[Surgical treatment of chronic pericardial effusions. Personal experience]. / Il trattamento chirurgico dei versamenti cronici del pericardio. Esperienza personale.

The authors report their experience about 15 patients surgically treated for chronic large pericardial effusion; in 12 cases the etiology was malignant neoplasm, while in the other 3 cases was inflammatory disease. In 4 patients a simple subxiphoid pericardial drainage was carried out, while in the other cases a pericardial window was performed. These cases were managed using an anterior left thoracotomy in 8 patients and a videothoracoscopy in 3. The authors conclude that pericardial window with videothoracoscopic approach is the preferable procedure, but it cannot be used in every case because a lot of patients have seriously compromised conditions and the use of this technique can be hazardous.

[Video-assisted lower pulmonary lobectomy]. / La lobectomia polmonare inferiore video-assistita.

The authors present 2 cases of pulmonary lower lobectomy (right and left) using video-assisted modality. The I patient had a stage I NSCLC and the II had a metastasis from rectal carcinoma. The operation was performed using the modern videoendoscopic means introduced into the thoracic cavity thorough three ports and an anterior 4 cm mini-thoracotomy. The patients had an uneventful postoperative course and no pain or trouble breathing were observed. In conclusion the authors are of the opinion that performing lower pulmonary lobectomy, video-assisted technique is feasible and reliable; in very selected cases it should become the modality of choice.

Role of videoendoscopy in pulmonary surgery: present experience.

Videothoracoscopic techniques were utilized in managing 88 consecutive patients. The series was composed of 36 patients with pneumothorax, 44 cases of single and 9 of multiple pulmonary nodules and 1 patient with diffuse lung disease. In 14 cases (15.9%) conversion to open thoracotomy was necessary while in the remaining 74 patients the procedure (30 blebectomies, 2 bullectomies, 37 wedge resections, 6 lobectomies and one multiple biopsies) were carried out as planned. In each lobectomy and in six wedge resections an accessory small incision was necessary; we consider only this video-assisted thoracic surgery (VATS). Benign disease, aside from the blebs and bullae, was found in 12 cases of solitary pulmonary nodules and in 1 case of multiple lesions, while malignant lesions were detected in 31 patients. Primary carcinoma was diagnosed in nine cases after a wedge resection had been performed on a suspicious solitary nodule. In two of these wedge resection had to suffice because of poor lung function, while in the remaining seven cases, a lobectomy was carried out through an open thoracotomy in two patients, and in five cases VATS was attempted successfully in four, while in one case a formal thoracotomy was necessary due to bleeding. Solitary metastases were found in 14 patients and were managed by 12 wedge resections and 2 lobectomies. Seventy-one patients (97.3%) had an uneventful postoperative course while 2 (2.7%) had only minor complications. No recurrences were observed, however follow-up is limited. Videothoracoscopy techniques are very useful and are good alternatives to conventional thoracotomy in managing cases of pneumothorax, benign pulmonary lesions and in taking biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopic repair of bilateral and/or recurrent inguinal hernia]. / L'alloplastica laparoscopica nel trattamento dell'ernia inguinale bilaterale e/o recidiva.

The Authors report their three-year experience in the laparoscopic management of bilateral or recurrent hernia using a polypropylene mesh through a transabdominal extraperitoneal approach: out of a total of 500 laparoscopic hernioplasties performed, 162 patients with bilateral hernias and 51 with recurrent hernia underwent this procedure. In bilateral hernias a single wide patch was used to cover both the myopectineal foramen, therefore performing a Stoppa procedure by laparoscopy. Two major complications were registered in this series: 1 bleeding and 1 intestinal obstruction, both managed laparoscopically. Minor complications were: 2 cases of neuralgia and 6 seromas which required single or multiple evacuations. Patients were carefully followed up (1-31 months), and no relapses were recorded. Although the follow up is still too short, the Authors stress the characteristics of this technique which shows great advantages mainly represented by a good compliance, quick return to normal work and sport activity; in fact, recovery is obtained in a shorter period as compared to traditional surgery even when the latter includes the use of prosthetic mesh.