Papers by Gianmattia Del Genio
The American journal of gastroenterology, 2018
To investigate correlation between rectal wall thickness (RWT) and anorectal pressures, in obstru... more To investigate correlation between rectal wall thickness (RWT) and anorectal pressures, in obstructed defecation syndrome (ODS) patients caused by internal rectal prolapse. ODS patients and healthy volunteers (HVs) underwent 3D endorectal ultrasound (3D-EUS) and high-resolution anorectal manometry (HRAM); RWT, total rectal wall volume (TRWV), pushing endorectal pressure (PEP), recto-anal gradient were determined RESULTS: We enrolled 35 ODS patients and 25 HVs. Patients showed markedly decreased TRWV, PEP, and recto-anal gradient. Linear correlation was found between markedly reduced TRWV and markedly hypotonic PEP. HRAM and 3D-EUS could be performed in ODS assessment, to better understand rectal function.
International wound journal, 2017
No studies have examined scars and quality of life after different treatments of wound dehiscence... more No studies have examined scars and quality of life after different treatments of wound dehiscence in patients undergoing post-bariatric abdominoplasty. Scars and quality of life of patients with postoperative wound dehiscence managed with negative pressure wound therapy (group A) and conventional wound therapy (group B) were reviewed 6 months after wound healing. Of 38 patients undergoing treatment for wound dehiscence after 203 abdominoplasty, 35 (group A = 14 versus group B = 21) entered the study. Wound healing in group A was significantly faster than group B (P = 0·001). Patients (P = 0·0001) and observers (P = 0·0001) reported better overall opinions on a scar assessment scale for group A. Better overall quality of life and general health satisfaction were observed in group A (P < 0·05). A significant correlation was observed between the World Health Organization Quality of Life scores and Patient and Observer Scar Assessment Scale scores (r=-0·68, P < 0·0001) in all 35 p...
Nonostante il ricorso a terapie chirurgiche aggressive, il carcinoma esofageo è tuttora una neopl... more Nonostante il ricorso a terapie chirurgiche aggressive, il carcinoma esofageo è tuttora una neoplasia a prognosi estremamente infausta, con una mortalità del 90% a 5 anni (1). Gli approcci chirurgici tradizionali (toracotomia, laparotomia) sono associati ad elevati tassi di morbilità e mortalità e ritardo nella ripresa dell'attività lavorativa (2,3). I recenti progressi in chirurgia miniinvasiva, con i suoi vantaggi in termini di morbidità operatoria e diminuzione dei tempi di degenza, hanno spinto alcuni chirurghi a realizzare l'esofagectomia totale per via laparoscopica (4-6). I loro risultati sembrano dimostrare che tale tecnica è realizzabile e sicura specie in centri con notevole esperienza di chirurgia mini-invasiva (4-6). Sulla scorta dei risultati presenti a tutt'oggi in letteratura, presso la I Divisione di Chirurgia Generale e Gastroenterologica della Seconda Università degli Studi di Napoli si è iniziato il trattamento laparoscopico del carcinoma squamoso esofageo localmente avanzato (T3-T4/Nx-N1) del terzo medio-inferiore dell'esofago, dopo radiochemioterapia neoadiuvante. Nel periodo dal marzo 1998 (epoca di inizio del programma) al marzo 2002 sono stati osservati 35 pazienti, 20 maschi e 15 femmine, età media 63.2 anni (range 50-72), affetti da carcinoma squamoso del terzo medio-inferiore dell'esofago localmente avanzato (6 pz T3N0, 18 T3N1, 11 T4N1). Per la valutazione strumentale pre-trattamento ci si è avvalsi dell'Rx esofago-stomaco, dell'EGDS, della ecoendoscopia e della TC collo, torace e addome; la broncoscopia è stata realizzata nei casi di sospetto d'infiltrazione della carena tracheale. Tutti i pazienti sono stati sottoposti a radiochemioterapia neoadiuvante e hanno completato il trattamento di 4 settimane. I cicli di chemioterapia alla prima ed alla quarta settimana sono stati eseguiti mediante l'infusione continua di 5-FU 1000 mg/m 2 per 4 giorni e la somministrazione di CDDP 100 mg/m 2 al primo giorno; la radioterapia è stata praticata ad una dose totale di 40 Gy ripartita in frazioni giornaliere di 2 Gy per 5 giorni a settimana. A distanza di 4 settimane dal termine del trattamento, i pazienti sono stati rivalutati mediante ecoendoscopia e TC ed operati in funzione della risposta alla terapia neoadiuvante. Il successo della terapia neoadiuvante è stato valutato mediante ecoendoscopia: si è considerata una risposta positiva al trattamento radiochemioterapico una riduzione di almeno il 50% della massima estensione trasversale della neoplasia. Ventidue dei 35 pazienti osservati (62.9%) sono stati operati avendo presentato una risposta positiva al trattamento neoadiuvante; 13 pazienti (9T4N1, 4T3N1) non hanno mostrato risposta positiva alla radiochemioterapia e sono stati indirizzati a trattamento palliativo. Per quanto riguarda la tecnica chirurgica, il paziente è posto in posizione supina con le gambe abdotte ed il chirurgo tra le sue gambe. Il primo assistente è posto alla destra del chirurgo, il
International Journal of Surgery Case Reports, 2016
