Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference.

Purpose: The laparoscopic treatment of ventral incisional hernias is the object of constant attention and is becoming increasingly widespread in the international scientific-surgical community; however, there is ample debate on its technical details and indications. In order to establish a common approach on laparoscopic ventral incisional hernia repair, the first Italian Consensus Conference was organized in Naples (Italy) on 14-15 January 2010.

Methods: The format of the Consensus Conference was freely adapted from the standards of the National Institute of Health and the Italian Health Institute.

Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial.

Objective: The durability of carotid endarterectomy (CEA) may be affected by carotid restenosis. The data from randomized trials show that the highest incidence of restenosis after CEA occurs from 12 to 18 months after surgery. The optimal CEA technique to reduce perioperative complications and restenosis rates is still undefined.

European multicentre experience with modular device (Medtronic Aneurx) for the endoluminal repair of infrarenal abdominal aortic aneurysms.

Objective: Transfemoral endoluminal repair of AAA, introduced for the first time in the early 90's, has become a very promising alternative to conventional open repair and more and more centers are reporting satisfactory postoperative results in a high percentage of cases. Straight and bifurcated grafts represent the devices available on the market at present and aortic, as well as iliac aneurysmal lesions can be safely treated through a transfemoral approach. The possibility to indicate an endovascular AAA repair is related to the configuration (length and size) of the proximal and distal necks, tortuosity and calcification of the access arteries and to vascular and non-vascular comorbidities, which afflict the patients.

Experience with the Stentor endograft at four Italian centers.

Purpose: To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device.

Methods: Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.

Totally laparoscopic aortobifemoral bypass: a review of 10 patients.

The main purpose of this study is to evaluate the feasibility of totally laparoscopic aortobifemoral bypass for occlusive aortoiliac disease. Ten patients who had incapacitating claudication have been included to date in this investigation. We have designed a transabdominal retroperitoneal technique that allows performance of the procedure without the problems associated with retraction of intraperitoneal organs.

A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial.

Purpose: The EVEREST Trial was designed to determine whether the surgical technique influences the durability and complications of carotid endarterectomy (CEA). The current report focuses on the study design and preliminary results.

Methods: EVEREST is a randomized multicenter trial.

Morgagni-Larrey hernia correction by laparoscopic surgery.

A new method of closure of Morgagni-Larrey hernia by video-assisted surgery is described in a child. Laparoscopy could in our opinion be an advantageous method for treatment of diaphragmatic defects.

Pain therapy in elderly cancer patients.

In most (65-80%) cancer patients at an advanced stage of illness we find significant, invalidating symptoms of pain. Cancer pain is a complex pain (with a nociceptive, neuropathic and deafferentation component), which requires a multidisciplinary approach (surgery, radiochemotherapy, and pain therapy). Pain therapy has various pharmacological strategies at its disposal (opiates, anti-inflammatory and adjuvant drugs) together with modulation and neurodestructive techniques, which must be applied taking account of both the stage of the disease and the pain intensity.

[Laparoscopic repair of bilateral and/or recurrent inguinal hernia].

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.

[Diverticulosis of the sigmoid colon: when to operate and which surgical treatment to use].

Diverticulosis of the colon is an increasing frequent disease: 50% of all subjects over 70 are affected by this pathology. The paper reports a series of cases and a therapeutic approach for simple, symptomatic and complicated diverticulosis. The long-term results are also reported.

Pancreatectomy and metabolic alterations.

The authors describe problems about anaesthesia management in peri- and post-operative periods in seven patients undergoing total pancreatectomy. They underline that metabolic alterations in these cases show, until now, some unsolved problems. Sometimes artificial pancreas is very useful in post-operative management of these patients.

Intubating conditions with propofol under muscle relaxation with vecuronium bromide. A time-related comparison with thiopental.

In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation.

[Prevention of colonic ischemia during surgery of the aorta].

The authors report the results of 53 revascularizations of the Inferior Mesenteric Artery, performed during 315 aortic reconstructive procedures, in 19 (35.85%) cases out of a group of 102 aortic aneurysms and 34 (74.15%) cases in a group of 213 aorto-iliac obstructive lesions.

Effect of different intravenous nutrients on metabolic changes in short-term fasted man.

It is well documented (1-3) that a balanced use of nutritive solutions is important to maintain metabolic homeostasis and a better control of nutrient flux in fasting patients. In this trial, 10 healthy males, aged 30-50 years, fasted for 12 h, were subjected to intravenous nutrient loads in three separate trials. In the first trial they received only a fat emulsion, in the second fat emulsion and L-amino acid solution, and in the third fat emulsion, L-amino acid solution and glucose solution, 240 and 480 min after intravenous infusion plasma triglycerides, serum cholesterol, free fatty acids, lactate, glucose and plasma amino acids were determined.

Early gastric cancer: evaluation of diagnostic, clinicopathologic and therapeutic aspects in 60 cases.

A series of 60 patients with early gastric cancer (EGC) operated on from 1.1.1971 to 31.

[Case contribution on intraoperative cholangiography].

An assessment is made of the systematic application of intraoperative cholangiography in the light of a consecutive series gathered over a period of four years. The importance of employing this technique as a routine measure is clearly demonstrated by the results. If properly performed, it greatly reduces unnecessary choledochotomy, diminishes the incidence of overlooked calculi, and leads to the detection of papillo-oddian diseases.