Treatment of median incisional hernia. Laparoscopic vs. open surgery: meta-analysis.

In the last ten years we assisted to spreading of laparoscopic approach on the correction of median incisional hernia, although for increased interesting toward mini-invasive techniques than for matching results between lap and open approaches. The aim of our study is the critical analysis of the results of lap and open surgery in the approach of ventral hernia, through the meta-analytical revision of the principal checked prospective trials. There were emerged 7 perspective studies to fit to a meta-analysis with the revision of the literature, with 1165 patients in total. Among the perioperative outcomes the briefer surgical time and a reduction of postoperative hospitalization were observed with the significant statistic data in favor of the lap. Laparoscopy can be considered a valid technical alternative to traditional open surgery in the treatment of ventral incisional hernia. The advantages of mini-invasive approach are the reducing of the surgical time and of the total hospital stay. There were not emerged any significant differences regarding the other surgical end-points or the recurrences of hernias after 1 and 5 years.

Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report.

Gastrointestinal haemorrhage is extremely frequent, but in some cases the aetiology may remain unknown. Haemorrhage from the small bowel especially can create important diagnostic problems. We report the case of a patient admitted to hospital with intestinal bleeding in an ileal site in association with aortic stenosis. Enteric angiodysplasia is a frequent pathology in the surgery of the gastrointestinal tract. Recognizing bleeding lesions in the small intestine can be really difficult. Concerning the case reported here, the most probable diagnostic hypothesis is Heyde's syndrome, which is characterised by valvular aortic stenosis together with gastrointestinal bleeding due to cryptogenetic angiodysplasias. The choice to be made in the therapeutic management of angiodysplasia is still a debatable issue and should be suited to the patient's clinical state and the site and extent of the bleeding. In the literature the link between aortic valvular stenosis and intestinal angiodysplasia is unclear. The physiopathological relationship between the two entities is still mysterious.

[Intestinal carcinoid tumours: personal experience and a review of the literature]. / I carcinoidi intestinali: esperienza personale e revisione della letteratura.

The observation of a number of cases of intestinal carcinoid tumours prompted the authors to review the literature in order to define the principal biological and anatomopathological aspects and the current therapeutic choices. The diagnosis is often obtained on the basis of anatomopathological examination. The kind of surgical treatment is still a matter of controversy: minimal or extended resection? A number of criteria may orient the surgeon towards major surgery, such as tumour size, node involvement, infiltration of the serous membrane, and liver metastases.

Single gallbladder and multiple pancreatic metastases from renal cell carcinoma sixteen years after nephrectomy.

We describe a case of female patient presenting with acute biliary symptoms and severe haemobilia due to the presence of a large metastasis in the gallbladder wall from renal cell carcinoma treated by radical nephrectomy 16 years before. CT examination also showed the presence of multiple small round metastases from renal carcinoma in the pancreas, subsequently confirmed surgically and pathologically.

[Incarcerated inguinal hernia in elderly: personal tension-free hernioplastic technique]. / Tecnica operatoria di ernioplastica protesica tension-free nelle ernie inguinali intasate nei pazienti anziani.

AIMS OF THE STUDY: With the increasing of the middle age, more and more elderly patients with incarcerated inguinal hernia have to be surgically treated with lower operatory time and lower anesthesiological stress. The Authors present a personal tension-free hernioplastic technique. MATERIALS AND METHODS: Thirthy-seven male patients (range 80-92 years) recovered for incarcerated inguinal hernia (Gilbert II tipe) without vascular injury, underwent to tension-free hernioplastic technique without inguinal canal opening, in local anaesthesia. RESULTS: The average operative time was 33 minutes (range 25-42 min). Follow-up at 10 days, 3 months and 5 years shows a correct position of the plug, no recurrence, no alterations of normal testicular vascolarization in absence of paresthesia or chronic pain. The post-operative pain was absent or trascurable whitout the use of any antalgical therapy.

[Single symptomatic small bowel metastasis from primary lung cancer. A clinical case]. / Metastasi unica sintomatica all'intestino tenue da carcinoma primitivo del polmone. Caso clinico.

Small bowel metastases from primary lung cancer have rarely been reported and a single symptomatic metastasis to the small bowel is a rare occurrence. In the case reported here there was no evident additional site of metastatic disease and the diagnosis was made on the basis of morphology and immunohistochemistry analysis using CK 07, CK 20 and TTF-1 monoclonal antibodies. However, even in patients in whom the intestine is the sole metastatic site, the prognosis is dismal and most of patients die within 2 months.

[Gallbladder torsion: a case report and review of the literature]. / Volvolo della colecisti: descrizione di un caso clinico e revisione della letteratura.

Gallbladder torsion is a rare but potentially life-threatening event due to its insidious course and to the gravity of the clinical picture when the diagnosis is established late. In 85% of cases this situation affects females, aged 70 to 90 years. The aetiopathogenesis is still unknown and the diagnosis is often made during surgery. A thorough review of the literature suggests a specific clinical pattern which, when combined with improvements in radiological techniques, should allow early diagnosis and treatment. Nevertheless, only 10% of cases are correctly diagnosed before surgery. The aim of this case report was to evaluate the specific pattern of this clinical picture and the accuracy of the radiological and laboratory findings for the purposes of achieving an early diagnosis and adequate treatment.

[Difficulties in diagnosing and treating GIST: report and analysis of a case]. / Difficoltà diagnostiche e terapeutiche nei GIST: nostre considerazioni su un caso clinico.

Gastrointestinal stromal tumours account for fewer than 1% of malignant tumours of the digestive system. Analysing a case referred to us for observation, we review the literature with regard to diagnostic and therapeutic difficulties. A 68-year-old patient was referred to our institute with a diagnosis of "retroperitoneal haematoma". Computerised tomography showed a solid mass with a liquid component, occupying almost the whole of the abdominal cavity. An ultrasonography-guided biopsy examination suggested the presence of a sarcoma. Exploratory laparotomy and the histological examination, which was positive for CD117, CD34 and the smooth muscle marker caldesmon, allowed a diagnosis of gastrointestinal stromal tumour to be made. Thus, no thoroughly reliable and accurate diagnosis of gastrointestinal tumour can be made without surgical exploration and consequent histological and immunohistochemical examinations that still represent the only method capable of confirming or ruling out a diagnosis of gastrointestinal stromal tumour. Such tumours are rare and aggressive and their prognosis is closely related to tumour size and the mitotic index per high power field. Radical resection affords the only possibility of long-term survival.