[Laparoscopic ileo-colic resection in Crohn's disease]. / Résection iléo-colique coelio-assistée pour maladie de Crohn.

UNLABELLED: The objective was to evaluate the reliability and safety of laparoscopic ileocolic resection for Crohn's disease. PATIENTS AND METHODS: From June 1995 to February 1999, 40 patients underwent a laparoscopic ileocolic resection for Crohn's disease. Fistulizing disease, phlegmons and patients with previous laparotomy were excluded. Early morbidity, postoperative comfort and clinical recurrence were rates evaluated. RESULTS: No intra-operative incident or conversion occurred. Mean operating time was 163 min. Complications occurred in three patients: 1 pelvic hematoma with super-infection, 1 protracted ileus (7 days), 1 venous thrombosis. Opiate analgesics were used for a mean period of 3.1 days. Delay before bowel movements was 3.2 days. Post-operative hospital stay was 8 days. Mean size of the wound was 4.1 cm. Twelve patients (30%) developed long-term clinical recurrence; the mean disease-free interval was 10 months. No patient required secondary re-operation. CONCLUSION: Laparoscopic ileocolic resection was reliable and safe in the treatment of Crohn's ileal strictures. The possible role of this method in the treatment of fistulizing disease or recurrence has to be evaluated.

Experience gained from operation of 103 adrenal incidentalomas.

BACKGROUND: Adrenal incidentaloma poses a perplexing problem for physicians. The challenge is to identify the rare functioning or malignant adrenal tumor that should be removed. PATIENTS AND METHODS: From 1970 until December 1996, we managed 579 patients with adrenal hyperplasia or neoplasm. Of these, 110 were followed without any operation and 469 were operated on. The histology from the operated patients revealed 145 pheochromocytomas, 72 Cushing's syndrome, 98 aldosteronomas, 21 virilizing tumors, 3 feminizing tumors, 98 non-functioning adrenalomas, 17 metastases, 7 cysts, and 15 miscellaneous tumors. RESULTS: Among the 98 non-functioning adrenal tumors, 79 were incidentalomas. Histological examination of 103 operated incidentalomas found 55 adenomas (5 functioning=aldosteronomas), 12 benign pheochromocytomas, 3 malignant or suspicious pheochromocytomas, 8 cystic lymphangiomas, 4 metastases, 4 angiomas, 3 ganglioneuromas, 4 myelolipomas, 1 hyperplasia, 2 hematomas, 2 cysts, and 5 adreno-cortical carcinomas. Among the non-operated incidentalomas, the most frequent findings were adenomas, metastases, hematomas, cysts and pseudotumoral hyperplasia; three disappeared spontaneously. No patients died of unrecognized adrenocortical carcinoma. CONCLUSION: Our experience confirms that in case of incidentaloma, the first concern is a nonfunctional pheochromocytoma (15%), and the less common occurrence is adreno-cortical carcinoma (2%). We recommend a restrictive surgical approach in the setting of adrenal incidentalomas.