The Bariatric Surgery is performed almost exclusively through minimally invasive surgical access such as laparoscopy or highly minimally invasive and reversible procedures such as gastric banding and gastric bypass. But there are also irreversible surgeries such as vertical gastrectomy (sleeve gastrectomy) and bilio-pancreatic diversion with/without duodenal switch.

Each of these interventions affects weight loss and therefore also the resolution of co-morbidities with different effectiveness.

The decision to perform one rather than another is derived from the careful assessment of the type of obesity (gynoid/visceral), BMI, the patient’s eating habits, and thus the presence or absence of severe eating disorders, as well as the presence of associated conditions such as Type 2 Diabetes Mellitus.

Urological Surgery in general deals with traditional surgery, urological endoscopy, and to some extent genital surgery.

In addition to traditional urological surgery and endoscopy, urogenital reconstructive surgery techniques have been perfected at Casa di Cura San Rossore.

In fact, urogenital reconstructive surgery is a superspecialty branch that is gaining an increasingly insistent foothold in the international surgical scene.

The diseases that require the intervention of the urogenital surgeon are varied. Among many:

• Neoplastic pathology of the genitals, in which demolitive surgery was used until now.
• Penile cancer, for which, until recently, amputation of the organ was used, with the obvious functional and psychological consequences, especially in young individuals. Using urogenital reconstructive and plastic surgery techniques, it is now possible to reconstruct the amputated portion with excellent aesthetic and functional results. Then, thanks to erectile dysfunction surgery, hydraulic tricomponent prostheses can be implanted, with resumption of sexual activity.
• La Peyronie’s disease or induratio penis plastica.
• Genital trauma.
• Congenital male genital disorders such as congenital curved penis or hypospadias
• Male incontinence. Some patients undergoing radical prostatectomy for prostate cancer suffer from urinary incontinence: there are currently perineal surgical techniques that allow, with the application of urethral suspension devices, the restoration of continence.
• Female urinary incontinence, for which there are mini-invasive transvaginal techniques that allow restoration of continence.
• Female bladder prolapse, for which there are vaginal surgical techniques that through the application of prolene mesh reconstitute female aesthetic and functional integrity.
• Traumatic pelvic pathology or urethral infections, which can then be responsible for more or less complex stenosis of more or less extensive portions of both the anterior and posterior urethra. With urethral surgery through reconstructive surgery techniques using buccal mucosa or skin grafts, ureral stenoses are reconstructed.

Hemorrhoids or hemorrhoid pathology is the most frequently encountered proctological disease. It is estimated that about 50 percent of the population over the age of 50 in most industrialized countries suffer or have suffered from disorders related to hemorrhoidal disease (hemorrhoids).

The most innovative surgical procedure with regard to the treatment of hemorrhoids is THD (Transanal Hemorrhoidal Arterial Dearterialization), a method that is performed by means of an apparatus to which an anoscope, specially constructed for this use, is connected.

THD is a pioneering method in the treatment of hemorrhoids because it revolutionizes the surgical approach to hemorrhoid disease, ensuring maximum effectiveness of results and minimizing the levels of invasiveness, pain and stress for the patient.

The method that includes dearterization, that is, the selective identification and ligation of the terminal branches of the superior rectal artery, is mucopoxy, that is, the repositioning, thanks to submucosal stitches given from the point of ligation of the artery to the pectine line, of the pads in their natural anatomical location; all under local anesthesia with sedation, so that the patient can restore normal physiology and a rapid post-operative recovery, and without tissue removal. Therefore, in the postoperative period, discomfort for the patient is reduced compared to more invasive methods.

VARICES OF THE LOWER LIMBS

Definition: varicose veins are a pathological dilatation of certain veins in the lower extremities and represent stage II Chronic Venous Disease. This disease is more frequent in the female sex (3:1 to 4:1), has a pronounced familial component, and other factors such as type of work activity, work environment, diet (importance of weight) and physical activity influence it.

