A prospective analysis of the postoperative and long-term functional outcomes of a novel technique to perform rectal transection during laparoscopic restorative proctectomy and ileal pouch-anal anastomosis.

Background: Laparoscopic ileal pouch-anal anastomosis (IPAA) technique is not standardized. An irregular division of the rectum could result in poor functional outcomes and residual diseased mucosa. The aim of the study was to develop a new technique for performing the rectal transection via a laparoscopic approach, and to compare the outcomes of this technique with those of the open surgery IPAA.

Granular Data: A Rare Submucosal Tumor of the Colon-Case Report and Review of the Literature.

Introduction: Granular cellular tumors are unusual lesions that can occur in the gastrointestinal tract, where they localize most commonly to the esophagus followed by the colon.

Areas Covered: We report a case of a young man with a sub-epithelial lesion of the ascending colon, removed by endoscopic submucosal dissection. Histological examination revealed a granular cellular tumor without features of malignancy.

Endoscopic Ultrasound-Guided Stented Gastro-Gastrostomy for Strictured Vertical Banded Gastroplasty.

Herein, we make a video presentation of an endoscopic reversal of a strictured vertical banded gastroplasty (VBG), carried out through an endoscopic ultrasonography (EUS)-guided transluminal therapy system, in order to accurately identify the common gastric wall and to allow the application of an endoscopic stent. The operative time was 60 min, and no intraoperative complication was recorded. On postoperative day 1, an upper GI swallow showed the oral contrast easily flowing into the body of the stomach throughout the stent.

TAMIS-Flap Technique: Full-thickness Advancement Rectal Flap for High Perianal Fistulae Performed Through Transanal Minimally Invasive Surgery.

The formation of an advancement rectal flap could be technically demanding in the presence of high perianal of rectovaginal fistula, and the outcomes could be frustrated by the inadequate view, bleeding and a poor exposure through the standard transanal approach. The application of the transanal minimally invasive surgery (TAMIS) to the advancement rectal flap procedure could overcome these difficulties. In the lithotomy position, a partial fistulectomy was performed and the internal opening was closed.

Prepouch Ileitis After Ileal Pouch-anal Anastomosis: Patterns of Presentation and Risk Factors for Failure of Treatment.

Background And Aims: There is a lack in the literature about prepouch ileitis [PI], in particular regarding risk factors associated with failure of the medical treatment. Aim of the study is to analyse the characteristics of PI patients and to compare those who required surgery with those who were successfully treated with conservative therapy.

Methods: All cases presenting a diagnosis of PI were included and analysed.

Total Lymphadenectomy and Nodes-Based Prognostic Factors in Surgical Intervention for Esophageal Adenocarcinoma.

Background: To evaluate prognostic factors based on the number of resected lymph nodes, we considered 202 patients who underwent radical resection and "total lymphadenectomy" for esophageal adenocarcinoma according to a prospective protocol.

Methods: Fifty-eight tumors surrounded by Barrett's epithelium underwent esophagectomy and esophagogastrostomy, and 144 tumors without Barrett's epithelium underwent esophageal resection at the azygos vein level, total gastrectomy, and Roux-en-Y esophagojejunostomy. All nodes and fat tissue were resected at the following stations: chest 4L and R3, R4, R7, R8, and R9 (TNM seventh edition) and abdomen 1-12 according to the Japanese Classification of Gastric Carcinoma (1998).

Collis-Nissen gastroplasty for short oesophagus.

The Collis-Nissen procedure is performed for the surgical treatment of 'true short oesophagus'. When this condition is strongly suspected radiologically, the patient is placed in the 45° left lateral position on the operating table with the left chest and arm lifted to perform a thoracostomy in the V-VI space, posterior to the axillary line. The hiatus is opened and the distal oesophagus is widely mobilized.

Fungal Dysbiosis in Mucosa-associated Microbiota of Crohn's Disease Patients.

