Obesity is a current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past 10 years and we can observe an early onset of obesity. We have used a modified BAROS and SF36TM questionnaire to conduct a descriptive study on 34 obese patients undergoing surgery for obesity—laparoscopic sleeve gastrectomy (LSG). The inclusion criteria were the embodiment of surgery for obesity: BMI (body mass index) >40 kg/m2 or BMI > 35 kg/m2 and associated comorbidities. The postoperative BMI was 25.7670 ± 3.74759 kg/m2 (mean ± SD). The average number of lost kilograms was 38.74 ± 12.526 (mean ± SD), and the average percentage of excess body weight loss (% EBWL) was 85.9952 ± 22.69028% (mean ± SD). Patients lost an average of 36.88–38.56 kg at 6–12 months after surgery, and they reach a % EBWL of 94.69 ± 30.02% and a normal BMI of 23.96 kg/m2 at 18 months postoperatively. All patients significantly reduced the amount of food eaten after surgery. More than 2 years after the surgery, patients increased their food intake by about 30%, but maintained their weight loss and a normal BMI. Related to quality of life, 77.78% of patients declared a vast improvement, 11% a good quality of life, and only 3.7% said that the quality of life is worse than before the surgery. Also, a relationship between quality of life and the improvement of sexual life, or with the increased frequency of physical exercise has been observed. Improving quality of life is directly related with the weight loss, with %EBWL, and with the postoperative BMI. Bariatric surgery should be understood in all the positive changes that it generates in everyday life.

INTRODUCTION:Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, which can derive from either parasympathetic or sympathetic paraganglia and are closely related to pheochromocytomas.CASE REPORT:We present the case of a young male patient of 37 years old, who was admitted for hypertensive crisis and palpitations. His medical history included medically controlled type 2 diabetes mellitus, (diagnosed 10 months ago), Hepatitis A. Hormonal evaluation revealed elevated urinary metanephrines and normetanephrines, with mainly increased normetanephrines (2330 ug/24 h). Plasmatic metanephrins were in normal range, but levels of plasmatic normetanephrins were elevated (952 pg/ml). The assessment of pituitary and aldosterone-renin axis values were within normal limits. Abdominal computed tomography showed left adrenal nodular lesion on the external arm, bilobulated, size 32/33 mm with maximum axial and cranio-caudal diameter of approx. 45 cm, suggestive of a benign lesion, keeping the cleavage plane to vecinatate structures. Left adrenalectomy was performed by laparoscopic approach. We mention that immediately after induction of anesthesia were recorded blood pressures of 298/143 mmHg. Histopathologic and immunohistochemical examination diagnose paraganglioma, without invasion of adjacent tissues. The patient evolution was favorable, with the remission of the symptoms and normalization of hormonal markers. It is imperative to note the remission of diabetes in the postoperative period.DISCUSSION:This is the case of a young patient with functional retroperitoneal paraganglioma, who presented with symptoms of pheochromocytoma. Compared to pheochromocytomas, paragangliomas are rarely symptomatic and functional. Association with diabetes is even more rare. Specialized investigations allowed the proper diagnosis and the therapeutic approach above was the result of a multidisciplinary cooperation.

The main challenges of benign uterine surgery are fertility preservation, choosing the optimal approach (open or minimally invasive) and the management of complications. Conventional laparoscopy is the main technique used for laparoscopic hysterectomy for benign indications. We present three cases of complex patients with uterine fibromatosis, along with a literature review over the continually regressing limits of the laparoscopic approach of uterine pathology.