Pouchileitis in excluded reservoir : an unusual complication of restorative proctocolectomy for ulcerative-colitis

One case of pouch ileitis after restorative proctocolectomy for ulcerative colitis is described. Diagnosis was made by endoscopy, histology and electron microscopy. The most prominent feature was intense inflammation of the mucosa and submucosa, with atrophy of the villi, and colonic metaplasia, occurring before closure of the loop ileostomy. The patient improved after a course of metronidazole therapy, but ileostomy closure was postnoted. It appears that the ileum mucosa of patients with ulcerative colitis is highly prone to the development of inflammation and careful, regular follow-up is recommended

Iatrogenic injury in videolaparoscopic cholecystectomy : difficult surgical correction biliary tract

Two cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. In the first case of lithiasic cholecystitis there had been a complete damage of the common biliary duct; in the second case there had been a double main biliary duct binding with removal of a biliary tract segment. In both cases a biliary confluence-jejunal anastomosis with Roux-en-Y loop was made up. In the first one the operation was difficult because of the main bile duct's fragility and modest expansion. In the second one the presence of a secondary biliary duct in gallbladder fossa not recognized, but drained outside with a common drainage placed during the operation prevented appearance of jaundice with dilatation of biliary ducts. It was heavily conditioned performing confluence-jejunal anastomosis with Roux-en-Y loop. The post-operative course was characterized by appearance of an external biliary fistula which has spontaneously disappeared. One year later, neither of the two patients had any stenosis or cholangitis problems

Il bypass bilio-intestinale : un'esperienza trentennale

AIM: Aim of our study was the evaluation of Italian experience with biliointestinal bypass in the surgical treatment of morbid obesity. MATERIALS AND METHODS: 1030 patients; mean age 36.1 years; preoperative mean weight Kg 136.7; mean preoperative BMI 48.9 kg/m 2; mean follow-up 6.8 years (1-28). 838 patients underwent open and 192 laparoscopic biliointestinal bypass. The laparoscopy operation was performed with five lap ports. Section of the jejunum 30 cm from the Treitz was made by linear stapler. The cholecysto-jejunal anastomosis was completed with 45 mm linear stapler. A sideto- side anastomosis between the proximal jejunum and the last 12-18 cm of the ileum was created by firing a 60 mm linear stapler. RESULTS: Weight loss was satisfactory in 93% of operated patients. Comorbilities (arterial hypertension, diabetes, sleep apnea syndrome) solved in majority of the patients. The main late complications were incisional hernia in open technique and oxalic nephrolithiasis. The reversal rate was 2.5%. CONCLUSION: Our experience showed that biliointestinal bypass can obtain good results. Using laparoscopic technique it is possible to reduce pain, in-hospital time, respiratory and thromboembolic complications, convalescence and incisional hernia