[Our experience on the treatment of epigastric hernia]. / Nostra esperienza sul trattamento dell'ernia epigastrica.

The epigastric hernia represents a rare surgical affection, sometimes insidious, whose pathogenesis has been discussed for a long time, revealing, in the course of the years, multiple predisposing and responsible factors of its appearance. From our experience and the data reported in the literature, it is clear that a standard surgery does not exist for this pathology, and it is often necessary to perform preliminary uncommon diagnostic exams. Our retrospective study consists in the analysis of the surgical treatments executed, from 2003 to 2006, on 37 patients suffered from epigastric hernia, for everyone of which, on the basis of the clinical features, of the preoperative diagnostic results and of the characteristics of the hernia defect, it has been encouraged a personalized surgical procedure,obtaining therefore, for the same pathology, different treatment protocols (open or laparoscopic procedures, ordinary hospital stay or day-surgery, prosthetic or not surgical repair).

[The use of dermic substitutes in the repair of cutaneous defect due to a phlebostatic wound]. / L'utilizzo di sostituti dermici nella riparazione del difetto cutaneo da ulcera flebostatica.

The use of dermic substitutes is a valid and effective choice in the treatment of the cutaneous defects with loss of substance. In our experience, the aesthetic and functional results of dermic substitutes is really positive and encouraging, with better tolerance by patients than the autologue grafts.

Peritoneal malignant mesothelioma: case report.

Our study reports peritoneal diffuse malignant mesothelioma (DMM) in a 43 years old male patient, with no exposure to asbestos in his medical history; the partner of the patient was also not exposed to asbestos. The exposure to X-rays was also excluded. Different pathogenic mechanisms for the pathogenesis of a peritoneal diffuse malignant mesothelioma in this patient can be hypothesized, for example, SV40 infection and genetic susceptibility; a minimal domestic exposure to asbestos can be not excluded. Therefore, further studies in a larger number of subjects are necessary to determine whether one or all of these hypothetic pathogenic mechanisms are more significant for the development of malignant mesothelioma.

Abscess and cecum carcinoma in inguinal hernia: case report.

Cecal adenocarcinoma within an inguinal hernial sac is an uncommon clinical condition. A primary adenocarcinoma of the cecum in a right sided inguinal hernia is presented and discussed. This case represents one of the unexpected findings in a hernia sac and also very rare septic evolution. This particular condition is a main dignostic and therapeutic challenge.

Pathological evaluation in colorectal polyps endoscopic treatment.

This retrospective study shows that endoscopic polypectomy is the technique of choice to remove the majority of polyps; follow-up and pathologic examinations shed light on the carcinogenesis of colorectal lesions. From January 1990 to December 2001, 1302 adenomatous polyps were removed, 1175 endoscopically, 127 with surgical procedures. The anatomical and morphologic conditions of the colon and some characteristics of the polyps represent limits to the feasibility and to the efficacy of polypectomy, and the most important variables for the correct management of the patients affected by colorectal adenomatous polyps.

[Varicose disease of lower limbs: our actual orientation]. / La malattia varicosa degli arti inferiori: nostro attuale orientamento.

A retrospective analysis of a series of patients treated during 5 years was made evaluating, on the basis of the clinical and ultrasonographic examination, the results obtained in the treatment of the varicose disease of the lower limbs for each one of three surgical methodic employed (crossectomy, long or short stripping) as well as patients compliance. All the patients previously underwent ultrasonographic examination to evaluate the reflux rank of the internal saphena and to point out every insufficient veins. On the basis of specific indications, from routinary pre-operative and anaesthesiologic examinations, all the patients were operated. Totally, 784 operations were performed. Thanks to the follow-up, carried out through an objective evaluation (echocolor-Doppler) and subjective one (degree of satisfaction fullfilled through some tests), it is concluded that the most favourable method, among those used, is that of short stripping with wrapping up a silk thread, in accordance to Van der Stricht.

[Surgical treatment of varicocele in day-surgery: our experience]. / Il trattamento chirurgico del varicocele in day-surgery: nostra esperienza.

