Aortoesophageal fistulas are life-threatening conditions of which over half are secondary to thoracic aortic aneurysms. Four cases related to perforation of a Barrett's ulcer have been described so far, accounting for less than 1% of published aortoesophageal fistulas. We report a fifth case, which presented with severe hypotension, anemia and hematemesis. The patient underwent emergency esophagectomy and aortic closure but postoperatively required aortic endoprosthesis for residual bleeding. This case highlights the great diagnostic and therapeutic challenge associated with perforated Barrett's ulcer.

Laparoscopic adjustable gastric banding is one of the most frequently performed bariatric procedures because of its low operative risk and morbidity. Postoperative chylothorax has never been reported following bariatric surgery. We present the case of a 41-year-old woman who developed a massive right chylothorax after a laparoscopic gastric banding, whose lymphogram showed thoracic duct disruption. Good outcome was achieved after thoracoscopy approach with duct ligation. Although rare, chylothorax is a severe complication, and surgeons must be aware of anatomic landmarks. Chyle leak could be under-diagnosed in postoperative uncomplicated pleural effusions.

1175150 min compared with 95 min for open surgery. The exact P value was 0.05 and in two earlier studies in open colonic surgery the median duration of surgery was In these two studies the IL-6 level was comparable to the level observed in the present study following open surgery. The explanation that laparoscopic colectomy causes more intraperitoneal trauma is speculative and not in agreement with other studies'. We have not observed any port-site metastases in the patients so far.We do not agree with the observations of Drs McCall and Parry. The principal aim of this small randomized study was to evaluate the differences in systemic and immune responses and convalescence between the two groups. To secure appropriate numbers of patients in both groups for evaluation of these issues we found it necessary to accrue new patients for evaluation throughout the study period. We agree that the three patients in the laparoscopic group who had to undergo conversion may be viewed as failures and this is acknowledged in the first part of the discussion.The mesenteric pedicle was divided with either vascular stapler, metallic clips or polyglactin suture in the laparoscopic group. We agree that the study is too small to allow conclusions concerning long-term survival. We have concluded therefore that the differences between the two methods are not marked and laparoscopic surgery may not be completed in all patients. Obviously larger randomized studies are necessary to clarify whether long-term survival is different between the two methods. 1 Kehet H, Nielsen HJ. Impact of laparoscopic surgery on stress responses, immunofunctions and risk of infectious complications. J Am Col Surg (in press). 2 Schulze S, Sommer P, Bigler D et al. Effect of combined Prednisolone, epidural analgesia, and Indomethacin on the systemic response after colonic surgery. Arch Surg 1992; 127: 3 Schulze S, Andersen J, Overgaard H et al. Effect of Prednisolone on the systemic response and wound healing after colonic surgery.