Following an inguinal hernia repair with open or laparoscopic technique, 1-15% of patients show persistent neuralgia, a severe, potentially debilitating, complication. Several therapeutic procedures have been proposed, but consensus regarding choice of treatment has not yet been achieved. We performed a prospective study on 32 such cases. Patients underwent anaesthetic infiltration to identify, when possible, the involved nerve, and we then carried out a step-by-step therapeutic protocol. In the initial phase, patients were treated with oral analgesic and afterwards with repeated infiltrations of anaesthetic and cortisone. Surgery was reserved for patients not responding to the infiltrations, though with no good success. The authors believe that noninvasive methods are to be preferred, whereas neurectomy interventions should be reserved for selected cases.
Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumors of the gastrointestinal tract. The macroscopic growth of these lesions can be intraluminal, extraluminal, or intramural, but only 6 cases in literature report a description of the pedunculated type. A 69-year-old man was admitted to our department after an echocardiographical control revealing, as an incidental consequence, an epigastric mass. Computed tomography and magnetic resonance imaging showed the presence of an oval lesion between the third segment of the liver and the front wall of the gastric antrum, measuring approximately 40 × 30 mm and suspected for pedunculated GIST. We describe the laparoscopic approach performed and the surgical technique that we suggest in similar cases. Although there are still many controversies on the use of laparoscopy in the treatment of gastric GISTs, laparoscopic resection can safely be adopted for an exophytic pedunculated GIST in an institute with experience in minimally invasive surgery.
Background In the last ten years Day Surgery has significantly evolved, due to improvements in surgery and anaesthesia, and the need of reducing long term admission costs [1]. However, is Day Surgery suitable for elderly patients? The aim of this paper is to assess the risk of over 70 year-old outpatients who underwent inguinal hernia repair, and suggest an adequate preoperative pathway
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