What makes a gastric bypass a good gastric bypass? Opinion and hypothesis

Gastric bypass is widely accepted as the gold standard bariatric operation. It was first reported 1967 and has been the subject of many technical alterations and variations since that time. Each of these variations has the potential to confer different outcomes, in terms of such things as weight loss, ease of surgery, risk, complications and durability of weight loss. All variations being performed these days should be accomplished with high levels of safety, in which case the primary interest of those undergoing surgery is the degree of weight loss that can be expected and the durability of that weight loss. Broadly speaking these two features will also determine the degree to which all co-morbidities are improved, which is also a goal of those undergoing surgery. In this article the authors describe the features of the Fobi Pouch gastric bypass which make it the most predictable and reliable variant of gastric bypass and report such evidence in the literature as exists for their contentions.

Current concepts of laparoscopic splenectomy in elective patients

Formerly, open splenectomy represented the conventional surgical treatment for many hematologic diseases. Currently, thanks to permanent technical development and improved skills, also laparoscopic splenectomy (LS) has become a recognized procedure in the treatment of spleen diseases, even in case of splenomegaly. A systematic review was performed with the aim of recalling the proved concepts of this surgical treatment and to browse new devices and techniques and their impact on the surgical outcome. The literature search was initially conducted in PubMed by entering general queries related to LS. The record identified through PubMed searching (n = 1599) was then screened by applying several criteria (study published in English from 1991 to 2013 with abstract available, by excluding systematic/non-systematic reviews, meta-analysis, practice guidelines, case reports, and study involving animals). The articles assessed for eligibility (n = 160) were primarily evaluated by excluding studies that did not report operative time and conversion to open surgery. For articles that treated multiport LS we included only clinical trials with patients > 20. The studies included in qualitative synthesis were 23. The search strategy carried out in PubMed does not allow to obtain an overview of the items returned by the main queries. With this aim we replicated the search in the Web of Science^TM database, only including the studies published in English in the period 1991-2013 with no other filter/selection criteria. The full records (n = 1141) and cited references returned by Web of Science^TM were analyzed with the visualization of similarities (VOS) mapping technique. Maps of title/abstract text corpus and bibliographic coupling of authors obtained by applying the VOS approach were presented. If in normal-size or moderately enlarged spleens the laparoscopic approach is unquestionable, in massive splenomegaly the optimal technique remain to be determined. In this setting, prospective randomized trials to compare open vs LS are needed. Between the new techniques of LS the robotic single port splenectomy has the ability to join all the positive aspects of both techniques. Data about this topic are too initial and need to be confirmed with further studies.

Outcomes of continuous flow ventricular assist devices

Heart transplantation is commonplace, the supply is limited. Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the axial flow pump. Left ventricular assist device (LVAD) therapy is ever evolving. As the use of LVAD therapy increases it is important to understand the indications, surgical considerations and outcomes.

Notaras procedure for incarcerated rectal prolapse

Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.

Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis

Alveolar echinococcosis (AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis (E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography (US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography (CT), magnetic resonance imaging (MRI), including magnetic resonance cholangiography (MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.

Review of (acquired) incidental, rare and difficult tracheoesophageal fistula management

Acquired benign tracheoesophageal fistula is a rare condition and a difficult problem. The rarity and unpredictable presentation of this condition makes the design and setting of randomized prospective trials impossible. Guidelines on this matter are also difficult to establish. Based on a comprehensive evaluation of published literature and their experience, the authors review the etiology and best options for treatment, either surgical and non surgical, according to present knowledge.

Intraperitoneal drains during open appendicectomy for gangrenous and perforated appendicitis

Intra-abdominal drains are still routinely used in the surgical management of gangrenous and perforated appendicitis. A systematic review was performed with the aim of establishing their influence on postoperative complications in such cases. A literature search was conducted using the search engines PubMed and Cochrance Central Register of Controlled Trials. Included were retrospective case-controlled and prospective randomized controlled trials on the use of drain for open appendicectomy in gangrenous and perforated appendicitis. Twelve articles were found that met the inclusion criteria. Intrabdominal abscesses, postoperative ileus, surgical site infections, fecal fistulas and burst abdomen had significant higher incidences in the drain vs non drain group (10.3%, 20.3%, 32.5%, 3.4% and 5.7% vs 4.7%, 8.5%, 16.2%, 0% and 0%, respectively). In most cases the risk was more than doubled in the drain group compared to the non-drain one. There were no significant differences among groups in terms of mortality while the results were underpowered to effectively evaluate wound dehiscence and adhesions. The use of intra-abdominal drains in the management of gangrenous and perforated appendicitis by open appendicectomy is associated with an increased rate of common postoperative complications.

