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Resume But de l'etude. – Etudier l'efficacite a long terme du traitement laparoscopique du reflux gastro-œsophagien. Patients et methodes. – Entre le 1er janvier 1992 et le 31 decembre 1996, 161 patients etaient operes pour un reflux gastro-œsophagien (RGO) par une fundoplicature laparoscopique complete ou partielle ; les techniques utilisees etaient la fundoplicature complete de Nissen-Rossetti (123 cas) ou de Nissen (26 cas) et la fundoplicature partielle de type Toupet (12 cas) ; le recul minimal etait de cinq ans. Cent quarante et un patients ont ete suivis a trois mois, deux ans et cinq ans ; il y avait quatre deces de causes non reliees a la chirurgie et 16 perdus de vue (10 %). Une pHmetrie et une manometrie ont ete realisees en preoperatoire et a trois mois de distance. A deux ans et a cinq ans la reevaluation etait realisee par un questionnaire telephonique. Resultats. – La mortalite postoperatoire etait nulle, la morbidite de 1,2 % et le taux de conversion de 5 %. La dysphagie postoperatoire etait de 23,4 % a trois mois et de 12 % a cinq ans. Les recidives a cinq ans etaient de 12 %. Conclusion. – Le taux global de satisfaction subjective etait de 91,4 % a cinq ans. L'intervention de Nissen-Rossetti enregistre les meilleurs resultats a cinq ans, en terme de dysphagie postoperatoire et de recidive.

Pseudomyxoma peritonei is a rare disease, usually diagnosed after the discover of "jelly belly" by laparotomy. With the progress of immunohistochemistry, most authors now acknowledge the appendix to be the principal origin of this disease. Pseudomyxoma peritonei need to considered as border line malignant disease because of its inevitable persistence and progression without adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) into specialized centres. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade.

Resume Objectif. – L’anastomose transsuturaire facilite le retablissement de la continuite digestive au fond du pelvis, mais represente une anastomose a risque. Le but de l’etude etait l’evaluation de ce risque en termes de resultats immediats et de recidive tumorale dans le cadre du traitement des cancers du rectum. Patients et methode. – Les dossiers de 301 patients operes consecutivement selon cette technique entre 1980 et 2000 ont ete analyses retrospectivement afin d’analyser les indications operatoires, l’intervention et les complications peroperatoires, les complications postoperatoires immediates et le taux de recidive. Resultats. – Parmi les 301 patients (192 hommes et 109 femmes), d’un age median de 66 ans, seuls 19 (6,3 %) ont ete operes en urgence pour occlusion. Il s’agissait d’un adenocarcinome du rectum situe dans le haut rectum dans 132 cas (43,8 %), dans le moyen rectum dans 141 cas (46,8 %) et dans le bas rectum dans 19 cas (9,4 %). Une radiotherapie preoperatoire etait realisee dans 148 cas (49 %), avec une dose de 30 Grays (Gy) entre 1987 et 1996, de 39 Gy ensuite et de 45 Gy dans 12 cas. A partir de 1990, 113 patients ont eu une chimiotherapie adjuvante pour des tumeurs de stade III et IV et quelques cas particuliers de stade II. La resection laissait une marge de securite sous la tumeur de moins de 2 cm dans 59 cas (19,6 %) et l’anastomose siegeait a 5 cm et moins de la marge anale dans 178 cas (59 %). Une stomie de derivation etait associee dans 39 cas (13 %). Un defaut de l’anastomose etait note pendant l'intervention dans 18 cas (6 %) et 23 fistules sont survenues dans les suites operatoires (7,6 %), significativement associees au niveau de l’anastomose par rapport a la marge anale ( p = 0,0009). La mortalite hospitaliere etait de 8 cas (2,6 %). Les stenoses etaient rares : 11 cas (3,6 %), significativement associees a la realisation d’une radiotherapie preoperatoire ( p = 0,02). Le taux de recidive locale etait de 12 % (37 cas) dans un delai median de 16 mois, essentiellement lie au stade initial du cancer ( p = 0,004). Conclusion. – L’anastomose transsuturaire colorectale apres resection anterieure du rectum pour cancer est une technique sure avec un faible taux de complication et de recidive tumorale, le traitement chirurgical s’inscrivant dans le cadre d’une prise en charge multimodale du cancer.