Background And Aims: Gut microbiota is involved in many physiological functions and its imbalance is associated with several diseases, particularly with inflammatory bowel diseases. Mucosa-associated microbiota could have a key role in induction of host immunity and in inflammatory process. Although the role of fungi has been suggested in inflammatory disease pathogenesis, the fungal microbiota has not yet been deeply explored.

Results of left thoracoscopic Collis gastroplasty with laparoscopic Nissen fundoplication for the surgical treatment of true short oesophagus in gastro-oesophageal reflux disease and Type III-IV hiatal hernia.

Objectives: Controversy exists regarding surgery for true short oesophagus (TSOE). We compared the results of thoracoscopic Collis gastroplasty-laparoscopic Nissen procedure for the treatment of TSOE with the results of standard laparoscopic Nissen fundoplication.

Methods: Between 1995 and 2013, the Collis-Nissen procedure was performed in 65 patients who underwent minimally invasive surgery when the length of the abdominal oesophagus, measured intraoperatively after maximal oesophageal mediastinal mobilization, was ≤1.

Surgery for Type III-IV hiatal hernia: anatomical recurrence and global results after elective treatment of short oesophagus with open and minimally invasive surgery.

Objectives: Type III-IV hiatal hernia (HH) is associated with a true short oesophagus in more than 50% of cases; dedicated treatment of this condition might be appropriate to reduce the recurrence rate after surgery. A case series of patients receiving surgery for Type III-IV hernia was examined for short oesophagus, and the results were analysed.

Methods: From 1980 to 1994, 60 patients underwent an open surgical approach, and the position of the oesophago-gastric junction was visually localized; from 1995 to 2013, 48 patients underwent a minimally invasive approach, and the oesophago-gastric junction was objectively localized using a laparoscopic-endoscopic method.

Esophagogastric metaplasia relates to nodal metastases in adenocarcinoma of esophagus and cardia.

Background: Immunohistochemical profiles of esophageal and cardia adenocarcinoma differ according to the presence or absence of Barrett's epithelium (BIM) and gastric intestinal metaplasia (GIM) in the fundus and antrum. Different lymphatic spreading has been demonstrated in esophageal adenocarcinoma. We investigated the correlation among the presence or absence of intestinal metaplasia in the esophagus and stomach and lymphatic metastases in patients who underwent radical surgery for esophageal and cardia adenocarcinoma.

The frequency of true short oesophagus in type II-IV hiatal hernia.

Objectives: The misdiagnosis of short oesophagus may occur on recurrence of the hernia after surgery for type II-IV hiatal hernia (HH). The frequency of short oesophagus in type II-IV hernia is undefined. The aim of this study was to assess the frequency of true short oesophagus in patients undergoing surgery for type II-IV hernia.

Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty.

Background: The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size.

Barrier effect of Esoxx(®) on esophageal mucosal damage: experimental study on ex-vivo swine model.

The aim of the present study was to assess the potential barrier effect of Esoxx(®), a new nonprescription medication under development for the relief of gastroesophageal reflux symptoms. Esoxx is based on a mixture of hyaluronic acid and chondroitin sulfate in a bioadhesive suspension of Lutrol(®) F 127 polymer (poloxamer 407) which facilitates the product adhesion on the esophageal mucosa. The mucosal damage was induced by 15 to 90 minutes of perfusion with an acidic solution (HCl, pH 1.

Obscure gastrointestinal bleeding: single centre experience of capsule endoscopy.

The advent of capsule endoscopy (CE) has resulted in a paradigm shift in the approach to the diagnosis and management of patients with obscure gastrointestinal bleeding (OGIB). With increasing global availability of this diagnostic tool, it has now become an integral part of the diagnostic algorithm for OGIB in most parts of the world. However, there is scant data on optimum timing of CE for maximizing diagnostic yield.

Improving the surgery for sigmoid achalasia: long-term results of a technical detail.

