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The laparoscopic adjustable gastric band (LAGB) has become a common, usually successful treatment for morbid obesity. Complications occur in 10-20%, most commonly band slippage and port system problems, especially infection of the port area. A rare complication is penetration of the band into the stomach. We report the penetration of the tube connecting the port system with the gastric band, into the colon 1 year after treatment of a port infection.

A 48-year-old woman presented with bloody diarrhea, exsiccosis, abdominal pain and fever. A CT-scan showed air inclusions and thickening of the colonic wall. Laparotomy revealed partial necrosis of the colonic wall from the cecum to the rectosigmoid junction. After colectomy with ileorectostomy recovery was uneventful. The histological examination showed erosions, ulcerations, necrosis and some abscesses along the colonic wall which were not typical for ulcerative colitis or Crohn's disease. The patient reported medication with diclofenac for rheumatoid arthritis. The most probable diagnosis was NSAID-induced colitis. That NSAID may cause colitis has often been described in literature, but there have been only few records on nearly total colon necrosis.

Aim: To determine whether a thoracoscopic lobectomy used for treatment of primary non-small cell lung cancer shows a higher or lower morbidity in comparison to the conventional resection (thoracotomy) postoperatively., Methodology: 42 patients with the presumption diagnosis of a lung cancer received a thoracoscopic lobectomy (n=28) or a conventional lobectomy (n=14). Postoperative complication rate (30 days) was analysed prospectively. There were no differences between the groups referring to age, co-morbidity, localisation of the tumor and stage., Results: Patients with a conventional operation revealed a significant higher morbidity in comparison to the patients of the thoracoscopic group (50 % vs. 14.2 %, p=0.03)., Conclusion: The thoracoscopic lobectomy represents a safe operation method and an alternative to the conventional operation (thoracotomy).

Background: Newly developed meshes with low weight and large pores such as Vypro (Ethicon, Norderstedt) were exactly adapted to the physiology of the human abdominal wall and proved to reduce chronic inflammatory processes. It was hypothesized that the reduced inflammatory response to a Vypro mesh would lead to reduced adhesion formation following intraperitoneal implantation in comparison with a Prolene mesh (Ethicon)., Materials and Methods: To test this hypothesis, 20 25-kg pigs underwent resection of a 10 x 10-cm section of the full-thickness anterior abdominal wall, excluding subcutaneous and cutaneous surface. The fascial defect was repaired using a 20 x 20-cm piece of either Vypro or Prolene mesh, which was sutured in inlay position with 4-0 Prolene single sutures at the edges. The main endpoint was the presence and degree of intra-abdominal adhesions to the mesh after 3 months. The amount of adhesions was calculated as a percentage of the mesh square and classified into four grades., Results: There were no significant differences in the amount and grade of adhesions between the groups. Adhesions were less intensive in the Vypro group, but this difference was not significant. Dense adhesions between the liver and the mesh and small-bowel obstruction were observed only in the Prolene group., Conclusions: From the results of this study, Prolene and Vypro meshes cannot be recommended for intraperitoneal placement in hernia surgery because of their adhesion potential and risk of bowel obstruction.

The optimal reconstruction protocol after total gastrectomy is still a matter of debate. Pouch reconstructions are developed to create a larger reservoir for food, to provide a barrier against intestinoesophageal reflux, and to lengthen the food transit time. Preservation of the duodenal passage should result in better physiologic regulation of the ingested food. Controlled randomized clinical studies must be conducted to assess the quality of life after gastrectomy and various types of reconstruction. In the present trial, which compared Longmire's reconstruction without a pouch and Longmire's reconstruction with a pouch of varying sizes, we evaluated the quality of life for 41 patients during the first postoperative year. The quality of life was examined by an EORTC questionnaire and an organ-specific module. There were no statistically proven benefits for pouch reconstruction in comparison with Longmire's reconstruction alone. Some benefits are shown for the large pouch but it was only a trend. This is especially so with regard to diarrhea and food consumption. A definitive answer to the question about the value of a pouch reconstruction after gastrectomy has not yet been attained. It is possible that there will be significant differences between reconstruction groups during the long-term follow-up.

Background: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications. The experience with this new kind of band is reported., Methods: Between April 1998 and August 1998, 15 morbidly obese patients were treated by laparoscopic adjustable gastric banding using a new band type (manufactured by MEDING, Heinsberg, Germany). The band was fixed by single sutures using the eyes at each side of the buckle. There were 13 women and 2 men, with mean age 34 (range 21-54) years and mean body-weight 138.6 (range 113-213) kg., Results: Intraoperative complications did not occur. Postoperatively 8 patients (53%) had increasing capacity for food intake and 2 (13%) had uncharacteristic abdominal pain. Radiographs revealed band rupture in 13 of 15 patients 3-11 months postoperatively. These patients were operated laparoscopically using a new technique for band change. Now, a Lap-band (BioEnterics, Carpinteria, CA, USA) was inserted and fixed to the ventral stomach with three sutures similar to a ventral fundoplication. Radiographic and clinical follow-up have been uneventful in all patients until now., Conclusion: This series demonstrated: 1) the importance of clinical follow-up; 2) a material defect of a new band type; and 3) development of a new laparoscopic technique for band change.

