General and Digestive disease surgeon trained at Hospital Clinic Hospital of Barcelona. Dedicated especially to minimally invasive surgery for the treatment of Bariatric and Gastrointestinal patholog.
Formerly Medical content manager in AIS Channel, involved in the search of contents and organization of the different events of the web.
Selected publications from PubMed
Perioperative Outcomes in Patients with and Without Chronic Preoperative Therapeutic Anticoagulation Undergoing Metabolic Surgery at an Academic Medical Center.
Fares S, Barajas-Gamboa JS, Zhan K, Dang JT, Mocanu V, Wills MV, Diaz Del Gobbo G, Abril C, Pantoja JP, Guerron AD, Raza J, Corcelles R, Rodriguez J, Kroh M
J Clin Med. 2025 Jan 10;14(2) doi: 10.3390/jcm14020424.
Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis.
Restrepo-Rodas G, Barajas-Gamboa JS, Dang JT, Piechowska-Jóźwiak MI, Khan M, Diaz Del Gobbo G, Abdallah M, Moreno C, Abril C, Pantoja JP, Guerron AD, Corcelles R, Kroh M, Rodriguez J
J Clin Med. 2024 Jul 8;13(13) doi: 10.3390/jcm13133989.
Bariatric Surgery Outcomes in Patients with Severe Obesity Compared to Patients with Non-Severe Obesity at A New Institution in The United Arab Emirates.
DeCicco JP, Barajas-Gamboa JS, Dang JT, Diaz Del Gobbo G, Raza J, Abril C, Guerron AD, Pantoja JP, Hegazin SB, Corcelles R, Rodriguez J, Kroh M
J Clin Med. 2024 Mar 26;13(7) doi: 10.3390/jcm13071907.
Safety and Efficacy of Metabolic Surgery in Patients with Type 2 Diabetes in the Middle East and North Africa Region: An Analysis of Primary Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Outcomes.
Fares S, Barajas-Gamboa JS, Díaz Del Gobbo G, Klingler M, Pantoja JP, Abril C, Raza J, Guerron AD, Corcelles R, Allemang M, Rodriguez J, Kroh M
J Clin Med. 2023 Aug 2;12(15) doi: 10.3390/jcm12155077.
Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass to Enhance Weight Loss: Single Enterprise Mid-Term Outcomes and Literature Review.
Diaz Del Gobbo G, Mahmoud N, Barajas-Gamboa JS, Klingler M, Barrios P, Abril C, Raza J, Aminian A, Rosenthal RJ, Corcelles R, Kroh MD
Bariatr Surg Pract Patient Care. 2022 Dec 1;17(4):197-205 doi: 10.1089/bari.2021.0096.
The laparoscopic approach to right colectomy has now been proven to be safe in oncological terms. Most surgeons perform an extracorporeal anastomosis after the resection. Current literature seems to regard the intracorporeal approach a better strategy, but the learning curve is steeper and may prolong surgical time in the first cases. An intracorporeal anastomosis after a right colectomy is ideal for patients with morbid obesity or a bulky mesentery. This strategy makes it possible to make a smaller incision in the abdominal wall and prevents increased traction to the mesentery during the exteriorization of the specimen. The descending colon must be prepared after a sigmoid resection. A well vascularized colon must be selected and a correct pursestring made to attach the anvil. This video was produced to show several safety maneuvers such as the supervision of an untwisted mesocolon and a tension free anastomosis The selection of an optimal site for anastomosis so far has been dependent on subjective clinical indicators of intestinal viability: color of the bowel wall, bleeding edges of resected margins, and palpable pulsations. Indocyanine green fluorescence is a relatively new technique. Its intensity is correlated to tissue perfusion and bright fluorescence indicates good perfusion. The ICG may lead us to change the colonic site to perform the anastomosis. The green arrow distinguishes the well vascularized colon from the poorly vascularized one. Patients with an indication of proctocolectomy require a reservoir to achieve bowel transit restoration. The J Pouch is the most popular option due to a favorable balance between postoperative complications and quality of life. We have produced a video with the main steps to build a J pouch through mechanical anastomosis. TaTME involves different situations, which require different surgical steps and instruments. Each procedure needs a different type of anastomosis such as: hand sewn colo-anal anastomosis which is indicated in very low rectal cancer, an end to end mechanical anastomosis can be used if we have a sufficient distal margin to use a stapler. A side to end anastomosis is indicated when we have sufficient proximal colon to exteriorize the specimen through a Pfannenstiel incision or through the anus. With this kind of anastomosis we are looking for better functional outcomes. We encourage you to visit our open classroom section to see all the details.
