[Incisional hernia repair in the region of Brescia and in Lombardy: results of a survey and discussion]. / Il trattamento del laparocele in provincia di Brescia e in Lombardia. Risultati di un'inchiesta e loro discussione.

This paper reports the results of a survey on the surgical therapy of incisional ventral hernia in the county of Brescia (19 surgical wards) compared with the results in Lombardy. Using epidemiological data on open and laparoscopic surgery we investigated the recent trends in this kind of surgery, addressing aspects that are not yet supported by evidence-based data in the literature. Laparoscopic repair is performed in about half of the surgical wards, and in the majority (85%) of Lombardy hospitals that replied to the questionnaire. It is also performed in a small number of primitive ventral hernias. The creation of a pneumoperitoneum is accomplished both by the Verress and the Hasson techniques, without significant differences. Composite meshes have proved most interesting, and fixation by titanium spiral tacks is most commonly used. We found rapid discharge and low morbidity rates, similar to the published data. The preferred open technique is still the Rives-Stoppa submuscular mesh repair. It is generally agreed that there will presumably be a major diffusion of laparoscopic repair, in spite of the fact that it is nowadays performed only by surgeons familiar with advanced laparoscopic techniques and is still more expensive than open repair, which, however, is offset by the distinct benefit afforded by the patient.

Occasional finding of mesenteric lipodystrophy during laparoscopy: a difficult diagnosis.

Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs.