Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality. R0 resection allows acceptable survival rates to be achieved. There is even a group of patients with invaded lymph nodes at the N2 level surviving at 5 years. It appears to be very important that this surgery is performed by specialised surgeons.

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There are references in medical literature to the influence of psychopathological changes and their negative impact on the results of laparoscopic fundoplication. The objective of this study is to analyze the influence of psychological changes, as assessed by the General Health Questionnaire-28 (GHQ-28), on patients undergoing surgery for gastroesophageal reflux. This is a prospective study in a series of 103 consecutive patients (62 males and 41 females with a mean age of 40 years) undergoing laparoscopic fundoplication. In addition to functional studies, patients completed the SF-36, Gastrointestinal Quality of Life Index, and GHQ-28 before surgery. Functional tests and questionnaires were repeated 6 months after surgery. Patients were also questioned about their degree of satisfaction. Postoperative results of patients with a normal GHQ-28 and patients showing psychopathological changes as defined by the GHQ-28 questionnaire before surgery were compared. Overall, all patients experienced an improvement in their quality of life. Forty-one patients showed a pathological result in the preoperative GHQ-28 questionnaire. No differences were found in functional results and degree of satisfaction with surgery between patients with normal and pathological results in the preoperative GHQ-28 questionnaire. However, patients with a pathological result in the preoperative GHQ-28 had poorer results in all domains of the postoperative Gastrointestinal Quality of Life Index and SF36 quality of life questionnaires as compared to patients with a normal preoperative GHQ-28 questionnaire. Patients with pathological results in the preoperative GHQ-28 had poorer results in terms of postoperative quality of life despite having normal postoperative physiological studies; this decreased quality of life did not have an impact on the degree of satisfaction with surgery performed. The GHQ-28 does not therefore appear to serve as a predictor of postoperative satisfaction.

Acute massive gastric dilatation is a rare condition mainly seen in patients with alimentary disorders. This massive distention may cause gastric necrosis and even perforation and emphysematous gastritis. We report the case of an 18-year-old female with intense abdominal pain and signs of sepsis. Computed-tomography scan diagnosed an acute massive gastric distention within gas into the gastric wall. Despite rapid instauration of conservative treatment, the patient finally underwent surgery. It is important to discard this infrequent pathology even in young and healthy people. An early diagnosis is crucial, a rapid instauration of conservative management may be effective and avoid surgery.

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