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Biomedical subjects

A Sauvanet

Publications and source records attributed to A Sauvanet.

At least 109 records · Page 6Linked to original sources
PubMed1996

Laparoscopic mobilization of the stomach for oesophageal replacement.

Nine patients of mean(s.d.) age 61(8) years underwent oesophagogastrectomy with laparoscopic gastric mobilization and abdominal lymphadenectomy for oesophageal cancer. Moderate to severe airway obstruction was present in all patients, in whom the mean(s.d.) value of forced expiratory flow rate at 1 s was 65(17) (range 35-85) per cent of the predicted value. Six patients had an abdominal laparoscopic approach combined with a right open thoracotomy; the other three had a laparoscopic abdominal and transhiatal approach combined with a left cervicotomy. No patient required conversion to open laparotomy. All had an uneventful postoperative course with extubation occurring at the end of the surgical procedure (n = 2) or on day 1 after operation (n = 7). Mean(s.d.) duration of hospitalization was 10.3(3.1) (range 8-18) days. The laparoscopic approach for gastric mobilization and abdominal lymphadenectomy is safe and can be used in patients with impaired pulmonary function.

Aged↗
PubMed1996

Laparoscopic fenestration in polycystic liver disease.

Sixteen laparoscopic cyst fenestrations for symptomatic adult polycystic liver disease (APLD) were performed in 13 women, including four patients who had had previous attempts at treatment (percutaneous sclerotherapy in two and fenestration via a laparotomy in two). The median number of cysts deroofed was 32 (range 18-58) during the 13 primary procedures. There was no in-hospital death. Postoperative transient ascites occurred in six patients. After operation 11 patients experienced immediate relief of symptoms but during a median follow-up of 26 (range 6-49) months, eight of these patients developed recurrent symptoms. Two patients underwent three repeat laparoscopic fenestrations, at which time perihepatic adhesions were rare and no complication occurred. Because repeat procedures may be performed, laparoscopic fenestration appears to be useful for the treatment of symptomatic APLD. However, it is less effective than fenestration at open surgery or liver resection and should be employed only in patients with predominantly large cysts.

Adult↗
PubMed1996

Wound recurrence after resection of hepatocellular carcinoma.

Cutaneous metastases arising along the exit site of an abdominal drain in one patient and within the operative wound in two others after resection of a hepatocellular carcinoma (HCC) are reported. All patients underwent curative hepatic resection, and cutaneous metastases occurred 9, 12, and 22 months after surgery respectively. Cutaneous metastases were not associated with intrahepatic recurrence and were treated by local excision. Two patients are alive and disease-free 48 and 49 months after hepatic resection, respectively; the third patient died from recurrence 39 months later. These observations suggest that cutaneous malignant seeding may occur, and the authors recommend the observance of special care during liver surgery to prevent occurrence of this complication, including the use of wound protection and avoiding the opening of the specimen by the surgeon. The follow-up of patients who have undergone liver resection for an HCC should include the examination of all operative wounds including the exit site of abdominal drains. These subcutaneous nodules should be resected as an appreciable survival can be expected.

Aged↗
PubMed1996

Anatomic basis of mesenteric elongation for ileo-anal anastomosis with J-shaped reservoir: comparison of two techniques of vascular section.

Total proctocolectomy followed by ileo-anal anastomosis with a reservoir is the operation of choice for the treatment of familial adenomatous polyposis and of certain forms of hemorrhagic proctocolitis. Vascular section is sometimes necessary to enable the extremity of the reservoir to reach the anal sphincter without traction. The aim of this study was to compare the gain in length obtained by two different techniques of vascular section and to assess in terms of the vascular anatomy of the last small intestinal loop which technique best preserved the vascularisation of the reservoir as a whole. Twenty-two fresh cadavers had an ileal J-shaped reservoir of 18 cm fashioned from the last loop of small intestinal loop after section of the root of the mesentery. The gains in length so obtained were measured after section of the ileocolic a. at its origin (group A) or section between the two vascular arches of the last small intestinal loop (group B); the superior mesenteric vessels were then injected with colored resin. The gain in length obtained by these two methods was identical (2.3 +/- 1.1 cm for group A as against 2.18 +/- 0.9 cm for group B), but only if the section of the ileocolic a. was accompanied by section of the mesenteric peritoneum up to the vascular arch formed by the anastomosis between the terminal branch of the superior mesenteric a. and the ileocolic a. The constancy of this anastomosis always allowed section of the ileocolic a. while preserving good vascular distribution to the entirety of the reservoir. Section between the two arches was difficult when the distance separating them was small.

