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Type 2 diabetes (DM2) and obesity are chronic diseases that often coexist with considerable morbidity and mortality. Approximately 85 % of all DM2 patients have a body mass index (BMI) ranking them as overweight (BMI 25‑29,9 kg/m 2 ) or obese (BMI > 30 kg/m 2 ). Metabolic surgery is the only treatment for diabetes that results in long-term remission in 23 to 60 % of patients in the office depending on the preoperative duration of diabetes and the severity of the disease. This review presents evidence for the use of metabolic surgery (CM) as a primary treatment for DM2, potential mechanisms of its effects, and recommendations for its use in expanded patient populations.

Hiatal hernia is a frequent pathology. Two types have been described : sliding hernia and paraesophageal hernia (PEH). The first one is the most frequent and is associated with reflux disease. Patients with PEH have a large variety of symptoms, such as chest pain, dyspnea, regurgitation, iterative pneumonia and iron-deficiency anemia. Operative management is necessary for sliding hernia with reflux disease and for symptomatic PEH, respectively. In patients with asymptomatic PEH, operative risk must be balanced with the risk of postoperative complications. No specific operative technique has been validated so far as surgical standard. Several technical details are important and technique has to be adapted according to the size and type of hernia, preoperative symptoms and patient's comorbidities.

The year 2016 allowed further implementation of previous years innovations with the PIPAC treatment for peritoneal carcinomatosis, the development of new surgical technologies and procedures and challenging general principles in general and digestive surgery, including cholecystectomy and appendectomy. Prevention, improved general and perioperative care (ERAS program) become an integral part of our standard surgical activity.

The management of patients with resectable cancer of the esophagus or gastroesophageal junction is currently not standardized. A multi- disciplinary regional consensus has been developed and is presented in this article. The standard workup includes an upper endoscopy, ultrasonography and a CT-scan. For locally advanced tumors, surgery should be associated with either preoperative radiochemotherapy orperioperative chemotherapy after discussion in multidisciplinary tumor board. Before the operation, smoking and alcohol cessation is imperative and nutritional status should be optimized. Nowadays, surgery is well standardized and generally performed minimally invasive accesses. After surgery, clinical and oncological follow-up is necessary.

In this year 2015, the developments of new technologies as well as multidisciplinary management remained successfully. The implementation of enhanced rehabilitation after surgery pathways continued to expand both geographically and in various surgical specialties. The use of the vaporized intraperitoneal chemotherapy (PIPAC) showed promising results. Minimally invasive surgery was further implemented in various fields of rectal, endocrine and oesophageal surgery.

Le cancer oesogastrique reste une pathologie relativement rare mais en augmentation ces dernières années, en raison d'une multitude de facteurs prédisposants. Un bilan préopératoire extensif ainsi que la discussion multidisciplinaire de chaque cas sont les éléments-clés de la prise en charge. Pour les tumeurs résécables, la chirurgie reste la pierre angulaire du traitement, tout en sachant qu'elle est grevée d'une morbidité postopératoire aux alentours de 40 à 60%, même dans les centres à haut volume. Les séquelles à long terme (par exemple, dénutrition, sténose anastomotique tardive) ainsi que le suivi oncologique nécessitent une surveillance étroite, conjointement par le médecin généraliste ainsi que par l'équipe chirurgicale et oncologique, afin d'optimiser non seulement la survie globale mais aussi la qualité de vie des patients. Esophago-gastric cancer remains a relatively rare pathology with, however, an ascending tendency in the recent years due to a variety of predisposing factors. An extensive preoperative workup and a thorough multidisciplinary discussion are the key elements to define treatment strategy. Surgery is the cornerstone of treatment for resectable tumors, even if it is associated with morbidity rates of 40-60% in medium and high-volume centers. Long-term consequences (e.g. malnutrition and late anastomotic stenosis) are present in a high proportion of patients and they raise the need for a close follow-up with the collaboration of the general practitioner, surgeon and oncologist. This multidisciplinary treatment and aftercare has the best chance to offer to the patient not only a longer overall survival, but a better quality of life as well.

BACKGROUND: Extrahepatic Portal vein aneurysm (EPVA) is a rare finding that may be associated with different complications, e.g. thrombosis, rupture, portal hypertension and compression of adjacent structures. It is being diagnosed more frequently with the advent of modern cross-sectional imaging. Our review of the English literature disclosed 13 cases of thrombosed EPVA. CASE PRESENTATION: A 50-years-old woman presented with acute abdominal pain but no other symptom. She had no relevant medical history. Palpation of the right upper quadrant showed tenderness. Laboratory tests were unremarkable. A computed tomography showed portal vein aneurysm measuring 88 × 65 mm with thrombosis extending to the superior mesenteric and splenic vein. The patient was treated conservatively with anticoagulation therapy. She was released after two weeks and followed on an outpatient basis. At two months, she reported decreased abdominal pain and her physical examination was normal. A computed tomography was performed showing a decreased thrombosis size and extent, measuring 80 × 55 mm. CONCLUSIONS: Although rare, surgeons should be made aware of this entity. Complications are various. Conservative therapy should be chosen in first intent in most cases. We reported the case of the second largest thrombosed extra-hepatic PVA described in the literature, treated by anticoagulation therapy with a good clinical and radiological response.

Angesichts der vielen unspezifischen Symptome kann die Diagnose nur mit einer gezielten Anamnese und Untersuchung gestellt werden. Einfache, standardisierte Fragen geben einen ersten Hinweis, gegebenenfalls verifiziert durch eine eingehende Untersuchung. Der nächste Schritt besteht in einer hausärztlichen Beratung, gegebenenfalls unterstützt durch Pharmaka, wie Disulfiram, Acamprosate und Naltrexone. Viele kontrollierte Studien in der hausärztlichen Praxis haben gezeigt, daß auch eine minimale ärztliche Intervention wirksam ist. Aus diesem Grund lohnt es sich für den Hausarzt, alkoholkranke Patienten zu behandeln.

Retroperitoneoscopy and the transperitoneal approach are well-established for retroperitoneal procedures. Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving mode of surgical access to body cavities. NOTES has been well-demonstrated in animal models and in (sporadic) human cases for various surgeries.1 In this report, we describe the first human case of transrectal endoscopic retroperitoneoscopy for drainage of a paraaortic periprosthetic abscess.

After the first report by Kalloo et al on transgastric peritoneoscopy in pigs, it rapidly became apparent that there was no room for an under-evaluated concept and blind adoption of an appealing (r)evolution in minimal access surgery. Systematic experimental work became mandatory before any translation to the clinical setting. Choice and management of the access site, techniques of dissection, exposure, retraction and tissue approximation-sealing were the basics that needed to be evaluated before considering any surgical procedure or study of the relevance of natural orifice transluminal endoscopic surgery (NOTES). After several years of testing in experimental labs, the revolutionary concept of NOTES, is now progressively being experimented on in clinical settings. In this paper the authors analyse the challenges, limitations and solutions to assess how to move from the lab to clinical implementation of transgastric endoscopic cholecystectomy.