Most of the findings are non-significant and can be predicted if UGIE plus multiple biopsies is routinely included in the bariatric work-up with significant cost reduction. In those patients who had a significant finding prior to the surgery or intraoperatively, the pathological examination of the specimen is recommended.

BACKGROUND:The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). METHODS: Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. RESULTS: Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 ± 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 ± 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). CONCLUSION: Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development.

Nu există limită de timp în ceea ce priveşte apariţia fistulelor după sleeve gastrectomy LSG, iar cele cu debut tardiv pot evolua către fistule persistente, cronice. Scopul acestui studiu retrospectiv a fost de a analiza incidenţa, tratamentul şi urmările după acestea, tratate într-un Centru de Excelenţă de chirurgie bariatrică şi de a dezvolta un tratament standard. Materiale şi Metode: între 2011-2018, 9 cazuri de fistule postoperatorii au apărut după un număr total de 1365 LSG (0,65%), 7 prezentând debut tardiv (minim 10 zile de la operaţie). Au fost identificate şi analizate fistulele cronice, persistente, inclusiv o fistulă gastro-bronhială şi una gastro-cutanată. Rezultate: prezentăm 3 cazuri particulare de fistule foarte tardive, cronice de tip III (fistule complexe), cu debut variind de la 6 până la 84 luni după LSG, şi tratamentul acestora (conservativ, radiologie şi/sau endoscopie intervenţională, chirurgical). Concluzii: managementul fistulelor tardive, cronice de tip III, este variabil, nestandardizat şi ar trebui planificat pe baza evoluţiei clinice, momentul diagnosticului, resursele disponibile şi expertiza locală. Un centru bariatric de excelenţă poate garanta un diagnostic şi tratament mai adecvat, pe baza resurselor şi a posibilităţilor existente. Cuvinte cheie: fistula cronică, sleeve gastrectomy, fistula complexă tip III, gastro-bronhică, gastro-cutanată Persistent Fistula after Sleeve Gastrectomy: A Chronic Dilemma Chirurgia, 114 (6), 2019 www.revistachirurgia.ro 791

Purpose: This retrospective study aimed to evaluate the clinical outcomes (mortality rate, operative time, complications) of elective LC when performed by a surgical resident in the backdrop of Italian academic centers.Methods: A retrospective review of all patients undergoing elective LC between January 2016 and January 2022 at six teaching hospitals across Italy was performed. Cases were identi ed using the Current Procedural Terminology (CPT) code 5123 (LC without cholangiogram). All cases of emergency surgery, ASA score > 3, or when cholecystectomy was performed with another surgical procedure, were excluded. All suitable cases were divided into 2 groups based on primary surgeon: consultant (group A) or senior resident (group B).Results: A total of 2331 cases (1425 females) were included, of which, consultants performed 1683 LCs, while the residents performed 648 surgeries. The groups were statistically comparable regarding demographics, history of previous abdominal surgery, operative time, or intraoperative complications (p > 0.05). The rate of conversion to open cholecystectomy was 1.42% for group A and none for Group B.However, a statistically signi cant difference was observed between groups A and B regarding the average length of stay and postoperative complications (2.2 ± 3 versus 1.6 ± 1.3 days, and 1.7% versus 0.5%, respectively; p < 0.05 each).Conclusions: Our study demonstrates that in selected patients, senior residents can safely perform LC when supervised by senior staff surgeons.