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Domenico LOFFREDO

Azienda Sanitaria Potenza, Villa d’Agri Hospital
Potenza, Italy
MD
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Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.
Surgical intervention
3 years ago
1899 views
87 likes
0 comments
08:20
Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.
Laparoscopic gastric plication with intraoperative endoscopy: a guide for a correct procedure
The field of bariatric surgery is continually evolving. Laparoscopic gastric plication (LGP) is an experimental bariatric procedure developed with the intent to offer the same effect as sleeve gastrectomy in gastric restriction without the same degree of risk. The LGP procedure consists in a complete mobilization of the fundus and body, followed by an invagination of all the greater curvature of the stomach, maintained by a full-thickness suture, from the angle of His down to 6cm from the pylorus, in order to create a large intraluminal gastric fold.
The aim of the present video was to report our technique in LGP, presenting the role and all the advantages of intraoperative endoscopy.
The procedure was completed in a 37-year-old woman, with previous gastric banding. Due to limited weight loss, LGP was performed in a single step procedure after concomitant gastric banding removal.
The video shows all surgical steps: gastric banding isolation and removal, mobilization of the greater gastric curvature, gastric plication by double invagination suture lines controlled by intraoperative endoscopic evaluation. The endoscope was left in place during the whole plication procedure like a calibration tube to ensure a patent lumen, and the intragastric vision represents a three-fold guide: a guide for the surgeon in terms of size of the gastric fold, a guide in terms of shape of the gastric lumen, and a guide for a correct suture and position of full-thickness bite.
The video is also completed by a postoperative 8-month endoscopic evaluation, to assess the appearance of the fold and plication durability.
In our preliminary experience, intraoperative endoscopy is a mandatory combined procedure during LGP to achieve all the required information for a correct surgical procedure. The endoscopic evaluation also represents a fundamental step during follow-up, also considering the experimental phase of this surgical procedure.
Surgical intervention
5 years ago
2220 views
17 likes
0 comments
07:26
Laparoscopic gastric plication with intraoperative endoscopy: a guide for a correct procedure
The field of bariatric surgery is continually evolving. Laparoscopic gastric plication (LGP) is an experimental bariatric procedure developed with the intent to offer the same effect as sleeve gastrectomy in gastric restriction without the same degree of risk. The LGP procedure consists in a complete mobilization of the fundus and body, followed by an invagination of all the greater curvature of the stomach, maintained by a full-thickness suture, from the angle of His down to 6cm from the pylorus, in order to create a large intraluminal gastric fold.
The aim of the present video was to report our technique in LGP, presenting the role and all the advantages of intraoperative endoscopy.
The procedure was completed in a 37-year-old woman, with previous gastric banding. Due to limited weight loss, LGP was performed in a single step procedure after concomitant gastric banding removal.
The video shows all surgical steps: gastric banding isolation and removal, mobilization of the greater gastric curvature, gastric plication by double invagination suture lines controlled by intraoperative endoscopic evaluation. The endoscope was left in place during the whole plication procedure like a calibration tube to ensure a patent lumen, and the intragastric vision represents a three-fold guide: a guide for the surgeon in terms of size of the gastric fold, a guide in terms of shape of the gastric lumen, and a guide for a correct suture and position of full-thickness bite.
The video is also completed by a postoperative 8-month endoscopic evaluation, to assess the appearance of the fold and plication durability.
In our preliminary experience, intraoperative endoscopy is a mandatory combined procedure during LGP to achieve all the required information for a correct surgical procedure. The endoscopic evaluation also represents a fundamental step during follow-up, also considering the experimental phase of this surgical procedure.
Single Incision Laparoscopic Surgery (SILS): gastric banding removal for acute gastric pouch dilatation
In a significantly short time, Laparoscopic Adjustable Gastric Banding (LAGB) for morbid obesity has become a common operation in Europe and elsewhere.
Recent series show a high percentage of patients re-operated on, almost always with excision of the banding system. The reasons for re-operation are esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation.
This video demonstrates the removal of a gastric band for acute gastric pouch dilatation. The procedure was completed using a single access technique, with conventional laparoscopic instrumentation. A 2cm incision is performed on the port site and the same one is removed first maintaining the connection tube on site in order to place traction on the band. A 10mm port is inserted using an open technique, and two further 5mm ports are placed anteriorly just to the left and to the right side of the previous one.
Surgical intervention
9 years ago
2933 views
8 likes
0 comments
06:06
Single Incision Laparoscopic Surgery (SILS): gastric banding removal for acute gastric pouch dilatation
In a significantly short time, Laparoscopic Adjustable Gastric Banding (LAGB) for morbid obesity has become a common operation in Europe and elsewhere.
Recent series show a high percentage of patients re-operated on, almost always with excision of the banding system. The reasons for re-operation are esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation.
This video demonstrates the removal of a gastric band for acute gastric pouch dilatation. The procedure was completed using a single access technique, with conventional laparoscopic instrumentation. A 2cm incision is performed on the port site and the same one is removed first maintaining the connection tube on site in order to place traction on the band. A 10mm port is inserted using an open technique, and two further 5mm ports are placed anteriorly just to the left and to the right side of the previous one.