Robotic Splenic Flexure and Transverse Colon Resections

Since the 1990s, laparoscopic technique has become a standard approach for several surgical procedures in the field of colorectal surgery. Laparoscopic approach to splenic flexure and transverse colon cancer, however, is still a matter of debate and considered challenging for both anatomical and technical aspects. The relationship with the spleen and the absence of a consensus on the extent of surgery for splenic flexure cancer are two of several aspects that make splenic flexure surgery mostly debated. Robotic technique has overcome some pitfalls of laparoscopy, thanks to its stability of vision, tremor filtering, and fine movements of the robotic arms that can help in better identifying and managing both vascular structures and side organs, thus avoiding splenic and pancreatic injuries. In addition, robotic system can allow a better fashioning of the intracorporeal anastomosis, and the advent of fluorescence is useful to guide dissection and to evaluate the vascularization of the colon. Herein we discuss a standardized approach for robotic splenic flexure resection and transverse colon

Formazione retroperitonale: caso clinico

Gli Autori riportano un caso clinico di ?formazione? retroperitoneale recentemente occorso alla loro osservazione. Delineando le diverse ipotesi diagnostiche, alla luce dell?evoluzione del quadro clinico e radiografico, ne ipotizzano la natura traumatica e la riconoscono come ematoma renale sottocapsulare verificatosi due anni prima e complicato recentemente da rottura capsulare, con conseguente spandimento ematico nel retroperitoneo e superficializzazione della raccolta, parzialmente ascessualizzata, in sede lombare sinistra. English version The Authors discuss about a case of retroperitoneal mass, recently observed in their Institution. About the nature of the mass, by the imaging and clinical evolution, the Authors suppose a traumatic genesis: subcapsular renal hematoma, occourred 2 years before, broken and expanded in retroperitoneal space and then superficialized in the left lumbar region

Ruolo del palloncino intragastrico in chirurgia bariatrica

Gli Autori presentano la loro casistica sul palloncino intragastrico (BIB) nel trattamento dell?obesità. Il BIB è un dispositivo meccanico restrittivo, costitutito da un involucro in silicone che viene introdotto in cavità gastrica per via endoscopica, riempito con 500 cc di soluzione fisiologica colorata con blu di metilene e mantenuto in situ per 6 mesi. Nell?arco di 2 anni sono stati posizionati 98 palloncini intragastrici a 88 pazienti la cui età media era di 37.1 anni e l?indice di massa corporea (BMI) medio di 41.9; l?eccesso ponderale medio era 47,6 kg. Le complicanze registrate sono state l?intolleranza, il reflusso gastro-esfageo (RGE), la rottura e/o la desufflazione del palloncino e meteorismo. Il BIB è risultata una procedura efficace nel trattamento temporaneo dell?obesità potendo indurre un soddisfacente calo ponderale e un miglioramento a breve termine delle comorbilità. English version Intragastric balloon (BIB) is a mechanical restrictive device formed by a silicone wrapper inserted endoscopically in the stomach, filled with 500 cc of phisiological blue metilene solution and kept in situ for 6 months. In two years 98 intragastric balloon have been set in 88 patients at the average age of 37.1 years, of 41.9 of BMI and 47.6 kg of weight. Complications were intolerance, gastro-oesophageal reflux, break and/or deflation and meteorism. BIB is an effective procedure in obesity temporary treatment leading a satisfactory loss of weight and a short-term comorbility improvement

Laparoscopic combined Nissen-Rossetti fundoplication and cholecystectomy: our experience - [Plastica Nissen-Rossetti e colecistectomia in un unico tempo laparoscopico: esperienza personale]

The aim of this study is to valuate the opportunity to associate both laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in patients with gallbladder cholelithiasis and gastro-oesophageal acid reflux (endoscopically and pHmetrically assessed), considerating that the gallbladder removal makes duodenal-gastric reflux worse. From 2005 until 2007 we associated laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in 10 patiens, who presented surgical indications for gallbladder cholelithiasis and gastro-oesophageal reflux. Clinical data, surgical procedures and post-operative complications were compared to our esperiency on the singular procedure (laparoscopic Nissen-Rossetti fundoplication and cholecystectomy). Results were valuated at 3, 6 and 12 months after surgical interventions by clinical and instrumental follow up (24-pH-metry and oesophagus-gastro-duodenoscopy). The analysis of instrumental data of these associated procedures doesn't present significative differences between the singular surgical approach. In all the patients treated by combined procedure, the follow-up shows a normal pHmetric exam, a good control on the acid reflux by fundosplication, absence of distal oesophagitis and gastric reflux symptoms. The association of laparoscopic Nissen-Rossetti fundoplication and laparoscopic cholecystectomy is indicated in patients who present both pathologies and needs to be considerating in relations to the good results and the low postoperatoric morbidity

Functional Evaluation at 1-Year Follow-Up of Laparoscopic Nissen-Rossetti Fundoplication

Laparoscopic Nissen fundoplication is currently the gold standard for surgical treatment of gastroesophageal reflux disease. The aim of this study was to present our experience with this procedure at 1 year of follow-up. Forty patients were operated on between January 2006 and July 2007, and 30 underwent a 24-hour postoperative pH-metry study. Ninety-two percent of the patients were asymptomatic at a follow-up of 12 months. All pH-metric parameters improved. DeMeester and Johnson's score was reduced from 44.7 to 7.75; endoscopy with histologic samples revealed the healing of esophagitis in all patients; 4 (13%) patients complained of dysphagia, which resolved within 1 month after surgery. Twenty-seven (90%) patients were completely satisfied by their surgical results. One year after surgery, 24-hour ph-metric results show that laparoscopic Nissen fundoplication can completely control acid reflux with relatively few complications and a high degree of patient satisfaction