Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: Systematic review of the literature.

BACKGROUND: Longitudinal pancreaticojejunostomy, also known as modified Puestow or Partington-Rochelle procedure, is a technique for the treatment of chronic pancreatitis. It is usually performed by laparotomy, but in a very small number of cases it has been performed using a laparoscopic or robot-assisted approach. We carried out a systematic literature review to clarify the current status of laparoscopic longitudinal pancreatojejunostomy (LLPJ). METHODS: Adhering to the PRISMA guidelines, a systematic search for LLPJ was performed in PubMed, Embase, and Cochrane Library, for articles published up to 31 December 2017. RESULTS: 357 articles were evaluated for eligibility and 17 were included for critical appraisal: eight case reports, eight retrospective case series, and one series of cases and controls without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to the CEBM. Patients were relatively young (mean age 37 years), with a slight preponderance of males (ratio 1.3: 1). All had long-standing disease, ERCP prior to surgery and a dilated pancreatic duct (mean 11 mm). The surgery was usually performed laparoscopically using four trocars; the conversion rate was low (5%), bleeding was minimal, the morbidity rate was 11% and no mortality was reported. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short (less than two years). The results for pain control were very good since 90% of patients reported no pain, although visual analog scales were rarely used. CONCLUSIONS: In conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.

Management of acute diverticulitis in a tertiary care institution.

BACKGROUND: Diverticular disease of the left colon is a common disease, mainly in the population over 50 years of age. The surgical management of acute diverticulitis is remains controversial, especially in severe forms. OBJECTIVE: This study aimed to evaluate the results of laparoscopic surgery for diverticular disease in a tertiary care institution with a specialist interest in minimally invasive surgery. DESIGN: All patients who had elective laparoscopic sigmoidectomy for diverticulitis within eight years at University Hospital of Luxembourg were selected from a retrospective database to evaluate laparoscopic benefit in moderate and severe disease. RESULTS: A total of 155 patients were divided in two groups: Moderate Acute Diverticulitis (MAD) and Severe Acute Diverticulitis (SAD) respectively. The short-term outcomes, after laparoscopic sigmoidectomy, were evaluated. There were not important differences between two groups. CONCLUSIONS: The laparoscopic management of diverticular disease after moderate and severe crisis gives same benefits and short-term outcomes are similar. Elective Laparoscopic surgery is actually the standard of care for moderate and severe diverticular disease in our institution.

Transjugular Intrahepatic Portosystemic Shunt and Laparoscopic Colorectal Resection: the ideal minimally-invasive management for the treatment of colorectal cancer in severe cirrhotic patients. A case report and literature review.

Surgical interventions on gastrointestinal tract are often not well tolerated by patients with cirrhosis and severe portal hypertension, impairing their prognosis if suffering from malignant disease. Combining the benefits of two minimally invasive techniques such as Transjugular intrahepatic portosystemic shunt (TIPS) and Laparoscopic Colorectal Resection (LCR), the complications related to surgical intervention might be reduced and thus, it allows patients with liver disease, to undergo a curative intervention. One patient with cirrhosis and portal hypertension diagnosed with a rectal cancer underwent a meticulous preoperative preparation through placement of TIPS before laparoscopic surgery. TIPS placement was performed without intraprocedure complications. The patient was successfully operated by laparoscopic technique 36 days after TIPS placement without intraoperative bleeding or postoperative complications. Our experience, despite being based on one case, allows us to conclude that decompression of portal system by TIPS, already used in open surgery, may be applicable as a preoperative laparoscopic procedure with equally satisfactory results.

Influence of obesity-susceptibility loci (MC4R and INSIG2) on the outcome of weight loss and amelioration of co-morbidity in obese patients treated by a gastric-bypass.

BACKGROUND: Genome-wide association and linkage studies have identified multiple susceptibility loci for obesity. OBJECTIVE: We hypothesized that such loci may affect weight loss and comorbidity amelioration outcomes following a gastric-bypass. DESIGN: A total of 200 obese patients who underwent a gastric bypass surgery were genotyped for single-nucleotide polymorphisms (SNPs) in insulin induced gene 2 (INSIG2) and melanocortin 4 receptor (MC4R) obesity genes. RESULTS: After a follow-up of 18 month, the patients (192) data of weight excess loss (72%) and co-morbidities (Hypertension -62- and Diabetes -39-) were analyzed and compared. 26 Patients with SNP were found (9 MC4R and 17 INSIG2). No significant differences in weight excess loss and amelioration of comorbidities were revealed. CONCLUSIONS: The data suggest no influence of weight excess loss and amelioration of co-morbidities after gastric-bypass by genetic susceptibility.

Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the "gold standard".

BACKGROUND: The purpose of this article is to define the state of the art in laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3) in order to advance the good option towards the "gold standard". METHODS: Based on a large review of the literature as well as on our personal experience the authors define clearly: the feasibility and the effectiveness of LLS 2 and 3. RESULTS: In this review the conversion rate was <4%, the histological positive margins was <0.8%, and the mortality was inferior to 0.8%. CONCLUSION: The LLS 2 and 3 seem equivalent or perhaps better option compared with the same intervention performed by laparotomy and can be proposed as primary with a grade C recommendation.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: results of a 2-year follow-up study.

BACKGROUND: The world's epidemic of obesity is responsible for the development of bariatric surgery in recent decades. The number of gastrointestinal surgeries performed annually for severe obesity (BMI > 40 kg/m2) in the United States has increased from about 16,000 in the early 1990s to about 103,000 in 2003. The surgical techniques can be classified as restrictive, malabsorptive, or mixed procedures. This article presents the results for 2 years of bariatric surgery in the authors' minimally invasive center and analyzes the results of the most used surgical techniques with regard to eating habits. METHODS: Between January 2002 and January 2004, the authors attempted operations for morbid obesity in 110 consecutive patients adequately selected by a multidisciplinary obesity unit. This represented 43% of all consultations for morbidly obese patients. The patients were classified as sweet eaters or non-sweet eaters. All sweet eaters underwent gastric bypass. The procedures included 70 Roux-en-Y gastric bypasses, 39 Mason's vertical banded gastroplasties, and 1 combination of vertical gastroplasty with an antireflux procedure. Revision procedures were excluded. RESULTS: The mean age of the patients was 41.36 years (range, 23-67 years), and 72.3% were female. The mean preoperative body mass index was 44.78 kg/m2 (range, 34.75-70.16 kg/m2). The mean operating time was longer for gastric bypass than for the Mason procedure. Three patients required conversion to an open procedure (2.7%). The two operative techniques had the same efficacy in weight reduction. Early complications developed in 11 patients (10%), and late complications occurred in 9 patients (8.1%). The postoperative length of hospital stay averaged 4.4 days (range, 1-47 days; median, 4 days), and was longer in the gastric bypass group. The mortality rate was zero. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used. CONCLUSION: With zero mortality and low morbidity, bariatric surgery performed for adequately selected patients is the most effective therapeutic intervention for weight loss and subsequent amelioration or resolution of comorbidities. The patient's eating habits before surgery play an important role in the choice of the operative technique used.

Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients.

BACKGROUND/AIMS: The objective of our paper is to report on the remote results of patients with gastric cancer treated by mini-invasive surgery as a surgical tool with the "intention to treat with laparoscopy". METHODOLOGY: Between June 1993 and January 2004, 101 patients comprising 72 men and 29 women with gastric adenocarcinoma were prospectively selected by two hospitals based on prior agreement (the CHU Charleroi, Belgium, and Zumárraga Hospital, the Basque Country, Spain). Patients with adenocarcinoma of the cardia were excluded. Average age of the patients was 67 (37-83). RESULTS: Postoperative mortality within 60 days of operation was of 5 patients; 87 patients were therefore properly followed-up for an average of 41 months (7-129). Average survival time for 10 non-resected patients was 4.5 months. Average survival rate of the 10 palliatively resected patients was 7.1 months. Actuarial 5-year survival rate RO-type surgery was 34%. The global actuarial 5-year survival rate after resective surgery was 29%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a heavy but safe operation, and produces acceptable mortality and morbidity rates in patients with advanced gastric cancer in a general poor condition. Laparoscopic gastrectomies for locally advanced cancers are equivalent to those reported by laparotomy as far as long-term oncological results are concerned.

Present state of the Mini-Invasive Surgery (MIS) in esophageal and gastric cancer.

