Bariatric surgery reduces the incidence of hidradenitis suppurativa in individuals with obesity: results of a nationwide administrative data study in France.

BACKGROUND: Hidradenitis suppurativa (HS) is a systemic inflammatory condition associated with obesity, metabolic syndrome, and environmental factors. Bariatric surgery (BS) is effective in reducing weight and resolving obesity-related medical problems. OBJECTIVES: The aim of this case-control study is to evaluate the effects of BS on the occurrence and recurrence of HS in individuals with obesity. SETTING: Nationwide administrative data study using the French national discharge database. METHODS: We compared 297,776 individuals with obesity and without a history of HS who underwent BS (BS group) with 2,735,930 individuals with obesity who did not receive BS (control group) to assess the incidence of de novo HS. From the same database, we compared hospitalization rates for HS recurrence between 310 individuals with obesity and HS who had BS (HS_BS group) and 3875 individuals with obesity who did not have BS (HS_control group). Propensity score matching using the nearest-neighbor method was implemented to create comparable patient groups. RESULTS: Individuals with obesity and without a history of HS who received BS exhibited a significantly reduced risk of developing de novo HS (RR = .736 [.639; .847]). Among patients with a history of HS, those who underwent BS had a nonsignificantly reduced risk of HS recurrence (RR = .676 [.369; 1.238]) compared with those who did not. CONCLUSION: BS reduces the risk of developing de novo HS and seems to have a protective effect on its recurrence in individuals with obesity, although the latter effect was not statistically significant.

Can robotic gastric bypass be considered a valid alternative to laparoscopy? Our early experience and literature review.

Background: Robotic bariatric surgery serves as an alternative to laparoscopy. The technology provides the surgeon with an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the operating room. Hypothesis: We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass to demonstrate its safety and feasibility. The aim of this study is to evaluate potential differences between the robotic and laparoscopic techniques. Materials and methods: Our study retrospectively identified 153 consecutive obese patients who underwent either laparoscopic or robotic gastric bypass (RGB) procedures over a 2-year period at the Department of Medical and Surgical Sciences, University of Foggia. Data on demographics, operative time, conversion rate, length of hospital stay, and mortality were collected and compared between two groups of patients: 82 patients who underwent laparoscopic procedures and 71 who underwent robotic procedures. Results: We analyzed 153 patients who underwent gastric bypass with a mean age of 42.58 years, of whom 74 were female; 71 were treated with a robotic approach and 82 with a laparoscopic approach. The mean operative time was 224.75 ± 10.4 min for RGB (including docking time) and 101.22 min for laparoscopic gastric bypass (LGB) (p < 0.05), which is statistically significant. The median length of stay was 4.1 days for the RGB group and 3.9 days for the LGB group (p = 0.89). There is only one conversion to laparoscopy in the RGB group. We observed only one case of postoperative complications, specifically one episode of endoluminal bleeding in the laparoscopic group, which was successfully managed with medical treatment. No mortality was observed in either group. Conclusion: The statistical analysis shows to support the robotic approach that had a lower incidence of complications but a longer operative duration. Based on our experience, the laparoscopic approach remains a technique with more haptic feedback than the robotic approach, making surgeons feel more confident.This study has been registered on ClinicalTrial.gov Protocol Registration and Results System with this ID: NCT05746936 for the Organization UFoggia (https://clinicaltrials.gov/ct2/show/NCT05746936).

Remission of nonalcoholic steatohepatitis after bariatric surgery: a single referral center cohort study.

