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Metastases to the penis from rectocolic adenocarcinoma are extremely uncommon with 50 cases reported; the diagnosis is often delayed and the prognosis is very poor. The choice between an aggressive surgical approach and a palliative treatment is difficult, but surgery seems to give the best results in limited penile lesions. The authors report a case of metastatic involvement of the penis by a recurrent rectocolic adenocarcinoma in a 42 year old patient. A MR scan was performed before surgical treatment of both lesions.

Laparoscopic intestinal anastomosis is not very reliable and needs to be evaluate in an experimental model in animals before being performed in man. The purpose of this study was to evaluate the feasibility, efficacy and safety of manual anastomosis comparatively to the standard stapling suture. Twenty female pigs weighing 20 +/- 5 kg. were used for this study. A 5 cm ileal segment resection was performed under laparoscopy. The animals were assigned to 2 groups. Group I: 10 animals underwent end-to-end hand-swen anastomosis with Polyglactin 910, dec 1.5. Group II: 10 animals underwent side-to-side anastomosis using the Endo stapler. Operating time and anastomosis time were compared using the Mann-Whitney test for statistical analysis. On the 15th postoperative day, the animals were sacrificed and the anastomoses were evaluated. There was no operating death in the 2 groups. The operative time was significantly longer in group I than in group II (p < 0.01), with 180 +/- 40 min vs 49 +/- 25 min respectively. This difference was due to the anastomosis time of 130 +/- 40 min vs 16 +/- 6 min respectively (p < 0.01). There was 1 postoperative death related to fistula and peritonitis in group I and none in group II. The post-operative follow-ing showed 5 anastomotic leakages (4 in group I and 1 in group II) and 2 relative stenoses in group I. This study shows the simplicity and rapidity of performing stapling intestinal anastomosis under laparoscopy. Hand-sewn anastomosis is technically more difficult to perform under laparoscopy and requires a greater experience.

In a study including 392 patients we compared two groups of patients according to the indication for laparoscopic cholecystectomy: group I: 293 patients treated for simple cholelithiasis (n = 291) or gallbladder polyps (n = 2). Group II: 99 patients operated for complicated cholelithiasis. For each patient, 14 pre, intra and postoperative parameters were analysed and compared. Mean operative time was 80 minutes. Primary and secondary laparotomies were necessary in 5.8% and 1.3% of cases respectively. Biliary injury was the most frequent complication (1.3%). Mean hospital stay was 4.5 days. In terms of mean age, operative time, intraoperative incidents and complications, and primary laparotomy. There was a significant difference between the two groups (p less than 0.001). There were 4 secondary laparotomies in group II and one in group I. These results suggests that laparoscopic cholecystectomy is a safe technique with a low mortality rate (0.25%). The comparative study proves that this technique, first indicated for simple cholelithiasis, is also applicable to the majority of complicated cholelithiasis.

Between 1984 and 1989, 30 patients underwent total coloproctectomy with J ileal pouch and ileo-anal anastomosis. They corresponded to 29 cases of ulcerative colitis and one case of familial polyposis. The authors report their own experience and the related morbidity and functional results. There were 23% fistulae, 6.6% pouchitis, 10% stenoses, 8.7% pelvic abscesses, 10% bowel obstructions, 6.6% fistulae after ileostomy closure. Only one pouch had to be removed for severe pouchitis. Functional results were partly related to post-operative complications: 50% of patients had normal continence, 57% at least 6 stools per day, 81% had one stool per night, 15% had soiling. Morbidity is discussed for the various types of complications.