GSD Healthcare

Robotic surgery for the correction of hiatal hernia has become increasingly popular within the surgical activity of the IRCCS Galeazzi Hospital – Sant'Ambrogio.

The hiatal hernia involves the ascent of part of the stomach through the diaphragm, a dome-shaped muscle that separates the chest from the abdominal cavity and presents a natural opening called the esophageal hiatus.
The esophagus passes through this opening and connects directly with the stomach. Through this opening, the stomach can move upwards, rising into the thoracic cavity, thus giving rise to a hiatal hernia.
Typical symptoms are those associated with gastroesophageal reflux, that is, heartburn and regurgitation.

However, other extra-esophageal symptoms may also appear, such as chest pain, difficulty swallowing, asthma, chronic cough, dyspnea, dysphonia, and hoarseness.

The first approach to hiatal hernia is a conservative medical one. However, the surgical approach may be indicated in the case of:
• Persistent symptoms
• Young patients who do not want to take reflux therapy continuously
• Barrett's esophagus
• Very large hernias

Surgical intervention via robotic surgery or laparoscopy is the only definitive treatment.
Robotic surgery for the treatment of hiatal hernia is an advanced, minimally invasive technique, thanks to the numerous advantages for both the patient and the surgeon performing the operation. Robotic surgery is the evolution of laparoscopic surgery, where the surgeon controls the instruments from a console external to the operating field.

The advantages of robotic surgery:
• better precision: the three-dimensional, magnified, and high-definition field of vision is much more stable than what happens with traditional laparoscopic techniques. This allows the surgeon to carry out more precise dissections;
• less bleeding: the accuracy and precision of the surgical dissection of this technique minimizes trauma, consequently reducing bleeding;
• lower risk of post-surgery complications: the combination of precision, improved visibility, and advanced control often leads to better and more consistent surgical results, with a reduction in complications;
• shorter recovery times: according to data emerging from scientific literature, patients undergoing robotic surgery have faster recovery times. Hospitalization times are shorter, so it is possible to return to your daily activities quickly.

However, most hiatal hernia treatment operations are performed using the laparoscopic technique.
Laparoscopy is a minimally invasive surgical technique for correcting hiatal hernia. In this case, the surgeon operates using a two-dimensional camera inserted through small incisions in the abdomen (very similar to those performed with the robotic technique).


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Getting in shape before undergoing surgery is always advisable. Clinical studies have shown that setting up a pre-habilitation protocol, an ad hoc pre-operative habilitation protocol for hip or knee replacement, can improve the postoperative course.

We are used to hearing about post-operative rehabilitation. Still, the ambitious project of the Istituto di Cura Città di Pavia, promoted by the physiotherapy service in collaboration with orthopedic specialists, provides a pre-habilitation path to improve operative performance in addition to the standard post-operative path.
A good level of preoperative fitness positively influences the outcome of lower limb arthroplasty. “In clinical practice, it is found daily that many of the patients who are candidates for hip and knee replacement surgery are in conditions of poor mobility and reduced functional capacity, some even in a state of fragility. On the other hand, a more toned and stronger musculature improves the prognosis and shortens recovery times."

A prehab service will be activated at our institute's physiotherapy gym for patients to practice under the supervision of physiotherapists. Considering the high number of patients not resident in Pavia, we have also thought of a tele-prehab service based on supervised exercises and/or the use of electrostimulation from the comfort of your own home.
Furthermore, the patient will be provided with an explanatory brochure with the exercises he will have to perform, enriched with specific advice helpful in preparing for the operation. Those who are more technological will also be provided with a link to access the exercise videos and information pills, which are helpful for pre-and post-intervention.

Pre-qualification includes:
• Exercise protocols to acquire greater strength, improve muscle, tendon, and ligament condition, and prevent hypotrophy from reduced mobility.
• Patient education, whereby information is provided on the posture to maintain while carrying out daily life activities.
• Balance and gait training to improve walking dynamics.
• Electrostimulation is used to recover or increase muscle tone and strength using devices on-site or at home.
• Pressotherapy is indicated for draining any fluid stagnation in the lower limbs.
• Cryotherapy, thanks to its anti-inflammatory action, acts on contractures and soothes pain.
• Continuous passive movement that improves joint excursion, allowing a decrease in pain.
• Psychological support to accompany the patient, should he feel the need, during the clinical process.

The advantages of pre-qualification:
• The patient, with simple exercises to be performed in person or at home, following the instructions provided during the visit, can enjoy a better surgical outcome and quicker healing.
• Professionals, doctors, and therapists working with patients more aware of their muscular and motor abilities can manage a shorter hospital stay and have better outcomes in most cases.


