[Appendectomy for appendicitis by colonoscopy after a cecal invagination of the appendix during childhood]. / Appendicectomie par coloscopie, pour appendicite après invagination appendiculaire intra-caecale dans l'enfance.

Appendiceal intussusception (the inside-out appendix) was often practiced in pediatric surgery when the appendectomy was performed during laparotomy. Complications are exceptional. We report the first case of appendiceal intussusception in an adult appendectomized by this procedure during childhood, reviewing the radiological aspect, pathogenesis, and treatment. This delayed complication of appendiceal intussusception should be known to the surgeon. Treatment during colonoscopy is possible. This inflammation of the vaginated appendix can be prevented by coagulating the appendicular vessels to the serous membrane before turning it inside-out.

[A rare cause of intestinal obstruction after laparoscopic colectomy]. / Une cause rare d'occlusion après sigmoïdectomie par laparoscopie.

Described here is a case of obstruction of the ileal loop caused by a volvulus forming on an internal hernia through the mesenteric opening following left laparoscopic-assisted hemicolectomy. The clinical radiologic, pathogenic and therapeutic aspects are described with review of the literature.

[Watermelon stomach: a rare cause of iron deficiency anemia, surgically treatable; a new case with review of the literature]. / L'estomac pastèque : une cause rare d'anémie ferriprive, de traitement chirurgical; un nouveau cas et revue de la littérature.

The authors report a new case of water-melon stomach, without portal hypertension, and responsible for a iron deficiency anemia cured by antrectomy. Water-melon stomach is a particular form of gastric antral vascular ectasia, characterized by a specific and striking endoscopic aspect. The diagnostic, histologic, pathogenic and therapeutic aspects are reviewed.

Laparoscopic splenectomy for benign and malignant hematologic diseases: 35 consecutive cases.

The feasibility and safety of laparoscopic splenectomy (LS) has been shown for a variety of diseases with small or moderately enlarged spleens. Immune thrombocytopenic purpura thus has become the typical indication for LS, although few data are available to demonstrate any superiority of the laparoscopic approach over conventional surgery for this indication. We retrospectively analyzed 35 cases of LS for benign (22 patients) or malignant (13 patients) hematologic disorders. LS was attempted irrespective of the volume of the spleen. The overall operative mortality rate was 2.9%, and complications occurred in 23% of all patients. The conversion rate was 9%, and accessory spleens were found in 17% of patients. Although the patients with malignant disease were significantly older, were higher operative risks (ASA score), had much larger spleens, and required longer operative times, more conversions to laparotomy, and more blood transfusions than patients with benign disease, their mortality and complication rates and the duration of their hospital stays were not significantly different from those with benign disease. They also compare favorably with the results of conventional surgery for the same indications. Patient selection, operative technique, and outcome of laparoscopic and conventional splenectomy are discussed with regard to the literature. Although the experience with LS for these indications is still limited, the reported results indicate that LS may be as beneficial for patients with malignant as for those with benign hematologic conditions.

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients.

BACKGROUND/AIMS: Evaluation of the feasibility and results of the one-stage treatment combining routine intraoperative cholangiography and laparoscopic common bile duct exploration for choledocholithiasis. PATIENTS AND METHODS: Multicentric (5 centers-9 surgeons) prospective study in 247 consecutive patients (mean age 68 years; range 21-92) during a 50-month period (November 1991-December 1995). Laparoscopic treatment of choledocholithiasis was attempted irrespective of the circumstances leading to the diagnosis of biliary lithiasis or the preoperative suspicion of choledocholithiasis. RESULTS: One out of four patients (n = 61) had unsuspected choledocholithiasis disclosed by routine intraoperative cholangiography. A laparoscopic complete clearance of choledocholithiasis was achieved in 208 of 236 attempted cases (88%), with either transcystic duct extraction (n = 116) or choledochotomy (n = 92). Open surgery was required in 20 patients for failure of laparoscopic treatment and in 3 patients despite successful extraction. Twenty-one of 25 patients (84%) referred for failure of retrograde endoscopic stone extraction had successful laparoscopic choledocholithiasis clearance. The mean duration for the laparoscopic transcystic approach and choledochotomy were 108 min (range 50-300) and 173 min (range 70-480), respectively. Eleven patients had retained stones (4.4%). Minor and major complications were recorded in 9 and 22 patients respectively. The operative mortality was 0.4% (95% confidence interval: 0-1.2%). CONCLUSION: Intraoperative cholangiography during laparoscopic cholecystectomy and laparoscopic common bile duct exploration when required should be considered as the simplest and most efficient treatment for choledocholithiasis. The multicenter character of this study including consecutive patients from public and private practices, strengthens our conclusions and is consistent with a wide diffusion of this diagnostic and therapeutic strategy.

Tolerance of laparoscopy for resection of phaeochromocytoma.

We describe two patients who underwent resection of phaeochromocytoma by a laparoscopic approach. Although outcome from surgery was successful, there was marked variability in hormonal and haemodynamic changes. In one patient, despite an infusion of nicardipine, peritoneal insufflation produced a marked increase in catecholamine concentrations associated with transient but intense vasoconstriction, but there was no change in the second patient. In both patients, exsufflation caused no significant haemodynamic changes in spite of the high doses of nicardipine given throughout the procedures.

[Treatment of common bile duct lithiasis under laparoscopy. A prospective multicenter study in 189 patients]. / Traitement de la lithiase de la voie biliaire principale sous laparoscopie.

OBJECTIVES: The aim of this study was to assess the feasibility and results of common bile duct laparoscopic treatment and exploration in patients with choledocholithiasis. PATIENTS AND METHODS: From November 1991 to December 1994, 189 consecutive malades (120 females; mean age 68 years, range: 21-92) with choledocholithiasis identified during routine intraoperative cholangiogram underwent surgical exploration of common bile duct in 5 surgical centers. Twenty patients were referred to surgery after unsuccessful endoscopic sphincterotomy. RESULTS: Following laparoscopic exploration and intraoperative cholangiography, common bile duct stone extraction by laparoscopy was not attempted in 11 patients (5.8%). The common bile duct was successfully cleared of all stones in 153 patients (81% of the overall population and 86% of laparoscopic attempts), either via the transcystic route (n = 97) or through choledocotomy (n = 56). Eighteen patients required conversion to open surgery, 16 for unsuccessful stone extraction and 2 despite successful stone extraction. Postoperative endoscopic sphincterotomy was required in 7 patients (4.4%) for retained stones after laparoscopic treatment. There were no postoperative deaths (95% confidence interval 0-1.6%), and follow-up, ranging from 3 to 42 months, has shown no further clinical evidence of retained stones. CONCLUSION: Diagnosis and treatment of common bile duct stones is feasible by laparoscopy, and the results in this series compare favorably with those of conventional surgical treatment. Complete treatment of biliary lithiasis, in one operation, avoids the pitfalls of patient selection for preoperative endoscopic retrograde cholangiography and the risks of endoscopic sphincterotomy.