Slippage after adjustable gastric banding according to the pars flaccida and the perigastric approach

To evaluate laparoscopic adjustable gastric banding and the 'pars flaccida' techniques for treating morbidly obese patients. Between May 1999 and July 2002, 64 patients underwent laparoscopic adjustable gastric banding. The 'perigastric' technique was performed in the first 31 patients. From September 2000 the band was positioned according to the 'pars flaccida' technique in the remaining 33 patients. The patients were divided into three groups: group 1 - 'perigastric' technique using Lap-Band size 9.75 and 10 cm [31 patients]; group 2 - 'pars flaccida' technique using Lap-Band size 10 cm [12 patients], and group 3 - 'pars flaccida' technique using the Swedish band [21 patients]. There were 58 females and 6 males with a mean age of 36.6 years [range 17-56]. The preoperative mean body mass index was 46.2 kg/m2. Band slippage occurred in 10/31 patients [32.2%] of group 1, 3/12 patients [25%] of group 2 and none in group 3 patients [p < 0.01]. The 'pars flaccida' technique significantly reduces the incidence of postoperative slippage after gastric banding. This complication is further reduced in the Swedish band group. Furthermore, we do not recommend using the 10-cm Lap-Band in the 'pars flaccida' technique

Primary omental torsion: Two case reports

To describe two cases of primary omental torsion as an uncommon cause of abdominal pain. Two female patients presented to our surgical service with right-sided abdominal pain. In view of their clinical presentation and workup, both patients required operative intervention. At laparotomy, the cause of the pain was recognized to be due to infarcted omentum secondary to torsion. Both patients underwent omentectomy and appendectomy and had an uneventful recovery. Primary torsion of the omentum is difficult to diagnose preoperatively; this condition is usually detected during surgical exploration for acute abdominal pain

Laparoscopic splenectomy for hematological disorders

The aim of this prospective study was to evaluate the safety and feasibility of laparoscopic splenectomy [LS] in patients with hematological disorders of the spleen. Subjects and Between 1999 and 2001, 15 patients [11 female and 4 male], with a mean age of 30 years, underwent LS after preoperative evaluation. If difficulties were encountered in LS, one trocar site incision was enlarged to 7-8 cm to engage the left hand for hand-assisted laparoscopic splenectomy [HALS] and the procedure was completed. Various parameters were reported, including spleen size as assessed by ultrasound scan, postoperative mortality and morbidity rates, accessory spleen removal, conversion rate, operative times and length of hospital stay. LS was successfully completed in 9 patients [60%] and HALS was performed in 4 patients [26.6%]. Two patients required conversion to open splenectomy. The mean operative time was 209 min and the mean hospital stay was 8.1 days. The hospital stay was significantly longer among HALS patients than LS patients. The mean age of patients and splenic size were associated with a significantly higher conversion rate. No deaths were attributed to the procedure. Complications occurred in 2 of 15 patients. Accessory spleens were identified in 2 patients. Conclusions: LS is both a safe and feasible procedure, but it requires great technical care to avoid serious complications