Experimental modified orthotopic piggy-back liver autotransplantation.

UNLABELLED: The classical orthotopic liver autotransplantation is a very challenging and time wasting technique; it includes the division of major hepatic vessels and choledocus, and subsequent reconnection by end to end anastomoses. The caval end to end anastomoses are the most difficult to be performed and the interposition of a prosthesis can be required. We adopted the classical orthotopic liver autotransplantation technique in 2 patients affected with diffused liver metastases from colorectal cancer, for extracorporeal neutron capture therapy (BNCT). The procedure required very long operating times and the extracorporeal circulation (ECC) set up; furthermore the vena cava reconstruction was performed by the interposition of a goretex-prosthesis. We propose a "modified orthotopic piggy-back technique" to simplify liver reconnection and shorten the operating time. MATERIALS AND METHODS: The technique was developed in the swine (25 kg body weight), under general anaesthesia. We performed the resection of the retro-hepatic vena cava with preservation of the caval flow during the anhepatic phase, by interposing a goretex-prosthesis. The reconstruction of the vena cava was then performed by a side-to-side cava-prosthesis anastomosis with lateral clamping of the prosthesis. The procedure was then completed according to the classical technique of liver transplantation. RESULTS: The mean time for VC reconstruction was 56 (+/-10)min. and the mean time for side-to-side VC-prosthesis anastomosis was 13(+/-4)min. CONCLUSIONS: The "modified orthotopic piggy-back technique" can simplify the reimplant of the liver during autotransplantation and shorten the operating time. Furthermore also the time of total extracorporeal circulation is reduced, as during the anhepatic phase and during the side-to-side cava-prosthesis anastomosis the flow in the inferior vena cava is uninterrupted.

[Ano-rectal traumatic lesions. Etiology and treatment]. / Lesioni traumatiche ano-rettali. Eziologia e trattamento.

From January 1976 to December 2000, in the Surgical and Specialistic Sciences Department, Ist Chair of Surgical Physiopathology, University of Bari, we observed 13 cases of ano-rectal trauma. Except in wartime, these traumas are unusual. The aetiology is variable. In our experience we found 3 lesions due to firearms (24%), 2 patients with polytrauma after car accidents (15%), 3 iatrogenic lesions (24%), 1 lesion due to compressed air (7%), and 4 lesions due to objects used for autoeroticism (30%). Timely diagnosis and treatment were essential for a good outcome. The surgical choice was based on the patient's condition, the aetiology of the lesion and its anatomical site. We constructed 7 temporary colostomies and performed 2 Hartmann's operations. In 4 patients we extracted objects from the rectum. Four patients died.

[Comparison of hernioplasty using the technic of Bassini and Trabucco. Comparative analysis and results]. / Ernioplastica secondo Bassini versus Trabucco. Analisi comparativa dei risultati.

We evaluated comparatively trough a randomized perspective study the hernioplasty by Bassini technique and the Trabucco repair, respectively using general and local anaesthesia, in a group of 80 patients. We studied incidence of complications and recurrences, surgery, in-patient hospitalization time, postoperative pain, costs and work resuming. Trabucco repair had better results in each considered parameter: hospitalization time, pain and costs respectively 80%, 50% and 66% lower vs Bassini technique; moreover we found no recurrence and work resuming two weeks shorter.