Lumbar disc herniation (LDH) is a common disease characterized by leg pain, numbness, and low back pain, which are also encountered in peripheral nerve and paralumbar spine disease. This study describes other diseases with symptoms similar to LDH. Patients with paralumbar spine diseases such as superior cluneal nerve entrapment neuropathy (NEN), gluteus medius muscle pain, piriformis syndrome, and sacroiliac joint pain experience lowback, buttock, and leg pain. Peripheral nerve diseases of the leg including lateral femoral cutaneous NEN, common and superficial peroneal NEN, and tarsal tunnel syndrome also cause leg symptoms. These diseases can produce intermittent claudication, thought to be specific to lumbar spine disease, and can be misdiagnosed as LDH. They are rather common and can be treated less invasively. As a misdiagnosis may result in failed back-surgery syndrome, it is important to differentiate between LDH and the diseases described here.

Experienced surgeons have reported excellent results for laparoscopic Nissen fundoplication to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up. This review focuses on the proper preoperative workup, patient selection, surgical technique, and follow-up for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD and the esophageal physiology is essential. An extensive dissection of the esophagus and crus in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication are important technical points. New onset or persistent symptoms after the operation must be carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup, patient selection, surgical technique and follow-up are rigorously observed.

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

Methods: This prospective study was conducted on 12 children with persistent complete rectal prolapse who failed to respond to adequate conservative measures from July 2015 to July 2016. The technical details of the procedure are described. Patients were followed up for at least 6 months and were assessed clinically and radiologically for continence and constipation using the appropriate scoring systems.

Results: Twelve patients were included, 8 females and 4 males, laparoscopic rectopexy and sigmoidopexy were done for all cases. The mean duration for surgery was 58.42 min. No intraoperative complications recorded. One case (8.3%) had partial thickness recurrence and 1 case had skin stitch sinus. No postoperative constipation nor incontinence was observed.

Conclusion: The laparoscopic rectopexy and sigmoidopexy is an effective approach for the treatment of refractory complete rectal prolapse in children. The 3-point fixation proved efficient in controlling rectal prolapse in children with minimal complications.

Aim: Full-endoscopic posterior cervical foraminotomy (FPCF) has been utilized to treat cervical lateral disc herniation and provided good surgical outcomes. The authors examined the superiority of FPCF in patients with spondylotic foraminal stenosis.

Methods: Fifty-nine cases of FPCF were evaluated. Of the 59 patients, 34 had lateral disc herniation (group H) and 25 had spondylotic foraminal stenosis (group S). Operative time, complications, length of hospital stay, visual analog pain scale scores of neck and arm pain, and the amount of facet joint resection were compared between the groups.

Results: The mean operative times were 96 min (group H) and 100 min (group S). The lengths of hospital stay were 3.0 days and 3.9 days, respectively. No significant differences were observed in pre-operative neck and arm pain between the groups. Average neck pain at the final follow-up was significantly less severe in group H (2.9) than in group S (12). However, postoperative arm pain was the same after surgery in both groups (14). In both groups, 52% of the facet joint was resected.

Conclusion: The surgical outcome of FPCF in patients with spondylotic foraminal stenosis is equivalent to that in patients with lateral disc herniation.

Aim: To evaluate the application of laminectomy using the interlaminar approach (ILA) for percutaneous endoscopic lumbar discectomy (PELD).

Methods: Minimal laminectomy using the ILA for PELD was performed in 13 patients with lumbar disc herniation (LDH). The width of the interlaminar space, shape of the caudal margin of the upper vertebral laminae (CM-UVL), LDH size, and caudal migration grade were radiologically evaluated. Ten LDHs were removed via the shoulder of the corresponding nerve root, and three via the axilla of the corresponding nerve root and dural sac. Bone status was evaluated preoperatively and postoperatively using two- and three-dimensional computed tomography.

Results: All patients (mean age 46.3 years) underwent PELD at a single spinal level, mostly at L5/S1. Compared with a previous study without laminectomy, the mean operative duration (57.5 min) and operative outcome, evaluated using the modified Japanese Orthopaedic Association and Numerical Rating Scale scores, were similar; no complications were observed. However, the width of the interlaminar space was significantly narrower, and eight cases revealeda narrow interlaminar space (width < 20 mm and/or lost concave shape of CM-UVL).

Conclusion: Minimal laminectomy using the ILA for PELD is feasible for treating LDH with the narrow space and highly migrated LDH.

Percutaneous renal access remains the cornerstone initial step in varied clinical settings. For obtaining the best surgical outcome and minimizing patient morbidity, an appropriate access to the target calyx is needed. Though the site of entry depends upon anatomy of pelvicalyceal system and indication for access, a proper technique should be used for gaining access and at the same time minimizing the associated complications. This article describes our technique of gaining access to the pelvicalyceal system and subsequent percutaneous nephrostomy placement in a stepwise manner.

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

Methods: This prospective study was conducted on 12 children with persistent complete rectal prolapse who failed to respond to adequate conservative measures from July 2015 to July 2016. The technical details of the procedure are described. Patients were followed up for at least 6 months and were assessed clinically and radiologically for continence and constipation using the appropriate scoring systems.

Results: Twelve patients were included, 8 females and 4 males, laparoscopic rectopexy and sigmoidopexy were done for all cases. The mean duration for surgery was 58.42 min. No intraoperative complications recorded. One case (8.3%) had partial thickness recurrence and 1 case had skin stitch sinus. No postoperative constipation nor incontinence was observed.

Conclusion: The laparoscopic rectopexy and sigmoidopexy is an effective approach for the treatment of refractory complete rectal prolapse in children. The 3-point fixation proved efficient in controlling rectal prolapse in children with minimal complications.

Experienced surgeons have reported excellent results for laparoscopic Nissen fundoplication to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up. This review focuses on the proper preoperative workup, patient selection, surgical technique, and follow-up for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD and the esophageal physiology is essential. An extensive dissection of the esophagus and crus in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication are important technical points. New onset or persistent symptoms after the operation must be carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup, patient selection, surgical technique and follow-up are rigorously observed.

Aim: Mesh is commonly utilized in the laparoscopic repair of sports hernias. A hybrid mesh was recently released containing a single light weight layer of macroporous, polypropylene mesh between layers of biologic mesh. Having an extensive experience with laparoscopic and sports hernia repairs, a small sample of hybrid mesh was trialed.

Methods: From April 2015 to August 2016, 16 male patients with sports hernias were consented for hybrid mesh repair. A prospective data base was developed and patients were followed at 1 week, 4 weeks and 4 months after surgery.

Results: Ages ranged from 18 years to 43 years (average 22.9 years). Operative times ranged from 25 min to 75 min (average 42.5 min). All were athletes playing basketball, soccer, baseball, football and track. There were no operative problems. Two patients developed post-operative seromas requiring radiologic drainage. All patients completed a post-operative therapy program and all have returned to their sport without problems.

Conclusion: There is not one type of mesh repair that has been proven to be the most effective treatment for sports hernias. Continued follow up as well as a more structured study will be necessary to prove if hybrid mesh has long term effectiveness for the laparoscopic treatment of sports hernias. The initial study has promising findings.

Lumbar disc herniation (LDH) is a common disease characterized by leg pain, numbness, and low back pain, which are also encountered in peripheral nerve and paralumbar spine disease. This study describes other diseases with symptoms similar to LDH. Patients with paralumbar spine diseases such as superior cluneal nerve entrapment neuropathy (NEN), gluteus medius muscle pain, piriformis syndrome, and sacroiliac joint pain experience lowback, buttock, and leg pain. Peripheral nerve diseases of the leg including lateral femoral cutaneous NEN, common and superficial peroneal NEN, and tarsal tunnel syndrome also cause leg symptoms. These diseases can produce intermittent claudication, thought to be specific to lumbar spine disease, and can be misdiagnosed as LDH. They are rather common and can be treated less invasively. As a misdiagnosis may result in failed back-surgery syndrome, it is important to differentiate between LDH and the diseases described here.

Anisakiasis is increasing worldwide, even in Europe and in the Mediterranean region due to the increased practice of raw fish consumption. Usually, a detailed food history is the key to the diagnosis. A 52-year-old woman affected by pathological obesity underwent esophagogastroduodenoscopy (EGD) for a 1-year history of epigastric pain. In the gastric fundus, an Anisakis sp. larva, was casually detected. The nematode was successfully removed with a biopsy forceps. In this case, the finding of the parasite was casual, being detected during an accurate EGD performed for a 1-year history of epigastric pain in the patient.

Aim: Traditional methods of cervical dilatation such as Hegar rods and laminaria are associated with the damage leading to the risk of cervical incompetence or require two sessions with higher risk of infections. In this study, a new dilator based on expanding triple balloons is assessed.

Methods: Cervical dilation with the triple balloon was evaluated in 15 women with various indications. After measuring the diameter of the cervix the triple balloon was inserted and inflated for 5-7 min and thereafter measured again.

Results: This time was sufficient to achieve the diameter of 4.5-9.5 mm which allowed performing all planned procedures without any need for further dilatation except for one case with cervical stenosis.

Conclusion: Further studies are needed, but the triple dilating balloon might become the optimal dilatation method for universal use.

Aim: Full-endoscopic posterior cervical foraminotomy (FPCF) has been utilized to treat cervical lateral disc herniation and provided good surgical outcomes. The authors examined the superiority of FPCF in patients with spondylotic foraminal stenosis.

Methods: Fifty-nine cases of FPCF were evaluated. Of the 59 patients, 34 had lateral disc herniation (group H) and 25 had spondylotic foraminal stenosis (group S). Operative time, complications, length of hospital stay, visual analog pain scale scores of neck and arm pain, and the amount of facet joint resection were compared between the groups.

Results: The mean operative times were 96 min (group H) and 100 min (group S). The lengths of hospital stay were 3.0 days and 3.9 days, respectively. No significant differences were observed in pre-operative neck and arm pain between the groups. Average neck pain at the final follow-up was significantly less severe in group H (2.9) than in group S (12). However, postoperative arm pain was the same after surgery in both groups (14). In both groups, 52% of the facet joint was resected.

Conclusion: The surgical outcome of FPCF in patients with spondylotic foraminal stenosis is equivalent to that in patients with lateral disc herniation.

Aim: Current financial and work hour constraints make proctored on-site laparoscopic simulation training challenging. An independent learning approach utilizing proficiency-based training is a potential solution. The purpose of this study was to determine if an independent approach using a portable, laparoscopic training device within one’s home environment could effectively train novices in laparoscopic procedural skills.

Methods: After baseline testing, laparoscopic novices (n = 16) were randomized to one of two study groups. The on-site group (n = 7) received unlimited access to the workplace laparoscopic trainers and the home group (n = 9) received portable laparoscopic trainers for home. Both groups underwent self-directed, proficiency-based training for three months then were retested. Results were compared with parametric and non-parametric statistical tests.

Results: Baseline characteristics were similar between groups. The practice rate (56%) and practice time (range, 0.18 to 2.6 h) were poor in both groups during the training period. At post-test, the number of participants who demonstrated an improvement (86% on-site, 78% home) on the peg task was not different between groups. The successful completion of the suturing task post-test had significantly improved compared with pre-test in both groups (71% vs. 29% on-site; 44% vs. 22% home, P < 0.001). Although the majority of participants reported it was difficult to practice on a regular basis (86% on-site, 89% home), 56% of the home group participants agreed that the at-home trainer was a helpful teaching modality.

Conclusion: Learning of laparoscopic skills by novice trainees can be augmented by an independent learning approach using either home or on-site laparoscopic trainers. Although over half the candidates found it was useful to have the training device at home, none of the participants practiced more than an hour or two in the three month training period. Thus, the solution to conducting training does not lie in merely providing home training, but rather to understand the work-related stressors and reconfigure jobs.

Several reconstruction techniques are possible after totally laparoscopic distal radical gastrectomy. An optimal technique of digestive tract reconstruction after distal gastrectomy has not yet been established. The ideal reconstruction should be not only for doctors but also for patients. Alimentary intake, satisfactory nutritional status and easy performing should be all considered. The aim of the study was to describe the different Billroth-I reconstruction techniques that can be proposed after totally laparoscopic distal radical gastrectomy.

Laparoscopic Heller’s myotomy is the most common surgical procedure to treat achalasia. It is the most accepted therapy for non-advanced stages of the disease. In the setting of advanced disease with marked esophageal dilatation or sigmoid-shaped esophagus the ideal surgical procedure is debatable. Esophagectomy is believed by several authors to be the operation of choice in these cases. Others; however, opt for less invasive alternatives. Laparoscopic Heller’s myotomy has been shown to be a safe and resourceful alternative in end-stage achalasia as well.

Idiopathic and Chagas’ disease achalasia are characterized by absent or partial lower esophageal sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation, heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic examination and esophageal manometry, which is considered the most accurate exam to characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus. Despite similarities in clinical and manometric presentation there is evidence of greater loss of inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas’ disease there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect patients’ clinical presentation, and hence treatment options should be the same for both diseases.

Aim: The advent of minimally invasive abdominal and thoracic surgeries has led to a meaningful reduction in complication and mortality rates among patients undergoing esophagectomy, especially when used for the treatment of benign diseases such as megaesophagus.

Methods: Two hundred thirty-one patients, 152 (65.8%) men and 79 (34.2%) women, with a mean age of 52.46 (19-80) years, were treated for advanced megaesophagus between September 1996 and October 2016. Two hundred ten patients (90.91%) had chagasic megaesophagus and 21 patients (9.09%) had idiopathic megaesophagus.

Results: Immediate complications were observed in 37 patients (16.01%): hemopneumothorax in 22 cases (9.52%), gastric stasis in 11 (4.76%), cervical fistula in 11 (4.76%), dysphonia in 18 (7.8%), and mediastinitis in 1 case (0.43%). Two patients (0.86%) died: 1 patient with a pacemaker died of cardiorespiratory arrest on postoperative day 12 and the other patient died of mediastinitis on day 28. Our standardized protocol includes nutritional and pulmonary outpatient care.

Conclusion: With a standardized multidisciplinary protocol and a team adequately trained in laparoscopy, minimally invasive esophagectomy is an excellent option for the treatment of advanced megaesophagus. The technique is easily standardized and reproducible, and provides excellent postoperative outcomes.

Achalasia is a primary esophageal disorderth variable causes, with an incidence between 0.03 to 1/100,000 people, and prevalence of approximately 10/100,000, with no difference between gender. It is more frequent in South and Central America, where Chagas disease is endemic. There are several methods to treat achalasia including endoscopic and surgical procedures, however, all of these methods are palliative. This article discusses 2 different endoscopic methods to treat advanced megaesophagus in Chagas disease, pneumatic balloon dilatation (PBD), and peroral endoscopic myotomy (POEM). Although varying between studies, PBD has an average symptom relief in 93% of patients in 6 months and 44% in 6 years. Some risk factors for failure of PBD are: younger age, male gender, a wider esophagus, poor emptying on post-treatment barium esophagogram and Eckardt scale < 3 before the treatment. Despite relatively short-term follow-up of an average of 3 years, POEM has excellent results. The clinical success achieved in 98 % with the Eckardt score decreased from 6.9 preoperatively to 0.77. Regarding sigmoid-shaped esophagus, only a few papers have been published on POEM. The largest population was 32 patients with a follow-up of 2 years. There was an efficacy of 96%, with the Eckardt scale decreasing from 7.8 to 1.4. In conclusion, PBD, is still widely used mainly due to its availability, especially in patients with a higher surgical risk and in patients who already had a Heller myotomy who persist or develop dysphagia. POEM has already demonstrated excellent results, but it requires advanced technical skills and Long-term results and randomized clinical trials are needed to validate the use of POEM in routine clinical practice.

Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications.This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus.

Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation.

Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients.

Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up.