Laparoscopic surgery of the upper gastrointestinal tract

Laparoscopic surgery of the upper gastrointestinal tract is nowadays associ ated with little morbidity and mortality. Cardiomyotomy with semifundoplica tion for management of achalasia and the various forms of fundoplication fo r treatment of reflux syndrome have proved beneficial and have largely repl aced conventional surgery. Independent of the operative approach, it has no t yet been established with certainty whether gastro-esophageal reflux can best be prevented by 360 degrees fundoplication or semifundoplication. A pe rforated peptic ulcer can be treated effectively by laparoscopic over-stitc hing of omental patch-plasty, although the superiority of the laparoscopic method has yet to be proved. Benign lesions and early malignancies are curr ently resected laparoscopically, but the role of laparoscopy in the curativ e treatment of advanced gastric carcinoma remains to be clarified. Diagnost ic laparoscopy is used to avoid unnecessary laparotomy in inoperable cancer and to ascertain whether neoadjuvant therapy is indicated in advanced gast ric carcinoma.