Operative indications of follicular type tumors, based on Japanese clinical guidelines

AIM: To investigate the accuracy of preoperative examinations in follicular type tumors, we re-evaluate results of our operative cases.

METHODS: Cases are follicular neoplasms in 36 patients, which are more than 30 mm in diameter and underwent surgery in our hospital in 2005-2006. These cases had been suspected of malignancy on one or more of the preoperative examinations, including ultrasound (US), thallium-technecium (Tl-Tc) scinitigram, computed tomography (CT), or fine needle aspiration biopsy (FNA) examinations. Concern about operative procedure, lobectomy plus sentinel lymph node biopsy (SNB) was performed in all 36 follicular tumors at the first surgery. Because we can diagnose a suspected follicular tumor as carcinoma and can change the operative procedure intra-operatively, when the metastasis of lymph nodes, outside of the thyroid, is found. The operative procedure was changed from lobectomy to total thyroidectomy plus lymph nodes dissection (central component), when the SNB has metastasis. All thirty six cases were obtained to track the prognosis until 2012, for 6-7 years follow up periods.

RESULTS: The final pathological results are 3 cases of follicular carcinoma, 6 cases of papillary carcinoma, 1 case of papillary carcinoma follicular type, 1 case of malignant lymphoma, 16 cases of follicular adenoma, and 9 cases of adenomatous goiter. The malignant tumor were observed in 11/36 (30.6%) cases. All six papillary carcinomas were less than 20 mm, and present with follicular adenoma and adenomatous goiter, which have more than 40 mm diameter. In physical examination, tumor size of 36 cases of follicular neoplasm is more than 30 mm all at the time of surgery. The tumors were palpable somewhat stiff, such as no cystic component in 34 cases. Occasional dyspnea, dysphagia, and cough was accompanied in all 36 cases. The true ratio of correct diagnosis of preoperative US, Tl-Tc scinitigram, CT, and FNA were 17/36 (47.2%), 16/36 (44.4%), 24/36 (66.7%), 21/36 (58.3%), respectively. In 11 malignant cases, there was one SNB positive case (one lymph node metastasis in 3 SNB: 1/3). This case was changed the operative procedure from lobectomy to total thyroidectomy plus lymph node dissection (central component). There is other lymph nodes metastasis in dissected lymph nodes (4/15). For the remaining malignant 10 cases, the observations were selected without additional resection, because surgical margins and SN were negative in postoperative pathology results at the first operation. No recurrence and metastasis are allowed in 11 malignant cases, up to 7 years after post-operation. Over all, the more than 30 mm in diameter follicular neoplasms, which were suspected the malignancy in the one and more preoperative examinations, are present the malignancy by pathological diagnosis in 11/36 (30.6%) cases after surgery. The non SNB metastasis cases had no symptoms of lymph nodes metastasis up to 7 years after post-operation.

CONCLUSION: We think that more than 30 mm in diameter follicular neoplasms are considered as candidates of surgery from our results.

Platelet therapy: A novel strategy for liver regeneration, anti-fibrosis, and anti-apoptosis

