Giant Sigmoid Diverticulum: A Rare Presentation of a Common Pathology

Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up

The treatment of breast cancer in one day surgery. A four year experience.

The number of short-stay surgery procedures has progressively increased since the concept of short-stay surgery was first introduced. Initially this type of surgery was reserved for patients undergoing inguinal hernia repair, proctological surgery, and various minor procedures. Careful patient selection makes it possible to apply one-day surgery to other surgical specialties including breast cancer surgery. Reducing the length of hospital stay lowers health care costs, and shortens waiting lists. The most important benefits for patients are a more rapid return to work and positive psychological effects. Exclusion criteria for one-day surgery are the lack of home care, excessive distance from place of treatment and the presence of any concomitant pathology that is a contraindication to this type of surgery. We report our experience in oncological surgery of the breast in one-day surger

Trattamento delle metastasi epatiche da carcinoma colorettale: nostra esperienza [Treatment of liver metastases from colorectal carcinoma: our experience]

The latest hepatic surgical strategies enable liver resections to be performed on a larger number of patients, improving the survival rate. Moreover, the contribution of radiological techniques and chemotherapy to surgery has led to the multidisciplinary management of patients suffering from liver metastases, involving surgeons, radiologists and oncologists. If surgical treatment is not considered curative, it is appropriate to advise alternative strategies in order to down-stage the disease and make it resectable

La S.T.A.A.R. nel trattamento del rettocele. Esperienza personale [Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience]

La stipsi cronica dovuta a rettocele interessa circa il 12% della popolazione dei Paesi Occidentali. La terapia scelta per tale affezione risulta necessariamente di tipo chirurgico. La S. T. A. R. R. (Stapled Transanal Rectal Resection) è in grado di risolvere il rettocele e consente di ridurre le recidive postoperatorie. L’esperienza degli autori suggerisce l’utilità di una fisioterapia pre- e postoperatoria in grado di rinforzare il pavimento pelvico. Dal gennaio 2005 al gennaio 2007 20 pazienti sono state sottoposte ad intervento di S. T. A. R. R. e seguendo un rigido protocollo diagnostico comprendente anamnesi, visita colonproctologica ed uroginecologica, defecografia, manometria anorettale, anorettoscopia, ecografia transrettale ed elettromiografia perineale. Nel protocollo terapeutico sono previste 3 fasi operative distinte: I fase: rieducazione funzionale preoperatoria del pavimento pelvico; II fase: intervento chirurgico; III fase: completamento post-operatorio della rieducazione funzionale del pavimento pelvico. Il risultato clinico è stato suddiviso in “eccellente” (6 pz), quando la sintomatologia presentata è scomparsa completamente, con la ripresa di una normale attività defecatoria, “buono” (11 pz) quando la paziente presenta uno o due episodi mensili di defecazione ostruita risolti con l’impiego di lassativi, senza mai ricorrere a manovre di digitazione o ad uso di clisteri, “sufficiente” (2 pz) con più di due episodi al mese ed “insufficiente” (1 pz) quando l’intervento non è stato in grado di modificare alcun sintomo. I risultati da noi ottenuti, confermati anche in letteratura, ci suggeriscono di considerare la tecnica di Longo, come il “gold standard” nella terapia dell’ODS da rettocele.Rectocele is an organic cause of chronic constipation, with a prevalence ranging from 8.95% to 12% in Europe and United States. Necessarily, the approach for rectocele repair is a surgical operation. Stapled transanal rectal resection (STARR) is safe and effective in the treatment of obstructed defecation syndrome. The authors' experience suggests that the surgical operation needs to be combined to rehabilitation exercises, before and after the surgical treatment, in order to strengthen the muscles of the pelvic pavement. From January 2005 to January 2007, 20 patients with outlet obstruction underwent STARR. Patients were selected for operation based on a strict diagnostic protocol: anamnesis, clinical examination, coloproctological and urogynaecological examinations, defecography, anorectal manometry, transrectal ultrasonography and peritoneal electromyography. The therapeutic protocol consists of 3 parts: phase I: rehabilitation of the pelvic pavement; phase II: surgical operation; III phase: post-surgical rehabilitation of the pelvic pavement; The clinical result was classified into: excellent (6 patients), when all constipation symptoms disappeared, good (11 patients), when patient has 1 or 2 obstructed defecation episodes treated with a laxative, fairly good (2 patients), more than 2 episodes, and poor (1 patient), when surgical operation doesn't improve any of the symptoms. Our results, confirmed by the literature, suggest that Longo's technique should be considered as gold standard for rectocele treatment