IJGII Inernational Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012
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< PreviousNext >Int J Gastrointest Interv 2019; 8(1): 1~61
  • Greetings 2019-01-31

    Greetings from the Guest Editors

    Mariano E. Giménez, MD, PhD, FSIR, Eduardo Houghton, MD

    Cited By: 0

  • Editorial 2019-01-31

  • Review Article 2019-01-31

    Robotic surgery for liver, pancreas, and bile duct pathologies: A critical analysis and personal views

    Ronald Matteotti *

    Abstract : At the beginning of this millennium robotic surgery was launched and quickly became accepted in many surgical specialties. Initially only resection procedures were performed with a few surgical steps made towards reconstructive elements. Robotic surgery helped to overcome disadvantages seen and experienced when performing laparoscopic procedures, mainly lack of haptic feedback, lack of ‘free movement’ in the abdominal cavity and inferior visualization. Since its initiation, robotic surgery was utilized more and more in complex procedures. Its use in complex liver and pancreatic surgery is still controversial as it requires a high volume center and superb training to achieve acceptable results. Robotic surgery for hepato-pancreato-biliary disease is only performed by a few centers in the United States. A team approach is mandatory and the bed side assistant is as important as the console surgeon in achieving acceptable oncological outcome. This article aims to review the most recent literature and gives some personal views into the near future with anticipated development of this exciting technology.

    Cited By: 0

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  • Review Article 2019-01-31

    Complex percutaneous biliary procedures: Review and contributions of a high volume team

    Eduardo Houghton *

    Abstract : A comprehensive literature review was performed to evaluate the state of art and level of evidence of complex percutaneous biliary procedures and their safeness and effectiveness. Amidst those procedures, the review focused on techniques to achieve non-dilated biliary drainage, multiple self-expandable metallic stents, multiple plastic stents for the treatment of benign biliary strictures, simultaneous biliary and duodenal stent placement, rendezvous maneuvers, and use of magnets to treat biliary stenosis or even create new anastomosis with the jejunum or duodenum. A description of each technique and revision of literature provides useful tools for clinical practice decisions.

    Cited By: 1

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  • Review Article 2019-01-31

    From image-guided surgery to surgeOmics: Facing the era of intelligent automation and robotics

    Juan Manuel Verde , Mariano E. Giménez

    Abstract : Digital images do not represent anatomy, they are just a reliable translation from a full-colored and three-dimensional physical world to a grayscale and two dimensions image domain. As a consequence of the imaging technologies disruption in the medical field, a vertiginous “race to see” had been seeking higher definitions. This process got closer and even exceed human naked-eye resolution and the human brain skills to decode gray-scale bidimensional pictures. In the diagnostic field, as a result, the last decade showed important technological advances addressing this issue and computer-aided detection and diagnosis emerged to complement and enhance radiologist frameworks. In this new era methodologies designed to extract more information from images are a must. Radiomics addressed this item using images as datasets, focusing in the region of interest and extracting features, allowing reproducibility, and finally introducing radiology into the quantitative sciences. Technological disruption in medical imaging also found momentum in the therapeutics arena, empowering a bunch of audacious surgeons to perform less invasive procedures with more confidence and precision, finally launching and shaping the image-guided surgery (IGS) discipline. Here instead, there is no “use as data” counterpart and surgeOmics is the first proposed approach. A wide range of semantic and agnostic features can be extracted from the different phases of the IGS’s workflow, like entry point coordinates, angle, distance, target location, amongst the most important ones. In summary, we are coining the surgeOmics neologism to name this approach, which holds great promises to deal with future demands. It has the potential to improve surgeon-hardware interaction and its central hypothesis is that distinctive algorithms using images as data can provide valuable information for personalized and precision surgery in the era of robotics and intelligent automation. SurgeOmics has emerged from IGS, but can be applied to other wide range of medical problems.

    Cited By: 0

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  • Review Article 2019-01-31

    Gallbladder stones in bariatrics and management of choledocholithiasis after gastric bypass

    Mariano Palermo , Manoel Galvao Neto

    Abstract : It is known that the rapid weight loss is a predisposing factor to develop biliary lithiasis. The physiopathology is related with an oversaturation of bile with cholesterol, bile stasis, and increase in mucin concentration in bile. The incidence of cholelithiasis post gastric bypass is estimated around 37%. Almost 50% developed disease in the first year of monitoring, and 60% in the first 6 months. Meanwhile the patients undergoing sleeve gastrectomy have an incidence of cholelithiasis of 27%. Diverse kinds of protocols exist: prophylactic surgery (simultaneous cholecystectomy and gastric bypass in every patients, whether they have or not cholelithiasis), elective (simultaneous cholecystectomy with conventional gastric bypass in the patients with asymptomatic cholelithiasis), and conventional cholecystectomy only in the presence of cholelithiasis with symptoms. Which way to go is still a topic of discussion among surgeons but the majority agree that prophylactic surgery shouldn’t be an option because the number of patients that will develop symptomatic cholelithiasis is low (around 6% to 8% of them) and this leads to an elevated number of patients exposed to an unnecessary procedure with potential complications. The presence of gallstones in the common bile duct (CBD) although is a rare complication after Roux-en-Y gastric bypass (around 0.2% of the bariatric patients) represents an important challenge due to the anatomical modifications of the gastrointestinal tract. This leads to having to pursue other methods to reach the papillae for the resolution of choledocholithiasis: laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), balloon enteroscopy assisted ERCP, percutaneous biliary drainage with subsequent trans fistula treatment and laparoscopic exploration of CBD. Which of these methods should we choose must be based on the surgeon experience, the equipment available and the location of the stone. But whatever the method, a special training is needed on endoscopy, percutaneous surgery and laparoscopy.

