Surgical Endoscopy

Bonnard, A.; de Lagausie, P.; Leclair, M.D.; Marwan, K.; Languepin, J.; Bruneau, B.; Berribi, D.; Aigrain, Y.

doi: 10.1007/s004640090092pmid: 11727138

Background: Between December 1990 and March 1999, five laparoscopic Duhamel pull-through procedures for extended or total aganglionosis were performed in our department, one of which had a rectosigmoid form with a short bowel and a colonic resection due to a volvulus. Methods: The aim of this study was to show that even when the extended form of Hirschprung's disease or anatomic difficulties such as a short bowel and anterior colonic resection are encountered, the laparoscopic approach is possible and total colectomy is feasible. The procedure has been described previously. We used one camera port and three working ports. The sigmoid, transverse, and right colon up to the last ileal cove were mobilized laparoscopically. A standard posterior ileo-anal anastomosis was performed, and an endo-GIA stapler was used for the anterior anastomosis. Results: A total of five patients underwent laparoscopic surgery for Hirschprung's disease. There were three total colonic forms, one rectosigmoid form with a short bowel and colon resection attributed to a volvulus, and one transverse variant that required a Deloyers' maneuver for the pull-through. Three of the infants required total parenteral nutrition (TPN) for an average of 49 days (range, 28-60) from diversion until the time of the definitive procedure. Only one patient did not receive TPN. Postoperatively, there were two complications-one wound infection and one hectic fever. The clinical results were good, with no soiling or stool incontinence and no constipation. Conclusion: The laparoscopic procedure for total aganglionosis or the extended form of Hirschprung's disease is safe, feasible, and reproducible.

Geerdes, B.P.; Geukers, C.hW.G.M.; van Erp, W.F.M.

doi: 10.1007/s004640000184pmid: 11727140

Background: Patients with degenerative disc disease were treated by laparoscopic spondylodesis. Clinical outcome and quality of life were then analyzed in a retrospective study. Methods: Thirty patients with a mean age of 43 years (range, 26-63) who suffered from instability of levels L4-L5 (n = 23), L5-S1 (n = 3), or both (n = 2) underwent surgery. Spondylodesis was achieved with two BAK cylinders. After ?6 months, all patients completed a questionnaire designed to assess satisfaction with the operative outcome. Results: After a median follow-up of 2.3 years (range, 0.9-3.5), 23 patients were free of pain or greatly improved. Complications included bleeding (n = 2), cage displacement (n = 1), retrograde ejaculation (n = 3), and postoperative ileus (n = 1). Good improvement was reported in daily activities and quality of life. Conclusion: Laparoscopic spondylodesis has a good clinical outcome with a low rate of morbidity. Notable improvements can be achieved in terms of daily activities and quality of life; however, these improvements are moderate in degree, and patient activity remains somewhat limited.

Ammori, B.J.; Vezakis, A.; Davides, D.; Martin, I.G.; Larvin, M.; McMahon, M.J.

doi: 10.1007/s004640000019pmid: 11727146

Background: Morbid obesity is generally regarded as a risk factor for laparoscopic cholecystectomy due to increases in operative time, morbidity, and conversion rate to open cholecystectomy. The aim of this study was to evaluate the feasibility and outcome of laparoscopic cholecystectomy (LC) in morbidly obese patients. Methods: A total of 864 consecutive patients underwent LC at our institution between 1990 and 1997. This series represents a continuing policy of LC for all comers. Data were collected prospectively. There were 659 nonobese (NO: BMI <30 kg/m2), 188 obese (OB: BMI30-40 kg/m2), and 17 morbidly obese patients (MO: BMI >40 kg/m2). Laparoscopic bile duct exploration was performed in 28 (4.2%), nine (4.8%), and one (5.9%) patients, respectively. Results: Obesity and morbid obesity were associated with trends toward an increased conversion rate (2.3% NO; 4.3% OB; 5.9% MO), a longer operative time (median, 80, 85, and 107 mins, respectively), greater postoperative morbidity (4.7%, 5.9%, and 11.8%, respectively), and a reduced ability to obtain cholangiography (86.1%, 80.1%, and 71.4%, respectively). None of these differences, however, were statistically significant (c2 test, p > 0.05). Postoperative hospital stay for LC was similar for all three groups (median, 1 day). Conclusion: LC in morbidly obese patients is a safe procedure, but it may be associated with increased operative difficulty and morbidity, as compared with nonobese and obese patients.

Abad, C.; Caceres, J.J.; Alonso, A.

doi: 10.1007/s00464-001-0038-ypmid: 11727155

C. Abad J.J. Caceres A. Alonso Department of Cardiovascular Surgery, Hospital Universitario de Gran Canaria Dr. Negrin, c/ Barranco de la Ballena s/n, 35020 Las Palmas de Gran Canaria, Spain ES Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrin, c/ Barranco de la Ballena s/n, 35020 Las Palmas de Gran Canaria, Spain ES Department of Pathology, Hospital Universitario de Gran Canaria Dr. Negrin, c/ Barranco de la Ballena s/n, 35020 Las Palmas de Gran Canaria, Spain ES

Kao, M.-C.

doi: 10.1007/s004640080152pmid: 11727159

doi: 10.1007/s00464-001-0065-8pmid: N/A