Biofragmentable anastomosis ring for laparoscopic bowel surgery

Laparoscopic Surgical Management of Perforative Peritonitis in Enteric Fever

Early surgery in enteric perforation is the only accepted form of treatment in modem day medicine and gives excellent results. Exploratory laparotomy continues to be the mainstay of surgical treatment and several different procedures are recommended in literature. Between January 1998 and November 2001, we have successfully managed 6 consecutive cases of enteric perforation laparoscopically with complete resolution of the disease. There were 4 males and 2 females in our study. The mean time of presentation to us was 38 hours after the perforation (range 22 hours to 63 hours). The mean age was 32 years (range 28 years to 43 years). All patients presented with free air under the diaphragm. A laparoscopic approach was carried out through a 10 mm supraumbilical port and two 5 mm additional ports in the midline infraumbilical area and the left iliac fossa area. Simple one layer closure of the perforation was carried out with 2-0 silk intracorporeally and the peritoneal cavity was washed out and adequately drained. All perforations were localised to the terminal ileum and were single in number. The mean operating time was 54 minutes-(range 42 to 75 minutes). All patients received parenteral ofloxacin and metrogyl. Postoperative recovery was uneventful in all patients and there were no major complications. All patients were discharged from hospital by the 4th postoperative day. Follow up over a period of 12 to 16 months revealed all patients to be in normal health. We strongly recommend a first line laparoscopic approach in all patients with typhoid perforation; as it is a safe and effective method of managing such cases.

Laparoscopic sigmoid resection: a comparative experimental study between double-stapling and foreign material free-biostent technique (TESA). Transient endoluminally stented anastomosis

In current clinical practice the "double-stapling technique" is the standard for reanastomosis following minimally invasive sigmoid resection. In the present study, we compared the TESA technique (transient endoluminally stented anastomosis) with conventional stapled anastomosis and evaluated the effect of remnant foreign material on follow-up examination with endosonography. Laparoscopic sigmoid resection was performed in 12 pigs (mean weight 63+/-5.9 kg). Animals were randomly divided into two groups: In Group A, reanastomosis was performed following a standard technique using a 29-mm circular stapler. In Group B, the TESA technique using a resorbable radiopaque stent of polyglycolic acid was applied. The anastomosis was examined by plain x-ray on days 1, 7, and 14, and by contrast enema on day 42, respectively. Endosonography, macroscopic inspection, and histological evaluation of the anastomosis were performed on day 42. All anastomoses in group A were patent. In one animal in Group B stent displacement with subsequent leak of the anastomosis was observed. Circumferential length of the anastomosis on day 42 did not differ between the groups (Group A: 8.00+/-0.45 cm vs. Group B: 7.8+/-2.0 cm, p = 0.82). The duration of the operation was 130+/-27 minutes in Group A and 100+/-18 minutes in Group B (p = 0.06). Weight gain was equal: Group A: 24+/-9.6 kg vs. Group B: 24+/-5.0 kg, p = 0.74. Endosonography on day 42 postoperatively in the area of the anastomosis in group A was impaired due to metallic staples. TESA is a competitive method for reanastomosis following laparoscopic sigmoid resection. In contrast to the conventional technique, the anastomosis is free of foreign material 1 month after the operation, which facilitates follow-up examinations with endosonography as well as other imaging diagnostics.

Laparoscopic colectomy for cancer: a review

BACKGROUND

The success of laparoscopic cholecystectomy in providing patient benefits in the immediate postoperative period has led to laparoscopic techniques being used for many other intra-abdominal procedures. Colorectal resection for malignancy is one of the more contentious applications of this new technology, because the postoperative benefits are more subtle and the long-term onco logical results are as yet unknown.

METHODS

A review of the English-language literature was undertaken in order to collate and analyse all published series where 20 or more laparoscopic colectomies were performed. and where the indication for resection in the majority of cases was adenocarcinoma of the colon.

RESULTS

Laparoscopic colectomy for cancer can be performed safely by experienced surgeons, although there is a considerable learning curve for the procedure. The expected benefits of minimal access surgery are provided by laparoscopic colectomy, although to a lesser extent than that seen with other procedures. The oncological safety of the procedure is as yet unproven. It is clear that an equivalent resection can be performed, but not whether this translates to an equivalent recurrence and survival rate. Reports of isolated port site recurrences are of concern.

CONCLUSIONS

Early results of laparoscopic colectomy for cancer are encouraging, although the fate of this procedure rests with the analysis of the large multicentre prospective randomized trials currently under way, particularly with regard to the long-term recurrence and survival rates.