Objective To study the approach of the combination of endoscopy and laparoscopic hepatectomy in the treatment of intra-and extrahepatic bile duct stones.Methods Eighty-one patients with intra-and extrahepatic bile duct stones who had been admitted to Nankai Hospital from July 2004 to March 2008 were divided by random number table into 2 groups.Twenty patients in group A underwent open hepatectomy+biliary exploration.Sixty-one patients in group B received duodenoscopy first,and patients with successful clearance of stones in the extrahepatic bile duct underwent total laparoscopic hepatectomy or hand-assisted laparoscopic hepateetomy according to the location of the stones in the liver;patients with residual stones in the extrahepatic bile duct underwent hand-assisted laparoscopie hepateetomy+biliary exploration.The changes of the indexes during perioperative period of the 2 groups were analyzed by t test.Results Minimally invasive surgeries were successfully carried out in group B.Satisfactory outcomes were obtained,and no severe complication was observed.The gastrointestinal function recovery time of patients who underwent hand-assisted laparoscopic hepatectomy+biliary exploration in group B was significantly shorter than in group A(t:3.062,P＜0.05),but there was no significant difference in operation time and perioperative blood loss between the 2 groups(t=0.953,0.911,P＞0.05).Compared with patients who underwent hand-assisted laparoscopic hepateetomy,the operation time was significantly longer,hut the gastrointestinal function recovery time was significantly shorter in patients who underwent total laparoscopic hepatectomy(t:2.046,2.316,P＜0.05),there was no significant difference in operation time between the 2 groups(t=0.874,P＞0.05).Conclusion Endoscopy+laparoscopic hepatectomy is safe and effective,and can decrease the trauma to the minimum for patients with intra-and extrahepatic bile duct stones.

Objective To investigate the clinical characteristics and feasibility of laparoscopic repair of giant hiatal hernia. Methods From January 2008 to August 2010, 25 consecutive patients with giant hiatal hernia underwent laparoscopic repair. Crural closure was performed by means of two or three interrupted nonabsorbable sutures plus a tailored PTFE/ePTFE composite mesh. It was patched across the defect and secured to each crura with staples. Laparoscopic fundoplication was performed concomitantly in 16 cases according to the specific conditions of patients. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results All laparoscopic surgeries were accomplished successfully. The operating time was 85 -210 minutes (mean, 106 minutes) ,the operative blood loss was 55 - 150 ml( mean, 94 ml) ,the postoperative hospital stay was 4 -21 days( mean, 6.8 days). The symptoms in most cases were adequately relieved after operation. There was no severe postoperative morbidity. After the follow-up period of 3 - 35months ( mean, 13.6 months), the satisfaction rate of surgery was 88%. 4 cases had mild symptom recurrence of acid reflux.Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic repair of giant hiatal hernia is a safe and effective minimally invasive procedure, with the advantages of minimized trauma, quick recovery and reliable effect. The use of a tailored PTFE/ePTFE composite mesh ( Bard CruraSoft Mesh)for giant hiatal hernia proved to be effective in reducing the operation time and technique demands, and the rate of postoperative hernia recurrence, with a very low incidence of mesh-related complications.

Objective To investigate the feasibility and clinical value of laparoscopic surgery in treating patients with gastroesophageal reflux disease. Methods From September 2001 to August 2009, 372 patients with gastroesophageal reflux disease undertwent laparoscopic fundoplication, including 146 cases of Nissen fundoplication, 79 Toupet fundoplication, and 147 anterior 180 degrees partial fundoplication. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results Laparoscopic surgery was successfully performed in all patients, and no conversions were required. The operating time was 50 -210 minutes (mean, 85 minutes), the operative blood loss was 40 - 150 ml( mean, 86 ml) ,the postoperative hospital stay was 3 - 21 days( mean, 4.3 days ). The symptoms in most cases were adequately relieved after operation. There were no severe postoperative morbidity and mortality. Endoscopy, radiology, esophageal manometry and 24-hour pH monitoring were repeated 3 months after surgery. After the follow-up period of 3 -63 months ( mean, 27.3 months), the satisfaction rate of operation was 92.57%. 19 cases had mild dysphagia when eating solid food. Symptoms recurrence of acid reflux occurred in 6 cases, which were controlled by antacid medications. Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic operation should be the method of choice to treat the moderate to severe gastroesophageal reflux disease, with the advantages of minimized trauma,quick recovery, safety,feasibility and reliable effect. According to individual condition of patients, appropriate fundoplication procedure should be employed carefully to ensure results of operations, reduce operating difficulties and the rate of postoperative complications.

Benign diseases of gastroesophageal junction include gastroesophageal reflux disease,hiatal hernia and achalasia of the cardia.Surgical intervention is superior in the treatment of moderate to severe cases.With the rapid development of laparoseopic technology,minimally invasive surgical procedures,such as laparoscopic fundoplication,laparoscopic rear of hiatal hernia and laparoscopic cardiamyotomy are widely applied with excellent efficacy.According to our experience and clinical study,laparoscopic surgery,with advantages of minimal trauma,rapid recovery,safety and reliable efficacy,could be the first-line treatment for benign diseases of gastroesophageal junction.

