The pylorus-preserving technique in duodenopancreatectomy.
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Common Bile Duct Neoplasms↗
Biomedical subjects
A Rohner
Publications and source records attributed to A Rohner.
[Hepatic resections for metastases].
Between January 1981 and December 1990, 79 liver resections were performed for hepatic metastases in 73 patients. Eight of these patients had a repeat resection (2 patients had their first resection performed before 1981). This figure represented 35% of 228 liver resections performed during this period. Mean age was 56.5 years (23 to 81 years). There were 38 men and 35 women. Fifty-four resections were performed for colorectal metastases and 25 resections for secondaries of other origins. There were 45 major hepatectomies (57%), defined by the resection of at least 3 Couinaud segments, and 34 minor resections (less than three segments). In 12 patients, liver resection was associated with excision of the primary tumor. Complications were observed in 25 patients (32%), pulmonary complications being the most frequent. Five re-explorations were necessary: 3 for postoperative bleeding, one for an abdominal abscess and one for intestinal obstruction. Mean postoperative stay was 18 days. There was no mortality for the first liver resections in 71 patients. One death was encountered among the second resections in 8 patients, with a global mortality of 1.3%. Follow-up was obtained for all patients but one (lost to follow-up at 5 years). Actuarial survival for the 50 patients operated on for colorectal secondaries was 98% at 6 months, 83% at 1 year, 46% at 2 years, 24% at 3 years and 15% at 5 years. In non-colorectal secondaries, the survival depended on the nature of the primary tumor but was very different from one patient to another.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Acute Budd-Chiari's syndrome after surgical treatment of polycystic liver disease].
A case of acute Budd-Chiari syndrome after surgical treatment of polycystic liver disease is described. This complication, presently unreported in the literature, was secondary to the operative interruption of two hepatic veins, while the third was already obstructed by pericystic fibrosis. Preoperative radiologic vascular mapping should be performed in case of voluminous polycystic liver disease when associated liver resection appears likely.
Acute Disease↗
Gallstone ileus and bowel perforation after endoscopic sphincterotomy.
Gallstone ileus as a complication of endoscopic sphincterotomy (ES) is exceptional, and this is only the second reported case. The present case is unique in that there was no previous instrumentation to the papilla, the bowel was obstructed and perforated, and the patient survived. This case again points out the danger of performing ES for large common bile duct stones. When a large stone is not extracted after ES, close monitoring is mandatory until unequivocal stone passage through the intestine is proven. In both cases reported so far, the lack of adequate monitoring after failure of stone extraction by ES was critical to the severity of gallstone ileus.
Aged↗
[Pneumomediastinum and subcutaneous cervical emphysema as signs of rectosigmoid perforation].
Pneumomediastinum and subcutaneous emphysema of the neck occur exceptionally in spontaneous, retroperitoneal perforation of the sigmoid colon. These signs, in association with a septic syndrome and multiple organ failure, mandate the search of a gastrointestinal tract perforation, even in the absence of digestive symptoms. Careful deep palpation of the abdomen may determine the abdominal origin of the septic focus and thereby provide justification for exploratory laparotomy without further diagnostic investigations.
Aged↗
[Perforation of gastric ulcer in inguinal hernia].
We report about a case of perforation of a peptic ulcer in an inguinal hernia. A 64-year-old female patient had been suffering from bilateral inguinal hernias for several years, without digestive complaints. The sudden occurrence of symptoms resulted not from strangulation, but from a specific complication of the incarcerated organ, ie. the perforation of an ulcer of the antrum, probably secondary to the intake of nonsteroid anti-inflammatories. Surgical treatment consisted in the suture of the perforation and the cure of the hernia with a net.
Female↗
[Who are the candidates for liver transplantation?].
Over the past 12 years, new immunosuppressive agents, better knowledge of anesthesiology and postoperative reanimation as well as refinement in surgical technics modified the indications for and results of orthotopic liver transplantation (OLT). At the beginning of the OLT era, liver tumors that could only be removed by total hepatectomy were one of the most frequent indications. Nowadays, this indication is mostly abandoned in view of a high rate of recurrence and poor long-term results. In contrast, the prognosis of fulminant hepatic failure has been dramatically improved by OLT, once efficient organization systems allowed adequate organ supply and emergency transplantation within a few hours. Three main groups of diseases (cholestatic diseases, inborn errors of metabolism and parenchymal diseases) can be treated by OLT with excellent results (actuarial survivals of 80 to 90% have been reported at one and 2 years). Later graft dysfunction is rare except for virus B recurrence. Primary biliary cirrhosis and the group of inborn errors of metabolism are regarded as the optimal indications of OLT in adults and children respectively. Precocious evaluation of patients, before advanced stages of the disease associated with multiple complications, should prevent them from dying on a waiting list and decrease operative as well as early postoperative risks. Not only does OLT provide mere survival (among 5 patients with lethal hepatic disease, 4 are alive at 2 years from OLT), it also provides a regained quality of life with a virtually normal (for the price of a daily medication intake) family, professional and sportive life. Such achievements prompt us today to propose early transplantation to these patients.