BACKGROUND: Obesity is associated with nonalcoholic steatohepatitis (NASH), which leads to an increased rate of primary liver cancers, cirrhosis, and decreased life expectancy. Metabolic/bariatric surgery (MBS) determines long-term weight loss and the resolution of obesity-related medical problems. OBJECTIVE: The aim of this study was to evaluate the impact of MBS on liver histologic features in individuals with obesity. SETTING: Tertiary referral university hospital. METHODS: We retrospectively analyzed data on 37 patients undergoing MBS from a prospectively held database. All patients had a liver biopsy at the time of MBS and a second liver biopsy in case of further surgery or for NASH follow-up. Eighteen patients had NASH on the first liver biopsy. The primary endpoint was the resolution of steatohepatitis without worsening of fibrosis on the second liver biopsy. Secondary endpoints were the evolution of liver steatosis, hepatocyte ballooning, nonalcoholic fatty liver disease activity score, and biochemical parameters from the time of the first to the second liver biopsy. RESULTS: Fifteen (83.3%) patients had significant resolution of steatohepatitis (P < .001) without fibrosis worsening. There was a statistically significant improvement of all blood tests except for low-density lipoprotein, alkaline phosphatases, and bilirubinemia. The Homeostatic Model Assessment (HOMA) index was significantly improved after MBS (P < .001), and circulating insulin and leptin concentrations were significantly reduced. Mean weight loss was 47 kg, with a 16.6 kg/m2 body mass index reduction and a % of total weight loss (%TWL) of 40.3 ±14% from the moment of MBS to the last follow-up. CONCLUSION: MBS is effective in determining NASH regression without fibrosis worsening and in reducing HOMA index and leptin and insulin concentrations.

Metastatic melanoma causing small bowel perforation: A case report.

INTRODUCTION AND IMPORTANCE: Metastatic localization of melanoma often affects the gastrointestinal tract, with reference to the small intestine. CASE PRESENTATION: In this work we present the clinical course of a patient affected by a surgically treated melanoma of the right conjunctiva, suddenly manifesting abdominal symptomatology. The abdominal computed tomography scan (CT scan) show evidence of free air into the peritoneal cavity, cholecystitis and brain lesions highly suspicious for metastases. Patient underwent emergency surgery, consisting of ileo-cecal resection, cholecystectomy, with the construction of an ileostomy. The histological examination diagnosed multiple ileal and gallbladder localizations of pigmented epithelial melanoma, and localization. CLINICAL DISCUSSION: The treatment of conjunctival melanoma consists in surgical removal. Distant metastases frequently affect the gastrointestinal tract, leading to the necessity to assess patients with abdominal symptoms, in order to avoid emergency scenarios such as the one reported in our study. CONCLUSIONS: Intra-abdominal metastases from melanoma are an event that should not be underestimated, because if detected in time, they can be treated with surgery resulting in a clear improvement in the prognosis. Late diagnosis of intestinal metastases can cause an acute abdomen scenario frequently caused by intestinal obstruction or gastrointestinal bleeding.

Anastomotic leak test using indocyanine green during laparoscopic Roux-en-Y gastric bypass: A cohort study.

Background: Indocyanine green (ICG) can be injected into the human bloodstream and it allows us to show stomach vascularity in real time. The aim of our study is to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic Roux-en-Y Gastric Bypass (RYGB in our center and how the perfusion of the gastro-jejunal anastomosis affects the onset of fistula. Materials and methods: 30 consecutive patients underwent RYGB with ICG fluorescence angiography at our center from January 2020 to December 2021.5 ml of ICG were then injected intravenously to identify the blood supply of the stomach and the gastro-jejunal anastomosis. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05476159 for the Organization UFoggia. Results: In the RYGB tested with ICG, we all have adequate perfusion but despite this a methylene blue test was positive and allowed us to reinforce the suture of the gastro-jejunal anastomosis. Conclusion: Intraoperative ICG testing during laparoscopic RYGB may be helpful in determining which patients are at an increased risk for leakage but multiple factors concur to the pathophysiology and the incidence of gastric fistula not only the perfusion.

Is Emergency Surgery Back to Pre-Covid-19 Era? Our Cohort Study.

Introduction: The aim of this study is to analyze the progress of hospitalizations and how the emergency operations in our Department of Medical and Surgical Sciences of the Foggia Hospital have changed qualitatively and quantitatively from pre-Covid-19 to today. Methods: Our cohort-study was conducted by analyzing four groups of patients admitted in emergency to our department from 2019 to 2022. Results: We observed a total of 150 patients for the group 1, 25 patients for the group 2, 71 patients for the group 3 and 110 for the group 4, of these 20 were emergency admission during 2019, 16 during 2020, 31 during 2021 and 10 during 2020 (p 0.05); 130 were elective admission during 2019, 9 during 2020, 40 during 2021 and 100 during 2022 (p 0.05). Of the emergency admissions 11 were operated during the no covid period in 2019, 14 during 2020, 29 during 2021, 6 during 2022. Conclusions: The contraction of hospitalizations for urgent and emergency conditions during the first lockdown has been accompanied by positive implications. The measures employed in hospitals to contain the infection determined a reduction in COVID cases, allowing the nearly complete resumption of the surgical activity provided in the pre-COVID era.

