The Trabucco technique in the treatment of inguinal hernias; A six-year experience.

BACKGROUND: The introduction of both polypropylene prosthesis and the new tension-free methods for the treatment of inguinal hernias, induced us to choose the Trabucco technique since August 1994. METHODS: Up to April 2001 983 inguinal hernia repairs were carried out in 825 patients, 948 with the Trabucco technique. RESULTS: Minor complications (hematoma, seroma, inguino-crural pain) were 42 (5.1%) with no wound infections. There were 3 relapses (0.36%), one treated in an other hospital and the other two were surgically treated because of the small dimension of the hernia and they were not troublesome for the patients, although they were strictly controlled. CONCLUSIONS: In spite of the limited follow-up period, there is satisfaction for the short-term period outcomes which showed the superiority of the Trabucco method compared with the traditional techniques both as to hospitalization and good recovery and to the early relapse.

[Carcinoid of the appendix. Clinical report of 3 cases and diagnostic and therapeutic considerations]. / Il carcinoide dell'appendice. Osservazione clinica di 3 casi e considerazioni diagnostiche e terapeutiche.

The Authors report three cases of carcinoid of the appendix and discuss the difficult preoperative diagnosis and the different therapeutic options available. Over the period from January 1994 to December 1999, in the Surgery Unit of Penne Hospital, 424 appendicectomies were performed in 182 males and 242 females (age: 12-86 years; mean age: 39.9 years). In three cases the histological response was positive for carcinoid of the appendix. No postoperative mortality or morbility were reported. The authors analyze the biological peculiarities and the prognostic factors associated with appendiceal carcinoid tumours, such as tumour size and the lymphatic or vascular infiltration of the mesoappendix (and the corresponding more aggressive surgical treatments) and recommend an appropriate postoperative follow-up since synchronous or metachronous bowel carcinomas are likely to occur. Pharmacological therapy has also made important progress, with the possibility of administering compounds capable of interfering with tumour development and neoplastic growth.

[Laparoalloplasty by the Rives' technique for the treatment of large ventral hernias. Ten-year experience]. / Laparoalloplastica secondo Rives per il trattamento dei grandi laparoceli. Dieci anni di esperienza.

The problems of the surgery of bulky laparoceles began to find concrete solutions with the introduction of materials of synthesis that can be used to reinforce or to substitute the abdominal wall. Despite that, the ideal prosthesis has still not been found, the Dacron (Mersilene), the Polypropylene (Marlex, Prolene) and PTFE (Goretex) are today considered the best materials for the alloplasty. The authors describe their experience in matter of bulky laparocels treated with the technique of Rives. 49 patients have been operated, using Dacron in 44 cases and Polypropylene in 5. They had no mortality and no relapse, while the most frequent complication was 6 seromas, all resolved with conservative therapy. In their series 3 infections of the subcuticular occurred more of which required the removal of the prosthesis.

[Cancer of the gallbladder]. / Il cancro della colecisti.

Carcinoma of the gallbladder is the most frequent neoplasia of the biliary tract with an incidence of 2.5-4.4 cases for every 100,000 inhabitants; it more often affects females and elderly patients (60-70 years). It is an extremely malignant tumour with an often fatal prognosis owing to both its site and the generally late diagnosis; the majority of patients in fact undergo surgery at an advanced stage of the disease when surgery is only palliative. At the Surgical Division of S. Massimo Hospital in Penne (PE) a total of 897 operations on the gallbladder and biliary tract were performed between 1988 and 1994, revealing 21 cases of carcinoma of the cholecyst (2.3%). Sixteen patients were female (male-female ratio 1:3.2) with a mean age of 67.8 years (range 58-83 years). These patients were divided into 5 stages according to the UICC-1992 classification: 80.9% of cases were stage 3-4. Diagnosis was performed intraoperatively in 2 patients, whereas in 3 cases cancer had been diagnosed by the anatomo-pathologist. A total of 3 simple cholecystectomies were performed, 4 were associated with hepatic resection and lymphadenectomy of the hilus and hepatoduodenal ligament; surgery was enlarged in 2 cases due to the involvement of adjacent organs. After exploratory laparotomy, palliative surgery was performed in the remaining 12 patients in the form of biliary and derivation. Four system were implanted for intra-arterial chemotherapy. The most frequently found histological type was adenocarcinoma (76.2%). The mean survival rate of patients who died was 7.6 months. Six of the operated patients are still alive, of whom only one with a follow-up of 4 years. In conclusion, the authors agree with those who consider carcinoma of the gallbladder generally fatal in view of the rarity of early diagnosis and the difficulties of performing radical therapy.

