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Biomedical subjects

C Gouillat

Publications and source records attributed to C Gouillat.

At least 19 recordsLinked to original sources
PubMed2006

[Results of resection of locally recurrent rectal cancer].

AIMS OF THE STUDY: The treatment of locally recurrent rectal cancer (LRRC) remains a difficult and controversial issue. The aim of this study was to retrospectively assess the results of an univocal attitude associating resection of a priori resectable lesions using visceral excisions as required, without sacral excision, but including intra-operative radiotherapy (IORT). PATIENTS AND METHODS: Between 1989 and 1999, 32 patients underwent resection for LRRC. Twelve had previously undergone abdomino-perineal excision and 22 had received radiotherapy. Twenty-three patients underwent pelvic exenteration (total in 17, with rectus myocutaneous flap in 18). Twenty-five patients underwent IORT. RESULTS: Three patients (9.3%) died in the early postoperative period and 11 experienced complications (37%). Resections were considered R0 in 6 patients, R1 in 21 patients and R2 in 5 patients. Five-year survival rates, overall and without disability, were respectively 12%, 12% and 5%. Median survivals, overall and without disability, were respectively 22 and 12 months. CONCLUSION: Resection of LRRC remains a surgical challenge. It may achieve an average of one-year survival without disability, and hope for a few cures. Improvement of oncologic results might come from a more accurate patient selection.

Adult↗
PubMed2006

[Hepatocellular carcinoma revealed by prurigo].

BACKGROUND: Paraneoplastic cutaneous manifestations associated with hepatocellular carcinoma may allow early diagnosis and curative treatment. Chronic prurigo alone may reveal hepatocellular carcinoma hepatocellular carcinoma in the absence of any other abnormal laboratory results potentially indicative of hepatic disease. CASE REPORT: A 79-year-old woman was referred to our unit for prurigo beginning 3 months earlier, occurring night and day and causing insomnia. The initial results were completely normal. In the absence of improvement under treatment with dermal corticosteroids, additional investigations were performed, in particular, abdominal ultrasound. The latter showed a liver nodule of 1.5 cm in diameter. CT scan confirmed the presence of this nodule and revealed morphological changes consistent with hepatocellular carcinoma in segment VIII. Alpha-fetoprotein was elevated. Following surgical treatment of this hepatocellular carcinoma, skin lesions regressed without any further treatment. One year later, no relapse of skin lesions was observed and the patient was in complete remission regarding hepatocellular carcinoma. DISCUSSION: Prurigo may constitute a paraneoplastic sign of hepatocarcinoma, the prognosis of which depends upon the stage at which it is discovered. For small tumors (< 3 cm), surgery may be curative. Of the few cases reported in the literature, our patient is the first to undergo curative surgery thanks to early diagnosis.

Aged↗
PubMed2006

[Capillary hemangioma of the spleen on conventional and contrast-enhanced US].

We report a case of splenic vascular neoplasm in a 75 year old asymptomatic woman. CT and enhanced sonography were not consistent with a typical hemangioma. Splenectomy was finally realised and pathologic exam showed a capillary hemangioma with thrombosis. The imaging appearance of splenic hemangiomas may be complex because of splenic topography, size and complicating features. The differentiation of these lesions from malignant disease may not be possible.

Aged↗
PubMed2005

[Local excision of rectal cancer for cure].

Local excision of rectal cancer is advocated for cure only in selected patients. It should be done according to specific standards and needs close follow up. The transanal technique is well defined and indicated for posterior rectal wall tumours. Otherwise, technical modifications or microsurgery can be performed. The transacral approach should be abandoned.

Humans↗
PubMed2005

[Arterio-ureteral fistula, report of three cases].

On connection with four cases of arterio-uro-enteric fistula in three patients and after a review of the literature, the authors propose to make light on this extremely rare complication describing aetiologies factors and the diagnostic means and therapeutics. Two patients had had a pelvic exenteration with respectively Bricker and Kock pouch. The third patient had had an anterior resection in block with the right deferent duct and right seminal gland. All three received high doses of radiotherapy. These fistulas had appeared by abundant haemorrhages. The surgical operation in urgency had made it possible to treat these fistulas with success in two patients. The other patient had deceased of cataclysmic haemorrhage.

Adult↗
PubMed2005

[Reinterventions for complication and defect of coloesophagoplasty].

