Foregut caustic injuries: results of the world society of emergency surgery consensus conference.

INTRODUCTION: Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. PURPOSE OF THE STUDY: The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. METHODS: An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). RESULTS: One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. CONCLUSIONS: The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.

Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients.

BACKGROUND: This study aims to evaluate the 12-24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease. METHODS: A systematic review and meta-analysis of prospective interventional studies reporting the most commonly performed laparoscopic surgical procedures, i.e., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and cardiovascular risk reduction after surgery. RESULTS: The bibliographic research conducted independently by two authors yielded 18 records. When looking at RYGB and AGB separately, we observed a relevant heterogeneity (I (2) index ≥87 %) when BMI reduction was considered as the main outcome. When hypertension, type II diabetes, and hyperlipidemia risk reduction was estimated, a highly significant beneficial effect was found. The risk reduction was 0.33 [0.26; 0.42] for type II diabetes, 0.52 [0.42; 0.64] for hypertension, and 0.39[0.27; 0.56] for hyperlipidemia (P < 0.0001 for all outcomes considered). When looking at surgical technique separately, a higher but not statistically significant risk reduction for all outcomes considered was found. Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction. CONCLUSIONS: The present study showed an overall reduction of cardiovascular risk after bariatric surgery. According to our analysis a BMI reduction of 5 after surgery corresponds to a type II diabetes reduction of 33 % (as reported by Peluso and Vanek (Nutr Clin Pract 22(1):22-28, 2007); SAS Institute Inc., (2000-2004)), a hypertension reduction of 27 % (as reported by Buchwald and Oien (Obes Surg 23(4):427-436, 2013); Valera-Mora et al. (Am J Clin Nutr 81(6):1292-1297, 2005)), and a hyperlipidemia reduction of 20 %(as reported by Adams et al. (JAMA 308(11):1122-31, 2012)); Alexandrides et al. (Obes Surg 17(2):176-184, 2007). In summary, our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients.

[Intestinal carcinoid tumours: personal experience and a review of the literature]. / I carcinoidi intestinali: esperienza personale e revisione della letteratura.

The observation of a number of cases of intestinal carcinoid tumours prompted the authors to review the literature in order to define the principal biological and anatomopathological aspects and the current therapeutic choices. The diagnosis is often obtained on the basis of anatomopathological examination. The kind of surgical treatment is still a matter of controversy: minimal or extended resection? A number of criteria may orient the surgeon towards major surgery, such as tumour size, node involvement, infiltration of the serous membrane, and liver metastases.