[Consideration regarding 20 antireflux laparoscopic operations for hiatal hernia]. / Consideratii în legatura cu 20 operatii antireflux efectuate pe cale laparoscopica pentru hernia hiatala.

AIM: To evaluate the clinical, therapeutical and evolutive aspects of the patients with hiatal hernia with laparoscopical approach. MATERIALS AND METHODS: Retrospective analysis of 20 patients diagnosed with hiatal hernia and operated, laparoscopical, between 13.01.1999-10.04.2002. RESULTS: At 18 cases (90%), were sliding hiatal hernia and at 2 cases (10%), were paraesophageal hiatal hernia. There were performed laparoscopical: 1 (5%) Dor anterior hemi-fundoplication, 4 (20%) Rosetti fundoplication, 3 (15%) Toupet posterior hemi-fundoplication and 11 (55%) Nissen fundoplication. For the dissection, the ultrasound scissors (Ultra-Shears) was used and for the suture of the both diaphragmatic crus and the wrap, the Endo-Stitch. There were reported 1 (5%) optional conversion and 3 cases (15%) with bleeding solved by clipping and hemostatic suture. No postoperative complications, deaths intra and postoperative were reported. The average duration of the intervention decreased in time, due to the experience, from 180 to 60 minutes, but in accordance with the complexity of the procedure (Nissen-Toupet-Dor). At 2 (10%) cases with Nissen fundoplication was reported a transitory dysphagia, which was remitted between 1-2 months. We noticed a decreasing of the duration of hospitalisation for the antireflux laparoscopical interventions, compared with the classic methodes. CONCLUSIONS: There is a tendency of the laparoscopical approach of hiatal hernia to come the standard in the GERD, due to his minimal invasive character, significantly reducing costs and good postoperative results.

[Mechanical suture in colorectal surgery]. / Sutura mecanica în chirurgia colorectala.

THE OBJECT: Of this work was the study of using, as well as the utility of the mechanical sutures in colorectal surgery; because of the special caution needed to be taken for any colonic or rectal suture, more than any other digestive segment. The frequency of the postoperative fistulas after the suture and anastomosis is higher at this level and so it increases the period and costs of the hospitalization. MATERIAL AND METHOD: We studied the possibilities of performing and evolution of 64 mechanical sutures for 19 patients, with colorectal pathology, hospitalized in our department from july 1999 to december 2000. RESULTS: We performed 64 mechanical sutures, as followed: 47 in open surgery and 17 in laparoscopic. From all these, 56 was bowel sutures, 8 of them were vascular (in laparoscopic, for cutting the most important vascular pedicles). We did 18 anastomosis: 15 in open and 3 in laparoscopic surgery. It was 2 postoperative fistulas from all 56 intestinal sutures (3.57%). We haven't any intra or postoperative bleeding from the vascular anastomosis. It was 3 intraoperative bleeding from the intestinal anastomosis, and only 1 case of postoperative bleeding (5.26% of the cases: 1.56% of all mechanical sutures). In only one case, the mechanical suture couldn't be initially done, but it succeeded after the removing of the segment of the bowel involved. CONCLUSIONS: Mechanical sutures offers a high level of safety to the colorectal anastomosis. It provides a very good vascularization to the anastomosis and decreases the time needed for performing the suture or anastomosis, versus manual sature. Also, for the patients with rectal ampular neoplasm, it creates the possibility of anal sphincter preservation by making a low colorectal anastomoses--which is difficult by manual suture.

[Intraoperative ultrasonography, dissection with ultra-shears and trans-cystic choledochoscopy during laparoscopic approach in obstructive lithiasis icterus case]. / Ecografie intraoperatorie, disectie cu foarfeca cu ultrasunete si coledocoscopie transcistica într-un caz de icter mecanic litiazic rezolvat pe cale laparoscopica.

The authors present the case of a 48 years old male with lithiasis obstructive icterus who was operated by laparoscopic transcystic approach with choledochoscopy. This minimally invasive technique was very spectacular trough the using of laparoscopic ultrasonography, dissection with Ultra-Shears device and transcystic choledochoscopy. Careful watching of abdominal laparoscopic view and transcystic choledochoscopic view is the particularity of laparoscopic transcystic management of choledocholithiasis. This metod don't let us to explore the biliary tract before the junction between common bile duct and cystic duct.

[Intraoperative ultrasonography during laparoscopic surgery]. / Ecografia intraoperatorie în chirurgia laparoscopica.

AIM: Of this study is the introduction and the results evaluation of laparoscopic ultrasonography performed. MATERIAL AND METHOD: We realize a prospective study about laparoscopic ultrasonography performed in 37 cases with laparoscopic surgical treatment. The Aloka SSD 2000 mobile scanner is used. This system make possible the use of an linear-array transducer, with mechanical flexibility and availability of Doppler analysis. Most frequently we used intraoperative ultrasonography in laparoscopic cholecystectomy as an alternative for cholangiography to exclude CBD pathology. Because of various surgical pathology with laparoscopic approach, the laparoscopic ultrasonography utilization range was vastly. RESULTS: In all the cases we could performed the laparoscopic ultrasonography. In 6 of 27 cases with laparoscopic cholecystectomy we found pathological disorders of bile ducts. CBD with diameter found between 5-12 mm. We properly saw the distal segment of CBD in 23 cases (89.2%), and common hepatic duct in 26 cases (97.3%). The quality of visualization was very good in 21 cases (83.8%) and moderate in 6 cases (16.2%). We easy identify CBD stones and we successfully used Doppler color mode in differentiating vascular from non-vascular from non-vascular structures. Laparoscopic ultrasonography performed in a case with left colon cancer excluded liver metastasis and lymph nodes metastasis. CONCLUSIONS: 1. Laparoscopic ultrasonography combines the advantages of diagnostic laparoscopy and intraoperative contact ultrasonography; 2. Laparoscopic ultrasonography is a simple and very efficient intraoperative examination procedure; 3. Laparoscopic ultrasonography is the technique to choose in CBD intraoperative exploration; 4. Laparoscopic ultrasonography improve abdominal malignancy exploration, thus modifying therapeutic decisions; 5. Color Doppler mode guides the surgeon's steps in difficult directions.

[Mechanical suture in classic and laparoscopic general surgery]. / Sutura mecanica în chirurgia generala clasica si laparoscopica.

AIM: Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic. MATERIAL AND METHOD: We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000. RESULTS: Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler). CONCLUSIONS: There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.