Symptoms: They can cause complaints such as heaviness of the legs, edema (swelling) of the ankles, itching, tingling, pain, burning, and night cramps. In more severe cases and if present for a long time, thrombophlebitis of some of them, eczema (reddened and itchy lesions), skin dichromia associated with hardening of the skin (lipodermatosclerosis), and in even more severe cases ulcers may appear.

Types of intervention:

It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.

MICROSURGERY

Indications: all those patients at the early stage of the disease are candidates.

Type of Anesthesia: local

What the surgery consists of: using microincisions, varicosities are surgically removed. This type of technique, precisely because of its minimally invasive nature, does not involve cutting and therefore scarring; only sterile patches are applied after varicose veins are removed.

Post-operative course:after surgery, the patient walks immediately and after about 20 minutes can return to his or her activity.

TRADITIONAL SURGERY

Indications: All those patients in advanced stage of disease with excessive dilatation of the great saphenous vein or who have abnormalities in the course of the great saphenous vein and therefore cannot be subjected to endovascular treatments (LASER or Radiofrequency)

Type of anesthesia: local assisted

What the surgery consists of: a small cut (about 4-5 cm) is made in the groin, the diseased part of the great saphenous vein is removed, and the surgery is completed by removing the varicose veins present through microincisions (about 2-3 mm).

Type of hospitalization: Day Hospital

Post-operative course: about 15 minutes after surgery, ambulation is resumed, and after about 2 hours, the patient is discharged. The patient should wear an elastic stocking for about two weeks.

LASER OR RADIOFREQUENCED SURGERY

Indications:Candidates are those patients whose stage of disease is not advanced and whose great saphenous vein or small saphenous vein to be treated show specific ultrasound features.

Type of Anesthesia: local

What the procedure consists of: a micro-incision (about 2-3 mm) is made on the thigh or leg (the location varies from case to case), a LASER or Radiofrequency fiber is inserted inside the vein to be treated; an ultrasound-guided tumescent anesthesia of the venous axis is performed and the vein is obliterated. The procedure is completed with the removal of any varicose veins present using microincisions (approximately 2-3 mm).

Type of Hospitalization: outpatient

Post-operative course: The patient can ambulate about 10 minutes after surgery, and after about 30 minutes, he or she can be discharged. The patient should wear an elastic stocking for about two weeks.

SCLEROTHERAPY / SCLEROFOAM

Indications:any type of patient can undergo this procedure. It is generally reserved for those who cannot cope with the previously described interventions (the result of which has a longer duration of time)

Type of Anesthesia: none

What the procedure consists of: a chemical substance in liquid or foam form (Scleromousse or Sclerofoam) is injected inside the vein to be treated;

Type of Hospitalization: outpatient

Post-operative course: the patient ambulates immediately and can, after about 30 minutes, be discharged. The patient should wear an elastic stocking for at least two weeks.

EMODYNAMIC TREATMENT (CHIVA or ASVAL)

Indications:any type of patient can undergo this procedure.

Type of anesthesia:local/local assisted

What the surgery consists of: This technique involves multiple surgeries scheduled a few months apart with the aim of facilitating the passage of blood flow from diseased superficial veins to deep veins. Small incisions (2-3 mm to 4-5 cm) are made in one or more places on the thigh or leg by which certain types of veins are ligated. There is no removal of present varices, which disappear independently over time.

Type of hospitalization: outpatient

Post-operative course: depending on the level at which surgery is performed, the patient ambulates immediately or after about 20 minutes and can be discharged after about 30 minutes. The patient should wear an elastic stocking for at least two weeks.

It is important, before undertaking any treatment, to undergo a specialty examination which must necessarily include in the course of it an examination Ecocolor-Doppler to define the origin, the cause, which led to the development of varicose veins and the best approach to eliminate them.

For information you can call the following address: +39 050 586217