Necessity of fundoplication and mesh in the repair of the different types of paraesophageal hernia.

BACKGROUND: The management of paraesophageal hernia (PEH) has changed significantly since the introduction of laparoscopic surgery in the 1990's. This study aims to explore the need of a Nissen fundoplication or a posterior gastropexy and the use of mesh reinforcement in the surgical repair of PEH. PATIENTS AND METHODS: Seventy-three patients with a symptomatic and documented PEH type II, III or IV were included in this retrospective study. The following data were collected: type of PEH, surgical procedure, complications, length of hospital stay, recurrences, time to recurrence, type of PEH recurrence and treatment of recurrent PEH. RESULTS: All 73 patients underwent laparoscopic surgery without any conversion to open surgery. In 80% a posterior gastropexy was performed, while the remaining 20% suffered from GERDsymptoms and were treated with a Nissen fundoplication. In 18% of the patients a mesh was used as reinforcement of the repair. The surgical repair differed significantly according to the type of PEH. Fourteen percent of the patients suffered from a postoperative complication, pneumothorax and dysphagia being the most frequent. There were no perioperative deaths. The recurrence rate was 22% with a median time to recurrence of 12 months. CONCLUSION: Laparoscopic PEH repair is a safe and efficacious procedure with no mortality and minimal early morbidity. The surgical repair of PEH should be adjusted to the type of PEH. However, up until now the literature fails to produce clear guidelines on when to perform a gastropexy or Nissen fundoplication and which patients might benefit from a mesh reinforcement.

Differentiation of a single melanocytic lesion of the esophagus: primary malignant melanoma of the esophagus or esophageal metastatic melanoma.

A single melanocytic lesion of the esophagus should be differentiated from a primary malignant melanoma of the esophagus (PMME) or an esophageal metastatic melanoma (MME). This paper reviews the current knowledge about these entities and how to differentiate between them. Melanocytosis as a precursor of PMME is discussed as well.

Laparoscopic cholecystectomy in acute cholecystitis: support for an early interval surgery.

BACKGROUND AND STUDY AIMS: Although laparoscopic cholecystectomy is advocated for acute cholecystitis, debate still exists about its optimal timing. This retrospective study compares the outcome of laparoscopic cholecystectomy within versus later than 5 days of onset of symptoms in patients with acute cholecystitis. PATIENTS AND METHODS: One hundred thirty six patients with acute cholecystitis grade I or II were included in the study and divided in two groups. Group 1 received surgery within 5 days of symptoms and group 2 received conservative therapy and delayed surgery after 6 weeks. RESULTS: Group 1 and 2 consisted of 100 and 36 patients respec- tively. Because of failure of conservative therapy 5 patients of group 2 had surgery before 6 weeks. The remaining 31 patients underwent surgery after 6 weeks. Preoperative ERCP was indicated in 2 and 11 patients in groups 1 and 2 respectively (p < 0.001). The median total hospital stay was 3.0 days for group 1 and 11.0 days for group 2 (p < 0.001). In terms of operation time, conversion rates, intraoperative cholangiography, postoperative ERCP, morbidity or mortality both groups were comparable (p > 0.05). CONCLUSION: Laparoscopic cholecystectomy can be performed safely within 5 days after the onset of symptoms in patients with acute cholecystitis. Because of shortened total hospital stay and risk of failure of conservative therapy, early laparoscopic cholecystectomy should be favored.

Comparison between cartilage and fascia grafts in type 1 tympanoplasty.

OBJECTIVES: We retrospectively analysed long-term hearing results and graft take rates in our cases with both temporalis muscle fascia and the cartilage island technique. METHODOLOGY: Between September 2000 and October 2011, a total of 489 patients underwent cartilage tympanoplasty, while 318 patients had tympanoplasty using fascia. In this study we included patients with a follow-up period of at least 3 years. Exclusion criteria were ossicular chain defects, cholesteatoma, otorrhoea, middle ear granulation or effusion, and a history of middle ear surgery. RESULTS: The cartilage group consisted of 49 patients, with 28 patients being included in the fascia group. Both air conduction hearing thresholds and air bone gaps improved significantly in both groups. However, no statistical significance was found between the results for the two groups (p > 0.05). CONCLUSION: Our study concurs with many others in the literature, clearly indicating that cartilage produces hearing results that are comparable to temporalis muscle fascia grafts.