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.

The treatment of breast cancer in one day surgery. A four year experience.

The number of short-stay surgery procedures has progressively increased since the concept of short-stay surgery was first introduced. Initially this type of surgery was reserved for patients undergoing inguinal hernia repair, proctological surgery, and various minor procedures. Careful patient selection makes it possible to apply one-day surgery to other surgical specialties including breast cancer surgery. Reducing the length of hospital stay lowers health care costs, and shortens waiting lists. The most important benefits for patients are a more rapid return to work and positive psychological effects. Exclusion criteria for one-day surgery are the lack of home care, excessive distance from place of treatment and the presence of any concomitant pathology that is a contraindication to this type of surgery. We report our experience in oncological surgery of the breast in one-day surgery.

[Acute abdomen by anisakiasis and globalization]. / Addome acuto da anisakiasi e globalizzazione.

OBJECTIVES: The AA report a case of a patient with acute abdomen caused by intestinal Anisakiasis, a fish-transmitted infection that results from ingestion of raw or improperly cooked fish contaminated by live larvae of Anisakis Simplex, a round worm from the order of Ascaridida. MATERIAL AND METHODS: A 33-year-old man, presented to the emergency room with severe upper abdominal pain, nausea and vomiting, without fever. The patient revealed that he had eaten pickled anchovies a few days before. RESULTS: On the exploratory laparotomy an edematous and stenotic tract of 15 cm of jejunum was found, and a segmental resection was performed. Histologically, the resected jejunum showed a conspicuous and diffuse inflammatory infiltration, predominantly made up of eosinophil granulocytes, numerous mucosal erosions and the presence in the submucosa of sections of parasites which were identified as Anisakis Simplex larvae. DISCUSSION: The ingestion of fish contaminated by Anisakis larva is often followed by the appearance of systemic or gastrointestinal symptoms due respectively to the direct larva localization and the allergic reaction to some parasite components. Diagnosis is made frequently difficult by clinical manifestations that could mimic symptoms of other diseases more common in Italy. CONCLUSIONS: Globalization has made Anisakiasis a more and more frequent disease worldwide, as increased mixture of different cultures and international travelling has allowed the spreading of risky feeding habits. That's why Anisakiasis should be considered in differential diagnosis of intestinal obstruction in patients with positive anamnesis for suspiciously cooked or conserved seafood eating.

[Intestinal occlusion by ileal carcinoid]. / Occlusione intestinale da carcinoide ileale.

OBJECTIVE: Ileal carcinoids diagnosis, generally, is late because patients have aspecific symptoms. MATERIAL OF STUDY: The two cases described presented for a long time peristaltic abdominal pains, vomit episodes and reduction of weight, with negativity of radiologic reports. The first diagnosis was adhesion syndrome produced by previous abdominal surgical operation; just emergency surgical operation executed for intestinal occlusion noticed carcinoids, located into the distal ileum, which infiltrated muscular wall and interested regional lymph nodes. RESULTS: Ileal carcinoids diagnosis, generally, takes place during emergency laparotomy for intestinal occlusion which is the most frequent complication of this tumor. At the moment of diagnosis the tumor presents an advanced stage of evolution. DISCUSSION: Ileal carcinoids behave malignant because of their biologic aggressiveness and because of at the moment of diagnosis they present an advanced stage of evolution. Symptomatology is aspecific, just a carcinoid syndrome could addressed clinical diagnosis, but this is an rare event and however it needs of liver metastases to appear. In case there is an clinical suspect scintigraphy with Octreoscan can locate tumor and metastases. CONCLUSIONS: Surgical treatment of ileal carcinoids is based on large resections en bloc. Ileal carcinoids survival to 5 years is estimated inferior to 60% after surgical treatment.