Authors demonstrate the management of laparoscopic pyloroplasty in a diabetic female patient presenting with severe gastroparesis after Nissen fundoplication. Gastroparesis is often known to be caused by a vagal nerve lesion during fundoplication, and can be improved by diabetes mellitus. If medical treatment is unsuccessful, a surgical approach is mandatory. Various techniques are described such as pyloroplasty, gastroenterostomy or gastric neurostimulation. We chose the procedure with minimal complications and best postoperative quality of life results as the first-line surgical treatment, namely laparoscopic pyloroplasty.

We present the case of a 38-year-old woman with intractable gastroparesis. Her background history was significant for type I diabetes mellitus (DM), a pancreas kidney transplant in 2006, Nissen fundoplication, gastrotomy for bleeding Dieulafoy’s lesion, diabetic retinopathy, peripheral vascular disease, and gastroparesis which was diagnosed in 2007. She complained of daily vomiting, early satiety, abdominal discomfort, nocturnal diarrhea, and significant weight loss. In addition, she had required multiple hospital admissions with severe electrolyte derangement and repeat OGDs. Her symptoms were refractory to motility agents and to Botox therapy. Following a multidisciplinary discussion, she was offered a gastric stimulator. We present a laparoscopic approach to gastric stimulator insertion. The device that we use is the Medtronic Enterra® therapy system. The patient was discharged well after 48 hours. At a follow-up of 4 weeks, her symptoms had improved significantly: her vomiting had reduced to once per week, and she no longer suffered from nocturnal diarrhea. At a follow-up of 3 months, her vomiting had ceased completely and she was gaining weight. The patient returned to work and to normal daily activities.

There are some conditions in which jejunal feeding is preferred to gastric feeding such as a previous gastric, duodenal, or pancreatic surgery, gastroparesis, high risk of aspiration, and esophageal or gastric cancer. A surgical feeding jejunostomy tube may be placed via laparotomy, laparoscopy, endoscopy, as well as percutaneously using radiographic guidance. In this video, we present a totally laparoscopic jejunostomy performed at the same time of a laparoscopic exploration for a complete gastric cancer staging using a commonly available open device.

Large paraesophageal hernias (PEHs) occur most commonly in an elderly, debilitated patient population with existing co-morbid conditions. The surgical approach to paraesophageal hernias (PEHs) has changed with the advent of laparoscopic techniques. This video presents the case of a 72-year-old male patient referred to our unit for epigastric pain. In this patient, the endoscopy showed nothing specific concerning this pain. The barium swallow showed no abnormality, but just a lateralization of the esophagus. The CT-scan demonstrated a large hiatal hernia. The laparoscopic repair is presented here.

The description of the gastrectomy for benign lesions: modified partial gastrectomy covers all aspects of the surgical procedure used for the management of benign tumors.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical approach, gastrectomies/principles, proximal gastrectomy, modified resections/stapling device.
Consequently, this operating technique is well standardized for the management of this condition.