Retrieval of intraperitoneal Penrose drain under transvaginal endoscopic guidance.

BACKGROUND: One of the unfortunate complications associated with the use of Penrose drains is slipping down of the drain into the peritoneal cavity because of incomplete placement of skin sutures to secure the drain. CASE: A 49-year-old woman with the International Federation of Gynecology and Obstetrics (FIGO) stage IIIc ovarian cancer underwent bilateral salpingo-oophorectomy, total hysterectomy, partial omentectomy, and pelvic and para-aortic lymph nodes removal. On the third postoperative day, one of the Penrose drains slipped down, leaving it inside the patient. The intraperitoneal Penrose drain was successfully retrieved under endoscopic guidance through vaginal cut stump. She went home on the 9th day after the initial operation and started to receive postoperative adjuvant chemotherapy on the 17th day. CONCLUSION: The endoscopic-guided retrieval through vaginal cut stump of an intraperitoneal retained Penrose drain is an excellent option.

Laparoscopic Nissen fundoplication for gastroesophageal reflux disease in Japan.

PURPOSE: Laparoscopic antireflux surgery is the standard treatment for gastroesophageal reflux disease (GERD) in Western countries where this disorder is common; however, it has only recently been introduced in Japan. We examined the effectiveness of laparoscopic antireflux surgery in a small series of Japanese patients. METHODS: Between 1998 and 2001 we performed laparoscopic Nissen fundoplication in 23 patients to evaluate the efficiency of this technique. We examined the following four parameters pre- and postoperatively: symptoms, endoscopic findings, gastroesophagogram findings, and the results of intraesophageal 24-h pH monitoring. We also examined the operation time, blood loss, intraoperative complications, and postoperative complications. RESULTS: The operation was safely performed in all patients, regardless of age, and there were no intraoperative complications. Postoperatively, more than three parameters were effectively normalized in 17 (89.5%) of 19 patients. The only postoperative complications were delayed gastric emptying in three patients and persistent dysphagia in five patients. During follow-up, esophagitis recurred in two patients, one of whom underwent laparoscopic refundoplication, which normalized the condition. CONCLUSION: Laparoscopic Nissen fundoplication is highly effective for GERD and could become the standard surgical treatment in Japan.