Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line?

AIM: The aim of this study is to compare the material effectiveness of oversewing the staple line following laparoscopic sleeve gastrectomy. MATERIAL OF STUDY: A prospective randomized trial has been performed on 100 consecutive patients who underwent laparoscopic sleeve gastrectomy. Just before the intervention patients were randomized to receive (Group A) or not receive (Group B) a polypropylene 3-0 running oversewing suture of the staple line. RESULTS: By evaluating preoperative general demographics features and co-morbidities between group A and group B no statistical difference was observed. Main complications evaluated were fistol, bleeding and stenosis and there were no significant difference in fistulas occurrence (p = 0.55) and bleeding (p = 0,65) while on the other hand it has to be remarked how sleeve stenosis has been significantly higher when oversew is performed (p = 0.04). DISCUSSION: Staple line leakage is a worrisome complication of laparoscopic sleeve gastrectomy (LSG). Despite some reports describe oversewing of the staple line as the solution to prevent such problem; other authors have demonstrated the incidence of leaks being the same in oversewed and not oversewed patients. CONCLUSION: This randomized trial has so far shown oversew of LSG to be significantly useless to prevent fistulas formation in patients selected according to our study design.

[Percutaneous cholecystostomy and papilloplasty in elderly high-risk patient. Case report]. / Colecistostomia percutanea e concomitante papilloplastica in paziente anziana ad alto rischio chirurgico. Caso clinico.

When acute cholecystitis is suspected in a very high-risk patient, percutaneous cholecystostomy should be considered as a safe and effective temporary management of patients with gallstones. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy. In elderly patients who are inappropriate surgical candidates because of severe concomitant systemic diseases, less invasive treatments may prevent recurrence. Our experience shows the feasibility of percutaneous cholecystostomy to achieve an effective treatment of acute cholecystitis in surgical high-risk patients with a physiologic biliary drainage of gallstones in duodenum to prevent recurrence. Moreover we demonstrated the feasibility of a concomitant percutaneous treatment of biliary disease.

[Gastric non-Hodgkin lymphoma: guidelines for the therapeutic approach]. / Linfoma non Hodgkin a localizzazione gastrica: linee guida nell' approccio terapeutico.

The aims of this study were to contribute to the drawing up of guidelines for the therapeutic approach to primary gastric lymphoma and to identify the most effective sequence of treatment in the different stages of the disease. We conducted a retrospective analysis of the clinical data of 34 patients with primary gastric lymphoma admitted from 1993 to 2001 to the 4th General Surgery Department of the "Federico II" University in Naples. All the patients underwent surgical therapy and neoadjuvant or adjuvant chemotherapy. Patients were subdivided according to stage of disease, histological grade of malignancy and sequence of treatment. The 2- and 5-year overall survival rates were 94% and 68%., respectively. We observed a longer survival (81% at 5 years) in patients with IE-IIE stage disease (according to Mushoff's staging) than those with IIIE-IVE stages (56%). Patients with low and intermediate grade lymphoma (according to the working formulation) had a longer survival (83% and 71%, respectively) than patients with high-grade malignancies (55%). We noted that IE-IIE stage patients who underwent neoadjuvant chemotherapy and surgery survived longer (100%) than those in whom surgery preceded chemotherapy (66%), whereas IIIE-IVE stage patients in whom surgery was the first treatment survived longer (70%) than those in whom surgery followed chemotherapy (37%). On the basis of our experience, in patients with IE-IIE stages of disease chemotherapy should precede surgery while in patients with IIIE-IVE stages the inverse sequence is more effective in achieving longer survival rates.

[Surgical and endoluminal treatment of carotid stenosis: our experience]. / Trattamento chirurgico ed endoluminale delle stenosi carotidee: nostra esperienza.

Carotid endarterectomy and percutaneous transluminal angioplasty are known to prevent cerebrovascular accidents. From January 1997 to December 2002, 47 patients (35 male, 12 female; median age: 65 years) with carotid stenosis were observed. Neurological accidents were reported in 89.4%, while the other 10.6% were asymptomatic. The operative indications for the asymptomatic patients were high-degree stenosis (> 70%) of the internal carotid artery and ulcerated plaques with a moderate degree of stenosis (50%). Preoperative investigations consisted in colour Doppler ultrasonography, arteriography and cerebral CT scans or NMR. Endarterectomy was performed in 35 patients, while the other 12 underwent percutaneous transluminal angioplasty. The operative mortality in the 35 patients undergoing surgery was 5.7% (2 cases) and perioperative strokes occurred in 3 cases (8.6%). After 36 months, 32/35 patients (91.4%) were stroke-free, and one patient died as a result of a stroke. In the group of patients undergoing angioplasty, re-stenosis occurred in 2 cases (16.7%). Our results suggest that colour Doppler ultrasonography is a reliable examination for investigating the carotid axis and that both carotid endarterectomy and percutaneous transluminal angioplasty are safe procedures capable of preventing future cerebrovascular accidents.

Effect of bariatric surgery on obesity-related infertility.

BACKGROUND: There is a strong association between obesity and infertility, and weight loss can increase fecundity in obese women. In an attempt to determine the effect of bariatric surgery on obesity-related infertility, we reviewed the fertility outcomes after intragastric balloon placement, adjustable gastric banding, sleeve gastrectomy, and gastric bypass in childbearing women with a diagnosis of infertility at a university hospital in Italy. METHODS: This was a retrospective study of 110 obese infertile women. We evaluated the effectiveness of bariatric surgery in improving fertility, assessing the influence of age, surgical technique, co-morbidities (hypertension and diabetes), weight loss, and body mass index before and after surgery. RESULTS: Of these 110 women who had tried unsuccessfully to become pregnant before weight loss, 69 became pregnant afterward. The pregnancies proceeded without complications and ended with a live birth. Only the weight loss (odds ratio 20.2, P = .001) and the achieved body mass index (P = .001) after surgery were the predictors of pregnancy. CONCLUSION: Bariatric surgery might be effective in young infertile obese women who wish to become pregnant. Weight loss appears to be independent from the surgical technique in determining the increase in the pregnancy rate as well as the body mass index achieved at pregnancy.

The potential role of intragastric balloon in the treatment of obese-related infertility: personal experience.

The prevalence of people who are overweight or obese has increased dramatically in high-income countries over the past 20 years. There is a strong association between obesity and infertility, and weight loss can result in increased fecundity in obese women. The aim of this study is to demonstrate the potential role of intragastric balloon in the treatment of obese-related infertility. This is a retrospective study. A chart review of 27 obese women seen between September 2003 and July 2008 was performed. They all presented with the diagnosis of infertility and had undergone endoscopic intragastric balloon positioning. Among these women who tried unsuccessfully to become pregnant before weight loss, 15 became pregnant afterward. The pregnancies proceeded without complications and ended with live births. An improvement in the fertility status after weight loss has been described, although data on fertility after weight loss following bariatric surgery are still limited. The results obtained in our experience are not different from data reported in literature for bariatric surgery. Therefore, balloon treatment might be effective in young infertile obese women who wish to become pregnant.