Tube Duodenostomy to Treat Large Duodenal Perforation: Our Experience and Literature Review.

Background: Duodenal perforation is a life-threatening condition and ideal approaches for the management of duodenal perforations are nowadays unclear, so numerous variables must be considered. Peptic ulcer disease is the most common disease determining a duodenal perforation, however, there may be other less common causes. Methods: We retrospectively analyzed all the patients who presented at our Division of General Surgery for a Duodenal Perforation, from September 2018 to December 2019. We focused on patients requiring a tube duodenostomy. Five patients were included in this study. Results: Five patients suffering from a duodenal perforation were analyzed and their data collected. All patients were treated with tube duodenostomy, pyloric exclusion and omega loop gastro-enteroanastomosis. The duodenostomy was removed four weeks after surgery. All patients suffered postsurgical complications ranging from wound infection to pneumonitis; the incidence of severe complications was greater in the older patients. We did not record any deaths four months after the operation. Conclusions: The tube duodenostomy is an old and dated procedure but simple to implement, which may require an increase in post-operative hospitalization, but which subsists as an effective and safe way to treat patients in critical conditions.

Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy.

Bleeding after total thyroidectomy remains a rare event that affects early postoperative morbidity, occurring in 0.3% to 4.2% of cases. Intraoperative bleeding is an unpleasant complication, and it is often easily manageable, although postoperative bleeding may represent a life-threatening condition for the patient. The purpose of our study was to clarify the role of the Valsalva manoeuvre to reduce postoperative bleeding. Between January 2019 to February 2022, 250 consecutive patients were listed for thyroid surgery at our surgical department. The study cohort consisted of 178 patients, divided into two groups based on the execution of the Valsalva manoeuvre. There was no difference in the duration of surgery between groups. Group B had fewer reinterventions for bleeding. Group A had a significantly greater volume of drainage output than Group B. Cervical haematoma can compromise a patient's life, so bleeding control is crucial. Our results show that using a simple and safe Valsalva manoeuvre can improve the postoperative course with a significant reduction in drainage output, but does not prevent the risk of reoperation for hemorrhage.

Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?

BACKGROUND: Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula. MATERIALS AND METHODS: 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His. RESULTS: In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group. CONCLUSION: Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated.

Bariatric surgery: to bleed or not to bleed? This is the question.

BACKGROUND: Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in 1.3-1.7% of bariatric surgeries. MATERIALS AND METHODS: We examined patients undergoing Bariatric Surgery from July 2017 to June 2020 (Group A) and those operated from July 2020 to June 2022 (Group B) in our Department. Starting from July 2020 we have implemented intraoperative measures to prevent postoperative bleeding, increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneal pressure of CO2 to 8 mmHg in the last 15 min of the operation. RESULTS: The study gathered 200 patients divided into the two described groups. The mean age of Group A is 44 ± 8.49 and 43.73 ± 9.28. The mean preoperative BMI is 45.6 kg/m2 ± 6.71 for Group A and 48.9 ± 7.15 kg/m2 for Group B. Group A recorded a mean MAP of 83.06 ± 18.58 mmHg and group B a value of 111.88 ± 12.46 mmHg (p value < 0.05 and z-score is 4.15226 and the value of U is 13,900). We observed 9 cases of bleeding in group A, most of them being treated with medical therapy and transfusions; only 1 hemodynamically unstable patient underwent re-laparoscopy. We reported only 2 cases of bleeding in group B, one of which required blood transfusions. CONCLUSION: From our study we can conclude that increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneum pressure of CO2 to 8 mmHg in the last 15 min of the operation led to a decrease in bleeding cases in group B and, most importantly, all the bleedings were easily controllable with medical therapy and/or transfusions. These measures allowed us to reduce postoperative bleeding.

Lifestyle in Obese Individuals during the COVID-19 Pandemic.

