[Main points of vertical banded gastroplasty technique in open surgery]. / Punti chiave di tecnica della gastroplastica verticale con bendaggio per via laparotomica.

VGP represents the single more diffuse bariatric operation among the others restrictive ones, proposed and used from Mason since 1970. Other restrictive operations followed, introduced in the surgical armamentarium, but the Mason-like procedure remained the reference one, although with variations introduced by the single surgeon. On a basis of a personal experience of 163 patients operated with VGP, the Authors report the personal modifications of the procedure, in search of safety and better results.

[A possible late complication of Mason's vertical gastroplasty: the erosion of the vertical band]. / Possibile complicanza tardiva della gastroplastica verticale secondo Mason: il decubito della benderella.

AIM: To evaluate possible adverse consequences and complications following the procedure of Mason-McLeans Vertical Banded Gastroplasty (VBG), and in those cases the possibility to be related to a surgical mistake. PERSONAL EXPERIENCE: It is based on a casuistic of more than 180 patients, submitted to this restrictive bariatric surgery in the same institution since 2001. Controls of the prescribed postop follow up revealed a very low rate of complications, as only in three cases, all of them with spontaneous presentation, there was a complication related to the banding. RESULTS: All the observed complications were related to a late postoperative inadequate alimentation for excess of meals, after the immediate orthodox behaviour of the first months. DISCUSSION: From the comparative evaluation of all the patients submitted to the Mason-McLean procedure it seems of the utmost evidence the importance of a correct alimentation, mainly to the low bulk of the single meal, to avoid complications and obtain the best EWL%. CONCLUSIONS: Adherence to the guidelines for the post op alimentation in such patients is the key to obtain the best results from the operation avoiding the side effects and complications here described.

Diaphragmatic relaxation: pathophysiological alterations and current possibilities of surgical repair.

Diaphragmatic relaxation is a pathology not frequently observed because it is generally oligosymptomatic. The development of modern technology has induced an important contribution to the diagnosis and treatment of the disease which can find a possibility of restoration in surgery. A 63-year-old patient with a light syndrome of respiration deficiency and an altered relaxed profile of the right cupola was subjected to surgical treatment with the technique of diaphragmatic plicature without any adverse implication during and after the operation. After a brief recovery, the patient was discharged and after 9 years he affirmed still absence of dyspnoea from limited labor and absence of respiration problems. The selected surgical technique for the restoration of the altered muscle is the diaphragmatic plicature without incision or excision of the altered part of the muscle. The preferable access way today is that of laparotomy which is devoid of problems of thoracotomy and generally it permits quite easily the restoration of all diaphragmatic defects. Diaphragmatic plicature is a simple, effective and long-lasting intervention but we cannot determine the complete recovery of the normal contractile function of the muscle. There is no morbidity and mortality directly related to this technique, the latter incidentally associated with complications of general anesthesia.

[Experience of many years with the Mason-Mc Lean procedure for the treatment of obesity]. / Esperienza pluriennale con l'intervento di Mason-Mc Lean per il trattamento dell'obesità.

Bariatric surgery is still in search of a general agreement among surgeons for the more advisable technical procedure, and the various solutions actually overall performed are almost only on empirical basis. The main wanted result of such variety, of procedures is represented by the possibility to restore the body weight to physiological values without adverse effects. The Authors' experience is referred to 94 consecutive surgical procedures to treat obese patients and is completely homogenous, with all the patients treated by vertical gastroplasty, and the most of them are almost completely controlled till 24 months for clinical, biological, psychological and weight parameters. The complete absence of complications and the relevant compliance of all patients, without biological derangement from the normal values, correction of those preoperatively altered, and with the restoration of the body weight to the mean normal values of BMI, encourage the Authors to sustain the great advisability of the chosen technique.

[History and pathophysiologic analysis of the various techniques in bariatric surgery]. / Storia e analisi fisiopatologica delle diverse tecniche di chirurgia bariatrica.

Bariatric surgery for the treatment of morbid obesity or overweight refractory to medical therapy was born at the beginning of second half of the twentieth century, and its first steps were uncertain and with a not jet well definite purpose. In fact the main result to be pursued seemed to be simply the reduction of body weight, and any change of anatomy of the digestive tract able to reduce the absorbtion of nutrients was judged adequate. But very early the adverse consequences of malabsorption so obtained became evident, and other operations possibly free from those complications were devised and clinically tested. So aside the by-pass operations many other surgical procedures found their room, all of them aiming to fight the ever more diffuse obesity of the people. This historical review of the various surgical procedures attempted in these last sixty years for morbid obesity is very interesting for a better understanding of the problem and to have a solid basis for future rational choices.