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From an analysis of operations performed by the Authors between 1974 and 1988, sphincterotomy emerged as the operation of choice given the small percentage of complications compared to the higher percentage of complications that arose with choledochotomy with external biliary derivation, in which use of the Kehr tube is hardly ever directly implicated. However the results of choledochotomy shown also demonstrate a possible improvement through better intraoperative procedures or by complementary endoscopic sphincterotomy where indicated; hence this procedure with external biliary deviation, according to the Authors, merits reevaluation.

In the modern rectal surgery the AA. think it be useful to preserve the sphinteric integrity to the greatest part of patients with non neoplastic rectosigmoid perforations (traumatic, diverticular, anastomotic leakage). They obtain to remove, by a personal modification, the difficulties and the disadvantages of intestinal restitution following the Hartmann's procedure.

The AA. refear a case of massive necrosis of intrapancreatic biliary tract secondary to an acute necrotizing postoperative cephalopancreatitis. The high mortality lesion risk was successfully treated by many factors: surgicals and medicals. The AA. think that the wise use of Somatostatine was the most important factor.

A case of isolated surgical wound of the right hepatic duct is presented. Some considerations regarding all the pathogenetic, diagnostic and therapeutic problems are made. It is felt that, in this instance, surgical management was facilitated by the unusual length of the right hepatic duct, which terminated in the infundibulum of the gall bladder, due to a prior anatomical abnormality.

The AA. suggest to rationalise the criterion of choice in the operation of rectum tumour. According to the AA., the choice is between abdomino-perineal and anterior resection operation. In accordance with that acknowledgement and the respect of the precise oncological and anatomical presuppositions, they define the heart of the tumour and regulated their surgical conduct. In practice they perform the anterior resection for the tumours situated between the superior and inferior haemorrhoidal arteries which, after dissection, can be found at least 8-9 cm. from the anus, while they always deal with the abdomino-perineal the neoplasms which develop in the area of inferior and middle haemorrhoidal arteries.

The Authors report their experience about 20 cases of multiple large bowel adenocarcinomas, 9 of them synchronous and 11 metachronous. After developing a brief reexamination of epidemiology and etiopathogenesis, they explain their diagnostic and therapeutic considerations. The necessity of a real complete and exact radiological and endoscopical preoperative study, being also early, is at last emphasized, as well as an accurate postoperative follow-up.

Two cases of primitive malignant tumour of the duodenum are reported, with exclusion of neoplasias of the periampullar region. Such restriction makes this pathology rather rare. The clinico-diagnostic aspects are analysed and, for purpose of radicality, a comparison is made between two surgical techniques: duodenocephalopancreatectomy, possible for any localisation, and intestinal shortening with duodenal-jejunal resection for tumours of the 3rd and 4th portions.