G. Di Buono

Modified fixation free plug technique using a new 3D multilamellar implant for inguinal hernia repair: a retrospective study of a single operator case series.

AimImplant fixation, mesh shrinkage and poor quality of tissue ingrowth are unresolved issues in modern hernia repair. Many complications reported in the literature such as bleeding, nerve entrapment, hematoma, pain, discomfort, and testicular complications, are considered to be a direct results of implant fixation. This article describes the outcomes of a procedure carried out using a handcrafted implant that addresses the issues consequent to point fixation.MethodsThis was a retrospective study on the short, medium and long-term results of placing a-modified, fixation free three-dimensional polypropylene implant in 61 patients who underwent inguinal hernia repair using a novel delivery technique. The follow up length was at least 36 months postop.ResultsOnly minor adverse events and a low complication rate of the procedure were observed in this patient sample. There were no long- term complications. Postoperative pain was very low in both the short and long term. No chronic pain was reported. No recurrences occurred.ConclusionThe results of this retrospective study on a new method of inguinal hernia repair using a three dimensional handcrafted multilamellar implant delivered with a modified placement technique are promising. The short-, medium- and long-term complications were notably low. No recurrences were noticed but, more importantly, no chronic pain and extremely low discomfort rates were observed even in the long term.

Terminal or truncal ligation of the inferior thyroid artery during thyroidectomy? A prospective randomized trial

INTRODUCTION Thyroidectomy is a common procedure in general and endocrine surgery. The technique of ligation of inferior thyroid artery (ITA) has been invoked as a possible cause of appearance of postoperative hypocalcemia. METHODS We performed a prospective randomized study involving 184 patients undergoing total thyroidectomy to evaluate the differences of truncal ligation versus distal ligation of ITA in terms of postoperative hypocalcemia, vocal fold palsy, voice and swallowing impairment. The patients were divided into group A (trunk ligation of ITA) and group B (terminal branches ligation of ITA). RESULTS We evaluated postoperative PTH and calcemia (immediate, 6 and 12 months after thyroidectomy), postoperative day of discontinuation of calcium and vitamin D supplementation, voice and swallowing complaints, evaluated by mean of two specific tests available in literature, day of hospital discharge. CONCLUSION The only significant differences between the two groups were a higher immediate postoperative calcemia and a greater number of patients discharged without calcium and vitamin-D supplementation in the group B. In conclusion, no substantial differences were found between the two groups. The choice depends on the experience of the surgeon.

Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case

Highlights • Identify the preoperative radiologic features of adrenal hemangioma.• We examine the better surgical approach for adrenal tumors and adrenal hemangioma.• Controindication to laparoscopic adrenalectomy.

Adrenal cavernous hemangioma: which correct decision making process?

AGRUSA ANTONINO1, ROMANO GIORGIO1, DOMINGUEZ LIGIA JULIANA2, AMATO GIUSEPPE1, CITARRELLA ROBERTO3, VERNUCCIO LAURA2, DI BUONO GIUSEPPE1, SORCE VINCENZO1, GULOTTA LEONARDO1, GALIA MASSIMO4, MANSUETO PASQUALE2, GULOTTA GASPARE1 1Department of General Surgery, Urgency and Organ Transplantation, University of Palermo 2Department of Clinical Medicine and Emerging Disease, Geriatric Unit, University of Palermo 3Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo 4Section of Radiology Di.Bi.Me.F., University of Palermo

Topic: Inguinal Hernia — Joined guidelines

Introduction: Combined hernia represents an almost frequent type of inguinal hernia protrusion. It is characterized by the merging of a direct and indirect hernia that develops through the inguinal floor. Nevertheless, regarding its classification there is a certain degree of confusion. Further uncertainty exists in determining how the protrusions confluence and progress. This investigation aims to clarify these matters thus enabling a better understanding of its development. The results of the research could result helpful in finalizing updated surgical techniques for a suitable management of this intricate anatomical condition.