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The Authors report a prospective study on fetal cholelithiasis, analyzing its differences with the more widely known cholelithiasis of paediatric age. The study shows that the number of cases diagnosed by ultrasonography is higher than expected (0.39%, 3 cases on 764 pregnancies). The Authors could find no correlation between fetal cholelithiasis and any maternal, obstetrical and fetal factor. They have focused attention on sonographic imaging showing clinical-instrumental correlation between echogenic material, clinical features and their evolution. The study confirms that the most common evolution results in spontaneous resolution of fetal endocholecystic pathological images. Finally, wide review of the international literature is reported on the rare, but possible clinical manifestations and their complications.

Pain and endocrine-metabolic response to surgical stress, during surgery and in the early postoperative period, was compared in two groups of patients affected by gallstones and randomly assigned to Laparoscopic Cholecystectomy or Open Cholecystectomy. Pain was assessed by the VAS method also taking into account the need of analgesic administration in the postoperative period. The so called "stress hormones" (Prolactin (PRL), Cortisol (CORT), Human Growth Hormone (HGH)) and glycaemia were monitored during surgery and in the first postoperative 24 hours. The minimal invasive technique of laparoscopic cholecystectomy accounted for a very limited analgesic administration. In the intraoperative period laparoscopic cholecystectomy plasma hormone levels overlapped the open cholecystectomy ones, while in the postoperative period a constant increase in PRL and CORT levels was registered in the open cholecystectomy group demonstrating a prolonged stressful condition. The end results of this study show that laparoscopic cholecystectomy has major advantages than open cholecystectomy in the treatment of gallstones as far as pain and endocrine-metabolic response are concerned.

The authors analyze their experience with pancreatectomy, pointing out the digestive pathophysiologic sequelae of the operated patients. A follow-up protocol based on upper digestive endoscopy, laboratory tests, scintigraphic and pH-metric tests compares the results achieved after total pancreatectomy with the results of pancreaticoduodenectomy. Total pancreatectomy is complicated by peptic ulcer, stump gastritis and gastroenteric dyskinesia. The preservation of the pylorus and the separation of the gastric anastomosis from the biliary one avoid the pathologic biliary reflux and minimize the functional and organic sequelae of the operation.