Dysphagia after Laparoscopic 360 Repair for Gastroesophageal Reflux Disease.

In comparison to medical treatment, antireflux surgery is recognized as an effective, efficient and longlasting therapy, as well as the only treatment that is able to modify the natural history of gastroesophageal reflux disease (GERD). The 360 fundoplication is the most widely used surgical procedure for GERD. Although performed in the era of H2-blockers and open surgery, comparison of the so-called Nissen repair to both symptomatic and continuous medical therapies concluded that surgery was superior to medical therapy in every outcome measure used.

[Elective laparoscopic colectomy in uncomplicated diverticulitis: when should surgery be performed]. / Colectomía laparoscópica programada en la diverticulitis no complicada: cuándo se debe intervenir quirúrgicamente?

INTRODUCTION: Surgical resection in acute diverticulitis is indicated after 2-4 episodes, as well as in patients with associated processes. However, the optimal time to perform elective surgery remains to be determined. Compared with open surgery, elective laparoscopic colectomy is associated with fewer postsurgical complications in patients with uncomplicated acute diverticulitis. Nevertheless, the conversion rate to laparotomy is associated with an increase in postoperative morbidity. OBJECTIVE: We studied the impact of time interval to surgery on outcome parameters including operative incidents, postoperative complications and pathologic findings. PATIENTS AND METHOD: Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of NCD: group A (within 90 days) and group B (beyond 90 days). Case matching was performed by a computer program according to age, sex, BMI, number of previous episodes, ASA score and prior abdominal surgery. RESULTS: Between July 2000 and June 2004, 132 patients had LCR for NCD. 39 patients were included in group A (median: 40 days, range 21-90 days) vs 38 patients in group B (median: 170 days, range 91-375 days). No patient in either group underwent operation in an emergency setting while waiting for elective surgery. Conversion was required in 5 patients in group A (13%) vs 2 patients in group B (5%) (p = 0.11). Overall abdominal morbidity in Group A was 21% vs 5% in group B (p = 0.02). Mean hospital stay was 7.7 days in group A vs 5.0 days in group B (p = 0.08). Residual inflammation was significantly increased in group A (31%) as compared to group B (11%) (p = 0.01). CONCLUSIONS: Laparoscopic left colonic resection for acute diverticulitis is best performed beyond the third month after the last acute episode.

Laparoscopic two-stage left colonic resection for patients with peritonitis caused by acute diverticulitis.

PURPOSE: Purulent or fecal peritonitis is one of the most serious complications of acute diverticulitis. Up to one-fourth of patients hospitalized for acute diverticulitis require an emergent operation for a complication, including abscess, peritonitis, or stenosis. Open Hartmann's procedure has been the operation of choice for these patients. The advantages of laparoscopy could be combined with those of the primary resection in selected patients with peritonitis complicating acute diverticulitis. However, because of technical difficulties and the theoretic risk of poorly controlled sepsis, laparoscopic Hartmann's procedure has been seldom reported for such patients. METHODS: Data were prospectively collected from 2003 to 2005 in a single referral center specialized in abdominal emergencies. Laparoscopic Hartmann's procedure (Stage 1) was performed in selected patients with peritonitis complicating acute diverticulitis. Secondarily, Hartmann's reversal (Stage 2) also was performed laparoscopically. RESULTS: Thirty-one patients were studied. The median Mannheim Peritonitis Index score was 21 (+/-5; range, 12-32). The conversion rate was 19 and 11 percent for Stage 1 and Stage 2, respectively. There was no perioperative uncontrolled sepsis. Overall operative 30-day mortality and morbidity rates were 3 and 23 percent for Stage 1, and 0 and 15 percent for Stage 2, respectively. Stoma reversal was possible in 90 percent of patients. CONCLUSIONS: The results of this small series demonstrated that the indications of laparoscopy in diverticulitis could be extrapolated to selected patients with peritonitis. The technical feasibility and safety of laparoscopic Hartmann's procedure in selected patients seem acceptable. However, larger-scale, controlled studies are needed to define more accurately the role of laparoscopy in complicated diverticulitis.

Incisional hernias. I. Related risk factors.

Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors review the literature emphasizing the current knowledge concerning the pathogenesis of incisional hernias. The second article is focused on the treatment.

