Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: surgical phases and complications.

BACKGROUND: This study aimed to determine the nature of complications after transabdominal preperitoneal (TAPP) hernia repair, and to evaluate possible links to intraoperative factors in an effort to reduce the incidence of complications. METHODS: The TAPP procedures for inguinal/femoral hernias performed between 1992 and 2004 at a single center were analyzed retrospectively. Complications were categorized according to severity and stage of the surgical procedure at which they occurred. Individual surgeon performances were examined to determine whether the rates of complications were related to surgeon experience. RESULTS: A total of 1,973 TAPP procedures were reviewed, and 81% of the patients completed 5 years of follow-up evaluation. The 74 complications (3.7%) reported were categorized as follows: 33 major (1.7%) versus 41 minor (2.0%), 66 hernia-related (3.4%) versus 8 laparoscopy-related (0.5%) complications, and 12 recurrences (0.6%). Risk factors for complications included inguinoscrotal hernia (p < or = 0.001), dissection/reduction of the sac (p = 0.02), and surgeon experience (< 50 TAPP procedures; odds ratio, 7.1; 95% confidence interval, 4.2-11.9). CONCLUSIONS: Accuracy in dissection/reduction of the sac improves the outcome of TAPP hernia repair. This effect is related to the experience of the surgeon. Experience performing more than 75 procedures is required for optimal results.

[Lipid cell carcinoma of the breast]. / Carcinoma a cellule lipidiche della mammella.

A review of cases treated in 1978-82 revealed 1 case of lipid cell carcinoma of the breast out of 310 mammary carcinomas. Given the rarity of this histological type and the generally poorer than average prognosis, it seems likely that it should be considered separately from the other cases.

[Cholecystolithotomy with cholecystojejunostomy as surgical solution for cholelithiasis in portal hypertension caused by hepatic cirrhosis]. / La colecistolitotomia con colecistodigiunostomia come soluzione chirurgica della colelitiasi nella ipertensione portale da cirrosi epatica.

Cholecystolithotomy and cholecystojejunostomy has been carried out on 11 patients with severe hypertension from cirrhosis. The indications were frequently recurring attacks of biliary cholic or acute cholecystitis at onset. There was 1 postoperative death from cardiac infarction and only minor in-hospital morbidity. None of the remaining patients has to date developed post-cholecystojejunostomy sequelae. Except the case of extensive inflammation on gangrena, this procedure appears to be a safe and definitive operation, alternative to subtotal cholecystectomy.

[Upper digestive hemorrhage (observations on 201 cases)]. / Le emorragie digestive alte (osservazioni su 201 casi).

The results obtained in 201 cases of haemorrhage of the higher tract of the digestive tube are reported. The role of early endoscopy (less than 24 h) and that of a "rigorous" selection of patients for surgery treatment are emphasized. The value of surgical resection in serious haemorrhage of chronic peptic ulcus is confirmed by the satisfactory results obtained.

[Spontaneous pneumothorax (therapeutic consideration)]. / Il pneumotorace spontaneo (considerazioni terapeutiche).

The Authors report the results achieved in 74 patients with spontaneous pneumothorax. The treatment was conservative in 66 patients. The surgical treatment was performed in 8 patients operated with monolateral resection of apical bullae (7 cases) or lobectomy (1 case) through lateral thoracotomy.

[Transduodenal papillosphincterotomy. Remarks on 138 cases (1975-1982)]. / La papillosfinterotomia transduodenale. Rilievi su 138 interventi (1975-1982).

Transduodenal papillosphincterotomy, largely performed since many years, is still controversial. The retrospective analysis of 138 cases allows a discussion about its indications and some important details of surgical technique. Particularly, the authors report a relative low incidence of serious complications, with peculiar regard to postsurgical acute pancreatitis, and satisfactory long-term results (follow-up ranging from one to eight years) in the 95,2% of cases.

[Bronchogenic carcinoma (personal observations)]. / I carcinomi broncogeni (osservazioni personali).

The authors report the results achieved in the treatment of 62 patients with pulmonary cancer "non-microcytoma". The survival rate was 20.9% at 5 years (actuarial). The best prognosis is for patients with epidermoid cancer: 35.5%. The authors emphasize the importance of the exact stage of the neoplasm and the evaluation of the postoperative cardiopulmonary functional adaptation in the prognostic evaluation of resection for pulmonary carcinoma.

[Recurrent anorectal abscesses]. / Gli ascessi anorettali recidivi.

A study of 78 patients with recurrent anorectal abscess was carried out to elucidate the cause of recurrence. The inadequate treatment (incision and drainage) and the spontaneous rupture or resolution of the abscess with no further treatment were the most common reasons for recurrence. At surgery, 18 patients were found to have recurrent hidradenitis suppurativa. The authors recommend a careful regional exploration under anesthesia and an aggressive surgical approach to achieve satisfactory results and to ensure minimal, if any recurrence.