Summary and background data Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak. Methods Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed. Results Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, ( P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department. Conclusions In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.

Introduction and importance Gallstone ileus is an uncommon complication of cholelithiasis. It is usually presented as a small bowel obstruction. Elderly patients are commonly affected. The diagnosis is challenging, since needs a high index of suspicion and imagenology is key. Surgery is the mainstay management, most commonly performed by laparotomy, but laparoscopy is summing cases. Nevertheless the approach is still controversial. We report a gallstone ileus case, that was managed totally laparoscopic in our medium complex public institution. Case presentation An 71 years-old male patient, with symptomatic cholelithiasis, consulted in emergency department with symptoms and signs of small bowel obstruction. Computed tomography of abdomen and pelvis showed the classical Rigler's triad. Totally laparoscopic enterolithotomy alone was performed successfully. Postoperative evolution was without incidents, being discharge at fifth day. Clinical discussion Gallstone ileus represents around 0,3–0,5% of cholelithiasis complications. Mostly affect elderly women patients, with comorbidities. Mortality and morbidity is still high nowadays. The classical management of gallstone ileus is the open surgery, but the laparoscopic approach has been described and it can be done. Conclusion The laparoscopic management of gallstone ileus is effective and secure procedure and seems reasonable to attempt if the conditions and skills are available.

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LDP is a safe and feasible procedure for DP resections. LDP offers advantages over ODP in terms of reduction of operative blood loss, higher spleen preservation rate, and shorter hospital stay.

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Highlights

Bariatric surgery is the most effective available treatment for obesity, inducing a significant and durable weight loss, and improving several obesity-associated diseases. However, as the number of bariatric surgeries performed increases, so does the prevalence of patients who experience either insufficient weight loss or weight regain, accompanied by relapse or the emergence of new obesity-related diseases. Endoscopic and surgical bariatric revisional procedures are used to promote weight loss and improve metabolic function to address these problems. After a psychological, nutritional, medical, and anatomical evaluation of the gastrointestinal anatomy has been completed, patient candidacy to a revisional procedure must be defined. In those patients with insufficient weight loss or weight regain associated with relapse, the emergence of new obesity-related diseases, or quality-of-life deterioration, a revisional procedure must be selected. Although current evidence comes mainly from observational and retrospective studies, with a limited number of patients and short follow-up times, the available data indicate that revisional procedures are useful to induce a significant weight loss and/or promote remission of obesity-associated diseases, albeit an increased risk of surgical and/or nutritional complications. Thus, careful selection of patients is needed to minimize risk and maximize the benefit of these procedures.