BACKGROUND: To evaluate the use of a double loop reconstruction following pylorus preserving prox... more BACKGROUND: To evaluate the use of a double loop reconstruction following pylorus preserving proximal pancreaticoduodenectomy (PPPPD). METHODS: Morbidity and mortality were evaluated in 55 patients undergoing PPPPD for malignant tumors, followed by a double loop reconstruction. RESULTS: The mean intra-operative blood loss was 908 mL ± 531. In-hospital mortality was 5.4% (3/55 pts). The mean length of hospital stay was 17 ± 5 days (range 12-45 days). Postoperative complications occurred in 25 patients (46.2%). Five patients developed an anastomotic leak, one biliary and four pancreatic (4/55; 7%). Delayed gastric emptying occurred in 8 patients (14.5%). Reoperation was required in two patients for hemorrhage. CONCLUSIONS: A double loop alimentary reconstruction following PPPPD led to a low incidence of DGE and pancreatic fistula. Although mortality rate was higher than that reported by referral centres, this technique has been performed in a not specialized unit attaining acceptable results.
International Journal of Colorectal Disease, 2015
Dear Editor: Low transsphincteric fistula (LTF) is a tedious surgical disease and its treatment r... more Dear Editor: Low transsphincteric fistula (LTF) is a tedious surgical disease and its treatment relies on several conventional strategies among which the most common are fistulotomy and fistulectomy. Fistulotomy consists of leaving the anal wound open but is reported to be associated with prolonged wound healing, anal deformity, and an altered continence. In light of these findings, at the end of the 1980s, authors have described a technique based on the marsupialization of wound edges to leave less raw unepithelialized tissues to heal over. Previous randomized studies have compared the outcomes of marsupialization and open wounds in the treatment of anal fistula. To date, no study has specifically compared postoperative care management and recurrence in patients who underwent fistulotomy with or without marsupialization for LTF. In this letter, we compared shortand long-term outcomes of patients with LTF undergoing fistulotomy with those of patients undergoing fistulotomy with marsupialization in the same period. From December 2007 to October 2013, consecutive patients with a diagnosis of anal fistula referred to our surgical uni t , who underwent f is tulectomy with marsupialization (M) or with open wound (OW) on a 1.5:1 ratio over a 7-year period, were prospectively enrolled. At the baseline, all patients underwent anal manometry and endoanal ultrasound. Low transsphincteric anal fistula was defined as a fistula tract traversing the lower third of the external anal sphincter at preoperative instrumental evaluation and confirmed intra-operatively. Patient follow-up was based on regular outpatient clinic visits every 3 months, and information obtained from medical records, correspondence, and telephone contact. Postoperative pain was evaluated with the visual analogue scale (VAS) 12 and 24 h after surgery. Wound healing was defined by complete re-epithelialization recorded by one independent observer who attended the outpatients’ visits and contacted the patients by phone every day afterwards to plan the final outpatient visit. Local wound care was assessed by recording the daily frequency of dressing change or even need for and frequency of who (Bmy-self^; family; district nurse) performed it . Dressing change was strictly performed only at the three daily dressing assessments (every 8 h–7 a.m., 3 p.m., and 11 p.m.), only in case the dressing appeared moist and not absolutely clean and dry. This was recorded bymeans of diaries the patients were asked to complete. In addition, wound care was monitored during outpatient follow-up visits until the wound was closed or up to 3 months after dismissal from the hospital. Wound infection was defined as the presence of local symptoms of suppuration with or without an isolated pathogenic microorganism. A recurrent fistula was assessed by clinical examination and 3D endoanal ultrasound at the outpatient clinic by a competent observer, independent from the operating team. Recurrence was defined when symptoms of the disease recurred after an interval following complete wound healing. Two hundred and sixty-eight consecutive patients with a diagnosis of anal fistula were admitted in our department. Seventythree of 268 consecutive patients with a low transsphincteric anal fistula entered the study. Forty patients were male (male/female ratio 1:2), and the median age at the time of diagnosis was 41 (31–68) years. Forty-four patients (60.2 %) had a marsupialization (M group) and 29 had an open wound (OW group). The median operating time was higher in the M group (P=0.0001). Wound bleeding was less frequent in the marsupialization group than in the OW group (16 vs. 48%, P= * Paolo Limongelli [email protected]
Surgical Innovation, 2015
