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The second edition of Minimally Invasive Bariatric Surgery provides a comprehensive, state-of-the art review of this field, and it serves as a valuable resource for clinicians, surgeons and researchers with an interest in minimally invasive bariatric surgery. Additionally, the second edition includes new features that will benefit the resident, fellow, or bariatric surgeon new to the field. Specifically, each evidence-based chapter (i.e. outcomes, complications, epidemiology, etc) concludes with three or four exam questions that emphasize the salient points of the chapter and provide fellowship programs a valuable training tool and resource for their academic curriculum. These questions are either single-answer multiple choice or true/false format and the correct response with a brief explanation follows. As more emphasis is placed on completing a comprehensive curriculum and obtaining certification for bariatric training, this aspect of the book is unique and provides added value to the text. The new edition also incorporates many new or updated medical illustrations to enhance the technique chapters and provide more uniformity for the artwork throughout the book. Each of the major procedures include surgical technique, outcomes, and management of complications in separate chapters to provide an easy reference for the busy clinician preparing for a case or presentation. Another unique feature of the text is a link to video files hosted online for the relevant chapters. This video library will be of great value to the user. As the number of fellowships in laparoscopic bariatric surgery continues to increase, this updated text will provide a valuable resource for general and bariatric surgeons, laparoscopic surgeons, fellows, residents, medical students, obesity researchers, and industry representatives involved in this field

Background: Laparoscopic Sleeve Gastrectomy (LSG) is an effective and relatively safe bariatric procedure, but long-term results are still rare. Our aim was to evaluate the efficacy of LSG on weight loss, gastroesophageal reflux symptoms and Type 2 Diabetes. Methods: Medical records of all 105 patients undergoing SG at our Institution between 2006 and 2009 were retrospectively examined. Long-term outcomes were analyzed in terms of BMI, %TWL, %EWL, comorbidities resolution and revisional surgery. According to the preoperative BMI, patients were divided in two groups: Group 1 (n=61) BMI

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AIM: Comparing the different possible surgical procedures and the results in urgent/emergency and in elective surgery for obstructing colorectal cancer. MATERIAL OF STUDY: From 2008 we operated on 238 patients affected by colorectal cancer, 136 complicated tumours, 115 obstructing and 19 perforated. 23 patients had right-sided and 92 left-sided obstructing colonic tumour, divided retrospectively in 4 groups. 18 decompressive colostomy; 32 two-stages procedures: 25 Hartmann's operations and 7 total colectomies with terminal ileostomy; 7 one-stage procedures, with defunctioning ileostomy: 4 total colectomies and 3 colonic resections with wash-out; 35 one-stage procedures with primary anastomosis+wash-out or milking. RESULTS: Operative mortality is 7% in urgent/emergency versus 1% in elective surgery and anastomotic leakage affected 6 /58 cases, 5 requiring additional surgery. Overall, about 2/3 of the perioperative deaths were related to general complications and 1/3 to anastomotic failure. The local recurrence rate was 7% in elective and 11% in urgent/emergency surgery. DISCUSSION AND CONCLUSIONS: Obstructing colorectal cancer is associated with a high operative mortality and a worse prognosis, in terms of recurrence and survival. Actually, immediate resection with primary anastomosis represents the goldstandard in selected patients with a low anaesthetic risk, performing either as a typical resection with wash-out, or a subtotal colectomy; a temporary defunctioning colostomy or ileostomy could be proposed for patients with an intermediate risk; in high-risk cases, advanced obstruction, simultaneous colonic perforation, metastatic or locally advanced disease, Hartmann's operation should be used, as a safer procedure. Colon stenting can be an useful palliative or bridge-to-surgery option.