AIM OF THE STUDY: To report a series of 17 patients operated for a complication oesophagocoloplasty, with evaluation of therapeutic modalities, and both early and distant results. MATERIALS AND METHOD: From 1985 to 2003, 17 patients with a mean age of 50 years (range: 23-76) were reoperated after coloplasty pediculated on left superior colic vessels. Initial diseases were caustic ingestion (N=7), cancer (N=6), oesophageal perforation (N=2), gastric lymphoma (N=1) and oesotracheal fistula (N=1). Coloplasty has been performed as a first-intent procedure in 13 cases and as a second-intent procedure after failure of a previous operation in 4 cases. Nine patients were initially operated in another center and were subsequently referred in our unit. Complications needing reoperation were graft necrosis in 8 cases (47%) and stricture in 9 cases (53%). All patients with necrosis were reoperated within the 10 first postoperative days. RESULTS: Necroses were treated by complete (N=5) or partial (N=3) resection of the coloplasty. Strictures were treated by resection-reanastomosis (N=3), right ileocoloplasty (N=2), colic stricturoplasty (N=2), a free antebrachial flap (N=1) and a tubulized latissimus dorsi myocutaneous pedicled flap (N=1). The 30-day mortality rate was 12% (N=2) and the overall morbidity rate was 66%. All deaths occurred after reoperation for necrosis. Eleven patients (65%) kept or recovered digestive continuity (including the 9 with stenosis) and 8 (73%) eat normally. Four patients with transplant necrosis died before reestablishment. Four patients operated for necrosis died before restoration of digestive continuity and 2 patients are still awaiting restoration. CONCLUSION: Use of colon as an oesophageal substitute is risky. Reoperations for stenosis allows satisfactory oral feeding, while reoperation for necrosis is associated with both high early mortality and a low rate of restoration or digestive continuity. This later requires a range of complex surgical procedures.

Adult↗
PubMed2004

Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial.

Intraperitoneal positioning of conventional parietal mesh provides efficient reconstruction but causes visceral adhesion formation in 80-100% of the cases. The purpose of this clinical trial was to assess the performance and tolerance of a new generation of polyester mesh protected by a hydrophilic resorbable film. Eighty patients were included in a prospective multicenter clinical trial. Patients were treated for ventral hernia via an open approach (64%) or laparoscopically (36%). All meshes were implanted in a midline intraperitoneal location. The main objective was to evaluate the anti-adhesive capability of the mesh in relation to the viscera. In order to assess the absence of visceral adhesion objectively, an ultrasound (US) specific examination was initially validated (pre-operative prediction vs. per-operative findings) and then used during the follow-up. The usual clinical parameters were also collected to follow the patients on a period up to 4 years. Pre-operative US prediction vs. per-operative macroscopic findings: sensitivity 79%, overall accuracy 76%, negative predictive value 85%. After 12 months, 86% of the patients were ultrasonically adhesion free. Early post-operative complications were: seroma/hematoma (16%), subcutaneous infection (4%), cutaneous necrosis (1%) and occlusions (outside the mesh) (2.5%). No mortality was reported. Clinically, after 12-month follow-up, no complication related to post-operative adhesions to the mesh was noted: (occlusion 0%, fistula 0%). Late complications were: mesh sepsis (1%), new defects (4%) and recurrence (2.5%). Finally, 56 patients (75.7%) were clinically evaluated with a mean follow-up of 48+/-6 months. One direct recurrence was noted while six patients experienced new defect outside the mesh. No long-term severe complication such as occlusion or enterocutaneous fistula was observed. Based on a mean clinical follow-up of 4 years, the results of this prospective multicenter clinical trial demonstrate the safety and the efficiency of this composite mesh in the intraperitoneal treatment of incisional and umbilical hernia. In particular there was no early or long-term main complication due to the intraperitoneal location of the mesh.

Cicatrix↗
PubMed2003

[Laparoscopic pancreatic resections].

The feasibility of laparoscopic pancreatic resection has been demonstrated. However, the real clinical benefit for the patients remains questioned. The best indication for a laparoscopic approach appears to be the resection of benign or neuro-endocrine tumors without a need for pancreato-enteric reconstruction (i.e enucleation or distal pancreatectomy). The use of the laparoscopic approach for malignant tumors still remains controversial. The benefits of minimally invasive surgery are clearly correlated with the successful management of the pancreatic stump. Pancreatic related complication rate (fistula and collection) is 15% when using pancreatic transection with a laparoscopic endostappler.

Humans↗
PubMed2002

[Natural history of the pancreatic stump after duodenopancreatectomy of the pancreatic head].

