Bariatric surgery

Surgeries:
Approximately 1000/year.

The main type of operations include:

  • Sleeve gastrectomy: 550 operations/year
  • Gastric by-pass: 350 operations/year
  • Gastric bands: 100 operation/year
  • Post-bariatric plastic surgery: 600 operations/year.

 


Vincenzo Borrelli

Years of experience: 18

Clinical Institute Città di Pavia

Medical scientist in surgical science and PhD in Advanced Diagnostic-Therapeutic technologies at “Federico II” University of Naples, 2007.

OPERATIONS
Over 1000 operations executed as first operator:

  • Obesity surgery: Adjustable Gastric Band, Sleeve Gastrectomy, Gastric Bypass, Duodenal Switch, Biliopancreatic Diversion, Re-do surgery
  • Cholecystectomy
  • Gastric bypass
  • Plastic surgery for abdominal hernia
  • Surgical treatment of Gastroesophageal Reflux Disease.


Gallery

Gianluca Rossetti

Years of experience: 16

Clinical institute Beato Matteo of Vigevano (Pavia)

Member of the following societies: Società Italiana di Chirurgia (Italian Surgery Society), Società Italiana di Chirurgia Endoscopica e Mini-invasiva SICE (Italian Society of Endoscopic and Minimally Invasive Surgery), European Association for Endoscopic Surgery (EAES), Società Italiana di Chirurgia dell’Obesità SICOB (Italian Society of Obesity Surgery), International Federation for the Surgery of Obesity (IFSO). Lecturer at several national and international courses and conferences.

He has performed over 1300 operations, both in open and in laparoscopic surgery.

HOSPITAL ACTIVITIES
Medical activities within the Obesity Surgery Unit at Beato Matteo Institute:

  • Selection of candidates for obesity operations
  • Pre-surgery preparation of selected patients
  • Obesity treatment with laparoscopic surgery
  • Post-surgery nutritional and metabolic check-up
  • Weight loss remodelling surgery

OPERATIONS
Most operations are restrictive surgeries, such as the positioning of intragastric balloons and laparoscopic sleeve gastrectomy. This last type of operation is performed both as first option and as second option after failure of other types of bariatric operations (such as gastric band, gastric plication etc.). Weight loss remodelling surgery is also practiced, such as tummy tuck surgery or thigh and arm plastic lifting in patients that have already gone through bariatric surgery.

JUST A FEW FIGURES
Number of operations performed at Istituto Clinico Beato Matteo: 200.

Carlo Socci

 

Senior Consultant, Unit of Bariatric, Metabolic, and Transplant Surgery

MULTIDISCIPLINARY TEAM
Surgical Team of the Bariatric and Metabolic Surgery Unit, part of the Gastrointestinal Surgery Unit (Dir. Prof. R. Rosati):

  • Mr. Carlo Socci, MD
  • Mr. Paolo Giovanni Gazzetta, MD
  • Mr. Massimiliano Bissolati, MD.

Clinical Nutrition Area part of Endocrine and Metabolic Medicine Unit (Dir. Prof E. Bosi):

  • Dr. Alessandro Saibene, MD
  • Dr. Paola Vedani, MD
  • Dr. Monica Marchi, MD
  • Dr. Elisabetta Devecchi, MD.

Centre for Treatment of Behavioural Eating Disordes, part of the Psychiatric Day Hospital Area (Dir. Prof L. Bellodi):

  • Dr. Stefano Erzegovesi, MD
  • Psychology, part of the Clinical and Health Psichology Unit (Dir.  Prof. Lucio Sarno)
  • Dr. Camilla Ghidini 
  • Patient Manager: Mr. Giuseppe Serra.

The Bariatric and Metabolic Surgery Unit is part of the Gastrointestinal Surgery Unit of 24  beds effective.

RESUME - Mr. Carlo Socci, MD

PRIMARY MEDICAL QUALIFICATIONS

  • Master Degree (full marks) in Medicine and Surgery, Milan University Medical School, 1986
  • Postgraduate Surgical Training in A&E Surgery at Milan University Medical School (CCT with full marks in 1991).

