Subfascial endoscopic perforator vein surgery (SEPS) modified technique: subaponeurotic approach without balloon.

Subfascial Endoscopic Perforator Vein Surgery (SEPS) is one of the best procedures and a minimally invasive option for treating chronic venous insufficiency. We explain our experience with SEPS, which has been turned into a subaponeurotic approach without balloon, and assess the possible advantages of this technique. The subaponeurotic space was entered using the Visiport Plus (Autusuture, Tyco Healthcare) video-assisted technique, which shows how the trocar enters through the subcutaneous tissue and superficial aponeurosis of the leg. A blunt retractor was inserted which, together with CO2 insufflation (20 mm Hg), enabled the veins to be dissected. Ligation was performed using tripolar sealing. In no case was a balloon used. There were no incidents such as haemorrhage or subcutaneous emphysema during the procedure. The patients (n = 206) remained in the hospital for less than 24 hours and suffered no post-surgical complications. Active ulcers were cured, with no relapses, in 100% of cases. This is a very effective method for treating advanced chronic insufficiency because it prevents local damage and the rate of post-surgical complications is low. Technically it has more advantages because the fact that it does not use a balloon means that it exerts less pressure on the tissues.

Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications.

BACKGROUND: Ghrelin is an important factor in the regulation of intake. Most ghrelin is synthesized in the gastric fundus, but this is not the only location. The aim of this experimental study was to analyze the effect of sleeve gastrectomy (removing fundus) on the volume of intake in four experimental models and determine how this relates to changes in weight, plasmatic levels of glycemia, ghrelin, GLP-1, and insulin. METHODS: Sleeve gastrectomy was performed on four experimental models: (1) non-obesity; (2) exogenous obesity caused by excessive calorie intake; (3) genetically determined obesity (Zucker rats); and (4) genetically determined obesity and type 2 diabetes mellitus (Zucker diabetic fatty; ZDF rats). Model 2 had a control group on which sleeve gastrectomy was not performed. RESULTS: In the non-obese group, there were few changes after intervention, but in model 2, sleeve gastrectomy led to normalization of weight and endocrine-metabolic parameters that were the same as those for non-obese rats. The exception was for GLP-1, which has an anorexigenic effect: GLP-1 remained higher. In Zucker rats, sleeve gastrectomy had a slight effect on all parameters. In ZDF rats, sleeve gastrectomy led to a reduction in intake and a stabilization of weight. CONCLUSIONS: Sleeve gastrectomy is a very good option for exogenous obesity. Normalization of hormonal levels led us to find an extragastric ghrelin production.