Evaluation of a treatment pathway for the management of uncomplicated diverticulitis.

INTRODUCTION: Recent clinical practice recommendations have radically modified the management of colonic diverticulitis. The goal of our study was to evaluate a treatment pathway for uncomplicated diverticulitis and to analyze the outcome (patient compliance, treatment failure and complications). PATIENTS AND METHODS: All patients who presented to the emergency department with the diagnosis of uncomplicated diverticulitis were prospectively included in this study. The treatment pathway included an outpatient clinical re-assessment by a gastrointestinal surgeon. In case of symptomatic treatment failure, oral antibiotics were prescribed. If developed clinical signs of severity developed, the patient was referred to the emergency department for new laboratory and imaging workup. RESULTS: Eighty-seven patients were included. The mean interval before re-assessment was 2.8 days. Fifty-nine patients (67.8%) had symptomatic treatment upon discharge from the emergency department and were reassessed as outpatients by the surgical team. Patient evolution was satisfactory for 45 (76.3%); 10 (16.9%) required oral antibiotics. One (1.7%) patient developed complicated diverticulitis. Thirty-four (39.1%) patients did not comply with the current recommendations. CONCLUSION: In our experience, uncomplicated diverticulitis can be treated effectively in an ambulatory setting followed by early re-assessment by a surgeon.

Is histological analysis of pilonidal sinus useful? Retrospective analysis of 731 resections.

The pilonidal sinus (SP) is a common pathology. The treatment is a surgical excision. Many surgeons continue to systematically send this SP in histological analysis. The objective of our retrospective study was to evaluate the interest of this systematic histological analysis. The retrospective analysis of patients undergoing surgery was performed between 1 January 2006 and 31 December 2014. The primary observation was the presence of a malignant disease on the surgical specimen. Secondary observations were the wound healing time and the rate of recurrence. Seven hundred and thirty-one patients were analyzed. There was no malignant lesion. For 323 patients, the histological analysis did not describe the resection margins. Two hundred and eighty five patients had complete resect on and 38 were incomplete. Twenty-four patients had recurrence (7%). There was no significant difference between those who had complete and incomplete resection. The healing time was 61 days. Our study raises the question about the value of systematic histological analysis of the PS specimen.

Laparoscopic incisional hernia repair: long term results.

OBJECTIVE: The aim of this prospective monocenter study was to evaluate the long-term results of laparoscopic treatment of incisional hernias using intra-peritoneal prosthetic mesh. PATIENTS AND METHODS: Seventy-seven patients underwent laparoscopic treatment of incisional hernia between January 2002 and January 2008. All patients were followed for at least five years after surgery. The parameters assessed were hernia recurrences and post-operative pain. In case of doubt as to the diagnosis of recurrence or pain, a CT examination was performed. RESULTS: Nine patients were excluded: four patients refused to participate in the study and five died of unrelated disease during follow-up. Sixty-eight patients (89.7%) were followed for a mean of 92.3 (± 19.8)months. Mean age of patients was 58 (± 11.3)years. There were no deaths and no conversions. The mean operative time was 104 (± 48)minutes. The morbidity rate was 13.2%. Major complications included one case each of mesh infection, post-operative peritonitis (bowel injury), and surgical site pain requiring revisional surgery. Five patients developed seroma. The mean duration of hospitalization was 4.5 (± 2.3) days. The long-term recurrence rate was 8.8%. The average interval to onset of recurrence was 45.8 (± 31.1)months. Trocar site hernias were observed in three patients. Four patients had post-operative pain requiring long-term medical treatment. CONCLUSION: Laparoscopic incisional hernia repair using intra-peritoneal prosthetic mesh is a safe technique with satisfactory long-term outcome. One major complication occurred: bowel injury. Suture closure of 10mm trocar sites should be routine.

Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study.

BACKGROUND: The preoperative diagnosis of adult intussusceptions (AIs) remains difficult, and the assessment of the radiological methods has been evaluated very little in the literature. The aim of this study was to evaluate the interest of the different imaging modalities for the preoperative diagnosis of AI and describe causes of AI. PATIENTS AND METHODS: Consecutive patients of 15 years and older with the postoperative diagnosis of intussusception from 1979 to 2004 were reviewed retrospectively for this multicentric study. Data concerning clinical considerations, morphological examinations, surgical procedure, histological conclusions, mortality rate and recurrence were analysed. RESULTS: Forty-four patients with documented intussusception were included. The mean age was 51 years (15-93 years). The preoperative diagnosis of intussusception was made in 52% of the cases. The sensitivities of the different radiological methods were abdominal ultrasounds (35%), upper gastrointestinal barium study (33%), abdominal computed tomography (CT) (58%) and barium enema (73%). An organic lesion was identified in 95% of the cases. There was 29 enteric and 15 colonic (including appendicular) intussusceptions. Thirty-seven percent of the enteric lesions were malignant, and a bit less than 50% of them were metastatic melanomas. The benign enteric lesions were Meckel's diverticulum and Peutz-Jeghers syndrome in half of the cases. Fifty-eight percent of the pure colonic lesions (excluding appendix) were malignant, and 85% of them were primary adenocarcinomas. The benign colonic lesions were lipomas in 80% of the cases. All patients, except one, had a surgical treatment, and 13 of them had a complete reduction of the intussusception before resection. The mortality rate was 16% and recurrence occurred in three patients; two of them had a Peutz-Jeghers syndrome. CONCLUSION: Intussusception rarely occurs in adults, but nearly half of their causes are malignant. The CT scan is a helpful examination for enteric intussusceptions whether barium enema seems to be the most performing method for colonic lesions. Surgery is the recommended treatment, with or without a primary reduction of the intussusception. During the surgical procedure, this reduction can lead to a more limited bowel resection.

[Video-laparoscopic diagnosis and follow-up of a peritoneal tuberculosis]. / Diagnostic et suivi vidéolaparoscopique d'une tuberculose péritonéale.

A 21-year-old woman suffering from abdominal pain and a fever of 39 degrees C was hospitalized. Ultrasonography and computed tomographic scan showed a large amount of ascites and one hepatic node. The serum CA 125 level was elevated. Protein Chain Reaction (PCR) searching tuberculosis antigen in ascitic fluid was normal. A diagnosis of peritoneal tuberculosis was supposed and an exploratory laparoscopic procedure performed. Peroperative observation of the ascites, with multiple sites of adhesion, and pathological examination of the hepatic nodule and peritoneum confirmed initial diagnosis. Antituberculous treatment was given for one year. A second laparoscopic procedure was performed and found no disease remaining.