Platelets contain bio-physiological substances, including insulin-like growth factor-1, vascular endothelial growth factor, platelet-derived growth factor, hepatocyte growth factor, serotonin, transforming growth factor-β, adenosine diphosphate, adenosine tri-phosphate, and epidermal growth factor. Platelets have conventionally been considered to exacerbate the inflammatory response and liver injury. Recently, platelets were discovered to have a positive impact on the liver. In this review, we present experimental and clinical evidence indicating that platelets accelerate liver regeneration and have anti-fibrosis and anti-apoptosis activity, and we detail the mechanisms of action. Platelets accelerate liver regeneration by three different mechanisms: (1) a direct effect on hepatocytes, (2) a cooperative effect with liver sinusoidal endothelial cells, and (3) a collaborative effect with Kupffer cells. Platelets exert anti-fibrotic activity by deactivating hepatic stellate cells via the adenosine-cyclic adenosine 5’-monophosphate signaling pathway. Platelets prevent hepatocyte apoptosis by activating the Akt pathway and up-regulating Bcl-xL, which suppresses caspase-3 activation. Platelet therapy with thrombopoietin, thrombopoietin receptor agonists, and platelet transfusion has the advantages of convenience and cost-efficiency over other treatments. We propose that in the future, platelet therapy will play a promising role in the treatment of the various liver disorders that currently challenge the surgical field, such as liver failure after a massive hepatectomy, hepatectomy of a cirrhotic liver, and small grafts in liver transplantation.

Retroileal trans-mesenteric colorectal anastomosis

Colorectal anastomosis after extended left colectomies may result difficult, and, sometimes, impossible due to the shortness of the vascular pedicles and the distance between the two ends. Total colectomy with ileo-rectal or ileo-anal anastomosis with sacrifice of healthy colon and ileocaecal valve is usually preferred to overcome this problem. In this manuscript we describe the step-by-step surgical technique of retroileal transmesenteric colorectal anastomosis which can be used as a salvage technique for both open and laparoscopic surgeries. We also discuss the advantages and disadvantages of this approach compared to other techniques. We believe that the widespread of laparoscopic colorectal surgery as well as the raising volume of metachronous colorectal resections will revive this vintage overlooked approach.

Epidermoid cyst of intrapancreatic accessory spleen: A case report and literature review

Epidermoid cyst of intrapancreatic accessory spleen is exceedingly rare; only 30 new cases have been reported in the English literature over the last 30 years. An accurate preoperative diagnosis was made in almost none of them because of the lack of reliable preoperative diagnostic methods. In this report, we present a case diagnosed with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). A 41-year-old female who had breast cancer was routinely followed up by measuring the concentration of tumor makers. An increasing level of serum carbohydrate antigen 19-9 was detected and a cystic lesion located at the tail of pancreas was found by ultrasonography. A whole body fluorine-18 FDG positron emission tomography was performed because of a high suspicion for either a malignancy of the pancreas or a recurrence of breast cancer. No increased uptake of FDG was noted and therefore the cystic lesion was considered as pancreatic benign disease. Because pancreatic malignancy could not be entirely ruled out, distal pancreatectomy and splenectomy were performed. The final pathological diagnosis was epidermoid cyst of intrapancreatic accessory spleen (ECIAS). The FDG-PET findings matched the histopathology. A literature review reveals that the common clinical manifestations of ECIAS include asymptomatic findings on clinical examination, an occasional increase in tumor makers on laboratory results and occurrence only in the pancreatic tail. It is often misdiagnosed due to its extreme rarity and lack of a specific radiographic sign. There is no evidence of malignancy in ECIAS. Open or laparoscopic spleen preserving distal pancreatectomy is the minimally invasive procedure that would provide the best surgical management for epidermoid cyst of intrapancreatic accessory spleen.

Back to basics: A meta-analysis of stump management during open appendicectomy for uncomplicated acute appendicitis

AIM: To compare simple ligation vs stump invagination during open appendicectomy for uncomplicated acute appendicitis on the risk of postoperative complications.

METHODS: A meta-analysis was conducted on randomised controlled trials comparing the two stump closure methods in open appendicectomy. Databases searched were PubMed, EMBASE and Cochrane Library databases. Included were those studies focusing on inflamed and suppurative appendicitis while perforated and gangrenous appendix was excluded. We also excluded retrospective case-control studies, commentaries, historical technical articles, or trials involving laparoscopic appendicectomies. The outcome of the meta-analysis was to find eventual differences in the incidence of postoperative ileus and wound infections between the two techniques of stump invagination.

