Indications and results for transduodenal sphincteroplasty in the era of endoscopic sphincterotomy.

Background: Transduodenal sphincterotomy (TS) has fallen into disuse since endoscopists developed techniques to treat sphincter problems nonsurgically. However, some patients experience recurrent sphincter strictures after endoscopic sphincterotomy (ES), with the ampulla endoscopically inaccessible, and pancreas divisum (PD); these patients are referred to a surgeon because they are unsuitable for ES.

Methods: The medical records of patients who underwent TS at the First Department of Surgery of the Medical School, University of Rome "La Sapienza," between January 1997 and December 2005 were reviewed.

Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture.

Background: Pilonidal sinus (PS) is a common chronic disorder of the sacrococcygeal region. The optimal treatment for PS remains controversial, and recent reports have advocated different surgical approaches.

Methods: A prospective study was performed on 103 patients with nonrecurrent quiescent chronic discharging sinus.

Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease.

Background: Preservation of the inferior mesenteric artery (IMA) and consequential blood flow to the rectum would reduce the risk of leakage of a colorectal anastomosis.

Methods: One hundred and sixty-three patients undergoing left colectomy for complicated diverticular disease of the colon were randomly placed into two groups: A, n = 86; and B, n = 77. In group A, the integrity of the IMA was preserved by artery skeletization (IMAS); in group B, the IMA was divided at its origin.

Parietal sierosa for protecting colonic suture lines. Technical note.

Suture line leakage is a frequent, serious problem in colon surgery. We propose the use of a flap of the parietal peritoneum from the paracolic gutter, adjacent to the operative site, to protect right and left colon suture lines. The advantage of this method is that it permits complete exclusion of the sutured intestine from the peritoneal cavity and avoids the risks of leakage from an intestinal suture line within the peritoneal cavity.

[Use of vascular endostapler in surgery of the lower rectum].

A practical and effective method for rapid and bloodless preparation of the rectum using endovascular stapler devices during low anterior resection, or abdominal-perineal excision, is described. This method is presented as an effective means for easily dividing the anterior and lateral attachment of the rectum. The application of this technique is the absence of intraoperative bleeding related to injury of middle hemorrhoidal vessels, with minimal risk of autonomic pelvic nerve damage.