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Aim: The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes., Methods: All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space., Results: The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes., Conclusions: Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.

Background: Surgeons variously estimate usage of mechanical staplers in digestive surgery especially about the increase of the incidence of late complications like stricture (as some authors refer). We report a histomorphological aid to the comparison of staplers and hand-sewn sutures. Our aim was to observe at long term the healing process in the sutured tissue in the canine gastro-enteric tract., Methods: We describe three histological pieces: one manual suture in a dog which was euthanatized and necropsied 5 months after operation and two mechanical sutures performed in two different dogs: one died because of a gastric torsion 18 months after the operation while the other was euthanatized 5 months after the operation. The histomorphological study has been carried out with a peculiar cutting (Exact) and including method which lets the staples in situ., Results and Conclusions: Compared analysis showed that cicatrization goes on better in stapled than in hand sutured tissue.

Personal experience is reported of 59 hepaticojejunostomies performed on an excluded Roux loop in the treatment of benign pathologies of the main bile duct. The advantages and disadvantages of this approach are discussed. Several particular cases are described as is the surgical technique adopted. Complications arising in 5 patients included 3 duodenal ulcers, one of them bleeding and 2 cases of anastomotic stenosis. In all other cases the operation was satisfactory. Follow-up involved echographic and cholescintigraphic examinations. It is concluded that Roux en Y hepaticojejunostomy is the treatment of choice in benign pathologies of the main bile duct when transduodenal papillostomy is contraindicated.

A series of 4 patients with gallbladder cancer encountered in 1977-86 is presented. Carcinoma accounted for 2.5% of all biliary surgery with a higher incidence among female (F = 22, M = 12). Most of the tumours had reached an advanced by the time they reached the operating theatre. Given the difficulty in diagnosing tumours at an early stage, prophylactic cholecystectomy is highly recommended in patients with gallstones whether they are symptomatic or not.

The results of a study conducted on 24 patients given biliodigestive shunts are reported. Follow-up involved cholescintigraphy using 99m-IDA technetium. This examination provided valuable information about the morphodynamics of biliary flow and when the biliary peak and intestinal appearance times were lengthened, it was also able to identify significant obstructions. The technique is considered highly significant.

Bilio-digestive anastomoses represent a tried and tested surgical procedure in lithiasic or neoplastic type obstructions of the main biliary way. Among long-term postoperative complications the case of neoplasia in the stomy is rare. A clinical case of neoplasia on cholecystojejunal anastomosis diagnosed endoscopically is reported. The physiopathological aspects are discussed.