Contraindications↗
[Impact of organ shortage on the transplantation program].
The purpose of the study was to evaluate the consequences of a recent progressive shortage of donor organs on our different transplant programs. Although the waiting time before transplantation remained in general relatively short (4.6 [mean], 0-3, 0-10 months for renal, liver and heart transplantation, respectively), patients started to accumulate on our waiting list during the last year (1990) of the study (kidney transplantation). Furthermore some patients clearly deteriorated, other died awaiting transplantation (18% and 15% of the patients listed for liver and heart transplantation, respectively). In emergency, organs were provided most often by neighbouring foreign centers. Given these facts adhesion to supranational donor networks should be considered.
Humans↗
Critical review of the treatment of pyogenic hepatic abscess.
A retrospective review of 29 consecutive patients with pyogenic hepatic abscesses was undertaken to ascertain the efficacy of various treatments. Percutaneous routes were used 25 times (aspiration alone in 16 and with concomitant drainage in nine), as a primary step 22 times and for recurrent abscesses, three times. An operation was required in nine patients; initially in five and after percutaneous treatment in four. Antibiotics alone were used twice. There were seven deaths, two after antibiotics alone and five after initial percutaneous aspirations. There were six recurrent abscesses, all but one after percutaneous aspiration. Our results suggest that antibiotics alone and percutaneous aspiration alone are inadequate in the treatment of pyogenic hepatic abscesses; percutaneous management is valid provided concomitant drainage is used, and that once the abscess has been successfully handled percutaneously, surgical treatment is a safe alternative as a first step, for abscesses recurring after percutaneous management, or for removal of the primary cause of the disease.
Adult↗
[Orthotopic liver transplantation--indications and results].
Indications for and results of orthotopic liver transplantation (OLT) were modified over the past ten years by new immunosuppressive agents, earlier timing of transplantation and better knowledge of potential complications. In 1990, OLT appears justified in the treatment of all liver disease threatening life, in the absence of contraindications and other possible treatments. Between July 1987 and December 1990, 21 patients were transplanted at the Geneva University Hospital. Three children received part of an adult liver (two or three segments), using the reduced-size liver transplantation technique. Four OLTs had to be performed in an emergency situation. Two patients died within six months of transplantation, one after 7.5 months, and the last patient died after one year from cancer recurrence. 17 patients are presently alive (81%) at 4 to 39 months (median 14 months) following OLT. More than the mere survival, however, the quality of life regained after transplantation prompts us to consider transplantation early in the progress of the disease.
Adolescent↗
[Surgical treatment of hepatic hydatidosis].
Between January 1981 and December 1990, 41 patients were operated on for hepatic hydatid disease, representing 18% of the overall surgery for liver disease performed in our institution during the same period of time. The mean age of the patients was 39.5 years (range 17-71 years), 24 were females and 17 males. The most common clinical sign was abdominal pain (59%) with 3 patients jaundiced at the time of admission. 2 patients suffered from acute rightsided pneumonia, one of them with a very important productive cough due to bronchial perforation of the hydatid cyst of the liver. One patient was admitted due to anaphylactic shock with collapse. For 14 patients (34%) the discovery of the disease was casual, either by clinical hepatomegaly or by X-ray investigations performed for other reasons. We performed 18 pericystectomies, 4 subtotal pericystectomies and 16 liver resections. Only 3 patients were treated by partial cystectomy with removal of the prominent part of the cyst. Several other surgical procedures were performed concomitantly, including 2 pulmonary lobectomies, 1 cystojejunostomy, and pericystectomies for other hepatic or extrahepatic localizations of hydatid cysts. Rupture of the cyst into the bile duct was diagnosed in 13 patients. One patient presented with a peritoneal rupture of the cyst and 2 patients had a fistula through the diaphragm into the pleural cavity. Our postoperative morbidity is acceptable (10 patients, 25%). A bilioma and a biliary leak were successfully treated by percutaneous drainage, a postoperative hemorrhage required surgical treatment, four patients experienced pulmonary complications and the three others minor wound abscesses.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Primary malignant non-Hodgkin lymphomas of the digestive tract: the role of surgery].