Einleitung: Bei einem geringen Prozentsatz der CI-Träger können die erhöhten Impedanzen durch systemische Kortison- und Antibiotikagabe nicht normalisiert werden. Die explantierten Elektroden wiesen erodierte Platinelektrodenkontakte auf. Ziel der Studie ist die Etablierung eines in-vitro[zum vollständigen Text gelangen Sie über die oben angegebene URL], 87. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Background Bariatric surgery provides excellent results in term of weight loss and improve associated metabolic disorders such as type 2 diabetes mellitus (T2DM). There is low evidence in literature about changes in body composition in relation to different bariatric procedures and the presence of T2DM. Aim of this study is to evaluate changes in body composition in diabetic obese patients vs. non-diabetic obese patients who underwent different bariatric procedures, Gastric bypass (LRYGB) or Sleeve Gastrectomy (SG). Methods the Body composition of obese patients eligible to surgery was evaluated by bioelectrical impedence analysis (Tanita BC 418-MA) before and 1-year after surgery. A variation test was used to analyze results (BMI and body composition). Results 46 patients underwent bariatric procedures: 20 patients LRYGB and 26 patients SG. 21 patients preoperatively suffered from T2DM and 25 did not. Data concerning BMI and body composition were collected at baseline and 1- year follow-up in four subgroups of patients: obese non-diabetic patients (group 1) and obese diabetic patients (group 2) who underwent LRYGB, obese non-diabetic patients (group 3) and obese diabetic patients (group 4) who underwent Sleeve gastrectomy. At 1-year follow-up, fat mass and fat-free mass differences in percentage were statistically significant in each subgroup. There were no statistically significant differences as regards BMI, fat mass and fat-free mass percentages between subgroups 1 and 2 as there were, in contrast, between group 3 and 4. Conclusions bariatric surgery can induce good results in term of weight loss, reduction of fat mass as well as fat-free mass improvement. Obese diabetic patients submitted to Sleeve Gastrectomy have a worse improvement of fat mass and free-fat mass compared to non diabetic patients submitted to the same procedure.

An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.

Laparoscopic of the LAP-BAND System placement stage of obesity is a safe operation, but its indication in terms of stage of obesity is controversial. The aim of this study was to evaluate the 5 years stage of obesity results for weight loss in patients with varying preoperative ranges of body mass index (BMI).Data were obtained from the Italian Collaborative Study Group for LAP-BAND System (GILB) registry. Detailed information was collected on a specifically created database (MS Access 2000) for patients operated on in Italy from January 1996 to 2003. Patients operated on between January 1996 and December 1997 were allocated to four groups according to preoperative BMI range: 30-39.9 kg/m(2) (group A), 40-49.9 kg/m(2) (group B), 50-59.9 kg/m(2) (group C), and =60 kg/m(2) (group D) percent estimated weight loss respectively. Postoperative complications, mortality, BMI, BMI loss, and (%EWL) were considered in each group. Data are expressed as mean +/- SD, except as otherwise indicated. Statistical analysis was done by means of Fisher's exact test, and p0.05 was considered significant.After 5 years from LAP-BAND System surgery, 573 of 3,562 patients were eligible for the study. One hundred fifty-five of 573 (27.0%) were lost to follow-up, 24 of 418 (5.7%) underwent band removal due to complications (gastric pouch dilation, band erosion), eight of 418 (1.9%) were converted to other bariatric procedures, five of 418 (1.2%) died of causes not related to the operation or the band, and 381 of 573 (66.5%) were available for follow-up. Based on 96, 214, 64, and seven patients their preoperative BMI, Were allocated to groups A, B, C, and D, respectively. At time of follow-up mean BMI was 27.5 +/- 5.2 in group A, 31.6 +/- 4.7 in group B, 37.6 +/- 17.3 in group C, and 41.4 +/- 6.9 kg/m(2) in group D. Mean BMI loss was 9.8 +/- 5.4, 12.9 +/- 5.2, 15.8 +/- 8.1, and 23.2 +/- 4.9 kg/m(2), respectively, in groups A, B, C, and D. Mean %EWL at the same time was 54.6 +/- 32.3 in group A, 54.1 +/- 17.2 in group B, 51.6 +/- 35 in group C, and 59.l +/- 17.1 in group D.Initial BMI in this series did not correlate with %EWL 5 years after the operation. In fact %EWL was almost the same in each group, independent of preoperative weight. Initial BMI was an accurate indicator of the results obtained 5 years after LAP-BAND in group C (50-59.9 kg/m(2)) and D (=60 kg/m(2)) patients, who remained morbidly obese despite their %EWL.

The videolaparoscopic repair of a diaphragmatic hernia of Morgagni by external knot tying technique is described. A 69-year-old woman with subocclusive symptoms by intrathoracic migration of abdominal viscera had an immediate and complete postoperative recovery. The hernial sac was not excised. A four-year follow-up shows no hernia recurrence. This case indicated that the laparoscopic approach can be considered a suitable and safe procedure for treatment of Morgagni's hernia.