Objective: Heller myotomy results for the treatment of sigmoid achalasia are worse than those achieved for fusiform achalasia. We retrospectively examined two groups of sigmoid achalasia patients, in which we performed (1) the standard Heller-Dor procedure (no pull-down) and (2) the Heller-Dor plus a technique apt to obtain the verticality of the oesophageal axis (pull-down). We verified whether the latter technique improved long-term results.

Immunopathological patterns of the stomach in adenocarcinoma of the esophagus, cardia, and gastric antrum: gastric profiles in Siewert type I and II tumors.

Background: The morphologic and immunohistochemical profiles of gastric mucosa and of the tumor were assessed in Siewert type I, type II, and gastric antrum adenocarcinomas.

Methods: Sixty-two patients, prospectively operated upon, were included in the study: 37 type II, 15 type I, and 10 antrum adenocarcinoma. Samples of the tumor, the surrounding area, and the gastric corpus and antrum were analyzed histologically, and immunostained for cytokeratins (CK)7/20 (staining positive for cells labeled > or = 50%).

Long-term results after Heller-Dor operation for oesophageal achalasia.

Objective: In the literature, reports on the definitive rate of cure of the surgical treatment of oesophageal achalasia are not numerous. The aim of this study is to assess the clinical-instrumental-based patient's outcome related to long-term follow-up.

Methods: One hundred and seventy-four patients (80 men, median age 57 years, range 7-83) consecutively submitted to first instance transabdominal Heller-Dor in the period 1978-2002 were considered.

[Laparoscopic and left thoracoscopic Collis-Nissen procedure: technique and short term results].

The aim of this paper is to illustrate a laparoscopic-thoracoscopic technique for the surgical management of foreshortened esophagus in patients affected by severe gastro-esophageal reflux disease. The patient is placed on the operating table with the left chest and arm lifted to perform a thoracostomy in theV-VI space, posterior to the axillary line. The hiatus is opened and the distal esophagus is mobilized.

The surgical treatment of the intrathoracic migration of the gastro-oesophageal junction and of short oesophagus in gastro-oesophageal reflux disease.

Objectives: In the rush to implement laparoscopic surgery for gastro-oesophageal reflux disease (GORD), the necessity to treat a short oesophagus with dedicated techniques was not always adequately considered. The aim of this study was to define the frequency, patterns and surgical treatment of the intrathoracic migration of the g-o junction and short oesophagus in GORD.

Methods: Between 1980 and 2003 our group indicated surgery only for severe and complicated GORD and for drawbacks of medical therapy.

Hiatus hernia and intrathoracic migration of esophagogastric junction in gastroesophageal reflux disease.

The prevalence and clinical presentation of reducible and irreducible hiatus hernia were investigated within a gastro-esophageal reflux disease patient population. Reflux symptoms and esophagitis data were collected on 791 patients. The barium swallow was used to assess the esophagogastric junction.

Radiological examinations in the morpho-functional evaluation of the esophago-gastric junction in gastro-esophageal reflux disease.

Purpose: The aim of our paper is to define, on the basis of a long experience, the anatomical and radiological classification of the progressive phases of the axial intrathoracic migration of the esophago-gastric junction (EGJ), through a standardised radiological method that allows precise identification of the anatomical structures involved.

Materials And Methods: From 1981 to 2001, 1388 patients with gastro-esophageal reflux disease (GERD) were examined by traditional contrast techniques that consisted in taking single contrast radiograms of the patients in different positions after administering a small high-density bolus of barium: with the patient standing up in frontal position, at rest, during forced inspiration, and during straining; standing up in a right front 30 degrees oblique position; and in prone position, in a right posterior 30 degrees oblique projection. On the basis of previous radiological and manometric studies aimed at verifying the diagnostic reliability of the radiological examination [8], the distance of the esophago-gastric junction from the esophageal hiatus was indirectly evaluated in an anterior-posterior projection, according to the criteria introduced by Monges [3].