Peripheral neuropathies after bariatric surgery. Preliminary results from a single-centre prospective study in Northern Italy.

INTRODUCTION: Bariatric surgery (BS) has gained popularity in order to treat morbid obesity. However, post-operative (PO) neurologic complications have become increasingly recognized. Our aim was to examine incidence, clinical presentation, and outcomes of neurologic disorders secondary to BS. METHODS: Patients who underwent BS between the years 2012 and 2015 at Parma University were included in this survey, and assessed before (T0) and 1 year after surgery (T1). Baseline characteristics and medical comorbidities, type of surgery, and PO complications were retrieved. Patients with a previous history of peripheral neuropathic disease were excluded from the analysis. If a patient presented with a new onset neurologic symptom including extremity numbness, paresthesia, muscle weakness, the status was considered "positive" for PO-neuropathy. RESULTS: Overall, we retrieved data from 61 patients (n=30 Roux-en-Y Gastric bypasses, n=31 Gastric banding; 81.0% females). Of them, 7 (11.4%) developed some signs of PO-neuropathy, that eventually disappeared at T+24 months. The most common manifestations were paresthesia (n=6) and muscle weakness (n=4), similarly distributed in Gastric Bypass (n=4) and Gastric Banding (n=3) groups. Although patients affected by PO-neuropathy exhibited higher SF-36 score at T0 (p=0.018), no significant differences were found regarding BMI (T0, T1), percentual weight loss, serological data (i.e. vitamin B1, B2, B6, B12: in all cases p>0.05). CONCLUSION: PO-BS neuropathy is usually associated with lower levels of vitamin B1, B2, B12. However, no differences in PO-BMI, excess weight loss, and metabolic data levels were found. Larger data and more extended follow-up are required to validate our results.

Minimally invasive esophagectomy for caustic ingestion after 73 years and over 200 endoscopic dilations: is it just a matter of time?

Refractory esophageal strictures are a common sequela of caustic ingestion. If endoscopic dilation becomes ineffective, esophagectomy represents the only therapeutic option. The minimally invasive approach, specifically the thoracoscopic access in prone position, may allow postoperative morbidity to be reduced. We present the first case described in the Literature of minimally invasive esophagectomy in prone position for a long-term failure of endoscopic dilation after caustic ingestion.

Late surgical complications of subtotal colectomy with antiperistaltic caeco-rectal anastomosis for slow transit constipation A critical analysis.

PURPOSE: Despite a good percentage of success, mainly related to the amelioration of patient selection, surgery for slow transit constipation still presents failures and late complications, often unpredictable, and sometimes related to technical variants. The aim of the study is to critically analyze late surgical complications of subtotal colectomy with caeco-rectal anastomosis (SCCRA), examining the peculiar risks of the procedure and possible prevention measures. METHODS: Follow-up data of 43 compliant patients submitted to SCCRA at our Institution were reviewed. Patients undergoing further surgery for a complication clearly related to SCCRA at our centre were included. RESULTS: We identified three late surgical complications (7%): a caecal distension, an ileo-caecal volvulus and an ileal volvulus. all patients were successfully treated. an evident predisposing condition was found only in the first case. CONCLUSIONS: Peculiar long term complications related to the presence of a dysfunctional or mobile caecal stump may be prevented by careful patient selection and surgical technique. KEY WORDS: Constipation, Complication, Caecal distension, Ileo-caecal volvulus, Subtotal colectomy.