Double loop reconstruction following pancreaticoduodenectomy for malignant tumor: Short-term outcome.

Background: To evaluate the use of a double loop reconstruction following pylorus preserving proximal pancreaticoduodenectomy (PPPPD).

Methods: Morbidity and mortality were evaluated in 55 patients undergoing PPPPD for malignant tumors, followed by a double loop reconstruction.

Results: The mean intra-operative blood loss was 908mL±531.

Sleeve gastrectomy and development of "de novo" gastroesophageal reflux.

Background: Sleeve gastrectomy (SG) is currently gaining popularity due to an excellent efficacy combined to minimal anatomic changes. However, some concerns have been raised on increased risk of postoperative gastroesophageal reflux disease (GERD) due to gastric fundus removal, section of the sling muscular fibers of gastroesophageal junction, reduced antral pump function, and gastric volume. We undertook the current study to evaluate by means of high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) the impact of SG on esophageal physiology.

Objective outcomes of extra-esophageal symptoms following laparoscopic total fundoplication by means of combined multichannel intraluminal impedance pH-metry before and after surgery.

Identifying and treating patients with extra-esophageal symptoms is a challenge. When the patient is unable to control his symptoms with pharmacological therapy alone, anti-reflux surgery may be indicated. This study aims to evaluate the outcomes of total fundoplication in the resolution of extra-esophageal manifestations and verify changes in 24-h MII-pH monitoring before and after surgery.

Impact of total fundoplication on esophageal transit: analysis by combined multichannel intraluminal impedance and manometry.

Background: Laparoscopic total fundoplication is considered the most effective surgical option for gastroesophageal reflux (GER) disease. Some authors assume that total fundoplication may expose the patient to delayed transit of the swallowed bolus and increased risk of dysphagia, particularly when peristaltic dysfunction is present. We undertook this study to evaluate by means of combined multichannel intraluminal impedance and esophageal manometry (MII-EM) the impact of fundoplication on esophageal physiology.

Weekly chemotherapy with cisplatin and paclitaxel and concurrent radiation therapy as preoperative treatment in locally advanced esophageal cancer: a phase II study.

We evaluated the association of a weekly cisplatin (35 mg/mq) and paclitaxel (45 mg/mq) regimen with radiotherapy (46 Gy) as primary treatment in locally advanced esophageal cancer (LAEC). The main end point was the activity in terms of pathologic complete response (pathCR) rate. Thirty-three LAEC patients received chemoradiation therapy during weeks 1-6 followed by esophagectomy.

Adjuvant chemoradiotherapy in patients with stage III or IV radically resected gastric cancer: a pilot study.

Background: Adjuvant chemoradiotherapy does not represent the standard of care in patients with resected high-risk gastric cancer; however, results from phase 2 and randomized trials suggest improvement in overall survival. We assessed the feasibility and toxic effects of chemoradiotherapy as adjuvant treatment in locally advanced gastric cancer.

Design: Pilot study.

[Laparoscopic total fundoplication is not an obstacle to oesophageal emptying after oesophago-gastric myotomy for the surgical treatment of achalasia].

There are different surgical possibilities for the treatment of oesophageal achalasia ranging from a short extramucosal oesophagomyotomy to an extended esophago-gastric myotomy combined with a partial fundoplication to restore the main antireflux barrier. A total 360 degrees fundoplication is generally regarded as an obstacle to oesophageal emptying. The aim of this study was to evaluate the role and efficacy of total 360 degrees laparoscopic Nissen-Rossetti fundoplication after oesophago gastric myotomy in the treatment of oesophageal achalasia.

Hiatal hernia recurrence: surgical complication or disease? Electron microscope findings of the diaphragmatic pillars.

Introduction: Although laparoscopic Nissen fundoplication has been recognized as the standard of care for hiatal hernia (HH) repair, HH recurrence due to breakdown of the hiatoplasty have been reported as a common mechanism of failure after primary repair. Different surgical techniques for diaphragmatic pillars closure have been proposed, but the problem remains unsolved. The authors hypothesized that ultrastructural illness may be implicated in this recurrence.

The short esophagus: intraoperative assessment of esophageal length.

Objective: To define the frequency and predictors of short esophagus in a case series of patients undergoing antireflux surgery.

Method: An observational prospective study from September 10, 2004, to October 31, 2006, was performed at 8 centers. The distance between the esophagogastric junction as identified by intraoperative esophagoscopy and the apex of the diaphragmatic hiatus was measured intraoperatively before and after esophageal mediastinal dissection; a distance of 1.

Prospective assessment of patient selection for antireflux surgery by combined multichannel intraluminal impedance pH monitoring.

Introduction: Selecting gastroesophageal reflux disease (GERD) patients for surgery on the basis of standard 24-h pH monitoring may be challenging, particularly if this investigation does not correlate with clinical symptoms. Combined multichannel intraluminal impedance pH monitoring (MII-pH) is able to physically detect each episode of intraesophageal bolus movements, enabling identification of either acid or non-acid reflux episodes and thus establish the association of the reflux with symptoms.

