In the last 10 years we have treated 450 consecutive patients symptomatically affected by 1st- or 2nd-degree hemorrhoids with rubber band ligation. The patients were divided into 2 groups: group A, 216 patients treated from 1983 to 1989, and group B, 234 patients treated from 1990 to 1993. In group A multiple ligations (2 or 3) were made in a single session. In the group B one ligation at a time was performed. In group A satisfactory results were obtained in 78% of the cases, whereas in group B the results were good in 91% of patients (p < 0.01). Complications also decreased: bleeding decreased from 25 to 5% and pain from 22 to 9% (p < 0.01). Sepsis was present in 30% of the group-A cases, but was never seen in group B. In conclusion rubber band ligation offers better results if it is made with one ligation at a time, repeating the operation every 4 weeks.

Background/Aims: The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically. Methods: Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson’s criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy. Results: No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal. Conclusion: The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.