BACKGROUND: Stay-at-home orders in response to the Coronavirus 2 (SARS-CoV-2) pandemic have forced abrupt changes to daily routines. The aim of this study is to describe the behavior of lifestyles of individuals with obesity on the waiting list for bariatric surgery in the Department of Medical and Surgical Sciences of University of Foggia during the COVID-19 pandemic. MATERIALS AND METHODS: From June 2020 to December 2020 an online survey format was administered to all the patients (n = 52) enrolled for bariatric surgery subjects with obesity, to obtain information about the COVID-19 pandemic's impact on patients with obesity starting 9 March 2020 until 18 May 2020. RESULTS: Our data showed that 58% of patients stated that the pandemic negatively affected their mood, 60% of patients confirmed that they changed their dietary behaviors during the stay-at-home period, as they consumed more unhealthy foods or spent less time cooking home cooked meals. In addition, 71% of patients stated that the closure of the gyms worsened their obesity condition and their mental well-being with an increase of a feeling of anxiety. CONCLUSIONS: Results showed that the COVID-19 pandemic has had a significant impact on health behaviors, including quality of life, mental health physical activity, weight maintenance, and consumption of sweets in obese patients.

Emergency Surgery for Colon Diseases in Elderly Patients-Analysis of Complications, and Postoperative Course.

Background and Objectives: Colon diseases can turn in a clinical emergency with the onset of some important complications. Some critical conditions are more common in aged patients because they are frailer. The aim of this study is to examine patients over 80 years of age who are undergoing emergency colorectal surgery, and evaluating the aspects associated with post-operative complications and other problems in the short term. Methods: From November 2020 to February 2022, we included 32 consecutive patients older than 80 undergoing emergency surgery due to colon diseases. We collected and analysed all demographic and operative data, and then applied CR-POSSUM score and correlated this with postoperative hospital stay and the onset of postoperative complications according to the Clavien Dindo classification. Results: Postoperative factors were selectively evaluated based on the clinical scenario and different colic pathologies. There were no statistically significant differences, in terms of postoperative hospital stay, postoperative complications, reoperation rate and 30-day mortality. The number of cases of blood transfusions was significant and was more numerous in cases of intestinal perforation and bleeding cases. The value of the Operative Severity Score in bowel perforations was significantly higher. Conclusions: The use of a score to stratify the risk is a useful tool, especially in elderly patients undergoing emergency surgery. The CR-POSSUM score was important for predicting morbidity in our study. Emergency manifestations of colon diseases in the elderly show higher morbidity and mortality rates. The effect of age on outcome is a concept that needs to be emphasized, so further investigation is needed.

Leak after sleeve gastrectomy with positive intraoperative indocyanine green test: Avoidable scenario?

BACKGROUND: The staple line gastric leak (GL) is estimated to be the most serious complication of the sleeve gastrectomy. The use of indocyanine green (ICG) has been introduced in minimally invasive surgery to show the vascularization of the stomach in real time and its application to the gastroesophageal junction (GE) during Laparoscopic Sleeve Gastrectomy (LSG) seems very promising. CASE PRESENTATION: We present the case of a 40-year-old female underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine green test showed a small dark area in the proximal third of the staple line reinforced with fibrin glue. Two weeks later the patient presented to the emergency room (ED) with abdominal pain, fever, vomiting, intolerance to oral intake and the evidence of a leak on the abdomen Computer Tomography (CT). The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05337644 for the Organization UFoggia. CONCLUSIONS: This case report shows that intraoperative ICG test can be helpful in determining which patients are at greater risk of the leak and, more importantly, the cause of the leak but further tests are needed to determine if the ICG predicts leak due to ischemia.

Banded versus non-banded sleeve gastrectomy in obese patients: A systematic review & meta-analysis.