Anal Canal↗
PubMed1996

Restriction of V beta gene usage of liver-derived lymphocytes in chronic hepatitis B and C.

T lymphocytes have been reported to be the predominant inflammatory cells in the liver of patients with chronic viral hepatitis. Their presence may reflect either nonspecific inflammation or a virus-specific immune response. To assess the repertoire of intra-hepatic T cells, we investigated the TCR V beta gene usage of T cells in 10 patients with chronic hepatitis B and 15 with chronic hepatitis C. Liver-derived lymphocytes and peripheral blood lymphocytes were analyzed by flow cytometry. Five out of the 10 hepatitis B patients were found to have an accumulation of certain V beta T cells in the liver (V beta 6.7; V beta 6.7; V beta 3.1, V beta 5.1, and V beta 6.7; V beta 3.1; V beta 12.1, respectively). Four out of the 15 hepatitis C patients were found to have an accumulation of certain V beta T cells in the liver (V beta 5.1; V beta 8 and V beta 5.2 and 5.3; V beta 3.1 and V beta 5.2 and 5.3; V beta 3.1 and V beta 12.1, respectively). Despite a limited screening of V beta subfamilies, this study indicates that, in patients with chronic hepatitis B and C, T cells using a certain V beta gene may accumulate in the liver. This suggests that intra-hepatic T cells are oligoclonal and possibly virus specific. Our results argue against the role of a superantigen in perpetuating liver disease. In addition, this study supports a role for T lymphocytes in the pathogenesis of chronic hepatitis C.

Adult↗
PubMed1996

Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study.

OBJECTIVE: The authors compared operative course of patients undergoing major liver resections under portal triad clamping (PTC) or under hepatic vascular exclusion (HVE). SUMMARY BACKGROUND DATA: Reduced blood loss during liver resection is achieved by PTC or HVE. Specific complications and postoperative hepatocellular injury mediated with two procedures have not been compared. METHODS: Fifty-two noncirrhotic patients undergoing major liver resections were included in a prospective randomized study comparing both the intraoperative and postoperative courses under PTC (n = 24) or under HVE (n = 28). RESULTS: The two groups were similar at entry, but eight patients were crossed over to the other group during resection. In the HVE group, hemodynamic intolerance occurred in four (14%) patients. In the PTC group, pedicular clamping was not efficient in four patients, including three with involvement of the cavohepatic intersection and one with persistent bleeding due to tricuspid insufficiency. Intraoperative blood losses and postoperative enzyme level reflecting hepatocellular injury were similar in the two groups. Mean operative duration and mean clampage duration were significantly increased after HVE. Postoperative abdominal collections and pulmonary complications were 2.5-fold higher after HVE but without statistical significance, whereas the mean length of postoperative hospital stay was longer after HVE. CONCLUSIONS: This study shows that both methods of vascular occlusion are equally effective in reducing blood loss in major liver resections. The HVE is associated with unpredictable hemodynamic intolerance, increased postoperative complications with a longer hospital stay, and should be restricted to lesions involving the cavo-hepatic intersection.

Adolescent↗
PubMed1996

Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.

The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.

Adult↗
PubMed1996

[Total duodenal diversion in the treatment of complex peptic esophagitis].

Two duodenal diversion was performed in 107 patients with complex peptic oesophagitis (peptic stenosis, Barrett's mucosa, past history of gastro oesophageal surgery). A standard operation included truncular vagotomy, antrectomy and gastro-jejunal anastomosis on a 70 cm Y loop in 68 patients. Technical adaptations were required in 39 patients. Two patient died (pulmonary embolism and duodenal fistula). The operation was successful with stable cure of the oesophagitis at 3 months in 89% of the patients. Post-prandial pHmetry over 3 hours confirmed control of the reflux in 92% of the cases. Anastomotic ulcer occurred in 4 patients who did not have a vagotomy. One complete regression of Barret's oesophagitis was achieved and in 6 other cases the regression was partial. Stenosis improved in all patients except 1, sometimes after 1 or several dilatations. Digestive sequellae, were observed during the first few months after surgery in 27% of the cases. Persistant sequellae were found in 14% of the operation patients after a delay of 36 months. These results suggest that duodenal diversion is a useful treatment for complicated and complex peptic oesophagitis.

