[A serious complication in colorectal surgery: anastomotic leakage. Our experience]. / Una grave complicanza in chirurgia colorettale: la fistola anastomotica. Nostra esperienza.

Anastomotic leakage is a severe complication in colorectal surgery with a lot of generic and specific risk factors. There are still controversies about the possibility to prevent it or to limit its severity with the use of faecal diversions. We report our experience on 189 patients operated in five years on colon-rectum, in election and emergency, with manual or mechanical anastomoses in the last 20 cm from the anal verge. We have had 21 anastomotic leakages (11%), symptomatic in 10 cases (5.5%), and 5 deaths (2.6%), 3 directly correlated to the leakage. In the patients (n 98) with loop-ileostomy there wasn't anastomotic leakages reduction, but only of clinical impact. We prefer loop-ileostomy in cases of extraperitoneal anastomoses, always in emergency and in anastomoses at risk.

[Laparoscopic cholecystectomy for acute cholecystitis: our experience]. / La colecistectomia videolaparoscopica nella colecistite acuta: nostra esperienza.

Laparoscopic cholecystectomy (LC) is now the gold standard in the treatment of cholelithiasis. LC is safe even in patients with acute cholecystitis. In our 118 cases there was 4 major complications as bile duct injuries (3%) and 13 minor complications (11%); conversion rate was 21% (24 patients), without mortality. Our experience confirms the validity of early LC in the treatment of acute cholecystitis, but laparoscopic procedure is associated with higher conversion rate (21% versus 3%) and complication rates compared to the treatment in non-acute patients.

[Manual colonic anastomosis with continuous single layer suture. Our experience]. / Anastomosi coliche manuali con sutura continua monostrato. La nostra esperienza.

The use of staplers has produced a reduction on operative times in the colorectal surgery without reduction of anastomotic complications. We present our experience about colonic anastomoses (ileo-colic, colo-colic and colo-rectal intraperitoneal anastomoses) with extramucosal one-layer continuous suture in synthetic slow absorbable one-filament. In the period January 2000-January 2003 we performed 157 operations on the large bowel, with 113 manual colonic anastomoses. Our results are similar to the best series of literature. The hand-sewn suture actually represents our common technique for the anastomoses of the large bowel.

[Digestive anastomosis in general surgery]. / Le anastomosi digestive in chirurgia generale.

Still today the digestive anastomoses are a subject very discuss and controversial in relation to the better technique. In fact the introduction of mechanical suture has placed the problem between this instrumentation and the classic technique. The Authors, comparing these two techniques, observe the peculiar aspects of each one and relate on the progresses, in last years, whether of the mechanical suture, with the improvement of the handy and the resistance of the anastomosis, or the threads of suture, ever more inert and resistant. Subsequently, the Authors relate your experience showing the form of realization of the anastomoses in the esophagogastric surgery, small intestine, colon-rectum, hepato-biliary and pancreatic surgery. In particularly, about the hand-sewn anastomosis, the Authors relate personal technique of reconstruction with extramucosal continuous suture, one-layer, with synthetic slow absorbable one-filament (PDS). In conclusion, the Authors declare that the introduction of the mechanical suture has certainly influenced the development of the new therapeutic solutions and has allowed intestinal anastomosis in sites of difficult access (abdominal esophagus, low rectum), but they think that the surgeon must to learn to know when is useless or neoplastic mechanical suture and he can realize manually the same anastomosis with quickness and safety.

[Clinical considerations on a case of giant ovarian cysts]. / Considerazioni cliniche su di un caso di cisti ovarica gigante.

The Authors report a case of giant ovarian cyst recently observed. The diagnosis was quite difficult because the patient refused for long time to undergo clinical examination. Following elective surgery a complete recovery was obtained, and at six months from the operation the patient is in good health.

Reoperation for retained and recurrent bile duct stones.

The results obtained in 45 patients who underwent 48 common bile duct reoperations for retained or recurrent choledocholithiasis are reported. The preoperative diagnosis was based on intravenous cholangiography and, in jaundiced patients, on echography and percutaneous transhepatic cholangiography with a Chiba needle. The operations performed on the biliary tract were choledocholithotomy and sphincterotomy (46%), choledocholithotomy (21%), sphincterotomy (16%), choledochoduodenostomy (15%) and Roux-Y choledochojejunostomy (2%). There were three (6.6%) operative deaths: one biliary fistula and two massive digestive hemorrhages. Follow-up lasting from six months to 16 years was carried out in 83% of the patients: 73% reported complete well-being. The causes of "secondary" calculosis are analysed with a critical review of the cholangiographic data and the technique performed. The authors conclude that routine operative cholangiography with the possible addition of choledochoscopy, and adequate biliary drainage are sufficient to prevent "secondary" choledocholithiasis.