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Introduction The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. Methods One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. Results Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. Conclusions The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids.

Purpose To assess the efficacy, safety and gain in procedure time of the technique of balloon occlusion hepatic venography with iodinated contrast used to target the portal vein during TIPS. The technique is assessed versus wedged hepatic venography. Materials and methods Fifty-eight TIPS were prospectively included. The portal vein was located in 30 cases by the wedged hepatic venography (group 1) and in 28 cases by balloon occlusion hepatic venography (group 2). To compare both techniques a “portogram quality” score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded. The complications of both procedures were assessed and classified in groups as intrahepatic hematoma or intraperitoneal hemorrhage. Results The right portal vein was visualized in a significantly higher number of patients using balloon than with wedged retrograde venography 71.3% (20/28) versus 13.3% (4/30) respectively ( P = 0.002). The quality score for the portogram was significantly higher for balloon hepatic venography 2.21 than for wedged hepatic venography 1.07 ( P = 0.002). The mean time required to puncture the portal vein was significantly shorter when the right branch of the portal vein was visualized 21 min versus 33.5 min ( P = 0.046). We recorded one intrahepatic hematoma (3.3%) and 4 intraperitoneal hemorrhage (13.3%) secondary to wedged hepatic venography. There were no complications with balloon occlusion hepatic venography ( P = 0.053). Conclusion The use of balloon occlusion hepatic venography improves the quality of the retrograde portal venography to target the portal vein and decreases procedure time. The balloon technique is also burdened with fewer complications than the standard wedged hepatic venography.

By "acute scrotum" is meant a sudden, painful tumefaction in one or both testicles with local and systemic symptomatologies. It can be caused by spermatic cord torsion in about 50% of cases in paediatric age, while in adults such a cause is much rarer. In addition to the clinical examination, Doppler, eco colour-Doppler and scintigraphy with 99mTc pertecnetate may be of use even though these investigations are not often immediately employable. In addition, as the hours pass, the damage caused to the gonad becomes irreversible; this, of course, influences therapeutic conduct. Starting from the description of a recently observed case of torsion of Morgagni's hydatid, the authors discuss the importance of differential diagnosis to protect the vitality of the testicle and show that surgical exploration, in cases where a definite aetiological diagnosis is missing, is the preferable and most rational therapeutic choice.

Postoperative chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics after retroperitoneal dissection. Generally the management is conservative based on a low fat diet and total parenteral hyperalimentation. However, such therapy requires weeks to months before resolution of the ascites. On the other hand, surgical approach is associated with a high failure rate to ligate leaky lymphatics. The Authors, therefore suggest a surgical resolution of the ascite with the use of fibrin glue to occlude rapidly and permanently the lymphatics ruptured.