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Overweight and obesity are medical conditions characterized by excess body fat that can negatively affect your health and increase the risk of developing heart disease, type 2 diabetes, hypertension, sleep apnea, some types of cancer, and other chronic medical conditions.
Weight management through a balanced diet, regular exercise, and medical support are key to preventing and treating overweight and obesity. In some cases, gastric balloons or other weight loss options may be considered adjunctive therapies under the supervision of a medical professional.

A gastric balloon is a flexible balloon, generally made of silicone, inserted into the stomach through an endoscopic procedure to treat obesity and overweight.
Once in the stomach, the balloon is filled with a sterile saline solution or air to occupy part of the gastric cavity, thus reducing its capacity and inducing a feeling of early satiety during meals. This helps patients consume less food and lose weight more quickly.
The classic gastric balloon is temporary and must usually be removed after 6 months/1 year via an endoscopic maneuver.

Scientific research has now made it possible to have a gastric balloon designed to help people lose weight without the need to perform invasive procedures. The balloon can now be swallowed like a pill and then inflated in the stomach with the help of a catheter connected to a water-filled balloon. Once inflated, the balloon occupies part of the stomach, reducing the volume of food consumed and inducing a feeling of early satiety.

One of the main advantages of this innovation is that it does not require an endoscopic procedure for installation or removal, as the balloon naturally deflates and is expelled through the digestive tract after approximately 4 months. No anesthesia or endoscopy is required.
Only in rare cases will early balloon removal require an endoscopic procedure in case of marked intolerance.

This innovation satisfies us immensely, with an average weight loss of 10-15%. The patient is satisfied with the results obtained and less alarmed by the procedure, satisfying even the most particular needs of people who cannot perform anesthesia due to medical problems.
However, it is essential to highlight that the treatment also depends on the patient's adopted lifestyle, especially after the balloon has been expelled.
The balloon helps reduce appetite and the amount of food that can be consumed in a meal, but the patient must work hard to optimize weight loss and maintain results in the long term.

During this treatment period, patients are followed by a specialized team that provides clinical, dietary, and behavioral support to maximize the therapy's benefits. The patient is encouraged to follow a balanced diet and engage in a regular physical activity program.

The results obtained with this method will give the patient great motivation, leading him to a positive and long-term approach to a correct lifestyle, a healthy diet, and constant physical activity suited to his abilities. The treatment, in fact, is only part of a program whose aim is real nutritional re-education.
It is also important to underline that gastric balloons are, in any case, a temporary solution for weight loss and not a permanent cure for obesity. They can be used as part of a comprehensive weight management program.


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The IRCCS San Raffaele Hospital (HSR) is the leader of an international study that has identified a treatment to prevent a more frequent and deadly pathology than acute myocardial infarction.
There are over 300 million surgical operations worldwide every year, and 1 million are performed with the aid of cardiopulmonary bypass. The body and organs of patients undergoing surgery are subjected to acute stress, and several studies state that the kidneys are significantly affected by surgical stress, as renal perfusion is reduced and the risk of developing acute renal failure increases (ARF), which can subsequently progress to chronic kidney disease.
There has never been a specific preventive intervention for acute renal failure other than implementing supportive measures. AKI, present in 10-15% of all hospitalized patients in the world (about half a billion per year) and in 50% of patients admitted to intensive care, represents a critical condition with high mortality and morbidity. In fact, one study found that the 90-day mortality rate in critically ill patients with AKI can be as high as 30-40% (BioMed Central), making this event significantly more deadly than myocardial infarction.
The work just published in the prestigious New England Journal of Medicine (NEJM) was coordinated by Professor Giovanni Landoni, director of the Anesthesia and Resuscitation Research Center of the HSR in Milan and full professor at the Vita-Salute San University Raffaele, and by Professor Alberto Zangrillo, head of the operational unit of Anesthesia and general resuscitation, Cardio-Thoraco-Vascular and the single area of intensive care and cardiac surgery, management contact for the clinical areas of the HSR, full professor of Anesthesia and resuscitation at the Faculty of Medicine and Surgery and vice-rector for institutional clinical activities of the Vita-Salute San Raffaele University, and conducted in collaboration with various Italian centers and around the world - in particular with Professor Rinaldo Bellomo, professor of Intensive Care at the University of Melbourne and PhD in intensive care.
Research demonstrates for the first time the effectiveness of intravenous administration of amino acids in preventing the onset of ARF following cardiopulmonary bypass surgery.

