light of the recent international literature and the new achievements in terms of endovascular technique.

Introduction of laparoscopic appendectomy: a retrospective comparison with the open technique.

Laparoscopic appendectomy (LA) is gaining favour as an alternative to the traditional laparotomic technique (OA) despite the persistence of controversy regarding indications, morbidity, hospital stay, costs and surgical time. We present a retrospective analysis of our first three years of experience with the procedure. During this period we performed 235 appendectomies (102 laparoscopic and 133 laparotomic). The conversion rate was 9.7%, due to severe peritonitis, high-grade inflammation and an unfavorable position of the appendix; we found a significantly higher percentage of difficulty due to these factors in the laparotomic procedures. Operating time was similar in the two groups. The rate of associated pathology was higher (22.5% vs 6%) after laparoscopy, but conversion to laparotomy was never necessary for treatment. Early morbidity was limited to 2 patients who underwent laparoscopic appendectomy (1 re-operation for a micro-abscess and 1 conservatively treated haemorrhage), while wound infections (13.5% vs 1.9%) and incisional hernias (0% vs 2.3%) were more frequent in the open procedures. Hospital stay was slightly less in the laparoscopic group (4.0 vs 4.7 days). In our initial experience, laparoscopic appendectomy has shown significant advantages in terms of intraoperative diagnosis of associated diseases and diminished morbidity. We advocate a laparoscopic approach to appendicular disease, reserving conversion to laparotomy for selected cases after exploration.