ABSTRACT
Laparoscopic Nissen fundoplication is positioned to become the standard of surgical treatment for patients with gastroesophageal reflux disease [GERD]. The present study aimed to evaluate in a prospective manner the technique and the clinical results of laparoscopic Nissen fundoplications. Between Ianuary 1998 and January 2001, 28 patients [17 male and 11 female with a mean age 42 +/- 6.7 years] who had undergone a laparoscopic approach for a Nissen fundoplication in El-Minia University Hospital were studied. All patients had undergone medical treatment for at least 3 months and then were referred to surgery due to unsatisfactory symptom control in 19 patients [67.8%] or to avoid lifelong medications in 9 patients [32.2%]. Laparoscopic Nissen fundoplication was done with or without division of short gastric vessels. It was successful in 24 of 28 patients [85.7%]. The mean operative time was 126 +/- 12.4 minutes. The mean post operative hospital stay was 3.1 + 0.2 days. Conversion from laparoscopic to open fundoplication was needed in 4 cases [14.3%]. There was no operative mortality with low serious morbidity. The mean heartburn score was 2.68 +/- 1.26 before operation versus 0.35 +/- 0.79 after operation by one year, with significant improvement [P<0.01]. The mean preoperative dysphagia score was 1.1 +/- 0.9 versus 0.32 +/- 0.21 by one year postoperatively [P<0.01]. Troublesome dysphagia was reported in 10 patients [35.7%], one was reoperated upon and 9 cases responded to dilatation or diet management
Conclusion: Laparoscopic Nissen fundoplication is a promising technique because it is safe with low morbidity rate and short hospital stay. The short term functional results shows the effectiveness of the technique in controlling the gastroesophageal reflux disease. Long term results should be studied
ABSTRACT
Postoperative adhesions are the most common cause of recurrent small bowel obstruction [SBO]. Laparotomy has classically been used in its treatment. The aim of this prospective study was to assess the feasibility, safety and clinical outcome of laparoscopic adhesiolysis in patients with recurrent 530 with the use of the ultrasonically activated shears. Between January 1998 and January 2001, elective laparoscopic adhesiolysis was attempted in 23 patients [13 men and 10 women, mean age 49.6 +/- 6.3 years, range 16-63 years] with post operative recurrent 530. All patients were subjected for complete clinical assessment, laboratory investigations, serial abdominal radiographs, abdominal ultrasound and CT. Patients in whom the bowel obstruction resolved within one day and who fulfilled the following criteria were treated laparoscopically: at least 2 prior episodes of small obstruction, confirmed improvement in physical signs of peritoneal inflammation, a decrease in white blood cell count to normal level and disappearance of air and fluid levels on plain abdominal radiographs . The technique of open laparoscopy was used for initial access to the peritoneum. The adhesions were lysed with the ultrasonically activated shears [Harmonic Scalpel]. Follow up evaluation was performed by clinical examination every 6 months for 3 years [range 1-4]. Laparoscopic adhesiolysis was successful in 18 patients [78.26%]. Conversion to laparotomy was required in 5 cases [21.74], because of intestinal peforation in one patient [4.5%], and convoluted masses in 4 patients [17.9%]. T here was no mortality and low morbidity in the form of serosal injuries in 4 patients [17.9%] and intestinal perforation in one patient [4.5%]. The mean time of operation, return of intestinal motility, and postoperative hospital stay were significantly shorter in the laparoscopically successful adhesiolysis group versus the group of patients who were converted to laparotomy. [[115 +/- 9.1 vs 130 +/- 6.7] P<0.001, [1.9 +/- 0.3 vs 3.8 +/- 1.2] P<0.01, [5.5 +/- 2.2 vs 8.3 +/- 3.4] P<0.001, respectively]. Recurrent SBO developed in 2 patients [12.5%] over a mean period of follow up [3 years]
Conclusion: Laparoscopic adhesiolysis is a feasible procedure for recurrent SBO with the use of the ultrasonically activated shears. It is safe [low morbidity and no mortality] and effective [low rate of recurrence of intestinal obstruction]. Conversion to laparotomy should be considered only in patients with intestinal perforation or convoluted masses
ABSTRACT
Background: The treatment of umbilical hernia in the setting of cirrhosis poses unique specific management problems due to pathophysiology of cirrhotic ascities
Purpose: Thirty cases of liver cirrhosis have been studiedfor the outcome of complicated umbilical hernia in the presence of ascites. Methods: From November 2001 to October 2002, we received 30 cases of complicated umbilical hernias in patients suffering from liver cirrhosis with ascites. Twelve of these patients were classified as Child C while 18 of them were considered Child B. All the cases were subjected to surgical management under local anesthesia
Results: Six cases had ruptured umbilical hernia and they underwent closure in two layers after reduction of the contents. Twenty-four cases presented with irreducible hernia and upon exploration, 12 cases had gangrenous omentum that was resected and the other 12 cases had gangrenous intestinal loops where resection and anastomosis was carried out without drains. Out of 30 patients, 8 patients developed postoperative tense ascites that responded to medical treatment in 6 of them and 2 patients needed paracentesis. One patient of this series died on fourth postoperative day of liver failure while the rest 0f the patients had an uneventful postoperative course in a follow up period ranging from 3 to nine months, Conclusion: Complicated umbilical hernia can be managed safely in ascitic patients under local anesthesia