Elective laparoscopic sigmoid colectomy for diverticulitis. Results of a prospective study.

BACKGROUND: We undertook a prospective evaluation of elective laparoscopic sigmoid colectomy for diverticulitis in order to assess the risks and benefits of this approach. METHODS: Between November 1992 and November 1996, 54 consecutive patients were included in this study. Their mean age was 59 +/- 13 years (range, 36-81). The number of attacks of diverticulitis before colectomy ranged from one to four (mean, 2.2 +/- 0.7). The operative technique consisted of elective division of the inferior mesenteric vessels, left colonic flexure mobilization, and colorectal anastomosis using the cross-stapling technique. RESULTS: Five procedures (9.2%) were converted. The primary cause for conversion was obesity. These patients had a simple postoperative course. There were no postoperative deaths. Three patients (6.1%) developed abdominal complications, and four patients (8.2%) had abdominal wall complications. Postoperative paralytic ileus lasted only 2.3 +/- 0.7 days (range, 1-6), allowing for a rapid reintroduction of regular diet. The mean postoperative hospital stay was 6.4 +/- 2.7 days (range, 4-15). CONCLUSIONS: Elective laparoscopic colectomy for diverticulitis is feasible in most cases. In most cases, the operative risk is low and the postoperative course is uneventful. Elective sigmoid laparoscopic colectomy should be considered a good therapeutic option for symptomatic diverticulitis.

Factors influencing long-term survival in 100 cases of small intestine primary adenocarcinoma.

BACKGROUND: Factors influencing long-term survival in patients undergoing operation for adenocarcinoma of the small intestine are poorly recognized. METHODS: Retrospective study of 100 cases culled within a 10-year period by questionnaire, including 59 males and 41 females, median age 61 years (range 30 to 86). No patients were lost to follow-up (median 27 months). All patients underwent operation: curative in 65% and palliative in 35%. RESULTS: Overall actuarial 5-year survival was 38%, 0% after palliative treatment and 54% after curative resection. In patients undergoing curative resection, 5-year survival was 63% when the lymph nodes were not involved, and 52% when they were; 57% when the serosa was not involved, and 53% when it was; 56% when the tumor was well or moderately well differentiated and 40% when it was undifferentiated. Other factors influencing long-term survival were the emergency setting, the site, the multiplicity, and the size of tumor (none with statistically significant differences). Five and 10-year survival was 78% and 69%, respectively, when the patient was anemic compared with 35% and 17%, respectively when the patient was not (P <0.01). There were 14 patients with previous carcinoma, 2 with Crohn's disease, and 1 each with celiac disease and ileal tuberculosis. There were also 8 patients with associated duodenal and proximal jejunal polyps. Thirteen patients sustained a total of 14 further cancers. CONCLUSIONS: Patients should be followed up closely because the possibility of sustaining another abdominal carcinoma is high (16%). As associated polyps are nearly always duodenal or jejunal, preoperative or intraoperative endoscopy of the upper gastrointestinal tract including the initial portion of the jejunum should be able to detect their presence and reduce the risk of early recurrence.

[Association of ankylosing spondylarthritis, cauda equina syndrome and dilatation of the lumbar cul-de-sac with voluminous arachnoid diverticulum. Clinical, radiological and tomodensitometric study of a case]. / Sur l'association spondylarthrite ankylosante, syndrome de la queue de cheval et dilatation du cul-de-sac lombaire avec volumineux diverticule arachnoïdien. Etude clinique, radiologique et tomodensitométrique d'un cas.

The authors report a clinical and radiological observation of cauda equina syndrome associated with ankylosing spondylitis. Although only 32 cases have been reported in the literature over the last twenty years, such an association is probably not exceptional. The mode of onset and the course of the neurological symptoms is quite similar from case to case: ankylosing spondylitis preexisting for many years, and inactive when neurological signs develop, the latter usually being very slowly progressive. The usual radiological features, demonstrated by saccoradiculography in the supine position, are posterior diverticulas of the lumbar theca, contiguous to bony erosions of the laminae, well visualized by computed tomography. Pathogenesis remains obscure, and none of the attempted therapies, including surgical procedures, have proved effective.

[Habitual luxation of the extensor apparatus in regard to the metacarpophalangeal joint of the fingers]. / Luxation habituelle de l'appareil extenseur en regard de la métacarpo-phalangienne des doigts.

The sagittal bands of the metacarpophalangeal joint play an important role in the control of the mobility and stability of the extensor aponeurosis of the joint. A case of dislocation of the extensor tendon from rupture of the radial sagittal fibers is reported. A method of repair of the tendon is discussed. The result at one year is excellent.

[Gardner's syndrome (author's transl)]. / Syndrome de Gardner: présentation d'un cas.

Gardner's syndrome is a dominant autosomal non sex-linked hereditary condition resulting from lesions of all three primary germ layers : ectoderm, entoderm and mesoderm. It therefore includes a variety of symptoms which concern E.N.T. specialists, dermatologists, maxillo-facial surgeons and gastroenterologists, although the present tendency is to recognize the existence of partial or dissociated Gardner's syndromes. The finding of an isolated symptom of the Gardner's series should lead to a systematic search for polyposis of the large bowel, as the latter carries a short- or long-term risk of malignant degeneration which has considerable bearing on prognosis.