Supragastric belch may be related to globus symptom - a prospective clinical study.

BACKGROUND: The etiology of globus is poorly understood. It is controversial, whether gastroesophageal reflux disease (GERD) has a role in globus. To investigate the possible esophageal background of this symptom, we performed transnasal esophagoscopy (TNE), high-resolution manometry (HRM), and 24-h multichannel intraluminal impedance (MII) and pH monitoring on globus patients. METHODS: Thirty consecutive patients were referred to Helsinki University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery for treatment of globus; 24 consecutive patients with difficult reflux symptoms from the Department of Surgery served as controls. We compared the results of the patient groups in endoscopies, HRM, and 24-h MII-pH monitoring. KEY RESULTS: In MII monitoring, globus patients had supragastric belch (6/20, 30% vs 1/24, 4%; p = 0.038) more often than controls. Total reflux time was higher in controls (p = 0.004), and they had more acid reflux events (p = 0.002) in MII, but between groups, the number of non-acid reflux events was similar. In pH monitoring, DeMeester score and total pH <4 time were higher in controls (P < 0.001). In HRM, the upper esophageal sphincter (UES) mean basal and residual pressures did not differ. CONCLUSIONS & INFERENCES: Supragastric belch was more common in globus patients, suggesting the possible role of this condition in globus sensation. However, globus patients in this series had no acid or non-acid GERD or elevated UES pressure.

Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh.

We report a rare complication after laparoscopic fundoplication using a dual-sided PTFE/ePTFE (Bard® Crurasoft™) mesh fixation. A 53-year-old man was re-operated for a recurrent hiatal hernia. The hiatal hernia was reinforced using a mesh. Two years later, the patient presented with serious dysphagia and weight loss. An endoscopy revealed a migrated mesh in the stomach. The mesh was excreted within the stool without notice. The PTFE/ePTFE mesh, which is designed for treating hiatal defects, is considered to have superior tissue incorporation, together with less adhesion formation and fistulation. As mesh migration into the upper gastrointestinal tract is possible, it should be used with great care in the peri-oesophageal region.

Smoking increases the incidence of complicated diverticular disease of the sigmoid colon.

BACKGROUND AND AIMS: The aim of this study was to establish whether smoking is associated with complicated diverticular disease and adverse outcomes of operative treatment of diverticular disease. Smoking has been associated with increased rate of perforations in acute appendicitis as well as failure of colonic anastomosis in patients resected for colonic tumours. It has also been suggested that smoking is a risk factor for complicated diverticular disease of the colon. MATERIAL AND METHODS: Retrospective investigation of records of 261 patients electively operated for diverticular disease in Helsinki University Central Hospital during a period of five years. RESULTS: The smokers underwent sigmoidectomy at a younger age than the non-smokers (p = 0.001) and they had an increased rate of perforations (p = 0.040) and postoperative recurrent diverticulitis episodes (p = 0.019). CONCLUSIONS: We conclude that smoking increases the likelihood of complications in diverticulosis coli. The development of complicated disease also seems to proceed more rapidly in smokers.Key words: Sigmoid resection; laparoscopy; laparoscopic sigmoidectomy; smoking and diverticular disease; complicated diverticular disease; diverticulitis.

Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients.

BACKGROUND: We report the results of patients treated from January 2000 to June 2004 for full-thickness rectal prolapse with trans-abdominal surgery in Helsinki. METHODS: Sixty-five of 75 patients were treated laparoscopically, with a 6% conversion rate. Ten patients were operated on openly. Half of the patients were scored as American Society for Anesthesiologists III or IV. RESULTS: The operation time was similar in the laparoscopic and the open rectopexy procedures (p = 0.15), whereas laparoscopic resection rectopexy was more time-consuming compared to the open procedure (p = 0.007). Intraoperative bleeding during laparoscopic surgery was minimal in comparison to open surgery (p = 0.006). Patients treated laparoscopically had a shorter median hospital stay than those treated with an open procedure (rectopexy, 3 and 7 days, respectively; resection rectopexy, 4 and 7.5 days, respectively) (p < 0.00001). There was no mortality and minor morbidity. During follow-up, there were two prolapse recurrences. All surgical techniques improved fecal continence considerably. Eighty-four percent of rectopexy patients and 92% of resection rectopexy patients considered the surgical outcome to be excellent or good. CONCLUSIONS: Both rectopexy and resection rectopexy cure prolapse with good results and can be performed safely in older and debilitated patients. The laparoscopic approach enables a shortened hospital stay and is well tolerated in elderly patients.