Adult↗
PubMed1996

[Is early extubation after surgery for esophageal cancer possible?].

In a series of 50 patients undergoing elective oesogastrectomy through a laparotomy and a right thoracotomy, the avoidance of overnight ventilatory support was made possible by the agreement of anaesthetists and surgeons on suitable policies. The attempt to extubate the patients immediately postoperatively differentiated two groups. For the first group (32 patients; 64%), early extubation could be performed and only one patient was reintubated and required prolonged ventilation. A second group comprised 18 patients who could not be extubated early (36%). For most of the patients in this second group extubation was only delayed until the next day, and recovery was otherwise uneventful. In three cases, however, pulmonary atelectasis with infection was a major problem, and these patients required broncho-endoscopies, and prolonged ventilatory support. Nevertheless, morbidity and mortality after oesophagectomy were significantly reduced in this series, compared with a previous study in the same hospital. Careful postoperative assessment of the patient is essential. The main factors leading to the decision for early extubation appeared to be: absence of serious cardiovascular history, absence of peroperative surgical complications, adequate rewarming, normal chest X-ray, and the presence of clinical criteria for extubation along with adequate arterial blood gases. If the above criteria can be achieved, then early extubation should be routine and can be safely performed in the majority of cases.

Adult↗
PubMed1995

Transplantation for fulminant and subfulminant hepatic failure with preservation of portal and caval flow.

This article describes experience with preservation of portal and caval flow during orthotopic liver transplantation (OLT) for fulminant or subfulminant hepatic failure (FSHF) as an alternative to venous bypass. As a modification of the standard procedure, hepatectomy and graft implantation were performed with preservation of caval patency in combination with a temporary portocaval shunt. From July 1991 to March 1994, 25 consecutive patients with FSHF underwent OLT with preservation of portal and caval flow. All patients had severe confusion (n = 9) or coma (n = 16) with a mean(s.d.) clotting factor V of 13(5) per cent and a mean(s.d.) serum bilirubin level of 408(151) mumol/l. During the anhepatic phase, haemodynamic data showed a preservation of cardiac filling pressure, mean arterial pressure, and renal perfusion pressure, while the mean(s.d.) urine flow was maintained at 182(120) ml/h. Venous bypass was not required. There were three (12 per cent) deaths after the operation, and all survivors made a full neurological recovery. Normal postoperative creatinine values allowed the early use of baseline immunosuppression. The authors conclude that, in patients with FSHF, successful liver transplantation can be achieved with this technical procedure.

Adult↗
PubMed1995

Preservation of renal perfusion and postoperative renal function by side-to-side cavo-caval anastomosis in liver transplant recipients.

Postoperative renal failure is common after liver transplantation (LT). The aim of this study was to investigate peroperative renal perfusion and postoperative renal function in 12 patients who underwent LT with side-to-side cavo-caval anastomosis (SSCCA). Three phases were considered during the procedure: hepatectomy, the anhepatic phase, and the postreperfusion phase (phases 1, 2, and 3, respectively). Mean arterial pressure, IVC pressure, and renal perfusion pressure were significantly higher during phase 2 than during phases 1 and 3. Cardiac index and pulmonary capillary wedge pressure did not differ significantly during the three phases. Creatinine clearance did not significantly decrease postoperatively. We conclude that SSCCA is associated with both the preservation of renal perfusion pressure during the entire procedure and the preservation of postoperative creatinine clearance. It is, moreover, a technique that results in a low rate of postoperative renal failure after LT.

Adult↗
PubMed1995

Temporary portocaval anastomosis with preservation of caval flow during orthotopic liver transplantation.

