Marcello Bezzi

Functional Evaluation at 1-Year Follow-Up of Laparoscopic Nissen-Rossetti Fundoplication

Laparoscopic Nissen fundoplication is currently the gold standard for surgical treatment of gastroesophageal reflux disease. The aim of this study was to present our experience with this procedure at 1 year of follow-up. Forty patients were operated on between January 2006 and July 2007, and 30 underwent a 24-hour postoperative pH-metry study. Ninety-two percent of the patients were asymptomatic at a follow-up of 12 months. All pH-metric parameters improved. DeMeester and Johnsons score was reduced from 44.7 to 7.75; endoscopy with histologic samples revealed the healing of esophagitis in all patients; 4 (13%) patients complained of dysphagia, which resolved within 1 month after surgery. Twenty-seven (90%) patients were completely satisfied by their surgical results. One year after surgery, 24-hour ph-metric results show that laparoscopic Nissen fundoplication can completely control acid reflux with relatively few complications and a high degree of patient satisfaction.

Simple method for stapled low colorectal or coloanal anastomosis

A technique of stapled low colorectal or coloanal anastomosis is described, which follows eversion through the anus and stapled closure of the anorectal or anal remnant. The procedure is rapid and safe, and allows a secure distal clearance under direct visual control when dealing with tumors of the lower third of the rectum.

A simple technique for sutureless very low colorectal anastomosis

An accurate distal purse-string suture can be difficult to place and close on the rectum when performing low anterior resection. The double stapling technique after closure of the rectal stump with linear stapler avoids these difficulties [1]. Nevertheless, in some cases with a narrow pelvis and a lower third rectal cancer, it is particularly difficult to insert the linear stapler without direct vision to assure a satisfactory distal margin below the level of the tumor. For these reasons we found it useful to perform the anastomosis after stapled closure of the everted anorectal stump [2]. Some limitations of the double stapling procedure have, however, been reported. The incidence of anastomotic leakage is no less than with other techniques, while the risk of stricture is higher [3]. There is now evidence that a sutureless anastomosis using a biofragrnentable ring can be performed in the large bowel more easily with more reliable healing than with other anastomotic techniques [4]. The BAR device has been used in anterior resection for cancer of the upper third of the rectum but so far no transanal insertion technique has been described. In patients requiring a low colorectal or coloanal anastomosis we have used the BAR with eversion of the anorectal stump after endorectal pull-through of the left colon.