The purpose of this review is to stress the role of the Mini-Invasive Surgery (MIS) in the treatment of the esophagogastric malignant illnesses, supporting ourselves on the most relevant publications of the literature as well as on our own experience in this subject. In short, although no randomised prospective study has proven the MIS advantages in relation to the traditional surgery in the esophagectomy due to cancer, some authors preferently indicate this approach to selected and informed enough patients, who present the following: - High grade dysplasia, preferently choosing from laparoscopic transhiatal esophagectomy (LTE). - Carcinoma in situ, preferently choosing the LTE vs thoracoscopy. - Esophageal tumour locally advanced, in resectable patients with contraindication for a thoracotomy or, in initially non-resectable patients with tumoral reduction after neo-adjuvant chemo-radiotherapy. The arguments given by the authors are the postoperative spectacular improvement in relation to the comfort and quality of life and, the absence of oncological negative effects in the long-term followup. Concerning gastric cancer, the MIS, as exeresis surgical tool in the so-called <> gastric forms, is such a definite and oncological approach as the traditional approach, and superior to this as far as quality of life is concerned. When the MIS is used for treating locally advanced forms of gastric cancer, it is as safe as the laparotomic way and it seems to obtain the same oncological outcomes in the long-term.

Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

[Laparoscopic surgery of gastric cancer]. / Cirugía laparoscópica del cáncer gástrico.

INTRODUCTION: The present state of minimally invasive surgery in gastric cancer is reviewed and its technical aspects are detailed. PATIENTS AND METHOD: The authors provide their personal experience in a non-randomized prospective study, in two different settings (the CHU Charleroi, Belgium and the Hospital of Zumárraga, the Basque Country, Spain) carried out between June 1993 and January 2004. In this study involving 101 patients with gastric adenocarcinoma, the mini-invasive laparoscopic approach was employed as a surgical tool with the "aim of treatment by laparoscopy". The average age of the patients was 67 years (37-83). RESULTS: Postoperativemortality after 60 days was 5 patients; 87 patients were subjected to an oncological follow-up averaging 41 months (7-129). The average of survival observed in the 10 non-resected patients was 4.5 months. The average of survival observed in the 10 patients subjected to a palliative resection was 7.1 months. The actuarial survival after 5 years observed following type RO exeresis was 34%. The 5-years actuarial survival of the resected patients was 29%. CONCLUSIONS: Laparoscopic gastrectomy associated with any type of lymphadenectomy is a significant but safe intervention, with acceptable rates of morbidity and mortality in patients with advanced gastric cancer, who frequently present a bad general status. The long term oncological results are similar to those obtained via laparotomy. More prospective studies are needed that evaluate the results of this approach, both its short-term benefits and the long range oncological result.

Laparoscopic liver resection of benign liver tumors.

OBJECTIVE: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. BACKGROUND: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. METHODS: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. RESULTS: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. CONCLUSIONS: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

The current role of laparoscopic surgery in the treatment of benign gastroduodenal diseases.

BACKGROUND/AIMS: The impressive breakthrough in laparoscopic surgery has urged several authors to adopt such an approach in the treatment of both benign and malignant gastric diseases, even though laparoscopic gastric resection has not yet met with widespread enthusiasm. The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic (LGRs) and laparoscopic-assisted (LAGRs) gastric resections in the treatment of non-malignant gastric conditions. METHODOLOGY: As of April 1997, we performed LGRs or LAGRs on a total of 24 patients (M:F = 15:9; mean age: 43 years; range: 19-65 years), among whom 8 presented with chronic gastric ulcer, 4 had benign pyloric stenosis, 8 were affected with recurrent duodenal ulcers no longer amenable to treatment, and 4 with persistent symptomatic biliary reflux. Pre-operatively, all patients underwent blood tests, upper GI endoscopy coupled with biopsy, and barium swallow. Post-operatively, all patients were administered saline solution and water dextrane for the first 5 days; antibiotics (cefuroxim 4 g i.v. daily) and analgesics (paracetamol 6 g i.v. daily) for the first 48 hours. A hydrosoluble swallow was scheduled for the 5th post-operative day. RESULTS: The surgical procedure consisted of a Billroth II distal gastrectomy in 13 cases and total duodenal diversion with Roux-en-Y gastrojejunostomy in 11. Among such patients, 18 underwent a totally laparoscopic procedure, whereas 6 had laparoscopic-assisted gastrectomy, with the use of a Dexterity device in 1 case. The mean duration of the procedure was 150 min (range: 120-200), and blood losses were not remarkable. No intra-operative complication ever occurred. Post-operatively, we observed one case of retrogastric collection and incisional hernia in 1 patient who underwent a laparoscopic-assisted procedure. The abscess was drained percutaneously and hernia conventionally repaired 5 months post-gastrectomy. Post-operative hospital stay was 7 days on the average (range: 5-25). One patient was lost to follow-up. In the remaining cases, no major functional sequelae were observed at a mean follow-up of 19 months (range: 2-41), apart from 2 cases of transient diarrhea. CONCLUSIONS: Laparoscopic surgery appears to be an invaluable tool for the treatment of gastric diseases and LGRs are a valid option in experienced hands and in selected centers, allowing patients to benefit from a less cumbersome hospital stay and fewer functional sequelae. The economic impact of such a practice, however, needs better clarification.

Unusual complication after pelvic surgery: unilateral lower limb crush syndrome and bilateral common peroneal nerve paralysis.

We present a patient who developed a right anterior leg compartment syndrome and bilateral common peroneal nerve paralysis following radical hysterectomy in the lithotomy position. We describe the physiopathology of the syndrome, its various etiologies, the treatment, and prevention of this complication.

[The contribution of anterior seromyotomy with posterior truncal vagotomy in the treatment of chronic duodenal ulcer]. / Apport de la séromyotomie antérieure avec vagotomie tronculaire postérieure dans le traitement de l'ulcus duodénal chronique.

Contribution to the anterior seromyotomy and posterior truncal vagotomy in the treatment of chronic duodenal ulcer. The authors report a technique of anterior seromyotomy of the gastric lesser curvature with posterior truncal vagotomy for the surgical treatment of chronic duodenal ulcer disease. This technique offers more advantages than the highly selective vagotomy: it is an easier operation to perform, less time consuming and reproducible. Our results are similar to those following highly selective vagotomy.

[Diverticular and instrumental perforations of the colon]. / Considérations sur les perforations diverticulaires et instrumentales du côlon.

From july 1976 to july 1982, two groups of patients consisting of eleven peritonitis due to acute perforated diverticulitis, and five instrumental colonic perforations were treated in our department. None of the patients died in both groups. The relative infrequency, the important morbidity and the inaugural aspect of the perforation in the diverticular disease are in agreement with the literature. The ideal surgical attitude is still controversial. With the majority of the authors, we prefer the Hartmann's operation. The frequency of iatrogenic perforations is not negligible, and could increase in the future, with the development of endoscopic investigations. The morbidity is lower than in the first group, provided that the surgical treatment is applied early.

Gallbladder volvulus: a case report.

Gallbladder volvulus, a rare disease generally affecting older aged women, is generally due to an abnormal anatomical fixation of the gallbladder. As clinical and radiological signs are poor the diagnosis is generally made at laparotomy. The prognosis is excellent when early surgical treatment is performed.

[Pyostercoral peritonitis of diverticular origin. Retrospective analysis of 22 cases]. / La péritonite pyostercorale d'origine diverticulaire. Analyse rétrospective de 22 observations.

Twenty-two cases of diverticulitis with perforation and peritonity have been treated whether by colostomy (13 cases) or primary resection (9 cases). Primary resection reduces mortality and morbidity of the emergency operation and the combined mortality and morbidity of all operative procedures.

[One-stage subtotal colectomy in the emergency treatment of occlusive left colonic neoplasms]. / La colectomie subtotale en un temps dans le traitement en urgence des néoplasies coliques gauches occlusives.

The authors present a series of 17 emergency subtotal colectomies as treatment of malignant occlusions of the left colon. They insist on the advantages of this operation as well as for the short term results (morbidity, mortality) and for the rare functional disease (diarrhea).

[94 inguinal hernias treated by interposition of a prosthesis using medial and preperitoneal approach]. / Nonante-quatre hernies de l'aine traitées par prothèse interposée par voie médiane en prépéritonéal.

Having chosen the utilization of a Teflon prosthesis, interposed in preperitoneal position by medial incision, in a series of 58 patients presenting 94 hernias, the authors wish to express a preference to this method for reoccurring and bilateral hernias. They underline the simplicity of the technique, its reduced morbidity, and they focus on the infrequency of reoccurrence in 47 patients reseen 6 months to 4 1/2 years in follow up. The authors have not observed a difference in the local results, recent and long term, after intervention using this technique under general or local-regional anesthesia. But they do appreciate however, a low percentage of general complications encountered in the group operated without general anesthesia, which thus permits an enlarged spectrum of indications for patients at risk. Previous operations by low midline incisions (prostatectomy, etc...) do not constitute a contra-indication.