Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity.

BACKGROUND: Since the first laparoscopic adjustable gastric banding (LAGB) operation on September 1, 1993, there have been important publications related to this procedure. The majority of the articles reported surgical technique and short-term results. Long-term results of LAGB are lacking. The authors report long-term data (at least 4 years) from 3 major bariatric centers in Belgium that perform LAGB routinely. METHODS: The 3 centers applied the same patient selection criteria, the same standard surgical technique, the same laparoscopic band (Lap-Band) and the same follow-up program. 763 patients have been enrolled. Sex ratio was 22% male/78% female. Mean age was 34 years, and mean preoperative BMI was 42 kg/m2. RESULTS: The follow-up rate was 90%, and the minimum follow-up time was 4 years. The average BMI after 4 years was 30 kg/m2. Early complications were: gastric perforation 4 (0.5%); large bowel perforation 1 (0.1%); bleeding 1 (0.1%); and conversion to open 10 (1.3%). Late complications were: erosion 7 (0.9%); total food intolerance 59 (8%); access port problems 20 (2.5%); re-operations 80 (11.1%); death 1 (0.1%). CONCLUSION: Long-term results of LAGB have been rarely reported, although publications on the procedure are copious. Our long-term data found that BMI evolution is good, the complication and re-operation rates are acceptable and the overall long-term results of the Lap-Band system are good.

Mesenteric cysts. A case treated by laparoscopy and a review of the literature.

Mesenteric cysts are one of the rarest abdominal tumors. Since the first report of a mesenteric cyst by Benevienal in 1507, only 820 cases have been reported. The symptoms depend on the size and location of the cyst. The main presenting symptom is abdominal pain, followed by nausea and vomiting. Some mesenteric cysts may present as an acute abdomen due to a possible complication, such as hemorrhage, rupture, or torsion of the cyst. The treatment of choice for mesenteric cyst is complete excision to avoid recurrence and possible malignant transformation. We report an additional case of mesenteric cyst which, to our knowledge, is the first to be treated by laparoscopy.

[An acute pseudo-cholecystitis]. / Une pseudocholécystite aiguë.

In an emergency department, many patients were admitted with abdominal pain. The problem is to made the right diagnosis between an acute abdomen that must be manage by a medical approach and an acute abdomen with immediate surgical treatment. We present the case of a 44 year-old man admitted in our emergency department with clinical signs of acute cholecystitis. After a new interrogation and the inadequacy of the diagnostic procedures a lead intoxication treated by a medical approach was diagnosed.

Laparoscopic Toupet fundoplication: prospective study of 100 cases. Results at one year and literature review.

We report a prospective evaluation of 100 patients who underwent laparoscopic fundoplication according to Toupet. All these cases where suffering from gastro-oesophageal reflux resistant to medical treatment or recurring after stopping it. Only one conversion into laparotomy was required. Perioperative morbidity (4%), mortality (0%), median hospital stay (4 days) and return to work (3 weeks) were lower than in case of open surgery in the literature. One year after the operation, clinical results were similar to those of laparotomy with 93% of patients free of symptoms. Excellent results of this technique lead us to assert that laparoscopic Toupet procedure is an interesting way of treating the gastro-oesophageal reflux that does not respond to medical treatment.

Giant colonic diverticulum: presentation of one case and review of the literature.

Since the first case described in 1946, fewer than 100 cases of giant colonic diverticula have been reported in the literature. We discuss the clinical, radiologic, and pathologic findings in a case of giant colonic diverticulum and review the etiology and differential diagnosis.

Piperacillin-tazobactam treatment for severe intra-abdominal infections.

In this limited series of 23 patients suffering from severe or life-threatening intra-abdominal infection, piperacillin + tazobactam, together with adequate surgical drainage and resections, cured 78% of our patients and eradicated almost all the pathogens. Side effects included essentially eosinophilia and elevation of transaminases but was never severe. Piperacillin + tazobactam seem thus to be an acceptable treatment, associated with correct surgical drainage. This regimen has to be compared in appropriate trial versus gold standard therapy, such as imipenem, a beta-lactam with aminoglucoside and imidazole or clindamycin or with broad spectrum beta-lactam and other inhibitors or beta-lactamases, but our rate of cure is impressive in such a population.

[Indications and surgical technic in gynecomastia]. / Indications et techniques chirurgicales des gynécomasties.

In our opinion, very few publications represent a practical attitude on surgical level concerning a gynaecomasty; so we tried to sum up the operative indications and to establish a classification of the useful surgical techniques, not only in function of the existence or non-existence of a cutaneous excess, but also of the type and the localization of the vascular stalk feeding the nipple-plate. The post-operative complications are described and finally, we present you our personal experience in 21 cases.

[Preoperative selection for lumbar sympathectomy using a mixed hyperemia test]. / Sélection pré-opératoire à la sympathectomie lombaire par une épreuve d'hyperhémie mixte.

The decision to perform a lumbar sympathectomy in cases of severe distal arteritis should be made according to an objective selection method. The mixed active hyperemia test meets that condition.

[Importance of the Limberg triple flap in the surgical treatment of cancer of the breast in the male]. / Intérêt du triple lambeau de Limberg dans le traitement chirurgical du cancer du sein chez l'homme.

Two cases of male breast cancer are presented. The patients underwent a modified radical mastectomy with immediate closure of the defect using a triple L-shaped transposition flap. We briefly recall the behaviour of these tumors and the applied surgical principles to define better the value of this plastic procedure. A variety of surgical plastic techniques are described and compared. The triple L-shaped Limberg flap, very well adapted to the treatment of male breast cancer, is described in detail. The results are gratifying both from the plastic and cancerologic view-point.