[Surgical treatment of pilonidal sinus with open surgical technique]. / Trattamento chirurgico del sinus pilonidalis col metodo aperto.

BACKGROUND: Personal experience and results about the surgical treatment of pilonidal sinus using the open technique operation are reported. METHODS: Between January 1984 and June 2001, 577 patients (457 males and 120 females) underwent this surgical technique. Eighty-five patients presented recurrences of the under-lying disease previously treated with closed technique in other centres. In order to reduce the risks of recurrence, pilonidal sinus was widely resected in order to remove every fistulous track laterally or towards the anal edge. The surgical wound has to be wide, carefully drained, without vertical walls: the outer part of the wound should be wider than its bottom. The persistence of a hairless scar is a suitable result to avoid relapses. RESULTS: This surgical technique allowed very good RESULTS: Postsurgical morbidity was not observed in these patients; the median time to achieve healing was 8+/-2 weeks. Furthermore, after a 3 year follow-up, only 4 patients (0.69%) relapsed. Recurrent dressings are needed; anyway they neither represent a limit of this technique nor lead to a long term absence from working. The postsurgical period of resting is quite similar to that usually prescribed after other surgical techniques and mainly depends on the patient nature. The treatment with connective tissue repairing drugs may be useful to obtain an effective healing. CONCLUSIONS: In the authors' experience, the open surgical technique may obtain the definitive removal of pilonidal sinus, even if particularly wide, with a safe postsurgical course and a very hight percentage (99.31%) of complete healing without any relapse.

[Surgical treatment of anal fistulas. Personal experience on 1,000 patients over a 20-year period]. / Trattamento chirurgico delle fistole anali. Nostra esperienza relativa a 1.000 pazienti operati in 20 anni.

BACKGROUND: Considering their long experience acquired during the period October 1981 and October 2001 related to the treatment of 1,000 patients suffering from anal fistulas, the authors reasses the problem of this affection from an etiopathogenic, classifying, diagnostic and therapeutic point of view. METHODS: Surgical treatment of Arnous's French School was performed; these methods foresee the division of the operative times and slow sphincteric sectioning by an elastic constriction. RESULTS: Results were excellent: 99.2% of complete recoveries and very few failures and complications: 0.5% incomplete recovery, 0.3% relapse, 1.3% soiling, 1.5% gas temporary incontinence. CONCLUSIONS: The main premise to obtain the patient's recovery is to perform a faultless technique and to follow assiduously and minutely the long postoperative period of surgical wounds.

[Anal and perianal lesions in Crohn's disease]. / Le lesioni anali e perianali nel morbo di Crohn.

Crohn's disease is not a homogeneous clinical entity but may shows many clinical pictures during its period, prognosis and response to therapy. Anal and perianal localisations are frequently found; they can occur isolated, months or years in advance the disease, or can be concomitant with an ileal, colic or rectal involvement. There can be many kinds of lesions: simple, such as eczema or fissuration, complex, such as high rectal or rectovaginal fistulas. A rational classification of anal and perianal manifestations is suggested. Local medical therapy, is very effective in minor lesions, and has to be associated with systemic medical therapy particularly nowadays: the knowledge on phlogosis, biology and biotechnology revolution, have launched a new therapeutic era. Surgical therapy can be performed only in case of complex disease non responsive to medical therapy or when it is necessary to give a rest to anorectal tract. To perform a correct follow-up, considering unpredictability of lesions, a careful clinical evaluation and an intensive surveying plan associated with objective evaluation parameters are suggested.

[Fecal incontinence. Personal experience in direct sphincteric repair]. / Incontinenza fecale. Nostra esprienza nella riparazione sfinterica diretta.

BACKGROUND: Fecal incontinence is a disabling condition causing social isolation, whose real incidence is difficult to be exactly valued because patients are often reluctant to speak about it, even with their physician, or because they don't trust on surgical procedure. Aim of this study is report our experience in sphincteric reconstruction by direct sphincteric repair in patients suffering from post-traumatic fecal incontinence. METHODS: Seven patients suffering from fecal incontinence due to traumatic lesions of anal sphincterial apparatus were surgically treated between 1981-2000; in the first patient cause was an injury due to impaling, in the second a previous obstetrical lesion and in the last five a previous fistulectomy. Direct sphincteric reconstruction after finding and isolation of two retracted terminals of sectioned sphincter was performed in all the patients. Sphincteric reconstruction has been always accompanied by total parenteral nutrition for about two weeks during the postoperative period. A protective colostomy was never performed. RESULTS: In five cases the results were excellent: patients had continence total recovery and postoperative manometry recorded basal and voluntary contraction pressures normalisation. In the two remaining cases there was only a modest improvement because of concomitant pudendal neuropathy. No operative wound infection was observed. CONCLUSIONS: We hope that more attention is paid to fecal incontinence either regarding instrumental semeiotics or medical or surgical therapy. In particular, direct sphincteroplasty can restore a satisfactory continence in a strong number of patients with anal sphincterial apparatus single traumatic lesions without pudendal neuropathy, relieving them from a heavily disabling condition.