[The selective use of intraoperative cholangiography in video laparoscopic cholecystectomy]. / L'utilizzo selettivo della colangiografia intraoperatoria nella colecistectomia videolaproscopica.

Intraoperative cholangiography, a diagnostic method through images introduced in to clinical use in 1932, has recently become a different technical support from that attributed by traditional surgery and it has got a different diagnostic meaning with the introduction of video surgery. The authors used it in 54 of 194 patients submitted to a CVL, always making use of the trans-cystic access, with a percentage of success of 82.6%. It was not possible in 8 patients due to the complete section of the cystic duct during the work (3 cases) and the impossibility of introducing the catheter (5 cases). There is still no common agreement about the opportunity to use IC daily: the authors think selective use is better preceded by a careful clinical laboratory instrumental preoperative study to find patients with the common duct stone. Besides, they are of the opinion that a rigorous surgical technique is fundamental to reduce the lesions of the VBP that there are not in their experience.

[A rare case of Meckel's diverticulum perforation]. / Un raro caso di perforazione del diverticolo di Meckel.

Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.

[Branchial carcinoma]. / II carcinoma branchiale.

The Authors report three cases of epidermoidal carcinoma arising from a congenital cyst of the anterolateral region of the neck. This type of tumor, rarely found in daily practice, arises from a degenerate branchial tissue and differential diagnosis often includes nodal involvement from systemic neoplasias. However, diagnostic criteria of such diseases are well defined; furthermore the rarity of branchial carcinoma is opposed to the high frequency of metastatic lymph nodes deriving from tumors with similar histological aspects located in other sites which could alter the real percentage of branchial tumor manifestation.

[Laparovideocholecystectomy]. / La laparovideocolecistectomia.

The authors present the guidelines which have been followed to introduce into their own Surgical Division an alternative method to cholelithiasis treatment: laparovideocholecystectomy (l.v.c.). They point out how the directions for use of the new surgical method, in place of the traditional laparectomic technique, must be limited to non-complicated cholelithiasis cases, especially in the initial learning stages. That sets the global "morbility" of the above said l.v.c. beneath the cholecystectomy performed with traditional technique. In addition, they point out the sure economic advantages at social and contributions level arriving at the conclusion that l.v.c. is the best treatment for Gallstones.

[Extraperitonealization of the liver in the Chilaiditi syndrome]. / Extraperitoneizzazione del fegato per sindrome di Chilaiditi.

The Chilaiditi syndrome or viscero hepato diaphragmatic interposition is a rare anomaly. The authors describe one case they observed. Even if it is often asymptomatic, it may manifest also by recurrent sub-occlusion or occlusion. Only a few patients need corrective surgical operation. The operation of choice is hepatic extra-peritonealization, which after replacement of the dislocated gastroenteric tract, brings the superior face of the liver again into direct contact with the related diaphragmatic dome.

[Lumbar hernia of Grynfeltt's quadrilateral space. Apropos a case]. / Ernia lombare del quadrilatero di Grynfelt. A proposito di un caso.

The authors discuss a case of Grynfeltt's quadrilateral lumbar hernia in an 85-year-old patient. These rather rare hernias can be classified as Grynfeltt's hernias of the superior lumbar space, as Petit's inferior lumbar space and as diffused hernias concerning the whole hip. In our case this hernia was located in the superior lumbar space and it was delimited on the upper part by the 12th rib and by the serratus posterior-inferior muscle; in the lower part by the internal oblique muscle and by the lumbar quadratus muscle. Surgical treatment was effected by plastic surgery with synthetic material put in the extra-peritoneum space and fixed by serum-muscular stitches. Postoperative control effected after a month from the operation proves a good keeping of the plastic surgery reconstruction with total disappearance of the hernia.