[Posterior rectopexy in total rectal prolapse-]. / Rectopexie selon orr-loygue dans le prolapsus total du rectum.

STUDY AIM: The aim of this retrospective study was to report the results of posterior Orr-Loygue rectopexy in 55 patients operated on for rectal prolapse. PATIENTS AND METHOD: From 1986 to 1997, 114 patients were operated on for rectal prolapse and 55 had an Orr-Loygue operation. There were 47 women and 8 men (mean age: 55 years). Twenty-five patients (45%) had fecal incontinence, 26 (47%) described preoperative 'constipation'. The procedure was performed under general anesthesia, through laparotomy in 51 patients, through laparoscopy in 4 patients. Resection of sigmoid colon was associated to rectopexy in four patients. RESULTS: Mortality rate was 0 and morbidity rate 12%. Mean hospital stay duration was 13.5 days. Mean follow-up was 63 months and at the end of the study, four patients (7%) had recurrence, 5/25 patients had still incontinence; 55% of the patients had unchanged postoperative bowel function, 22% described improvement (including the four patients with resection-rectopexy) but 38% (21/55) suffered from postoperative 'constipation'. The rate of 'constipation' induced or majored by rectopexy was 22% but the functional trouble described appeared often complex. CONCLUSION: Posterior Orr-Loygue rectopexy is the operation recommended for patients in good general condition, especially if fecal incontinence is associated. In the course of the procedure, preservation of pelvic nerves and hypogastric plexus, and positioning of the strips not too tight between the anterolateral rectal walls and promontory must be emphasized. Posterior Orr-Loygue rectopexy is contraindicated when general anesthesis is too risky and when bowel dysfunction and/or rectal exoneration dysfunction are present.

Diffuse peritonitis in steroid-treated patients.

Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, specially from gastrointestinal perforation. We performed a retrospective study of 37 patients on systemic steroid therapy who underwent surgery for diffuse peritonitis. Clinical presentation of peritonitis was usually aspecific, making the diagnosis difficult. The median interval between onset of symptoms and surgery was 3.3 days, reduced to 2.0 days between hospitalization and surgery. The mortality rate was 46% (17 of 37 patients). We emphasize aggressive diagnostic efforts and early abdominal exploration in front of any persisting abdominal pain in patients on systemic steroid therapy.