"What Really Matters When Performing a Laparoscopic Roux-en Y Gastric Bypass?" Literature-Based Key Steps Towards Success and Standardization of the Procedure.

Lack of standardization in the Roux-en-Y gastric bypass (RY-GBP) is quite well established. We all learned the basics of the technique, but a lot of differences do exist in performing each step of the procedure. Based on scientific evidences, coming from an extensive and meticulous review of the literature of the last 20 years, we thus address the different technical steps of the procedure and their importance to try and propose a standardization of RYGBP. A lot of possibilities exist at each and every step of a RYGBP. They influence the postoperative complications, the end weight loss (EWL), weight regain, and resolution of obesity bounded comorbidities. Furthermore, lack of standardization leads to problems regarding comparison of scientific data in the related literature.

Is recurrence of varicose veins after surgery unavoidable?

Recurrence of varicose veins is a common problem. Four main reasons for recurrence are discussed: insufficient understanding of venous anatomy and haemodynamics, inadequate preoperative assessment, incorrect or insufficient surgery and development of new locations of superficial-to-deep insufficiency. Better insight in the variable anatomy of the venous system and better training of junior surgeons in this matter may improve the results of venous operations. Accurate preoperative assessment using (colour) duplex sonography should permit the surgeon to give the patient a differentiated, individualized treatment. Careful dissection of the saphenofemoral junction combined with additional stripping of the long saphenous trunk to just below the knee appears to be the best way to prevent recurrence from the long saphenous vein in the thigh. Concerning the short saphenous vein preoperative location of the exact level of the saphenopopliteal junction is of major importance in the prevention of recurrence. In this way, all diagnostic and surgical efforts should aim to minimize recurrence to about only 5% of patients.