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Biomedical subjects

B Gayet

Publications and source records attributed to B Gayet.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis].

OBJECTIVES: To analyze a unicentric series of 100 consecutive elective laparoscopic colon resections for diverticular disease and to evaluate in intention to treat the early- and middle-term postoperative results. METHODS: From February 1993 to March 1998, 100 colon resections for complicated diverticular disease were performed through laparoscopy with systematic mobilization of the splenic flexure and resection of the rectosigmoid junction. The colorectal anastomosis was stapled or manual without proximal stoma. In 53 females and 47 males (mean age 60.4 years), indications for surgery were: one or more attacks of acute diverticulitis (n = 70), abscess (n = 17), symptomatic stenosis (n = 8), colovesical fistula (n = 4) and diverticular bleeding (n = 1). RESULTS: Mortality was nil. The conversion rate was 9%, never for anesthetic reasons. The mean operating time was 226 +/- 68 min. There was no splenic or ureteral injury. The morbidity at 30 days was 19% with fistulae rate accounting for 2%, 2 patients were reoperated on. The median time for passage of flatus was 3 days and median length of hospital stay was 7 days. Late morbidity was 10%, one patient complained of retrograde ejaculation. CONCLUSION: This study demonstrates that laparoscopy is a safe alternative to laparotomy for elective one-stage colectomy for complicated diverticular disease.

Adult↗
PubMed1999

Laparoscopic Heller's cardiomyotomy in achalasia. Is intraoperative endoscopy useful, and why?

BACKGROUND: Inappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller's cardiomyotomy, is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller's cardiomyotomy. METHODS: In a group of 19 patients with intraoperative endoscopy with laparoscopic Heller's cardiomyotomy, surgical and endoscopic criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared with those of another group of 16 patients previously operated on without intraoperative endoscopy. RESULTS: Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19, 58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal technique were more frequent in the group without intraoperative endoscopy (7/16 patients) than in the other group (2/19 patients). CONCLUSIONS: Endoscopy during laparoscopic Heller's cardiomyotomy is of great assistance in identifying the cardia, and thereby could improve surgical outcomes.

Cardia↗
PubMed1999

[Laparoscopic splenorraphy using a resorbable prosthesis in splenic injuries. Apropos of 5 cases].

STUDY AIM: The aim of this retrospective study is to report five cases of laparoscopic splenorraphy with an absorbable perisplenic mesh for splenic injury. PATIENTS AND METHOD: From January 1996 to February 1998, three men and two women (mean age: 52 years) were included in this study. The splenic lesions were due to either a fall (n = 3), a traffic accident (n = 1), or pleural paracenthesis in a patient with mediastinitis after valvular replacement. Splenic injury was recognized by ultrasonography. The patients were operated as either emergency cases (n = 2), or within 24 hours (n = 3). The procedure included evacuation of the hemoperitineum, total liberation of the spleen, and splenic hemostasis with a perisplenic mesh which was used in open surgery. The mesh placed behind the spleen, covering its superior and inferior poles, was unrolled forwards and burses progressively tightened. RESULTS: There was no conversion, no mortality, no morbidity. In the four injured patients, the mean duration of surgery was 120 minutes (70-180), without any blood transfusion, and the patients were discharged on d4 or 5. The fifth patient, after valvular replacement, was operated on with anticoagulation. The mean duration of surgery was 270 minutes. Four blood units were necessary. He was discharged at d26. CONCLUSION: This technique combines the advantages of the perisplenic mesh which is efficient and safe, with the advantages of laparoscopic surgery which simplifies the postoperative course. It can only be used in case of isolated splenic injury in patients with stable hemodynamic condition.

Absorbable Implants↗
PubMed1999

[Preoperative staging of pancreatic adenocarcinoma: a practice survey of French gastroenterologists and digestive surgeons. Ordering of supplemental examinations and preoperative criteria of loco-regional spread].

BACKGROUND: Means used by physicians to perform preoperative staging of pancreatic adenocarcinoma are not well known. Therapeutic strategy used relies on knowledge of loco-regional spread criteria. AIMS: To assess the frequency of prescription of imaging procedures in patients with suspected pancreatic head adenocarcinoma; the use by French gastroenterologists (GE) and digestive surgeons (S) of criteria which lead to suspect lymph node invasion or vascular involvement; the frequency of histological determination in patients with unresectable tumor; if there is a difference between GE and S. METHODS: All the French GE (n = 3466) and S (n = 687) were sent a survey asking them about their habits. RESULTS: 615 answers were received (GE = 426, S = 189). There was no significant difference between GE and S for the prescription of ultrasonography and CT scan. Endosonography and upper digestive endoscopy were more systematically performed by GE than S (44 vs 35% and 50 vs 35%, respectively). Celio-mesenteric angiography was less often used by GE (6 vs 13%). Laparoscopy was electively used by 35% GE and 52% S. None of vascular involvement criteria was used by more than 75% of GE and S. Tumor-vessel interface loss was used by 46% GE and 16% S (P < 0.001). Intravascular thrombosis and truncular portal hypertension signs were used more often by S than GE (84 vs. 71%: P < 0.001; 65 vs. 51%: P < 0.001). None of nodal involvement criteria was used by more than 50% of physicians. All these nodal criteria were used more often by GE than S (P < 0.001). Percentage of physicians requiring histological confirmation in case of unresectable tumor was 41%. CONCLUSION: Preoperative staging of suspected pancreatic head adenocarcinoma is performed with grossly the same manner by GE and S. Histological proof is searched for in a low percentage of cases. Imaging criteria of loco-regional spread of pancreatic adenocarcinoma are heterogeneously used by GE and S, the former using them more frequently than the latter. A better use of imaging criteria is necessary to optimise the treatment of patients with pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1999

[Spontaneous gas gangrene of the pancreas caused by Clostridium perfringens].

