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The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors. MATERIALS AND METHODS. From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics. RESULTS. All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)( p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival. CONCLUSIONS. Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.

INTRODUCTION AND OBJECTIVES. Ureteral stenosis and vesicocoureteral reflux after renal transplantation represent a key concern because of their incidence and the associated morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed patients with single kidney. The aim of this study is to evaluate the success rate of the endourological techniques in the management of such complications. MATERIALS AND METHODS. Between January 1996 and December 2006, 647 kidney transplants were performed. Urinary tract continuity was re-established by ureteroneocystostomy according to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11 cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral stent placement in the other. Recipients with late stenosis underwent laser incision and balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case. Combined antegrade and retrograde endoscopic approach was performed in 7 patients, whereas retrograde access in 1. RESULTS. Endourologic treatment was successful in 9 cases (69.2%); 2 patients required open reconstructive surgery due to endourological technique failure (early ureteropelvic junction stricture, late ureterovesical anastomotic stricture). Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy for recurrent reflux. No technique-related morbidity was observed. With a mean follow- up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft). CONCLUSIONS. Considering their low morbidity and the satisfactory success rate, we claim that endourological procedures should be considered the preferred treatment for ureteral stenosis and vesicoureteric reflux in selected patients.

Purpose: Percutaneous renal artery embolisation has been introduced as an alternative to nephrectomy in patients with non-functioning allograft and Graft Intolerance Syndrome (GIS). The symptoms resulting from GIS include fever, local pain, hypertension and haematuria., Materials and Methods: From April to October 2003, five patients were treated using this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-300 to 700-900 microns) and occlusion was completed by the insertion of 5mm to 8mm steel coils into the renal artery., Results: The procedure was well tolerated in all cases and no major complications occurred. In 3 patients GIS-related symptoms disappeared immediately. One patient required a second embolisation due to collateral circulation arising from a lumbar artery with resolution of symptoms. In the last case, the patient underwent nephrectomy because of septic fever., Conclusions: On the basis of our preliminary experience we believe that, in selected patients, percutaneous renal artery embolisation is an effective, repeatable and minimally invasive alternative to nephrectomy with no significant serious complications.

Celiac artery compression syndrome and superior mesenteric artery syndrome are two rare diseases, extensively documented in the literature, with a pathogenesis which is still controversial. Their association never been carefully studied and only one such case has been reported. For this reason we reviewed our experience from january 1974 to december 2000, including 57 patients diagnosed with coeliac artery compression syndrome and 27 patients with superior mesenteric artery syndrome. We found the presence of both syndromes in 6 patients. All 6 were submitted successfully to a duodeno-jejunal bypass and decompression of the coeliac artery. In this paper we analyse the pathogenesis, clinical presentation, diagnosis and treatment of these syndromes emphasising their common aspects. The association of the coeliac artery compression syndrome and superior mesenteric artery syndrome has never been thoroughly studied because of their rarity. The lack of recognition of this association may, in some cases, justify the controversial results reported in the surgical treatment of these syndromes.

Colonic perforations associated with colonoscopy are uncommon. We determined the incidence, clinical presentation, and medical and surgical treatments of iatrogenic colon perforations. We present the medical records of 8 patients with iatrogenic colorectal perforations seen over a period of 17 years. The median age 68.3 years. Emergency laparotomy was performed in 7 patients. One case was treated with a medical approach. One postoperative death occurred. In the absence of significant contamination primary repair is the best treatment. Non-operative management is indicated in patients without peritoneal irritation.

The improvement in surgical and anesthesiological techniques have allowed a reduction in oncological surgical morbidity and mortality. The objective of this retrospective study is to evaluate the morbidity and the mortality in oncological gastric surgery up to date. Between 1979 and 1994 we evaluated 281 patients for gastric cancer, of whom 249 underwent surgery. The patients ranged in age from 34 to 88 years, with a mean age of 67.8 years, and included 158 males and 91 females. An oncological radical excision was performed in 184 patients (122 gastroresections and 62 gastrectomies). The other 65 patients underwent exploratory or palliative surgery: 26 explorative laparotomies, 26 gastroenteroanastomoses, 9 gastroresections, 3 digiunostomies and one gastrostomy. The overall post-operative morbidity has been 40.1%, 27.3% was generic and 12.8% was surgical morbidity. The overall mortality has been 9.6%, of whom about one third following surgical complications. In our experience the factors related with morbidity and mortality have been: age, preoperative nutritional state and stage of the disease.

Open adrenalectomy needs surgical incisions often large and traumatic, with a not negligible morbidity. Laparoscopic adrenalectomy, according to the experiences reported in the literature, certainly initial, but nevertheless considerable, seems to offer a sound option and will probably become one of the strongest indications of the minimal-access surgery of the retroperitoneal space. Operative times are certainly longer initially than in open surgery but morbidity is very low and mortality almost nil. The authors make a review of the literature about laparoscopic adrenalectomy with about 400 operations collected, analyzing the results and the technical details. The collected data support the conclusion that the adrenal pathology, with the exception of the malignant tumors, will be treated in the future mainly laparoscopically. Even the size of the tumor, in case of a not malignant mass, can not be considered probably a true contraindication.

The authors describe the technique applied in their first case of laparoscopic splenectomy, in a patient with idiopathic thrombocytopenic purpura. Different technical approaches adopted by other surgeons are referred and discussed. The laparoscopic approach to splenectomy seems safe and allows the patients to re return to normal activity sooner than the "open" technique. Laparoscopy should be considered in patients who require splenectomy for benign disease.

