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B Delaitre

Publications and source records attributed to B Delaitre.

At least 19 recordsLinked to original sources
PubMed1995

Laparoscopic splenectomy. The "hanged spleen" technique.

We have now used a new patient position for laparoscopic splenectomy: The patient is placed in right lateral supine position on a "bean bag" positioning apparatus and the left arm is elevated. The operator is located on the right of the patient; the first assistant is on the same side and the second is on the left. We have a very good view of the spleen which is hung on the diaphragm by the peritoneal attachments, and we can sever successively inferior polar splenic vessels, short gastric vessels, and hilus splenic vessels. With this patient position, it is our opinion that laparoscopic splenectomy is feasible and safe if the spleen volume is not too large. To date, we have performed thirteen splenectomies with this procedure. We have had twelve good results and one conversion to laparotomy.

Humans↗
PubMed1995

[Laparoscopic splenectomy. The "hanging spleen technique" in a series of nineteen cases].

We have used an new patient position for laparoscopic splenectomy: the patient is placed in the right lateral supine position on a "bean bag" positioning apparatus and the left arm is elevated. The operator stands to the patient's right, the first assistant is on the patient's right and the second is on the patient's left. This position provides very good exposure of the spleen, which hangs from the diaphragm by the peritoneal attachments and the inferior pole splenic vessels, short gastric vessels and splenic hilus vessels can be released successively. We have now performed 19 splenectomies using the "Hanging Spleen Technique" with three conversions to open surgery. Splenectomy was always possible with the use of a plastic bag through the 12 mm trocar hole in 12 cases and through this enlarged hole in 2 cases. The mean post-operative stay was 4.3 days and the mean time to return to work was 19 days. Laparoscopic splenectomy is a feasible and safe procedure with this patient position. Obesity and splenomegaly are no longer absolute contra-indications.

Acetaminophen↗
PubMed1995

[Teaching digestive laparoscopic surgery in France: from education to accreditation?].

The extremely rapid development of laparoscopic surgery since 1989 has given evidence, by the increase in the number of local and vital complications, that teaching of laparoscopic surgery is absolutely necessary, especially technical and practical training. Indeed, laparoscopic surgery is not only a new and different way to attain abdominal organs, but it needs also a complete different acquiring of gestures, which are difficult since the eyes and hands are dissociated due to the videotechnics. The University post-graduate training courses (University Diploma D.U.), which were first organized by the authors in Paris and Nice since 1990, have given the best answers to this challenge: training a large number of surgeons in a minimum of time. In 1994, a new Collège of general visceral and digestive surgeons was founded and the teaching conditions have been modified since. This college courses of general and digestive surgery (D.E.S and D.E.S.C respectively) and during post-graduate formation (F.M.C). After having given recommendations for the program of theoretical and practical teaching of laparoscopic surgery, the authors suggest that this teaching should be integrated in graduate courses of general surgery and in post-graduate courses. These courses represent the best training and are the guarantee of good quality and it would be a big error to suppress them. They should continue under the constant control of the French College of Digestive Surgeons and be supervised by the French National order of medical Doctors.

Accreditation↗
PubMed1992

[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

Adolescent↗
PubMed1989

[Extracorporeal lithotripsy in the treatment of biliary calculi].

The authors present their experience from February 1988 with biliary lithotripsy in 125 patients. They review the protocol inclusion criteria and the various forms of complementary medical treatment. From this group, 30% of the patients underwent cholecystectomy, 45% received medical treatment and only 25% did not eventually require complementary medical therapy.

Cholelithiasis↗
PubMed1988

[Perforated gastroduodenal ulcers. Treatment by peritoneal dialysis. 72 cases].

Seventy-two perforated gastroduodenal ulcers were treated by an original method aimed at avoiding emergency surgery, which consists of peritoneal dialysis associated, during 3 days, with gastric aspiration. Over a 3-year period this method was applied to all patients admitted with a perforated ulcer. The ulcer was revealed by the perforation in 25 p. 100 of the cases, and 90 p. 100 of the patients had pneumoperitoneum. Contrast radiography with Gastrografine (sodium and meglumine amidotrizoate) located the perforation. Fifteen patients had another disease which made the prognosis worse. The time elapsed between perforation and treatment was 15 hours on average. Peritoneal fluid infection was present in 30 p. 100 of the cases. The outcome was favourable in 69 patients (96 p. 100). One patient died of pulmonary embolism, another was operated upon on the 4 th post-perforation day for a bleeding ulcer and a third patient with giant gastric ulcer developed subphrenic abscess. This method seems to be indicated in patients at high surgical risk (elderly people or people with severe underlying disease), and in young patients with perforated acute ulcer. In chronic ulcers, peritoneal dialysis ties the patient over the first hours, thus enabling radical surgery to be electively performed. In perforations seen after 24 hours, it helps in supporting the patient prior to surgery. The method in contra-indicated in gastric ulcers.

Adolescent↗