Modified rives technique (double-breasted alloplasty) in the repair of large incisional hernias.

Prosthetic materials in surgery have been widely used to repair incisional hernias thus reducing the recurrence rate. The wrong use of such prostheses has been the cause of serious postoperative complications. We propose a tension-free technique which allows the best abdominal wall reconstruction with correct positioning of the mesh even for large parietal defects. A retrospective study was conducted in a series of 64 patients treated with our personal technique using a polypropylene mesh for large incisional hernias. Median follow-up was 32 months. We had 1 case of respiratory discomfort (1.5%) and 4 recurrences (6.25%). No prosthesis infections were reported. The proposed surgical procedure allows correct prosthesis implantation and good short-term and long-term results. This versatile, reproducible technique can also be used for minor incisional hernias.

[Anastomotic occlusive mucosal web. An unusual complication of the Knight-Griffen procedure associated with protective ileostomy]. / Il diaframma mucoso. Una singolare complicanza della tecnica di Knight-Griffen associata a stomia protettiva.

In stapled anastomosis following anterior rectal resection, the anastomotic occlusive web rate is unknown and the management of this complication is not well defined. A 74-year-old man underwent a curative resection of a rectal cancer and, at the same time, a jejunal resection of an incidental stromal tumor. The colorectal anastomosis, performed according to the Knight-Griffen technique, and the hand-sewn end-to-end jejunal anastomosis were covered by a protective loop ileostomy. A number of features makes the case very unusual. The anastomotic occlusive web was made up of mucosal layer in the absence of a granulation reaction. Several factors contributed to the onset and misidentification of this complication. After the endoscopic approach had failed, the condition was successfully treated during an emergency operation for intestinal perforation.

[Aggressive angiomyxoma of the pelvis and perineum: a case report and review of the literature]. / Angiomixoma aggressivo della pelvi e del perineo. Presentazione di un caso clinico e revisione della letteratura.

Aggressive angiomyxoma is a rare mesenchymal tumour arising from soft tissue of the pelvis and perineum. Other features of this tumour are non-specific clinical signs, local invasion, a high local recurrence rate, and recurrence long after initial excision. We provide a case report with a review of the literature. A 57-year-old woman with a large bulky mass in the perineum was admitted to our institution. She had previously undergone iterative surgery for excision of pelvic and perineal masses. The preoperative diagnostic procedure is described as well as the therapeutic surgical approach (a double simultaneous laparotomic and perineal approach was opted for). The surgical procedure was difficult, time-consuming and dangerous owing to an extensive area of hard retroperitoneal sclerosis involving the low urinary viscera, the vaginal stump and the mesorectum. Radical excision of the mass favoured the re-establishment of the normal pelvic anatomy, resolution of the preoperative symptoms and complete recovery of working capability. Surgical excision is the gold standard in the treatment of aggressive angiomyxoma. This benign neoplasm may sometimes present a malignant course owing to involvement of pelvic viscera. It is also associated with a high late recurrence rate due to local aggressiveness, and longterm follow-up is therefore necessary.

[Usefulness of lateral internal sphincterotomy combined with hemorrhoidectomy by the Milligan-Morgan's technique: results of a prospective randomized trial]. / L'utilità della sfinterotomia interna laterale associata all'emorroidectomia sec. Milligan-Morgan: risultati di uno studio prospettico randomizzato.

Pain is invariably experienced after haemorrhoidectomy. Internal anal spasm is considered to be a major factor in the genesis of such pain. This prospective randomized study was designed to compare the effectiveness of two manoeuvres (surgical sphincterotomy and chemical sphincterotomy) in reducing post-haemorrhoidectomy pain. Sixty patients (38 males, 22 females) with grade III and IV haemorrhoids were included in this study. In all cases resting anal pressure was reported in the range of 50-100 mm Hg. Group A patients underwent Milligan-Morgan haemorrhoidectomy plus chemical sphincterotomy; group B patients underwent Milligan-Morgan haemorrhoidectomy plus internal left lateral sphincterotomy (0.8-1 cm in length) and group C patients underwent Milligan-Morgan haemorrhoidectomy alone. The postoperative course was carefully evaluated and was found to be better in group B. None of the patients treated by surgical sphincterotomy developed incontinence. Two patients in group C developed anal strictures. When indicated, internal left lateral sphincterotomy (0.8-1 cm) is a safe procedure and reduces post-haemorrhoidectomy pain and stenosis.