[Our experience in the transanal excision of tubulovillous adenomas of the rectum]. / Nostra esperienza in tema di escissione per via transanale degli adenomi tubulo-villosi del retto.

BACKGROUND: Personal experience on transanal excision of rectal adenomas without affecting sphincteric function is reported. METHODS: From 1985 to 1997, 27 patients suffering from rectal adenomatous polyps underwent surgery; the sites of lesions were within 3 to 10 cm from anal orifice in the whole series; the age of patients ranged from 30 to 81 years. Two different procedures were employed: the Parks' technique and the electroresection by traction flap technique according to Faivre. RESULTS: Any postsurgical complication such as hemorrhage, stenosis or incontinentia occurred; surgical mortality was absent. Histological examination disclosed severe dysplasia as well as in situ carcinoma in 6 patients (22.2%) and malignant polyps in 9 patients (33.3%). Only in a case a palliative excision was performed since the poor general conditions of this patient did not permit a more extended treatment; a local relapse of the tumour associated with liver metastases led the patient to death 22 months after surgery. Three patients were lost to follow-up and 2 patients died because of other causes, 6 and 8 years after surgical excision, respectively. CONCLUSIONS: The conclusions are is drawn that either Park's and Faivre's procedures are useful and safe for the surgical treatment of rectal villous polyps extended up to 8-12 cm from anal orifice, in spite of the presence of malignant foci within their mass. These surgical procedures are simple and relatively poor traumatic; for this reason they are more suitable than other transabdominal or abdomino-perineal approaches for older patients and other at risk-patients. It is underlined that the treated patients require a long-term follow-up aimed at the early diagnosis of possible relapses of adenomatosis.

[Our experience in internal medioposterior sphincterotomy with anoplasty]. / Nostra esperienza in tema di sfinterotomia interna mediana posteriore con anoplastica.

BACKGROUND: The technique of the posterior medial internal sphincterotomy according to Arnous is described and advice from personal experience reported. METHODS: From 1981 to 1995 posterior medial internal sphincterotomy with anoplasty was performed in 270 patients (132 males and 138 females) affected with chronic anal fissure, alone (112 cases) or associated with hemorrhoids (80 cases); moreover, the Arnous's operation was performed as well for hemorrhoids with posterior subsidiary packet and internal sphincter hypertonia (52 cases), relapsed hemorrhoids with postoperative anal stenosis (24 cases) and postoperative anal stenosis with painful fissure and residual internal sphincter hypertonia (2 cases). RESULTS: The results have been excellent; the average stay in hospital has been 7 days and the complete recovery occurred after 4-6 weeks without early or late complications. CONCLUSIONS: The importance of anorectal manometry for the preoperative valuation of the sphincteric hypertonia is emphasized: in this manner it is possible to modulate the sphincterotomy avoiding too economic sphincteric sections with next residue hypertonia or, in the contrary, too plentiful sphincteric section with problems of continence. Finally, the internal lateral-left sphincterotomy is mentioned, which is efficacious in the treatment of acute anal fissure. However, the proctological surgeon, on the basis of his experience, will propose the most convenient technique.

Pruritus ani.

The possible dermatological and proctologic causes, of Pruritus Ani that often, due to its persistence and for its consequent lesions of scratching, becomes a real disease, are analysed. Particular attention is given to therapeutical treatment, describing which hygienic-dietetic rules must be followed and which treatments can be utilised, if the cause of the symptom is known and if it is possible to remove it or not. Moreover, personal experience on 312 patients examined in twelve years is reported.

All-optical processing by means of vectorial interactions in second-order cascading: novel approaches.

Based on the tensorial nature of second-order nonlinear susceptibilities, we show how two orthogonal field components at frequency omega can interact by means of the generated second harmonic, with a resulting coherent control of one onto the other. All-optical transistor operation and polarization switching are among the signal functions that can be implemented in properly oriented crystals.

[Reconstruction of the breast: critical evaluation of surgical technics]. / La ricostruzione della mammella: valutazione critica delle tecniche chirurgiche.

After reviewing the reasons for the increasingly widespread practice of breast reconstruction, the authors describe at some length the most reliable surgical techniques available and, on the basis of the results obtained, suggest an even broader range of indications for this type of surgical therapy.