Background: Rats are widely used for basic research in laparoscopic surgery. We have developed a new technique of laparoscopic partial hepatectomy in the rat. Methods: 40 American Cancer Institute rats were randomized into 3 groups. Group A (n = 14) underwent laparoscopic liver resection using a CO₂ pneumoperitoneum. Group B (n = 14) was operated on with a gasless laparoscopic technique using a lifting device. A control group C (n = 12) underwent conventional open liver resection. In each group half of the animals underwent single lobectomy and the other half bilobectomy. Results: The liver resection was performed successfully in all 40 rats. No conversion to open surgery was necessary. No mortality or morbidity was observed. Conclusions: This new technique of laparoscopic partial hepatectomy proved to be feasible and safe. It is the first description of a laparoscopic hepatic resection in the rat that could prove valuable in further investigations of liver physiology and pathology.

Surgical treatment of diffuse peritonitis is applied very variably. There is no question that source control is the most important treatment principle, but the role of additional treatment concepts such as continuous postoperative peritoneal lavage remains controversial. In a prospective survey (1993)(1994)(1995)(1996) we analyzed the need for additional treatment concepts in our patient material. In 186 patients with diffuse peritonitis we applied the concept of source control and extensive (20-30 l) intraoperative lavage. Additional treatment principles such as continuous postoperative peritoneal lavage (n = 17) or staged lavage (n = 5) were applied only "on demand", namely in 20 patients (11 %). In 166 patients (89 %) source control of diffuse peritonitis was possible. The mean severity of peritonitis (n = 186) was 28.5 (range 16-43) using the Mannheim Peritonitis Index. The primary cause of peritonitis in our patients was perforation or leakage in the lower GI tract (52 %). The hospital mortality rate was 12 % in the whole group, and the postoperative morbidity rate was 34 %. We conclude that nowadays, using high-quality intensive care as well as modern antiinfective treatment, only a few patients (ca. 10 %) need additional therapy measures such as postoperative lavage. Surgical source control in combination with intraoperative lavage is sufficient in most of the patients with diffuse peritonitis.

Despite the fact that laparoscopic hernia repair was already described in 1979, its value has still not been well defined. The standard treatment for uncomplicated primary hernia repair in Europe is an open anterior approach (i.e. Shouldice), and ‘tension-free’ mesh plug repair in the USA. At present, posterior mesh insertion is used to repair so-called complicated hernias with a complete myopectineal defect, and recurrent and bilateral hernias. Laparoscopic hernia repair (transabdominally and extraperitoneally) mimics this posterior mesh insertion and is therefore mostly used for treating complicated hernias. Whether or not a transabdominal or extraperitoneal approach is used depends on the type and size of the hernia, the risk to the patient, previous abdominal operations and the surgeon’s experience. However, the extraperitoneal approach is now recommended because of its lower complication rate compared to the transabdominal approach. Compared to open surgical procedures the laparoscopic approach shows significant advantages in terms of less postoperative pain, decreased time off work and decreased overall costs. The disadvantages are increased operating time as well as difficulty in performing the procedure itself. A recent large randomized series has for the first time been able to demonstrate the advantages of the laparoscopic approach in a long-term follow-up. However, further studies are needed to define the exact place of laparoscopic hernia repair in the treatment of groin hernias.