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Ten patients presenting with hiatus hernia and gastro-oesophageal reflux underwent laparoscopic Nissen-Rossetti fundoplication. All patients had either medical treatment failure or invalidating reflux. At present, complete fundoplication is the most effective surgical treatment of gastro-oesophageal reflux. The laparoscopic procedure was rigorously identical with the habitually used "open" procedure, the only difference being the abdominal access. No laparotomy was necessary in our patients, and no major complication was observed. The follow-up showed good clinical results. Laparoscopy has been reported to decrease postoperative pain and ventilatory disorders. Morover, this minimally invasive surgical technique enables rapid resumption of social and professional activities.

The aim of this study was to prospectively study the complication rate of our 100 initial laparoscopic cholecystectomies. The ultimate goal was to obtain a morbidity rate comparable to open cholecystectomy. No major complications were noticed. The conversion rate to open cholecystectomy was 8%, slightly higher in comparison with the literature. Absence of major complications could be explained by: a) indications limited to symptomatic non complicated cholelithiasis; b) assistance at the beginning of our experience of gynecologists used to laparoscopic techniques; c) conversion to open cholecystectomy in case of technical difficulties. Application of these principles allows the digestive surgeon to start laparoscopic cholecystectomy without submitting the patient to additional risks.

Among upper abdominal computed tomography (CT) scans, 0.6 per 1000 fortuitously reveal an adrenal tumour, an "image pathology" now known as "adrenal incidentaloma". Should the clinician avoid useless, iatrogenic surgery or run the risk of failing to identify a malignant adrenocortical tumour? We outline a clinical procedure aimed at distinguishing between solid vs liquid, secreting vs non-secreting and primary vs metastatic tumour. Nevertheless, in the end the diagnosis may be uncertain, in which case tumour size becomes the deciding factor. For tumours of less than 3 cm close surveillance is advocated, whereas surgery is necessary for tumours larger than 3 cm; for tumours in between these sizes only the individual clinician can decide.

Photodynamic therapy is a useful new antitumoral treatment, since it is relatively selective and noniatrogenic. The photosensitizers become preferentially localized in the tumoral tissue, where their excitation by light causes the production of free cytotoxic radicals. If haematoporphyrin derivatives are the most widely used photosensitizers, numerous molecules are being tested. Now used as a palliative photodynamic therapy could logically be used as adjuvant treatment in curative surgical excision. The practical utility of peroperative photodynamic therapy in gastroenterological surgery is being evaluated experimentally and clinically.

Angiectasia of the right colon is a new entity which must be considered in cases of lower intestinal haemorrhage. Moore's classification is the one that is generally accepted today; it distinguishes between 3 types the most interesting and best individualized of which is type I. It consists of acquired lesions occurring after the age of 60, often multiple, localized in the right colon and frequently associated with aortic stenosis and atheroma. The diagnosis of these vascular malformations is usually delayed because the lesions are submucosal and not visible at endoscopy. Bimesaraic arteriography may show typical images where extravasation of contrast medium is associated with vascular tuft or "tuff". Even the anatomicopathological confirmation of the diagnosis is difficult, since the lesion can only be located by special techniques, such as intra-arterial injection of a silicone-containing substance. Owing to the failure of modern techniques such as embolization, the only possible treatment is surgical, based on resection of the colonic segment involved.

An objective review of the experimental and clinical literature comparing stapled- and hand-sutured anastomoses in gastrointestinal surgery is presented. Experimental studies support the hypothesis that stapled-sutured lines heal by primary intention, thus avoiding the inflammatory time lag, and resulting in a stronger wound during the first post-operative week. In contrast, manual sutures always produce an early inflammatory reaction with a transitory rise in collagenase activity in the submucosa, which explains the particular fragility of the anastomosis during that phase. Nevertheless, it was difficult to find a concordance between this histological quality of the stapled suture line and clinical results. In oesophageal surgery, a slightly higher rate of stenosis and a lower rate of anastomotic leakage were observed. In gastric and colorectal surgery, the superiority of the stapled suture was not proved. However, in colorectal randomized studies, the presence of "withdrawn" group for which the stapler was the only technically possible alternative, provides undeniable proof that this technique is an indispensable adjunct in modern digestive surgery. Conversely, its value seems negligible in surgery of the small bowel or of the intraperitoneal colon where manual suturing remains the technique of choice.