BACKGROUND & AIMS: Weight regain represents an important issue after sleeve gastrectomy (SG), hence banded sleeve gastrectomy (BSG) was proposed. Aim of this meta-analysis was to compare the performance ofBSG versus SG in obese patients. METHODS: We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized-controlled trials (recruiting673 patients). The primary outcome was % excess weight loss (%EWL); secondary outcomes included % total weight loss (%TWL), HbA1c improvement, overall complication and major complication rate, gastro-esophageal reflux disease (GERD)occurrence. We performed pairwise meta-analysis through a random effects model and expressed data as standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI). RESULTS: A sharp decline in %EWL at 1 year was observed with both treatments with no significant difference (SMD 5.99, -1.17 to 13.16), whereas a clear benefit with BSG over SG was observed over time (SMD 15.95, 13.31 to 18.58 at 2 years; 18.37, 13.31 to 23.42 at 3 years; 24.75, 22.38 to 27.12 at 4 years; 29.85, 27.22 to 32.49 at 5 years). Meta-regression did not find any significant correlations between age, sex, and baseline BMI with %EWL. Similarly, no difference in terms of %TWL was observed at 1 year (SMD 1, -3.31 to 5.30), whereas the magnitude of the benefit with BSG increased significantly from the second year onwards (SMD 5.99, 3.7 to 8.27 at 2 year, 6.86, 5.13 to 8.59 at 3 year, and 9.36, 7.07 to 11.65 at 5 year). No difference in terms of HbA1c improvement was observed (SMD 0.40, -0.64 to 1.43). No difference in overall complication (OR 1.44, 0.55-3.76), major complications (OR 1.14, 0.52-1.87), and incidence of GERD was observed (OR 1.06, 0.56-2). CONCLUSION: BSG is superior to SG in obese patients, due to its ability to significantly increase %EWL with no additional safety issues.

The new onset of GERD after sleeve gastrectomy: A systematic review.

Background: The main adverse effect is gastroesophageal reflux disease (GERD), with concern on the development of Barrett's esophagus and esophageal adenocarcinoma in the long term. However, the relationship between SG and GERD is complex. The aim of this study is to systematically evaluate all published data existing in the literature to evaluate the effect of sleeve gastrectomy on GERD, esophagitis, BE in order to clarify the long-term clinical sequelae of this procedure. Materials and methods: This systematic review was conducted in accordance with the guidelines for Preferred Reporting Items for Systematic Review. The work has been reported in line with the PRISMA criteria [19]. We evaluated the quality and risk of bias of this Systematic Review using AMSTAR 2 checklist [20]. Published studies that contained outcome data for primary sleeve gastrectomy associated with the primary and secondary outcomes listed below were included. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05178446 for the Organization UFoggia. Results: 49 articles were eligible for inclusion that met the following criteria: publications dealing with patients undergoing laparoscopic SG, publications describing pre- and postoperative GERD symptoms and/or esophageal function tests, articles in English, human studies and text complete available. Conclusions: We have controversial data on LSG and GERD in the literature as there is a multifactorial relationship between LSG and GERD. The most recent studies have shown satisfactory control of postoperative reflux in most patients and low rates of de novo GERD. These data are leading to wider acceptance of LSG as a bariatric procedure even in obese patients with GERD.

Different Expression of Micro-RNA in the Subcutaneous and Visceral Adipose Tissue of Obese Subjects.

Obesity is a pathology characterized by an excessive accumulation of adipose tissue and it is a condition associated with complex alterations affecting different organs and systems. Obesity has great influences on cardiovascular and respiratory morbidity and mortality, and impairs the multiple aspects of metabolism. Since micro-RNAs (miRNAs) are thought to play a role in the regulation of various pathological processes, in this complex framework, the investigation of these classes of noncoding regulatory RNA seems to be promising. Selected group of obese subjects was recruited. We analyzed the expression of seven miRNAs from obese adipose tissue supposed to have a role in the pathogenesis of cardiovascular and respiratory disease related to obesity and we compared it with the expression of the same miRNAs in a group of nonobese controls. In this study what emerged is miR-27b and miR-483 significant downregulation in subcutaneous adipose tissue from obese group compared with nonobese ones. For visceral adipose tissue, a significant decrease in miR-27b and miR-223 expression was observed in obese group. Moreover, a different expression of miR-26a and miR-338 in the obese group was found. Those findings could help the individuation of previously unknown key players in the development of different diseases usually associated with obesity, such as cardiovascular and pulmonary diseases. Clinical Trials.gov ID: Ref 17/CE/2014.

Relationship between residual gastric area and weight loss after sleeve gastrectomy: A Cohort study.

