Early experience with laparoscopic antireflux surgery in the rural setting.

BACKGROUND: Gastroesophageal reflux (GERD) affects a significant portion of the population, and refractory or untreated disease can have serious long-term complications. Antireflux procedures are now done more frequently because of advances in laparoscopic technique. It has been reported in the literature that the quality of care is better in larger urban hospitals than in smaller facilities. We report our experience with laparoscopic antireflux surgery in a 35-bed rural county hospital. METHODS: We reviewed the charts of 26 patients who had a laparoscopic antireflux procedure in our facility during a 2-year period. Data from the preoperative evaluation, the operative procedure, and the postoperative period were recorded. The patients had office follow-up after the procedure and also were contacted at the time of the study to evaluate their outcome. RESULTS: Ninety-five percent of the patients had excellent symptomatic relief from heartburn and required no medication at follow-up. There was no mortality. Our complication rate was 7%, and the conversion rate to laparotomy was 7%. Most patients were discharged on the day after the procedure. CONCLUSION: Laparoscopic antireflux procedures can effectively relieve symptoms of GERD with minimal morbidity and mortality. The outcome of our initial experience in a small rural facility is analogous to results previously published in the literature.

Paraganglioma and adrenal pheochromocytoma presenting simultaneously in an elderly female. Case report and review of the literature.

Paragangliomas are chromaffin tissue tumors arising in an extra-adrenal location. It is quite rare to find a paraganglioma concurrently with a pheochromocytoma. We report a patient who underwent resection of a retroperitoneal mass that was characterized pathologically as a malignant paraganglioma. An incidental finding was a microscopic pheochromocytoma in the ipsilateral adrenal gland.