Laparoscopic Toupet fundoplication: prospective study of 100 cases. Results at one year and literature review.
Lefebvre JC. Belva P. Takieddine M. Vaneukem P.
Department of Digestive Surgery, C.H.U. de Charleroi, Belgium.
We report a prospective evaluation of 100 patients who underwent laparoscopic fundoplication according to Toupet. All these cases where suffering from gastro-oesophageal reflux resistant to medical treatment or recurring after stopping it. Only one conversion into laparotomy was required. Perioperative morbidity (4%), mortality (0%), median hospital stay (4 days) and return to work (3 weeks) were lower than in case of open surgery in the literature. One year after the operation, clinical results were similar to those of laparotomy with 93% of patients free of symptoms. Excellent results of this technique lead us to assert that laparoscopic Toupet procedure is an interesting way of treating the gastro-oesophageal reflux that does not respond to medical treatment.
Laparoscopic ultrasound in abdominal surgery.
Catheline JM. Champault G.
Department of General and Digestive Surgery, Hopital Jean Verdier, Bondy, France.
Laparoscopic ultrasound combines the advantages of diagnostic laparoscopy with peroperative ultrasonography. This new technique allows visualization of deep structures that are not palpable. The technical aspects of this technique and its applications in abdominal surgery are described. The main indications are the search for common bile duct stones during a laparoscopic cholecystectomy and the assessment of the spread of abdominal cancers. The information obtained from laparoscopic ultrasound can influence the therapeutic management.
Five years of surgical experience with peritoneal dialysis.
Remes J. Peeters J. Coosemans W. Donck J. Geuens M. Vlaminck H. Vanrenterghem Y.
Department of Surgery, UZ Gasthuisberg, Leuven, Belgium.
In this study, we evaluate retrospectively five years experience with the Swann Neck Missouri DC catheters. Sixty three catheters are placed in 51 patients. The total observation period is 695.6 months and the average time is 13.6 months per patient. The last 21 catheters are coiled type. Infectious complications remain the most worrisome problem in peritoneal dialysis. Exit site infections are seen in 24%, tunnel infections in 8%, peritonitis in 38% and abdominal hernias in 16% of the patients. The results in our series (peritonitis every 29.0 patient-months) are in accordance with data from the literature. The combination of a good surgical technique and an efficient postoperative attendance have reduced this frequency. In the situation of a tunnel infection, surgical removal remains the treatment of choice. To prevent an exit site infection, the entry port must be well nursed and protected. A coexisting abdominal hernia can be repaired during the implantation procedure. Fourty six peritoneal dialysis catheters have been removed. Transplantation and death are the main reasons (59%).
Richters femoral hernia: a clinical pitfall.
Vervest AM. Eeftinck Schattenkerk M. Rietberg M.
Department of General Surgery, Stichting Deventer Ziekenhuizen, The Netherlands.
A.G. Richter described in 1777 a hernia in which the antimesenteric part of the small intestine was incarcerated. We demonstrate in the article the diagnostic pitfalls of the Richter's femoral hernia. The physical signs consist of vague abdominal complaints, swelling in the groin but usually no symptoms of intestinal obstruction. The Richter's femoral hernia can be complicated by a stenosis in the initially incarcerated distal ileum.
Acute cardiac herniation following intrapericardial pneumonectomy.
Vanoverbeke HM. Schepens MA. Knaepen PJ.
Department of Cardio-Thoracic Surgery, Sint-Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Cardiac herniation is a rare but potentially fatal complication of intrapericardial pneumonectomy. It usually occurs within the first 24 hours postoperatively. Symptoms are side-related. It has a sudden onset and invariably evolves to cardio-vascular collapse. Clinical suspicion combined with plain chest X-ray and electrocardiographic changes must lead to a quick diagnosis. Definitive treatment requires prompt surgical action. Closure of the pericardial defect during initial operation does not exclude the possibility of cardiac herniation. We present a patient with a right-sided cardiac herniation after intrapericardial pneumonectomy. Patient was treated surgically and survived.