RESULTS: Seven studies were included corresponding to 1468 patients. Postoperative complications consisted in wound infections (7%), ileus (4%), pyrexia (2%), vomiting (1%), obstructions from adhesions (0.1%). No cases of peritonitis, fecal fistulas (stump leaks), abdominal abscesses or wound dehiscences were reported. Postoperative ileus within the first 72 h was four times more frequent with stump invagination compared to simple ligation (OR: 4.06; 95%CI: 2.14-7.70; P < 0.0001). No significant differences were noted for wound infections (OR: 1.24; 95%CI: 0.83-1.87; P = 0.30) while for the remaining complications the incidence was extremely low in both groups. There was a high homogeneity on results (Q value for heterogeneity of postoperative ileus P = 0.17; Q value for heterogeneity of wound infections P = 0.98).

CONCLUSION: Stump invagination does not seem to prevent infective complications but is associated with an increased risk of postoperative ileus in uncomplicated cases. Appropriate studies on complicated appendicitis should now evaluate the influence of the two techniques in this higher-risk subgroup.

Treatment of cervico-mediastinal goiters

AIM: To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.

METHODS: From January 2000 to December 2009, of 1530 patients who underwent thyroidectomy in our department, we selected 105 cases of cervico-mediastinal goiter. In the majority of cases, the cervical approach is the standard procedure and only occasionally sternotomy or thoracotomy is necessary. The indications for surgery are generally related to a progressive increase of the thyroid mass into the anterior mediastinum with compression and dislocation of the trachea or esophagus and the possibility of an unknown malignancy.

RESULTS: In 98 (93.3%) of our 105 patients, the standard surgical approach was anterior cervicotomy followed by total thyroidectomy. In three cases, total sternotomy was performed and in the remaining four patients, a partial split sternotomy was effective to remove the intrathoracic mass. Post-operative complications included transient recurrent laryngeal nerve palsy in 6 patients (5.7%) which only became permanent in 2 patients (1.9%). The transient hypoparathyroidism rate was 22% but 2 mo after surgery permanent hypoparathyroidism was confirmed in only 2% of our selected group. No patients required temporary tracheostomy following surgery related to a possible bilateral nerve palsy. Patients received a single prophylactic antibiotic dose preoperatively and wound infections were not significant. There was no mortality in our selected group and most patients showed a significant improvement of dyspnea and other correlated symptoms postoperatively.

CONCLUSION: The majority of cervico mediastinal goiters can be completely removed through a cervical incision. In selected cases, generally malignancies with local infiltration of mediastinal soft tissues and adhesions to large vessels, split sternotomy may be a safer approach to not increase morbidity.

Screening for colorectal neoplastic lesions following acute diverticulitis: Would a sigmoidoscopy suffice?

AIM: To investigate the yield of colorectal malignant or premalignant lesions during colonoscopy performed following an episode of acute diverticulitis.

METHODS: A prospectively maintained electronic database of a public teaching hospital (Modbury Hospital, South Australia) was searched for international classification of diseases codes for acute diverticulitis from July 2007 to June 2011. The electronic database and each patient’s medical records were reviewed for demographic data, clinical presentation, investigation results, colonoscopy details and surgical intervention.

RESULTS: Two hundred and nineteen patients were diagnosed with acute diverticulitis with a median age of 60 years (range 24-93). One hundred and thirty-nine patients (63.5%) had follow-up screening colonoscopy, with the median interval between the episode of acute diverticulitis and colonoscopy being 8 wk (range: 1-66). Colonoscopy revealed polyps in 21 patients (15%) and no cases of colorectal cancer. Of the 21 patients with polyps, there were 14 patients (10%) with tubular/villous adenomas (13 in rectosigmoid region and 1 in descending colon).

CONCLUSION: Detection of colorectal cancer in patients undergoing routine colonoscopy following acute diverticulitis is rare. However, colonic polyps in the left colon are noted. A flexible sigmoidoscopy is an adequate screening tool in such patients. A complete colonoscopy reserved for patients with family history of colorectal cancer or with polyps detected on flexible sigmoidoscopy to evaluate the rest of the colon.

A simple alternative technique for harvesting split thickness skin grafts

AIM: To assess the use of a simple split skin graft harvesting technique, requiring only a scalpel and a swab.

