Anthony Gonzalez

Helicobacter pylori Infection in Patients Undergoing Gastric Bypass Surgery for Morbid Obesity

Background: Studies suggest that the incidence of Helicobacter pylori infection in obese patients, including those undergoing gastric reduction surgery, may be increased. Methods: We examined the histologic findings at the time of surgery in a series of patients who were undergoing Roux-en-Y gastric bypass (RYGBP) for morbid obesity and compared these results with patients in our institution undergoing endoscopy. Results: Of 60 patients undergoing RYGBP,material for histologic examination was available in 56 cases, and in 40 cases gastric fundic mucosa from the anastomotic site was sampled at the time of surgery. Active chronic gastritis was present in 6 (15%), and chronic gastritis was present in 27 (68%). H. pylori was present in all 6 cases of active chronic gastritis and in 9 cases of chronic gastritis (total 38%).This incidence of H. pylori infection was higher than that found in the series of gastric biopsies (107/500, 21%, p = 0.03) and fundic biopsies (10/80, 13%, p = 0.003), but was not different when compared with age-matched gastric biopsies (44/177, 25%, p = 0.12). Conclusions: The incidence of H. pylori in patients undergoing RYGBP was higher than that found in all patients undergoing endoscopy and biopsy and than those undergoing fundic biopsies, but not higher when age-matched controls were considered.

Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology

Some authors recommend primary closure of the defect before placement of the mesh. The purpose of this study is to compare laparoscopic ventral hernia repair (LVHR) without primary closure of the defect (NPCD) versus LVHR with primary closure of the defect (PCD).

Robotic repair of giant paraesophageal hernias.

This report suggests that robotic repair of giant para-esophageal hernia has a lower recurrence rate than standard laparoscopic methods, but complications and mortality are similar to standard laparoscopic approaches.

Description of robotic single site cholecystectomy and a review of outcomes.

New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns. J. Surg. Oncol. 2015; 112:284–288.

Neumonia por pasteurella multocida

Se presenta un raro caso de neumonia por Pasteurella multocida, en el que se llego al diagnostico por puncion pulmonar aspirativa.

Laparoscopic Management of Gastric Torsion After Sleeve Gastrectomy

Introduction: Gastric volvulus occurs primarily when the stomach suffers torsion on itself due to laxity, elongation, or agenesis of the stomach ligamentous attachments or secondary to diaphragmatic hernias. Gastric torsion after sleeve gastrectomy is a rare complication. We present a case report of 3 patients with gastric torsion after sleeve gastrectomy. Case Description/Technique Description: Three patients with gastric torsion after sleeve gastrectomy were identified. Time between sleeve gastrectomy and gastric torsion symptomatology was 25, 211, and 98 days. Endoscopy established the diagnosis in all patients. Operative findings were organoaxial torsion due to adhesions of the sleeve’s staple line to the liver in all cases. Gastropexy was required in 1 case after laparoscopic lysis of adhesions. Recovery was uneventful for all patients, without torsion recurrence. Discussion: Because sleeve gastrectomy alters the normal stomach attachments, gastric torsion must be considered after sleeve gastrectomy in patients with any degree of obstruction symptoms, at any time of the postoperative course. Endoscopy is a valuable tool for the diagnosis. Laparoscopic torsion reduction by lysis of adhesions is successful, with or without gastropexy.

Current perspectives in robotic hernia repair

The surgical treatment of hernias has developed throughout the evolution of surgery. The fascination with hernia surgery is in part driven by its prevalence and by the variety of treatment options. Minimally invasive hernia surgery has a goal of a robust repair with minimal complications, and new robotic techniques are being developed in complex abdominal wall hernias with promising results. This review focuses on inguinal, ventral, and incisional hernias and their outcomes with a discussion on the traditional open, laparoscopic, and robotic techniques. The prevalence of minimally invasive hernia surgery and its advantages are also outlined. We highlight our experience in these procedures, specifically robotic herniorrhaphy, as it pertains to ventral incisional and inguinal hernia repair. We conclude that the robotic platform is proving to be a benefit to hernia repair. Many studies are showing its feasibility and comparable results to standard laparoscopy, and some have shown improved results, including shorter hospital stay without significant increases in cost. The robotic option of hernia repair has resulted in an increase in minimally invasive hernia repair, a number that has remained stagnant for the last decade. With more surgeons gaining training and experience and greater availability of the robotic platform, we expect to see greater numbers of minimally invasive hernia repair.

Robotic Single-Site Surgery: A Summary of the Current Clinical Experience

Abstract The robotic single-site platform was released in late 2011 and since then it has been applied in the fields of gynecologic surgery and general surgery. In this review, we include the reported robotic experience in the above-described fields using this platform to perform surgery as well as its advantages and limitations.