Laparoscopic treatment of hydatid cysts of the liver and spleen.

BACKGROUND: The short-term results from laparoscopic treatment of hydatid cysts of the liver and spleen were reported previously. The procedure was shown to be feasible and safe, offering the advantages of laparoscopic surgery. This is the first report on the long-term follow-up of this operation in a large group of patients. METHODS: In this study, 108 hydatid cysts of the liver and spleen in 83 consecutive patients (43 males [52%] and 40 females [48%]) were approached laparoscopically. The mean age of the patients was 40 years (range, 13-85 years). There were 104 liver cysts and 4 spleen cysts. The liver cysts were located in the right lobe in 42 patients (53%), in the left lobe in 21 patients (26%) and in both lobes in 16 patients (21%). Of the 104 cysts, 44 (42%) were uniloculated and 60 (58%) were multiloculated. RESULTS: All cysts were approached laparoscopically. The mean operative time was 80 min (range, 40-180 min). The conversion rate was 3%. The mean hospital stay was 3 days (range, 2-7 days). There were no mortalities, and complications occurred in nine patients (11%). All were managed conservatively except one patient in whom a laparotomy was needed. All patients were followed up for a mean period of 30 months (range, 4-54 months) with serological testing and ultrasonography if needed. In three patients (3.6%) recurrence of the disease developed. CONCLUSION: The laparoscopic approach to uncomplicated hydatid cysts of the liver and spleen is a safe and effective option with favorable long-term results.

Laparoscopic Nissen-Rossetti fundoplication.

Although antireflux surgery offers very good results and patient's satisfaction, the referral rate to the surgeon remains very low. We present our experience with a less-invasive procedure that would result in minimal pain and very rapid return to normal activities and thus might lead to earlier referral. Fifty-nine patients with documented reflux esophagitis were treated. There were 31 females and 28 males whose age ranged from 27 to 69 years and whose weight varied between 140 and 280 lbs. Pre-op work-up included endoscopy, barium swallow, manometry, and 24-h pH studies. There was no mortality and morbidity was minimal; hospital stay was 2-3 days. Ten patients were lost to follow-up; all the remaining patients are completely asymptomatic, and the patients who had their pre-op work-up repeated showed normal results. Laparoscopic fundoplication seems to be as efficient and safe as the open procedure.

Laparoscopic treatment of hydatid cysts of the liver.

We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst was evacuated laparoscopically and marsupialized, and its remaining cavity was packed with omentum. The patient did well postoperatively and was discharged home on the third postoperative day. He had minimal biliary leak that ceased spontaneously on the fifth postoperative day.

Laparoscopic cholecystectomy: initial experience in Lebanon.

Laparoscopic Cholecystectomy became very rapidly the procedure of choice for dealing with gallstones. We present our initial experience in Lebanon with 45 cases. All patients referred for cholelithiasis without any exception had a laparoscopic procedure. The conversion, mortality and morbidity rates were 0%. Post-operative hospital stay was 24 hours in the majority of the cases. The results clearly demonstrates the major advantages this procedure has over the conventional cholecystectomy and we believe it should be the procedure of choice for cholelithiasis.

Laparoscopic Nissen's fundoplication: preliminary report on ten cases.

We present our experience with ten cases of laparoscopic Nissen's fundoplication. Reflux esophagitis is a very common disease and is associated with a lack of response to medical treatment in a significant number of cases, yet the rate of referral to a surgeon is extremely low. We believe that the endoscopic treatment of this disease is much less invasive and more cost-effective and is associated with lower rates of complications. Indeed, our patients left the hospital at 24-48 h post-surgery and were involved in their regular activities at 4 days to 1 week thereafter. Neither mortality nor complications associated with the procedure were encountered. We believe that the feasibility and the benefits of this procedure will lead to earlier referral and hence to avoidance of long-term complications of gastroesophageal reflux disease.