Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases.

BACKGROUND: Inguinal hernioplasty has always been one of the most commonly performed operations in clinical practice. In the last 15 years, thanks to the development of mini-invasive surgery, new video-endoscopic techniques for the treatment of inguinal hernia using trans-peritoneal (TAPP) and extraperitoneal (TEP) access have emerged. Both have a definite role in the treatment of bilateral and recurrent hernias, while the debate is still open about the treatment of primary mono-lateral hernias. In acute incarcerated hernia requiring an emergency operation, the endoscopic approach is uncommon and controversial, and even considered contraindicated. The aim of this publication is to verify the efficacy and the technical feasibility of TAPP operation by analyzing a consecutive series of patients operated on for incarcerated inguino-crural hernia associated with suspected visceral ischemic lesion in an emergency setting. MATERIALS AND METHODS: From September 2004 to October 2005, 13 patients were operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Four were excluded from the endoscopic treatment due to anesthesiologic contraindications or huge hernia dimensions. Nine patients were operated on using a trans-peritoneal approach (TAPP). Visceral mobilization and hernia reduction were obtained by incision and opening of the hernia ring. Visceral resection was performed in one case with intestinal ischemia following a prolonged observation time or "test time." RESULTS: One case was associated with intestinal resection and incisional hernia repair, one with obturator hernia repair, and one with hepiployc appendix repair. None of the cases were converted to open technique, and no intra- or postoperative complications were recorded. Mean operative time was 72 min (35-180); mean hospital stay was 2.7 days (1-8). No recurrences were observed after a mean follow-up time of 18 months (8-24). CONCLUSIONS: The TAPP procedure can be proposed for emergency treatment of inguino-crural incarcerated hernias, allowing not only hernia correction, but also visual control and the contestual treatment of the hernia content. TAPP is a more challenging procedure compared to the traditional open anterior approach and therefore requires an adequate laparoscopic training. Exclusion criteria are constituted by anesthesiologic contraindications or dimensional criteria of the hernia.

Femoral hernia repair. Kugel retroparietal approach versus plug alloplasty: a prospective study.

Plug insertion for primary femoral hernia repair may cause p.o. discomfort. The Kugel technique may avoid this problem. Patients' satisfaction to the Kugel and the plug techniques is compared in the present study. Demographics, surgical, outcome and analgesic consumption data of 26 patients treated for with the plug technique (P group) are compared with 24 operated with the Kugel patch (K group). Patients' p.o. discomfort to the two procedures was measured with quantitative (VAS score) and a qualitative (the short form of McGill pain questionnaire, SF-MPQ) methods, and compared. P group presented higher early p.o. pain (P<0.001), higher analgesic consumption and a significative delay in the return to physical activity (P<0.001). SF-MPQ scores at p.o. day 8, day 30 and month 6 were significantly lower for K group (P<0.001, P<0.001, P<0.005). The Kugel technique for femoral hernia treatment seems to cause less p.o. discomfort to patients than the plug technique.

Kugel hernia repair: open "mini-invasive" technique. Personal experience on 620 patients.

A large monoinstitutional series adopting the Kugel retroparietal technique for inguinal hernia surgery is analysed. Our aim is to assess the "mini-invasiveness" of this technique. Six hundred and twenty patients (pts) affected by monolateral inguinal hernia were treated with a preperitoneal alloplasty with a posterior approach (Kugel hernia repair, KHR) between January 2002 and September 2004. The surgical incision extension was 3.5 cm on average (range 2-4.5). The mean operation time was 33 min (range 20-45). Spinal anaesthesia and ambulatory procedure were applied in 595 cases (96%). Postoperative complications affected 20 pts (3%). The postoperative pain was well controlled. No chronic neuropathic pain was registered at follow-up. Patients resumed work after an average of 9 days (range 7-12) from operation. Recurrence rate was 0.8%. Conclusions. The Kugel hernia repair satisfies the standards to be awarded as a "mini-invasive" technique.

[D2 gastrectomy in the surgical treatment of gastric cancer]. / Gastrectomia D2 nel trattamento chirurgico del cancro gastrico.

The study is conducted on a series of 57 patients treated with D2 gastrectomy with curative intent for gastric cancer between January 2000 and December 2004, at Policlinico Multimedica (Milan). Postoperative mortality was 2%. Recurrence rate was 10%. The overall survival of the series is 36% at 4 years follow-up. Negative prognostic factors were: high grade tumor, locally advanced primary disease, presence of lymph node metastases, advanced stage of disease and recurrent disease at follow-up. The data of the study are comparable to those in the literature.

[Intraperitoneal hyperthermic chemotherapy. Preliminary experience with 22 consecutive patients]. / Chemioterapia ipertermica intraperitoneale. Esperienza preliminare in 22 pazienti consecutivi.

The study analyses the results of surgical treatment and intraperitoneal hyperthermic chemotherapy on a group of 22 patients, affected by peritoneal carcinomatosis of different origins, and treated at Policlinico Multimedica (Milan) between June 2001 and December 2004. Surgical major complications were present in the 23% of the patients, and post-operative mortality rate was 13%. None of the patients presented chemotherapy related toxicity. Six patients died within 2 and 40 months after surgery, while 13 are alive within 4 and 40 months after operation.

Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation.

PURPOSE: Functional results of total colectomy with ileorectal anastomosis for the treatment of chronic constipation caused by colonic inertia are often considered unsatisfactory because of the frequency of postoperative diarrhea and the high rate of postoperative small-bowel obstruction. Patients affected by severe colonic inertia underwent a subtotal colectomy with a novel antiperistaltic cecorectal anastomosis. The aim of the study was to assess the functional results after preservation of the cecorectal junction. METHODS: Eight females affected by isolated colonic inertia and two females with both paradoxical puborectalis contraction and colonic inertia, of a median age of 40 years, underwent subtotal colectomy with antiperistaltic cecorectal anastomosis. Before antiperistaltic cecorectal anastomosis all ten patients were laxative-dependant, with a mean bowel frequency of ten days; eight of them (80 percent) had distention, seven (70 percent) bloating, and three (30 percent) abdominal pain. RESULTS: There was no mortality or major postoperative morbidity. One month after antiperistaltic cecorectal anastomosis, bowel frequency was a mean of 2.2 (range, 1-4) per day, with a semiliquid stool consistency. After one year, bowel frequency was a mean of 1.3 (range, 0.5-3) per day, with a solid stool consistency; the same results were recorded at last follow-up. Although no patients used antidiarrheal medicine, laxatives continued to be used by both patients with paradoxical puborectalis contraction. All ten (100 percent) of the patients reported a good or improved quality of life. CONCLUSION: This preliminary experience seems to show that antiperistaltic cecorectal anastomosis is safe and effective for patients with colonic inertia. It results in prompt and prolonged relief from constipation for patients with isolated colonic inertia.