1,546 research outputs found
Complications of staple line and anastomoses following laparoscopic bariatric surgery
No full textWith over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery
“Consumo di bevande alcooliche e livelli di alcolemia prima e dopo Sleeve Gastrectomy (SG) Studio prospettico comparativo”
No full textPurpose The aim of this original research is to evaluate the effect of SG on alcohol intake symptoms, blood alcohol content (BAC), and alcohol metabolite levels. Methods At 0–6–12 months after SG, BAC of patients was measured at 0, 15, 30, and 60 min, and then every 30 min, and urinary metabolite (ethanol and acetaldehyde) levels were measured 2 h after consuming a standard red wine drink. Symptoms perceived by patients were evaluated using symptom alcoholization post-obesity surgery scores. Results Thirty obese patients (12 men/18 women; mean body mass index, 44 ± 4 kg/m2) who underwent SG were enrolled in this study. At 12 months after SG, no alcohol use disorder was observed and BAC tended to peak after 15 min, with alcohol intoxication symptoms (nausea/vomiting, flushing, and diaphoresis), and return to zero after 90 min of wine intake. Ethanol and acetaldehyde levels were significantly different at 12 months compared with the levels at time 0 (p < 0.05). Conclusions Following SG, patients exhibit a high BAC at 15 min after moderate alcohol consumption accompanied with increased metabolite excretion and intoxication symptom
IBC-Ox26 Concomitant hiatal hernia repair during bariatric surgery: is it the reinforcement making the difference?
No full textAlcohol consumption after laparoscopic sleeve gastrectomy. 1-year results
No full textAbstract
Introduction Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide
with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with
hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption.
The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using
a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate
relationships between different ages and sexes.
Materials and methods A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a
modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive
impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery.
Subgroup analyses were performed between male and female and between under and over 40 years old.
Results The median AUDIT score decreased from 2.70 (range 1–18) before surgery to 1.38 (range 1–7) after 1 year of SG,
indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery
the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at
baseline 45% of patients consumed alcoholic drinks “from 2 to 4 times per month”, whereas 26 and 39.4% consumed alcohol
“never” and “less than once a month,” respectively. After surgery, nobody consumed more then six alcoholic drinks. No
differences were found between the subgroups in terms of alcohol consumption and social behavior.
Conclusions The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional
follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our
The history of the Romano famili and "Angelo, tyran de Padoue" by Victor Hugo.
No full textreservedVictor Hugo, nel dramma Angelo, tyran de Padue, ricama tre diverse epoche storiche: i primi decenni dell’Ottocento, a lui contemporanei; la metà del Cinquecento, prescelta per lo svolgimento dell’azione drammatica; il tardo Medioevo evinto dai personaggi principali che compongono il racconto. Tuttavia, l’interesse storico e prettamente romantico verso il periodo medievale assume in quest’opera una rilevanza primaria. Tra le tante casate del nord Italia nominate dall’autore nell’opera, una su tutte sembra essere davvero simbolica. Particolarmente interessante è stato comprendere come la storia della famiglia da Romano costituisca il fulcro della costruzione drammaturgica. Ezzelino III e Cunizza da Romano sono elevati a emblema della poetica romantica e divengono funzionali al messaggio politico e sociale dell’autore.Victor Hugo, in his play Angelo, tyran de Padue, embroiders three different historical epochs: the first decades of the 19th century, contemporary with him; the middle of the 16th century, chosen for the unfolding of the dramatic action; and the late Middle Ages evoked by the main characters in the story. However, the historical and purely romantic interest in the medieval period takes on primary importance in this work. Of the many northern Italian lineages named by the author in the work, one in particular seems to be truly symbolic. It was particularly interesting to understand how the history of the da Romano family forms the core of the dramaturgical construction. Ezzelino III and Cunizza da Romano are elevated to emblems of romantic poetics and become functional to the author's political and social message
Unpredictable evolution of a 20-years history of a bariatric patient. Case report of a migrated gastric band after redo gastric bypass