BACKGROUND: A novel technique of orthotopic liver transplantation was developed whereby both vena caval and portal venous blood flows are preserved during the entire procedure. PATIENTS AND METHODS: This method of liver transplantation was successfully performed in 51 consecutive patients and included a temporary portocaval shunt, a total hepatic resection with vena caval preservation, and an end-to-side cavocaval anastomosis. RESULTS: Preservation of vena cava and portocaval anastomosis were feasible in 51 patients (100%), including 34 patients with cirrhosis and 2 patients undergoing elective retransplantation. Both caval and portal flows were preserved during the entire procedure in 48 patients (94%). No venovenous bypass was required. Four deaths (7.8%) occurred postoperatively, all of them unrelated to the surgical procedure. CONCLUSION: We believe adoption of this orthotopic liver transplantation technique will obviate the need for venovenous bypass.

Humans↗
PubMed1995

[Adenocarcinoma of the cardia: does the extent of gastric resection and lymph node excision influence survival?].

OBJECTIVES: In the curative treatment of the adenocarcinoma of the cardia (AC), the extent of the esogastrectomy and the need for lymph node dissection are still debated. The palliative treatment of AC is now currently non-surgical. The aim of this study was: a) to assess early results of palliative surgery; b) to evaluate the results of curative resection with reference to the influence of the extent of gastrectomy and lymph node dissection on early results and long-term survival. METHODS: From 1979 to 1989, 179 patients (mean age = 60 +/- 12 years) with AC had 45 palliative resections (mean age = 56 +/- 15) and 134 curative resections (mean age = 61 +/- 12). Thirty-eight proximal subtotal esogastrectomies (PSOG) and 7 total esogastrectomies (TOG) were palliative; 72 PSOG and 62 TOG extended to the spleen were curative and associated with lymphadenectomy. RESULTS: The operative mortality rate was 8.9% regardless of the palliative or curative intent of resection. After palliative resection, the mortality rate was 2.6% (1 case out of 38) after PSOG and 42.9% (3 cases out of 7) after OGT (P = 0.01); the median survival was 8 months. After curative resection, the mortality rate was 12.5% (9 cases out of 72) after PSOG and 4.8% (3 cases out of 62) after extended TOG (P = 0.2); actuarial 5-year survival rate was 42% after PSOG and 39% after extended TOG. CONCLUSIONS: These results suggest that: a) palliative PSOG for AC can be performed with a low mortality; b) resection with extensive lymphadenectomy allows substantial survival regardless of the extent of gastrectomy.

Adenocarcinoma↗
PubMed1995

[Imaging of cancer of the esophagus: ultrasound-endoscopy or computed tomography?].

The aim of this retrospective study, in 100 patients who had an esophagectomy from 1987 to 1992 for squamous cell carcinoma of the thoracic esophagus, was to determine the accuracy of endoscopic ultrasonography (EUS) and computed tomography (CT) in the preoperative staging of esophageal squamous cell carcinoma (SCC). The EUS report were compared to the pathological findings for the T stage. Both EUS and CT reports were compared with surgical and pathological findings for N stage (N0/N1) and mediastinal extension. In the 100 patients, EUS accuracy for T stage was 80%; EUS was more accurate for N stage than CT (71% vs 55% respectively; p < 0.02), and as accurate as CT for mediastinal extension (86% vs 85%). In the 26 SCC estimated superficial by EUS (all passed through), EUS accuracy was 92% for T stage and 77% for the distinction between mucosal and submucosal tumours; for N stage, EUS and CT accuracies were equivalent (77% vs 81%). In the 44 SCC passed and estimated advanced by EUS, EUS accuracy for T stage was 68%; EUS was more accurate than CT for N stage (77% vs 48%, p < 0.01) and as accurate as CT for mediastinal extension (86 vs 84%). In the 30 SCC not passed by EUS, accuracies of EUS and CT were equivalent for N stage (57% vs 47%) and for mediastinal extension (73% vs 73%). This study suggests that: a) for SCC estimated superficial by EUS, EUS does not differentiate reliably mucosal from submucosal tumors and CT is useless; b) routine EUS seems unnecessary for SCC not passed through by endoscopy; c) CT is still useful in patients with advanced SCC, mainly for detection of distant metastases.

Aged↗