Laparoscopic right posterior hepatic bisegmentectomy (Segments VII-VIII).

The role of laparoscopy in liver surgery is still a subject of debate. Up to now, isolated hepatic lesions requiring a segmental (or bisegmental) resection have been considered to be an indication for laparoscopic surgery only when they are located in the left lobe or in the right lower lobe, whereas an open approach by laparotomy or thoracotomy is still preferred for lesions of the upper right lobe. Here we report a case of a right posterior hepatic bisegmentectomy (segments VII-VIII) performed for a hepatic hemangioma that was carried out entirely laparoscopically. In our opinion, there is not an a priori contraindication to the laparoscopic resection of any hepatic benign lesion, wherever it is located in the liver parenchyma. Nevertheless, major hepatic resections still have to be performed by expert surgeons in specialized centers.

Nonfunctioning neuroendocrine tumors of the pancreas: clinical presentation of 7 patients.

BACKGROUND: Neuroendocrine tumors of the pancreas (NPT) are rare and represent less than 0.5% of all pancreatic tumors. MATERIALS AND METHODS: The authors describe the clinical presentation, the pathological findings and the treatment of 7 patients with nonfunctioning NPT. RESULTS: Non-specific symptoms were noted in 6 patients, depending on the size and the location of the tumor, and 1 patient was asymptomatic. A correct preoperative diagnosis was done in only one case. Immunohistochemical studies, most often on surgically resected tissue sample is needed for diagnosis of NPT. The treatment requires surgical resection. Among 4 patients (57%) classified No at the time of surgery, 3 (75%) are alive, free of recurrence, more than 2 years after tumor resection. CONCLUSION: The preoperative diagnosis is difficult to assess. NPT differ from pancreatic adenocarcinomas by the younger age of the patients, their immunohistochemical pattern and a better prognosis after surgical resection.

The definitive stoma: complications and treatment in 50 patients.

Intestinal stomas remain required in many operations for inflammatory bowel disease, for colorectal tumours, trauma and diverticulitis. During one year, 50 patients (20 ileostomies and 30 colostomies) underwent an intestinal stoma and were followed by an enterostomal therapist. The morbidity, the local complications and the treatment are analyzed. An appropriate skin protection is mandatory in the early post-operative period after performing ileostomy or right colostomy. The mucocutaneous dehiscence can be treated by local protection. The quality of life of patients with a stoma is improved by information and careful medical attention given by the surgeon and the enterostomal therapist.

What did the laparoscopic Nissen approach of the gastro-oesophageal reflux really change for the patients 8 years later?

BACKGROUND: Nissen fundoplication (NF) is recognized as the surgical treatment of the gastro-oesophageal reflux disease (GERD). NF can be achieved either by open surgery or by laparoscopic approach. METHODS: From 1987 to 1997, 210 patients were treated for GERD by NF: 61 by open and 149 by laparoscopic approach. All the patients were followed more than 1 year and were scored by clinical assessment (Visick scale adaptation). In case of Visick score > 1, GI-endoscopy, X-ray series or 24-hour pH-study complete the evaluation. RESULTS: The operative time was comparable between both groups. The postoperative recovery was statistically faster in the laparoscopic group (p = 0.0001). The mean time of follow-up was 6 years after open NF and 4 years after laparoscopic NF. After open NF or laparoscopic NF, 72% and 67% of the patients are respectively scored Visick 1, 13% and 21%--Visick 2, 6.8% and 6%--Visick 3 and 8.2% and 6%--Visick 4 (NS). Patients with recurrence of GERD were scored Visick 4, so failure of the surgical treatment is observed in 5 patients after open NF and 9 patients after laparoscopic NF. The occurrence of incisional hernia was significantly higher in the open group (p = 0.0001). CONCLUSION: NF remains a safe procedure for surgical treatment of GERD and can be achieved by laparoscopic approach with comparable results to those by open laparotomy. In our experience, the advantages of the laparoscopic approach is a faster postoperative recovery and a lower risk of incisional hernia.