Single Stapler Parachute Technique (SSPT): a new procedure for large hemorroidal prolapse.

Procedure for Prolapse and Hemorrhoids (PPH or Longo procedure), a stapled circumferential anal mucosectomy, has proven to be very popular as it is considered safe and successful. However, a high haemorrhoid recurrence rate is reported, specially due to insufficient mucosal resection. The authors have come up with a technical modification to the mucoprolapsectomy, notably the Single Stapler Parachute Technique (SSPT), in order to obtain more abundant mucosal resection. In this study they will present the results obtained in 80 patients treated for muco-haemorrhoidal prolapse, 40 of whom underwent traditional PPH, while the remaining 40 patients underwent SSPT, both performed in two different specialised centres located in Rome, Italy.

Feasibility of stapled haemorrhoidopexy in day surgery.

The aim of this study was to report the results of a stapled haemorrhoidopexy for patients with second to fourth degree of rectal prolapse, with reference to its feasibility as a day-surgery procedure. Between January 2005 and December 2007, 203 patients with symptomatic hemorrhoids have been operated for stapled haemorrhoidopexy. Surgery was performed between the 8:00 to 9:00 am using a standard sedation and a regional perianal local block. All the patients were discharged from the hospital at 18:00 of the same day of the surgery. Postoperative analgesia with a disposable device for infusion, after 24 hours was removed at home. Four patients after 3 hours from the operation have had an anal bleeding in the hospital. Four patients have had an anal bleeding at home during the night. One patient has had an important anal pain at home during the night. Stapled haemorrhoidopexy in day surgery may be a viable addition to the therapy for rectal prolapse with the advantages of an early discharge and a lower cost than a longer hospitalization. With this procedure, performed in a single day, we provided a value-added service to the patients with less cost and without a significant compromise on safety and efficacy.

[Posterior mediastinum neoplasms: a case of schwannoma]. / I tumori del mediastino posteriore: un caso di schwannoma.

The Authors report the case of a 33-year-old male affected with an asymptomatic schwannoma of the posterior mediastinum, and review the relevant Literature, discussing the difficulties in making the differential diagnosis of the posterior mediastinum lesions, particularly in the pre-clinical phase. Neurogenic tumors represent about 75 percent of all tumors of mediastinum and about one third of all tumors of the mediastinum. They can originate from the peripheral nervous system group, from the sympathetic nervous system group or, in rare cases, from the vagus nerve. In adult patients, they are usually found by chance during radiographic examination of the thorax, and they are usually asymptomatic and benign. During preoperative evaluation, a magnetic resonance examination of rachis should be done to exclude the possibility of intraspinal involvement. If there are no contraindications, the treatment of choice should be surgical resection by means of thoracoscopy or thoracotomy, when size and location of the tumors allow it in order to prevent malignant evolution.

Lymph node dissection in surgical treatment of esophageal neoplasms.

BACKGROUND: Until now therapy of carcinoma of the esophagus has presented an aura of pessimism, resulting in an attitude among physicians that cure was impossible. Presently the overall 5-year survival is between 38.3% and 55% thanks to new radical surgical techniques. The aim of this work is to evaluate lymph node dissection in treatment of esophageal carcinoma by analyzing morbidity, mortality, survival and quality of life. METHODS: From 1975 to 1995, 170 patients with carcinoma of the esophagus and cardia underwent operation, of whom 165 underwent 2-field lymphadenectomy and four 3-field lymphadenectomy; one patient was submitted to self-transplanting jejunal loop to neck. One hundred and twenty-two patients had standard resection and 47 en bloc resection. RESULTS: Lymph node involvement is often found in patients with superficial carcinoma and it greatly influences outcome after esophagectomy. In 2-field lymphadenectomy morbidity and mortality are more frequent in en bloc resections; global 3-year survival was better in patients with early lesions. Three-field lymphadenectomy was performed in only few cases, not sufficient to express a definitive opinion. CONCLUSIONS: On the basis of our experience, we conclude that the better survival is particularly dependent on early diagnosis, histological type of neoplasia and following surgical treatment, especially on the type of resection with 2 or 3-field lymphadenectomy.

Surgical treatment of differentiated microcarcinomas of the thyroid.

Thyroid microcarcinomas (TMC) are histologically malignant diseases, despite their limited dimensions and non-aggressive behaviour; frequent multifocality of the disease and local recurrence is really possible after conservative resection. Modern therapeutic approaches to thyroid microcarcinoma include both radical surgical treatment, influenced by the frequent locoregional diffusion of TMC, consisting of a total thyroidectomy with an eventual central and/or functional unilateral lymphadenectomy, depending on the clinical evidence of lymh node metastases and conservative treatment based on more limited resections which take into account the slow clinical progression of this type of tumour. The aim of our work is to examine the therapeutic guidelines for surgical treatment of TMC which, in our experience, are closely dependent on clinical presentation type. From 1991 to 2000, more than 400 patients with thyroid disease were referred to the Department of Surgical Science and Applied Medical Technologies "F. Durante". Threehundred-seventythree patients received surgical treatment: in 311 patients a benign disease was diagnosed, while in 62 neoplasia was present. In total we observed 30 TMC, consisting of 28 papillary and 2 follicular microcarcinomas. On the basis of clinical presentation we divided patients in three groups: A--patients with a clinically suspicious neoplastic lesion before surgical treatment; B--patients in whom histological diagnosis of cancer was "incidental" after an operation performed for benign disease; C--patients in whom a neck lymph node metastases were clinically found before diagnosis of an "occult" papillary carcinoma in the thyroid gland. 27 total thyroidectomies and 3 conservative resections, that required successive total exeresis, were performed. In 5 cases a central neck lymph node dissection was carried out and in 5 + 1 cases functional modified lateral neck dissections was deemed necessary. Our data suggest that an evaluation of tumor's malignancy cannot be carried out on the basis of its dimensions alone. Indeed, biological aggressivity, whether local or at a distance, is a prerogative of both large and small tumours. Therefore a microcarcinoma must be considered a full-blown form of thyroid cancer and as such must be treated. Total thyroidectomy may be followed by identification of possible local metastases. "Whole body" scintigraphy allows to identify and treat with radioiodine therapy, possible recurrent lesions. Therefore in conclusion, total resection is not only a useful, but also a necessary treatment for the correct diagnostic and therapeutic follow-up of these patients.