Search

Background and Objectives The incidence of locoregional recurrences (LR) following radical surgery of rectal cancer varies from 5% to 30% according to the literature. The purpose of this prospective study was to compare the outcome of the Abdomino-Perineal Excision (APE) vs. the Anterior Resection (AR) in a consecutive series of 188 patients who underwent surgery for cure from 1980 to the end of 1992 (81 APE and 107 AR), followed for 5 years, evaluating their influence on the incidence of the recurrences. Methods The patients were enrolled at random in the two surgical groups, provided that a radical excision of the tumour, with only two limits: the level of the lesion from the anal verge and the presence of a severe incontinence instrumentally proven. TNM, Dukes staging, grading, and tumour location were statistically evaluated. Further primary suture vs. packing of the perineal wound in APE and handsewn vs. stapled anastomosis in AR were compared in relation with the incidence of LR. Results The overall local recurrence rate was 19.2% (32/167), in details 19.7% for APE and 18.5% for AR. Similar recurrence rates were observed following both procedures, matching the patients according to the Dukes stage and different details of techniques. A slight statistically significant difference was found as far as the tumour location is concerned in the group treated with anterior resection (p =

The incidence of gallstones is rather high and is referred as approximately 13%-17% among the western population, [Bateson, 2000; Barbara et al., 1987; Everhart et al., 1999; Pixley et al., 1985]. It is well known that most of the people with gallstones are asymptomatic and often they are absolutely unaware of their presence, it is even referred that no more than 15-20% of them has the probability of suffering from a biliary colic later on [Attili et al., 1995], which, once occurred, could recur more easily causing sometime serious complications, such as pancreatitis by stone’s migration and biliary obstruction, that over a 10-year period can be expected to occur in 2–3% of patients with initially silent gallbladder stones [Gracie & Ransohoff, 1982]. The incidence of common bile duct (CBD) stones has been reported as ranging between 5% to 18% of patients undergoing cholecystectomy for gallstones, and patients with symptoms suggestive of choledocholithiasis have an even higher incidence, also increasing with age [Martin et al., 2006]. Because of the continuous developing of the diagnostic and therapeutic techniques from the introduction of intra-operative cholangiography by Mirizzi in 1932, the choose of the most effective strategy in the management of the common bile duct (CBD) stones associated with gallstones is object of close discussions far from any conclusive agreement. The new diagnostic techniques as magnetic resonance cholangiography (MRC) and endoscopic ultrasound (EUS), give the opportunity to visualize the biliary tree without any invasive exploration of the ducts and share the same idea as the minimally invasive laparoscopic surgical approach. They are progressively evolving as well as the standard of care for the management of common bile duct (CBD) stones, historically performed via

Incisional hernia is a frequent complication of abdominal surgery with an incidence reported in the literature of 2–20%. The condition is associated with local and systemic, potentially severe risks. The incidence of incisional-hernia recurrence is even higher, between 8 and 55%, depending on the initial type of repair technique. Thus, incisional hernia should be regarded as a serious and disabling clinical condition, with a poorly understood aetiology and dangerous complications, especially incarceration with resulting obstruction or necrosis of the bowel and omentum. Other aspects of incisional hernia must also be mentioned, such as total loss of the abdominal contents due to postural, respiratory, and dynamic deficiencies that impair overall physical activity and the daily quality of life.

Records of 134 patients treated by abdomino-perineal resection (1971-1979) were reviewed. One hundred and thirteen had curative operations. Mortality was 2.6% and morbidity was 51%. Ninety-three were evaluable and were followed for 5 to 8 years; they were evaluated for survival and pattern of recurrence. Five-year survival for Dukes' A, B, C, and D lesions was 86, 62, 31, and 0%, respectively. Thirty-seven had recurrence: Four pelvic, nine pelvic and distant, and 24 only distant lesions. The overall incidence of failures was 47%, failure rates by stage were 11% for stage A, 27% for B, 48% for C, and 70% for D. Incidence of local recurrence was significantly higher in stage C compared to stage B. Irrespective of stage, after detection of local or distant recurrence, survival did not differ. Furthermore, radiotherapy for local recurrence and chemotherapy for distant lesions did not improve survival time.

In view of the growing number of examinations proposed and employed for the diagnosis of diseases of the thyroid, a retrospective evaluation was made of their validity in a series of 2500 patients (1500 operated). Attention was paid to scintiscanning, oncotropic indicators, echography, needle biopsy, thyrolymphography and thyroid hormones as aids to determining the nature of thyroid lesions and the planning of their treatment. Scintiscanning and needle biopsy proved of primary importance in determination of the nature of a lesion. Echography supplied additional, though not necessarily indispensable information. Oncotropic indicators and thyrolymphography do not appear to be useful. They do not provide data enabling a diagnostic problem to be solved, but can only help to increase any doubts that may exist. Determination of thyroid hormones is clearly indicated when planning the management of hot lesions (single, multiple or disseminated nodes), in cold lesions where thyroiditis is suspected, and in all cases where the clinical evidence suggests hypothyroidism. In euthyroid subjects requiring surgery with no objective signs of hypofunction, preoperative determinations appear to be unnecessary, where as post-operative values are of assistance in assessing the functional efficiency of the residual thyroid tissue. The conclusion to be drawn, therefore, is that diagnostic examinations should be employed in a more selective and discriminating manner.