Advances In Surgery Channel

The inclusion of Denonvilliers’ fascia is still a matter of debate among the surgical community, as it has functional consequences when taken during the total mesorectal excision. Some experts would agree on including it only for anterior tumors. Do you agree with these experts recommendations? Join our debate and enrich our surgical community!

The Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for bariatric surgery. Small bowel obstructions are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of severe bowel obstructions.

Professor Soren Laurberg from Aarhus University Hospital in Denmark explains the evolution in global standards for rectal cancer and how the centralization of rectal cancer care improves outcomes. He also discusses the need for proper training in rectal surgery and the importance of functional outcomes for rectal cancer survivors.

Professor Peter Sagar, Colorectal Surgeon at St. James’s University Hospital in Leeds (England) discusses the management of pelvic sidewall lymph nodes and masses in rectal cancer. He explains the lymphatic spread of the rectal cancer, the long-term prognosis of pelvic side lymph nodes, the rationale behind pelvic lateral dissection, and demonstrates a nerve sparing surgery with lateral dissection.

Preservation of left colic artery has clinical, functional and oncologic implications and is an ongoing debate. Several studies have compared results with and without preserving the left colic artery. Performing a low ligation of the inferior mesenteric artery (IMA) with preservation of the left colic artery provides excellent vascular supply, while potentially limiting mesenteric length and the number of lymph nodes harvested. On the other hand, standard high ligation without preservation of the left colic artery is technically easier to perform and provides excellent mesenteric length but relies solely on marginal vessel blood supply from the middle colic artery. Furthermore, several studies have compared results with and without preserving the left colic artery. So when should we preserve the left colic artery and when not?

Antonio M. Lacy, Head of the Gastrointestinal Surgery Department at the Hospital Clinic in Barcelona, gives a brief introduction to the current status of TaTME, and then discusses the various pitfalls that can appear during this surgery, as well as possible solutions based on his extensive experience in this technique, having performed a very large number of cases.

Professor Giovanni Dapri explains the advantages, applications and basic principles of Transanal TME and the experience with Transanal TME associated with single incision laparoscopy and the use of ICG.

Roel Hompes explains the rationale for transanal total mesorectal excision, the past of rectal surgery and the development of the technique with the concerns about its fast acceptance among the surgical community.

AIS CHANNEL’s educational achievements have been recognized at the European Chapter of IFSO 2017 held in Naples, Italy in May 2017. The interest aroused by the presentation of our online-based training model is a reflection of the enthusiasm of the surgical community for the implementation of new technologies in the service of education. With this recognition, the AIS Channel is encouraged even more to continue to work towards universal training, and will soon open new sections. Thus we will become a tool for excellence not only in the teaching of bariatric surgery, but in the teaching of any surgeon.

Pneumoperitoneum is usually secondary to perforation of gastrointestinal tract. In very rare cases this perforation can be caused by a barotrauma.  A barotrauma is the trauma caused by rapid or extreme changes in air pressure, especially affecting enclosed cavities within the body such as the middle ear, the sinuses, the lungs and the bowel.

Intestinal barotrauma is produced by gas that is retained in the digestive tract after some manipulation of the respiratory tract. Gas retention may go unnoticed or cause only   abdominal pain, but in some isolated cases it could cause intestinal perforation due to the tension of the intestinal wall, especially if there is any cause that makes it likelier, such as the presence of a Diverticular disease.

Retrorectal tumours are uncommon and have a wide range of etiologies, congenital etiologies being the most common. The clinical presentation is heterogeneous and retrorectal tumours often pose diagnostic difficulties as non-specific chronic pain and suppuration are the most common symptoms.

Pica syndrome occurs in patients with severe personality disorders who repeatedly ingest foreign bodies resulting in life threatening situations. Despite of multiple medical therapy and surveillance some patients requires several interventional or surgical procedures during their lives. Minimal invasive surgery has a favorable role even in patients with multiples previous surgical interventions.

The development of laparoscopy started in the 20th century along with the advancement of technology, extending to different disciplines. Many technological improvements have been implemented in laparoscopic equipment, particularly in optics. One of the latest revolutions is the evolution of cameras from 2D to 3D, creating a new working environment for the surgeon. On the next presentation, a summary of the most current 3D optics is shown.

Jean-Marc Chevallier MD, Professor of surgery at Service de Chirurgie générale et digestive, Hôpital Européen G. Pompidou (Université PARIS 5, France) gives an interesting lecture on the One Anastomosis Gastric Bypass.

The Hospital Clinic in Barcelona implements a prehabilitation program that reduces postoperative complications in high-risk surgical patients by 50%. Rafael Nadal, the Majorcan tennis player, has given a crucial boost to this project, facilitating a partnership agreement between the hospital, AIS Channel and the company Technogym which has made it possible provided state-of-the-art technology for the facilities.

Sleeve gastrectomy is a bariatric operation that is becoming increasingly popular. One of the reasons may be that it is seen as less difficult than other surgical procedures. However, complications such as GERD are also increasing and some patients require surgical intervention for its treatment.