Materials And Methods: We prospectively assessed and reviewed data from 314 consecutive patients who underwent MII-pH for GERD not responsive or not compliant to proton pump inhibitor therapy.

Laparoscopic sleeve gastrectomy with duodeno-jejunal bypass: a new surgical procedure for weight control. Feasibility and safety study in a porcine model.

Background: One limit of the Roux-en-Y gastric bypass (GBP) is the preclusion of exploring the bypassed stomach with conventional endoscopy and radiological studies. In this study, we explored the feasibility, safety, and weight progression of a new bariatric procedure that eliminates this inconvenience.

Methods: Eleven 40- to 50-kg Yorkshire pigs underwent laparoscopic sleeve gastrectomy and Roux-en-Y duodeno-jejunal bypass (SG-DJBP).

Endoscopic cervical bariatric surgery: follow-up study in a porcine model.

Background: The realisation of bariatric surgery has to date modified the digestive process solely through procedures within the abdominal cavity. However, endocrine surgeons have recently demonstrated the feasibility of a minimally invasive approach to the neck. In this study, we explored the feasibility, safety and weight progression of a bariatric procedure performed at the neck.

Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH-multichannel intraluminal impedance.

Background: Studies have demonstrated that Nissen fundoplication controls acid gastroesophageal reflux (GER). Combined 24-h pH and multichannel intraluminal impedance (MII-pH) allows detection of both acid and nonacid GER. Antireflux surgery is considered for any patient whose medical therapy is not efficient, particularly patients with nonacid gastroesophageal reflux disease (GERD).

Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication.

Background: We investigated which factors are significantly associated with long-term quality of life after laparoscopic total fundoplication in the treatment of gastroesophageal reflux disease.

Methods: Patients (n = 144) were given a standardized frequency-intensity symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication.

Results: At follow-up evaluation (n = 102), patients had a significant reduction in their symptoms score and no deterioration in quality of life.

Laparoscopic duodenal switch for pathologic duodenogastric reflux: initial experience.

Duodenogastric reflux (DGR) is barely responsive to medications and antireflux fundoplication is not able to control the gastric symptoms. Duodenal switch (DS) preserves the physiologic food transit while creating an effective Roux-en-Y diversion to duodenal juice. However, it never enjoyed great popularity, perhaps due to the invasiveness of the open approach.

Metabolic and nutritional status changes after 10% weight loss in severely obese patients treated with laparoscopic surgery vs integrated medical treatment.

Background: Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI] > 40 kg/m(2)).

Methods: Twenty patients (9 males, 11 females; 37.

Laparoscopic conversion of an omega in a Roux-en-y reconstruction after mini-invasive total gastrectomy for cancer: a technical report.

Introduction: Few cases of laparoscopic total gastrectomy have been published. Reconstruction of the digestive tract was generally accomplished with a Roux-en-y esophagojejunal mechanical anastomosis. Here we report the first 2 cases of laparoscopic conversion of an omega in a Roux-en-y reconstruction due to the occurrence of a severe alkaline esophagitis after mini-invasive total gastrectomy for cancer.

A mesenteric window to approach a posterior side leak after laparoscopic assisted stapled strictureplasty for Crohn's disease.

Strictureplasty leak in patients with Crohn's disease increases considerably morbidity rate. Intra-operative evaluation of the integrity of suture line and proficient management of any leakage after strictureplasty is mandatory to prevent post-operative complications. When a leakage is detected at the posterior side, through intra-operative insufflation or methylene blue test, it may be difficult to repair as the suture line is completely covered up by mesentery.

[Esophageal perforation: which factors affect the prognosis? Results of a 10-year experience].

Oesophageal perforations are a catastrophic event with a 10-40% mortality rate. The decisive prognostic factor is the time from the event to the diagnosis, while there is no agreement as to the therapeutic options. The aim of this study was to present our ten-year experience in the treatment of oesophageal perforations together with an evaluation of the prognostic factors.

[Endoscopic ultrasonography-guided management of mesenchymal tumors of the upper digestive tract].

Stromal tumours of the gastrointestinal tract can be defined by endoscopic ultrasonography as "hypoechoic intramural tumours" on the basis of their echostructure. Unfortunately, this definition is inadequate for distinguishing between the biological behaviour patterns of different types of stromal tumour. One hundred and twelve hypoechoic intramural tumours observed from 1998 to 2005 were classified in 4 distinct groups (leiomyomas, gastrointestinal stromal tumours, gastrointestinal stromal tumours suspected of malignancy, and malignant stromal tumours) according to more detailed endoscopic ultrasonography criteria in order to better plan the surgical treatment.

Gastroesophageal junction adenocarcinoma: what are the factors influencing long-term survival?

The incidence of gastroesophageal junction adenocarcinoma is increasing. About 30% of the tumors cannot be completely resected, and 40% of the patients relapse after complete resection. There is much controversy over the role of neoadjuvant therapy, the approach route, lymphadenectomy, and the extent of esophageal resection.