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Background: Surgical esophagomyotomy has been shown to provide superior long-term symptom relief as compared with nonsurgical interventions. Failure of surgical treatment remains the center of controversy regarding this topic. Methods: A retrospective review was conducted of all patients who underwent surgical treatment of achalasia from January 2005 to July 2009 at Cleveland Clinic Florida. Results: A total of 66 patients (41 women and 25 men), with a mean age of 51 years (range, 24 to 86 y). Fifty-nine patients (89%) underwent laparoscopic surgery, including 2 (3%) with recurrent achalasia. One patient was converted to laparotomy. Twelve patients required a reintervention because of failure or complications (18%). Six cases were confirmed intraoperatively to be recurrent achalasia that necessitated redo Heller myotomy. Conclusions: Early reoperations after Heller’s Dor esophagomyotomy are mostly related to technical errors, whereas most late reoperations are related to recurrent disease. Laparoscopy seems to be safe and the preferred approach for primary as well as redo procedures.

Nous rapportons un cas de technique endovasculaire innovante utilisee pour la reparation d’une rupture traumatique bilaterale de l’artere axillaire. Un patient de 36 ans travaillant dans le Bbtiment fit une chute d’un echafaudage d’une hauteur de huit etages et presentait des lesions traumatiques bilaterales des arteres axillaires. La continuite entre les arteres brachiales et axillaires etait retablie en utilisant de longs stents nus auto expansibles (Zilver). A notre connaissance, il s’agit d’un cas original d’utilisation des techniques endovasculaires dans un trauma center de niveau 1 pour le traitement de lesions traumatiques bilaterales des arteres axillaires, avec un suivi a long terme.

data base (7F, mean age 457y, BMI 518 kg/m 2 , HbA1c: 8.31%). 16 LRYGB Obese Diabetics with similar pre-operative features (Group2), were identified (7F; mean age 458y; BMI 484 kg/m2, HbA1c: 8.51%). LRGBP alimentary limb was 150 cm and bilio-pancreatic limb was 50 cm from Treitz ligament. SG vertical transection was calibrated on a 40F oro-gastric bougie. Data were analyzed at 15 days, 6 months, 1 year according weight loss and diabetes resolution (fasting glucose 126 mg/dl without hypoglycemic drugs). Data were reported as meanSD, statistical analysis was by Fisher’s exact test (p0.05 was significant). Results: Group1 and Group2 BMI were comparable at 15 days: 467 and 445 kg/m2, respectively (p0,479). BMI was significantly lower in Group2 (354 and 325 kg/m 2 ) vs. Group 1 (426 and 385 kg/m 2 ) at 6 months and 1 year respectively (P0.02). Diabetes resolution occurred in 66, 77and 77% of Group1 patients and in 94, 100, 94% of Group2 at 15 days, 6 months and 1 year, respectively (pns). Conclusion: In spite of its statistically significant inferiority regarding weight loss in comparison with LRYGB, SG is equally effective for the diabetes resolution.

We describe a case of innovative endovascular techniques to repair traumatic bilateral axillary artery disruption. A 36-year-old male construction worker fell eight stories from a scaffold and sustained bilateral axillary artery injuries. The injuries between the brachial and axillary arteries were bridged using long bare self-expanding stents (Zilver). To the best of our knowledge, this is a novel case report from a level-one trauma center where endovascular techniques were employed to repair bilateral axillary arteries with long-term follow-up.