[Laparoscopic resection of gastric diverticula: two case reports]. / Die laparoskopische Resektion von Magendivertikeln: zwei Fallberichte.

Gastric diverticula are rare. In the literature the mentioned incidences vary between 0.01 % and 2.6 % depending on the method of detection. Until now the laparoscopic treatment of gastric diverticula is reported worldwide by eight authors (eight laparoscopic resections and one laparoscopic invagination with oversewing). Between September 2000 and November 2004 we have operated upon two patients laparoscopically for a gastric diverticulum. In two case reports we describe our operative and perioperative procedure. In both cases the gastric diverticulum was resected with a linear stapling device. In the second patient we did simultaneously a laparoscopic 360 degrees -Nissen-fundoplicatio plus dorsal hiatorrhaphy and fundopexy because of reflux disease based on a cardia insufficiency. The dates of the literature concerning incidence, localisation, classifications, symptoms, diagnostic and therapy are summarized and discussed. Our two case reports show, like the cases mentioned in the literature, that symptomatic gastric diverticula can be treated by laparoscopic resection with very good results.

Laparoscopic management of traumatic ruptures of the diaphragm.

INTRODUCTION: As a result of the relatively high frequency of high-speed accidents, diaphragmatic rupture is a diagnosis that is increasingly being established. Not all of these, usually multi-traumatized, patients are diagnosed as having diaphragmatic rupture immediately following the traumatic event--rather, an appreciable number of these injuries are not detected until some time later--often after a considerable delay. Most of the cases involve rupture of the left diaphragm, with most defects occurring in the region of the central tendon. METHODS: During the course of the second half of the year 1998, we operated on three patients with left diaphragmatic rupture. Two of these patients were treated immediately following traumatization, while the third case was a 10-year-old rupture originally misdiagnosed as a para-esophageal hernia. In all three cases, we were able to reduce the hernia and close the diaphragmatic defect laparoscopically. In the case of the two patients with a fresh rupture, the post-operative course was unremarkable, while in the patient with the missed rupture, a serous pleural effusion requiring drainage occurred on the left side. CONCLUSION: Overall, it would appear that in the case of an acute traumatic diaphragmatic rupture in particular, laparoscopic management, with its low level of traumatization and excellent access, offers a favorable alternative to conventional surgery. A point to be considered, however, is the fact that probably not every hospital will have the facilities for laparoscopic management available on a 24-h basis. In the case of longstanding ruptures, reduction of herniated bowel and treatment of the rupture will make considerable demands on the surgeon.

[Ascaridiasis as an incidental finding after intraoperative cholangiography during a laparoscopic cholecystectomy]. / Ascaridiasis als Zufallsbefund nach intraoperativer Cholangiographie im Rahmen einer laparoskopischen Cholezystektomie.

We report a case of biliary ascariasis which was detected fortuitously during a routine intraoperative cholangiography following laparoscopic cholecystectomy. The diagnosis was confirmed by the finding of worm eggs in the faeces. We were able to discharge the patient on the 15th postoperative day after antihelmintic treatment.