Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort

Techniques in Coloproctology - The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. All adult patients treated with SiLaT in our...     

Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

AIM: To confirm that systematic histological study of hemorrhoidectomy specimens is useless, as is proposed by the French Society of Coloproctology (Société Nationale Fran?aise de Colo-Proctologie) under the sponsorship of the French National Health Accreditation and Evaluation Agency (Agence Nationale d'Accréditation et d'Evaluation en Santé). METHODS: Retrospective histological analysis of hemorrhoidectomy specimens obtained in a coloproctology unit between January 1, 1985 and December 31, 2001. RESULTS: We found 56 histological abnormalities (0.69%) among 8153 hemorrhoidectomy specimens considered normal at gross examination, with three cases of intraepithelial neoplasia of the anal canal (0.04%) and four cases of severe dysplasia (0.05%). Specimens associated with anal fissure (N = 906) or suppuration (N = 610) did not display more histological lesions. For all patients, the initial surgical resection prevented recurrence. CONCLUSION: Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive. All operating procedures in proctology should reflect this attitude. It is nevertheless advisable to select for gross and microscopic evaluation any suspicious areas noticed at the preoperative examination or during the procedure.     

The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation

Gallbladder bile collected by duodenal intubation or during surgery was examined microscopically in patients who were free of stones and in patients with proven stones. None of the 16 patients free of stones had cholesterol monohydrate crystals or calcium bilirubinate granules in bile. Among the 17 patients with proven cholelithiasis, 13 with cholesterol stones had cholesterol monohydrate crystals in their bile, but only 2 of the 4 patients with pigment stones had calcium bilirubinate granules. These data confirm that cholesterol monohydrate crystals are sensitive and specific for cholesterol stones, whereas calcium bilirubinate granules lack sensitivity for the diagnosis of pigment stones. From these results, the diagnostic usefulness of microscopic examination of bile collected from the duodenum was studied prospectively in 46 patients with symptoms suggestive of cholelithiasis but in whom stones had not been visualized at cholecystography and ultrasonography. In 15 of them, bile was found to be abnormal: cholesterol monohydrate crystals were seen in 11, cholesterol crystals + calcium bilirubinate granules in 2 and calcium bilirubinate granules in 2. To date, nine of these patients have been operated on: 6 (all with cholesterol monohydrate crystals) had small cholesterol gallstones and 3 (2 with cholesterol monohydrate crystals and 1 with calcium bilirubinate granules) had signs strongly suggestive of the recent migration of gallstones. One patient refused operation, but minute pigment stones were found to be associated with calcium bilirubinate granules at duodenal intubation. In the other 31 patients, bile contained neither cholesterol monohydrate crystals nor calcium bilirubinate granules. They were not operated on and were followed up with repeated investigations for 12 to 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)