Background. Hemostasis during thyroidectomy is essential; however, the safest, most efficient, an... more Background. Hemostasis during thyroidectomy is essential; however, the safest, most efficient, and most cost-effective way to achieve this is unclear. This randomized, multicenter, single-blind, prospective study evaluated the efficacy and safety of using different hemostatic approaches in patients undergoing total thyroidectomy. Methods. Patients aged ≥18 to 70 years were randomized to Floseal + a harmonic scalpel (HS), Floseal alone, HS alone, or standard total thyroidectomy. Primary endpoint was 24-hour drain output. Secondary endpoints included surgery duration and complications. Results. Two hundred and six patients were randomized to Floseal + HS (n = 52), Floseal alone (n = 54), HS alone (n = 50), and standard total thyroidectomy (n = 50). The 24-hour drain output was lower in the Floseal + HS group compared with standard thyroidectomy. Floseal + HS also had a shorter surgery time ( P < .0001) versus the other 3 treatments. Conclusion. Floseal + HS can be effective at redu...
International surgery
Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatm... more Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatment of patients with esophageal achalasia. Persistent or recurrent symptoms occur in 10% to 20% of patients. Few reports on reoperation after failed Heller myotomy have been published. No author has reported the realization of a total fundoplication in these patient groups. The aim of this study is to evaluate the efficacy of laparoscopic reoperation with the realization of a total fundoplication after failed Heller myotomy for esophageal achalasia. From 1992 to December 2007, 5 out of a series of 242 patients (2.1%), along with 2 patients operated elsewhere, underwent laparoscopic reintervention for failed Heller myotomy. Symptoms leading to reoperation included persistent dysphagia in 3 patients, recurrent dysphagia in another 3, and heartburn in 1 patient. Mean time from the first to the second operation was 49.7 months (range, 4-180 months). Always, the intervention was completed via...
Surgery for Obesity and Related Diseases, 2016
Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. E... more Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. Objectives: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. Setting: University Hospital, Division of Bariatric and ENT Surgery, in Italy. Methods: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. Results: All patients completed the 5-year follow-up. A significant (P o .001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 Ϯ 1.7 to 5.8 Ϯ 1.2 (P o.001), 4.9 Ϯ 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. Conclusion: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
Chirurgia italiana
Diaphragmatic ruptures are fairly frequent after thoraco-abdominal traumas (0.8-5%). In 90% of ca... more Diaphragmatic ruptures are fairly frequent after thoraco-abdominal traumas (0.8-5%). In 90% of cases, they are left-sided. In the literature, very few cases are treated by laparoscopy. The aim of this study was to evaluate the feasibility and effectiveness of laparoscopic repair of a giant right post-traumatic diaphragmatic hernia without the use of a mesh. We present the case of a 28-year-old male operated by the laparoscopic approach for a giant right post-traumatic diaphragmatic hernia, diagnosed 18 months after the trauma. Surgical repair was carried out by means of 10 non-absorbable interrupted stitches, without the use of a mesh. The duration of the operation was 145 minutes. The patient was discharged 3 days after the surgical procedure, and no complications occurred. After a 40-month follow-up, the patient is asymptomatic and healthy. Laparoscopic repair of post-traumatic diaphragmatic hernias without the use of a mesh is safe and effective and affords an early postoperative...
Surgical Endoscopy, 2014
Background To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (... more Background To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett's esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND-or LGD-BE after medical and surgical treatment. Methods We studied a cohort of ND-and LGD-BE patients who underwent laparoscopic total fundoplication and a cohort of ND-and LGD-BE patients managed medically. Patients were matched for age, sex, and disease duration. After 1 year of follow-up at least, all patients underwent upper endoscopy with esophageal biopsies to evaluate any histological changes, as well as manometry and impedance-pH-metry to reassess reflux patterns. Results Thirty-seven patients (20 LGD, 17 ND) undergoing laparoscopic fundoplication were enrolled and compared with 25 patients (13 LGD, 12 ND) managed with proton pump inhibitors (PPI). Laparoscopic fundoplication resulted in a better control of both acidic and weakly acidic reflux (P \ 0.001) and was associated with a higher probability of reversion for LGD (P \ 0.01). Esophageal motility did not differ between surgically and medically treated patients. Conclusions In patients with ND-or LGD-BE, laparoscopic fundoplication seems to warrant a better control of all kinds of refluxate and it is associated with a higher likelihood of reversion of both LGD-and ND-BE, compared with PPI therapy.
