Laparoscopic heller cardiomyotomy for esophageal achalasia. Initial results

Laparoscopic Heller cardiomyotomy is replacing open surgery for esophageal achalasia. The aim of the present study was to evaluate the initial results of laparoscopic Heller cardiomyotomy. Sixteen patients [9 women and 7 men, mean age of 45 +/- 11.3 years and mean duration of symptoms of 5.2 +/- 4.5 years], who fulfilled the clinical, radiographic, endoscopic and manometric criteria for a diagnosis of esophageal achalasia, underwent laparoscopic myotomy with Dor fundoplication. Follow up to one year was complete in 14 patients. Laparoscopic Heller myotomy with Dor fundoplication is a highly effective and safe treatment for achalasia and preventing simultaneous gastroesophageal reflux. The outcome of the procedure is related to the preoperative stage of the disease on the esophagogram

Laparoscopic versus open repair for perforated peptic ulcer, a randomized study

Between June 1998 and June 2002, 23 patients with a clinical diagnosis of perforated peptic ulcer were randomly allocated to open repair [group 1] or laparoscopic repair [group 2], in El Minia University Hospitals. Open repair was performed in 14 patients [9 men and 5 women, with a mean age of 45.2 +/- 14.1 years]. Laparoscopic repair was performed in 9 patients [6 men and 3 women, with a mean age of 46.1 +/- 15.1 years]. The risk factors were similar in both groups. Laparoscopic repair had a significantly longer operative time than open repair [group 2, 115.6 +/- 45.3 versus 58.6 +/- 43.2 minutes in group 1, but the amount of analgesic required after laparoscopic repair was significantly less than in open surgery [median 3 doses versus 6 doses. There was no significant difference in the two groups of patients in terms of duration of nasogastric aspiration, hospital stay, time to return to normal activities, morbidity and mortality rates

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