Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy is a new bariatric technique based on the biliopancreatic diversion with duodenal switch in which after the sleeve gastrectomy, the duodenum is anastomosed to the ileum in a Billroth-II fashion. A 200-cm common channel-alimentary limb is devised. Anticipating an appropriate weight loss, at least similar to that obtained after gastric bypass, theoretical benefits for operated patients are a shorter operative time, the performance of only one anastomosis, and no mesentery opening. A prospective trial is now being conducted to find out the results of the procedure and to compare them to those obtained with gastric bypass and standard duodenal switch.

Lymph node involvement in adenocarcinoma of the esophagogastric junction (EGJ) is similar to that of gastric cancer. The impact on survival of the number and site of lymph nodes involved in a subgroup of patients undergone surgery for adenocarcinoma of EGJ is reported. Sixty-four patients undergone transthoracic esophagectomy with two-field lymphadenectomy for adenocarcinoma of the EGJ were retrospectively assessed. Five-year survival according to AJCC gastric cancer nodal classification and central node invasion was evaluated. In N0 patients survival was assessed in relation to the number of lymph nodes removed. Five-year survival was 72% in N0, 46% in N1 and 0% in N2 and N3 group. Intergroup differences were statistically significant (P<0.05) except between N2 and N3 groups. Overall survival was different depending on the infiltration of distal or proximal site nodes, 23% vs. 58% (P<0.05); in N0 patients it was related to the number of lymph nodes removed (83% >15 vs. 57% <15, P<0.05). Classification of lymph node involvement in adenocarcinoma of the EGJ by gastric cancer criteria is adequate for prognostic purposes. The involvement of distal nodes in all cases and the removal of <15 nodes in N0 group resulted as independent negative predictive factors.

Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation.

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Cefminox is as effective and as safe as M+G in the treatment of intra-abdominal infections.