No abstract

This report describes a laparoscopic procedure for prosthetic repair of inguinal hernias using an extraperitoneal approach. A total of 51 primary direct and indirect hernias were repaired in this series, including 11 recurrent and 12 bilateral hernias. Operative time for this laparoscopic procedure was similar to that of the comparable open surgery and no unusual complications were noted. All patients were discharged the day following surgery and returned to work within 7 days.

ObjectiveA prospective, randomized trial was performed to determine which of two antireflux procedures, a complete wrap (Nissen) or a 200N wrap (Toupet), was more effective with fewer sequelae. Summary Background DataLaparoscopic procedures for gastroesophageal reflux disease appear to be as effective as those done by open laparotomy. The Nissen fundoplication is used most frequently, but postoperative bloating, inability to belch, and dysphagia occur. The partial wrap has been said to be as effective with less unfavorable postoperative symptoms. MethodsPatients with reflux esophagitis were approached laparoscopically using a six-port technique. After division of the short gastric vessels and dissection of the terminal esophagus and fundus of the stomach to allow performance of either procedure, patients randomly were assigned one of the procedures by a card drawn in the operating room. ResultsForty patients underwent operation, but 1 was excluded when an open procedure became necessary. Twenty-three patients received a complete wrap and 16 received a partial wrap. The average operating time was 155 minutes for the Nissen procedures and 162 minutes for the Toupet procedures. The postoperative stay averaged 2.7 days for the Nissen procedures and 2.5 days for the Toupet procedures. There were no deaths. Including the patient converted to an open procedure, three patients had operative complications. At follow-up, Visick scores after the complete wraps were 1-13, 11-8, 111-2 and after the partial wrap were 1-12 and 11-3. Two patients indicated they would not have the operation again. ConclusionsA partial or a complete wrap after division of the short gastric vessel offers effective therapy for reflux esophagitis with >90% patient satisfaction. The authors' study shows no clear advantage of one wrap (partial or complete) over the other. 647

Morbidly obese patients experience more intense GI symptoms than control subjects, and many of these symptoms return to control levels 6 months after LRYGBP. Dysphagia is equivalent to control subjects preoperatively but increases significantly after LRYGBP. This data suggests another quality-of-life improvement (relief of GI symptoms) for morbidly obese patients. Further follow-up is needed to document the long-term reduction of GI symptoms.

A prospective randomized clinical trial was undertaken to compare the effects of gastric bypass with Roux-en-Y gastrojejunostomy and a gastric partitioning procedure. Operative groups were comparable, with regard to preoperative weight, age, sex, historic findings and operative complications. Post-operative weight loss was followed for one year. Patients receiving the gastric partitioning procedure showed significantly poorer weight loss as early as three months postoperatively than did those receiving gastric bypass. This poorer performance persisted throughout the study period.