Hiatoplasty with crura buttressing versus hiatoplasty alone during laparoscopic sleeve gastrectomy

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG

Results of medium seventeen years' follow-up after laparoscopic choledochotomy for ductal stones

INTRODUCTION: In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series. METHODS: One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required. RESULTS: Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy. CONCLUSIONS: Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Introduction: The safety and efficacy of laparoscopic transperitoneal lateral adrenalectomy and retroperitoneoscopic adrenalectomy have been reported. The aim is to report the authors’ experience in laparoscopic left adrenalectomy with an alternative transperitoneal submesocolic and retropancreatic approach with patient supine

Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery

BACKGROUND: Local excision after radiotherapy for node-negative low rectal cancer may be an alternative to radical excision. This study evaluated the results of local excision in patients with small (less than 3 cm in diameter) T2 and T3 distal rectal tumours following neoadjuvant therapy. METHODS: One hundred patients with rectal cancer (54 uT2 and 46 uT3 uN0 tumours) were enrolled. All patients underwent preoperative radiotherapy followed by local excision by means of transanal endoscopic microsurgery. RESULTS: Definitive histological examination revealed nine pT1, 54 pT2 and 19 pT3 tumours. A complete response (R0) or microscopic residual tumour (R1mic) was found in three and 15 patients respectively. Minor complications occurred in 11 patients and major complications in two. At a median follow-up of 55 (range 7-120) months, the local failure rate was 5 per cent and metastatic disease was found in two patients. The cancer-specific survival rate at 90 months' follow-up was 89 per cent, and the overall survival rate 72 per cent. Salvage abdominoperineal resection was performed in three patients, two of whom were disease free at 15 and 19 months. CONCLUSION: Treatment of small uT2 and uT3 uN0 rectal cancers with preoperative high-dose radiotherapy followed by transanal endoscopic microsurgery is an acceptable alternative to conventional radical resection

A challenging upper digestive tract continuity restoration after recurrent esophago-colonic anastomosis complications

Background: Acute and chronic complications in esophago-colonic anastomosis have a significant impact in the postoperative course of patients with colonic transposition. Evidence about their management is poor and surgical treatment is mostly based on tailored approaches, so each new experience could be useful to improve knowledge about this peculiar condition. We report a unique case of an esophago-colonic resection and re-anastomosis without sternal approximation after recurrent anastomosis failure and strictures. Case presentation: A 69-year-old woman was referred to our hospital for worsening dysphagia. The patient had undergone esophago-gastrectomy with right colon interposition 12 years prior due to caustic ingestion. The esophago-colonic anastomosis was initially complicated by an enterocutaneous fistula, which was treated with anastomosis resection and left colon transposition. This was then further complicated by dehiscence and sternal infection treated with resection of the distal portion of the sternum and a new colo-jejunal anastomosis. Finally, a chronic anastomotic stricture occurred, refractory to endoscopic dilatation and prothesis positioning. We planned a new colonic-esophageal resection and re-anastomosis. The main technical challenges were addressing the adhesions resulting from previous surgery and mobilizing an adequate length of the intestinal tract to allow conduit continuity restoration. Blood supply was assessed through Indocyanine Green Fluorescence. To avoid compression of the digestive conduit sternal margins were not re-approximated, and the transposed tube was covered and protected using both pectoralis major muscles flap. We decided to avoid the use of any prosthetic material to reduce the risk of infection. The patient was able to resume oral food intake on the 12th day postoperatively after a barium swallowing test showed an adequate conduit caliber. Conclusion: Esophago-colonic anastomosis complications represent a life-threatening condition. Therefore, reports and sharing of knowledge are important to improve expertise in management of these conditions

Active degassing across the Maltese Islands (Mediterranean Sea) and implications for its neotectonics

The Maltese Islands, located in the central Mediterranean Sea, are intersected by two normal fault systems associated with continental rifting to the south. Due to a lack of evidence for offshore displacement and insignificant historical seismicity, the systems are thought to be inactive and the rift-related deformation is believed to have ceased. In this study we integrate aerial, marine and onshore geological, geophysical and geochemical data from the Maltese Islands to demonstrate that the majority of faults offshore the archipelago underwent extensional to transtensional deformation during the last 20 ka. We also document an active fluid flow system responsible for degassing of CH4 and CO2. The gases migrate through carbonate bedrock and overlying sedimentary layers via focused pathways, such as faults and pipe structures, and possibly via diffuse pathways, such as fractures. Where the gases seep offshore, they form pockmarks and rise through the water column into the atmosphere. Gas migration and seepage implies that the onshore and offshore faults systems are permeable and that they were active recently and simultaneously. The latter can be explained by a transtensional system involving two right-stepping, right-lateral NW-SE trending faults, either binding a pull-apart basin between the islands of Malta and Gozo or associated with minor connecting antitethic structures. Such a configuration may be responsible for the generation or reactivation of faults onshore and offshore the Maltese Islands, and fits into the modern divergent strain-stress regime inferred from geodetic data

Shallow geophysics of the Asinara Island Marine Reserve Area (NW Sardinia, Italy)

We present a high-resolution swath bathymetric and backscatter map of the entire sector of the Marine Reserve Area (MRA) of the Asinara Island, along with a geological and sediment thickness map derived from the interpretation of a large set of high-resolution seismic profiles, and an airborne-derived hyperspectral image of the Asinara Island. Acquired data show that most of the eastern marine sector of the Asinara Island is characterized by quite gentle bathymetric gradients, whereas the western coastline appears to be very indented, with an articulated and rough morphology of the seafloor, which deepens sharply towards the open sea. The maps presented in this study at the 1:50.000 scale do not only provide the first, high-resolution bathymetry of the MRA of the Asinara Island but also may furnish the base for the creation of a benthic habitat map and a more comprehensive maritime spatial planning of this protected area

Digital world meets urban planet – new prospects for evidence-based urban studies arising from joint exploitation of big earth data, information technology and shared knowledge

The digital transformation taking place in all areas of life has led to a massive increase in digital data – in particular, related to the places where and the ways how we live. To facilitate an exploration of the new opportunities arising from this development the Urban Thematic Exploitation Platform (U-TEP) has been set-up. This enabling instrument represents a virtual environment that combines open access to multi-source data repositories with dedicated data processing, analysis and visualisation functionalities. Moreover, it includes mechanisms for the development and sharing of technology and knowledge. After an introduction of the underlying methodical concept, this paper introduces four selected use cases that were carried out on the basis of U-TEP: two technology-driven applications implemented by users from the remote sensing and software engineering community (generation of cloud-free mosaics, processing of drone data) and two examples related to concrete use scenarios defined by planners and decision makers (data analytics related to global urbanization, monitoring of regional land-use dynamics). The experiences from U-TEP’s pre-operations phase show that the system can effectively support the derivation of new data, facts and empirical evidence that helps scientists and decision-makers to implement improved strategies for sustainable urban development

Active faulting offshore the Maltese Islands revealed by geophysical and geochemical observations

The Maltese Islands (central Mediterranean Sea) are intersected by two normal fault systems associated with continental rifting to the south. Because of a lack of evidence for offshore displacement and insignificant historical seismicity, the systems have been considered to be inactive. Here we integrate aerial and marine geological, geophysical and geochemical data to demonstrate that: (i) the majority of faults offshore the Maltese Islands underwent extensional to transtensional deformation during the last 20 ka, (ii) active degassing of CH4 and CO2 occurs via these faults. The gases migrate through Miocene carbonate bedrock and the overlying Plio-Pleistocene sedimentary layers to generate pockmarks at the muddy seafloor and rise through the water column into the atmosphere. We infer that the offshore faults systems are permeable and that they were active recently and simultaneously. The latter can be explained by a transtensional system involving two right-stepping, right-lateral NW-SE trending faults, either binding a pull-apart basin between the islands of Malta and Gozo or associated with minor connecting antitethic structures. Such a configuration may be responsible for the generation or reactivation of faults onshore and offshore the Maltese Islands, and fits into the modern divergent strain-stress regime inferred from geodetic data.peer-reviewe