UNLABELLED: Major complications following pancreaticoduodenectomy are thought to be chiefly associated with exocrine secretion of the pancreatic remnant which is not well known. This work aims to assess the exocrine secretion of the pancreatic remnant within the early post-operative period. PATIENTS AND METHODS: Seventy-five patients undergoing pancreaticoduodenectomy for presumed tumour were included in a prospective multicentre study. A tube was inserted in the pancreatic duct at the time of construction of the pancreatic anastomosis. Peripancreatic drainage was routinely used. Pancreatic juice and peripancreatic drainage fluid were collected and measured and pancreatic enzyme monitored. For 7 days patients received total parenteral nutrition and continuous infusion of randomly Somatostatin 14 (S-14) at a dose of 6 mg/24 h (days 1-6) and 3 mg/24 h (day 7) or matching placebo. Pancreatic fistula was defined as a daily drainage of more than 100 cc of amylase-rich fluid after day 3, persisting after day 12 or associated with symptoms or needing specific treatment. RESULTS: Daily output of pancreatic juice was low during the first postoperative day and then increased gradually until day 5. A high enzyme concentration was observed in pancreatic juice on the first post-operative day. S-14 infusion resulted in a significant decrease of both pancreatic fistula rate and enzyme concentration in peripancreatic fluid. CONCLUSIONS: During the first postoperative days, the outflow of the exocrine secretion of the pancreatic remnant is low but contains a high enzyme concentration with significant leaks within the peripancreatic area. S-14 infusion results in a decrease of pancreatic juice leaks from the pancreatic remnant.

Adolescent↗
PubMed2002

[Surgical treatment of acute pancreatitic with infected necrosis by necrosectomy-pancreatostomy].

UNLABELLED: Technical modalities of surgical treatment of infected pancreatic necrosis remains controversial. The aim of this retrospective study was to assess the results of necrosectomy associated by pancreatostomy using active drainage according Mikulicz, which is currently an unusual technique. PATIENTS AND METHODS: From 1985 to 1997, 18 consecutive patients (median age = 63; range = 35-88 years) were operated on through laparotomy for infected necrosis and treated by necrosectomy combined with Mikulicz drainage. Fourteen patients were referred from another center, including 9 who had previous surgery. Necrosectomy was performed after a median delay of 22 days (1-45) after onset of pancreatitis, in all patients because of severe sepsis (including 12 patients with persisting shock) and presence at CT scan of necrotic collections containing gas bubbles (n = 15) and/or infection proven by percutaneous aspiration (n = 3). RESULTS: After the first procedure, patients underwent between 2 and 25 (median: 5) additional necrosectomies through the pancreatostomy tract. Thirteen surgical complications were observed in 8 patients: digestive fistula (n = 7), intraabdominal bleeding (n = 3), gastrointestinal haemorrhage (n = 1), colic stenosis with colectasy (n = 1). Five patients, all referred from another center, died (28%) between the 47th and the 140th day from multiorgan failure (n = 4) or gastrointestinal haemorrhage (n = 1). The median hospital stay was 109 days (26-265) including 51 in intensive care unit (1-134). The 13 surviving patients were followed during an average of 2 years (4 months-7 years). All developed an incisional hernia of the pancreatostomy tract, which was surgically treated in 6 cases. CONCLUSIONS: Necrosectomy-pancreatostomy is an appropriate treatment of acute pancreatitis with infected necrosis, despite the usual need of additional but easy necrosectomies, and the frequent occurrence of incisional hernia. Results observed in patients referred to our center suggest that earlier diagnosis of necrosis infection using percutaneous aspiration could improve the prognosis.

Adult↗
PubMed2001

Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy.

BACKGROUND: It remains debatable whether somatostatin can prevent pancreatic fistula and other pancreatic stump-related complications following pancreaticoduodenectomy. This study assessed the effects of somatostatin-14 (S-14) on pancreatic remnant exocrine secretion. METHODS: This was a double-blind, randomized, placebo-controlled trial in patients undergoing pancreaticoduodenectomy for malignancy. Patients received a continuous infusion of S-14 (n = 38) or placebo (n = 37) for 7 days. Pancreatic juice and peripancreatic drainage fluid was collected and measured, and pancreatic enzymes were monitored daily. Postoperative complications were recorded. RESULTS: S-14 infusion was associated with a decrease in median daily pancreatic juice and pancreatic amylase output. Amylase concentration and output in the peripancreatic drain fluid were significantly lower after S-14 infusion than in the control group (both P < 0.05). The incidence of clinical pancreatic fistula (two of 38 versus eight of 37; P < 0.05) and total pancreatic stump-related complications (five of 38 versus 12 of 37; P < 0.05) was lower in patients treated with S-14. Duration of hospital stay was shorter after S-14 (18 versus 26 days; P = 0.01). CONCLUSION: Although the effect of S-14 on exocrine secretion remains difficult to demonstrate, it did reduce pancreatic juice leakage from the pancreatic remnant.

Adolescent↗
PubMed2001

Pancreatic surgical complications--the case for prophylaxis.

