Khalil Aouad

Elective laparoscopic-assisted colectomy for diverticular disease : A prospective study in 50 patients

AbstractBackground: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question, we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid colon for diverticular disease. Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn anastomosis. Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280 min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days. Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.

Carcinome sarcomatoïde du côlon : présentation d’un cas et revue de la littérature

Resume Les carcinomes sarcomatoides ou carcinosarcomes sont des tumeurs rares a double composante, carcinomateuse et sarcomateuse. A ce jour, seuls 13 cas d’atteinte colo-rectale ont ete publies. Nous rapportons un cas de carcinome sarcomatoide du colon chez une femme de 67 ans hospitalisee pour anemie et hemorragie digestive. Une hemi-colectomie gauche etait realisee. L’etude immuno-histochimique de la piece operatoire mettait en evidence 2 contingents cellulaires, l’un carcinomateux indifferencie et l’autre sarcomateux, faisant porter le diagnostic de carcinome sarcomatoide. L’evolution etait rapidement defavorable, le deces survenant 2 mois apres la chirurgie initiale. Notre revue de la litterature confirme le mauvais pronostic des carcinomes sarcomatoides coliques.

Parietal mesh abscess as an original presentation of cancer of the caecum.

We report a case of cancer of the caecum in a 71-year-old male who presented with parietal mesh abscess. Two years before, he was treated for a right inguinal hernia by insertion of a Dacron mesh. CT scan then colonoscopy determined the existence of a voluminous caecal tumor perforated in the abdominal wall with an important abscess around the mesh. Right colectomy and parietal muscles excision were performed completed with postoperative radiochemotherapy. At 2 years, there is no evidence of recurrence. Atypical features with a hernia mesh repair associated with a sudden change in the patient’s condition should alert the clinician to the possibility of a further subjacent pathological process.