The international study coordinated by the HSR, financed thanks to the victory of a Grant from the Italian Ministry of Health, saw the participation of 3,511 patients from 22 centers, including Italy, Croatia and Singapore, and will be presented by Professor Giovanni Landoni and Dr. Martina Baiardo Redaelli on 12 and 14 June in Belfast (Northern Ireland), on the occasion of the Critical Care Reviews Meeting 2024, the scientific conference that highlights the best clinical studies in intensive care in the world.
The researchers administered the amino acid therapy intravenously to an initial group of 1,759 adult patients undergoing cardiac surgery with cardiopulmonary bypass in the 3 days following surgery, while the remaining 1,752 were administered a placebo. They then found that AKI occurred in 474 patients in the group who received the drug (26.9%) compared to 555 patients in the group who received the placebo (31.7%), recording a decreased likelihood of occurrence of ARF of 5%.
"We have seen that" by administering a solution of amino acids intravenously from the moment immediately before the operation up to 3 days post-surgery, the kidney can maintain good perfusion, optimizing renal oxygenation and glomerular filtration, thus decreasing the probability of an IRA arising is very high,” explains Professor Giovanni Landoni.

After decades of studies on amino acids mainly based on their nutritional effect or on raising body temperature, the San Raffaele research opens the way to new uses, promising an update of the guidelines and a revolution in the clinical field: "The data that we have collected with this study confirm that amino acid therapy can prevent acute renal failure," says Professor Alberto Zangrillo.

From today, we will be able to study and perhaps apply these results not only to surgical interventions carried out with bypass but also to:
• To those suffering from heart failure.
• To those undergoing a kidney transplant.
• To those with ongoing renal failure.
• To septic patients, and can also be used to reduce damage from contrast agents.

“We are confident "that our contribution can make a difference in the world of medicine. It is the first time in history that we protect the kidney pre- and post-surgery with a drug. This paradigm shift could improve the outcome of millions of patients every year," concludes Professor Rinaldo Bellomo.


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Cardiac electroporation is a method of cardiac ablation to treat cardiac arrhythmias in patients unresponsive to pharmacological therapies or at risk of complications. Its goal is to eliminate small portions of the heart responsible for the improper impulse of the muscle.
This innovative and minimally invasive technique was recently introduced and is already in use at the IRCCS Galeazzi Hospital Sant'Ambrogio. The modern and minimally invasive methodology was introduced for the treatment of pathologies such as:
• Atrial fibrillation, a cardiac pathology characterized by an irregular and rapid atrial rhythm;
• Atrial flutter, an arrhythmia affecting the atria of the heart.

Cardiac electroporation is used to treat atrial arrhythmias, i.e., disorders linked to the rhythm and frequency of the heart that originate in the cardiac atria. In the future, it is possible to hypothesize extending the field of action of this technique to other types of tachycardia of ventricular origin. The procedure acts selectively on the cardiac tissue, safeguarding the endothoracic structures close to it.

The treatment consists of applying a very intense and short-lasting electrical impulse in the areas of the heart responsible for rhythmic anomalies. Electrical energy is delivered through an irrigated multipolar catheter placed within the left cardiac atrium. Using high-voltage pulses for a few seconds, holes in the cell membrane are induced in cardiac cells, resulting in instant necrosis of the pathological cells and the source of the arrhythmia.
Compared to traditional methodologies, electroporation, through the use of these impulses that act only on targeted points, presents itself as an energy:
• More selective for the myocardial tissue itself.
• Less harmful to the structures surrounding the heart, such as nerves, esophagus, and blood vessels.
• With a lower risk of complications, thanks to tissue selectivity.

Furthermore, this procedure reduces surgery ex*****on times by 30% compared to traditional methods.

Cardiac electroporation, therefore, offers numerous advantages for the candidate patient compared to thermoablation and cryoablation methods.
These traditional thermal energies act in the heart to cause a controlled thermal injury, heating or cooling the heart tissue. They are widely known and very effective, but they also involve the structures surrounding the heart in the ablative process; in some cases, it is possible to have side and unwanted effects, which constitute the real complications of this procedure.
However, the new electroporation methodology was developed to make the ablative procedure as less invasive as possible and to reduce the risks associated with traditional methodologies.

The post-operative course of cardiac electroporation is comparable to previously used procedures (without complications). “In our hospital, the patient is usually discharged home on the second post-operative day without any significant limitations other than avoiding intense physical activity for 15-20 days."

