[Results of laparoscopic treatment of morbid obesity: report of 27 cases]

BACKGROUND

Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach.

AIM

To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass.

METHODS

From May 2001 to July 2007, 27 patients were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 patients with gastric bypass. The primary endpoint was: excessive weight loss (EWL), BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion.

RESULTS

The mean age was 36 years. There were 4 males and 23 females. The mean preoperative weight was 122.4 kg (range: 87-152) and the mean body mass index (BMI) was 42,5 kg/m2 (range 36.5-52 kg/m2). The mean operating time was 129 minutes (range: 50-300). The mean hospital stay was 4.76 days (range: 3-8). There were no postoperative deaths. Early complication was present in 3 patients. Late complications were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%;

CONCLUSION

The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results.

Buschke Lowenstein tumor: unusual bilateral localization

BACKGROUND

The tumor of buschke lowenstein or giant condyloma acuminata is a pseudo-épitheliomatous profileration bilonging to verrucous carcinoma group due to their aggressive local evolution. A malignant change as micro invasive carcinoma or epidermoid kératinizing carcinoma well-differentiated was reported. Diagnosis and surgical treatment represents an efficient alternative at the moment that must be precocius and large due to the frequencies of local recurrences and malignant change.

AIM

We present in this stady an observation of an unusual localization of buschke Lowenstein tumor with review of literature.

CASE REPORT

50-year-old men presented with bilateral tumours in the battock area whose diagnosis of buschke Lowenstein tumour has been clinically suspected and confirmed by biopsy and histopathologic study. The cover has been achieved by VY fasciocutaneous flaps of the muscle gluteus maximus.

[Laparoscopic treatment of gastroesophageal reflux: report of 51 cases]

BACKGROUND

The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. BUT: The purpose of this retrospective study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature.

METHODS

We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance (persistence of symptoms of reflux on treatment), drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our outcome measures were mortality, morbidity, specifically, the conversion rate and functional outcome in the short and medium term.

RESULTS

These 24 men and 27 women of average age 38 years (range: 17-71 ans). All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels (Nissen) and 34 without section of short vessels (Nissen-Rossetti). The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients (7.8%). Mortality was nil. The specific complications were observed in 2 patients (4%), a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non-specific complications were dominated by pneumonia in 4 patients (7.8%). In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphagia, present in (77%) cases, was transient in 40 patients (62%) and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring.

CONCLUSION

the laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature.

[Gastro-epiploic lymphangioma. A case report]

The authors report a case of a gastro-epiploic lymphangioma in a 29-year-old male patient presenting with epigastric cramps. Physical examination was normal. Ultrasound and abdominal CT-scan showed a cystic mass under the left lobe of the liver containing fine septations and extending to the lesser sac. At surgery, a large cystic mass was found, situated around the celiac trunk. It was adherent to the lesser curvature of the stomach and posterior surface of the antrum and extended to the lesser sac. Excision of the mass and antrectomy were performed. Histologic examination was consistent with a diagnosis of cystic lymphangioma.