[Ramirez abdominoplasty for large incisional hernia: personal experience]. / L'addominoplastica secondo Ramirez nei laparoceli voluminosi: esperienza personale.

The Authors report their experience with the surgical treatment of incisional hernias over the period from July 2000 to June 2004 in the Division of General Surgery of the Department of Surgical Sciences of the University of Foggia where 22 patients were operated on. Nine of them had an incisional hernia of considerable size, while in the other 13 patients the hernia was less voluminous. The authors emphasise the essential role of synthetic prostheses (polypropylene) which now replace and supersede the reabsorbable ones which have fallen into disuse due to the lack of guarantees regarding their strength over lengthy periods. An interdisciplinary approach is now mandatory for a pathology which requires the contribution of many different healthcare operatives such as cardiologists, respiratory physiopathologists, physiokinesitherapists, endocrinologists and resuscitators who all share in the work of the surgeon who represents the last link in the chain and has the technical task of resolving the basic pathology. The technique adopted for the larger incisional hernias was a Ramirez abdominoplasty, the first step of which consists in a very meticulous separation of the different structures of the abdominal wall followed by synthesis of the different anatomical layers with the application of polypropylene meshes. Our results in terms of intra- and postoperative mortality, complicating diseases and hospitalisation are compared with those reported in other studies using the Rives technique.

[Prosthetic treatment in inoperable cancers of the oesophagus and cardia: a report of 7 cases]. / Il trattamento protesico nelle neoplasie inoperabili dell'esofago e del cardias: contributo di 7 casi.

The Authors report their personal experience with 9 patients affected by cardial cancer and 4 with medio-distal oesophageal cancer, treated at the Department of Surgical Sciences of the University of Foggia. Of the 9 patients with cardial cancers, 4 were submitted to total gastrectomy; while the other 5, who had clearly inoperable forms, were fitted with a self-expanding metal prosthesis (Ultraflex). Of the 4 cases with medio-distal oesophageal cancers, which were considered beyond any kind of surgical treatment, 2 (with stenosing forms) were fitted with the self-expanding prosthesis (Ultraflex), while the other 2 (with friable, bleeding tissue) were treated by laser therapy with all the drawbacks such treatment entails. After application of stents, dysphagia decreases and on the whole we obtain real functional success and a better quality of life. Furthermore, the percentage of acute complications such as profuse bleeding, perforation of the pharynx or migration of the prosthesis and late complications such as obstruction by food, neoplastic obstruction, or haemorrhage is marginal. Finally, the ease of application and the economic saving achieved (due to reduction in hospitalisation time and charges) confer undeniable additional advantages on the procedure.

[Esophago-pharyngeal diverticulum: a case report]. / Diverticolo faringo-esofageo: presentazione di un caso.

The Authors report a case of Zenker's diverticulum seen and treated at the University Department of Surgical Sciences of the University of Foggia. The treatment of this condition is invariably surgical and consists in a diverticulectomy combined with a lengthwise extramucosal myotomy. This latter technical adjunct, however, would not appear to be accepted by all Authors. Other techniques have been proposed for the treatment of this condition, but no confirmation of their efficacy exists in the literature. Mortality fluctuates in the various case series, from 0.45% to 8.1%, and the morbidity varies from 5.3% to 40%. The risk of postoperative complications is always present, but can be reduced if the patient undergoes a thorough preoperative investigation.