Laparoscopic Nissen fundoplication: technique and preliminary results

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

Timing and method of reversal of Hartmann's procedure

The objective of this study was to evaluate the reversal of Hartmanns colostomy by comparing the complications of surgery with the time interval from formation to reversal as well as with the technique of anastomosis. Between March 1998 and March 2002, 32 patients with Hartmann's colostomy [18 men and 14 women with a mean age +/- SD 60.1 +/- 8.1 years] were included in this prospective study in El- Minia University Hospitals. All patients received complete clinical examination and routine investigations and the mean follow up period was 12 +/- 3.2 months. The study concluded that the late reversal [after four months] of Hartmanns procedure is more safer than the early reversal [before four months]. The reversal by stapled anastomosis is associated with a low incidence of major anastomotic complications and permanent colostomies

Endoscopic and laparoscopic treatment of mirizzi syndrome

Endoscopic followed by laparoscopic treatment of Mirizzi syndrome has been shown to be safe and effective. This technique was applied in 15 patients with Mirizzi syndrome. Ten patients had a single large stone and five had multiple stones impacted in the cystic duct. Nasobiliary drainage tube [NBDT] or stent was applied in patients for preoperative drainage of biliary tree and to prevent acute cholangitis by endoscopic retrograde cholangiopancreatography [ERCP]. Laparoscopic cholecystectomy was tried in all patients within 3 days after endoscopic intervention. In 6 cases, conversion was done from laparoscopic to open cholecystectomy. Conversion was due to fistula in three cases, injury to common bile duct in two cases and bleeding from slipped cystic artery in one case. Mortality was zero. Preoperative endoscopic drainage has many advantages including abortion of endotoxaemia in acute cholangitis, lowering the elevated serum bilirubin, improving the clinical condition of the patient, allowing easy identification of the anatomy of the bile ducts intraoperatively and immediate detection of any injury to bile ducts. The presence of stented bile duct allows for primary closure of the injury