Acute colonic pseudo-obstruction in vascular patients (Ogilvie syndrome).

Two patients with acute colonic pseudo-obstruction are presented. Acute colonic pseudo-obstruction, first described by Ogilvie in 1948, is characterised by signs of colonic obstruction, but without mechanical obstruction to the intestinal flow. The current hypothesis states that it is caused by an imbalance between sacral parasympathetic excitatory nerves and sympathetic inhibitory nerves, thus inducing functional obstruction.

The prognosis of patients operated on for gastric cancer in relation to the percentage of lymph nodes invaded by tumour.

Introduction: In evaluating the type of gastrectomy and lymphadenectomy for gastric cancer, adequate prognosis has been dependant on the retrieval of at least 15 lymph nodes. We propose an alternative method in which the prognostic value is evaluated, according to whether or not more than 20% of the retrieved lymph nodes are invaded by tumour.

Materials & Methods: Sixty-five patients (36 men, 29 women) with a median age of 69 years (mean age 68.

Laparoscopic treatment of Boerhaave's syndrome: a case report and review of the literature.

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate.

Surgical anatomy of the inguinal region: implications during inguinal laparoscopic herniorrhaphy.

Introduction: In laparoscopic inguinal hernia repair the inguinal region is approached and hernia repair performed from the interior side instead of the classical open external access. Exploration and placement of staplers in the internal inguinal region during laparoscopic hernia repair may sever different anatomical structures, or induce specific complications such as nerve entrapment, neuralgia, hematomas or osteitis. The incidence of these complications may be reduced by careful dissection of the preperitoneal tissues and by placing a prosthetic mesh without the use of stapling.

Videothoracoscopic resection of intrathoracic neurogenic tumors: report of two cases.

Two cases of intrathoracic neurogenic tumors are discussed. The benign neoplasms were located in the posterior mediastinum and caused no clinical symptoms. In both cases, complete resection of the lesion was achieved by video-assisted thoracic surgery (VATS).

Use of anti-emetics after intragastric balloon placement: experience with three different drug treatments.

Background: Tropisetron treatment was compared with alizapride treatment. The secondary aim was to assess whether droperidol supplement would still improve the therapeutic outcome of tropisetron.

Materials And Methods: A series of 51 obese patients was treated with an intragastric balloon to obtain weight reduction.

Enterogastric intussusception: a rare postoperative complication.

The authors present a case of postoperative enterogastric intussusception after previous Billroth II-gastrectomy, associated with a Braun's W-anastomosis of the efferent small bowel loop. Loss of viability of the incarcerated jejunal loop required segmental small bowel resection. Total recovery was obtained.

Contraceptive treatment after biliopancreatic diversion needs consensus.

Background: An important population of patients who undergo biliopancreatic diversion (BPD) are fertile women. A consensus is needed with regard to contraceptive therapy after BPD by evaluating the risks of pregnancy, the safety of oral contraception and the changes in fertility after this bariatric surgery.

Method: From May 1997 until May 1998, 40 women who underwent a BPD were included in a prospective study evaluating the hormone status preoperatively and postoperatively after 2 and 7 days, 3 and 6 months and 1 year.

Giant diverticulum of the colon: report of two new cases and review of the literature.

Diverticulosis coli affects more than one in three individuals older than 65 in the Western world. Giant diverticulum of the colon is an extremely rare complication of diverticular disease; only 113 cases, mostly situated in the colon sigmoideum, have been reported in the world literature. Two new cases of giant diverticulum of the colon sigmoideum, with totally different clinical presentation, diagnosis, and management, are reported-one being the cause of chronic anemia and the other presenting as an acute abdomen.

A technique for prevention of port complications after laparoscopic adjustable silicone gastric banding.

Background: Laparoscopic adjustable gastric banding is a safe and effective treatment method for morbid obesity. Injection port dislocation, tube perforation and access port infection are generally classified among the minor complications, although they can require a reoperation at the port-site or even at the level of the band which may have to be removed. We designed a technique to fix the port, that can avoid unnecessary complications.

Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin.

Background: Postoperative thromboembolic disease has been suggested to occur with higher frequency during laparoscopic cholecystectomy than during other laparoscopic procedures or conventional cholecystectomy. The aim of this prospective study was to evaluate the occurrence of deep vein thrombosis (DVT) in laparoscopic cholecystectomy patients, whether they were treated with low-molecular-weight heparins or not.

Methods: All 238 laparoscopic cholecystectomy patients included in the study underwent pre- and postoperative venous duplex scanning of both legs.

Blind loop syndrome after biliopancreatic diversion: a diagnostic challenge.

Background: Biliopancreatic diversion (BPD) according to Scopinaro's method is a safe and effective technique for treatment of morbid obesity. In this operation a side-to-side enteroenterostomy is created 60 cm proximal to the ileocecal valve. Malabsorption of fat and starch is one of the main goals of the BPD.

Weight reduction by means of intragastric device: experience with the bioenterics intragastric balloon.

Background: A new intragastric balloon is available for weight reduction.

Methods: Patients consulting for a weight reduction plan and refusing any kind of actual surgery, or suffering from obesity but not meeting the IFSO standards for surgery, were offered the possibility of weight reduction by the BioEnterics intragastric balloon (BIB). A preoperative questionnaire was completed by all patients, inquiring about medical history, co-morbidity factors, dietary habits, previous treatments for weight and social, psychological, relational and economic impact of the obesity.

Abdominal stab wounds: a five-year patient review.

Over a period of 5 years, 101 patients were treated for abdominal stab wounds at our emergency department. Exploratory laparotomy was performed in 41 of these cases. The indication for laparotomy was set by clinical investigation in 20 cases, instrumental exploration in six patients, ultrasound in six, paracentesis in seven and computerized tomography scanning in two cases.

Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations.

Objective: To compare the outcome of emergency and elective haemorrhoidectomy.

Design: Retrospective study.

Setting: Teaching hospital, Belgium.

Isolated colonic injury following blunt abdominal trauma.

A case of delayed diagnosis of colonic injury after blunt abdominal trauma leading to faecal peritonitis is presented. Diagnostic problems and possibilities as well as treatment of these injuries are reviewed. The key to diagnosis remains the serial clinical and ultrasound examinations.

A safe and simple method for routine open access in laparoscopic procedures.

Background: Access to the peritoneal cavity in laparoscopic procedures is generally achieved by means of a pneumoperitoneum, following introduction of a Veress needle. Because this procedure must be done blindly, it is not without visceral or vascular hazards. Therefore, we sought an alternative technique that might obviate these complications.

Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases.

Background: Biliopancreatic diversion (BPD) by Scopinaro's method is used by many as a surgical treatment for morbid obesity. The authors present their results in 180 consecutive cases.

Method: Between June 1995 and May 1998, the authors performed BPD by Scopinaro's method on 180 patients (36 men) with morbid obesity, mean age 35.

Laparoscopic transperitoneal versus extraperitoneal inguinal hernia repair: a prospective clinical trial.

A prospective series of 106 inguinal hernias in 91 patients is studied, comparing two methods of laparoscopic hernia repair: a transperitoneal technique with preperitoneal stapled mesh fixation (TransAbdominal PrePeritoneal or TAPP-technique) performed in 33 patients, and a totally extraperitoneal placement of non stapled mesh (Totally ExtraPeritoneal Approach or TEPA-technique) performed in 58 patients. Conversions to open repair were equally frequent (5% vs. 7% respectively) and were due to adhesions, haemorrhage, irreducible intestinal loop in the hernial sac or important subcutaneous emphysema.