Colectomía laparoscópica programada en la diverticulitis no complicada: ¿cuándo se debe intervenir quirúrgicamente? / Elective laparoscopic colectomy in uncomplicated diverticulitis: When should surgery be performed

Introducción. En la diverticulitis aguda no complicada está indicada la resección quirúrgica tras 4 o 2 episodios, así como en pacientes que presentan otros procesos patológicos asociados. Sin embargo, aún no se ha determinado cuál es el momento idóneo para la realización de la intervención quirúrgica de manera programada. En comparación con la cirugía abierta, la colectomía laparoscópica electiva se acompaña de menos complicaciones posquirúrgicas en los pacientes con diverticulitis aguda no complicada. No obstante, la tasa de conversión a laparotomía se asocia a un incremento de las tasas de morbilidad postoperatoria. Objetivo. Se ha evaluado el impacto del intervalo transcurrido hasta la intervención quirúrgica en diversos parámetros de evolución, como los incidentes intraoperatorio, las complicaciones posquirúrgicas y los hallazgos anatompatológicos. Pacientes y método. Un análisis retrospectivo de dos series de pacientes con características similares, con la única variable del tiempo transcurrido entre el último episodio de diverticulitis aguda no complicada: grupo A (pacientes intervenidos los 90 días siguientes) y grupo B (pacientes intervenidos después de transcurridos los primeros 90 días). La equiparación de las características de los pacientes se realizó mediante un programa informático según la edad, el sexo, el índice de masa corporal, el número de episodios previos, la puntuación ASA (American Society of Anesthesiologists) y los antecedentes de cirugía abdominal. Resultados. Entre julio de 2000 y junio de 2004, 132 pacientes fueron intervenidos mediante resección colónica laparoscópia por diverticulitis no complicada. En el grupo A participaron 39 pacientes (período mediano transcurrido desde el último episodio, 40 [intervalo, 21-90] días), mientras que en el grupo B lo hicieron 38 pacientes (período mediano transcurrido desde el último episodio, 170 [91-375] días). Todos los pacientes estaban en lista de espera para cirugía programada y no fue necesaria la intervención quirúrgica urgente en ninguno de ellos. Se requirió la conversión a laparotomía en 5 (13%) pacientes del grupo A y en 2 (5%) pacientes del grupo B (p = 0,11). La morbilidad abdominal total en los grupos A y B fue del 21 y del 5%, respectivamente (p = 0,02). La hospitalización media fue de 7,7 y 5,0 días en los grupos A y B, respectivamente (p = 0,08). La inflamación residual fue significativamente mayor en los participantes del grupo A (31%) que en los del grupo B (11%) (p = 0,01). Conclusiones. La resección colónica izquierda laparoscópica en pacientes con diverticulitis aguda se acompaña de mejores resultados cuando se realiza después de transcurridos 3 meses desde el último episodio agudo (AU)

Introduction. Surgical resection in acute diverticulitis is indicated after 2-4 episodes, as well as in patients with associated processes. However, the optimal time to perform elective surgery remains to be determined. Compared with open surgery, elective laparoscopic colectomy is associated with fewer postsurgical complications in patients with uncomplicated acute diverticulitis. Nevertheless, the conversion rate to laparotomy is associated with an increase in postoperative morbidity. Objective. We studied the impact of time interval to surgery on outcome parameters including operative incidents, postoperative complications and pathologic findings Patients and method. Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of NCD: group A (within 90 days) and group B (beyond 90 days). Case matching was performed by a computer program according to age, sex, BMI, number of previous episodes, ASA score and prior abdominal surgery. Results. Between July 2000 and June 2004, 132 patients had LCR for NCD. 39 patients were included in group A (median: 40 days, range 21-90 days) vs 38 patients in group B (median: 170 days, range 91-375 days). No patient in either group underwent operation in an emergency setting while waiting for elective surgery. Conversion was required in 5 patients in group A (13%) vs 2 patients in group B (5%) (p = 0.11). Overall abdominal morbidity in Group A was 21% vs 5% in group B (p = 0.02). Mean hospital stay was 7.7 days in group A vs 5.0 days in group B (p = 0.08). Residual inflammation was significantly increased in group A (31%) as compared to group B (11%) (p = 0.01). Conclusions. Laparoscopic left colonic resection for acute diverticulitis is best performed beyond the third month after the last acute episode (AU)