[Impact of obesity on postoperative results of elective laparoscopic colectomy in sigmoid diverticulitis: a prospective study]. / Incidence de l'obésité sur les résultats postopératoires de la colectomie laparoscopique élective pour sigmoïdite diverticulaire: étude prospective.

STUDY AIM: The aim of this prospective study was to assess the outcome of laparoscopic colectomy for sigmoid diverticulitis in normal weighted, overweighted and obese patients. PATIENTS AND METHOD: From January 1995 to December 2000, all patients (n = 77) undergoing an elective colectomy for sigmoid diverticulitis were included in the study. The patients were divided into three groups: group 1 (n = 29): normal weighted patients (BMI: 18-24.9); group 2 (n = 27): overweighted patients (BMI: 25.0-29.9); group 3 (n = 21): obese patients (BMI: 30.0-39.9). Comparison between these three groups was only made during the per and postoperative period. RESULTS: There were no differences in the three groups with regard to age, sex and ASA classification. Duration of operation did not differ between group 1 and 2 (187 vs 210 min, P = 0.6) but was shorter in group 1 than in group 3 (187 vs 247 min, P = 0.003). Conversion rate did not differ and was respectively in group 1, 2 and 3: 13.8, 14.8 and 14.3%. The postoperative period during which parenteral analgesics were required was not different for group 1 and 2 but was longer in group 3 than in group 1 (8.5 vs 5.7 days, p = 0.03). Morbidity rate was similar in group 1, 2 and 3: 15, 14 and 17%. There was no perioperative mortality. Duration of hospital stay was similar in the three groups. CONCLUSION: Data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to overweighted and obese patients.

Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis.

BACKGROUND: The aim of this prospective study was to compare the outcome of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis versus those with chronic cholecystitis and to determine the optimal timing for LC in patients with acute cholecystitis. METHODS: From January 1991 to July 1998, 796 patients (542 women and 254 men) underwent LC. In 132 patients (67 women and 65 men), acute cholecystitis was confirmed via histopathological examination. These patients were divided into two groups. Group 1 (n = 85) had an LC prior to 3 days after the onset of the symptoms of acute cholecystitis, and group 2 (n = 47) had an LC after 3 days. RESULTS: There were no mortalities. The conversion rates were 38.6% in acute cholecystitis and 9.6% in chronic cholecystitis (p<10(-8)). Length of surgery (150.3 min vs. 107.8 min; p<10(-9)), postoperative morbidity (15% vs. 6.6%; p = 0.001), and postoperative length of stay (7.9 days vs. 5 days; p< 10(-9)) were significantly different between LC for acute cholecystitis and elective LC. For acute cholecystitis, we found a statistical difference between the successful group and the conversion group in terms of length of surgery and postoperative stay. The conversion rates in patients operated on before and after 3 days following the onset of symptoms were 27% and 59.5%, respectively (p = 0.0002). There was no statistical difference between early and delayed surgery in terms of operative time and postoperative complications. However, total hospital stay was significantly shorter for group 1. CONCLUSIONS: LC for acute cholecystitis is a safe procedure with a shorter postoperative stay, lower morbidity, and less mortality than open surgery. LC should be carried out as soon as the diagnosis of acute cholecystitis is established and preferably before 3 days following the onset of symptoms. Early laparoscopic cholecystectomy can reduce both the conversion rate and the total hospital stay as medical and economic benefits.

[Laparoscopic cholecystectomy after age 75]. / Cholécystectomie coelioscopique après 75 ans.

AIM OF THE STUDY: The aim of this prospective study was to determine the feasibility, complications and benefits of laparoscopic cholecystectomy in the patients over 75 years of age. METHODS: From January 1992 to July 1998, among the 863 patients who underwent laparoscopic cholecystectomy, 102 patients over 75 years (group I) were compared to 761 younger patients (group II). RESULTS: The conversion rate was 22% in group I versus 13% in group II (P = 0.017). Mortality and morbidity rates were respectively 1% and 13.7% in elderly patients versus 0 and 6.6% in younger patients (P = 0.009). Mean length of hospital stay was higher in group I: 6.9 versus 4.5 d in group II (P < 10(-6)). CONCLUSIONS: Laparoscopic cholecystectomy is feasible in patients above 75 for the treatment of symptomatic gallstones and acute cholecystitis with a low morbidity rate.

[Surgical treatment of pancreatic enzyme serous effusions]. / Le traitement chirurgical des épanchements séreux enzymatiques d'origine pancréatique.

