[Transperitoneal anterior access in video-laparoscopic adrenalectomy]. / Accesso anteriore transperitoneale nella surrenalectomia videolaparoscopica.

BACKGROUND: The more wide spread laparoscopic technique to operate on the adrenal gland is transabdominal approach with a lateral flank adrenalectomy. However, the transabdominal anterior approach can be a sure and safe alternative in selected patients. METHODS: From 1997 to 1999, 18 selected patients underwent laparoscopic anterior adrenalectomy. Mean age was 43 years (range 25-63) with a male/female ratio of 1:1. Indications were Conn's adenoma in 10 patients, pheochromocytoma in 3 cases, Cushing syndrome in 1 and incidentaloma in 4. All the procedures were carried out laparoscopically and only one patient required conversion to an open adrenalectomy for clear signs of malignancy. The mean time for adrenalectomy was 140 minutes and the shorter times were recorded in the right-sided procedures (mean time 84 minute). Estimated blood loss was minimal and no transfusion was done. There were no postoperative complications related to the surgical technique and the hospital stay was 4 days in average. RESULTS: Our data confirm, according with other authors, that this method is feasible in selected patients. Longer times recorded for the left-sided lesions were due to the more difficult dissection required to gain the left adrenal gland. CONCLUSIONS: Transabdominal adrenalectomy with patient in the supine position is feasible, but its use is restricted to the cases with suspect bilateral or multifocal pheochromocytoma, to patients with concomitant abdominal pathologies that can be operated on laparoscopically, to surgeons who prefer to have a frontal view of the operative field.

[Pneumoretroperitoneum due to pneumatosis cystoides intestinalis. An etiopathogenetic and clinico-diagnostic assessment. A clinical case report]. / Pneumoretroperitoneo da pneumatosi cistica intestinale. Valutazioni etiopatogenetiche e clinico-diagnostiche. Presentazione di un caso clinico.

A case of pneumoretroperitoneum which came out to be caused by pneumatosis cystoides intestinalis, after careful and proper diagnostic evaluation, is described. Physiopathology, etiopathogenesis and clinical peculiarities of this infrequent pathology are examined; most useful tests to be performed in diagnostic differential evaluation, and clinical and surgical therapeutic approaches are also described, especially facing rare complications of PCI, such as pneumoperitoneum and pneumoretroperitoneum.

[Treatment of parastomal colostomy hernia]. / Il trattamento delle ernie pericolostomali.

BACKGROUND: Parastomal hernias are the most common cause of in patients surgically with stomy reoperation treated. METHODS: Treatment of parastomal hernias has been faced through two kind of technics: the first one consisted in the translocation of colostomy, the second one was placing around the colostomic hole a marlex mesh which was inserted at muscular structure level. From January 1993 to May 1997 we treated 8 patients affected by paracolostomic hernia associated to laparocele. The laparocele was treated according Rives' technique with the prosthesis positioned in the properitoneal site. The parastomal hernia was treated with translocation of the colostomy in 3 cases; in the other patients a plastic surgery of the colostomic orifice was made using polypropylene little bandages in properitoneal site. RESULTS: In the postoperative period the complications concerned a single case of skin parcellar necrosis, that healed spontaneously with medications and a case of prolonged serous secretion the mean follow-up was 2 years from the wound. CONCLUSIONS: In our experience the use of marlex mesh may be effective in treatment of parastomal hernia only a patient treated with translocation of the stoma showed a recurrence of parastomal hernia. The positioning of the prosthesis at properitoneal level is subject to a lower incidence of recurrent parastomal hernia.

A case of "silent" pheochromocytoma presenting as spontaneous retroperitoneal hematoma.

Pheochromocytoma of the adrenal gland can be the cause of massive and lethal retroperitoneal haemorrhage presenting as acute abdomen. Here we report a case of retroperitoneal hematoma, with concomitant peritoneal spillage, due to the spontaneous rupture of a silent pheochromocytoma. The main clinical findings of this disease will be described. Therapy and prognosis will be also discussed.