Varicocele has been recognized as a treatable cause of male infertility. Recently, new techniques have been described for varicocele repair, including microsurgery, embolization and laparoscopy. The aim of this study is to evaluate the results of a group of patients who underwent subinguinal varicocelectomy using local anaesthesia in Day Surgery, after a careful ultrasonographic study to evaluate the degree and the quality of the reflux in the spermatic vein. The study shows that outpatient subinguinal varicocelectomy is a safe and reliable procedure. This approach is performed in local anaesthesia, has minimal morbidity and recurrences and, in our experience, has led an improvement in the quality of seminal fluid.

[Retroperitoneal leiomyosarcoma: a case report]. / Il leiomiosarcoma del retroperitoneo: descrizione di un caso clinico.

The Authors report a rare case of retroperitoneal leiomyosarcoma in a 80 years woman with respiratory symptoms and right abdominal pain. A large neoplasm occupied the right abdomen, looking asymmetric. Upper abdominal CT showed a retroperitoneal neoplasm close to right kidney, liver, aponeurosis of right oblique muscles, producing a left-side dislocation of the intraabdominal organs. A surgical "en bloc" resection of the neoplasm was performed; neoplasm was plurilobed and capsulated. The histologic examination confirmed the diagnosis of leiomyosarcoma. The best treatment of these neoplasms is surgery, that in the last years has drawn advantage from more sensible and specific diagnostic procedures, which show a more radical surgical option. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, a careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the closer structures.

[Metachronous carcinoma of the colon: report of a clinical case]. / Carcinoma 'meta-metacrono' del colon: descrizione di un caso clinico.

The Authors deal with a rare case of 'meta-metachronous' carcinoma of the colon. A seventy years old man was admitted to ward after being diagnosed an adenocarcinoma of the transverse colon. The anamnestic data pointed out that the patient had already been operated twice for the colon carcinoma, which had been diagnosed in the left colon and in the cecum respectively seven and two years before. A colonoscopy performed sixteen months before did not show any lesion of the residual colon. It is likely that tiny lesions, which were still in the adenoma phase, were not diagnosed by the endoscopy; it is also possible that the adenoma-carcinoma sequence was extremely fast. On the basis of this experience the Authors recommend that patients with metachronus carcinoma undergo either frequent controls or a preventive subtotal colectomy.

[The use of drainage in the "per primam" treatment of recurrent pilonidal cysts]. / L'uso del drenaggio nel trattamento "per primam" delle cisti pilonidali recidive.

Recurrent pilonidal sinus treatment is still controversial, as more and more frequently methods used determine unpleasant discomforts to the patients ("open" method) or increase recurrences rate. According to this consideration, the Authors have made a review of their cases (27 patients with recurrences), selected by standardized criteria and treated by "en bloc" excision of all pathologic tissue and following closure "per primam" of the wound, previously placing an aspirative drainage, then removed after 2 or 3 days. Ordinary use of the drainage, antibiotic prophylaxis extended to postoperative sixth or seventh day and daily careful disinfection of the wound and surrounding skin until suture removal got them excellent results.

[Predictive factors and treatment of small bowel adhesive obstruction]. / Fattori predisponenti e trattamento dell'occlusione intestinale da sindrome aderenziale.

Our study is based on a retrospective analysis about a ten years' control on patients with a small bowel adhesive obstruction (SBAO) due to primitive abdominal surgical operations. From the valuation of the obtained data and through a literatures review we tried to better define the best treatment. On 297 admissions of 248 patients with a diagnosis of SBAO 196 operations were performed, which indication was based on every clinical data, haematologic and radiologic examinations. Moreover, it was analysed the responsive factor that caused adhesions with a careful valuation of the primitive surgical operation and the possibility of recurrences. From this study it is evicted that SBAO can be considered as a surgical differentiable urgency, where there aren't any signs of intestinal strangulation or peritonitis, and where the principal etiologic factor is represented by colorectal operations in the male and gynecologic operations in the female. Morbility and mortality in the surgical procedures for SBAO show greater percentages than the elderly patients.

