A retrospective study on the efficacy of short-term perioperative prophylaxis in abdominal surgery for hernia repair in 1,254 patients.

Between 1992 and 1999 1,254 patients requiring hernioplasty came to our Department of Surgery, at San Giovanni Valdarno Hospital, Arezzo. In 94% of cases a prosthetic device was inserted. All patients received a preoperative antibiotic prophylaxis with ceftriaxone, administered intravenously in a single 2 g dose, before surgery. We have retrospectively evaluated the incidence of postoperative infections in these patients: no surgical wound infection occurred, while we observed 10 cases of systemic infections, 5 respiratory tract infections and 5 urinary tract infections, all of which were successfully treated with antibiotics. Tolerability was good: no adverse reaction to ceftriaxone was observed. In this retrospective study ceftriaxone was shown to be effective in preventing the onset of postoperative infections.

[The use of mesh in abdominal wall defects]. / Impiego delle reti nei difetti addominali parietali.

Today abdominal wall defect repair can't prescind from the use of prosthetic materials. Inguinal, femoral and incisional hernias represent more frequent events in which, only using prosthetic materials is it possible to perform "tension-free" repair. Prosthetic repairs "agree with" abdominal, wall physio-pathology, guarantee results and prevent recurrences. Permanent biomaterials like polypropylene and dacron mesh deserve special attention for their distinctive features are suitable for abdominal wall defect repair. Selection of material is an important step according to surgical technique and to avoid complications; the most alarming of which is a possible infection. However the average incidence of infection on prosthesis is about 0.5%. While infection risk is really scarce, the benefits of prosthetic repairs are clear: the recurrence rate of traditional hernia repairs is about 33% and 0-0.7% in prosthetic repairs. Likewise the recurrence rate for traditional incisional hernia repair is between 14% and 50%, whereas in prosthetic repairs it is 0-4.5%. Therefore it is necessary to use prosthesis for the following two reasons: firstly to avoid tension on the suture line, the prime cause of recurrence, and secondly to increase formation of collagen fibres on the transversalis fascia that appears histologically and biochemically altered. The authors report their experience of 660 prosthetic repairs, 600 for hernia and 60 for incisional hernia, performed, in the period April 1992-December 1994, at the General Surgery Department in San Giovanni Valdarno Hospital. The surgical techniques used were "tension-free" and "sutureless" and the prosthesis laid down always a polypropylene mesh. Complications only occurred in 33 patients, particularly 4 cases of infection (0.6%) however mesh remove was not required. The follow-up until today evidenced only two early recurrences owing to our technical mistakes in the beginning of our experience. For incisional hernia repair we laid down a giant dacron mesh on preperitoneal space. No complications were registered. The average stay in hospital was 5 days and follow-up showed no recurrence. The use of prosthetic materials in abdominal wall defect repair expressed large benefits with evident and clear reduction in recurrence rate. Traditional techniques produce tension on the suture line and high percentage of early and late recurrences since an essential surgical principle is transgressed. In fact traditionally repair has been accomplished by approximation of anatomical structures, that are not normally in apposition and by utilization of defective tissue. Metabolic alteration involving collagen turnover is evident in these patients. The answer to this problem is prosthetic repair. At present there is no ideal prosthesis, however the surgeon can use several suitable synthetic materials. The selection of prosthetic materials is a fundamental step also considering the possible infection; that however develops rarely. In conclusion the authors think that mesh repairs represent an overcoming of traditional surgical techniques in abdominal wall defect repair.

[Spontaneous biliodigestive fistulas. Clinico-radiological considerations on 17 cases]. / In tema di fistole biliodigestive spontanee. Considerazioni clinico-radiologiche su 17 osservazioni.

An account of the aetiology, pathogenesis, anatomical and pathological picture, progression and complications of spontaneous biliodigestive fistula is flowed by a description of its clinical picture and diagnostic problems. Reference is also made to 7 patients subjected to emergency surgery and 10 electively operated. Diagnosis is ensured by careful review of the history, radiological examination of the abdomen in blank, and assessment of the digestive apparatus with an opaque meal and clyster. Little assistance is provided by the objective data and radiological examination of the bile ducts.

[Congenital cysts of the liver. Their instrumental diagnosis and the indications for surgical treatment]. / Cisti congenite del fegato. Diagnosi strumentale e indicazioni al trattamento chirurgico.

The authors report their experience of 8 cases of congenital cysts of the liver describing instrumental examinations used for diagnosis and different surgical operation performed. The Authors believe that the choice of surgical procedure, performed in symptomatic patients and large cysts, has to be according to different parameters as morphology and localization of the cysts and coexisting pathologies. Being non-malignant pathology, conservative surgery often avoids the complications of liver resection.