Acute localized diverticulitis: optimum management requires accurate staging.

Between 1977 and 1989, 151 patients were treated in our institution for acute sigmoid diverticulitis. Thirty-one patients were operated on for diffuse peritonitis, and were excluded from the study. One hundred twenty patients had localized disease. There were 59 men and 61 women, with a mean age of 60 years (range, 30 to 87 years). Thirteen were under 40 years of age. A "phlegmonous" diverticulitis (no pericolic abscess) was diagnosed in 78 cases (group I). A pericolic abscess was identified in 42 cases (group II). The medical treatment was successful in 97% of the patients of the group I. Only 15 patients required a delayed elective resection for recurrence or chronic complications, within the next 24 months. There were no operative deaths. All the other patients were doing well after a mean follow-up of 5 years (9-144 months), without any disease-related death. Patients presenting with a localized pericolic abscess (group II, n = 42) were initially treated either conservatively (n = 22) or by a more or less extensive drainage (n = 20). There were two deaths in the "conservative" group. Primary or delayed colonic resection was indicated in 34 cases because of uncontrolled sepsis, recurrence or secondary chronic complications. It is concluded that accurate classification of the disease is essential. If no peritonitis has developed, the presence of an abscess is the main determinant in both prognosis and treatment. Most patients who develop an acute phlegmonous diverticulitis do well with conservative treatment, and prophylactic resection is not indicated. Curative colectomy is reserved for patients developing persistent complications over the next few months.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of prosthetic material in rectopexies.

Among the 80 different techniques that have been devised to repair rectal prolapse, abdominal rectopexies are the most suitable. The majority of these operations secure the rectum to the sacrum by means of a prosthetic material. Ripstein's technique, in USA, and Wells procedure, in Great Britain, have gained wide acceptance, despite a rather high rate of complications. A modified technique has been recently proposed by Keighley et al., with excellent results. From 1979 to 1982, 20 patients were operated upon in our department for rectal prolapse. The mean age of the patients was 43 years, and there was a rather high percentage of male patients (30%). Eleven exhibited an obvious external prolapse patients (30%). Eleven exhibited an obvious external prolapse but the others complained of the "occult rectal prolapse syndrome". The Orr-Loygue procedure, that secures the rectum to the sacral promontory by means of two strips of nylon mesh, was performed in all these cases. No mortality was observed and the morbidity was minimal. No infectious complications occurred. The procedure was performed without sexual consequences in the young patients. Clinical, endoscopic and cineradiographic checks illustrate that the Orr-Loygue rectopexy is an efficient treatment of both incipient intussusception and external prolapse, and offers good control of most associated troubles. But a longer survey is necessary before definitive conclusions may be drawn.