Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients.

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.

Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.

EUS-Guided Transrectal Evacuation of Organized Pelvic Collection Following Roux-en-Y Gastric Bypass After Failure of Radiological and Surgical Approach.

Introduction: Postoperative collections are an important cause of morbidity following obesity surgery. Surgical revision is most often required if general sepsis is present. Conservative treatment consists of broad spectrum antibiotics and percutaneous drainage of any collection.

A critical appraisal of laparoscopic pancreatic enucleations: right-sided procedures (Pancreatic Head, Uncus) are not mini-invasive surgery.

Laparoscopic pancreatic enucleation is increasingly performed worldwide. Few small-sized series show encouraging results, especially after enucleations performed for lesions located in the left part of the pancreas. The outcome of laparoscopic pancreatic enucleations was retrospectively evaluated by the analysis of prospectively collected parameters.

Laparoscopic minor pancreatic resections (enucleations/atypical resections). A long-term appraisal of a supposed mini-invasive approach.

Introduction: A few retrospective, small, often multicentric studies show encouraging results of laparoscopic minor pancreatic surgery, but do not allow for an evaluation of feasibility and effectiveness.

Aim: Evaluation of the results of laparoscopic minor pancreatic resections (LMPR), including atypical resections and enucleations.

Material And Methods: The outcome of all consecutive patients undergoing LMPR in a tertiary care university hospital specializing in the laparoscopic approach to solid organs (I.

Predictive factors of morbidity in distal pancreatic resections.

Objective: To evaluate the postoperative morbidity of distal pancreatic resections and to investigate its predictive factors.

Methods: The study was conducted retrospectively from a prospectively database maintained. From 1994 to 2008, 100 consecutive patients underwent left pancreatic resections.

Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time.

Background: The laparoscopic approach to liver resective surgery is slowly spreading to specialized centers. Little is known about factors influencing the immediate postoperative outcome.

Study Design: The purpose of the study was to evaluate the immediate outcome of laparoscopic liver resection (LLR), with particular emphasis on intraoperative bleeding and conversion.

Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique.

Objective: To retrospectively evaluate the feasibility of thoracoscopic removal of mediastinal parathyroids.

Summary Background Data: Mediastinal exploration to resect ectopic parathyroid(s) is needed in approximately 2% of cases in hyperparathyroidism. Recent advances in thoracoscopic surgery allow for a minimally invasive treatment.

Pancreatic fistula after pancreaticoduodenectomy: the conservative treatment of choice.

Background: A pancreatic fistula (PF) is the most common complication after pancreaticoduodenectomy (PD), and its reported incidence varies from 2% to 28%. The aim of the present study was to analyse the treatment of a complicated PF comparing the surgical approach with conservative techniques.

Methods: From January 2000 through to August 2006, 121 patients were submitted for PD.

Cholecystocolonic fistula: facts and myths. A review of the 231 published cases.

Background: Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Management of this uncommon but possible finding is still ill defined.

Methods: An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed.

Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization.

Most patients with hepatocellular carcinoma (HCC) are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis.

Early strangulated recurrence of incisional hernia after laparoscopic repair: an old complication for a new technique.

The introduction of laparoscopy in incisional hernia repair is giving rise to a new class of complications, specific of new techniques and materials. A case of early failure of incisional hernia laparoscopic repair complicated by the strangulation of a jejunal loop four months after surgery is reported. The use of inappropriate material (tacks) to fix the prosthesis to the abdominal wall, a sudden increase of intra-abdominal pressure caused by an episode of haematemesis four hours postoperatively (associated to its consequent endoscopic treatment), and the formation of rectus abdominis muscle hematoma are reported as the main factors determining the slippage of the mesh from the correct position and, ultimately, the early failure of the ventral hernia repair.

Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery?

Hypothesis: A subset of patients with stage IVA hepatocellular carcinoma (HCC) and preserved liver function may benefit from hepatic resection.

Design: Retrospective review of a prospectively collected database.

Setting: An academic tertiary care hepatobiliary unit.

Laparoscopic diagnosis and treatment of primary torsion of the greater omentum.

Clinical presentation of primary torsion of the greater omentum is nonspecific, thus rarely allowing for a preoperative diagnosis. Three patients presented with acute but nonspecific abdominal symptoms. Because ultrasonographic and radiologic findings were unclear, all patients underwent diagnostic laparoscopy.

TIMP-2 modulates neointimal formation in experimental ePTFE arterial grafts.

Background: In vascular reconstructive surgery, myointimal hyperplasia contributes to the adverse outcome of synthetic grafts. This phenomenon is because of unregulated extracellular matrix degradation and remodeling, and excessive smooth muscle cell proliferation and migration. Matrix metallopreoteinase 2 (MMP-2) is known as an important contributor to these events.

The role of intraoperative angiography in arterial thromboembolectomy for non-traumatic acute upper limb ischaemia.

The aim of the study was to investigate the influence of intraoperative arteriography on the outcome of upper limb acute arterial thromboembolectomy. In a retrospective study, 63 thromboembolectomies were analysed in 59 patients with acute ischaemia of the upper limbs (51 embolectomies and 12 thrombectomies). In 19 interventions, intraoperative angiography was performed either routinely or because of difficulty in passing the Fogarty catheter and/or absence of backflow.

Vascular endothelial growth factor increases the migration and proliferation of smooth muscle cells through the mediation of growth factors released by endothelial cells.

Background: Vascular endothelial growth factor (VEGF), a highly specific chemotactic and mitogenic factor for vascular endothelial cells (EC), appears to be involved in the development of atherosclerosis. The purpose of our study was to assess if VEGF might indirectly stimulate SMC migration and proliferation in a EC-SMC coculture system, through the mediation of growth factors released by EC.

Methods: Bovine aortic SMC were cocultured with bovine aortic EC treated with hrVEGF, to assess SMC proliferation and migration.