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The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy.Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy.No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment.Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera.The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy.Diverticulitis, Damage Control Surgery, Open Abdomen.Lo scopo di questo studio è di mettere in luce la nostra esperienza sull’uso della tecnica dell’addome aperto come strategia per la gestione della diverticolite complicata del colon con anastomosi o confezionamento di colostomia differita.Trenta pazienti, al III o IV stadio della scala di Hinchey, sono stati sottoposti a una procedura chirurgica con tecnica di addome aperto e applicazione del dispositivo Ab-thera. Un second look chirurgico è stato effettuato dopo 48-72 ore al fine di valutare la possibilità di eseguire un’anastomosi o una colostomia.Non sono stati riportati decessi in pazienti con anastomosi, ma sono stati registrati un caso di fistola anastomotica comparsa in ottava giornata postoperatoria e un caso di micro-embolia polmonare. I due pazienti più anziani sono stati dimessi in quindicesima e diciottesima giornata postoperatoria. Un paziente affetto da linfoma è stato trasferito in ematologia per ulteriori terapie.L’attuale tendenza è quello di trattare la malattia diverticolare con ascessi colici e paracolici mediante una terapia medica e drenaggio percutanei TC o eco- guidati. I pazienti in stadio III o IV della scala di Hinchey vengono trattati chirurgicamente mediante resezione del tratto interessato e confezionamento di anastomosi colo-colica o colostomia. La tecnica dell’addome aperto consente ai chirurghi di differire la decisione colostomia/anastomosi nel second look chirurgico a 48-72 ore trattamento con irrigazione e aspirazione mediante AB-Thera.La tecnica dell’addome aperto è un valido approccio terapeutico alternativo per i pazienti con malattia diverticolite acuta in III e IV grado Hinchey. Questo approccio terapeutico offre importanti vantaggi in quanto aumenta la possibilità di confezionamento di anastomosi e riduce la percentuale di confezionamento di colostomie.

The purpose of this analysis is to identify a therapeutic algorithm in case of Staple Line Leack (SLL) after Laparoscopic Sleeve Gastrectomy...

We discuss the presentation of a sudden sensorineural hearing loss (SNHL) occurred as a rare complication after laparoscopic sleeve gastrectomy (LSG). Etiology of this complication is not clear, it seems that diverse and complex pathogenetic mechanism are involved so the prevention and treatment seems to be difficult.

Background One of the most effective surgeries for sustainable weight loss in morbidly obese patients is laparoscopic sleeve gastrectomy (LSG). The present study aimed to assess the adherence of LSG patients with respect to following post-operative dietary requirements and micronutrient supplementation, as well as to investigate their perceived barriers in achieving optimal adherence. Methods Retrospective data analysis was performed (3, 6, 9 and 12 months after LSG) using the medical records of 96 morbidly obese patients who had undergone LSG at our institution during 2011–2013. Data collected from patient records were: adherence to prescribed diet; adherence to prescribed consumption of fruit, vegetables, legumes and cereals; use of prescribed micronutrient supplements; and barriers to diet and micronutrient therapy adherence. Data were analysed using spss, version 14.0 (SPSS Inc., Chicago, IL, USA). Results At 3, 6, 9 and 12 months post-LSG, the rates of patient non-adherence to a prescribed diet were 39%, 45%, 51% and 74%, respectively. In particular, there was a low consumption of fruit, vegetables, legumes and cereals compared to the post-surgery prescription. In addition, the rates of patient non-adherence to prescribed micronutrient supplements at 3, 6, 9 and 12 months post-LSG were 43%, 51%, 59% and 67%, respectively. The main reasons for patient non-adherence to diet were poor self-discipline (72%) and poor family support (11%) whereas difficulty swallowing pills or capsules (61%) and cost (20%) were reported as the main barriers to post-LSG adherence. Conclusions Morbidly obese patients who have undergone LSG do not follow exactly the post-operative dietary guidelines, including micronutrient therapy.

Sleeve gastrectomy (SG) is a surgical weight-loss procedure. Splenic abscess is a rare complication of SG. Four cases of splenic abscess after SG have been reported, all managed by surgical intervention. We report the first documented case of multiple splenic abscesses following SG managed conservatively by an integrated medical treatment Nonsurgical management of multiple splenic abscesses in an obese patient that underwent laparoscopic sleeve gastrectomy: case report and review of literature (PDF Download Available). Available from: https://www.researchgate.net/publication/281608632_Nonsurgical_management_of_multiple_splenic_abscesses_in_an_obese_patient_that_underwent_laparoscopic_sleeve_gastrectomy_case_report_and_review_of_literature [accessed Mar 24, 2016].

Bone metastasis is an uncommon event in advanced gastric cancer patients and bone metastases are rarely detected as isolated lesions. However, eleven years after treatment for locally advanced gastric cancer, including total gastrectomy followed by adjuvant chemotherapy, a 49-year-old female was admitted to the IX Division of General Surgery of the Second University of Naples (Naples, Italy) exhibiting severe progressive neurological symptoms. Magnetic resonance imaging indicated vertebral abnormalities, with evidence of marrow infiltration in several vertebral bodies; however, a contrast-enhanced computed tomography scan did not detect disease progression to other sites. Biopsy of the soft tissue at the level of the second lumbar vertebra (L2) revealed a metastatic lesion derived from gastric mucinous adenocarcinoma. The patient was initially treated with radiotherapy directed to the L2–L4 vertebral bodies to control the pain. Subsequently, systemic chemotherapy according to a FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin) regimen commenced. However, after eight cycles, pulmonary progression of the disease occurred. Thus, palliative care was administered and the patient succumbed one month later. The late relapse of gastric cancer in the current patient may be associated with the theory of tumour dormancy.