Micropouch vertical banded gastroplasty - new technique evaluation

In this study, 500 patients underwent the micropouch vertical banded gastroplasty [VBG], the median age was 35 years with a median preoperative BMI of 70 kg/m. The micropouch was constructed using single TLH55 stapler through a mini incision. The outlet of the tubular micropouch was banded with a prolene mesh. 98% of the patients showed a good control of their weight within five years and 2% started to gain weight after the first year. The mean operating time was 35 minutes. The use of small single stapler allowed the procedure through a mini incision. The incidence of intraoperative gastroesophageal perforation was 0.6%. The incidence of postoperative leak was 0.2%. Thirty patients were complaining of solid food intolerance. The mortality rate was 0.6%

Peritoneovenous shunt for treatment of intractable cirrhotic ascites: an unfulfilled promise?

Peritoneovenous shunt [PVS] is widely used for the treatment of cirrhotic ascites whether intractable ascites or not. Between February 996 and August 1998, PVSs were inserted in 22 patients [14 men and 8 women] with intractable cirrhotic ascites. The mean follow up period was 20 months. All patients were non-responsive to standard medical management. Nine patients were alive and palliated, seven of them with working shunts. Thirteen patients died within the first year, five of them died with non functioning shunts. Despite palliation, complications with PVSs were high and survival was limited. This modality was recommended only in patients with cirrhotic intractable ascites not responding to standard medical or surgical management

Microsurgical lymphovenous anastomosis for treatment of chronic lymphedema of the lower extremity

Lymphovenous anastomosis [LVA] offers ideal physiologic treatment for lymphedema. Between January 1995 and November 1998, 36 patients underwent operation for chronic lymphdema. LVA could be performed in 30 patients [20 women and ten men]. Twenty two patients had secondary lymphedema [sixteen of them had filariasis and 6 patients had lymphedema after inguinal lymphadenectomy] and eight had primary lymphedema. The median duration of lymphedema in these patients was 5 years. Mean follow up was 30 months. Limb circumference, number of postoperative episodes of cellulitis, lymphoscintigraphy and patient satisfaction with the result were used to assess results. Improvement occurred in twenty two patients [73.3%]; twenty patients of them had secondary lymphedema [90.9%] and two patients had primary lymphedema [25%]. There was no change in seven extremities [23.3%], and in one patient with primary lymphedema the edema progressed [3.3%]. Therefore, we recommend this procedure in the early stage of the disease [grade 1and 2] in patients with secondary lymphedema