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This paper reports the results of a survey on the surgical therapy of incisional ventral hernia in the county of Brescia (19 surgical wards) compared with the results in Lombardy. Using epidemiological data on open and laparoscopic surgery we investigated the recent trends in this kind of surgery, addressing aspects that are not yet supported by evidence-based data in the literature. Laparoscopic repair is performed in about half of the surgical wards, and in the majority (85%) of Lombardy hospitals that replied to the questionnaire. It is also performed in a small number of primitive ventral hernias. The creation of a pneumoperitoneum is accomplished both by the Verress and the Hasson techniques, without significant differences. Composite meshes have proved most interesting, and fixation by titanium spiral tacks is most commonly used. We found rapid discharge and low morbidity rates, similar to the published data. The preferred open technique is still the Rives-Stoppa submuscular mesh repair. It is generally agreed that there will presumably be a major diffusion of laparoscopic repair, in spite of the fact that it is nowadays performed only by surgeons familiar with advanced laparoscopic techniques and is still more expensive than open repair, which, however, is offset by the distinct benefit afforded by the patient.

Laparoscopic appendectomy (LA) is gaining favour as an alternative to the traditional laparotomic technique (OA) despite the persistence of controversy regarding indications, morbidity, hospital stay, costs and surgical time. We present a retrospective analysis of our first three years of experience with the procedure. During this period we performed 235 appendectomies (102 laparoscopic and 133 laparotomic). The conversion rate was 9.7%, due to severe peritonitis, high-grade inflammation and an unfavorable position of the appendix; we found a significantly higher percentage of difficulty due to these factors in the laparotomic procedures. Operating time was similar in the two groups. The rate of associated pathology was higher (22.5% vs 6%) after laparoscopy, but conversion to laparotomy was never necessary for treatment. Early morbidity was limited to 2 patients who underwent laparoscopic appendectomy (1 re-operation for a micro-abscess and 1 conservatively treated haemorrhage), while wound infections (13.5% vs 1.9%) and incisional hernias (0% vs 2.3%) were more frequent in the open procedures. Hospital stay was slightly less in the laparoscopic group (4.0 vs 4.7 days). In our initial experience, laparoscopic appendectomy has shown significant advantages in terms of intraoperative diagnosis of associated diseases and diminished morbidity. We advocate a laparoscopic approach to appendicular disease, reserving conversion to laparotomy for selected cases after exploration.

Remembering an observed case of intestinal invagination from Meckel's diverticle the A. describe the most important anatomical and anatomo-surgical characteristics of the diverticle of Meckel, laying particular stress on the variation in form; position and size with reference to the part they have in surgical operations. The operation tecnique of transportation of the diverticle in its various pathologic cases is also a point treated in this work; the principle methods of ablation are brought up to date with synthetic iconography.

Diagnostic peritoneal lavage has been evaluated in 44 pediatric cases, suspected of intraperitoneal hemorrhage. This test was proved to be a useful, safe, and highly accurate procedure for early diagnosis of intraperitoneal hemmorhage also in pediatric surgery.