Advances In Surgery Channel

Proctocolectomy with ileoanal pouch anastomosis is the definitive treatment for patients with ulcerative colitis. This video shows the feasibility of the procedure performed by specialists of Cleveland Clinic by SILS approach

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The severity of acute diverticulitis ranges from a mild inflammation to a complication with abscesses, perforation and fecal peritonitis. Management has evolved towards minimal invasive and conservative strategies with the aim of decreasing the rate of aggressive and technically demanding surgical resections of stoma creation. Current data indicate that treatment must be adapted, taking the complexity of the disease, operative risk and surgery-related complications into the account

The splenic artery aneurysm is a rare and potentially fatal pathology. It is the most frequent visceral aneurysm, presenting most often in female patients. Symptoms such as acute abdominal pain and syncope should arouse clinical suspicion. Prompt, correct management is mandatory to decrease the morbi-mortality rate.

Benign neoplasias at the esophagogastric junction are a challenge for endoscopists and surgeons looking for the least aggressive and optimal option of treatment. A combined work between both units enables local treatment with safer control over the procedure and good postoperative results.

Since the first cases the transanal approach has aroused the attention of the surgical community. It is an innovative technique that delivers a solution to actual problems. The Hospital Clínic of Barcelona delivers courses mentored by the best specialists.

Colonic lipomas are generally asymptomatic and are found by colonoscopy or surgery to treat other problems. Symptoms correlate with the size, and about 90% arises from the sub-mucosa. Treatment depends on the size and clinical manifestations (ranging from endoscopic removal to surgical resection).

Surgical treatment for morbid obesity has the strongest and most sustained results when compared to diet and lifestyle changes. Current evidence about procedures such as Lap Band, RYGBP and sleeve gastrectomy is available. Patients who underwent a Lap Band procedure may have an increased risk of complications and require revision due to weight recidivism, port infection, slippage or erosion.

Laparoscopic sleeve gastrectomy has gained worldwide popularity in recent years. The most common postoperative complications of sleeve gastrectomy are fistulas, but bleeding on the stapling line or into the abdominal cavity is also commonly reported and difficult to manage.

Extraluminal hemorrhage often occurs dramatically, as a hypovolemic shock requiring immediate resuscitation. The differential diagnosis with pulmonary embolism and myocardial infarction is crucial.  If a gastrointestinal bleeding is suspected, the test of choice is an endoscopy. If there is a massive extraluminal haemorrhage, an emergency reoperation would have to be performed.

Restorative procto-colectomy with ileo J pouch anal anastomosis remains the surgical treatment of choice for patients with ulcerative colitis. However, subsequent pouch dysfunction is common.

Some of the best surgeons in the world work with AIS Channel, the leading online platform for the latest advances in colorectal and bariatric surgery. In this video, they tell us about their experience with AIS Channel, and why they regard it as the best in the industry.

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There is less than 1% of symptomatic perineal hernia after a MILES procedure. Various risk factors have been described, such as: coccygectomy, previous hysterectomy, neoadjuvant chemoradiation, female gender, failure to close the peritoneal defect, poor nutrition, a history of tobacco use for more than 15 years, and perineal wound infection. There are several surgical procedures to treat this issue with different amounts of aggression and variable percentages of failure. Surgeons currently lack an ideal single treatment. The present video will show a minimal invasive repair of a perineal hernia.

The clinical manifestations of endometriosis are divided into three groups (pelvic mass, pelvic pain and infertility). Treatment of the patient should be tailored taking into account the location of the disease, tolerance to medical therapies and desire for conception. Surgery is reserved for cases with an unclear diagnosis or failure of medical management. This case summarizes the management of an endometriosis that simulated an appendicular neoplasia.

Marginal ulcers after a Roux-n-Y gastric bypass can be one of the most problematic complications. Smoking and intake of non-steroidal anti-inflammatory drugs are related to its development in the late postoperative period. Patients must be counseled to stop smoking, proton pump inhibitors must be prescribed and infection by helicobacter pylori must be ruled out or treated. Surgery is required if the symptoms persist after two months of medical therapy.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is the latest and least aggressive surgical approach. There are several access routes such as transoral, trans gastric, trans anal and trans vaginal. Back in 2004 the various routes to enter the abdominal cavity were assessed. The main limitations of the transvaginal approach are: Lack of universal application and that It is not accepted by 100% of female patients. This video reflects the technical considerations and feasibility of a Hybrid transvaginal sigmoidectomy.