Pierre Orsoni

Sacral Nerve Stimulation can Improve Continence in Patients with Crohn’s Disease with Internal and External Anal Sphincter Disruption

PurposeSacral nerve stimulation is a technique commonly used for the treatment of idiopathic incontinence. This study was designed to assess the efficiency of sacral nerve stimulation as a means of treating fecal incontinence in patients with Crohn’s disease with disrupted internal and external anal sphincters.MethodsFive patients (3 women) with fecal incontinence suffering from Crohn’s disease-related anoperineal lesions were treated by applying three weeks of sacral nerve stimulation and then by permanent sacral nerve stimulation implantation. Endoanal ultrasonography showed that all of these patients had disrupted external and internal anal sphincters.ResultsContinence was improved in all treated patients. The median follow-up time was 14 (range, 3–36) months. At the end of the follow-up period, the median Wexner’s score significantly improved from 15 to 6 and the median number of daily stools decreased from 7 to 2. The patients’ quality of life also increased significantly.ConclusionsSacral nerve stimulation improves fecal continence in patients suffering from Crohn’s anoperineal lesions with internal and external anal sphincters disruption.

Mid-Term Functional Outcome of Laparoscopic Restorative Proctocolectomy: A Prospective Study of 40 Consecutive Cases

INTRODUCTION This prospective study aimed to analyze the functional outcome after a two-stage laparoscopic total proctocolectomy with ileal pouch-anal anastomosis. MATERIALS AND METHODS From May 1999 to May 2008, 68 consecutive two-stage laparoscopic total proctocolectomies with ileal pouch-anal anastomosis were performed (ulcerative colitis: n = 61; familial adenomatous polyposis: n = 7). A covering ileostomy was used in all patients. Forty patients whose covering ileostomy had been closed for a minimum of 2 years were included in this series. RESULTS Conversion to laparotomy was necessary in 4 of 40 patients (10%). Thirteen postoperative complications occurred in 13 of 40 patients (30%). At a median follow-up of 38 months (range, 26-90), the median number of bowel movements was 4 per 24 hours (range, 2-10); 15 patients (38%) had no nighttime bowel movements. None of the patients had fecal incontinence or urgency. Thirty-four of the 40 patients (85%) experienced no soiling. Seven patients (18%) took regular antidiarrheal medication. All patients were able to resume all activities practiced prior to illness onset, and 36 of 40 (90%) were satisfied with their overall quality of life (very good or good). CONCLUSION Laparoscopic total proctocolectomy with ileal pouch-anal anastomosis provides satisfying mid-term functional outcome.

Fundoplicature postérieure cœlioscopique pour reflux gastro-œsophagien : résultats à moyen terme

STUDY AIM: The aim of this study was to report the mid-term results of the surgical management of gastroesophageal reflux disease (GERD) by laparoscopic posterior partial fundoplication (Toupet technique) in 100 patients, and to evaluate their post-operative quality of life. PATIENTS AND METHOD: Between November 1993 and January 2000, 100 patients were surgically treated for a medically refractory GERD. Laparoscopic posterior partial fundoplication was performed by the Toupet technique. In the postoperative period, the patients were asked to answer a questionnaire by telephone. The aim of this survey was three-fold: to identify clinical symptoms indicative of recurrence; to evaluate postoperative functional impairment; to assess the postoperative quality of life. pH monitoring was also proposed in asymptomatic patients at a minimum follow-up of two years, and in all patients with clinical symptoms of GERD recurrence. RESULTS: Six laparotomy conversions were necessary. The mean duration of follow-up was 18 months (range: 6 to 57 months). The rate of clinically diagnosed recurrence was 7.6%. Intermittent dysphagia was observed in 2.3% of cases. Postoperative digestive functional disorders were noted in 53% of patients without clinical recurrence, and 95.3% of them were satisfied or very satisfied with the results of surgery. CONCLUSION: Laparoscopic posterior partial fundoplication by the Toupet technique can satisfactorily treat GERD without mid-term recurrence in about 94% of cases. Patient satisfaction seems mainly to depend on the disappearance of clinical symptoms of GERD. It was found that postoperative functional disorders frequently occurred, but were well tolerated. Their etiology has not yet been determined, and it is considered that factors other than the surgical procedure may also play a role.

Coloproctectomie totale avec anastomose iléoanale vidéoassistée

Resume Les progres de l’instrumentation et la diffusion des techniques permettent l’extension des indications de la laparoscopie en chirurgie digestive. Les interventions complexes comme la coloproctectomie totale avec anastomose ileoanale necessitent outre une maitrise technique, la mise au point de tactiques operatoires specifiques a la laparoscopie. Le but de ce travail etait de rapporter notre experience technique de la coloproctectomie totale avec anastomose ileoanale videoassistee.The indication for laparoscopy in digestive surgery has evolved with the development of the laparoscopic material as well its increasingly frequent practice in the medical community. Those complex operations such as restorative proctocolectomy require a high level of technical skill as well as a specifically designed operative approach. The study aim was to report our experience of the video-assisted approach to restorative proctocolectomy.