Acute gastric volvulus related to adhesions after laparoscopic fundoplication.

Laparoscopic antireflux procedures currently are considered to be as safe, cost efficient, and effective as the techniques used previously in antireflux surgery, although life-threatening complications after antireflux surgery have been reported with both open and laparoscopic fundoplication. We report the case of a 38-year-old man who presented with acute abdominal pain and vomiting 8 months after a laparoscopic Nissen-Rosetti fundoplication. The diagnosis of gastric volvulus was suspected. The endoscopic examination showed a proper location of the fundoplication and features consistent with early gastric ischemia. Rotational maneuvers failed to untwist the volvulus. Emergency surgery was performed, involving a conventional laparotomy. At surgery, the volvulus was found related to a thick adhesion between the opening of the xiphoidal cannula and the hilus hepatis. The section of the adhesion allowed immediate untwisting of the volvulus. Despite a general assumption that laparoscopic procedures will reduce the incidence of postoperative adhesion formation, it should be kept in mind that laparoscopic techniques do not preclude the deposit of unusual foreign microbodies, which is an admitted mechanism of adhesion formation.

Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study.

BACKGROUND: Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS: Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS: Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS: A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.

Laparoscopic colo-rectal surgery: analysis of 113 cases.

BACKGROUND/AIMS: The aim of the study is to relate our five years experience with laparoscopic colorectal surgery. MATERIALS AND METHODS: One hundred-thirteen procedures were performed between October 1990 and February 1996, 7% of which were performed as emergencies. Elective indications (93%) included 45 cancers, 31 cases of diverticulosis, 18 cases of benign tumor, and 11 other reasons. Procedures performed were sigmoidectomy (61 cases), rectal resection (12 cases), segmental colectomy (15 cases), right hemicolectomy (14 cases) and restoration of continuity following a Hartmann's procedure (5 cases) and miscellaneous (6 cases). RESULTS: Operative complications occurred in 14% of the cases. The conversion rate to laparotomy was 6%. Post operative complications occurred in 14% of the patients. Reoperation was performed in 7% of the cases and overall mortality was 1.7%. Mean length of hospital stay was 9.6 days. Long-term oncology results demonstrated no recurrence for DUKES stage A disease followed-up from 5 to 65 months, and 2 recurrence on 11 DUKES B or C. All DUKES D patients died in an average of 17 months. No abdominal wall metastases were seen during the follow-up period in 45 patients with cancer who were treated. CONCLUSIONS: Laparoscopic colo-rectal surgery is technically feasible and has an acceptable complication rate. The best indications are treatment of benign disorders, principally excision of polyps and treatment of uncomplicated diverticulosis. This is also a good approach to treat degenerated polyps (DUKES A). The procedure should be assessed in curative excision of DUKES B or C disease.

Laparoscopic Nissen-Rossetti fundoplication. First results.

From January 1992 to July 1994, 148 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent Nissen-Rossetti fundoplication by a laparoscopic approach. There was no conversion and no postoperative death. The main intraoperative complications were hemorrhage (n = 12), pleural opening (n = 5), and gastric perforation (seromuscular effraction) (n = 1). Laparoscopic reoperation was necessary in two patients as a result of bleeding, and there were two cases of food impaction. The median hospital stay was 4.9 days; 117 patients were observed for follow-up for 3-31 months (median 6.2 months). Eleven cases of dysphagia extending beyond 2 months have been observed. In five of those cases, endoscopic dilatation provided effective treatment of dysphagia and in four others, a further laparoscopic intervention enabled a cure to be obtained. Eighty-four percent are satisfied with their decision to have the operation. The laparoscopic Nissen-Rossetti fundoplication can be carried out safely and effectively with positive results similar to those obtained with the open procedure and with all of the advantages of the minimally invasive approach.

[Results of the celioscopic treatment of gastroesophageal reflux according to Nissen-Rossetti. Apropos of 94 cases]. / Résultats de la cure coelioscopique du reflux gastro-oesophagien selon Nissen-Rossetti. A propos de 94 cas.

From January 1992 to July 1993, 94 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent laparoscopic Nissen-Rossetti fundoplication. The median follow-up was 4.5 months. There was no conversion to open surgery and no postoperative mortality. Laparoscopic reoperation was necessary in 2 patients haemorrhage and there were 2 cases of food impaction. 6 patients developed a chest postoperative infection. 6 cases of dysphagia extending beyond 2 months were observed. In 3 of these cases, endoscopic dilatation provided effective treatment of dysphagia, and in 3 others, a further laparoscopic operation achieved cure. We observed 2 relapses of hiatal hernia, one of which was a voluminous recurrent paraesophageal hernia, and the other was a patient with slipped-Nissen. 84% of patients were satisfied with the surgical result. Laparoscopic fundoplication is an effective the treatment for gastroesophageal reflux.

[A rare cause of obstruction: hernia through the hiatus of Winslow. Apropos of 3 cases]. / Une cause rare d'occlusion: la hernie à travers l'hiatus de Winslow. A propos de trois cas.

Exceptional pathology whose preoperative diagnosis is based upon clinical and radiological signs; the herniation through the foramen of Winslow is a variety of internal herniation. About three recent cases observed in the service, it seemed interesting to see, reviewing literature, what are the diagnostic characters and therapeutic modalities knowing difficulties because of a quasi exclusive vascular collect.