Published
Nov 2016
Case A 28-year-old female with a history of Crohn’s disease for 9 years. The patient had tried several treatments, which had only been effective temporarily. Finally, the patient had been taking adalimumab with poor control. The patient had presented with recurring episodes of obstruction over the last few months. On imaging, a 10 cm stenosis on the distal ileum was causing dilation of the proximal bowel. Prior endoscopic dilations of this segment had been attempted with no clinical improvement. Thus, the patient was proposed to undergo a laparoscopic ileocecal resection. Treatment Three trocars were used: a 12 mm umbilical port for the optic and two 5 mm trocars on the left lower quadrant and left upper quadrant. The cavity was explored to identify the diseased segment macroscopically on the distal ileum, which was adjacent to the ileocecal valve. The right colon was mobilized laterally starting at the cecum. The ileocecal vessels were identified. The vascular dissection began by opening a window on the peritoneum. Once skeletonized, an energy device was used to transect the vessels. The retroperitoneal plane was mobilized medial to lateral, reaching the level of the transection on the ascending colon which had previously been defined as healthy tissue. Once the place of section was identified, an EndoGIA was used to transect the colon. Then, the distal ileum was examined once again to delimitate the proximal section point, in order to resect all the diseased bowel segment. Approximately 50 cm of ileum appeared to be affected macroscopically. The meso was dissected reaching the chosen point of transection at the ileum, which was cut with an EndoGIA. The specimen was extracted through a Pfannenstiel incision, where an Alexis had been previously placed. In order to prepare for the intracorporeal anastomosis, the ileum was brought closer to the colon. With the aid of a fabric ribbon, the point of the anastomosis is marked. First, the colon is opened followed by the opening in the distal ileum at the same level. The intracorporeal ileocolic anastomosis was performed with an EndoGIA adjusting each blade to the colon and the small bowel. Once fired, the stapler is removed and the mechanic anastomosis is widely open with no signs of active bleeding. To close the gap, a stitch was placed superiorly that would later continue with the running suture closing the orifice through which the staple had been placed. The stitch is tied and the needle is kept in place. Afterwards, an interrupted single stitch is placed on the inferior side of the gap, tied and cut with long ends. The first stitch made will be the start for a running suture. The end of this running suture will be tied to the interrupted stitch made at the other side of the gap. Additional stitches can be placed between the ileum and the colon in order to release some tension from the anastomosis. Outcome Operative time was 95 minutes. The patient had an uneventful postoperative period, and left hospital on the third postoperative day. No complications have been found on the 4 weeks of follow-up.