Objective To investigate the management of complications after laparoscopic adjustable gastric banding (LAGB).Methods The clinical data of 83 obese patients who were treated by LAGB at the Nankai Hospital from September 2005 to June 2011 were retrospectively analyzed.The complications after LAGB were analyzed.The adjustable gastric band was installed under laparoscope so as to form a small gastric pouch with a volume ranged between 20-30 ml.The water pump was fixed in the rectus abdominis anterior sheath under the appendix ensiformis.The gastric band was adjusted according to the changes of the body weight,symptoms after diet and results of imaging examination of upper gastrointestinal tract.Patients were followed up via out-patient examination and phone call till July 2013.Results The incidence of complications of the 83 patients was 44.6％ (37/83).Six patients had short-term complications and 31 patients had long-term complications.The short-term complication mainly presented as post-prandial vomiting.The symptoms of 5 patients were relieved by changing of eating habit.The condition of 1 patient was severe,and the symptom was relieved 5 days later after fasting and nutritional support.For the 31 patients with long-term complications,25 were complicated with band erosion into gastric lumen via gastric wall (6 patients were complicated with infection of the water pump site),and they were cured by removal of band laparoscopicly.Ten patients were complicated with water pump-related complications,including 6 with infection of the water pump site and 4 with pump migration.The water pumps of the 4 patients with pump migration were surgically removed.Two patients had band slipping to the stomach.The band was restored to the original place after removing the liquid from the band and reducing the food intake,and then the position of the band in 1 patient was restored to normal,and no change was observed in another patient,and the band was removed laparoscopicly.Conclusions The incidence of complications after LAGB is high,and it increases as the time passes by.Most of the long-term complications after LAGB need to be treated by reoperation.

Objective To evaluate the efficacy and safety of double-frequency laser lithotripsy under endoscope in the treatment of refractory biliary stones. Methods A total of 23 patients with refractory biliary stones underwent double-frequency Nd:YAG laser lithotripsy from January 2002 to June 2004. The authors performed the laser lithotripsy during laparoscopic common bile duct exploration in 14 patients and during postoperative choledochoscopy in 9 patients. Results Biliary stones were completely removed in 19 patients, the stone free rate for refractory biliary stones being 82.6% (19/23). No bile duct or T-tube tract injuries occurred. Conclusions Double-frequency laser lithotripsy has the advantages of mini invasion, high efficiency, and low postoperative complication rate. It is an effective alternative for patients with refractory biliary stones during endocopic surgery.

Objective:To investigate the influence of laparoscopic versus open hepatectomy on the stress reaction of patients.MethodsRetrospectively 30 cases who received operation of laparoscopic and open left lateral lobectomy of liver for stones in bile ducts within left lobes of lives were selected form May 2006 to September 2010.The serum level of neutrocytes (N),adrenaline (AD),cortisol (Cor),blood glucose (BG),white blood cell (WBC),Natural killer cell ( NK cell),interleukin-6 (IL-6),C-reactive protein (CRP) were detected preoperatively as well as 24 h,28 h,72 h postoperatively.ResultsAD,Cor reached their peaks after operation,and N,BG,IL-6,CRP reached their peaks in 24 h postoperatively.There were significant difference between O and L groups (P＜0.05).NK cell sank to its lowest level in 24 h postoperatively,and there were no significant difference between the two groups (P＜0.05).ConclusionLaparoscopic and open left lateral lobectomy of liver are two methods curing stones in bile ducts within left lobes of lives,the former process can result in less stress reaction of patients than the latter.

Objective To evaluate long-term follow-up for laparoscopic anterior 180° partial fundoplication for gastroesophageal refulx disease (GERD).Methods A total of 48 patients had undergone a laparoscopic anterior 180° partial fundoplication from July 2004 to October 2007.Patients were followed up at 3 months,12 months,3 years,5 years by using a structured questionnaire via phone or e-mail which evaluated symptoms of reflux,dysphagia,side-effects,and overall satisfaction with the clinical outcome.Results Follow-up data were collected from 43 patients,ranging from 60 to 98 months.Postoperative heartburn significantly improved in 37 patients.Normal belching was preserved in 40 patients,and 38 patients were able to eat normally.Thirty nine (90.7％) patients reported a good or excellent result (minimal or no symptoms) at the late follow-up.Two patients underwent laparoscopic anterior 180° partial fundoplication again due to acid reflux at the 12th and 38th month respectively.Conclusion At minimum 5 years followup,laparoscopic anterior 180° partial fundoplication for GERD is effective and lasting,and most patients are satisfied with the outcome.

Objective To study the most appropriate approach of combination use of endoscopy and laparoscopy in the treatment of intra and extra-hepatic bile duct stones.Methods A total of 1 669 patients with intra-and extra-hepatic bile duct stones were treated from October 2000 to December 2005 in this hospital.According to patient's individual conditions,different surgical schemes were employed,including duodenoscopy only,combination of laparoscopy and duodenoscopy(or choledochoscopy),combination of duodenoscopy,laparoscopy,and choledochoscopy,and hand-assisted laparoscopic hepatectomy.The success rate and post-operative results were observed and analyzed.Results The combination use of endoscopy and laparoscopy was successfully carried out in 1 636 patients,the total success rate being 98.0%(1636/1669).There were no serious post-operative complications.Conclusions Combination use of endoscopy and laparoscopy can be employed for various conditions of patients with intra-and extra-hepatic bile duct stones.The technique integrates advantages of both digestive endoscopy and laparoscopy,broadens indications of minimally invasive treatment,and improves the success rate.

Objective To explore the real feeling and experience of the nurses when they changed their role into patients (in hospital), and find out the defect and disadvantage of nursing service, then we can identify the direction of how to improve our nursing service. Methods Six nurses who were hospital-ized for operations were interviewed about the feeling of being patients, before and after operations.The in-formation was collected and analyzed, then questions were raised up. Results The various feelings of 6 nurses before and after operation were got and 6 themes were summarized. Conclusions When the nurs-es have experienced the feeling of being patients, they understand the patients better, they consider that more thinking from another way could help to form good relationship between nurse and patient,"more un-derstand, more trust, less complain, less grumble".