METHODS: During the last 8 mo, we operated on a consecutive series of 52 patients (30 males, 22 females) with a mean age of 60 years (33-80). We used the technique we present in order to cover small skin defects. All procedures were performed under local anesthesia. Thirty-seven patients underwent bedside surgery, 8 patients were operated on in the outpatient department and the remaining 7 had their graft harvested in the operating room. After antiseptic preparation of the donor site, the margins of the graft were drawn by the use of a surgical marker. A No 15 scalpel was used for the graft elevation, under constant traction with a moist swab.

RESULTS: All procedures were completed successfully without immediate complications. The patients tolerated the procedure well. The mean operative time was 15 min. Twenty-four donor sites were left to heal by secondary intention, whereas 28 were sutured with interrupted 3/0 silk sutures in order to heal by primary intention. All 24 sites that were left to heal by secondary intention healed completely in approximately 14 d. For the sites that were sutured, the sutures were removed on the 10^th postoperative day. Out of the 52 operated cases, 6 patients (11%) developed complications. In 4 patients, the split thickness skin grafts were partially lost, whereas in 2 patients the grafts were completely lost. Wound dehiscence was observed in 2 patients, which were treated with local antiseptic and antibiotic therapy.

CONCLUSION: The skin graft technique described is simple, costless and effective and can be performed even on an outpatient basis, without the need for special equipment.

Reduced port surgery for appendectomy: Early experience and surgical technique

AIM: To evaluate our experience and surgical technique of laparoscopic appendectomy via reduced port surgery (LARPS).

METHODS: Sixteen patients (8 men and 8 women; median age: 31.0 years) who underwent LARPS between November 2009 and May 2012 were included in the present study. We performed LARPS, in which access devices were inserted through an umbilical skin incision with 1 additional skin incision in the left lower abdomen. After setting access devices, pneumoperitoneum was maintained at 10 mmHg using CO₂ and a 3 mm trocar was positioned (or direct puncture was performed by the Endo Relief system) under laparoscopic guidance. The mesoappendix was dissected using an ultrasonically activated device. After mesoappendix dissection, ligation was performed near the appendix base and the appendix was dissected using an ultrasonically activated device. The appendix was then removed. At the end of surgery, we administered local anesthesia with ropivacaine 1% (10 mL) for the skin incisions. The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of postoperative hospital stay and surgical complications.

RESULTS: Our surgical procedure allowed operators to use instruments as in conventional laparoscopic appendectomy. The basic principle of triangulation of instrumentation was maintained to some degree. LARPS was performed in 9 patients with catarrhal appendicitis, 5 with phlegmonous appendicitis, and 2 with gangrenous appendicitis. The median surgery time was 60 min and the median intraoperative blood loss was 1.2 mL. The median length of postoperative hospitalization was 4 d. There were no conversions to open surgery, no operation-related complications or mortality.

CONCLUSION: Our experience and surgical technique suggest that LARPS is a safe and feasible procedure for patients with appendicitis.

A rare case of malignant schwannoma of the brachial plexus

We report a rare case of malignant schwannoma of the brachial plexus treated during a surgical campaign aimed at the poorest communities in the Cuzco region of Peru. A Peruvian 40-year-old-female from a mountain community presented with a mass on the lateral side of her left supraclavicular space. No imaging tools were available during this surgical campaign and so a biopsy of the tumor was carried out. Histopathological examination revealed it to be a low grade malignant schwannoma. A nerve enucleation of the tumor was chosen as neither chemotherapy nor radiotherapy was available. The tumour was a firm mass 4 cm x 3 cm x 2 cm in size. After excision of the lesion the patient presented neurological sequelae (deltoid, bicep, and tricep weakness) but her condition improved over the next 3 years. We report this case of malignant schwannoma of the brachial plexus as its incidence is very rare (the reported incidence is 0.001%) and because of its challenging treatment in poor healthcare conditions.

Technique of transcylindrical gas-free cholecystectomy

AIM: To describe our method of transcylindrical cholecystectomy (TC) and its potential advantages over other surgical approaches for treating symptomatic gallstones.