The case of a 60-year-old patient with acute biliary pancreatitis spontaneously infected by Clostridium perfringens is reported. On CT scan, all the pancreatic bed was filled by gas. The patient survived. Four cases have previously been published. Three were fatal and 2 occurred after a pancreatic biopsy. Complete gas gangrene of the pancreas is a severity criterion and suggests an infection by Clostridium perfringens.

Gas Gangrene↗
PubMed1998

[Laparoscopy versus the Shouldice intervention in the treatment of unilateral inguinal hernia: can the operative surcosts be minimized?].

AIMS: Laparoscopy is more expensive than Shouldice procedure for inguinal hernia repair. The aims of this study were to evaluate the overcost, to look for its causes and to propose a strategy of cost reduction. METHODS: One hundred and sixty three unilateral inguinal hernia repairs were performed from January 1995 to June 1996 in our institution, functioning under financial rule of total endowment. Forty five of the 163 procedures were laparoscopic procedures. The mean operative cost of each procedure was calculated from physician, personnel and equipment costs (amortization, consumable products and maintenance). RESULTS: The mean costs were 2,210 FF and 6,779 FF for Shouldice and laparoscopic procedures, respectively. This overcost of 4,569 FF was reduced to 893 FF by increasing surgeon's experience, which shortened operative duration and ward cost, and by the use of a non specific mesh fastened in place with threads. The mean operative cost of laparoscopy was then 3,103 FF. CONCLUSION: A change in surgical practice allows a reduction in the operative overcost of laparoscopic unilateral inguinal hernia repair by 80.4%.

Clinical Competence↗
PubMed1998

[Benign intraductal papillary-mucinous tumors of the pancreas with a 30-year follow-up].

Intraductal papillary mucinous tumors of the pancreas are rare and characterised by a malignant potential. Their natural history is unknown. We report a case of intraductal papillary mucinous tumor of the pancreas, that was still benign although the first symptom was appeared 30 years before the diagnosis. This case report demonstrate the possible slow course of these tumors, for which malignant degeneration is unpredictable.

Cystadenoma, Mucinous↗
PubMed1998

[Colonic polyps considered unresectable by endoscopy. Removal by combinations of laparoscopy and endoscopy in 65 patients].

OBJECTIVE: To determine to what extent segmental colectomy could be avoided in patients with polyps though to be endoscopically unresectable by using combination laparoscopy and endoscopy. METHODS: Sixty-five patients referred for colonic polyps though to be unresectably by conventional endoscopy were studied. After analysis of the endoscopic findings, endoscopy was performed in a medicosurgical unit when possible, otherwise a surgical procedure was performed consisting of laparoscopy followed by colonoscopy. Therapeutic strategy depended on laparoscopic and endoscopic findings. RESULTS: Segmental colectomy was avoided in 44 patients (67.7%). Among them, 20 were treated by simple endoscopic polyp removal, 12 by laparoscopy-assisted colonoscopic polypectomy, 9 by laparoscopic wedge colonic resection and 3 by colotomy after colonic exteriorization and polyp resection. Laparoscopic or laparoscopy-assisted segmental colectomy was performed in 16. Segmental colectomy by laparotomy was necessary in 5. No complication occurred. CONCLUSION: Segmental colectomy for unresectable colonic polyps could be avoided in more than half of the patients using laparoscopy and colonoscopy combinations.

Adult↗
PubMed1998

[Cystic and mucinous lesion in an antral ectopic pancreas].

We report a case of heterotopic pancreas located in the gastric antrum. The cystic formation contained mucus. Tumoral markers in the cyst fluid were within the range pancreatic cystic mucinous tumors. Pathology examination of the resected specimen did not evidence any proliferative lesions but showed papillary hyperplasia probably due to duct occlusion.

Adult↗
PubMed1997

[Diffuse peritoneal carcinosis of pseudo-papillary and solid tumor of the pancreas. Role of abdominal injury].

We report the case of a young girl with diffuse peritoneal carcinomatosis due to pseudopapillary and solid tumor of the pancreas. Fourteen months before the diagnosis and treatment of the tumor, an abdominal trauma occurred. Initial treatment was tumor and visible peritoneal carcinomatosis resection. Eight months later, relapse of peritoneal carcinomatosis occurred and the patient was reoperated. All macroscopic lesions were removed. Thirty-seven months after first laparotomy, the patient was well but abdominal ultrasound led to suspicion of hepatic metastasis. Among 17 published cases of metastatic pseudopapillary and solid tumor of the pancreas (including 6 cases with peritoneal carcinomatosis), trauma was described in 11 cases (including 3 cases with peritoneal carcinomatosis). Pseudopapillary and solid tumor of the pancreas may spread outside the pancreas, particularly in peritoneal cavity. Metastatic spread may be promoted by trauma, including tumor biopsies which should never be performed.

Abdominal Injuries↗