[Intra-abdominal desmoid tumors: rare but important disease]. / I tumori desmoidi intra-addominali: una patologia rara, mai importante.

Desmoid tumors are rare benign neoplasms with high tendency to local recurrence, and they can be divided into extra- and intra-abdominal types (mesenteric fibromatosis). Eight cases have been treated in our Department from 1997 to 2006. Six patients (3 men and 3 women) affected by extra-abdominal desmoid tumors have been treated with radical excision. In two patients desmoid was intra-abdominal: 1) a 55 years old man admitted for acute abdomen and submitted, in emergency, to a laparotomy with excision of a mesenteric abscess including a jejunal loop at about one meter from Treitz; 2) 52 years old man, submitted to an elective excision of a capsulated neoplasm of the little omentum, which had caused an oppressive abdominal pain. In both cases the hystological diagnosis has been desmoid tumor. Surgical treatment of desmoid tumors must aim at radical excision to avoid frequent recurrences (25-65%); these have stimulated the research of other kinds of treatments, since a new surgical operation itself can lead to a further recurrence. Radiotherapy has been investigated with results in 79-96% of cases, antiestrogenic therapy has been used with success in 51% of patients, and high dose tamoxifen seemed to obtain a stable disease in non operable cases. Non steroidal anti-inflammatory drugs have been experimented in association with tamoxifen and chemotherapy. Conclusive results on the efficacy of these treatments have not been obtained yet, because of the rarity of the desmoid tumors even in greater Centres.

[Stapled versus hand sewn anastomosis in elective and emergency colorectal surgery]. / Anastomosi meccanica versus manuale in chirurgia colorettale elettiva d'urgenza.

We studied the incidence of anastomotic leakage in colorectal surgery with the alternative use of stapled anastomosis, hand sewn anastomosis and stapled/hand sewn anastomosis. 477 consecutive patients admitted for elective or emergency colon surgery were divided in: Group I? 337 elective patients submitted to mechanical bowel preparation; Group II - 140 emergency patients operated without mechanical bowel preparation. We analyzed surgical complications in the two group considering the different anastomosis made (stapled, hand sewn and stapled/hand sewn). Anastomotic leakages were 11 (3.3%) in Group I: 7 in stapled (3,4%), 2 in hand sewn (2,1%) and 2 in stapled/hand sewn anastomosis (5,3%); 10 patients (91%) with peritonitis or intra-abdominal abscess required re-intervention and there was a correlated death. In Group II there were 6 anastomotic leakages (4,2%): 1 in stapled (1,4%), 3 in hand sewn (8,3%) and 2 in stapled/hand sewn anastomosis (5,7%); four patients required re-intervention and there were no correlated deaths. Mean postoperative stays were similar among the different techniques of suture in the two groups. No statistically significant differences in surgical complications were noted among stapled, hand sewn and stapled/hand sewn anastomosis. The choice should be based on personal preference and surgeon experience, considering costs, using hand sewn suture whenever is possible.