Management of Staple Line Leaks Following Laparoscopic Sleeve Gastrectomy for Morbid Obesity.

Purposes: Management of staple-line leaks following laparoscopic sleeve gastrectomy (LSG) is challenging and controversial. Guidelines for leak treatment are not standardized and often involve multidisciplinary management by surgical, medical and radiological methods. Herein we present our experience and proposed strategy for handling leaks after LSG.

Laparoscopic sleeve gastrectomy for morbid obesity: role of intraluminal and intraperitoneal postoperative drainage.

Background And Aims: Bleeding and staple line leak are the most common postoperative complications of LSG. To prevent and/or to promptly identify such complications, conventional peri-operative protocols imply post-operative gastric decompression (NGT) and staple line drain (IAD). Our aim was to evaluate the role of naso-gastric tube (NGT) and intra-abdominal drain (IAD) in preventing and/or facilitating identification and treatment of post-operative complications after sleeve gastrectomy.

Fever of unknown origin due to intrahepatic wooden toothpick.

Ingestion of foreign bodies is a common clinical problem, but intrahepatic migration is an exceptional occurrence. Clinical history is not helpful. Abdominal ultrasonography and CT are fundamental to exclude surgical causes of fever of unknown origin.

Three-Dimensional Versus Two-Dimensional Laparoscopic Right Hemicolectomy.

Background And Aims: To address the issue whether three dimensional (3D) offers real operative time advantages to the surgical procedure (primary endpoint) and significant reduction of surgeon's physical strain (secondary endpoint), we have retrospectively analyzed two consecutive series of laparoscopic right hemicolectomy (LRH) performed by a single experienced laparoscopic colorectal surgeon with two different imaging systems (two dimensional [2D] and 3D).

Patients And Methods: Since January 2014, 25 consecutive patients with right colon cancer underwent 3D LRH and other 25 consecutive ones received a 2D LRH by a single experienced surgeon. After the insertion of the access ports, the surgical procedure has been divided in component tasks and the execution times were compared.

The Aquamantys® system as alternative for parenchymal division and hemostasis in liver resection for hepatocellular carcinoma: a preliminary study.

Objective: To evaluate the clinical feasibility and safety of a new technique for liver resection using a new saline-coupled bipolar sealing device (Aquamantys®) that has shown high performance in the animal setting.

Patients And Methods: Twelve Child-Pugh A cirrhotic patients with hepatocellular carcinoma underwent partial hepatectomies using Aquamantys®. Our primary end-point was to observe occurrence of early specific surgical complications as bleeding, biliary leakage and abscess development.

A clinical and nutritional comparison of biliopancreatic diversion performed with different common and alimentary channel lengths.

Background: This retrospective study compares the clinical and nutritional outcomes of 100 morbidly obese patients who underwent biliopancreatic diversion (BPD) with common (CC) and alimentary channel (AC) length, respectively, 50/250 and 80/200 cm.

Methods: One hundred patients who received BPD from October 2006 to November 2011 were identified from a database of bariatric procedures performed at the University Hospital of Messina, and the outcomes in terms of weight loss and morbidity were compared. Forty morbidly obese patients underwent BPD with CC 80 cm and AC 200 cm (group 1) and 60 morbidly obese patients underwent BPD with CC 50 cm and AC 250 cm (group 2).

Single-incision versus three-port conventional laparoscopic right hemicolectomy: is there any real need to go single?

Background: Preliminary results showed some benefits of single-incision laparoscopic surgery (SILS) over conventional laparoscopic colectomy, including better cosmesis, less postoperative pain, and faster recovery, but these results need further confirmation. In addition, the literature still lacks comparative studies between the two approaches to prove the above-mentioned advantages of SILS over conventional laparoscopy and, most importantly, its equivalent effectiveness in terms of initial oncological results.

Patients And Methods: Two consecutive series of 10 patients undergoing three-port conventional laparoscopic right hemicolectomy (3PCL-RH) and single-incision laparoscopic right hemicolectomy, respectively, were compared in their short-term surgical and oncological outcomes.

Postoperative outcomes and quality of life in patients with cystic fibrosis undergoing laparoscopic cholecystectomy: a retrospective study.

Background: Approximately 28% of the patients with cystic fibrosis are affected by cholelythiasis. More than 40% of them have a symptomatic disease, which would mandate cholecystectomy.

Aim: The aim of this study was to review surgical and respiratory outcomes and quality of life scores of cystic fibrosis patients undergoing laparoscopic cholecystectomy for symptomatic cholelythiasis to verify the hypothesis that cholecystectomy is a low-risk operation by laparoscopy, not affecting unfavorably respiratory function and quality of life.

Early experience with laparoscopic major liver resections: a case-comparison study.

Laparoscopic major liver resections are regarded as demanding operations whose convenience is still under evaluation. The aim of the present study was to report our early experience and to describe surgical technique of laparoscopic major liver resections. Study group consisted of 6 female patients with benign disease and a mean age of 40.

LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study.

Hypothesis: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative time without increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter.

Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux.

Background: Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial. The aim of the present study was to evaluate long-term quality of life of patients undergoing open fundoplication for chronic GERD and to investigate pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms.

Methods: A cohort of 25 patients who underwent open Nissen fundoplications was reviewed for an evaluation of long-term residual symptoms and quality of life at an average follow-up of more than 10 years.

Laparoscopic palliative gastrojejunostomy for advanced recurrent gastric cancer after Billroth I resection.

Palliative surgery for advanced gastric cancer has equivocal results. Laparoscopy is likely to provide some advantage compared to open procedures. We present a case of laparoscopic gastrojejunostomy for advanced gastric cancer, which recurred after Billroth I resection.

Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia.

Background: Unilateral neck exploration (UNE) is currently replacing conventional bilateral neck exploration with cervicotomy for the surgical treatment of primary hyperparathyroidism (PHPT). However, many concerns still exist about the indications and the effectiveness of this minimally invasive approach.

Methods: Prospective evaluation of operative results in consecutive patients having indications for UNE on the basis of strict selection criteria consisting of ultrasound-MIBI agreement in adenoma localization, absence of thyroid disease, and psychological suitability for undergoing a procedure under local anesthesia.

A primary pancreatic carcinoid tumour with unusual clinical complaints: A case report.

Background: Unless metastatic or compressing the pancreatic duct, carcinoid of the pancreas are asymptomatic showing normal levels of serotonine and its metabolites in plasma and urine, thus resulting in delayed diagnosis and a consequent poor prognosis. However, if resection is timely accomplished, no local recurrence might be encountered and a normal survival might be expected in the absence of metastatic disease.

Case Presentation: The reported case of pancreatic carcinoid tumour in a 62-year-old woman reporting only atypical symptoms consisting of intermittent epigastric pain and nausea.

Minimally invasive management of insulinomas. A case report.

Background: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are.

Case Report: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome.

Results of laparoscopic and open splenectomy for nontraumatic diseases.

The medical records of patients who had undergone splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic splenectomy for nontraumatic splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.

[Biliary lesions after laparoscopic cholecystectomy].

Laparoscopic cholecystectomy is the suitable treatment for symptomatic cholelithiasis, even if the incidence of biliary lesions following this procedure may be up to threefold higher than that of open cholecystectomy. We report our experience concerning the incidence, aetiopathogenesis, diagnosis and treatment of complications in a homogeneous group of laparoscopic cholecystectomies. In a total of 492 laparoscopic cholecystectomies only three bile duct lesions were observed (0.

Blind versus open approach to laparoscopic cholecystectomy: a randomized study.

Intraabdominal structures may be damaged during blind introduction of the first trocar for laparoscopic operations. In this study, 150 patients with gallbladder lithiasis who underwent laparoscopy were randomly assigned to two groups, a blind (V group) or an open (H group), in order to compare the results and the rate of complications. No mortality was observed.

[The role of necrosectomy and continuous peritoneal lavage in the treatment of acute necrotic-hemorrhagic pancreatitis].

Acute necrotizing pancreatitis involves high mortality. When diagnosed, the disease implies a choice of suitable timing and proper technique of surgical approach. The experience on 16 patients with acute necrotizing pancreatitis, 9 males and 7 females, mean age of 54.

[Urogenital sequelae in surgery of rectal carcinoma].

Seventeen consecutive patients with rectal cancer underwent surgery at our institution between January 1988 and December 1990. The aim of this study was to assess the urogenital symptoms after radical resection of the rectum. Ten of these patients were suitable for the study, 9 of whom had an Anterior Resection (with colorectal anastomosis in 7 cases and with coloanal anastomosis in 2) and 1 a Miles operation.

[Biliary scintigraphy. Application to the study of chronic cholestasis].

In a sample population of 49 subjects (7 normal, 42 with various liver diseases), the parameters of the activity/time curve of trimethylbromo-iminodicetic acid (TBIDA) biliary scintigraphy were compared with the clearances of bromosulfophthalein (BSP) and indocyanine green (ICG). Correlation between T1/2 and P2 BSP slope was r = 0.50 (n = 33; P < 0.

[The use of fibrin glue in the surgery of breast carcinoma].

Twenty-four patients operated on for breast carcinoma with associated axillary node dissection were randomly assigned to two protocols. In the first group fibrin glue was applied intraoperatively, in the second group no complementary treatment was accomplished. The aim of the study was to evaluate the effect of fibrin glue in reducing postoperative axillary sero-lymphatic secretion.

[Reflux esophagitis. What factors influence the choice of antireflux surgery?].

The surgical goal of gastroesophageal reflux treatment is to restore the ability of antireflux barrier. The basal tone and the length of lower esophageal sphincter are commonly considered the most important factors in the assessment of gastroesophageal reflux symptoms. However, reflux symptoms may also occur after surgical correction of sphincter incompetence.

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis].

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis.