Gastroesophageal Reflux After Sleeve Gastrectomy: New Onset and Effect on Symptoms on a Prospective Evaluation

Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss

Energy analysis of a wood or pellet stove in a single-family house equipped with gas boiler and radiators

In the residential sector, biomass appliances are widely used for space heating and often combined with other systems. This work aims at comparing the final and primary energy consumption of different configurations, including a conventional and a ducted pellet stove and a wood log stove using air as heat transfer fluid. A dynamic analysis of the interaction between biomass stoves and conventional heating systems, such as gas boilers and radiators, is carried out within a typical single-family house in a mild climate, using TRNSYS software. In addition, natural ventilation of the building is considered using CONTAM, with a focus on external infiltrations and internal air circulation due to the buoyancy effect. Results show that the biomass device in one room promotes the airflows between adjacent thermal zones, enhancing the heat distribution through door openings, in particular when an air ducted stove is present. The final energy consumption resulting from simulations with wood-burning stoves is 21% higher than pellet stoves. The pellet stove results in similar final energy and a 30% increase in overall primary energy, while the wood stove increases the final energy by 22% and approximately 40% of overall primary energy compared to the case of a traditional gas system coupled to radiators which is considered as reference. Nevertheless, non-renewable primary energy savings are higher than 50% with pellet stoves and 60% with wood-log stoves

Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT

Introduction: Surgical treatment for Hirschsprung disease (HD) has recently evolved into different minimally invasive techniques. The aim of the present study is to compare results from two different minimal invasive approaches, transanal endorectal pull-through (TERPT) and laparoscopic-assisted endorectal pull-through (LA-TERPT). Methods: Patients have been divided into two groups according to surgical technique. Data of HD patients treated by TERPT and those treated by LA-TERPT, respectively, performed at two different centers from January 2007 to December 2017, were retrospectively collected. Patients with aganglionosis confined to the recto-sigmoid colon with a minimum follow-up period of 4 years have been included. Demographic, clinical, surgical and functional outcome data were reviewed for each group using Chi-square and Fisher tests (statistical differences were considered for p < 0.05). Results: Among patients treated for HD in the two centers during the study period, 65 met the inclusion criteria (37 TERPT group and 28 LA-TERPT group). No differences regarding demographic and clinical data were observed between the two groups. Operative time was longer in the LA-TERPT group (p < 0.001). Time to start oral feeding was faster in the TERPT group while hospital stay was similar between the two groups. Three patients of the TERPT group required an additional abdominal approach. The rate of early complications was higher in the TERPT group. Long-term bowel function was assessed in 31 patients for the TERPT group and 24 patients for the LA-TERPT group. Outcomes showed that the bowel functional outcome was good (BFS ≥ 17) in 55% (n = 17) of TERPT group and 54% of LA-TERPT group (p = 0.97), moderate (BFS 12 to 16) in 16% (n = 5) and 33% (n = 8), respectively (p = 0.24), and poor in 29% (n = 9) and 13% (n = 3), respectively (p = 0.23). Conclusions: Both TERPT and LA-TERPT techniques should be considered safe and feasible for the treatment of HD patients. TERPT patients present faster time to return to normal bowel function while LA-TERPT patients have slightly lower incidence of postoperative complications. Long-term functional outcomes are similar between the two groups. Level of evidence: III