BACKGROUND: The aim of this study is to evaluate the impact of the actual size and area of the remnant stomach, as measured by Upper gastrointestinal tract radiography, on weight loss after sleeve gastrectomy. MATERIALS AND METHODS: From May 2017 to December 2019, 56 patients with morbid obesity were admitted to the Department of Medical and Surgical Sciences, University of Foggia and underwent laparoscopic sleeve gastrectomy. RESULTS: 56 patients underwent sleeve gastrectomy with a mean age of 43,5 ± 11 years of which 40 were female. The mean Excess Weight Loss (EWL) at 1 month was 24,09 ± 15,04%, at 6 months was 27,07 ± 19,55% and at 12 months was 69,9 ± 23,7%. The mean Excess Body Mass Index Loss (EBMIL) at 1 month was 23,1 ± 12,5%, at 6 months was 56,6 ± 19,7% and at 12 months was 69,7 ± 23,7%.The EWL % was correlated with the residual stomach area (RSA) at 1 month (r = -0,242 p = 0,072), at 6 months (r = -0,249 p = 0,064) and at 12 months (r = -0,451 p = 0,0005).The EBMIL % was correlated with the RSA at 1 month (r = -0,270; p = 0,043), at 6 months (r = -0,270; p = 0,043) andat 12 months (r = -0,46; p = 0,0004). CONCLUSION: A greater postoperative EWL % was correlated with a smaller RSA and this resulted in a statistically significant change at 12 months after surgery.

Indocyanine green fluorescence angiography in parathyroidectomy for primary hyperparathyroidism.

INTRODUCTION: Primary Hyperparathyroidism (PHPT) is a systemic pathology caused by an excessive secretion of parathyroid hormone. Parathyroidectomy is the treatment of choice in PHPT, and the success of surgery is based on precise localization of the abnormal parathyroid gland. Preoperative diagnosis makes use of imaging techniques and functional examinations, however these are insufficient in some cases for the precise location of the pathological gland. Therefore the need arises for an intraoperative localization technique. MATERIALS AND METHODS: We have retrospectively analyzed 20 consecutive patients with PHPT undergoing parathyroidectomy from April 2019 to September 2021, and divided them in two groups, in base of the use of Indocyanine Green (ICG) fluorescence during the surgery. RESULTS: Of the twenty patients considered in the two groups, all received a preoperative ultrasound evaluation, while second level examinations were reserved for the more difficult cases, with small volume parathyroid adenomas. In the group where the fluorescence method was employed, fluorescence was especially useful in doubtful cases, allowing easier identification of the parathyroid adenoma and consequently a reduction of time and operatory risks. In two procedures using Indocyanine green, a fluorescence signal was weak. CONCLUSIONS: ICG represents a convenient and safe way to detect parathyroid adenomas. We found that ICG fluorescence was very useful in all patients with non-localizing preoperative imaging studies. However further investigation is needed, to demonstrate how ICGfluorescence could be a useful localization method during parathyroid surgery. KEY WORDS: Endocrine surgery, Indocyanine green, Parathyroid surgery.

Management of post-bariatric complications. Our Center experience and literature review.

Bariatric surgery is recognized as the most effective treatment for morbid obesity, maintaining a stable weight reduction in the long term and reducing comorbidities, with a favorable impact on mortality. The aim of this study is to evaluate the complication rate and treatment techniques adopted in all patients undergoing bariatric surgery procedures in our center. From May 2017 to March 2020, 91 patients with morbid obesity are admitted to the Department of Medical and Surgical Science of the University Hospital of Foggia undergoing bariatric surgery. Seventyone patients underwent sleeve gastrectomy, nineteen gastric bypass and one mini-gastric bypass, five of these were redo operation procedures. Regarding postoperative complications (8,8%), there were 1 gastric leak (1,09%), 4 bleedings (4,39%) - 1 intraluminal bleeding and 3 intra-abdominal bleedings, 2 port-sites infections (2,19%) and 1 haemoperitoneum (1,09%). In our center we have also treated 3 cases of complications after bariatric surgery procedures performed in others centers. There were no deaths. Despite improvement in the performance of bariatric surgical procedures, complications are not uncommon. Flexible endoscopy has become an essential tool in managing bariatric surgery patients and offers the benefit of providing both diagnostic and therapeutic applications. KEY WORDS: Bariatric surgery, Bleeding post-bariatric surgery, Complications bariatric surgery, Gastric bypass, Leak post-sleeve gastrectomy, Mini invasive approach, Sleeve gastrectomy.