[Long-term follow-up of the treatment of high anal fistulas using fibrin glue]. / Fistules anales trans-sphinctériennes hautes traitées par colle biologique : suivi à long terme.

AIM OF THE STUDY: Many of the treatments proposed for trans-sphincteric and suprasphincteric anal fistulas are complex and often associated with permanent damage to the sphincter mechanism. In this study, we evaluate the long-term stability of fistula closure using fibrin glue. MATERIALS AND METHODS: Forty-five consecutive patients (mean age 41.5) underwent this procedure. Follow-up was obtained from all patients and their primary care physicians by January 1, 2008. RESULTS: Mean follow-up was 67 months. All recurrences occurred in the first six months after the initial fibrin glue injection procedure; there were no late recurrences. CONCLUSION: Long-term follow-up confirmed the safety, efficacy and durability of fibrin glue fistula closure.

[Laparoscopic cholecystectomy with transgastric gallbladder extraction: a new therapeutic approach]. / Cholécystectomie coelioscopique avec extraction vésiculaire transgastrique: une nouvelle approche thérapeutique.

OBJECTIVE: To evaluate a newly developed cholecystectomy technique which combines classical dissection with currently available mini-instrumentation (3 and 5 mm) and removal of the gallbladder through a short gastrotomy. METHODS: After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. The resected gallbladder was removed through a short gastrotomy on the anterior gastric wall, thereby minimizing abdominal wall trauma and permitting the patient to resume physical activity more quickly with no risk of trocar herniation. RESULTS: Cholecystectomy was performed by the described technique in 18 of 23 eligible patients between April 2008 and August 2008. There were seven males and 11 females with a mean age of 48 (range: 28-77); median BMI was 30 kg/m2 (range: 22-36). Eleven patients had a gallstone larger than 12 mm. There were no postoperative complications and recovery was rapid for all patients in our study. CONCLUSION: This procedure is technically feasible, safe and reproducible; results are good with minimal trauma to the abdominal wall. Normal physical activity can be rapidly resumed with no risk of incisional hernia.

[Biological fibrin used in anal fistulas: 31 patients]. / Colle biologique dans les fistules anales: à propos de 31 patients.

AIM OF THE STUDY: The different treatments proposed for transsphincteric and suprasphincteric cryptoglandular anal fistulas are often complex and often associated with complications. After one or two stage anal fistulotomy, the risk of change in fecal continence ranks from 30% to 40%. This rate is lower (10%) with transanal advancement flap repair technique. A new therapeutic approach (fistula track closure by means of a fibrin sealant) that we have developed in our study allows to avoid classical sphincter dissection or section which could jeopardize normal sphincter function. PATIENTS AND METHODS: Over a 20 month period, 31 consecutive patients (mean age: 42; 24 males and seven females) with transsphincteric (n = 28) or suprasphincteric (n = 3) anal fistula have been included in this study and treated with injection of a fibrin sealant into fistula track. Patients were controlled during a mean follow-up of 9 month. RESULTS: Fistula cure was obtained in 83.9% cases (75% after single fibrin sealant application). Success was achieved after a second application in two patients. Neither change in fecal continence nor other complication was observed during application and during follow-up period. CONCLUSION: This technique is simple (100% feasibility) and is reproductible. Results are comparable with "classical" techniques. However, despite this surgical procedure which could be seen as simple, it requires a throrough methodology.

[Cholecystectomy by celioscopy. Apropos of 126 cases]. / Cholécystectomie par coelioscopie. A propos de cent vingt-six cas.

One hundred twenty-six cases who underwent laparoscopic cholecystectomy were included in the study: 28 males and 98 females with a mean age of 44.2 years. Laparoscopic cholecystectomy was performed for uncomplicated cholelithiasis (111 cases), acute cholecystitis (10 cases), biliary pancreatitis (2 cases) and cholangitis (3 cases). The mean operative time was 78 minutes. In 7 cases, a transformation into open surgery was necessary (5.5%). There were no deaths and one major complication was reported: an iatrogenic injury to the bile duct requiring secondary laparotomy. The mean hospital stay was 3.4 days. However, despite several advantages, this new technique must be performed by a surgeon with experience of biliary tract surgery.

[Trans-suture anastomosis. Choice of procedure in the management of colorectal anastomosis]. / L'anastomose "trans-suturaire". Procédé de choix dans la confection des anastomoses colo-rectales.

The double stapling technique was used to perform low anterior resection for rectal tumors in 122 patients (68 men, 54 women) with a mean age of 65 years (range, 28 to 87 years). There was no perioperative death. Technical problems related to the stapling technique and requiring transitory colostomy occurred in one patients. The clinical anastomotic leak rate was 5 per cent (six patients); in 2 patients, the fistula was treated successfully with a defunctioning transverse loop colostomy. Hospital stay ranged from 6 to 23 days (mean 10.2 days). Continence was normal in all patients at 6 weeks. One soft colo-anal anastomotic stenosis required dilatation. These results appear promising. The double stapling technique appears to facilitate low anterior resection of the rectum with safety.

[In situ carcinoma and condylomata acuminata of the anus. A plea for an exclusive surgical treatment]. / Carcinome in situ et condylomes acuminés de l'anus. Plaidoyer pour un traitement chirurgical exclusif.

Although the association of in situ carcinoma and pointed condylomas of the anus is unfrequent, their etiopathogenetic similarities require the same diagnostic and therapeutic procedures. The treatment is based on surgical exeresis, the only technique that provides reliable histological findings, ensures healing and does not interfere with subsequent surveillance.

[Necrotising enterocolitis. Is there an ideal therapeutic intervention?]. / Entérocolite nécrosante. Existe-t-il une démarche thérapeutique idéale?

Necrotising enterocolitis is a physiological and anatomic entity. The diagnosis is made during surgical intervention, based on macroscopic aspect, distinguishing to other necrotizing enteritis. Surgical intervention underwent on consequences of this medical disease which prognosis is very poor.