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Postoperative adhesions are the leading cause of small-bowel obstruction in developed countries. Several arguments suggest that laparoscopy may lead to fewer adhesions than does laparotomy. We report here the short-term results of laparoscopy in patients admitted on an emergency basis for acute small-bowel obstruction secondary to adhesions.This prospective trial included 134 consecutive patients: 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis shortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place within 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions: 7% after elective laparoscopy and 36% after emergency laparoscopy.There were no operative deaths. One patient underwent a reoperation the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparoscopy and 59% after emergency laparoscopy.Emergency situations in acute small-bowel obstruction combine several circumstances unfavorable for laparoscopy: a limited work area and a distended and fragile small bowel. Laparoscopic adhesiolysis after the crisis has passed may produce better results, but only long-term follow-up can confirm the role of elective laparoscopy for this indication.

Resume Le traitement chirurgical en plusieurs temps des traumatismes graves de l'abdomen est un concept recent. Il est utilise chez des patients en defaillance multiviscerale par choc hemorragique, coagulopathie et hypothermie. La prise en charge initiale lors d'une laparotomie breve a pour but de controler l'hemorragie, de prevenir une contamination digestive et de fermer l'abdomen sans tension. Apres une periode de reanimation variant de 24 a 96 heures, une reintervention planifiee permettra la recherche de lesions meconnues et la reconstruction anatomique dans des conditions plus favorables. La reprise chirurgicale en urgence pour hemorragie ou hyperpression abdominale greve fortement le pronostic vital.

A case of bilateral truncal vagotomy and antrectomy for pyloric stenosis is presented. Other procedures for laparoscopic treatment of peptic ulcer disease are discussed.

Background A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%–4% of cases. Objectives To report our experience, results, and long-term follow-up after pneumatic dilation of late functional helix stenosis after laparoscopic sleeve gastrectomy. Setting Multicenter study led by an endoscopic tertiary referral center. Methods Thirty-five patients were dilated initially at 30 mm. Thirteen out of 35 patients underwent a second dilation up to 35 mm. Only 8 patients underwent a third pneumatic dilation up to 40 mm. The stricture was localized in the mid-body of the sleeve in 32 patients overall; 3 had narrowing adjacent to the cardia. Eleven twists formed an acute angle between the 2 segments of the stomach, whereas 24 angles were obtuse. Seven out of 35 patients presented with persistent dilated pouch above the twist. Two patients were lost to follow-up. Overall outcome at an average follow-up of 15.5 months after primary surgery (range 7–49 mo) was as follows: 12 clinical failures and 1 technical failure (40%) and 60% (20 out of 33) clinical success. Conclusion Pneumatic dilation of late functional helix stricture is an effective technique for treatment of dysphagia in the majority of patients treated. Complete helix stricture, defined in function of the angle within twist, as well as the presence of a persistently dilated gastric pouch above the kinking, seems to be correlated with higher failure rates.