With increased use of anticoagulant agents, femoral neuropathy subsequent to spontaneous hemorrhage within the ileo-psoas muscle has become a serious and more frequent clinical problem. The authors describe one case of femoral neuropathy from iliac muscle hematoma during heparin administration. The successful surgical treatment by decompression and drainage is reported. The anatomical and CT scanning features with the suspected pathogenesis are emphasized, as well as the role of early diagnosis in the assessment of prognosis and for successful operative decompression.

The authors report 2 cases of patients with single functioning kidney and severe hypertension caused by renal artery stenosis who were treated by percutaneous transluminal angioplasty (PTA). In one case an early and persistent improvement of renal function and a reduction of pressure values were observed. In the other patient, with preexistent severe functional damage, a progressive impairment of renal function required haemodialysis. On the basis of these results and of other reports in the literature, PTA is proposed as elective treatment of renal artery stenosis in patients with single functioning kidney.

This study aimed at investigating the changes in coronary vascular resistance induced by sudden increases in transmural pressure in the presence of a maximally vasodilated coronary bed. In anaesthetized open-chest dogs under artificial ventilation, aortic blood pressure, left ventricular pressure and the flow in the left circumflex coronary artery were recorded. The flow was derived by means of an electromagnetic flowmeter. Maximal vasodilatation was achieved by intracoronary infusion of dipyridamole (10-40 mg/h), increases in transmural pressure, starting from 70 mmHg, were obtained by constricting for 10 s the descending thoracic aorta with a plastic snare. While in the absence of vasodilatation the increase in pressure was accompanied with an increase in resistance because of an auto-regulatory response, when the coronary bed was maximally dilated the increase in pressure did not alter the coronary vascular resistance. These results seem to be in conflict with the observation that in the coronary circulation the distension of the vascular wall produced by increases in pressure is favoured by the reduction of the vasomotor tone. However, it may be argued that, while a reduction of the vasomotor tone can increase the vascular distensibility, a maximal vasodilatation, as it was seen in the resistance vessels of the skeletal muscles, brings the vascular diameter to such a size that no further distension can be induced when the transmural pressure is increased starting from a value of about 70 mmHg.

The use of intraoperative autotransfusion is progressively increasing both in emergency and in elective surgery. Intraoperative autotransfusion reduces the risk of infection and alloimmunization and allows a considerable saving of homologous blood. The authors describe their experience in the field of intraoperative autotransfusion by means of Dideco Autotrans BT 597. This equipment was employed in 172 patients submitted to general and vascular surgery. It is stressed the safety of this device particularly in trauma and vascular surgery where the quick availability of blood is essential.

The authors summarize their experience about the use of a drain after laparoscopic cholecystectomy. After an initial period without drainage, the drain is now routinely used by the Authors and their clinical experience suggests that it is probably very useful during the initial training and probably prevented some reoperations when biliary leakage and/or small hemorrhage from the gallbladder bed were present. Therefore the opinion of the Authors is to always drain after laparoscopic cholecystectomy, specially during the initial experience or after a particularly difficult operation.

A case of spontaneous rupture of the ureter initially presented as left acute abdomen in a 71 year old woman is described. A review of the literature has disclosed that in all reported cases a process directly or indirectly leading to the rupture was identified. On the basis of the clinical evolution and the radiological investigations the Authors discuss the diagnosis and the pathogenesis of the observed ureteral rupture.

The initial experience of laparoscopic cholecystectomy (50 cases), has been analyzed: the incidence of laparotomy, the complication rate and the postoperative course are in agreement with the data reported in the literature: however in the second half of the cases there was a striking reduction of laparotomies and complications while the postoperative course remained unchanged. Laparoscopic cholecystectomy is a relatively easy technique which requires nevertheless a didactic training and a constant application. On these premises the results can be good and explain the progressive diffusion of the techniques together with the development of the mini-invasive surgery.

Forty-one surgical patients at risk of deep venous thrombosis (DVT) were treated with defibrotide (400 mg/b.i.d./i.v.) or with heparin (5000 UI/t.i.d./s.c.). Neither DVT nor pulmonary embolism was evidenced. In the heparin group the healing rate was longer and during the first three days bleeding from the surgical wound was more pronounced. In particular one patient of the heparin group had to interrupt the treatment for haemorrhage.

Sometimes a common probe of an electromagnetic flowmeter cannot be chronically placed around the aorta in the dog because its weight and shape can induce vascular injuries. Moreover it may occur that the record is disturbed by the movements of the probe around the vessel. The authors describe a new type probe that is capable to produce a reliable signal of the aortic blood flow, in spite of a reduced structure of its components. Obviously, such a signal, which is greater that the one produced by a coronary blood flow probe, must be properly amplified.

The study aimed at evaluating the reliability of a new type of aortic flow probes to be used in conscious dogs and easy to be removed without a second surgical intervention, 48-72 hours after they have been implanted. The probes, which have been made in the Department of Human Physiology of the University of Turin, are light and thin enough to be cronically implanted around the aorta without removing the fat which surrounds the artery, and to be taken away without injuring the tissues. The records obtained 24 and 48 hours after they have been positioned, demonstrate the reliability of the probes. Histological examination of the aorta has not evidenced any tissue reaction.