Laparoscopic approach for retrorectal tumors.

BACKGROUND: Retrorectal tumors are uncommon and may represent a surgical challenge. Laparoscopic excision has been reported in very few papers. We present our experience of nine cases operated by a transabdominal laparoscopic approach, between 2005 and 2011. METHODS: There were two males and seven females with a mean age of 35 years (range 19-48). The tumors were discovered incidentally in four cases or because of nonspecific clinical signs. All patients have had an MRI preoperatively. RESULTS: Only one patient required open conversion due to a huge tumor >7 cm of diameter. Postoperative mortality was nil. One patient developed a hematoma in the pelvic area. The median hospital stay was 4.7 days (range 4-8). Final diagnostic were as follows: four schwannomas, one ganglioneuroma, two tailgut cysts, one anterior meningocele, and one paragangliomas. During the follow-up showed no recurrences, but four of nine patients developed neurologic complications as parenthesis and sciatic pain and one patient developed retrograde ejaculation. CONCLUSIONS: Our case series shows that the laparoscopic approach is a feasible and safe option. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space to minimize the vascular and neurological injuries.

Resizing of the Gastric Pouch for Weight Regain after Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: Is It a Valid Option?

Introduction: The laparoscopic resizing of the gastric pouch (LPR) has recently been proposed as a revisional technique in the case of weight regain (WR) after gastric bypass procedures. The aim of this study was to report our experience with LPR for WR. Materials and Methods: All patients with WR ≥ 25% after gastric bypass and with a dilated gastric pouch and/or gastrojejunal anastomosis who underwent LPR between January 2017 and January 2022 were retrospectively reviewed. From a radiological point of view, a gastric pouch was considered dilated when its volume was calculated at >80 cm3 for LRYGB and >200 cm3 for OAGB upon a 3D-CT scan. The endoscopic criterion considered both the diameter of the gastrojejunal anastomosis and the gastric pouch volume. All anastomoses > 20 mm for LRYGB and >40 mm for OAGB were considered dilated, while a gastric pouch was considered endoscopically dilated when the retrovision maneuver with the gastroscope was easily performed. These selection criteria were arbitrarily established on the basis of both our personal experience and literature data. Results: Twenty-three patients had LPR after a Roux-en-Y gastric bypass or one-anastomosis gastric bypass. The mean BMI at LPR was 36.3 ± 4.7 kg/m2. All patients underwent LPR, while the resizing of the GJA was also performed in 3/23 (13%) cases, and hiatoplasty was associated with the resizing of the pouch in 6/23 cases (26.1%). The mean BMI at the last follow-up was 29.3 ± 5.8 kg/m2. The difference between the BMI before resizing and the BMI at the last follow-up visit was statistically significant (p = 0.00005). The mean %TWL at 24.2 ± 16.1 months was 19.6 ± 9%. Comorbidities had an overall resolution and/or improvement rate of 47%. The mean operative time was 71.7 ± 21.9 min. The conversion rate was nil. Postoperative complications occurred in two cases (8.7%). Conclusions: In our series, LPR for WR showed good results in weight loss and in improvement/resolution of comorbidities, with an acceptable complication rate and operative time. Only further studies with a greater cohort of patients and a longer postoperative follow-up will be able to highlight the long-term benefits of this technique.

The Nissen-Sleeve: Early Postoperative Complications.

Introduction: Nissen Sleeve (NS) was introduced in the bariatric armamentarium with the purpose to decrease the risk of reflux symptoms following sleeve gastrectomy. The aim of this study was to evaluate our personal experience with this new technique, in particular concerning early postoperative complications (<30 days). Methods: We retrospectively reviewed our prospectively collected data on consecutive morbid patients with obesity receiving NS from December 2019 to August 2020. All data pertaining to each patient, including demographic data and preoperative and postoperative clinical data, were collected. Results: A total of 28 N-sleeve procedures were performed in the considered period. All the patients had a hiatal hernia that was evaluated between 2 and 6 cm of extent in the preoperative work. Esophagitis of stage A, according to the Los Angeles classification, was detected in 71% of the patients, while 8 out of 28 patients presented a stage B esophagitis. One of the patients had a preoperative diagnosis of Barrett esophagus. A complete disappearance of gastroesophageal reflux disease (GERD) symptoms was achieved in 25 patients out of 28, while the remaining patients reported an improvement in symptoms and continued to be treated with low doses of proton pomp inhibitors. Two reinterventions (7.1%) were performed (Clavien-Dindo IIIb). Three other patients (10.7%) experienced a transient postoperative dysphagia that in one case persisted for 4 months (Clavien-Dindo II). All the patients were managed with conservative treatment, and in each case an endoscopic dilatation was necessary. Conclusions: NS appears to be a safe surgical technique with an acceptable early postoperative complication rate. NS appears to be effective in treating patients suffering from obesity and preoperative reflux, but the data are insufficient to establish whether it can reduce the long-term risk of de novo GERD in laparoscopic sleeve gastrectomy patients.