Randomised trial comparing LigaSure haemorrhoidectomy with the diathermy dissection operation.

The study was designed to compare LigaSure haemorrhoidectomy with open haemorrhoidectomy performed by means of diathermy excision. Fifty-sixty consecutive patients with third- and fourth-degree haemorrhoids were randomly allocated to undergo either LigaSure haemorrhoidectomy (29 patients) or diathermy haemorrhoidectomy (27 patients). All patients were evaluated for operative time, pain, post-operative analgesic requirements, time to first bowel movement, length of hospital stay, wound healing period, time to return to work, and occurrence of early postoperative complications (such as urinary dysfunction, bleeding, soiling, seepage, continence disorders) and late complications (such as stenosis). A statistically significant advantage was observed in the patients who received the LigaSure technique as far as concerns length of operative time (9.2 vs. 12.2 min, p<0.001), post-operative analgesic requirements (14.1 vs. 16.8 administrations, p<0.001), wound healing period (16.3 vs. 37.5 days, p< 0.0001), and time to return to work (8.3 vs. 18.3 days, p<0.01). No significant difference was seen in the postoperative pain score, complications rate, first bowel motion or hospital stay. No recurrence was observed at the 6-month follow-up. In conclusion, our experience shows that the LigaSure haemorrhoidectomy offers definite advantages over the classic diathermy technique. This procedure is easier, safer, and more rapid to perform and is followed by a faster wound healing time, a significantly shorter hospital stay, less postoperative pain and faster wound healing.

Parastomal hernia surgery: personal experience with use of polypropylene mesh.

Following stoma construction, parastomal hernia is the most frequent complication. Many surgical techniques have been postulated for these patients, and prosthetic surgery represents the first-choice treatment. We report our personal experience with 8 cases of parastomal hernia in patients submitted to abdominal perineal resection according to Miles, for carcinoma of the lower rectum. Polypropylene mesh was shaped according to the size of the fascial defects, characterized by a romboid incision about 4 cm in length. The mesh was placed in suprafascial position, after suturing the fascial tear. One case of wound infection occurred and, to date, none of the patients have presented with recurrence after a 3-year follow-up. In conclusion, the use of polypropylene mesh for parastomal hernia repair represents a safe and successful technique.

Tall cell variant of papillary thyroid cancer.

Papillary histologic type is the most common form of thyroid carcinoma amounting to 85% cases. This pathology presents a rather good prognosis, but a few years ago, new subtypes have been described. Some of these variants show a fairly good prognosis i.e follicular, macropapillary, encapsulated while others appear to have a decidedly worse one, columnar cells, diffused sclerosing, or even to be clearly malignant as in the case of the tall cell variant. The authors report a case treated by a combined surgical and radiometabolic therapy and evidence the main characteristics of this rare and underestimated neoplasia.