METHODS: TC is a modified minilaparotomy performed gas-free through a single cylinder 3.8 cm (or occasionally 5.0 cm) in diameter and 10.0 cm in length. An efficacy, prospective and longitudinal study was conducted. Experience was accumulated over 15 years (1993-2008) and 387 operations, showing the feasibility and safety of TC. Since 2008, we have performed TC under local anesthesia plus sedation in most cases of symptomatic cholelithiasis.

RESULTS: Between 1993 and 2008, TC was carried out in 364 consecutive patients, including 78 acute cholecystitis, 37 acute biliary pancreatitis and 48 suspected choledocholithiasis. In another 23 patients (5.9%), the operation was converted into a subcostal laparotomy. Ten postoperative complications (2.75%) were registered in this series: 5 wound infections, 2 bile leaks (one causing death), 2 hemorrhages (requiring reoperation) and 1 residual stones. Since 2008, TC was planned and started under local anesthesia plus sedation in 60 patients. In another 12 patients (16.7%), the operation was decided, started and completed under general anesthesia. Surgery was satisfactorily completed through the cylinder in all patients of this series. In 13 patients (out of 60; 21.7%), local anesthesia was converted to general anesthesia. Among patients whose operation was attempted under local anesthesia (n = 60), postoperative complications were: 1 wound infection (1.7%), 2 wound seromas (3.3%) and 3 nauseas (5%). All but two patients in this series were discharged from hospital on the day of surgery and all patients were satisfied with the procedure. In our experience using TC, we have not had any cases of main bile duct injury.

CONCLUSION: TC should be considered in the search for the best alternative in the management of gallstone disease, deserving its inclusion in prospective randomized trials.

Molecular biology techniques for the surgeon

New technologies are constantly being introduced into the medical and surgical fields. These technologies come in the form of newer medicines, imaging methods and prognostic tools, among others, and allow clinicians to make more rational and informed decisions on the care of their patients. Many of these technologies utilize advanced techniques which are at the forefront of many research fields and represent a transition of bench advances into the clinical realm. This review will highlight four technologies that are at the forefront in the treatment of oncology patients treated by surgeons on a daily basis. Circulating tumor cells, microarray analysis, proteomic studies and rapid sequencing technologies will be highlighted. These technologies will be reviewed and their potential use in the care of surgical patients will be discussed.

Esophageal bypass using the midcolon: A modified technique for corrosive esophageal strictures

A new procedure known as mid-colon esophagocoloplasty for corrosive esophageal strictures is described. This has been used in 112 consecutive patients over thirty years from 1977 to 2010 with excellent results. The conduit is a modification of the left colon conduit. It is based primarily on the left colic pedicle and includes the entire transverse colon with both flexures. It has several advantages over conventional methods of esophageal bypass for corrosive strictures. The major advantages of this procedure are excellent vascularity of the conduit, adequate length giving scope for operative decision making on the length required for the conduit, the possibility of a wide cervical esophago-colic anastomosis, negligible necrosisand stricture rates and excellent long-term functional results. The procedure, its differences and merits compared to conventional colonic conduits for esophageal replacement are described in detail.

What is the purpose of launching the World Journal of Surgical Procedures?

The presentation of a new journal is both an honor and a burden for the one who takes on the task. World Journal of Surgical Procedures (WJSP) is an online scientific journal, whose preparatory work was initiated on December 6, 2010, and will be published on December 29, 2011. The WJSP Editorial Board has now been established and consists of 106 distinguished experts from 23 countries. In every single issue, published on the Internet, this journal will host articles from research groups scattered all over the world, with the intention of addressing the most important innovations in technology and applications in surgical disciplines. With the spirit that animates the new online journals, the WJSP will represent an accessible space for all, thus placing itself as the “journal for all”, and as such, the benefits for all. Another sign of this openness and sharing of space is the real willingness to respond to every writer who submits a paper rapidly, but packaged in a personal, non-formal manner. Sometimes it may also be an invitation to rewrite, a sort of board criticism, an editing service. The journal welcomes different types of articles from the editorial opinion to the panel discussions of clinical cases, from the follow-up to studies from researchers around the world, to see what others are doing. WJSP is a scientific journal with its feet firmly planted in the present, but also looking to the future. Using the Internet, WJSP can be visited by anyone, and is expected to reach more readers.