[Laparoscopic management of gastroesophageal reflux disease. Experience with 100 cases]. / Manejo laparoscópico de la enfermedad por reflujo gastroesofágico. Experiencia en 100 casos.

OBJECTIVE: To evaluate the results of laparoscopic Nissen-Rossetti funduplication and to compare them with the results obtained in open surgery. DESIGN: Prospective, observational, longitudinal, pre and post-procedure. CENTERS: Beneficencia Española, Hospital Angeles, and Hospital Francisco Galindo Chávez, ISSSTE, in Torreón, Coahuila, Mexico. PATIENTS AND METHOD: From December 1992 to February 1999, 100 patients with surgical indications due to gastroesophageal reflux disease (GERD) prospectively underwent a laparoscopic Nissen-Rossetti procedure. A clinical and endoscopic follow up from 3 months to 9 years was performed in 87 cases. RESULTS: Symptomatic control was achieved in 98% (85/87) of the cases and remission of overall endoscopic esophagitis in 79% (69/87); excluding Barrett cases, esophagitis remission was observed in 93% (67/72) of the subjects. The following recurrences took place: two with G-II and two with G-III esophagitis, one requiring pyloroplasty due gastric stasis, and other patient with G-IV esophagitis, who has needed to continue with postoperative dilations. Of 16 cases with Barrett's esophagus, two-showed remission and one did not return control. Perioperative complications included gastric perforations (3), acute pulmonary edema during the immediate postoperative period (1), deep vein thrombosis (1), and late esophageal perforation (1). All were resolved satisfactorily. Surgical mortality was 0 in the 100 cases undergoing the procedure. Eighty-six percent of cases had a 24-h hospital stay. Early morbidity: dysphagia in 60 patients, early satiety in 91 cases, abdominal distention in 25 cases, all this symptomatology disappears during the subsequent 3 months. Persistent morbidity: flatulence in 60% of patients, difficulty for vomiting in 10% of cases. CONCLUSION: The laparoscopic procedure is as effective as the open method with the advantage of being minimally invasive.

[Selective distal splenorenal shunt, surgery for portal hypertension. Experience of a general hospital]. / Derivación esplenorenal distal selectiva, cirugía de la hipertensión portal. Experiencia de un hospital general.

From 1982 to 1987, twenty patients underwent Distal Splenorenal Shunt. The surgical indication was hemorrhagic portal hypertension: two cases were done on an emergency basis and eighteen electively. In all patients endoscopy was performed, and the bleeding site was documented; splenoportography was done to 70% and the remaining had selective arteriography with venous phase. Portal pressure was measured during splenoportography or during the operation with catheterization of the right gastroepiploic vein. We had a preoperative histopathologic diagnosis in 60% of the cases. The overall preoperative mortality was 10%, with ascites in seven patients, pancreatic pseudocyst in one, chylous retrogastric collection in one and, encephalopathy in one case. The predicted overall survival for a 5-year period is 77%. We think this surgery can be done in the general hospitals of small cities.