IrelandCorrespondence to: Mr R. 6. Stephens The arrival of videoendoscopy has facilitated a wide range of endoscopic operative procedures across a variety of surgical disciplines, including gynaecology, otorhinolaryngology, orthopaedics and most recently general surgery. Laparoscopic cholecystectomy is currently the most common major abdominal operation performed endoscopically . Increasing familiarity with this new technique has resulted in a growing list of operations that can be performed with the aid of the laparoscope. The first laparoscopic approach to performing Meckel's diverticulectomy for acute inflammation is described. TechniqueA 28-year-old man with a previous appendicectomy presented with acute abdominal pain. A diagnostic laparoscopy was performed using a 10-mm trocar inserted below the umbilicus and a 5-mm trocar in the right iliac fossa. This revealed a swollen and inflamed Meckel's diverticulum. The diverticulum and its attached loop of small intestine were brought onto the surface of the abdominal wall (Figure 1 ) by pulling the diverticulum into the 10-mm trocar at the umbilicus and then removing the trocar from the abdominal cavity. A 3-mm extension to the incision was required to allow the loop of small intestine to come onto the surface. With the loop so exteriorized (Figure 2), the Meckel's diverticulum was then simply removed using a TA55 stapler (Auto Suture, Dublin, Ireland ) and the small bowel was replaced into the peritoneum. The two wounds were closed with subcuticular absorbable sutures. The patient recovered full mobility the following day and was discharged home on a normal diet on the third day after operation. Histology confirmed the presence of an acutely inflamed Meckel's diverticulum, containing gastric-type epithelium. DiscussionThe advantages of laparoscopy over laparotomy include rapid recovery of full muscle function and the lack of postoperative pain. In this patient, the laparoscope was used to make a diagnosis and to facilitate a standard operation by exteriorizing the relevant segment of small intestine. With the introduction of laparoscopic stapling devices, Meckel's diverticulectomy could be performed entirely within the peritoneal cavity under laparoscopic control, but this would probably not confer any great advantage over the procedure adopted in this case. The use of diagnostic laparoscopy is recommended in all patients with atypical abdominal pain for the purposes of establishing an accurate diagnosis and to perform definitive surgery where feasible. ReferencesOlsen DO. Laparoscopic cholecystectomy. Am J Sury 1991 ; 161 : 339 -44.

While anterior gastropexy has a significant incidence of recurrent herniation, the clinical results of this simple procedure in a high-risk population support its use as the initial surgical option.

No abstract

Our initial experience of using laparoscopy to perform appendicectomy for appendicitis has shown that the operation is feasible, safe and as effective as open surgery in early appendicitis. The precise role of laparoscopic appendicectomy will need to be defined by a prospective randomised trial.