Laparoscopic transperitoneal lumbar sympathectomy: a new approach.

A report of five sympathectomies for the treatment of vasospastic symptoms of coldness, rest pain and trophic lesions at the affected feet. Three patients had a right-sided sympathectomy done and the other two had left-sided done via laparoscopic surgery. This report has advocated original techniques: Under general anesthesia, a patient is put into a lateral position with the table broken between the ribs and iliac crest. The telescope port is inserted horizontally at the edge of the rectus sheath in line with the umbilicus. Two secondary ports (5 mm, 10 mm) are inserted under direct vision in the midclavicular line. The peritoneal reflection lateral to the colon is incised down to the pelvic brim. The use of the lateral position facilitates medial displacement of the colon and the kidney by virtue of gravity. The L2, L3, L4 sympathetic ganglia are then doubly clipped and divided between clips. When such a small piece of the sympathetic trunk has been removed, a laparoscopic transperitoneal lumbar sympathectomy should be a very reasonable, safe, minimally invasive alternative to the traditional operation.

Nontraumatic perforations of the small intestine.

Nontraumatic perforation of the small intestine is very rarely found as a cause of abdominal disease. A series of 8 patients admitted to our hospital from 1990-1994 was reviewed. Underlying conditions were typhoid ulcers, (two patients), adhesions (two patients), hemorrhagic ileitis, (one patient), radiation enteritis (one patient) and SLE (one patient). The cause remained unclear in one patient (idiopathic). As surgical therapy, resection and anastomosis were preferred in order to make thorough histologic examination of the perforated bowel possible. One anastomosis leakage with spontaneous closure was observed. There was no operative mortality.