Annals of Surgical Innovation and Research, 2008
Background: Esophagogastric fistula following an esophagectomy for cancer is very common. One of ... more Background: Esophagogastric fistula following an esophagectomy for cancer is very common. One of the most important factors that leads to its development is gastric isquemia. We hypothesize that laparoscopic gastric devascularization and partial transection is a safe operation that will enhance the vascular flow of the fundus of the stomach. Method: Our study included eight pigs. Each animal had two operations. In the first one, a laparoscopic gastric devascularization and mobilization took place. Vascular flow was measured previous to the procedure and immediately after it with a laser doppler (endoscopic probe). After three weeks, a second operation took place. We re-measured the vascular flow and sent a sample of gastric fundus for histopathologic evaluation. Results: The gastric fundus showed signs of neovascularization after both macroscopic and microscopic evaluation. These findings correlated with laser doppler measurements. Conclusion: Laparoscopic gastric devascularization and partial transection is a safe procedure that increases the vascular flow of the stomach in a three week period. This finding can have a positive impact in terms of decreasing fistula formation.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2007
Few cases of laparoscopic total gastrectomy have been published. Reconstruction of the digestive ... more Few cases of laparoscopic total gastrectomy have been published. Reconstruction of the digestive tract was generally accomplished with a Roux-en-y esophagojejunal mechanical anastomosis. Here we report the first 2 cases of laparoscopic conversion of an omega in a Roux-en-y reconstruction due to the occurrence of a severe alkaline esophagitis after mini-invasive total gastrectomy for cancer. Two male patients presented in 2004. One year prior, at another facility, they had undergone laparoscopic total gastrectomy for cancer, with reconstruction of digestive tract by means of an esophagojejeunostomy with a jejunal loop and Braun&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s side-to-side enteroanastomosis. They complained of daily symptoms of nausea, regurgitation, heartburn, and early postprandial fullness with reduction of appetite and weight loss of almost 15 kg. Instrumental examination diagnosed alkaline esophagitis. Intervention was performed via laparoscopic approach and the digestive reconstruction was reconfigured in a Roux-en-y type with a proximal limb of almost 60 cm. Operative time was 135 to 180 minutes. No postoperative complications occurred. After 1-year follow-up, symptoms resolution and esophagitis healing have been observed in both patients. Laparoscopic gastrectomy is gaining wide acceptance. In our opinion, a standardization of the technique is necessary: we believe Roux-en-y should be considered the preferred reconstruction route ensuring the best protection of the esophagus from alkaline reflux.
Surgical Endoscopy, 2006
Background: Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) and hiatal her... more Background: Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) and hiatal hernia has been validated worldwide in the past decade. However, hiatal hernia recurrence still represents the most frequent long-term complication after primary repair. Different techniques for hiatal closure have been recommended, but the problem remains unsolved. The authors theorized that ultrastructural alterations may be implicated in hiatal hernia. Thus, this study was undertaken to investigate the presence of these alterations in patients with or without hiatal hernia. Methods: Samples from Laimer-Bertelli connective membrane and muscular crura at the esophageal hiatus were collected from 19 patients with GERD and hiatal hernia (HH group), and from 7 patients without hiatal hernia enrolled as the control group (NHH group). Specimens were processed and analyzed by transmission electron microscopy. Results: Muscle and connective samples from the NHH group did not present any ultrastructural alteration that could be detected by transmission electron microscopy. Similarly, connective samples from the HH group showed no ultrastructural alterations. In contrast, all muscle samples from the HH group exhibited sarcolemmal alterations, subsarcolemmal vacuolar degeneration, extended disruption of sarcotubular complexes, increased intermyofibrillar spaces, and sarcomere splitting. Conclusion: The evidence of ultrastructural alterations in all the patients in the HH group raises the suspicion that the long-term outcomes of antireflux surgery depend not only on the surgical technique, but also on the underlying muscular diaphragmatic illness.
Obesity Surgery, 2008
The realisation of bariatric surgery has to date modified the digestive process solely through pr... more The realisation of bariatric surgery has to date modified the digestive process solely through procedures within the abdominal cavity. However, endocrine surgeons have recently demonstrated the feasibility of a minimally invasive approach to the neck. In this study, we explored the feasibility, safety and weight progression of a bariatric procedure performed at the neck. Eleven 40-50 kg Yorkshire pigs underwent endoscopic placement of an adjustable band to the cervical esophagus (ECB). Weight was monitored at postoperative days 15, 30, and after 7 weeks; weight progression was compared with an identical group of pigs who underwent a sham procedure. At autopsy, the surgical site was evaluated in a microscopic and macroscopic manner. Mean operating time was 66 +/- 5.76 min. All pigs tolerated the procedure well, except one subject that experienced food intolerance. The ECB group experienced significantly slower weight gain than the sham group (P = 0.005). Proper location of the band and absence of microscopic lesions at the esophageal wall were confirmed at autopsy and pathological examination. Bariatric surgery at the neck is feasible and produces effects on weight reduction. Further refinements and longer observation periods are required to propose this procedure as safe and effective alternative in humans.
Obesity Surgery, 2007
Background Bariatric surgery is considered the most effective treatment for reducing excess body ... more Background Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI]>40 kg/m 2). Methods Twenty patients (9 males, 11 females; 37.6± 8 years; BMI=50.1±8 kg/m 2) treated with dietary therapy and lifestyle correction (group 1) have been compared with 20 matched patients (41.8±6 years; BMI=50.4±6 kg/m 2) treated with laparoscopic gastric bypass (LGBP; group 2). Patients have been evaluated before treatment and after >10% WL obtained on average 6 weeks after LGBP and 30 weeks after integrated medical treatment. Metabolic syndrome (MS) was evaluated using the Adult Treatment Panel III/America Heart Association (ATP III/AHA) criteria. Resting metabolic rate (RMR) and respiratory quotient (RQ) was assessed with indirect calorimetry; body composition with bioimpedance analysis. Results At entry, RMR/fat-free mass (FFM) was 34.2±7 kcal/ 24 h•kg in group 1 and 35.1±8 kcal/24 h•kg in group 2 and did not decrease in both groups after 10% WL (31.8±6 vs 34.0±6). Percent FFM and fat mass (FM) was 50.7±7% and 49.3±7% in group 1 and 52.1±6% and 47.9±6% in group 2, respectively (p=n.s.). After WL, body composition significantly changed only in group 1 (% FFM increased to 55.9±6 and % FM decreased to 44.1±6; p=0.002). Conclusion After >10% WL, MS prevalence decreases precociously in surgically treated patients; some improvements in body composition are observed in nonsurgically treated patients only. Further investigations are needed to evaluate long-term effects of bariatric surgery on body composition and RMR after stable WL.
Obesity Surgery, 2009
Background Obesity is a chronic complex disease, consequence of an unbalance between energy intak... more Background Obesity is a chronic complex disease, consequence of an unbalance between energy intake and expenditure and of the interaction between predisposing genotype and facilitating environmental factors. The aim of the study was to evaluate body composition, abdominal fat, and metabolic changes in a group of severely obese patients before and after laparoscopic gastric bypass (LGBP) at standardized (10% and 25%) total weight loss. Methods Twenty-eight patients (14 M, 14 F; age 41.71± 6.9 years; body mass index (BMI) 49.76±5.8 kg/m 2) were treated with laparoscopic gastric bypass. All evaluations were performed before surgery and after achieving~10% and~25% weight loss (WL). Body composition was assessed by bioimpedance analysis; resting metabolic rate (RMR) was measured by indirect calorimetry. Results Body weight, BMI, and waist circumference significantly decreased at 10% and 25% WL. We observed a significant reduction of both RMR (2,492±388 at entry vs. 2,098 ± 346.6 at 10% WL vs. 2,035±312 kcal per 24 h at 25% WL, p=0.001 vs. baseline) as well as of RMR corrected for fat-free mass (FFM; 35.7±6.7 vs. 34.9±9.0 at 10% WL vs. 33.5±5.4 at 25% WL kilocalorie per kilogram FFM×24 h, p=0.041 vs. baseline). Body composition analysis showed a relative increase in FFM and a reduction of fat mass at 25% WL. A significant reduction in blood glucose, insulin, homeostasis model assessment index was observed. Ultrasonography showed a marked decrease in the signs of hepatic steatosis. Conclusion In conclusion, our study confirms that LGBP is a safe procedure in well-selected severely obese patients and has early favorable effects on both metabolic parameters and body composition. Longer-term observations are required for in-depth evaluation of body composition changes.
