Subject(s)
Abdominal Pain/diagnosis , Malaria, Falciparum/diagnosis , Splenic Infarction/diagnosis , Splenic Rupture/diagnosis , Abdominal Pain/etiology , Diagnosis, Differential , Humans , Malaria, Falciparum/complications , Male , Middle Aged , Military Personnel , Splenic Infarction/complications , Splenic Rupture/complicationsABSTRACT
INTRODUCTION: Surgical treatment of achalasia of lower oesophageal sphincter is Heller's myotomy, usually associated with a fundoplication due to an high risk of postoperative gastro-oesophageal reflux. The value of this fundoplication is discussed. The aim of this study was to evaluate retrospectively the results of Heller's myotomy without fundoplication but performed according to a precise technique preventing postoperative reflux. PATIENTS AND METHODS: Between 1975 and 1999, 123 patients underwent Heller's myotomy without systematic fundoplication. Diagnosis of achalasia was performed clinically and confirmed by investigations: baryum meal, fibroscopy and manometry. Myotomy was performed through an abdominal approach in 117 (95%) patients. Dissection preserved fixity of abdominal oesophagus in all cases, particularly its posterior meso. Myotomy was performed on abdominal oesophagus but not below the cardia. Posterior fundoplication was associated in 2 patients. RESULTS: One patient (0,8%) died from massive aspiration. Morbidity (1,6%) consisted in one peritonitis and one postoperative occlusion. At follow-up (mean = 5 years; range: 1-20), functional results were satisfying (excellent and good) in 112 (92%) patients. Seven patients (6%) developed postoperative reflux, including one who need surgical treatment. Dysphagia persisted in 3 patients (2%) who had to be reoperated. CONCLUSION: Results of this series show that systematic fundoplication is not necessary in Heller's myotomy for achalasia of lower oesophageal sphincter.
Subject(s)
Esophageal Achalasia/surgery , Fundoplication , Gastroesophageal Reflux/prevention & control , Postoperative Complications , Adolescent , Adult , Aged , Esophageal Achalasia/pathology , Esophagogastric Junction/surgery , Female , Gastroesophageal Reflux/etiology , Humans , Male , Middle Aged , Patient Satisfaction , Retrospective Studies , Treatment OutcomeABSTRACT
The study aim was to report an adenocarcinoma of the anal glands revealed by an anal abscess in a 64-year-old man. Malignant transformation of an anal fistula is discussed in the genesis of this disease. Clinical symptoms are not specific. Abdomino-perineal resection of the rectum is the usual surgical treatment and adjuvant radiation therapy didn't prove its efficiency.