No full textIntroduction: morbid obesity is a chronic disease, with resistance to multiple therapies. Bariatric surgery is the most efficient nowadays treatment, but with a certain price when we speak of surgeon’s efforts, patient’s compliance and tolerance, available technology and long term evolution. Materials: we present the case of 20 years evolution of a female obese patient, with multiple, sequential bariatric minimally-invasive interventions: intragastric balloon, gastric banding, gastric bypass (GBP), banding positioning on GBP, all complicated. Last attempt to treat weight regain was laparoscopic positioning of an adjustable banding over a failed gastric bypass in 2015, complicated 12 months after by acute intestinal occlusion due to band migration, leading to open emergency band removal, wound dehiscence and finally incisional hernia. Results: after multiple interventions, the patient has a BMI of 38 kg/m2, large incisional hernia, depression, over a non-satisfactory gastric bypass. Conclusion: bariatric surgery has some limitations in case of patient’s non-compliance and bad-luck, even with persistent, experienced tailored bariatric treatment. Non-responsive obese patients should be considered as possible subcategory of long-term outcomes
Leaks after laparoscopic sleeve gastrectomy. Overview of pathogenesis and risk factors
No full textBackground: Leak is the second most common cause of death after bariatric surgery. The leak rate after laparoscopic sleeve gastrectomy (LSG) ranges between 1.1 and 5.3 %. The aim of the paper is to provide an overview of the current pathogenic and promoting factors of leakage after LSG on the basis of recent literature review and to report the evidence based preventive measures.
Methods: Risk factors and pathogenesis of leakage after LSG were examined based on an extensive review of literature and evidence based analysis of the most recent published studies using Oxford centre for evidence-based medicine, 2011, levels of evidence.
Results: Pathogenesis of leakage after LSG can be attributed to mechanical or ischemic causes. Many factors can predispose to leakage after LSG which are either technically related or patient related. Awareness of these predisposing factors and technical tips may decrease the incidence of leakage.
Conclusions: This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4
Splenic and concomitant liver abscess after laparoscopic sleeve gastrectomy
No full textIntroduction: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure for losing weight and gaining control of obesity-related comorbidities. However, it is associated with postoperative complications such as bleeding, leak, and midgastric stenosis. Splenic and hepatic abscesses have been reported as unusual and rare complications after primary LSG. We report a case of splenic and concomitant hepatic abscesses after primary LSG, successful minimally invasive management, and midterm follow-up.
Case Description: We report a complex case of splenic abscess with satellite hepatic abscess plus splenic thrombosis (0.1%) diagnosed 67 days after LSG. This unusual complication was managed by a minimally invasive approach (spleen sparing) with complete resolution after 35 days. After 18 months of follow-up, the patient showed complete resolution of the splenic and liver abscesses and progressive loss of excess weight.
Conclusion: In high-volume centers, rare and life-threatening complications such as splenic and hepatic abscesses may be observed. The minimally invasive approach could represent an effective option of avoiding splenectomy in selected case
Michael Angelo Caruso, international author, consultant, and speaker on Campus
No full textTollefson, Elizabeth. (2013). Michael Angelo Caruso, international author, consultant, and speaker on Campus. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/223386
Oltre i confini della razionalità
No full text- Il contributo di Angelo Volpe prende in esame fondamentalmen-te due oggetti: primo, la potenzialità indiscussa nella sociologia contemporanea degli approcci individualistici e razionali e, secondo, la necessità di trascendere la gabbia stessa della razionalità e di andare oltre. Ciò che l’autore auspica è la realizzazione di un “modello a spettro intero” per l’analisi dei fatti sociali, un modello che possa espandere il raggio d’azione della comprensione sociologica al di là di ciò che possiamo vedere e misurare razionalmente.
- The contribution of Angelo Volpe essentially examines two objects: first, the unquestioned potentiality in contemporary sociology of individualistic and rational approaches, and, second, the need to transcend the very cage of rationality and go further. What the author hopes is the realization of a "full-spectrum model" for the analysis of social events, a model that can expand the scope of sociological understanding beyond what we can see and measure rationally
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