Pancreaticoduodenectomy (Whipple's procedure) represents a considerable surgical challenge. Postoperative complications are common and typically related to leakage of pancreatic exocrine secretions following anastomosis failure. Pancreatic proteases and lipase leaking from the organ remnant attack the surrounding tissue, potentially leading to severe inflammation, tissue necrosis, and fistula formation. In addition, the soft consistency of the normal pancreas can lead to difficulties in manipulating the organ and reduce the integrity of sutures. Pancreatic fistula is the most serious postoperative complication and especially common following resectional surgery for malignant disease. Through prophylactic inhibition of digestive secretions, it should be possible to reduce postoperative morbidity after pancreatic surgery. One such inhibitor is somatostatin-14, an endogenous peptide hormone with pronounced effects on secretion of pancreatic enzymes and hormones, gastrointestinal secretions, and pancreatic blood flow, all of which may decrease the risk of postoperative complications. A limited number of randomised controlled trials have investigated prophylactic administration of somatostatin-14 and the synthetic somatostatin analogue octreotide in reducing complications following pancreatic surgery. While the majority of studies with octreotide demonstrated a significant reduction in the overall complication rate, the benefits appeared less marked in relation to events specifically related to pancreatic secretion. However, preliminary results from a limited number of trials with somatostatin-14, administered as a continuous intravenous infusion, suggest that prophylactic pharmacotherapy produces a significant decrease in fistula formation and secretion related events after pancreaticoduodenectomy. Due to these promising data, further investigation of the role of somatostatin-14 prophylaxis in pancreatic surgery is warranted in large well controlled trials.

Clinical Trials as Topic↗
PubMed2000

[Megaduodenum in chronic intestinal pseudo-obstruction: management by duodenectomy-duodenoplasty].

BACKGROUND: Surgical management of primitive chronic intestinal pseudo-obstruction involving the duodenum (megaduodenum) is an uncommon but still difficult problem. PATIENTS AND METHODS: Six patients who experienced severe symptoms were managed by an original surgical procedure including partial duodenal resection and reconstruction of a duodenal tract using a large duodenal anastomosis (duodenectomy-duodenoplasty). RESULTS: There was no postoperative complication. All preoperative symptoms completely regressed in all but one patient who had previously undergone a vagotomy and experienced transient early post-operative gastric stasis. With a median follow-up of 6 years (range 4-9), all patients had good functional results without any evidence of other motility disorders. The mean weight gain was 10 kg (range 7-15). CONCLUSIONS: Duodenectomy-duodenoplasty is a safe procedure resulting in efficient symptom relief in patients suffering from megaduodenum.

Adolescent↗
PubMed1999

Resection of hepatocellular carcinoma in cirrhotic patients: longterm results of a prospective study.

BACKGROUND: Surgical resection of hepatocellular carcinoma in cirrhotic patients remains controversial because of a high reported recurrence rate. To assess the longterm results of resection, 37 patients included in a prospective study were followed for more than 5 years, with special interest in early detection of recurrence. STUDY DESIGN: Resection was performed from 1986 to 1991 with the goal of sparing the functional liver parenchyma. The mean tumor diameter was 5.3 +/- 2.6 cm (range 2 to 11 cm). Nineteen patients had tumors smaller than 5 cm. No additional perioperative therapy was performed. RESULTS: Evidence of intrahepatic recurrence was demonstrated in 26 of the 33 patients surviving the operation. Eight recurrences (31%) were diagnosed from the third to the fifth postoperative years. The recurrence-free survival rates at 1, 2, 3, 4, and 5 years were 68%, 40%, 26%, 13%, and 9%, respectively. Only 2 patients (7%) were alive and free of recurrence at 5 years. Some long survivals were observed after treatment of recurrence. The overall survival rates at 3 and 5 years were 35% and 24%, respectively. Tumor cell differentiation was the only significant prognostic factor for both recurrence and survival. Multifocal tumors were associated with a higher recurrence rate. Patients with good liver function had longer survivals that reached 38% in those with small solitary tumors. Study of the other dinicopathologic factors failed to demonstrate any prognostic value. CONCLUSIONS: Only a few patients are alive and free of recurrence 5 years after resection. Some long survival can be observed after treatment. Assessment of prognostic factors remains difficult, but the best results of resection are obtained in patients with small solitary hepatocellular carcinoma function.

Aged↗
PubMed1999

Somatostatin for the prevention of complications following pancreatoduodenectomy.

Pancreatoduodenectomy (PD) may be followed by serious complications chiefly associated with exocrine pancreatic secretion. Somatostatin and its analogues are able to inhibit pancreatic secretion and thus have been advocated for the prevention of complications following pancreatic surgery. In four published multicentric randomized trials, octreotide administration was associated with a decrease in overall complication rate. However and surprisingly, the benefit is less clear when focusing on complications associated with pancreatic secretion as in pancreatic fistula or in high-risk patients (PD and nonfibrotic pancreas). The efficiency of other somatostatin analogues has not yet been assessed in randomized trials. In conclusion, further studies would be useful before routine prophylactic administration of somatostatin analogues can be recommended.

Hormones↗