Recent advances in pathophysiology of the adrenal glands suggest new indications for adrenalectomy. In open surgery large incisions are needed to remove a small gland; on the contrary, laparoscopic procedures offer new possibilities. The present study is a review of the literature on indications, contraindications and surgical technique of laparoscopic adrenalectomy. Evaluations of these initial experiences are favourable, however, due to the small number of patients operated and to the short follow up, a definitive opinion on the role of laparoscopic surgery for adrenalectomy has to be formulated.

The authors report a study in which they evaluate the efficacy of some laboratory parameters for monitoring intrasplenic hepatocyte xenotransplantation (mouse to rat) as an alternative to 99Tc-HIDA dynamic scan and histologic exam. Swiss mouse and wistar rat hepatocytes were obtained with collagenase digestion. Wistar male rats were used as recipient and were allocated into three groups: A) omotransplanted rats; B) xenotransplanted rats; C) xenotransplanted and immunosuppressed (Cyclosporin A: 20 mg/kg/daily orally) rats. All rats underwent > 70% hepatectomy. Blood samples were obtained daily from a femoral vein and AST, ALT, ALP, bilirubin, albumin and urea were measured. No statistical differences were observed among groups and the laboratory parameters tested can't be considered a valid technique to xenotransplant rejection monitoring.

Authors report an experimental model of total hepatectomy in the rat. In this model whole liver was replaced by an autologous vascular prosthesis. On the contrary as reported in other experiences, in this model is maintained the cavo-caval flow, with absence of cavo-caval and porta-caval shunts. Anhepatic rats survival not exceeded two hours from surgery.

Recently, hepatocyte transplantation has widely increased its interest. This technique can be perspectively considered as an attractive alternative to orthotopic liver transplantation to support liver function in acute, chronic and genetic metabolic hepatic diseases. The authors review the most significant steps in the field of hepatocyte transplantation with particular reference to its clinical experimental application in genetic metabolic disorders and acute liver failure.

Recently, hepatocyte transplantation has widely increased its interest. This technique can be perspectively considered as an attractive alternative to orthotopic liver transplantation to support liver function in acute, chronic and genetic metabolic hepatic diseases. The authors review the most significant steps in the field of hepatocyte transplantation with particular reference to its clinical experimental application in genetic metabolic disorders and acute liver failure.

Laparoscopic cholecystectomy can be performed following two main approaches: the french technique, used by the majority of surgeons, and the anglo-saxon technique. The Authors describe the basic concept of the "left side" approach according to the Anglo-american method, underlining some of the advantages. Their one-year results (November 1990-November 1991) confirm the data already available in the Literature.

On the basis of their experience and a review of the International Literature, Authors evidence the main differences between French and Anglo-American approach on videolaparoscopic cholecystectomy. These differences are remarkable in the patient, surgeons and videolaparoscopic instrument disposition and, above all, in the different trochar placement, where a different surgical technique correspond.

Between January 1982 and April 1989, 134 patients with a suspected liver neoplasm were referred to the liver unit, Queen Elizabeth Hospital, Birmingham. In 105 (78 per cent), a primary hepatic neoplasm was histologically confirmed, and 47 patients (45 per cent) proved to have primary hepatocellular carcinoma. Twenty-nine orthotopic liver transplants were performed in 28 of these patients (27 per cent). Twenty patients (71 per cent) survived 30 days or longer (median 11.5 months; range 2-87 months), of whom nine are currently alive. We retrospectively analysed our data to determine the influence of preoperative evaluation, histological type and staging on outcome. Computed tomography proved to be superior to intraoperative assessment (86 versus 58 per cent) in diagnosing tumour positive nodes. Patients with tumour negative lymphadenopathy had a better prognosis. Postoperative stage I/II had a median survival of 16 months (range 3-87 months) compared with 7.5 months (range 2-20 months) for stage III. Non-cirrhotic patients with hepatocellular carcinoma had the best prognosis; cholangiocellular carcinoma and cirrhotic patients with hepatocelluar carcinoma had the worst outcome with no survivors beyond 1 year. Because of the advanced stage of disease at the time of presentation, the value of liver transplantation in primary liver cancer is limited. For those presenting with advanced disease confined to the liver (stage I/II) in whom conventional hepatic resection is not possible, significant benefit can be achieved in selected cases.

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