Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.

Laparoscopic vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

腹腔镜脾切除术治疗特发性血小板减少性紫癜(附11例报告)

目的探讨特发性血小板减少性紫癜患者进行腹腔镜脾切除术的方法和治疗效果。方法对 11例特发性血小板减少性紫瘢患者进行经腹腔镜脾切除术。结果 11例均顺利完成手术 ,处理脾周韧带时分别使用Ligasure 2例 ,超声刀 8例 ,电刀 1例 ;处理脾蒂应用Endo GIA 9例 ,结扎及钛夹夹闭 2例。术中脾窝均放置引流管 ,手术时间 12 0～ 2 4 0min ,出血 10～ 2 0 0mL ,平均术后 5天痊愈出院。

Evaluation of two esophageal myotomy methods to treat achalasia

Objective:To evaluate a better method for the outcome of achalasia between laparoscopic Heller procedures(LHP)with partial fundoplications and thoracoscopic procedures(TP).Methods: Eighty patients with achalasia were treated by LHP with partial fundoplications and another 120 cases re- ceived TP treatment.All the patients were from the First and Second Hospital of Xi'an Jiaotong Universi- ty.Their clinical information including dysphagia after surgery,operation time,staying in hospital,ab- normal gastroesophageal reflux and pH assay were recorded.Results:Achalasia treated by LHP with par- tial fundoplications can make a higher outcome remission rate compared to TP.Conclusion:LHP with par- tial fundoplications is better than TP.It is an ideal surgery for achalasia up to now.