Splenic and concomitant liver abscess after laparoscopic sleeve gastrectomy

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure for losing weight and gaining control of obesity-related comorbidities. However, it is associated with postoperative complications such as bleeding, leak, and midgastric stenosis. Splenic and hepatic abscesses have been reported as unusual and rare complications after primary LSG. We report a case of splenic and concomitant hepatic abscesses after primary LSG, successful minimally invasive management, and midterm follow-up. Case Description: We report a complex case of splenic abscess with satellite hepatic abscess plus splenic thrombosis (0.1%) diagnosed 67 days after LSG. This unusual complication was managed by a minimally invasive approach (spleen sparing) with complete resolution after 35 days. After 18 months of follow-up, the patient showed complete resolution of the splenic and liver abscesses and progressive loss of excess weight. Conclusion: In high-volume centers, rare and life-threatening complications such as splenic and hepatic abscesses may be observed. The minimally invasive approach could represent an effective option of avoiding splenectomy in selected case

A prospective evaluation on external jugular vein cut-down approach for TIVAD implantation

BACKGROUND: Totally implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates. The authors report a prospective evaluation of 83 consecutive external jugular vein cut-down approaches for totally implantable venous access devices implantation. METHODS: Eighty three consecutive patients (28 M, 55 F, mean age 54.2) suffering from solid tumors (58) or hematologic diseases (25) were consecutively submitted to totally implantable venous access devices insertion through external jugular vein cut-down approach (75 on right side, 8 on left side). RESULTS: All devices were surgically implanted; no instances of intraoperative complications were detected. After a minimum follow-up of 150 days, only one case of wound hematoma and one case of device malfunction due to incorrect catheter angulation were noted. Postoperative patient satisfaction was evaluated by the use of specific questionnaire that demonstrated a good satisfaction and compliance (92.8 %) of patients with implanted devices. CONCLUSIONS: Despite the lack of controlled studies comparing external jugular vein cut-down approach vs other approaches, this approach should be considered as a tool for long-term central vein catheters positioning, both as an alternative and for primary approach

A literature review on surgery for cervical vagal schwannomas

Cervical vagal schwannoma is a benign, slow-growing mass, often asymptomatic, with a very low lifetime risk of malignant transformation in general population, but diagnosis is still a challenge. Surgical resection is the treatment of choice even if its close relationship with nerve fibres, from which it arises, threats vagal nerve preservation. We present a case report and a systematic review of literature. All studies on surgical resection of cervical vagal schwannoma have been reviewed. Papers matching the inclusion criteria (topic on surgical removal of cervical vagal schwannoma, English language, full text available) were selected. Fifty-three patients with vagal neck schwannoma submitted to surgery were identified among 22 studies selected. Female/male ratio was 1.5 and median age 44 years. Median diameter was 5 cm (range 2 to 10). Most schwannoma were asymptomatic (68.2%) and received an intracapsular excision (64.9%). Postoperative symptoms were reported in 22.6% of patients. Cervical vagal schwannoma is a benign pathology requiring surgical excision, but frequently postoperative complications can affect patients lifelong, so, surgical indications should be based carefully on the balance between risks and benefits

Salvation Gastric Bypass as Conversion from Failed, Open Banded Vertical Gastroplasty

Introduction: Vertical-banded gastroplasty used to be one of the most performed bariatric procedures, but it fallen out of interest due to other emerging procedures and non-satisfactory long-term results. Options for revision include conversion to sleeve gastrectomy, a Roux-en-Y gastric bypass (RYGB) or VBG reversal via gastrogastrostomy. Objectives: To evaluate the role of laparoscopic RYGBP in the treatment of a previous, failed open VBG. Methods: we present the video of a laparoscopic conversion from previous open, adjustable banded vertical gastroplasty. Patient was operated in other center in 1997 at a BMI of 55.3 kg/m2 and arrived a minimumof 30 kg/m2. In 2017 she presented for weight regain and reflux disease (BMI 41 kg/m2), requesting further attention. Intraoperative difficulties, adhesiolisys, band removal, unexpected situations are presented. Results: Conversion to laparoscopic RYGBP was safe and efficient, with no need for open surgery conversion, and further weight loss recorded. Postoperative prolonged respiratory problems registered, successfully treated conservatively. An important improvement of the patients’ symptoms and satisfaction was achieved 6 months postoperatively, with suspension of medical therapy, at a BMI of 35 kg/m2. Conclusions: Conversion of open VBG to RYGB is feasible and safe and can be performed with an acceptable complication rates, especially in experienced bariatric centers. It gives excellentweight loss results and relief of outlet obstruction

Resource allocation in multi-domain networks based on Service Level Specifications

The current trend toward the utilization of the Internet as a common means for the offer of heterogeneous services imposes to address the issues related to end-to-end service assurance in the inter-domain scenario. In this paper, we first present an architecture for service management in networks based on service level specifications (SLS). The architecture is designed to be independent both of the specific network technology adopted and of the high level service semantics. Then, we focus on a specific functionality of the proposed architecture: Resource allocation in the multi-domain scenario. A distributed admission control algorithm is introduced, its complexity is evaluated and a comparison with related solutions is provided

Leak after sleeve gastrectomy. How long do we have to be worried?

Currently, laparoscopic sleeve gastrectomy (LSG) is the most popular procedure for the treatment of morbid obesity in USA and Europe. Minor complications have an overall incidence of 11 % while major l complications constitute about 5 % in large series. The mean incidence of leak is 2.1 % . According to the time of onset, Csendes et al. classified leakage as early when diagnosed within 4 days posteratively, intermediate within days 5–9 and late when occurring after the 10th postoperative day. Leak is the second most common cause of death with an overall reported mortality rate of 0.4 %. It remains unusual and unexplainable to see very late leaks occurring several months after LSG (6-7- months) as those reported in this paper

Gastric Bypass as Conversion from Abandoned Bariatric Procedures: Gastric Plication, Banding or Pacemaker, Toga or Banded Vertical Gastroplasty. A Video Remix

Introduction: recently, increased numbers of revision bariatric procedures are reported worldwide, especially due to insufficient weight loss or weight regain. Some of former bariatric procedures are currently abandoned or anecdotally used due to long-term failure and increased incidence of revision surgeries needed. Objectives: To evaluate the role of laparoscopic gastric bypass LGBP in the treatment of failure of previous, abandoned bariatric procedures. Methods: A video remix of laparoscopic conversion from gastric banding, gastric plication, gastric pacemaker, TOGA or banded vertical gastroplasty is presented. Patients operated between 1997 and 2010 with different bariatric procedures were converted for weight regain, comorbidities recurrence, unsatisfactory results. Intraoperative difficulties, adhesiolisys, different prosthesis removal, unexpected situations are briefly presented. Results: no conversion and no mortality were recorded. Conversion to LGBP was efficient and safe in all revision procedures, with further weight loss recorded. An important improvement of the patients’ symptoms and satisfaction was achieved 6 months postoperatively, with suspension of medical therapy, maintained one year after intervention.Conclusions: conversion in GBP is actually the best option of treatment in case of weight regain after abandoned, former bariatric procedures

NAPOLI FUTURA: Novel approaches for protecting critical infrastructures from cyber attacks

This paper presents the main objectives and preliminary results of the NAPOLI FUTURA project, which aims to define novel approaches for protecting critical infrastructures from cyber attacks. The paper focuses on the architectural design of the NAPOLI FUTURA platform. The platform leverages cutting-edge big data analytics solutions to detect security attacks and to support live migration of services in the context of Critical Information Infrastructures (CIIs)