EDUCATION, JOBS AND PROFESSIONAL EXPERIENCE

1984 1986:

  • Medical Student Internship in Surgery with prof. Valerio Di Carlo, Senior Lecturer in Surgical Pathology, San Raffaele University Hospital, Milan
  • Laboratory Training for Isolation and Transplantion of Pancreatic Islets with prof. P.E. Lacy, Dpt. of Pathology, Washington University of St. Louis, Missouri, USA.

1988 – 1990:

  • Research Grant at “San Romanello del Monte Tabor” Foundation, Experimental Surgery Laboratory (prof. Valerio Di Carlo), San Raffaele University Hospital, Milan University
  • Research Associate, Juvenile Diabetes Foundation International, Grant No. 188105, "Isolation and transplantation of swine pancreatic islets"
  • Research Associate, Juvenile Diabetes Foundation International, Grant No. 188105, "Isolation and transplantation of swine pancreatic islets".

1990 – 1992:

  • Post-Doctoral Fellowship, Juvenile Diabetes Foundation International, No. 390196.

1992 – 1993:

  • Chercheur Etrangér. INSERM U 25. Director: Prof. J.F. Bach. Hôpital Necker, Paris, France.

1992 -1999:

  • Research Assistant. Experimental Surgery Laboratory and Department of General Surgery (prof. Valerio Di Carlo), San Raffaele University Hospital
  • Research Assistant. Experimental Surgery Laboratory and Department of General Surgery (prof. Valerio Di Carlo), San Raffaele University Hospital
  • Research Fellow. Department of General Surgery (prof. Valerio Di Carlo), San Raffaele University Hospital
  • Research Fellow. Department of General Surgery (prof. Valerio Di Carlo), San Raffaele University Hospital
  • Junior Consultant, General Surgery Unit (prof. Valerio Di Carlo), San Raffaele University Hospital.

2002 – 2004:

  • Surgical Consultant On-Call, A&E Department, San Raffaele University Hospital.

09/2003-present:

  • Member of IACUC (Institutional Animal Care and Use Committee), San Raffaele University Hospital
  • 1 /01/2002-30/04/2015 Consultant. Surgical Coordinator of Kidney and Pancreas Transplant Program, General Surgery Unit (prof. Valerio Di Carlo), San Raffaele University Hospital
  • 01/05/15-present Senior Consultant, Unit of Bariatric, Metabolic, and Transplant Surgery, San Raffaele University Hospital.

RESEARCH AND TEACHING
18/02/2005:

  • Reviewer.  IPITA Meeting, Geneva, Switzerland.

a.a.2004-05:

  • Professor in the discipline of General Surgery (Transplant Surgery).  Medical School, Vita-Salute San Raffaele University, Milan.

a.a.2004-05:

  • Tutor (General Surgery). Medical School, Vita-Salute San Raffaele University, Milan.

a.a.2008-09:

  • Professor in the discipline of General Surgery (Transplant Surgery).  Medical School, Vita-Salute San Raffaele University, Milan.

2008 -09:

  • Member of the Living Donor Kidney Transplant Committee. National Institute of Transplants.

CENTRE OF BARIATRIC AND METABOLIC SURGERY, SAN RAFFAELE HOSPITAL, MILAN
At San Raffaele Hospital, people suffering from severe obesity and complicated metabolic conditions can get a global and innovative diagnostic, nutritional and surgical path, with the support of a multidisciplinary team of experts in the field of clinical nutrition, surgery, psychology, psychiatry, and anaesthetics.
The bariatric surgery program is crucial in the planning of a global treatment of obesity. It consists of a positive change in the pathway of food intake and absorption through a surgical procedure aimed at gastric volume restriction or partial intestinal malabsorption.
Surgery is now considered the interventional therapy of metabolic syndrome, especially in case of type II diabetes mellitus, which can be either dramatically improved or definitely treated.
Along with a progressive weight loss, other conditions are positively affected from bariatric surgery, such as blood pressure, lipids profile, and the function of heart, kidney, and liver.
The Metabolic and Bariatric Surgery Program at San Raffaele Hospital benefits from the collaboration of different multispecialistic teams:

  • Bariatric and Metabolic Surgery Unit (part of the Gastrointestinal Surgery Unit (Dir. Prof. R. Rosati), with a team of trained specialist in the field of advanced laparoscopic surgery and gastrointestinal surgery
  • Clinical Nutrition Area part of Endocrine and Metabolic Medicine Unit (Dir. Prof E. Bosi). It’s the nutritional and medical core of the program, enrolls doctors with specialised skills in the area of clinical nutrition, dietology, and diabetology
  • Centre for Treatment of Behavioural Eating Disordes, part of the Psychiatric Day Hospital Area (Dir. Prof L. Bellodi). It offers to patients with behavioural eating disorders specific pathway of diagnosis and care, along with a vital contribute to the follow-up of non-affected patients after bariatric surgery
  • Psychology, part of the Clinical and Health Psichology Unit (Dir.  Prof. Lucio Sarno), with specialists involved in the treatment and care of pre-existing psychological disorder (both related and unrelated to obesity) and following patients up during their weight loss program, detecting and treating any particular psychological need they should manifest.

BARIATRIC PROCEDURES AT SAN RAFFAELE HOSPITAL

  • Intragastric Balloon
  • Laparoscopic Adjustable Gastric Banding
  • Laparoscopic Sleeve Gastrectomy
  • Laparoscopic Roux-en-Y Gastric Bypass
  • Re-do Surgery (removal of gastric banding, convertion of gastric sleeve into bypass etc.).

Surgical Volume (reference year 2015):

  • 50  procedures/year.

RESEARCH
Peer-reviewed research projects:

  • Metabolic surgery to prevent the early-loss of kidney function in T2D patients. The Met-sure Study: Metabolic Surgery and Renal loss. PI: Paolo Fiorina, MD PhD Harvard Medical School-Boston and San Raffaele Hospital, Milan Italy; Co-Pi: Carlo Socci, MD, San Raffaele Hospital, Milan, Italy: Co-Pi: Marco Anselmino, MD, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; Co-Pi: Diego Massimini, MD San Gerardo Hospital, Monza, Italy
  • 'Immunometabolism in human obesity'. Principal Investigator: A. Petrelli, MD. Supervisor M Battaglia, MD. Marie Skłodowska-Curie Advanced Fellowship
  • 'Regulation of Metabolism by human visceral adipose tissue T cells: immune-mediated approach to obesity'. PI : L Piemonti MD, Co-PI:  Dr. C Socci, MD. European Foundation for the Study of Diabetes (EFSD).

PUBLICATIONS:

  • How to Target Obesity in the Transplant Population: is Bariatric Surgery an Option?" Socci C, GazzettaPG, Bissolati M, Secchi A, Rosati R. Submitted: Transplant International
  • Indocianina per lo studio della vascolarizzazione gastrica dopo sleeve gastrectomy. Socci C, Parolini D, Gazzetta PG, Rosati R.  XXIII Congresso Nazionale SICOB, Baveno 22-24 Aprile 2015. (Indocyanine green fluorescence for the assessment of gastric sleeve blood supply. XXIII National Congress of the Italian Bariatric Society).

Riccardo Rosati

 

Head of Department, MD, FACS, Professor of Surgery – “San Raffaele Vita-Salute” University

STAFF

  • Ugo Elmore, MD
  • Paolo Parise, MD
  • Carlo Socci, MD
  • Danilo Parolini, MD
  • Paola De Nardi, MD
  • Andrea Vignali, MD
  • Alessandra Melis, MD
  • Andrea Cossu, MD
  • Andra Tamburini, MD
  • Davide Poldi, MD
  • Paolo Gazzetta, MD
  • Massimiliano Bissolati, MD.

The Unit of Gastrointestinal Surgery has 24 beds effective.

