General Surgery

Policlinico San Marco

key figures 

CLINICAL SERVICES:

  • General and Oncologic Surgery 
  • Bariatric and Metabolic Surgery

PROCEDURES PERFORMED PER YEAR:

  • About 1000 procedures related to the treatment of obesity
  • More than 2000 general surgery procedures
    • 90% with laparoscopic approach 

The Department is recognized as a centre of excellence with regard to the laparoscopic treatment of colorectal disease, oesophageal-gastric disease and pancreatic disease. In addition, the Centre has recently been recognized as a National Centre of Excellence with regard to care and surgical treatment of obesity, with almost 1000 procedures performed each year.

In this Department of General Surgery, over two thousand surgical procedures are performed every year, more than 90% of them with a laparoscopic approach. The Centre is a European benchmark regarding the pathology of the abdominal wall (inguinal and incisional hernia repair) with one of the most important international case studies.

In the Department, resection and ablation procedures are performed (radiofrequency or microwave) to neoplastic disease of the liver, always laparoscopically. Every year they also organize training courses that attract surgeons from Italy and abroad who have the opportunity to follow surgical procedures in the operating room and learn the surgical techniques performed.

treatmentS

General and Oncologic Surgery

Gastric cancer is treated according to the most recent guidelines and most advanced protocols of neoadjuvant chemotherapy and surgery with extended nodal dissection. Laparoscopic total and subtotal gastrectomy are performed according disease's stage. The Unit is also a leading centre in diagnosis and treatment of benign functional diseases of the oesophagus and stomach. The most advanced diagnostic techniques are applied to obtain a thorough pre-operative work-up and a multidisciplinary evaluation is performed in order to establish a tailored treatment, normally by minimally invasive approach.

Colorectal surgery is the other most important part of the activity. All oncological cases pass through a multidisciplinary board to indicate the most appropriate clinical pathway. Neoadjuvant treatment is normally applied in locally advanced rectal cancer.   Surgery is carried out in the vast majority of cases with a minimally invasive treatment where the availability of our 3D technology gives best operative advantages. Benign disease such as diverticular disease and inflammatory bowel disease (Crohn and ulcerative colitis) are also an important part of clinical activity in lower GI: minimally invasive approach is also applied in these cases in diverticular disease and ulcerative colitis, and selectively in Crohn disease (primary surgery and selected cases of recurrence only). ERAS (Enhanced Recovery After Surgery) programs and standardized perioperative pathways are applied for the management of all cases.

Bariatric and Metabolic Surgery

Bariatric surgery currently offers the possibility of losing weight in patients with morbid obesity who are resistant to various medical, pharmacological and dietary treatments. The weight loss that is achieved with surgery is a real change of life. These changes make it possible to exercise normal daily activities with reduced risks of illness, the resolution of complications of medical conditions related to obesity (heart disease, diabetes, hypertension, osteo-articular problems, sleep apnoea). Especially in the case of diabetic patients, surgery is more effective than medical therapy. A fundamental parameter for assessing the severity of obesity is the body mass index (BMI), that is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in meters. According to the guidelines adopted also by the American Society of Metabolic and Bariatric Surgery and the Italian Society of Obesity Surgery, bariatric surgery must be adopted when the patient is the victim of an extreme condition of obesity with BMI> 40; Bariatric surgery can be adopted with a BMI> 35 with characteristic complications of obesity in the context of a clear resistance to medical therapy. Bariatric surgery, through different types of surgical interventions depending on the patient's clinical picture, will allow weight loss and an improvement in the overall quality of life of the obese patient. Synthetically, weight loss has, above all, a fundamental role in the regression of some metabolic alterations, and in particular of type 2 diabetes mellitus, interrupting the chain of events that leads to cardiovascular complications and therefore allowing operated patients a longer life expectancy than the obese patients. In this context, a third extremely significant element is represented by the reduction of the risk of some types of cancer (in particular breast tumours). Lastly, extremely significant and consequent to the interventions, is the improvement of the quality of life of the patients, evident both in the more exquisitely personal and in the relational sphere.

There are various types of bariatric interventions, which are divided roughly into 3 main groups: pure restrictive (adjustable gastric banding, gastric plication), malabsorptive (gastric bypass, biliopancreatic diversion...) and restrictive-metabolic (sleeve gastrectomy, sleeve gastrectomy with associated fundoplication).

ECOS (European Centre for Obesity Surgery), thanks to the high-quality standards that make it a highly specialized centre of excellence, and the proximity of Orio al Serio airport with countless flights connecting Bergamo to the rest of Europe, welcomes patients from all over Italy and also from abroad. ECOS, recognized as a Centre of Excellence since 2016, offers a comprehensive treatment proposal to the obese patient. All the most common, safe and effective bariatric procedures are performed. A continuous work of updating and research allows the Centre’s team to perform interventions for any degree of obesity with a laparoscopic technique, after an appropriate preoperative program that is organized at the facilities of the Centre itself. One of the most performed operations at the Centre is the laparoscopic sleeve gastrectomy. With this surgery, the stomach is reduced by approximately 60-85% of its volume permanently, leaving a gastric tubule that has the shape of a shirt sleeve. The loss of weight is guaranteed by the restriction of food intake, through the reduction of the volume of the stomach and the reduction of hunger (in particular nervous hunger), through the reduction of the action of hunger hormones, ghrelin and leptin, through the removal of their receptors with the stomach part removed. Moreover, acting only on the stomach, no changes in the intestine and absorption of food occur, with a better postoperative quality of life. The experience gained over the years has allowed us to implement new and innovative surgical techniques, including the association of sleeve gastrectomy and fundoplication, with notable improvement of gastro reflux disease -oesophageal in the obese patient. In addition, complex cases of recurrent obesity and redo surgery are referred to the Centre for revision surgery in the event of failure.

Main Pathologies Treated:

  • Oesophageal cancers
  • Gastric cancers
  • Barrett’s Oesophagus
  • Oesophageal leiomyomas
  • Oesophageal diverticula
  • Gastroesophageal reflux disease (G.E.R.D.)
  • Hiatal hernia
  • Achalasia
  • Cancer of the colon and rectum
  • Diverticular disease of the colon
  • Crohn disease
  • Ulcerative colitis
  • Haematological diseases of the spleen
  • Adrenal adenomas and cancer
  • Gallstones and lithiasis of the main bile duct
  • Abdominal wall defects
  • Morbid obesity, diabetes (detailed under separate document)

Main Surgical Procedures (open and minimally invasive):

  • Total and subtotal esophagectomy
  • Total and subtotal gastrectomy
  • Leiomyoma enucleation
  • Resection of oesophageal diverticulum
  • Antireflux surgery (Rossetti or Nissen or Toupet, etc. fundoplication)
  • HellerDor myotomy and fundoplication
  • Colectomies (partial or total)
  • Resection of the rectum with TME and colorectal or coloanal reconstruction
  • Total proctocolectomy with J pouch ileoanal reconstruction
  • Small bowel resection
  • Adrenalectomy
  • Splenectomy
  • Cholecystectomy and main duct exploration
  • Surgery for abdominal wall defect (incisional hernia, inguinal hernia, umbilical hernia…)
  • Proctological procedures
  • Laparoscopic bariatric procedures (sleeve gastrectomy, gastric by-pass, mini by pass, Sleeve and fundoplication, Gastric plication…)

Teaching and Research Activity

Training Activities

  • Lessons and tutoring for students of the School of Medicine at San Raffaele VitaSalute University
  • Lessons and tutoring for residents of General Surgery School of Specialization at San Raffaele VitaSalute University
  • Upper and Lower – GI Surgery courses dedicated to Italian and European General Surgeons
  • Abdominal wall defect courses dedicated to Italian and European General Surgeons
  • Bariatric surgery courses dedicated to Italian and European General Surgeons
  • Tutoring Centre of the laparoscopic abdominal wall surgery of School of the Italian Association of Hospital Surgeons dedicated to general surgeons
  • Tutoring Centre for laparoscopic Advanced Surgery of the Italian Association of Hospital Surgeons dedicated to general surgeons
  • Centre of excellence SICOB (Italian Society of Bariatric and Metabolic Surgery) since 2016

Research Activities

  • Oncologic and functional outcome of gastric minimally invasive vs. open surgery
  • Distribution of lymph nodal metastasis in gastric cancer and colonrectum cancer
  • Immunonutrition in surgical patients
  • Endoscopic vs. surgical treatments in benign oesophageal diseases
  • Oncologic outcome of minimally invasive colorectal surgery
  • Hernia and abdominal wall defect
  • Obesity and diabetes
  • New technique in obesity surgery
  • Outcome of minimally invasive surgery of IBD
  • Functional outcome of patients managed with Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery.

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • A fully equipped operating room is available for the Unit
  • Last generation high definition 4k and 3D and high definition 2D with InfraRed technology (for intraoperative ICG evaluation of organs vascularization and lymph nodes maps) minimally invasive racks are normally used
  • Last generation ultrasounds or radiofrequency tissue sealing energy devices are available as all kind of mechanical suturing devices 
Featured Physicians
- Uccelli Matteo
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