UNLABELLED: Enzymatic seritis is a rare complication of chronic pancreatitis. Thirty-four cases are analyzed from a series of 200 cases of operated chronic pancreatitis: 22 pleural effusions, 5 ascites and 7 combined effusions. The pancreatic leak was demonstrated preoperatively in 40% of cases. The leak originated from erosion of a pancreatic duct in 7 cases and leaking pseudocyst in 27 cases. All patients were operated: internal drainage (22 cases), left splenopancreatectomy (7 cases) and external drainage (5 cases). Postoperative mortality was 9% (n = 3); postoperative morbidity was 15% (n = 5). The effusion did not recur in any of the survivors, but repeat surgery for chronic pancreatitis complications was necessary in 7 patients (20.5%). CONCLUSION: after failure of medical treatment, the treatment of large serous effusions is surgical: internal drainage or pancreatic resection when the lesion is located in the tail of the pancreas.

[Prognostic factors of survival without clinical recurrences in medullary thyroid carcinoma: apropos of 52 operated cases]. / Facteurs pronostiques de survie sans récidive clinique dans les cancers médullaires du corps thyroïde: à propos de 52 cas opérés.

The aim of this retrospective study on 52 operated medullary thyroid carcinoma (MTC) was to assess clinical and biochemical factors influencing survival without clinical recidive. There were 52% of familial cases. Mean age was 44 years (3 to 78 years) with 58% of women. The diagnostic was made prostoperatively in 38% of case (nodular specimen), when it was strongly suspected for 50% of patients before intervention (familial context, and/or preoperative Calcitonin (CT) levels, and/or mutation). The medial survival rate was 54 month (3 to 360 month). The absence of postoperative negativation of the CT (between 1 to 3 month) was meeting in 43% of case. Twenty one patients (42%) had presented one or several clinical relapse. At the end of the study, five patients were died in a postoperative time-limit of 22 to 110 month. The different parameters studed were: the sex, the age, the tumoral stage, the familial cases, the tum-oral size, the calcitonin levels normalisation in the three month postoperatively, and the local nodes extent. The 5-year survival rate was 90%, and the 10-year survival was 80%. The familial cases had a better pronostic than the sporadic (no death in the familial group versus 80% of 5-year survival rate in the sporadic cases). In univariate analysis, the good survival-factors without clinical recidive were: the stage I or II (p < 0,0001), the female sex (p = 0,02), the tumoral size under 10 mm (p < 0,02), the postoperative negativation of CT levels (p < 0, 0002), and the absence of cervical node extent (p < 0,0005). In multivariate analysis, only the postoperative negativation of CT-levels was a good survival-factor without clinical relapse (p < 0, 001).

[Role of subtotal/total colectomy in emergency treatment of occlusive cancer of the left colon]. / Place de la colectomie subtotale/totale dans le traitement en urgence des cancers occlusifs du côlon gauche.

PURPOSE: The aim of this study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion. METHODS: STC was performed in 60 consecutive patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation. RESULTS: Postoperative mortality was 6.6% (n = 4): 3 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications; an 83 year-old female died as a result of an anastomotic dehiscence. Morbidity was 10% (n = 6) including one fistula which recovered without surgery. There were 5 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC. CONCLUSION: Emergency STC achieves one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes a possible synchronous carcinoma.

[Pancreatojejunal or pancreatogastric anastomosis after cephalic duodenopancreatectomy. A comparative retrospective study]. / Anastomose pancréatojéjunale ou pancréatogastrique après duodénopancréatectomie céphalique. Etude comparative rétrospective.

AIM OF THE STUDY: The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatico-duodenectomy. PATIENTS AND METHODS: From January 1980 to June 1995, 171 patients underwent pancreatico-duodenectomy, 136 for pancreas, ampulla, distal bile duct or duodenum cancers, and 36 for chronic pancreatitis. Pancreatic anastomosis was realised by pancreatico-jejunostomy in 91 cases and by pancreatico-gastrostomy in 80 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups concerned mainly postoperative mortality and morbidity. RESULTS: The overall postoperative mortality rate was significantly higher in the pancreatico-jejunostomy group (12%) than in the pancreatico-gastrostomy group (3.7%) (P = 0.05); death was directly related to necrosis of the remnant pancreas in four cases among the 14 postoperative deaths. The postoperative morbidity rate was respectively 23% after pancreatico-jejunostomy and 12.5% after pancreatico-gastrostomy; the pancreatic leakage and/or necrosis rate was higher in the pancreatico-jejunostomy group (13%) than in the pancreatico-gastrostomy group (3.75%) (P = 0.029). CONCLUSION: This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but these results have to be confirmed or invalidated by a prospective multicentric randomised trial.

[The role of subtotal/total colectomy in the urgent treatment of obstructive cancer of the left colon]. / Place de la colectomie subtotale/totale dans le traitement en urgence des cancers occlusifs du côlon gauche.

PURPOSE: The aim of the study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion. METHODS: STC was performed in 48 patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation. RESULTS: Postoperative mortality was 6.2% (n = 3): 2 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications: an 83 year-old female dies as a result of an anastomotic dehiscence. Morbidity was 12.4% (n = 6) including one fistula which recovered without surgery. There were 4 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC. CONCLUSION: Emergency STC achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes occasional synchronous carcinoma.