ABSTRACT
Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach. To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass. From May 2001 to July 2007, 27 patients were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 patients with gastric bypass. The primary endpoint was: excessive weight loss [EWL], BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion. The mean age was 36 years. There were 4 males and 23 females. The mean preoperative weight was 122, 4kg [range: 87-152] and the mean body mass index [BMI] was 42.5 kg/m2 [range 36,5 -52 kg/m2]. The mean hospital stay was 4.76 days [range: 3-8]. There were no postoperative deaths. Early complication was present in 3 patients. Late complications were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%.The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results
ABSTRACT
The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. The purpose of this retrospectise study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance [persistence of symptoms of reflux on treatment], drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our Outcome measures were mortality, morbidity specifically, the conversion rate and functional outcome in the short and medium term. These 24 men and 27 women of average age 38 years [range: 17-71 ans].All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels [Nissen] and 34 without section of short vessels [Nissen-Rossetti]. The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients [7.8%]. Mortality was nil. The specific complications were observed in 2 patients [4%], a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non specific complications were dominated by pneumonia in 4 patients [7.8%]. In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphiagia, present in [77%] cases, was transient in 40 patients [62%] and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. The laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature