laparoscopic partial posterior fundoplication [toupet technique]; an initial experience of forty cases

There has been increasing interest in the surgical management of gastroesophageal reflux disease [GERD], particularly after the introduction of minimal invasive techniques. Laparoscopic fundoplications are either total or partial; at least theoretically, partial procedures attempt to achieve a more physiologic antireflux mechanism. The aim of this study was to evaluate the safety and efficacy of laparoscopic Toupet fundoplication in the control of reflux in the patients with GERD. Forty patients were recruited to undergo partial posterior fundoplication [Toupet] using the laparoscopic technique. A simple questionnaire was used preoperatively to evaluate the typical and atypical GERD symptoms, and to provide a baseline for the postoperative symptoms as dysphagia and the ability to belch. Preoperative endoscopy, contrast and motility studies were performed to all patients. The anesthesia time, the occurrence of intraoperative, early postoperative complications, postoperative courses as well as length of hospital stay were all recorded. The patients were interviewed to follow on their old or new-onset symptoms at 6, 12 and 24 months after operation. Objective healing of reflux esophagitis was assessed by an upper GI endoscopy performed 24 months after operation. The mean anesthesia time was 100 minutes; no conversion to open technique was needed in this study. Intraoperative complications included trocar site bleeding [one case], hepatic laceration [two cases], upper splenic pole injury [one case] and seromuscular tears in gastric wall [one case]. Postoperatively, significant improvement in reflux symptoms was observed in all patients [p<0.05], and patients' ability to belch did not significantly alter. The most common postoperative problem was nausea and vomiting. Postoperative complications included splenic hilum hematoma [one case] and trocar site hernia [one case]. Mild dysphagia was reported [four cases], with no significant difference between patients with normal or abnormal esophageal body motility [p>0.05]. Toupet fundoplication also significantly healed the reflux esophagitis as documented by endoscopy at 24 months postoperatively. The laparoscopic Toupet fundoplication is an effective and safe technique, which can achieve excellent subjective and objective reflux control in patients with GERD

Prognostic value of analysis of serum and ascitic fluid levels of intercellular adhesion molecule-1 [ICAM-1] and vascular cell adhesion molecule-1 [VCAM-1] in patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is a life-threatening complication in patients with liver cirrhosis. Renal failure or multiorgan insufficiency is considered to be the main causes of death in patients with SBP. The aim of this work was the evaluation of serum and ascitic fluid levels of intercellular adhesion molecule-1 [ICAM-1] and vascular cell adhesion molecule-1 [VCAM-1] in patients with spontaneous bacterial peritonitis. We prospectively studied 18 cirrhotic patients with SBP, 9 cirrhotic ascitic individuals without any evidence of infection as cirrhotic ascitic controls and 10 healthy controls. Serum and ascitic fluid levels of ICAM-1 and VCAM-1 were measured and compared. Serum levels of ICAM-1, and VCAM-1 were significantly increased in cirrhotic ascitic patients, either infected or non-infected, compared with healthy controls. SBP was associated with significantly elevated serum and ascitic levels of ICAM-1, and VCAM-1 compared with non-infected cirrhotic ascitic patients. There was also, a significant increase in serum and ascitic levels of ICAM-1, and VCAM-1 in patients with SBP who developed renal failure. A prognostic significance can be attributed to increased serum and ascitic levels of ICAM-1 and VCAM-1 in patients with SBP as regard development of renal failure