Forty-two patients with non-Hodgkin's malignant lymphoma (NHML) of the gastrointestinal tract were operated on between 1971 and 1989. NHML was located in the stomach in 23 (55%), in the small bowel in 16 (38%), and in the colon in 3 (7%). One-fourth of patients were hospitalized with an acute abdomen and had to undergo emergency surgery. Preoperative diagnosis was obtained in 40% of cases only. Since 1986, however, and thanks to immunohistochemistry, gastroscopy was able to diagnose gastric NHML in 10 of 11 cases. Twenty-six patients (62%) underwent curative surgery. Operative mortality was 11.9%, 42% in case of emergency surgery, but mortality was nil after elective procedures. Half the patients had no further treatment. Five-year survival was 67%. Except for the mucosa associated lymphoid tissue (MALT) tumors, histopathological characteristics had less influence on prognosis than expected. On the other hand, prognosis was significantly better after curative surgery (p less than 0.001).
Female↗
[Ischemic colitis. Results of conservative treatment].
34 consecutive patients were admitted for ischemic colitis confirmed by colonoscopy, contrast enema, laparotomy, and/or post-mortem between 1984 and 1988. 13 underwent excisional surgery, usually at an early stage, because of acute abdomen. This study is devoted to the remaining 21 patients (62%), i.e. nearly two thirds of the whole series, who were treated conservatively (intravenous hydration and antibiotics). Our results suggest that (1) ischemic colitis usually affects elderly patients in whom an underlying cardiovascular disease is seldom found; (2) the right colon is infrequently involved, and (3) outcome is generally favorable in the absence of superimposed major pathology or of peritoneal signs which would require surgical exploration.
Adult↗
Use of a resorbable mesh graft to obtain haemostasis from the cut surface of the liver after hepatic resection.
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Hemostasis, Surgical↗
[Experience with a surgical mesh covering a hepatectomy incision].
A polyglycolic acid net (Vicryl) has been applied against the hepatectomy section of 27 patients (14% of all our liver resections) to complete its hemostasis. The indications for the use of this net were: the persistence of blood oozing and/or the necessity to shorten the operation. In one patient suffering from severe coagulopathy, active bleeding continued until the patient died; another patient bled until his blood dyscrasia was corrected. One case of abscess was encountered, and treated through a percutaneous approach. Although the achievement of perfect hemostasis is usual in surgical exeresis of the liver, a minority of patients can present with resistant bleeding of the resection slice, for which packing with a net may prove to be useful.
Adult↗
Conservative treatment of acute pancreatitis.
Most attacks of acute pancreatitis) have a favorable course and can thus be treated by conservative measures. The purpose of this review is: a) to present techniques (prognostic scores, computerized axial tomography, etc.) which can assist in the early identification of those cases of acute pancreatitis which can reasonably be submitted to non-surgical treatment; b) to summarize and discuss the main results of recent pharmaceutical research, and various conservative measures which have proven helpful in the treatment of this difficult disease.
Acute Disease↗
[Results of surgical treatment of ischemic colitis].
Between January 1984 and December 1989, 13 patients, aged 39 to 89 (median 63), underwent surgery for histologically proven ischemic colitis. Most suffered from pre-existing cardiovascular conditions (2 shortly after surgery for aortic aneurysm). One patient developed ischemia after the traumatic avulsion of the ileocolic artery and another after the spontaneous reduction of a strangled inguinal hernia. Diagnosis of ischemic colitis was made prior to operation in 4 instances only. The left colon was affected 5 times and the right colon 8 times (with the terminal coil of ileum 3 times). Treatment always consisted in segmental colectomy; laparotomy was used in 3 patients (2 to 7 reoperations). Colon anastomosis was performed directly 5 times, while 4 patients had secondary stomy closures; 2 patients still have their original stomy. Two patients died (15%), one of sepsis and the other following broncho-aspiration. The prognosis of ischemic colitis is rather favorable, even at the stage of transmural necrosis, provided all ischemic zones are resected. This is in contrast with the severe mortality of mesenteric infarcts, when extensive small bowel necrosis is found in association with colonic ischemia.
Colectomy↗
Protective effect of indomethacin in the development of the postreperfusion syndrome during liver transplantation in pigs.
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6-Ketoprostaglandin F1 alpha↗