Penetrating liver laceration with complete transection of hilar structures presenting with minimal clinical signs.

A 42-year old man with a penetrating laceration of the right liver lobe with complete transection of the right hepatic artery, right portal vein and left hepatic duct presented with minimal clinical signs and haemorrhage. Selective coeliac angiography and computer tomography (CT) revealed the vascular injuries. Forty-three hours after hospital admission the patient underwent right hepatectomy and bilioenteric anastomosis of the transected left bile duct to a Roux-en-Y segment of upper jejunum without stenting. Abscess formation and thrombosis of the inferior caval vein complicated recovery, but the patient was discharged from the hospital six weeks after this major hepatic injury, which usually presents with an exsanguinating massive haemorrhage.

Laparoscopic cholecystectomy for symptomatic gallstone disease. Experience of the first 200 cases.

Laparoscopic cholecystectomy was carried out in 200 patients between January 1991 and September 1992 at the Second Department of Surgery, Helsinki University Central Hospital. Mortality was nil. The overall major complication rate was 4% (n = 8). The incidence of common bile duct lesions was 0.5% (n = 1). In seven (3.5%) patients the procedure had to be converted into open cholecystectomy. Repeat surgery was needed in two patients. The average hospital stay was 3.0 +/- 1.5 days and the average sick leave 14 +/- 4 days. Obese and high-risk patients tolerated the procedure well without significant increase in complication rate or hospital stay. Laparoscopic cholecystectomy may be regarded as the treatment of choice for symptomatic gallstone disease.

Surgical treatment of gastric carcinoma.

To investigate changes in the results of treatment of gastric carcinoma, two 10-year periods between 1963 and 1982 with 641 and 630 patients, respectively, were compared. In the two groups, 94 percent and 92 percent of patients were operated on. The operation was considered curative in 200 and 265 patients in Groups 1 and 2, respectively. There was a shift towards more radical operations, with 215 total or subtotal gastrectomies in Group 2 compared with 76 in Group 1, when distal gastric resection was considered radical enough. Despite the increasing number of curative operations and more radical surgery in Group 2, no progress in the 5-year survival rate was noted. Distal and subtotal gastrectomies gave slightly better results than total gastrectomies, but the most important single factor contributing to the long-term survival was cancerous invasion of the serosa. It is concluded that in the past 20 years, the results of surgical treatment of gastric carcinoma have not improved, despite the more advanced diagnostic methods and more radical surgery.

Carpal tunnel syndrome. Anatomical and clinical investigation.

The anatomy of the carpal tunnel was studied by postmortem dissection of both wrists in ten adults with normal wrists. Preoperative clinical and EMG examinations were performed on 28 wrists in 23 patients suffering from carpal tunnel syndrome. Anatomical and histological studies were made in connection with operation, and postoperatively the condition was followed clinically and by EMG. Numbness, tingling, and pain of the hands were markedly relieved during 2 months of follow-up, whereas clumsiness and weakness showed no significant change. preoperatively, EMG showed sensory abnormalities in 96% of cases and motoric abnormalities in 82%. The diagnostic accuracy of EMG was good, in particular as regards the sensory aspect. The return to normal of EMg was slow. Pathoanatomical examination showed a normal tendon sheath and transverse carpal ligament in 52%, while rheuma was found in the specimens of 12%, fibrosis of the tendon sheath in 36%, and fibrosis of the transverse carpal ligament in 32%. No correlation was observed between the shape of the osseous carpal tunnel and the degree of clinical symptoms.