Advances In Surgery Channel

Complications after reversing an ileostomy are infrequent. The combination of abdominal pain and fever calls the attention of surgeons, that will evaluate the patient in order to diagnose an anastomotic leakage. In some cases clinical and radiological studies are not enough to clarify the suspicion,  a laparoscopic examination, if required, provides both diagnosis and treatment.

The Transanal Total Mesorectal Excision is an innovative approach for rectal cancer. It provides several advantages compared to the fully laparoscopic technique.  With this procedure, issues like transection of the distal margin and difficult cases may have found a solution.

At present, MIS for rectal cancer is fully represented by laparoscopic and transanal approaches. Both, are provided with particular benefits and a special learning curve. There is no doubt that a wide experience in colorectal surgery is important. It is a reality that a laparoscopic approach is a standardized procedure and is well accepted among surgeons.

Radical esophageal surgery is associated with a high rate of morbi-mortality. The actual effort is addressed to accomplish the resection and restore the bowel transit with the lowest aggression and improvement of the end result.

Intracorporeal anastomosis after resection of the right colon is provided with several pros and cons. In cases of difficult extraction of the specimen the benefits of a laparoscopic approach are appreciated.

Nowadays it is proven that right colectomy by laparoscopic approach is safe in oncological terms. Most surgeons perform extracorporeal anastomosis after the resection. Current literature seems to consider the intracorporeal manner as a better strategy but the learning curve is higher and may prolong the surgical time in the first cases.

There are limitations for the medical treatment of Crohn´s disease and Ulcerative Colitis. The actual effort is addressed in understanding the immunological processes involved in order to develop new options.

Up to 5% of patients may present abdominal pain after after a Roux-n-Y Gastric Bypass, the etiology is diverse, correlation of clinical manifestations and imaging/ endoscopic findings leads to the diagnosis but in some cases surgical evaluation is needed to diagnose and treat.

Bowel intussusception is more frequent in children. Secondary etiology (mechanical) is more usual in adults, it is important to rule out malignancy and guide patients definitive treatments with the lowest rate of aggression.

Techniques even less invasive than laparoscopy have recently arisen in the field of bariatric surgery. The sleeve gastrectomy is a procedure with low complexity that allows trying  to reduce the number of trocars, making it suitable for NOTES and SILS approaches.

When to perform a pouch? How to select the correct patient? These are questions with controversial answers for patients that require a proctectomy.

Natural Orifice Endoscopic Surgery (NOTES), lacks of safety to perform colorectal procedures. Many improvements in technology are needed, actual effort is directed in creating platforms that allow dissection, transection and extraction of organs. However Natural Orifice Surgical Extraction (NOSE) can be attempted to minimize the small aggression already provided by laparoscopic procedures.

The surgical treatment for patients with Achalasia is the Heller Myotomy by laparoscopic approach. This procedure solves the issue of the lack of relaxation at the lower esophageal sphincter during deglutition, however up to 20% of patients experience gastroesophageal reflux.

New approaches for rectal diseases is the present and future for modern rectal surgery. The transanal access was used in order to accomplish NOTES procedures but development of new devices is required. Nowadays the down-to-up dissection for rectal cancer brings several advantages that may improve the outcomes obtained by open or laparoscopic approach.

Conversion surgery for patients with complications after bariatric procedures can be technically challenging.  In these cases the key points are: correct surgical indication, excellent anatomical knowledge and meticulous dissection maneuvers.

Bronchopulmonary sequestration is an aberrant formation of lung tissue that has no connection with the bronchial tree or the pulmonary arteries. It is a rare clinical condition and when recurrent pulmonary infections occur surgery is required. The Video-Assisted Thoracic Surgery (VATS) improves the visualization and diminishes the aggression to the thoracic wall.