Advances In Surgery Channel

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.

Patients with severe GERD or younger ones that desire to avoid prolonged medical therapy are suitable for laparoscopic Nissen fundoplication. This approach has similar long term results and probably is more cost effective. Nowadays, the surgical technique is standardized and is important to respect the main principles to obtain good results.

Acute cholecystitis is a frequent pathology in the emergency room, the ideal treatment is early surgery by laparoscopic approach. Correct indications, anatomical landmarks and essential steps of this procedure must be known by general surgeons to perform a safe and effective therapy.

Patients with chronic complications after rectal resection develops life threatening conditions and experience a decrease in their quality of life. Synchronous transanal and transabdominal approach represents a potential solution for these difficult surgical cases.

Management of complications after colorectal surgery can be complex, fortunately the percentage anastomotic stricture is low, endoscopic dilation is used for its treatment. Surgery is reserved after failure of non invasive measure, the procedure is potentially difficult and is associated with unexpected injuries, a fact that impedes to restore the bowel transit.