Published
Oct 2016
Case This is a 68 year-old male who on screening colonoscopy was found to have a 4 cm villous polyp of the low anterior rectum, extending from the dentate line. There was no evidence of high grade dysplasia or malignancy on biopsy and the patient was taken to the OR for planned transanal endoscopic resection. Treatment The patient underwent full-mechanical bowel preparation with 2 enemas given the night before surgery. Routine parenteral antibiotic prophylaxis was provided. The patient was placed supine on the table and following anesthesia, he was placed in high lithotomy position with stirrups. Following an anal block with local anesthetic, anoscopy was performed and the low rectal villous polyp could already be visualized along the anterior rectal wall starting just at the level of dentate line and extending by 3-4 cm into the rectum. The anus was carefully dilated and the short beveled TEO platform ® (Karl Storz). was inserted transanally. The platform was sealed with the faceplate and CO2 was insufflated to a pressure of 12-15mmHg. After achieving excellent distention and visualization of the low rectum, the lesion was scored circumferentially with cautery with a 0.5-1 cm margin starting at the level of the dentate line and extending superiorly into the proximal rectum. The distal aspect of the lesion was mobilized along the submucosal plane using monopolar cautery, making every effort to avoid injury to the underlying anal sphincter muscle. As this dissection was extended superiorly, this dissection plane was extended deeper through the rectal wall using monopolar cautery. The lesion was entirely excised, exteriorized transanally and oriented with sutures for pathology. The rectal wall defect was closed using interrupted 2-0 vicryl sutures using the EndoStich device®. Then the TEO platform was removed and the distal-most aspect of the anorectal defect was closed with 2-0 vicryl sutures using an anoscope. After confirming complete closure of the defect, additional local anesthesia was administered, and the patient was extubated and transferred to the recovery room. Outcome The procedure was performed as an ambulatory (same-day) procedure. The OR time was 85 minutes and the patient was discharged home on the same day. The pathology demonstrated a 2.5 cm tubulovillous adenoma with no neoplasia and negative margins. The patient is scheduled for flexible sigmoidoscopy for 6 months following this procedure. TEO platform is one of the multiple options available for transanal resection of anorectal lesions, with good surgical outcomes as it maintains the same surgical principles.
Published
Oct 2016
Case A 52 year old female allergic to atropine with a previous history of high blood pressure and OSA treated with CPAP suffers from a morbid obesity with a BMI of 46 Kg/m2. Two years ago she underwent a POSE procedure in a private center which was unsuccessful. She only lost 6kg and then regained and developed gastro esophageal reflux. Preoperative workup was performed with an upper endoscopy that revealed a normal mucosa and some sutures from the previous POSE procedure, most of them in the gastric fundus. These sutures are uneffective as the gastric volume is almost normal as you can see in the gastrografin test. The Clotest was negative. The abdominal ultrasound showed liver steatosis and no cholelithiasis. Treatment Conversion into a roux-en-Y gastric bypass was performed with the patient under general anesthesia and placed in supine position with open legs. The surgeon stood between the legs with one assistant on each side of the patient. A total of 6 trocars were used. A 12 mm trocar was placed in a supraumbilical position for a 30° scope, three 12 mm trocars served as working channels for the leading surgeon at the epigastrium and on each flank, and the 5 mm trocar was placed in a more lateral position at the left flank. The last 12mm trocar was placed at the umbilicus and was used during the infraumbilical phase of the surgery. Luckily there are only few additions from the previous procedure. One assistant surgeon performs traction from the liver surface and the other performs traction from the stomach to improve exposure. As the plane is clear we use the hook to take down these adhesions. We perform the required dissection to identify the landmarks and build the pouch. Here the surgeon looks for the left crura and the angle of His. The surgeon's left hand achieves extra tension and exposure to identify the avascular plane. The hook may also be used to effectively perform blunt dissection. Once the limit between the esophagogastric junction and the crura is identified the goldfinger is used to perform blunt dissection. To perform traction against the crura and the stomach a retrogastric tunnel is built that serves as a landmark during the creation of the pouch. The assistant surgeons pulls up the stomach by bringing it close to the lesser curvature, at the height of the second short vessel we mobilize the gastric wall. Once again we found adhesions and fused planes. The LigaSureTM was used for blunt dissection, sealing and cutting. Step by step the dissection progress as the gastric wall gets lifted and a retrogastric tunnel is built to achieve this maneuver the camera must be one of the surgeon's instruments. The left hand keeps the gastric wall lifted while the right hand performs blunt dissection. Once the tunnel is created the left hand makes progress. With these movements the surgeons mobilizes the posterior gastric wall until the dissection performed at the angle of His is communicated. The goldfinger is used to check the dissection, it looks like there is a lot of fat pad that must be mobilized prior to building the pouch. We used the LigaSureTM to achieve this step of the procedure. Seal and cut is used when a vessel is visible. Otherwise, blunt dissection is effective. As you can see, this a very versatile surgical tool. Now we leave a laparoscopic debakey inside the retrogastric tunnel and the mechanical suture is introduced through the epigastric trocar, guided by the debakey it has better access to to the stomach. With the stapler closed we verify that the knots from the POSE are away. Once again the goldfinger is used to check the retrogastric dissection, this makes it possible to make the next mechanical suture, purple cartridges are safe in this thickened tissue. Now we confirm the remnant tissue to be sectioned, one last firing is enough. Outcome Surgery took 140 minutes and was uneventful. Drainage was left for postoperative surveillance. The patient was discharged two days after the procedure with no complications.
Published
Sep 2016
Case A 41-year-old male with familial adenomatous polyposis since the age of 14. The patient had declined to undergo an ileal pouch-anal anastomosis, choosing to have an open subtotal colectomywith ileo-rectosigmoid anastomosis in 2004. Approximately 20 cm of rectosigmoid colon were left in-situ. He remained on non-steroidal anti-inflammatory drugs and undergoing frequent endoscopic surveillance with removal of recurrent small rectal adenomas.Surveillance sigmoidoscopy in March 2015 demonstrated a confluent carpeting area of flat adenomatous tissue with interspersed areas of scarring, extending from 1 cm above the dentate line up to 4 cm, occupying approximately 50% of the posterior rectal wall surface. Endoscopic mucosal resection (EMR) was unsuccessful. He was planned transanal endoscopic resection of the polypoid area as patient was still refusing an ileoanal pouch. Treatment The patient underwent full-mechanical bowel preparation with 2 enemas given the night before surgery. Routine parenteral antibiotic prophylaxis was provided. The patient was placed supine on the table and, following anesthesia, he was placed in a high lithotomy position with stirrups and a foley catheter inserted. Following an anal block with local anesthetic, careful anal dilatation was performed followed by insertion of the short TEO platform® (Karl Storz). The platform was sealed with the faceplate and CO2 was insufflated to a pressure of 12-15mmHg. After achieving excellent distension and visualization of the low rectum, the confluent area of a large carpeting villous adenoma was noted. The area was initially scored circumferentially with a needle-tip cautery with a 0.5 cm margin. The rectal wall dissection was first initiated distally at the level of the dentate line, where endoscopicmucosectomy was performed following the previous cautery marks. The use of a flexible-tip cautery greatly facilitated endoscopic dissection through the rigid transanal platform as it enhances the movement capability of the instruments. The lesion extended posteriorly from just above the dentate line to just below the first rectal valve, occupying approximately 50% of the posterior circumference. As the dissection extended more cephalad towards the low rectum, full-thickness dissection through the rectal wall was performed. The specimen was retracted cephalad in order to facilitate plane exposure. Care was taken to avoid injury to the underlying muscle fibers of the anal sphincter during distal dissection. Following complete dissection of the lesion, it was oriented with 2 sutures for pathology, and exteriorized through the platform. The rectal wall defect was then irrigated with a saline and betadine solution. First of all a single suture was placed on the middle of the defect to begin the full thickness closure. The EndoSttitch® device was used with 2-0 vicryl stitches. Two continuous sutures from each end of the resection helped to close the rectal Wall defect. Each running suture was started laterally progressing towards the mid-point where both sutures were tied. Following air-tight closure of the rectal wall defect, hemostasis was confirmed and the platform was removed. Outcome The OR time was 90 minutes and the patient was discharged within the same day. Pathology found a 4.5cm tubulovillous adenoma with serrated architecture (low-grade dysplasia). All resection margins were free of dysplasia. Repeat flexible sigmoidoscopy 3 months postoperatively demonstrated small rectal adenomas which were easily removed, but there was no evidence of a residual carpeting adenomatous lesion. Transanal resection of large polyps can be performed with different platforms, maintaining the same surgical principles regardless of the device used, and providing the surgeon with multiple tools to approach rectal lesions.
Published
Sep 2016
Case A 51 year-old female with a previous history of autoimmune myositis (treated with 5 mg / day of prednisone), a laparoscopic cholecystectomy and a laparoscopic RYGBP due to morbid obesity (10 years ago with an initial BMI of 44 Kg/m2 and correct weight loss, going from 123Kg to 69Kg). She came to the emergency room due to sudden abdominal pain and persistent nausea. In evaluation her vital signs were stable, but the abdomen was slightly distended with pain at the epigastrium. White blood cells, PRC and hemostasis parameters were normal. Amylase and lipase were high with normal bilirubin. An abdominal CT Scan was performed to achieve the diagnosis identifying a 6-10 cm segment of proximal jejunum forming a concentric rings image which led to the diagnosis of jejuno-jejunal intussusception. This intussusception was causing a small bowel occlusion of the biliopancreatic limb as the gut had a diameter of up to 5 cm and a distended gastric remnant. Treatment Emergency surgical revision was performed laparoscopically with the patient under general anesthesia and in the anatomical position. Pneumoperitoneum was performed with a Veress needle at the upper left abdominal quadrant. A total of three ports were placed, in a configuration similar to that used in the inframesocolic phase of the gastric bypass. A 12 mm trocar was placed at the right flank for a 30º scope, an 11mm trocar was placed at the umbilicus and a 5mm port was placed at the epigastrium. The leading surgeon stood at the right of the patient with the assistant to his right. A segment of major omentum was attached to the abdominal wall. The hook was used to release it as it could be a future cause of small bowel occlusion. Notice the distended and viable small bowel, which seems to be the JJ anastomosis. There was some major omentum also attached to the descending colon. This adhesion was also released as it could become a cause of internal hernia. Special care must be taken if you use the hook as the colon may be close, so try to identify avascular planes. Performing good traction is crucial. Small bowel revision was performed from the terminal ileum to the proximal jejunum. This strategy allows systematic evaluation of the gut and makes it possible to manipulate the distended bowel last, avoiding injuries. We used laparoscopic Debakey's as they enable good, delicate traction to perform this kind of manipulation. It should be borne in mind that we are revising a RYGBP so this will be the common channel. As we are revising towards the proximal jejunum, the next thing that must be found is the JJ anastomosis. The best strategy is to try and place all the structures in their original location, and have a well exposed mesentery, evaluating for gaps and hernias. This allows us to identify a big mesentery gap without herniation at the moment. As the radiological findings suggested that intussusception was located at the level of the biliopancreatic limb, we revise it from the JJ anastomosis to the angle of Treitz . The leading surgeon keeps the biliopancreatic limb in position with his left hand, mobilizing the mesenteric root with his other hand.This maneuver clarifies the situation as the inferior mesenteric vein is identified. Performing simultaneous traction of the transverse colon and the small bowel makes it possible to identify the Angle of Treitz and the last segment of the duodenum. A final revision of the biliopancreatic limb was carried out. No intussusception was found. The intestinal walls and the mesenterium were in normal position. Maybe this clinical situation arose due to a distended biliopancreatic limb secondary to an intermittent occlusion due to herniations at the level of the mesenteric gap. The alimentary limb was also revised from the JJ to the gastro-jejunal anastomosis. Notice that we grasped the entire wall of the gut to perform effective traction and avoid injuries. This gut segment was normal. Petersen’s defect was also assessed and found to be sealed. As a last step in the procedure, the mesenteric gap was closed with a running 2-0 prolene suture. Care was taken to avoid major vascular injuries. This is feasible due to left hand traction. We are aware that the remnant stomach was distended but as the passage to the common limb was good and there were no signs of perforation, a decompressive gastrostomy was not performed. With this knot we finished the surgical procedure. Outcome Surgery took 84 minutes with no conversion to open approach or intra operative complications. Oral intake started on the second postoperative day and the patient left hospital three days after surgery. Three months later she remains asymptomatic.
Published
Aug 2016
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