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Endoscopic Gastric Surgery.
  1. R C MASON

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Endoscopic Gastric Surgery. Edited by E Hanisch, M Kitajima, T Wehrmann, et al (Pp 134; illustrated; £51.50/DM 149.00). Germany: Springer Verlag, 2000. ISBN 3540653333.

This is a small textbook which looks at specific aspects of gastric surgery from a laparoscopic approach. The overall format is attractive in that a chapter on physiology precedes the section on laparoscopic surgery. It does, however, in view of the rather concise nature, fall between two stools in that it is a specialist book and therefore does not necessarily appeal to the general trainee, but it is too short and the referencing is too limited to be a definitive text.

The book proceeds on the basis that the laparoscopic approach is correct and there is very little discussion on non-laparoscopic and open surgery. This may well be appropriate in the form of laparoscopic antireflux surgery and cardiomyotomy but is certainly not in the form of antiobesity surgery or surgery for cancer. The impression that the laparoscopic approach is well established is inaccurate for these latter conditions and malignancy, where open surgery holds sway. The discussion on laparoscopic antireflux surgery is limited to the 360° Nissen loose floppy wrap. The operation is described nicely with clear photographs which is a characteristic of the entire text. However, there is no discussion on the alternatives to a 360° wrap, namely a toupee 180° procedure or even the more modern partial anterior fundoplications. The various merits of these procedures would be an addition to the text as well as the role of the laparoscope in revisional surgery, and some comparison with open operations. Similarly, for cardiomyotomy for achalasia, a success rate related to open cardiomyotomy would be beneficial. Preceding these two operative sections however are two good chapters on the pathophysiology of reflux and achalasia. It is a pity in laparoscopic antireflux surgery that more comment is not made on the significant increase in the incidence of such surgery with the advent of the laparoscope. Is this a good thing or not? The pros and cons of treatment could be better discussed. With regard to cancer surgery, this really has to be emphasised as being experimental. Comparison with these success rates versus those of open surgery and a reflection on the reality of the situation, as seen in Western Europe where the disease presents at a more advanced stage, and the role of other modalities such as chemo/radiotherapy, would benefit the textbook and would expand it into a more comprehensive text. On the plus side however, the illustrations are superb and the intraoperative photographs explain the laparoscopic nodal dissection extremely clearly. It is not however a textbook of operative surgery. This book will appeal to the more specialist clinicians in upper gastrointestinal surgery and provides a cheaper and smaller alternative to the more weighty texts.