The aim of this study was to evaluate the long term efficacy of laparoscopic treatment of gastroesophageal reflux disease (GERD).Between 1(st) January 1992 and 31 December 1996, 161 patients underwent complete or partial laparoscopic fundoplication for a symptomatic GERD. One hundred and twenty three patients were submitted to Nissen-Rossetti fundoplication, 26 patients to Nissen fundoplication and 12 patients to a partial posterior Toupet fundoplication.141 patients were evaluated at 3 months, 2-years and 5-years. Since undergoing the operation, four patients died of unrelated causes, 16 patients could not be contacted for follow up (10%). pH monitoring and oesophageal manometry were performed preoperatively and at 3 months postoperatively. The patients were evaluated 2 and 5-years after surgery by specific phone questionnaire.There was no mortality, the morbidity rate was 1.2% and the conversion rate was 5%. Incidence of dysphagia 3 months after surgery was 23.4%, and 5-years after 12%; 12% of patients had recurrent symptoms at 5 years.The overall satisfaction rate at 5 years was 91.4%. Nissen-Rossetti fundoplication seems to have better results at 5-years regarding postoperative dysphagia and symptoms recurrence.

Stapled end to end anastomosis makes the restoration of digestive continuity at the level of lower pelvis easier, but carries a certain risk. The aim of this report was to evaluate this risk in terms of immediate results and tumor recurrence after surgery for rectal cancer.The data of 301 patients operated on following this technique between 1980 and 2000 have been reviewed in order to analyse the tumor characteristics, the operation and associated complications, the immediate postoperative complications and recurrence rate.Among the 301 patients (192 males and 109 females) with median age of 66 years, 19 (6.3%) received an emergency operation due to bowel obstruction. The rectal adenocarcinoma was located in the upper rectum in 132 cases (43.8%), in the middle rectum in 141 cases (46.8%) and in the lower rectum in 19 cases (9.4%). Preoperative radiotherapy was carried out in 148 cases (49%): between 1987 and 1996 with a dose of 30 Grays (Gy), later increased to 39 Gy and 45 Gy in 12 cases. From 1990, 113 patients have received adjuvant chemotherapy for stage III and IV tumors and in some position cases for stage II tumor. The excision left a safety margin under the tumor of less than 2 cm in 59 cases (19.6%), and the anastomosis was located at 5 cm or less from the anal verge in 178 cases (59%). Primary defunctioning stoma was formed in 39 cases (13%). An anastomotic defect was observed during the operation in 18 cases (6%) and 26 fistulas occured postoperatively (7.6%), significantly related to the location of the anastomosis with regard to the anal verge (P = 0.0009). The hospital mortality was 8 cases (2.6%). Cases of stenosis were uncommon : 11 cases (3.6%), significantly associated with preoperative radiotherapy (P =0.02). The local recurrence rate was 12% (37 cases) in a median time delay of 16 months, essentially related to the tumor stage (P = 0.004) and the considered period (P = 0.001).Stapled end-to-end colorectal anastomosis after excision of rectum for cancer is a reliable technique with a low rate of complication and tumor recurrence, when the surgical procedure is included in the curative therapy management of cancer.

Pseudomyxoma peritonei is a rare disease, usually diagnosed after the discover of "jelly belly" by laparotomy. With the progress of immunohistochemistry, most authors now acknowledge the appendix to be the principal origin of this disease. Pseudomyxoma peritonei need to considered as border line malignant disease because of its inevitable persistence and progression without adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) into specialized centres. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade.