The new onset of GERD after sleeve gastrectomy: A systematic review

Background: The main adverse effect is gastroesophageal reflux disease (GERD), with concern on the development of Barrett's esophagus and esophageal adenocarcinoma in the long term. However, the relationship between SG and GERD is complex. The aim of this study is to systematically evaluate all published data existing in the literature to evaluate the effect of sleeve gastrectomy on GERD, esophagitis, BE in order to clarify the long-term clinical sequelae of this procedure.Materials and methods: This systematic review was conducted in accordance with the guidelines for Preferred Reporting Items for Systematic Review. The work has been reported in line with the PRISMA criteria [19]. We evaluated the quality and risk of bias of this Systematic Review using AMSTAR 2 checklist [20]. Published studies that contained outcome data for primary sleeve gastrectomy associated with the primary and secondary outcomes listed below were included. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05178446 for the Organization UFoggia.Results: 49 articles were eligible for inclusion that met the following criteria: publications dealing with patients undergoing laparoscopic SG, publications describing pre-and postoperative GERD symptoms and/or esophageal function tests, articles in English, human studies and text complete available.Conclusions: We have controversial data on LSG and GERD in the literature as there is a multifactorial relationship between LSG and GERD. The most recent studies have shown satisfactory control of postoperative reflux in most patients and low rates of de novo GERD. These data are leading to wider acceptance of LSG as a bariatric procedure even in obese patients with GERD

Tube Duodenostomy to Treat Large Duodenal Perforation: Our Experience and Literature Review

Background: Duodenal perforation is a life-threatening condition and ideal approaches for the management of duodenal perforations are nowadays unclear, so numerous variables must be considered. Peptic ulcer disease is the most common disease determining a duodenal perforation, however, there may be other less common causes. We retrospectively analyzed all the patients who presented at our Division of General Surgery for a Duodenal Perforation, from September 2018 to December 2019.Methods: We focused on patients requiring a tube duodenostomy. Five patients were included in this study.Results: Five patients suffering from a duodenal perforation were analyzed and their data collected. All patients were treated with tube duodenostomy, pyloric exclusion and omega loop gastro-enteroanastomosis. The duodenostomy was removed four weeks after surgery. All patients suffered postsurgical complications ranging from wound infection to pneumonitis; the incidence of severe complications was greater in the older patients. We did not record any deaths four months after the operation.Conclusions: The tube duodenostomy is an old and dated procedure but simple to implement, which may require an increase in post-operative hospitalization, but which subsists as an effective and safe way to treat patients in critical conditions

Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?

Background Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula. Materials and methods 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His. Results In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group. Conclusion Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrate

Down-staging in Liver Transplantation for HCC

Down-Staging in Liver Trasplantation for HCC.Audit of an Experienc

Tumori stromali gastrointestinali: esperienza di un singolo centro

Gastrointestinal stromal tumor (GIST) is the most frequent mesenchymal neoplasm of the gastrointestinal tract. GIST occur most frequently in the stomach (60%), jejunum and ileum (30%), and less frequently in the deuodenum (5%), colon and rectum,esophagus and appendix. Nowadays GISTs are classified according to Fletcher’s classification. Objective: To rewiew the features of our GIST population and to analyse the outcomes of the patient treated at a single institution and followed-up prospectively. Patients and methods: Between August 1997 and March 2009 33 patients with GIST were treated at our institute. Patients were followed up with medical visit and blood sample tests every six mounth and with CT scan every 1 year. Data were analized with parametric and non-parametric tests. Results: Gender distribution of patient was 16 male (49%) and 17 female (51%); mean age of patient was 62 (37-83). Tumor location was as follow: stomach 18 (56%), ileum 6 (18%), colon -rectum 3 (9%), esophagus 2 (6%), duodenum 1 (3%), jejune 1(3%), mesentere 1 (3%) e lesser omentum 1 (3%). Tumors were classified according to Fletcher’s criteria as high risk (4=12.5%), intermediate risk (10=31%), low risk (18=56%) 30 patients underwent to R0 resection (94%) while 2 of them R1 resection (6%). No patients were treated with Imatinib after surgical treatment. Metastasis or tumor relapse occurred in two patient. Bigger lesions were statistically located in lower gastrointestinal tract (ANOVA p=0.045, Mann Whitney p=0.043). A strong correlation was found between the size of the lesion and the grading of the tumor (ANOVA p=0.0001). So far upper GISTs seam to be correlated to a lower grading (Mann Whitney p=0.043)The survival rate was 90% with a median follow-up of 46 months. Death occurred in 1 patients but the death was not correlated to disease. Conclusion: Our results are in according with the literatute in wich there is no different in sex distribution and the majority of cases are gastric tumors. The survival rate was 90% with a median followup of 46 months. Bigger lesions were statistically located in lower gastrointestinal tract and upper GISTs seam to be correlated to a lower grading