[Gastric lymphomas: surgical indications]. / I linfomi gastrici: indicazioni all'intervento chirurgico.

Primary gastric lymphoma (PGL) are lymphomas with an exclusive gastric localization. Histologically they are B-like non-Hodgkin lymphomas. Aim of Authors' study is to define the role of surgery in the treatment of PGL, on the basis of their series casistics and a review of the more recent literature data. The Authors observed 41 patients (23 F and 18 M) in a period of 10 years: 35 patients underwent to surgical operation associated in 18 of them to chemotherapic treatment; in 6 cases medical eradication of Helicobacter Pylori (H.P.) was performed as unique treatment. Antibiothic treatment allows the eradication of H.P. in 97% of the patients and a histologic decreasing of MALT lymphoma in 70% of the patients in about 6 months. That represents the first therapeutic choice for the low grade of malignancy MALT PGL at I and II stages. In the cases of partial decreasing or progression of PGL, the Authors consider opportune surgical operation. In the majority of the cases the surgical option represents, according to our advise, the best choice for the high percentage of definitive recoveries, allowing a 10 or more years of surviving of the 90%, if it is done in the first stages of the disease. The results of the association with neoadjuvant or aduvant chemotherapy are still controversial. On the basis of their experience total gastrectomy can be considered the elective choice operation, with IID level lymphadenectomy and possible splenectomy.

[Surgical treatment of hemorrhoids in day-surgery]. / Il trattamento chirurgico delle emorroidi in day-surgery.

The Authors report their own experience with day-surgery treatment of haemorrhoids and underline the advantages in terms of patients' compliance and reduction of the sanitary management in order to the cost that this way suggests. The serie here reported includes 72 patients treated, by two years, with day-surgery haemorrhoidectomy. Here are indicated criteria of selection of the patients, related to the state of the illness, association of other pathologies and social factors. All the patients, moreover, have been treated according to a scheme that generally includes: a careful preoperatory valuation, local anaesthesia, standardized surgical method (Milligan-Morgan intervention), dimission few hours after the operation, control of the patients at their own home. The results obtained, careful examinted through an objective valuation (complications, relapses, time or reability) and subjective one (index of satisfaction of the patients), can be considered extremely positive.

[Day-hospital treatment of inguinal hernia]. / Il trattamento delle ernie inguinali in regime di day-hospital.

Aim of the Authors' research was to evaluate advantages of day-surgery treatment for inguinal hernias. The study has been performed on a series of 138 patients, operated because of unrelapsed and uncomplicated monolateral inguinal hernia. Up-to-date therapeutic behaviour relating to hernia is the result of brilliant intuitions: technical order (tension-free repair), technological progresses (using new prosthetic materials), and refinement of anaesthesiological procedures (local and loco-regional anaesthesia). As regards surgical and anaesthesiological methods, general principles have been accepted by now from the most of the Authors. The new frontier of hernias' treatment is the possibility of operate in a day-hospital way: that means real advantages, both as regards patients' compliance and, in consideration of the high incidence of such pathology, as regards the high economic savings and more reasonable management of hospital stays. The significative increase of day-hospital hernioplastic operations in last years is due to standardization of restrictiveless criteria of choice for patients who can be treated with such modality.

[Recurrence after hernioplasty according to Lichtenstein: analysis of the cause]. / Le recidive dopo ernioplastica secondo Lichtenstein: analisi delle cause.

The performance of surgical interventions of tension-free hernia repair has certainly reduced the recurrence rate in comparison with the previous techniques; notwithstanding this it is not uncommon to observe some recurrences also after a Lichtenstein hernia repair. The aim of this study is that to analyse the causes. In the last 2 years, 42 patients (mean age of 68 years) with recurrent hernia have been operated by Lichtenstein technique; 11 of the 42 patients had been treated before with an useful mesh hernia repair. In 8 of these patients the recurrence was produced by an insufficient medial extension of the mesh; in the other 3 patients the cause was the presence of an unrecognized indirect hernia in patients operated for a direct inguinal hernia. All the patients treated have been submitted to a 18 months time of follow-up.