Obesity Surgery, 2013
Sleeve gastrectomy (SG) is currently gaining popularity due to an excellent efficacy combined to ... more Sleeve gastrectomy (SG) is currently gaining popularity due to an excellent efficacy combined to minimal anatomic changes. However, some concerns have been raised on increased risk of postoperative gastroesophageal reflux disease (GERD) due to gastric fundus removal, section of the sling muscular fibers of gastroesophageal junction, reduced antral pump function, and gastric volume. We undertook the current study to evaluate by means of high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) the impact of SG on esophageal physiology. In this study, 25 consecutive patients had HRiM and MII-pH before and after laparoscopic SG. The following parameters were calculated at HRiM: lower esophageal sphincter (LES) pressure and relaxation, peristalsis, number of complete esophageal bolus transit, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH with the patient in both upright and recumbent positions. At a median follow-up of 13 months, HRiM showed an unchanged LES function, increased ineffective peristalsis, and incomplete bolus transit. MII-pH showed an increase of both acid exposure of the esophagus and number of non-acid reflux events in postprandial periods. Laparoscopic SG is an effective restrictive procedure that creates delayed esophageal emptying without impairing LES function. A correctly fashioned sleeve does not induce de novo GERD. Retrograde movements and increased acid exposure are probably due to stasis and postprandial regurgitation.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012
Gastroesphageal reflux disease (GERD) is a common condition in the general population, affecting ... more Gastroesphageal reflux disease (GERD) is a common condition in the general population, affecting patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; quality of life and predisposing to Barrett&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s esophagus and its most fearsome complication, esophageal adenocarcinoma. The aim of this study is to compare objective and subjective outcomes of laparoscopic Nissen-Rossetti fundoplication after 2 years of follow-up. Seventy-six GERD patients underwent laparoscopic Nissen-Rossetti fundoplication. Patients were subjected to close follow-up. The DeMeester and Johnson score average decreased from a mean preoperative value of 35.48 (SD±40.24) to 9.83 (SD±6.40) at 6 months; at 12 months it was 11.44 (SD±10.28), and at 24 months it was 10.25 (SD±5.61). GERD Health-Related Quality of Life decreased from a preoperative value of 23.04 (SD±11.59) to 9.84 (SD±8.98) at 6 months, 8.34 (SD±8.98) at 12 months, and 6.8 (SD±6.46) at 24 months. The Short Form-36 measurement showed significant improvement. GERD patients need adequate reflux control. Successful antireflux surgery is more effective than medical therapy in preventing both acid and bile reflux. Surgical therapy is effective in terms of reflux control and improvement in quality of life. Strict and rigorous follow-up with both subjective and objective tests is important in order to identify asymptomatic recurrence of reflux after surgery.
Journal of Investigative Surgery, 2014
Although its excellent results, laparoscopic sleeve gastrectomy (LSG) presents major complication... more Although its excellent results, laparoscopic sleeve gastrectomy (LSG) presents major complications ranging from 0% to 29%. Among them, the staple line leak presents an incidence varying from 0% to 7%. Many trials debated about different solutions in order to reduce leaks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; incidence. No author has investigated the role of gastric decompression in the prevention of this complication. Aim of our work is to evaluate if this procedure can play a role in avoiding the occurrence of staple line leaks after LSG. Between January 2008 and November 2012, 145 patients were prospectively and randomly included in the study. Seventy patients composed the group A, whose operations were completed with placement of nasogastric tube; the other 75 patients were included in the group B, in which no nasogastric tube was placed. No statistical differences were observed between group A and group B regarding gender distribution, age, weight, and BMI. No intraoperative complications and no conversion occurred in both groups. Intraoperative blood loss (50.1 ± 42.3 vs. 52.5 ± 37.6 ml, respectively) and operative time (65.4 ± 25.5 vs. 62.6 ± 27.8 min, respectively) were comparable between the two groups (p: NS). One staple line leak (1.4%) occurred on 6th postoperative day in group A patients. No leak was observed in group B patients. Postoperative hospital stay was significantly longer in group A vs. group B patients (7.6 ± 3.4 vs. 6.2 ± 3.1 days, respectively, p: 0.04). Routine placement of nasogastric tube in patients operated of LSG seems not useful in reducing leaks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; incidence.
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Papers by Gianmattia Del Genio