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Aim of the Study: To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele., Patients and Methods: Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series., Results: The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients., Conclusion: The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.

Study Aim: Study of clinical, diagnostic and therapeutic aspects of mesenteric and mesocolic cystic lymphangiomas., Material and Methods: 15 cases were retrospectively analysed: 5 adults (mean age 36.8 years, range 26 to 46) and 10 children (mean age 23 months, range 0 to 5 years). Diagnosis was prenatal in 1 case. Symptoms were: abdominal pain (80%), fever (20%), abdominal mass (46%), occlusive syndrome (33%), chylous ascitis 1 case. Tumours were mesenteric (86%) or mesocolic (13%)., Results: Complete resection was performed in 11 cases (including 10 bowel resections), incomplete resections in 3 and doxycycline sclerotherapy once. Mean follow-up is 5 years. One recurrence occurred 6 years after complete resection and 1 tumour increased after incomplete resection. Patient treated by sclerotherapy was non symptomatic with a 3.5 years follow-up after last injection., Conclusion: Mesenteric and mesocolic cystic lymphangiomas are congenital benign tumours. Complete resection should be performed whenever possible. Intracystic sclerotherapy with doxycyclin is possible for unresectable lymphangiomas.

Purpose: The aim of this retrospective study is to present the results of a large homogeneous series of laparoscopic appendicectomy. Special attention is drawn to the reasons for conversion and postoperative complications., Methods: From May 1990 to December 1997, 906 patients were operated by laparoscopy for acute appendicitis, by one surgeon, using the same technique. Acute peritonitis and abscesses were found in 63 patients., Results: There was no post-operative mortality. The overall conversion rate was 2.3 per cent, but was 25 per cent for abscesses with severe inflammatory adhesions, and 0 per cent for diffuse peritonitis. Post-operative complications were more frequent in the early period. The overall morbidity rate was 0.1 per cent, including essentially intraabdominal abscesses., Conclusion: A recent critical review of twelve randomized controlled trials on laparoscopic appendicectomy failed to draw any definitive conclusion because of a statistical lack of power. The present study with a large number of patients shows that laparoscopic treatment is safe. The limit of the method essentially concerns abscesses with sclerous inflammation.

Purpose: To evaluate the use of Magnetic Resonance Imaging (MRI) for the treatment of problematical anal fistulas and follow-up of cases treated by long-term seton drainage with two or three-stage fistulotomy., Method: prospective study on 24 patients with surgical treatment between July 1993 and March 1995 selected for MRI among 100 anal suppurations according to following criteria: high trans-sphincteric or supra-sphincteric fistula with one or more previous definitive attempts at treatment (15), and/or severe anal or rectal fibrosis (11). Patients with Crohn's disease were not included. For 14 of these patients who had a long-term seton drainage, MRI tried to assess the quality of the surgical drainage and the course of residual abscess., Results: the overall accuracy of MRI for visualization of internal opening, primary and secondary tract was 84% when compared with surgical data. The sensitivity and specificity were 100% for the detection of horse shoe fistulous tracts (8). For the 14 patients followed by MRI, only one false positive was noted and in 5 cases the results of MRI modified the previous staged procedure (prolonged seton drainage or new excision). For the 20 patients treated for more than 6 months, the mean follow-up was 18 months and median was 14 months. Only one recurrence was noted with no loss of follow-up., Conclusion: this study confirms the high degree of accuracy of MRI for mapping of high complex fistula in ano. MRI is very helpful for the survey of healing in cases treated with seton drainage and two or three stage fistulotomy to preserve continence.