Luca Arru

Percutaneous and Reduced-Port Roux-en-Y Gastric Bypass: Technical Aspects

The well-known advantages of minimally invasive surgery, such as improved surgical vision and precision, less postoperative pain, faster recovery, shorter hospital stay, and reduced parietal complications, are particularly important in bariatric surgery. Patient acceptance and cosmetic results have also been widely demonstrated. The introduction of single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery, which are aimed at maximizing the benefits of laparoscopy, have generated considerable interest. Unfortunately, the current learning curve and acquisition of specific materials limit the spread of these techniques. The feasibility is well demonstrated but standardization, safety, and long-term results need additional assessment. In addition, there are higher hospital costs and an increased rate of port-site hernia compared with standard laparoscopic surgery, especially for single-incision laparoscopic cholecystectomy. In this context, reduced-port surgery (RPS) with classic laparoscopic triangulation could represent a new target, with no concerns related to procedural safety and surgical outcomes and no additional skills and equipment required. We have already demonstrated the standardization, reproducibility, and safety of RPS in other bariatric procedures. In addition, RPS can lead to better outcomes and avoid potential complications (eg, port-site hernia) that are more deleterious and difficult to manage in these patients. The purpose of this study is to describe our technique of laparoscopic Roux-en-Y gastric bypass (LRYGB) using RPS with percutaneous instrumentation, define the technical details, and analyze the short-term outcomes.

Thrombose d’une endoprothèse couverte aorto-bi-iliaque posée en cure d’une fistule artério-veineuse après chirurgie discale lombaire

OBJECTIVES Major vessel injury is a rare complication of spinal surgery. Iliac artery injury is the most common. Frequently, a chronic arteriovenous fistula develops. METHODS We describe the case of a 63-year-old woman who had developed a chronic arteriovenous fistula following lumbar disc hernia surgery. The patient was treated using an Anaconda™ stent graft (Vascutek Terumo). After 2years, the prothesis thrombosed and an aorto-iliac bypass was performed. RESULTS A gel soft prosthesis 18/9 (Vascutek Terumo) was implanted by laparotomy. The postoperative period was uneventful. A month later, the patient had recovered good lower limb function. CONCLUSION The choice between endovascular versus open surgery must take into account the patients age, the risk of long-term complications, and the need for radiographic surveillance. Curative open surgery remains a valid option for young patients.

Emergency Laparoscopy in the Elderly

Due to the steady increase in the elderly population, the issue of frail patients with acute abdomen management is ever more actual. Many questions remain unsolved, concerning both the indication to surgery and the type of surgical approach, open or laparoscopic. This chapter describes the specific problems of the elderly patient, providing to the emergency surgeon, who has to take a quick and often lonely therapeutic choice, a survey of the literature upon which to base a rational approach to treating frail patients with acute abdomen. Some diseases, such as cholecystitis, appendicitis, and complicated Hinchey stage 3 diverticulitis, can be treated with laparoscopic approach, if the answer to a series of 11 questions is always “yes.”