Only patients diagnosed with atrial fibrillation and atrial flutter can access the cardiac electroporation procedure. At the moment, patients with less complex fibrillations and in the absence of structural heart disease are subjected to it. This indication is present because the electroporation technique can only be used in specific portions of the heart.
After the electrophysiologist specialist for cardiac ablative therapy a clinical evaluation is conducted to establish the most suitable method.


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Eid Al Adha Mubarak. May this special day bring you and your loved ones peace, prosperity, and good health.

عيد اضحى مبارك. نتمنى لكم عيدا مليئا بالسلام والازدهار والصحة الجيدة.

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Intralipotherapy is a non-surgical aesthetic medicine procedure used to reduce localized fat deposits resistant to diet and physical activity, targeting areas such as the abdomen, hips, arms, and chin.

Intralipotherapy is an advanced treatment involving injecting a galenic lipolytic solution into subcutaneous fat. The solution consists of:
- Phosphatidylcholine: A phospholipid that helps emulsify fat into smaller particles for absorption.
- Deoxycholic Acid: A synthesized acid that aids in eliminating fat from treated tissues.

These substances work together to break down fatty cells and facilitate fat elimination, making it practical for reshaping and reducing fat in areas like the flanks, abdomen, buttocks, inner thighs, arms, knees, and subchin. It can also be used for fine-tuning after liposuction.

Intralipotherapy is recommended for men and women close to their ideal weight but with localized fat deposits that persist despite exercise and diet. It is not a substitute for weight loss, unsuitable for obese individuals, and contraindicated for those allergic to soy and eggs.

The treatment can be performed year-round without prior preparation. It involves:
- Physical examination
- Body weight assessment
- Discussion of patient expectations

The procedure lasts a few minutes, is painless, and requires no anesthesia. It involves small injections into the subcutaneous tissue where fat needs to be eliminated.

The treatment is generally well tolerated with minimal side effects, which may include:
- Mild erythema
- Edema
- Itching
- Slight tenderness in the treated area

These side effects usually resolve within 2-3 days. Patients are advised to avoid intense physical activity, hot baths, and saunas for 2-3 days post-treatment.

To achieve satisfactory results, 2 to 4 sessions are necessary, with at least a 3-week interval between sessions. Post-treatment, the treated skin appears smoother and more toned.


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In collaboration with IRCCS San Raffaele Hospital in Milan and the University of Chicago, the Veronesi Foundation will fund a five-year research project to improve lung cancer care. The project will focus on personalized therapies and early diagnosis. The initial Neo-memory project aims to identify biomarkers for optimal therapy selection.

Lung cancer remains a significant health challenge, with 44,000 new cases diagnosed in Italy in 2023 and high mortality rates. Despite advances in treatment, including immunotherapy and targeted therapies, identifying patients who will benefit most from immunotherapy remains crucial.

The Neo-memory project, led by Roberto Ferrara of Vita-Salute San Raffaele University, will study immunological memory and lymphoid formations in lung cancer patients. This research seeks to identify markers that predict long-term survival following neoadjuvant treatment and surgery.

Early diagnosis is also critical, as Professor Fabio Ciceri of IRCCS San Raffaele Hospital highlights. He notes that early detection, mainly through screening of heavy smokers, increases the chances of curing the disease. The Veronesi Foundation plans to enhance screening efficacy using AI for nodule detection and individual risk profiling for lung cancer and related diseases.

Chiara Tonelli, President of the Umberto Veronesi ETS Foundation's scientific committee, emphasizes the foundation's commitment to innovative research and long-term projects that will transform lung cancer care.


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World MS Day is dedicated to raising awareness about Multiple Sclerosis (MS), a chronic illness that affects the central nervous system, including the brain and spinal cord. MS disrupts the flow of information within the brain and between the brain and the rest of the body. Symptoms vary widely but can include fatigue, mobility issues, vision problems, and cognitive changes. Today, we unite to support those living with MS and promote research for better treatments and a cure.


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GSD Healthcare Chairman and GKSD President Kamel Ghribi, together with the Minister of Health, Dr. Saleh Mahdi Al-Hasnawi, signed a contract that will see GSD start up, operate, and manage the 429-bed al Sayyab Teaching Hospital in Basra. In so doing, GKSD/GSD is supporting the Iraq Government's healthcare framework for the future and bringing Italian healthcare excellence in training, management, and maintenance to the people of Iraq. Also present at the signing were Technical Deputy Minister Dr. Hani Moussa Al-Aqabi, the Director-General of Basra Health, Dr. Abbas Khalaf Al-Tamimi, and a number of General Directors in the ministry.
This is the second hospital in Iraq that GKSD/GSD will manage and operate. The aim is to bring Iraqi hospitals into line with modern European systems, both in terms of health services and staff training.
Kamel Ghribi commented, "The contract will be a starting point for increasing the volume of cooperation not only between Italy and Iraq in the health sector and other sectors, but lead the way for European cooperation as a whole."



