Miotomia laparoscopica secondo Heller per acalasia esofagea. C’è bisogno di una fundoplicatio?

The last decade has witnessed radical changes in the treatment of esophageal achalasia due to the development of minimally invasive techniques. Because of the high success rate of the laparoscopic Heller myotomy, a radical shift in the treatment algorithm of these patients has occurred, and today this is the preferred treatment modality for achalasia. This remarkable change is due to the recognition by gastroenterologists and patients that a laparoscopic Heller myotomy outperforms pneumatic dilatation and intra-sphincteric injection of botulinum toxin injection. While there is agreement about the technique of the myotomy per se, some questions still linger about the need for a fundoplication after the myotomy. The following review describes the data present in the literature in order to identify the best procedure that can achieve relief of dysphagia while avoiding development of gastroesophageal reflux

Riparazione laparoscopica delle ernie paraesofagee: un approccio “evidence-based”

The approach to paraesophageal hernias has drastically changed over the last decade. The goal of this paper is to describe in detail our surgical technique of laparoscopic repair of paraesophageal hernias and to provide an evidence-based approach to the most controversial aspects of this type of repair

Giovanni Sartori e la democrazia della Seconda Repubblica

Il saggio ripercorre e analizza criticamente tutti i passaggi istituzionali della cosiddetta Seconda Repubblica, ossia della peculiare democrazia maggioritaria che si imposta in Italia a partire dal 1994. Tali passaggi sono visti all'interno del pensiero di Giovanni Sartori e in particolare della sua teoria della democrazia. Tale pensiero si è manifestato sia attraverso opere scientifiche sia attraverso una continua attività pubblicistica, in particolare dalle colonne, come editorialista, del Corriere della Sera. Dall'esame di questo pensiero emerge una serrata e continua critica dei caratteri istituzionali della peculiare democrazia maggioritaria all'italiana.The essay traces and critically analyzes all the institutional steps of the so-called Italian Second Republic, that is the peculiar majoritarian democracy that is set in Italy since 1994. These steps are seen within the thoughts of Giovanni Sartori and in particular of his theory of democracy . Such thinking has manifested both through scientific works both through continuous publications, in particular from the columns, as a columnist, of the Corriere della Sera. From an examination of this thinking emerges a close and continuous criticism of the institutional character of the distinctive Italian style majoritarian democracy

Facelift thyroid surgery: a systematic review of indications, surgical and functional outcomes

Objective: To investigate indications, surgical and functional outcomes of robotic or endoscopic facelift thyroid surgery (FTS) and whether FTS reported comparable outcomes of other surgical approaches. Data sources: PubMed, Cochrane Library, and Scopus. Review methods: A literature search was conducted about indications, clinical and surgical outcomes of patients who underwent FTS using PICOTS and PRISMA Statements. Outcomes reviewed included age; gender; indications; pathology; functional evaluations; surgical outcomes and complications. Results: Fifteen papers met our inclusion criteria, accounting for 394 patients. Endoscopic or robotic FTS was carried out for benign and malignant thyroid lesions, with or without central neck dissection. Nodule size and thyroid lobe volume did not exceed 6, 10 cm, respectively. FTS reported comparable outcome with transaxillary or oral approaches about operative time, complication rates or drainage features. The mean operative time ranged from 88 to 220 min, depending on the type of surgery (endoscopic vs robotic hemi- or total thyroidectomy). Conversion to open surgery was rare, occurring in 0–6.3% of cases. The most common complications were earlobe hypoesthesia, hematoma, seroma, transient hypocalcemia and transient recurrent nerve palsy. There was an important disparity between studies about the inclusion/exclusion criteria, surgical and functional outcomes. Conclusion: FTS is a safe and effective approach for thyroid benign and malignant lesions. FTS reports similar complications to conventional thyroidectomy and excellent cosmetic satisfaction. Graphical abstract: [Figure not available: see fulltext.]SCOPUS: re.jinfo:eu-repo/semantics/publishe