Six years of experience in laparoscopic surgery of esophageal achalasia.

BACKGROUND: We show the experience of 6 years in laparoscopic surgical therapy of esophageal achalasia, performing of the Heller-Dor or Heller-Toupet operation, with particular regard to the technical aspect. METHODS: One hundred and ten laparoscopic interventions were done between November 1995 and December 2001. We studied operative time in hiatus approach, esophagocardiomyotomy, transoperative endoscopy, and anti-reflux procedure. We also analyzed the relation between complications and clinical evolution of disease with clinical stage. RESULTS: The mean surgical time of the intervention is 138 min, and it is significantly increased by transoperative endoscopic control; conversion to open surgery was not necessary. Clinical results are classified as excellent in 103 patients. Morbidity was 6%. CONCLUSION: This surgical procedure is a first line in the treatment of esophageal achalasia. It is necessary to have special care in early diagnostic cases to avoid electrosurgical injury.

Laparoscopic hand-assisted spleen autotransplantation.

BACKGROUND: Only recently has the spleen been perceived as an organ with a major immune function. This raised an interest in spleen salvage after spleen trauma and pancreatic tail resection, for the treatment of hematologic disorders and inducement tolerance for allogenic transplants. The purpose of this study was to evaluate the feasibility of a new technique for spleen transplantation: laparoscopic spleen autotransplantation in a large animal model. METHODS: Ten 35-kg pigs were used for this study. A laparoscopic hand-assisted splenectomy was first performed. The spleen was extracted through the handport to be flushed with a 4 degrees C saline solution and prepared extracorporeally. The graft was then reintroduced into the same animal's abdominal cavity, and a splenic-to-common iliac artery and vein bypass was performed laparoscopically using a 7-0 polytetrafluoroethylene running suture. The animal was killed 1 week postoperatively for histologic examination. RESULTS: All 10 animals tolerated the procedure well. No conversion to open surgery was required. The mean operative time was 253 +/- 45 min. The mean time needed to create the artery and vein anastomoses was 116 +/- 165 min, and the mean blood loss was 190 +/- 120 ml. There was no intra- or postoperative death. Intraoperative complications included two stenosed vascular anastomoses, which were taken down and revised. Seven of the 10 spleens were histologically viable 1 week after surgery. The nonviable transplantations were attributable to a thrombosis of the common iliac artery (n = 1) or the transplant artery (n = 2). CONCLUSIONS: Hand-assisted laparoscopic spleen autotransplantation is feasible in an animal model. This procedure could constitute an option when spleen resection is necessary for pancreatic tail resection, or when spleen preservation is important to the maintenance or restoration of an immune function.