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La faisabilite de la splenectomie par laparoscopie (SL) n'est plus a demontrer Les donnees quant a son efficacite a long terme chez les patients ayant un purpura thrombocytopenique idiopathique (PTI) sont rares. L'objectif de cette etude a ete de determiner retrospectivement l'efficacite immediate et les resultats a long terme d'un procede de splenectomie standardise chez le patient presentant un PTI resistant au traitement medical. La SL a ete realisee chez 35 patients pour PTI entre mai 1993 et mai 1998. Une approche laterale a ete utilisee chez les 27 derniers patients. Les donnees ont ete enregistrees retrospectivement chez ces derniers. Vingt-six patients (96%) ont eu une SL avec succes. La duree operatoire moyenne pour la SL a ete de 90 minutes. Il n'y avait aucune mortalite postoperatoire. On a enregistre trois complications postoperatoires. La PTI a regresse chez 93% des patients, mais sept patients (25%) ont eu une recidive pendant une moyenne de 28 mois de suivi. A present, aucun de ces patients n'a besoin de traitement medical pour maintenir son taux de plaquettes a la normale. La SL est faisable et sure chez les patients ayant un PTI. Les resultats a long terme de la SL pour PTI sont comparables a ceux obtenus pour la splenectomie a ciel ouvert.

This is a retrospective study on 128 patients who underwent surgery between 1986 and 1996 for incisional hernia repair with placement of an intraperitoneal prosthesis. A polyester mesh (Mersilene®) was used in 95 cases (74.2%) and one of PTFE in 33 cases (25.8%). Mortality was 2.34% (3 patients); 32 patients (25.6%) developed an early postsurgical complication. Overall morbidity was 3.9% (3 cases of postoperative pneumonopathy, one case of decompensated asthma, and one of sural vein phlebitis). Three (2.34%) early intra-abdominal complications occurred, manifest as an intestinal obstruction or postsurgical ileus. Seven patients (5.6%) developed a non-infectious abdominal wall complication, and 17 (13.6%) experienced an infectious abdominal wall complication which in 5 cases (29.4%) required surgery with removal of the prosthesis in 3 cases (60%). One patient (0.78%) developed a late small intestine obstruction, 18 months after the incisional hernia repair. Twenty patients (16%) had a recurrence and 22 (17.6%) complained of abdominal wall pain at an interval after the operation. The investigators concluded that placement of an intraperitoneal prosthesis should be reserved only for those cases in whom placement of an extraperitoneal prosthesis cannot be performed.

Obturator hernias comprise a rare group of abdominal hernias. They are often diagnosed when the small bowel has become obstructed and the patients are operated on without the causes of the obstruction being known. Although many techniques for closure of the defect are available, there is no agreement at the present time as to which is the procedure of choice.

es pseudomyxomes peritoneaux ou « maladies gelatineuses » du peritoine sont des maladies rares, definies par la presence d’une abondante substance gelatineuse dans l’abdomen secondaire a la rupture d’une lesion mucineuse appendiculaire dont l’aspect macroscopique kystique est la mucocele. L’analyse histologique permet de distinguer l’adenomucinose peritoneale diffuse (AMPD), forme d’evolution relativement benigne, des formes malignes ou carcinomatoses peritoneales mucineuses (CMP) d’evolution gravissime. Lors du diagnostic, le pseudomyxome peritoneal est generalement diffus, dissemine dans l’ensemble de la cavite peritoneale. Notre observation presente un cas de pseudomyxome peritoneal, detecte precocement en regard d’une mucocele appendiculaire rompue et localisee au cul de sac de Douglas.

Solitary rectal ulcer syndrome (SRUS) is an infrequent pathology often associated with pelvic floor disorders. The aim of this retrospective study was to review the long-term results of a surgical series of SRUS. Between 1988 and 1998, 13 patients were operated on for SRUS. Seven patients had associated internal rectal prolapse (58%), two had associated total rectal prolapse (15%), and two had associated mucosal prolapse (15%). We performed simple resection of the SRUS in one case (8%), a stoma as primary operation in one (8%), three rectopexies according to Orr-Loygue (23%), and eight Delorme's operations as modified by Berman (62%). Mean follow-up was 57 months (range 15-112). Simple resection of the solitary rectal ulcer syndrome did not improve symptoms. Colostomy permitted relief of symptoms and healing of the SRUS. Two of the three rectopexies achieved good results, and the third patient relapsed at the 6th postoperative month. A secondary modified Delorme's operation permitted relief of symptoms and healing of the SRUS. Five of the eight patients (62.5%) who received modified Delorme's operations had improved at a follow-up of 46 months. We conclude that, considering the high failure rate after surgery, operations should be performed only in patients with total rectal prolapse or intractable symptoms not amenable to behavioral therapy. Delorme's operation and abdominal rectopexy help in about 60% of cases.

The first case of early-onset postsplenectomy arthritis due to intermediately penicillin-resistant Streptococcus pneumoniae is reported. After initial parenteral vancomycin and rifampin followed by oral prystinamycin-rifampin, the patient recovered without any sequelae. This case should increase awareness of the risk of invasive disease caused by penicillin-resistant Streptococcus pneumoniae in the early postoperative period after splenectomy.