Chevrel technique for midline incisional hernia: still an effective procedure.

BACKGROUND: Prosthesis use in the treatment of incisional abdominal hernia is today an accepted concept worldwide. However, there is no agreement as to the most appropriate site of prosthesis insertion. The aim of this report was to analyse the operative steps of the premuscolo-aponeurotic repair and to present the results of our experience. METHODS: Between May 1996 and December 2006, 64 patients (52 women and 12 men, mean age 64 years) underwent a Chevrel repair for midline incisional hernia. They represented 52% of plasties performed for incisional hernia. Patients were subdivided according with Chevrel and Rath classification. Nineteen were operated on in emergency and 45 electively. Associated diseases, mainly cardiopathy, obesity, chronic pulmonary disease and diabetes, were recorded in 83% of the patients. Cholecystectomy and wide dermolipectomy were the more frequent procedures associated with plasty. Prosthetic material was polypropylene (53%), polyester (42%) and polypropylene + polyglactin 910 (5%). RESULTS: The mortality rate was 1.6%. Postoperative complications were exclusively parietal in 17 patients (26.5%), i.e. seroma, skin necrosis and superficial wound infection. No deep infection or intra-abdominal complications were observed. Mean postoperative hospital stay was 10 days, closely related to being elderly, associated operations and emergency admission. Two recurrences were registered, and chronic abdominal pain or late infections were not observed. CONCLUSIONS: Our experience shows that the Chevrel technique is a safe and effective procedure, easy to perform and reliable even in cases of septic risk.

[The incidence of 1,2-dimethylhydrazine-induced colonic neoplasms in the rat: the effect of constipation]. / Incidenza delle neoplasie coliche indotte da 1,2-dimetilidrazina nel ratto: influenza della stipsi.

The authors studied the role of slow bowel transit in the development of colonic neoplasias in rats treated with 1,2-dimethylhydrazine (DMH). Forty Sprague-Dawley male rats, weighing 400 g, were used in the experiment and were divided into 4 groups of 10 rats each. The first and the second group were given, weekly, subcutaneous injections of DMH at a dose of 25 mg/kg for 25 and 27 weeks respectively; in these groups constipation was obtained by reducing water intake throughout the period of the experiment. The third and the fourth group (control groups) received DMH at the dose of 25 mg/kg for 25 and 27 weeks respectively and water "ad libitum". The rats were weighed once a week and stool output, weight, and number of scybala/day were recorded once every four weeks. Rats were sacrificed one week after the final injection of DMH and every intestinal lesion macroscopically identified was histologically examined. All rats showed weight loss from the 22nd week to the sacrifice. The mean stool weight/day was 21.2 g +/- 1.47 in the groups A and B; while for the groups C and D it was 23.6 g +/- 1.81 (p = 0.019). The number of scybala/day was 26 +/- 3 in the groups A and B, whereas in the groups C and D was 34 +/- 4 (p = 0.05). An increased number of cancers per rat was recorded in the groups A and B compared to control groups, respectively from 0.66 to 1.4 at 25 weeks (p = 0.02) and from 0.9 to 2.44 at 27 weeks (p = 0.07). A corresponding increase in the number of polyps after 25 weeks was demonstrated, taking into account the possible polyp-cancer sequence. Our study suggests that the slow bowel transit induced an increased number of colonic neoplasia in relation to the prolonged contact of the carcinogen with the mucosa or to its greater concentration in the colonic lumen due to the fecal output reduction.

[Local recurrence caused by direct implantation from cancer of the colon; findings of a case report]. / La recidiva locale da impianto diretto nel cancro del colon: rilievi su un caso osservato.

The Authors report the case of a 60 year old woman who developed a local recurrence 3 months after a right hemicolectomy for a cancer of the ascending colon. The site of the recurrence along the suture line, the huge size of the tumor, the short interval from the first operation with its apparent radicality strongly support the origin of such recurrence from implantation. Pathogenetic mechanisms of local recurrence due to implantation metastases as well as current methods to prevent tumor seeding in colorectal surgery are reviewed. The importance of early endoscopic follow-up after colorectal resection is also stressed.