Gracilis muscle transposition in the treatment of faecal incontinence.

Between 1965 and 1994 eight selected patients with faecal incontinence for solid stool (Grade 4) were operated on by the original procedure described by Pickrell (1952), combined with biofeedback training postoperatively. No postoperative complication occurred. All patients were improved by this procedure. Five had normal continence and there were 3 incontinence for flatus. Anal manometry showed an increase in postoperative squeeze pressure (p < 0.05). Long term results (48.5 months) remained the same in five cases. One patient became incontinent following an anal dilatation at 108 months, and two required excision of mucosal ectropion at 7 and 78 months with restoration of continence. One patient died of unrelated disease at 31 months.

[Result of surgical treatment of exteriorized rectal prolapse in adults. Experience of 21 years]. / Résultats du traitement chirurgical du prolapsus rectal extériorisé de l'adulte. Une expérience de 21 ans.

Between 1971 and 1992, 89 patients (57 women, 32 men; mean age: 61 years) underwent surgical treatment for total rectal prolapse. 68.5% were constipated, and 12.3% had a solitary rectal ulcer, 46% were incontinent (3 grades 2, 11 grades 3, 27 grades 4). Twelve patients (21%) had been previously, but unsuccessfully operated. Manometry showed low resting pressures in the upper part of the anal canal, particularly in incontinent patients. Voluntary contraction was lower in incontinent patients. The resting anorectal angle was obtuse (113 degrees). Orr-Loygue operation (n = 53), modified rectopexy (n = 22), rectopexy to the left inguinal ligament (n = 6), Delorme operation (n = 4), and posterior rectopexy (n = 4) were performed. There was no operative mortality. Intraoperative and postoperative morbidity rates were 3.4% (n = 3) and 29%. Rectal prolapse recurred in 3 cases (3.4%). Solitary rectal ulcer healed in all patients. Only 8 patients were incontinent after operation, but control was better in 6 cases; in other both patients, preoperative electromyography showed grade III denervation. Bowel habit was postoperatively better (68.5% of patients were constipated before operation, 51.7% after operation). Resting pressures increased in preoperatively incontinent patients in the upper part of the anal canal; resting external sphincter pressures always increased. There was no change in the resting anorectal angle (112 degrees).

Major pulmonary resection by video assisted mini-thoracotomy. Initial experience in 35 patients.

Video-assisted thoracic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. From February to July 1993, 35 patients (25 male, 10 female; mean age = 60 years, range: 17-74) underwent a major pulmonary resection using a video-assisted technique: lobectomy (n = 30) or pneumonectomy (n = 5). Pathology disclosed bronchogenic carcinomas (n = 26), metastases (n = 3), and miscellaneous disorders (n = 6). All procedures required one 10.5 mm port for the video-camera, one 3.5 to 5 cm utility thoracotomy through which surgical instrumentation was inserted and the operative specimen removed, and one occasional supplementary 12 mm port. Lung resections were performed with separated dissection and division of each component of the pedicle. The mean operative time was 145 min (SD: +/- 17). There were two postoperative deaths (5.7%) that were not directly related to the technique. Seven patients (20%) experienced non-fatal complications. After lobectomy, the mean duration of chest tube placement was 7.3 days (SD: +/- 1.6). The mean hospital stay was 11 days (SD: +/- 3). All the patients experienced minor postoperative chest pain. We conclude that video-assisted lung resections are technically feasible without an increased risk.