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Background: Thyroid surgery presents a low incidence of complications. Death is certainly a rare, or even exceptional event. Hypoparathyroidism, above all if definitive, is the main complication of total thyroidectomy with percentages that very between 0 and 10% in the literature (average 2%)., Methods: The incidence of recurrent lesions varies between an improbable 0% to 8%, whereas lesions to the superior laryngeal nerve are relatively frequent, but often undervalued. Dysphagia, although always transient, presents a high risk of pneumonia ab ingestis and severe dehydration. Hemorrhage has an incidence of 0.1-3.8% and infection is reported in approximately 1% of cases. The permanent and recurrence nature of thyroid pathology in literature is between 5 and 11%, resulting from inadequate or sometimes useless surgery. Hypothyroidism is the logical consequence of total thyroidectomy. In the light of these data we have re-examined 300 operations involving thyroid pathology performed by the same team using the same method over the past 4 years (82% females, 18% males). 33% of the cases presented benign euthyroid nodular pathology, 27% hyperfunctioning benign nodular pathology, 2.6% Flajani-Basedow-Graves disease, 9% were adenomas, 7% were differentiated carcinomas, 2% anaplastic carcinomas and 0.7% medullary carcinomas. 99 extracapsular total loboisthmectomies, 135 total extracapsular thyroidectomies and 66 subtotal thyroidectomies were performed., Results: The following complications were observed: 31/300 symptomatic hypocalcemias of which 25 were transient and 6 (2%) were definitive but easily controlled with treatment; 9 recurrent monoplegias out of 501 isolated recurrent forms of which 4 (0.8%) was permanent; 5/300 (1.7%) postoperative dysphagias associated with recurrent monoplegia in 4 cases. Damage to the external branch of the superior laryngeal nerve was suspected in 11/300 cases (3.7%). Postoperative hemorrhage occurred with an incidence of 1.3%, whereas the incidence of wound infection and serous collection was 1.7%. Moreover, persistent hyperthyroidism after subtotal bilateral thyroidectomy was observed secondary to toxic plurinodular struma. A case of paralysis of the right ulnar nerve, when the arm was adducted, was observed on the operating table, but regressed after about 4 months. Mortality was zero., Conclusions: Thyroid surgery is still hampered by a relatively low percentage of complications, which are probably still the result of various technical limitations, and it appears difficult to reduce these, let alone eliminate them completely.

The authors present a series of 70 bilateral inguinal hernias selected from a total of 641 inguinal hernias operated from May 1994 to November 1996 using alloplastic surgery. They discuss the most appropriate methods of access for treating this pathology in a single operation, and propose inguinal access as the most preferable method owing to its easy execution and apparently greater safety. Laparoscopic techniques should be reserved for special cases such as pluri-recidivating hernias.

Ileal carcinoma is not frequent and its diagnosis is preoperatively quite difficult. The surgical approach often depends more on the on table situation than on a precise therapeutic protocol. The histological result is sometimes a real negative surprise and the five year survival of patients is similar to those operated for colonic carcinoma at the same stage.

A case of a symptomatic colonic lipoma causing recurrent abdominal pain and intestinal obstruction, not treated is reported. Lipomas are the most common mesenchymal benign tumors that can be found in the colon and are second as frequence only to the adenomatous polyps. In 65% of cases the lipomas are located in the large bowel and represent the most common cause of intestinal intussusception in the adult. Lipomas are most frequent in the right colon (40%-68%) an opposite distribution in comparison with adenocarcinomas and adenomatous polyps. When their diameter is more than 3 cm, lipomas become symtomatic. In lipomas less then 2 cm in diameter it is possible an endoscopic removal while for bigger sizes the surgical laparoscopic approach is recommended.

Intestinal injuries are pathologies frequently caused by toothpicks. In literature are reported serious damage to the cardiovascular system, lung and systemic fatal sepsis. In literature are also reported some deaths caused by delayed diagnosis. The authors report two cases of intestinal perforation by toothpick. Both patients had accidentally swallowed the toothpick. The clinical state was compatible with acute abdomen in a 59 year old psychopathic patient and acute appendicitis in a 27 year old patient. The aim of this paper is to emphasize the importance of a careful anamnesis for detecting the swallowing of a toothpick.

Sigmoid colon is the most frequent side for a volvulus. We present four cases of sigmoid volvulus admitted to our department during the period July 1994-December 1995. Intestinal volvulus, despite its benignity, has a quite high morbidity and mortality. Important factors such as the patient's features and frequent late diagnosis can influence the complicated outcome of the disease. Plane X-ray of the abdomen is helpful while barium enema can be therapeutical because of the pressure of the inflated air. Sigmoid resection is the most effective treatment for the disease.

The authors reports a case of a young woman suffering from mesenteric cyst. The incidence of these lesions is 1 to 100,000 admissions in adult patients and 1 to 20,000 admissions in pediatric age. These cysts, with retroperitoneal and omental cysts, have a similar etiopathogenesis as lymphatic ectopic tissue. In the majority of cases these cysts are asymptomatic and often the diagnosis is intraoperative. In this case the cyst was removed successfully with laparoscopic approach. This mini-invasive method allows a complete and radical excision of the cyst and reduces postoperative hospital stay and morbidity.

Sacrococcygeal pilonidal disease may take a variety of forms: a silent chronic form, acute with abscess and a chronic or acute form with fistula. In the acute form surgery consists of the incision and evacuation of the purulent matter, postponing definitive surgery to a second phase, which is not always necessary, considering that in 60% of cases patients do not manifest any further symptoms. The final operation may be performed using a closed, semi-closed and open technique. The authors performed a retrospective review of 64 patients, including 44 males and 20 females. 75% of operations were performed using an open method, 22% with a closed method and 3% with a semi-closed method. Recidivations using the open method amounted to 8% (6% with a single recidivation, 2% with two recidivations), and 14% with the closed method. Average hospital stay was 5.8 days with the open method and 7.3 with the closed method. Patients operated using the open method were discharged after two or three days and dressings were applied using gauze soaked in Betadine solution after cleaning with hydrogen peroxide. The scar was fully formed in around 45 days.