    Cited By: 5

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  • Original Article 2019-01-31

    Suprapubic single-incision laparoscopic right colectomy with complete mesocolic excision, lateral-to-medial approach and intracorporeal anastomoses

    Giovanni Dapri , Kelly Ann Bobb, Ernesto Jesús Barzola Navarro, Angel Arabadzhiev

    Abstract : Background Single-incision laparoscopic right colectomy (SILRC) has been reported in 2008, and since that time an increased number of reports appeared in literature. Currently, it remains popular between the centers with achieved experience. Adoption of suprapubic access, instead of umbilical or other access-sites, allows to enhance the final cosmetic outcomes, together with the realization of complete mesocolic excision (CME) and intra-corporeal anastomosis (ICA). Methods Between January 2016 and August 2018, 20 patients (10 females, 10 males) were submitted to suprapubic single-incision laparoscopic right colectomy (SSILRC) for adenocarcinoma. Mean age was 74 years and mean body mass index was 24 kg/m2. Sixteen patients have already been submitted to open abdominal surgery. Results Mean total operative time was 233.9 minutes and mean laparoscopic time was 199.4 minutes. Mean time for ICA was 34 minutes. Mean blood loss was 279.5 mL. One additional 5-mm trocar was necessary in 1 patient (5.0%). Mean length scar was 60.5 cm. Mean hospital stay was 7.8 days. A minimal use of pain killers was registered postoperatively. Mean number of lymph nodes retrieved was 24.5. Early complications were one suprapubic abscess and one suprapubic hematoma. No late complications, including suprapubic incisional hernia, were achieved. Conclusion Since the specimen has to be removed from the abdomen after conventional laparoscopic right colectomy, the suprapubic access can be an option. SSILRC allows to join the surgical procedure, the specimen’s removal and the enhanced cosmetic results through the same access. Other advantages are the CME, the ICA, the reduced postoperative pain, and the decreased incisional hernia’s rate.

    Cited By: 0

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  • Case Report 2019-01-31

    Percutaneous-transhepatic creation of a bilioenteric neoanastomosis in a patient with bile duct injury using cone-beam computed tomography

    Nathan Wnuk , Ana Maria Pabon-Martinez, Armeen Mahvash, Gouthami Chintalapani, Thomas A. Aloia, Bruno C. Odisio

    Abstract : We describe the creation of a percutaneous transhepatic bilioenteric neoanastomosis with the aid of cone-beam computed tomography (CBCT) in a patient suffering from a complicated bile leak after extensive hepatobiliary surgery. Access to the afferent bowel limb was safely performed in a single-stick manner via transhepatic approach with the aid of real-time navigation fluoroscopic imaging generated by CBCT arteriography. CBCT confirmed access of the afferent limb and absence of peri-anastomotic vessel damage, allowing the successful creation of a bilioenteric neoanastomosis, resolving the patient’s biliary leak. The patient is alive and asymptomatic at 12-month follow-up, demonstrating patency of the percutaneous bilioenteric neoanastomosis.

    Cited By: 3

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  • Case Report 2019-01-31

    Minimal invasive treatment of biliary leak after laparoscopic cholecystectomy

    Pablo Agustin Acquafresca

    Abstract : The laparoscopic cholecystectomy has become one of the most common operations for treatment of symptomatic gallbladder disease. However significant postoperative biliary duct injuries can occur, leading to biliary leaks. Here we present a case where multiple abdominal collections are detected in a 64-year-old male patient who underwent laparoscopic cholecystectomy due to gallbladder stones two weeks prior. Percutaneous drainage under computed tomography guidance is implemented to treat the collections which result to be bilomas. After controlling the leak, an endoscopic retrograde cholangiopancreatography with papillotomy and stent placement is performed believing that the problem was settled in the cystic duct. But after observing that the leak increased with this treatment, an anatomical variation is suspected. A percutaneous transhepatic cholangiography is performed which confirm the diagnosis. In case of any deviation of a normal surgical post operatory, a biliary leak must be suspected. Surgeons nowadays must be trained in different diagnosis and treatment methods.

    Cited By: 0

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  • Case Report 2019-01-31

    Migratory fish bone: Mini-invasive Image guided treatment

    Edgardo Serra , Sarita Almirón, Guillermo Árnica, Juliana Harfuch, Mariano E. Giménez

    Abstract : Although the frequency of ingested foreign bodies is high, Penetration and migration is a rare and dangerous condition, with possible lethal complications. We report an infrequently case of migratory fish bone in the neck, treated with mini-invasive image guided surgery.

    Cited By: 0

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