Although the use of laparoscopic techniques in gastric surgery had become a focus in upper gastrointestinal surgery, standardized procedures have not yet been developed. The purpose of the study was to develop a standardized technique for laparoscopic Billroth-II resection in a cadaver model. End points were intraoperative complications and patency of the gastro jejunostomy. Laparoscopic partial stomach resection was performed in seven cadavers. The specimen was removed through an enlarged trocar incision. The first part of the jejunum was temporarily taken out through the same incision and a side-to-side jejuno-jejunostomy created. The gastrojejunostomy was stapled intracorporally. After surgery, all cadavers underwent autopsy. No lesions of intraabdominal organs were found, and the gastrojejunostomy was patent with correct stapling. No major intraoperative complications were recorded. Using the described technique, a laparoscopic Billroth-II operation can safely be accomplished. The technique has been successfully performed in three patients in the last month.

Although laparoscopic techniques in gastric surgery have become an important part of upper gastrointestinal surgery, they are mainly utilized for organ preserving procedures. A standardized technique for laparoscopic gastrectomy has not yet been described in detail. The purpose of this study was to develop a standardized technique for laparoscopic gastrectomy with reconstruction by a stapled termino-lateral esophago-je-junostomy and Roux-en-Y-anastomosis in a cadaver model. The resected stomach was removed through an enlarged trocar incision. The described technique has been successfully performed in one patient with early gastric cancer.

A total of 701 patients operated on with the suspected diagnosis of acute appendicitis were included in a prospective study. Three hundred and nine patients were treated conventionally and 387 laparoscopically. In 14 patients the operation had to be converted. Operating time was 44 min in the laparoscopic group and 54 min in the conventional group. The advantages of the laparoscopic technique were better visualisation of the abdominal cavity, fewer complications, shorter hospital stay and better cosmetic result. Complications occurred in 2.9% of the patients in the laparoscopic group and in 13.6% of the patients in the conventional group. All complications following laparoscopic procedures could be treated laparoscopically.

We report the case of a 54-year-old patient with up-side-down-stomach with recurrent gastric bleeding. Reposition of the stomach, closure of the diaphragmatic opening with interrupted silk sutures, fundophrenicopexy and corpopexy to the anterior abdominal wall was done laparoscopically. Because the patient presented no reflux symptoms, but hypomotility of the oesophagus, no fundoplication was done. To prevent recurrence of the hernia a polypropylene mesh was fixed over the hiatus.

In the period October 1993-February 1994, we performed three distal stomach resection operations laparoscopically (two Billroth-II anastomoses, one Billroth-I anastomosis combined with truncal vagotomy). The first patient, 83-year old, presented a stenosing, bleeding, prepyloric, malignant Non-Hodgkin lymphoma. The second patient, 84-year old, presented an ulcerated, non-malignant leiomyoblastoma of the antrum. Due to the histological type of the tumors a radical lymphadenectomy was not performed. The partially resected stomach (two thirds) was removed in a lap sac through a 3.5 cm infraumbilical incision. The third patient presented a persisting, prepyloric ulcer combined with an almost complete stenosis of the pylorus. In all three cases, it was possible to follow the principles of conventional open surgery. The anastomoses were all stapled intracorporally, no intraabdominal complications occurred. However, the first patient died on the 21st postoperative day from cardiopulmonary failure, the remaining two patients were discharged on day 11/day 12 postoperatively.

This study provides the data and experience of 200 laparoscopic cholecystectomies. The stenosis of the bile duct caused by a ligature in one patient and aberration of the bile duct in two patients led to remarkable intraoperative complications. The average operation time as well as postoperative recovery periods emphasize the importance of laparoscopic cholecystectomy as a relevant alternative to the traditional approach.

It seems likely, in view of the large number of caesarean operations that are now being carried out and that too have complications, that the mechanism of obstetric procedures will sooner or later become of interest again to obstetricians. This study looks at a consecutive series of cases where dystocia in the upper part of the pelvis occurred and tries by analysing different obstetrical parameters to work out the best time for carrying out different obstetrical manoeuvres. It is possible to come to two conclusions, so long as both the mother and the fetus are watched carefully during the labour: the trial of delivery of the fetal head using the obstetric ventouse will bring about a significant reduction in the numbers of caesarean operations. it is always rewarding to be patient and it does not seem sensible to intervene too quickly. Two important results come from this approach: mechanical dystocia has practically disappeared, as it now only occurs in about 1% of labours. on the other hand, particularly in primiparous women, dystocia in the upper straight of the pelvis is quite common.