Since the beginning of the century, different surgical procedures have been employed to create new anal sphincters for a continent perineal colostomy after abdominal perineal anorectal resection for cancer. After a detailed review of all the currently employed surgical procedures, the authors present their experience with 15 cases treated by transposition of the gracilis muscles to the perineum. More than 50% of the operated patients had good functional results with complete continence for solid stools and sufficient control of the stimulus. Poor results are related to surgical complications or unexpected postsurgical diseases and cancer recurrence or metastases. This surgical procedure seems to be an interesting possibility for selected patients in the case of a permanent abdominal incontinent colostomy after the Miles operation.

Aged↗

PubMedDate not supplied

[A splenic autograft in posttraumatic splenectomies].

BACKGROUND AND AIMS: The authors report their experience regarding the use of autologous splenic transplantation in post-traumatic splenectomy unable to be treated using conservative surgery. After reviewing the international literature on the subject, they report a retrospective survey of cases treated from January 1992 to December 1996. METHODS: Owing to the particular logistic location of the hospital in an area with a high density of industry and at the crossroad of major road and rail routes, a total of 56 patients were admitted to the Emergency Ward suffering from abdominal trauma in 4 years. The patients included in this study could not be treated using conservative surgery: the study group included 15 patients aged between 14 and 76 years old. The surgical technique consisted of the graft of sections of splenic pulp in omental pockets, subsequently marked using metal clips. In order to evaluate splenic immunological function a complete hemochromocytometric examination was performed in each patient at the same time as emergency preoperative tests consisting of peripheral blood strip and pitted cells (PC) assay. This was followed by postoperative evaluations at weekly intervals, including platelet count, Howell-Jolly bodies assay (HJb), immunoglobulin M assay and hepatosplenic scintigraphy using erythrocytes marked with 99m-Technetium pertechnetate (99mTc). RESULTS: An adequate functional recovery of splenic tissue was achieved in all patients with partial recovery of hemocatheretic and immunological function. CONCLUSIONS: The authors' clinical experience confirmed the data inferred from animal experiments: the simplicity of the preparation technique and the autologous transplantation of splenic pulp in the absence of major complications confirms the possibility of applying this method in all splenectomies performed under emergency conditions.

Abdominal Injuries↗

PubMedDate not supplied

Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis.

BACKGROUND/AIMS: Minimally invasive surgery has developed as one of the most important advances in surgical techniques. The laparoscopic procedure has been successfully used to perform colonic resections. Inflammatory bowel diseases like ulcerative colitis (UC) and familial adenomatous polyposis (FAP) appear as a main indication for total laparoscopic proctocolectomy. METHODOLOGY: At the Second Department of Surgery of the "Regina Elena" Institute for Cancer Research, 5 non-selected patients were submitted within a 3-year period (1993-1996) to a total laparoscopic proctocolectomy with a restorative ileal J pouch-anal anastomosis. They comprised 3 males suffering from UC and 2 females affected by FAP. RESULTS: No patients undergoing laparoscopic procedure were converted. The average operative time was 364 min (480 min in the first case, 290 min in the fifth case). There were no intra-operative or post-operative complications (except a mild peritoneal bleeding in the first case, spontaneously stopped). Post-operative pain was mild and no analgesics were required. Late results were excellent, with good bowel function within 1 year after the operation, without dietetic, working and sport restrictions and without sexual disorders, mainly in males. CONCLUSIONS: Laparoscopic total proctocolectomy in the hands of skilled laparoscopic surgeons is a feasible, safe and effective procedure, with early and late results comparable to, and in some aspects better than, those obtained with "open" surgery. Moreover, it does not have the disadvantage of intra-operative fluid loss, prolonged post-operative ileus, pain and, in younger patients, psychological discomfort of the wide scar.

Adenomatous Polyposis Coli↗

PubMedDate not supplied

Colorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial.

BACKGROUND/AIMS: The purpose of this perspective study was to define the role of laparoscopic surgery in the treatment of colorectal carcinoma. METHODOLOGY: One hundred colorectal cancer patients were submitted to surgical treatment between 1993 and 1996. Fifty patients were operated on by videolaparoscopy, the other 50 were operated on according to the standard "open" technique. The two groups had similar demographic (age, gender), pathological (site, stage), and surgical (type and extent of resection) data. Early and late results, benefits and drawbacks of the minimally invasive technique are compared to those of standard open surgery. RESULTS: No intra-operative complications and no operative mortality occurred in the two groups. Early results (complications within 30 days from surgery) were: 1 pneumonia, 3 wound sepsis, and 3 fistulas (one required a reoperation) in the laparoscopic group; 2 wound sepsis and 5 fistulas (spontaneously recovered) in the open group. Late complications occurred in the laparoscopic group only: 1 bowel bridle occlusion 2 months after surgery (that required a reoperation), and 2 stenoses of the colorectal Knight-Griffen anastomosis, successfully treated by dilatation. Concerning the oncologic results, data were calculated on 40 laparoscopic and 43 open curative resections (stage I, II and III): 20% (8/40) of the laparoscopic and 23% (10/43) of the open group patients resulted in neoplastic progression. The neoplastic recurrences were single site (liver or regional) in 3 laparoscopic and in 5 open patients; multiple sites of relapse were observed in 5 laparoscopic (liver, peritoneum and 1 trocar site) and in 5 open (liver, peritoneum and 1 scar) cases. Five-year disease-free survival rates (Kaplan-Meier method) were similar in the two groups: 73.2% in the laparoscopic and 70.1% in the open. CONCLUSIONS: Laparoscopic surgery seems to be a feasible and effective treatment of colorectal cancer and, with the improvement of technology and surgeon skill, it will represent an excellent alternative to the more diffuse and consolidated open surgery technique.

Adult↗