[Spigelian hernia: an up-to-date]. / Attualità dell'ernia di Spiegel.

Nine cases of Spigelian hernia occurred and surgically treated in the years 1992-1997 are reported. Spigelian hernias were observed in 5 females and 3 males with mean age of 62.1 years (range 49-70). In 5 cases prosthetic repair has been done with preperitoneal mesh and a very good outcome. In a 61 years old obese female spigelian hernia was bilateral. Her left sided hernia needed an emergency operation for strangulation. Hernia has been repaired by simple suture and recurred early. For the diagnosis of Spigelian hernia it is essential to remember it inside the "Spigelian belt". The satisfactory results obtained at present by prosthetic repair are underlined.

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

[The long-term results of mechanical anal sphincteroclasis]. / Risultati a distanza della sfinteroclasia anale meccanica.

BACKGROUND: The long-term results of 36 patients operated of manual dilatation of the anus are presented. Chronic anal fissure or benign anal stricture have been treated by this procedure in the years '80s. METHODS: Patients have been in part clinically examined and the other called up by phone interview. Average follow-up is 78 months. RESULTS: Nobody has been re-operated for the same cause, but 2 patients underwent sphincter sparing operation for rectal cancer. Twenty-five patients (72%) completely recovered, 5 (12.5%) complain sometimes from sudden anal pain and 3 (8%) report minor incontinence problems. CONCLUSIONS: These long-term results do not confirm disastrous conclusions reported by other authors in the literature, even if the incidence of continence disorders is higher than in anal sphincterotomies.

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

[Stoppa's intervention. The complications nd results]. / L'intervento di Stoppa. Complicanze e risultati.

The authors report their experience with the giant prosthetic reinforcement of the visceral sac (Stoppa procedure), developed in the last 6 years operating 126 cases. Postoperative period was regular for two third of the patients, but only in 4 cases we can consider complication severe: 2 cases of preperitoneal haemorrhage with haematoma formation and subsequent recurrence; one sepsis of the preperitoneal space around the prosthesis, cured with drainage and conservative measures without recurrence, and then one peritonitis in a morbid obese individual. There was no mortality. 93.3% of the patients has been clinically controlled after over 6 months (average 27 months; range 6-67 months): 8 recurrences have been observed (3.6% of the hernias operated). 7 required reintervention. Therefore it is possible to affirm that 91% of the operated patients had good results.

[Prosthetic repair of inguino-crural hernia using Rives technique]. / La riparazione protesica dell'ernia inguino-crurale con la tecnica di Rives.

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected.

[Extra-pelvic mesonephric cyst]. / Una cisti mesonefrica extra-pelvica.

The authors report a case of parovarian mesonephryc cyst that came out through femoral canal outside the pelvis and appeared in crural region. Briefly its features are discussed and compared to Literature.

[Hemorrhagic pseudocyst of the spleen]. / La pseudocisti emorragica della milza.

The authors report a rare case of haemorrhagic pseudocyst of the spleen in a 37 years old female who had always enjoyed very good health and who didn't remember any previous chest or abdominal traumas. Due to the initial refusal of the patient to undergo splenectomy, it has been possible to follow pathology progress. An echography of the cyst 6 months later, showed a maximum diameter increase of more than 2 cm and a further thinning of the cyst wall. Afterwards the patient decided to undergo the operation. The spleen showed a hollow of 10 cm of maximum diameter, with a degraded haematic content; the final histological examination confirmed the initial diagnosis of haemorrhagic pseudocyst of the spleen.