[Surgical treatment of vaginal prolapse].
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Biomedical subjects
Publications and source records attributed to R Hattab.
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The question mark-shaped loop is a simplified excluded loop which combines the advantages of being prepared as rapidly as the Tomoda procedure modified by Hivet and of having the same functional benefits as Roux's Y-shaped loop. It is essentially an omega-shaped loop the afferent segment of which is severed a few centimetres upstream of its higher point. The two sections can be sutured manually or with mechanical staplers. The loop can be brought up through the mesocolon as easily as the Y-shaped loop without dissection of the mesentery and can be used to re-establish continuity after total gastectomy. It can also be passed through the mesocolon and behind the stomach to perform hepato-jejunal anastomoses. Finally, it can be used for double or triple derivations in the conservative treatment of chronic pancreatitis.
The main indications for the Hartmann operation are cancer and sigmoiditis. It is done as an emergency in 70% of the time, more often for peritonitis, generally from diverticulitis. (45% of the time) than for occlusion usually due to cancer (30% of the time). The high mortality (33%) is due to the precarious condition of the patients, and only 25% are due to the operation, usually from disruption of the rectal stump. The reestablishment of the intestinal continuity, now facilitated by the clip forceps, was possible in 37 cases with no mortality. This represents 28.9% of the group, but only 52.1% were alive six months later. Only 6.8% of the cancer cases were benefited; however, 51% of the sigmoiditis cases and 87.5% of the cases of traumatic perforation were benefited. These results plus the advantages furnished by the autosuturing forceps justify renewal of interest in this operation first described 60 years ago.
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