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Abdominal diastasis consists of the separation and progressive removal of the re**us abdominis muscles from the midline, a thin fibrous membrane that divides the re**us abdominis muscles into 2 sections.
Suppose the re**us muscles with their covering bands and the linea alba undergo forced distension. In that case, thinning occurs and the support, natural strengthening, and containment function of the abdomen is lost with the development of abdominal diastasis and related problems.

There are several causes why the abdominal muscles can move away:
• Pregnancy: Abdominal diastasis is evident in 66% of women in the third trimester and persists in 30-60% of women after giving birth. It is a problem that mainly affects women who have practiced sports before and during pregnancy.
• Excessive sport and physical effort: incorrectly regulated sporting activity can tear the re**us muscles, the linea alba, and the consequent diastasis of the re**us muscles due to excessive physical effort.
• Weight gain and obesity: the progressive increase in body weight determines a relaxation of the abdominal muscles and the transformation of the linea alba into an aponeurotic lamina.
• Family history and genetics: Collagen diseases, with their tissue changes.
• Age: advanced age leads to tissue laxity.

The typical sign of abdominal diastasis is a change in the shape of the abdomen with the emergence of a 'central bulge' above or below the level of the navel.
It is often associated with critical functional problems caused by diastasis, including:
• Low back pain, with a change in postural structure
• Urinary incontinence, precisely due to effort following coughing, sneezing, physical exercise
• Abdominal swelling and/or pain, digestive difficulties, nausea
• Alterations in respiratory mechanics often associated with a hernia of the abdominal wall

In many cases, especially after pregnancy, abdominal diastasis reduces or resolves spontaneously after a few months. In some cases like in the presence of stress urinary incontinence, recurrent or chronic low back pain, and umbilical or midline hernia, it may be necessary to resort to surgery which reconstructs the linea alba and repositions the muscles in their original site through the insertion of a prosthetic mesh, to reinforce the abdominal wall.
At our hospital, the operation can be performed laparoscopically, i.e., through 3 small incisions, with a technique called Mi-Sar.


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Colorectal cancer is one of the most diagnosed oncological pathologies and mainly affects the population of 60-75 years of age. Good prevention in the form of a healthy lifestyle and regular adherence to screening, associated with the performance of specific diagnostic tests, can make a difference in prognosis and life expectancy after diagnosis.

The cancerous pathology develops from adenomatous polyps, which are typical of the colorectal area. These are precancerous lesions that, especially if large, can degenerate into tumors.
Fortunately, mortality in this district is decreasing thanks to the progress made in research, oncological treatment, and surgical treatment.

Neoplastic pathologies of the colorectal tract are silent at their onset and become symptomatic only in the more advanced stages.
The most common warning signs to pay attention to are:
• Presence of blood in the stool
• Tiredness associated with anemia
• Weight loss not associated with a change in diet
• Sudden changes in the intestinal tract (constipation or diarrhea)

Screening with f***l occult blood and colonoscopy, when indicated due to age and familiarity, also plays a fundamental role in intercepting and interpreting symptoms in time.

If suspicion of tumors is raised, the patient can access a path from diagnosis to treatment at the Beato Matteo Clinical Institute.
There is a digestive endoscopy service that allows you to undergo recto-sigmoidoscopy and colonoscopy to formulate a diagnosis of oncological or inflammatory pathologies of the colon and re**um. If necessary, tissue samples can be taken during these tests to perform the histological examination and remove any polyps present.
Once the tumor has been diagnosed, a dedicated multidisciplinary team takes care of the patient, making it possible to complete the pathology staging directly at the Centre by carrying out targeted radiological tests. Once the diagnostic phase has been completed, the patient can undertake the therapeutic process.
The General Surgery team performs all colorectal surgery operations, with particular attention to the laparoscopic approach. Each patient is carefully evaluated during the surgical and pre-admission visit, and based on the type of tumor, its extension, and clinical conditions, an indication is given as to the kind of operation necessary and the most appropriate technique to perform to guarantee the patient the best possible treatment.


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