Laparoscopic nissen fundoplication for gastroesophageal reflux disease

Laparoscopic antireflux surgery is the standard treatment for gastroesophageal reflux disease [GERD] in western countries. This study is to examine the effectiveness and our results with laparoscopic antireflux surgery. Between July 2001 and November 2004, 23 patients were included in this study to undergo laparoscopic Nissen fundoplication [LNF]. We examined the following 3 parameters pre- and postopertively: patients symptoms, barium swallow and endoscopic findings in symptomatic patients. Also the operation time, intraoperative complications and postoperative complications were evaluated. Laparoscopic NF was successfully completed in 20 patients with 3 patients requiring conversion to open. The mean operative time was 175 minutes and the mean hospital stay was 2.4 days. There were 4 [17%] intraoperative complications 3 of which required conversion to open. There were 8 postoperative complications in 6 patients [30%]. The patients were followed for 36 months with a mean of 15 months. Seventeen patient 85% had substantial improvement of their symptoms and needed no proton pump inhibitors drugs. Three patients 15% require occasional medications and 3 patients did not improve. Laparoscopic Nissen fundoplication is an effective and durable treatment for gastresophageal reflux disease

Anocutaneous advancement flap closure of high anal fistulas

Eighteen patients presented by anal fistulas [15 high trans- sphincteric and three suprasphincteric] underwent anocutaneous advancement flap after excision of the internal opening, excision of the tract and closure of the internal opening at Surgical Department in Ain-Shams University Hospitals. The external component of the fistulous tract was excised and drained externally. The mean follow up period was 14 months. All cases had no any gas or stool incontinence. Complete healing was achieved in 12 patients 3-4 weeks after operation. Minor technical problems were noticed in three patients [flap hematoma in two patients and flap tip breakdown in one patient], such complications did not end with fistula. In the last three patients, recurrence of the fistula happened. In the first patients, recurrence was due to the failure of the flap; whereas in the other two patients, recurrence occurred after evacuation of perianal abscess. Those patients eventually had a low anal fistula and excisional surgery was performed without difficulty. Anocutaneous advancement flap is technically simple, heals rapidly with minimal scaring and cures anal fistulas while preserving the anal sphincter