OVERVIEW
The Unit of Gastrointestinal Surgery at San Raffaele is one of the leading Unit in Italy for advanced minimally invasive treatment of digestive system diseases. It’s one of the highest volume centers in Italy for Upper GI cancer treatment. Cancer of the esophagus and esophago-gastric junction is treated with a case load of approximately 80 patients per year with the most advanced multidisciplinary approach consisting of neo-adjuvant chemo or chemoradiation protocols. Hybrid (laparoscopy and thoracotomy) or totally minimally invasive (laparoscopy and thoracoscopy) esophagectomy are routinely performed with an experience with these techniques of more than 20 years. Cancer of the stomach is treated according to the most recent guidelines and most advanced protocols of neoadjuvant chemotherapy and surgery with extended nodal dissection. Minimally invasive gastrectomies are performed according to the stage of the disease. The Unit is also a leading center in diagnosis and treatment of benign functional diseases of the esophagus 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 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 this cases as a routine 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 all cases management.

TREATED DISEASES

  • Esophageal cancers
  • Gastric cancers
  • Barrett’s Esophagus
  • Esophageal leiomyomas
  • Esophageal diverticula
  • G.E.R.D.
  • Hiatal hernia
  • Achalasia
  • Esophageal perforations or ruptures
  • Caustic ingestions
  • Cancer of the colon and rectum
  • Diverticular disease of the colon
  • Crohn disease
  • Ulcerative colitis
  • Haematologic diseases of the spleen
  • Adrenal adenomas and cancer
  • Gallstones and lithiasis of the main bile duct
  • Abdominal wall defects
  • Proctological conditions
  • Morbid obesity, diabetes (detailed under separate document)
  • End stage renal insufficiency (detailed under separate document).

SURGICAL PROCEDURES (open and minimally invasive)

  • Total and sub-total esophagectomies
  • Total and sub-total gastrectomies
  • Leiomyoma enucleation
  • Resection of esophageal diverticulum
  • Trans-oral Zenker’s diverticulum treatment
  • Antireflux surgery (Nissen, Toupet, etc.)
  • Heller-Dor myotomy and fundoplication
  • Colectomies
  • Resection of the rectum with TME and colorectal or coloanal reconstruction
  • Total proctocolectomy with J pouch ileoanal reconstruction
  • Small bowel resection
  • Adrenalectomy
  • Spenectomy
  • Cholecystectomy and main duct exploration
  • Surgery for abdominal wall defect
  • Proctological procedures
  • Bariatric procedures (sleeve gastrectomy, gastric by-pass) (detailed under separate document)
  • Transplant surgery (kidney, pancreas) (detailed under separate document).

TECHNOLOGY
A fully equipped operating room is available for the Unit with six 8.00 a.m. to 8.00 p.m. slots per week. Last generation high definition 3D and high definition 2D with Infra-Red technology (for intraoperative ICG evaluation of organs vascularization) minimally invasive racks are normally used. Last generation ultrasounds or radiofrequency tissue sealing energy devices are available as all kind of mechanical suturing devices. Recently a robotic surgery room with Da Vinci Xi system is available.

DIDACTIC ACTIVITIES

  • Lessons and tutoring for students of School of Medicine of San Raffaele Vita-Salute University
  • Lessons and tutoring for residents of General Surgery School of Specialization of San Raffaele Vita-Salute University
  • Upper and Lower – GI Surgery courses dedicated to Italian General Surgeons.
  • Tutoring Center of the Esophageal Surgery School of the Italian Association of Hospital Surgeons dedicated to general surgeons.

RESEARCH ACTIVITIES

  • Oncologic and functional outcome of esophageal minimally invasive vs open surgey
  • Oncologic and functional outcome of gastric minimally invasive vs open surgery
  • Distribution of lymphnodal metastasis in esophageal cancer
  • Functional outcome of patients managed with Enhanced Recovery After Surgery (ERAS) protocols in gastric and esophageal surgery
  • Immunonutrition in surgical patients
  • Chemoresistance in gastrointestinal cancers
  • Endoscopic vs surgical treatments in benign esophageal diseases
  • Oncologic outcome of minimally invasive colorectal surgery
  • Transanal minimally invasive rectal surgery
  • Outcome of minimally invasive surgery of IBD
  • Ambulatory minimally invasive surgery for cholecystectomy and inguinal/ventral hernia repair
  • Functional outcome of patients managed with Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery.