Is laparoscopic left pancreatic resection justified?

BACKGROUND

We reviewed our experience of laparoscopic left pancreatectomy to establish the feasibility of this approach and the characteristics of the operating procedure.

METHODS

Thirteen patients with a mean age of 60 years were deemed for a left pancreatectomy. Preoperative diagnoses were: nine mucinous cystadenoma and one insulinoma, intraductal mucinous ectasia, chronic pancreatitis with ductal stenosis, and distal pancreatic tumor.

RESULTS

Operative mortality was nil. Two patients required conversion for bleeding from splenic vein injuries leading to a splenectomy in one case. The spleen was preserved in 10 cases. Postoperative course was uneventful in nine cases. Four patients experienced postoperative complications: one pancreatic fistula, two liquid cysts on the pancreatic margin, and one reoperation for bleeding from a trocar port. Length of stay ranged from 5 to 22 days.

CONCLUSION

These preliminary results confirm that in selected cases laparoscopic resection of the left pancreas is feasible and safe.

[Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases]

OBJECTIVE

The aim of this prospective study was to assess the feasibility and postoperative advantages of the laparoscopic-assisted elective colectomy for diverticular disease.

PATIENTS AND METHODS

From january 1989 to december 1997, among the 114 patients electively operated on for diverticulitis, 56 patients were treated by laparoscopic approach. Evaluated parameters included: gender, age, weight, size, ASA score, operating time, duration of hospital stay, of analgesic treatment, and of postoperative ileus, morbidity and mortality rate.

RESULTS

The study group consisted of 35 women and 21 men. Mean age was 59 years (34-81 years); 29 patients were ASA 1 and 27 ASA 2. Overall postoperative mortality rate was 0% and morbidity rate 16% (n = 9). There were no complications directly related to laparoscopic technique. The conversion rate was 14% (n = 8). Mean operating time was 300 min (200-600 min). Mean duration of postoperative ileus was 2.4 days. Mean duration of hospital stay was 9.4 days.

CONCLUSION

This study demonstrates the feasibility of elective laparoscopic-assisted colonic resection for diverticular disease in more than 80% of cases with a postoperative morbidity and mortality rate comparable to those of conventional surgery.

Localization of β (1-3) glucan in walls of the endomycorrhizal fungi Glomus mosseae (Nicol. & Gerd.) Gerd. & Trappe and Acaulospora laevis Gerd. & Trappe during colonization of host roots

Previous studies showed that cell walls of endomycorrhizal fungi belonging to the Acaulosporaceae and Glomaceae contain β (1-3) glucan polymers as well as chitin. Indirect immunolabelling with monoclonal and polyclonal antibodies has been used to investigate the distribution of these structural polysaccharides in cell walls of Glomus mosseae (Nicol. & Gerd.) Gerd. & Trappe and Acaulospora laevis Gerd. & Trappe as they interact with pea and tobacco roots, respectively. The (l-3) glucans were detected in the walls of external hyphae, and of hyphal coils and intercellular hyphae developing in outer root tissues. The glucan component was alkali-insoluble but treatment with chitinase resulted in solubilization of most of the β(1-3) glucans from the fungal wall. A decrease in immunolabelling was associated with thinning out of the hyphal wall as the fungi colonized deeper in the host root, and β(1-3) glucans could not be detected in walls of intercellular hyphae or arbuscules in the parenchyma cortical tissue. The molecular configuration of cell walls of G. mosseae and A. laevis is discussed in relation to fungal morphogenesis and the symbiotic state in endomycorrhiza.