Effect of Fibrin Sealant on Seroma Formation Post-Incisional Hernia Repair

2020

Background: Development of seroma after incisional hernia repair is a common complication. Our study aims to compare the outcomes of sublay incisional hernia repairs with or without spray instillation of fibrin glue. Methods: We enrolled fifty patients undergoing incisional hernia repair. In all patients a suction drain was placed in the subcutaneous space. In one group (FG) 4 ml fibrin glue was instilled in the subcutaneous space. In the control group (C) patients did not receive any prevention measure. Wounds fluids were collected on post-operative day 1 (POD) and once daily until drain removal. All patients were followed up by ultrasound on POD 15, 20, 40, 60. Results: Drain fluid produc…

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients.

2021

Abstract Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty…

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study.

2021

BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure (CAF) with internal anal sphincter (IAS) hypertonia, but it is burdened by high-risk postoperative faecal incontinence (FI). Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk. The most employed procedure is fissurectomy with anoplasty, eventually associated with pharmacological sphincterotomy. AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone. METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic …

Lymphatic Mesenteric Cyst, a Rare Cause of Surgical Abdominal Pain: Case Report and Review of the Literature

2020

A lymphatic mesenteric cyst (LMC) is a rare clinical entity, of unclear etiopathogenesis, which can arise in the abdominal cavity or retroperitoneum without a clear origin. We describe a case of a 74-year-old male presenting with abdominal pain that was non-specific and non-responsive to medical therapy. Laboratory tests clinical examination were inconclusive while the abdominal computed tomography (CT) scan showed a cystic lesion of the ileal mesentery. We performed an open surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted to be an LMC at the histological examination. At the five-year CT scan follow-up, we did not record any recurrences. LMCs pre…

Management of recurrent chronic anal fissure after lateral internal sphincterotomy

2021

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation.

2020

AbstractChronic anal fissure’s (CAF) etiopathogenesis remain unclear. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. The treatment of this disease aimed to reduce IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V–Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. We enrolled 45 patients undergone to fissurectomy and anoplasty with V–Y cut…

Surgical sphincter saving approach and topical nifedipine for chronic anal fissure with hypertonic internal anal sphincter

2020

PURPOSE The role of augmented internal anal sphincter (IAS) tone in the genesis of posterior chronic anal fissure (CAPF) is still unknown. Lateral internal sphincterotomy is the most employed surgical procedure, nevertheless it is burdened by high risk post-operative anal incontinence. The aim of our study is to evaluate results of sphincter saving procedure with post-operative pharmacological sphincterotomy for patients affected by CAPF with IAS hypertonia. Methods: We enrolled 30 patients, undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement; all patients received topical administration of nifedipine 0.3% and lidocaine 1.5% ointment-based therapy before and for 15 days…

Gallbladder Agenesis: Report of a Preoperative Diagnosis With Magnetic Resonance Cholangiopancreatography

2020

Agenesis of the gallbladder is an extremely rare congenital entity with shaded clinical and radiologic features, which make the preoperative diagnosis really challenging. Here, we report a case of a 52-year-old symptomatic female with biliary symptoms and contracted gallbladder at ultrasound (US). The final diagnosis was made with magnetic resonance cholangiopancreatography (MRCP) and the treatment was conservative. However, diagnosing this condition preoperatively is still challenging. However, with innovations in terms of biliary tract imaging technique, and with better knowledge of this entity, many unnecessary surgical procedures might be avoided.

Conservative Treatment of Splenic Haematoma After Colonoscopy: A Case Report

2020

Colonoscopy is a routine procedure performed worldwide, nevertheless, a small risk of splenic injury, often under-estimated, is still present. As a matter of fact, the diagnosis may be delayed, leading to a rising risk of morbidity and mortality. This paper describes a case of conservative treatment of colonoscopy-associated splenic injury. A 57-year-old woman presented with worsening pain in the upper left abdominal quadrant; she had radiation therapy to the ipsilateral subscapular region, and a diagnostic colonoscopy 18 hours earlier. The computed tomography (CT) scan revealed splenic laceration without signs of hemoperitoneum. Because of the hemodynamic stability of the patient, successf…

Early diagnosis of primary melanoma of caecum. Case report and review of the literature.

2021

Malignant gastrointestinal melanoma is usually a metastatic lesion. We report the case of a 79-year-old female asymptomatic patient. Colonoscopy revealed one plane 15 mm pigmented lesion in the caecum. Neither CT scan of the abdomen nor right hemicolectomy revealed no metastatic disease. Histopathological examination of the surgical specimen was indicative of malignant melanoma.A set of additional enquires such as laboratory and imaging tests did not point out any suspicious lesions in the skin, eye, leptomeninges or other sites. Therefore, we made the diagnosis of primary colonic melanoma.The diagnosis of this disease is still a challange and often demanding for a multidisciplinary approac…