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D Collet

Publications and source records attributed to D Collet.

At least 19 recordsLinked to original sources
PubMed2006

[Laparoscopic treatment of para-esophageal hernias].

AIM: This retrospective study aims at analyzing the functional results obtained in patients operated by laparoscopy for a para-esophageal hernia. PATIENTS AND METHODS: From 1994 to 2004, 38 patients underwent a laparoscopic procedure for a symptomatic para-esophageal hiatal hernia of at least 3/4 of the proximal stomach: 27 females and 11 males, mean age 65 years (extreme: 22-84). There was no case on emergency, 4 patients had have at least one episode of intrathoracic volvulus. The operation consisted in gastric reduction into the abdominal cavity, excision of the sac, suture of the crura reinforced with a mesh in 6 patients and the construction of a gastric wrap. A postoperative barium swallow was performed on POD 3 in order to confirm the anatomical result. RESULTS: Mean operating time was 157 minutes (75-480), no case was converted into laparotomy. Four postoperative complications were observed (morbidity 10.8%): one gastric perforation diagnosed on POD 1, 2 severe dysphagias linked to the wrap, and one atelectasia. There was no death in this series. Functional results were evaluated by the mean of a questionnaire in 33 patients who had a follow up more than 6 months. Thirty-three questionnaires have been sent, 3 patients were lost and one was dead. Among the 29 patients analyzed, 14 were very satisfied, 11 were satisfied and 3 were deceived by the operation. Best results are obtained in patients with GERD, dysphagia or postprandial cardiothoracic symptoms. CONCLUSION: These results compared to the published data allow us to discuss about indications of surgery, the necessity to removal the hernia sac, and the advantages to reinforce the crura by the mean of a non absorbable mesh.

Adult↗
PubMed2005

[Surgical management of obstructed colonic cancer].

INTRODUCTION: Management of obstructed colonic carcinomas is a surgical challenge because it happens more often in elderly patients. The aim of our study is to assess mortality and morbidity rates of procedures performed in emergency for this pathology. PATIENTS AND METHOD: Between January 1st, 1998 and December 31st 2003, 22 patients underwent an emergency procedure for obstructive colonic obstruction due to an adenocarcinoma. Obstruction was defined as an emesis, distension on examination, no gas or stool since 24 hours and confirmatory plain radiograph film. RESULTS: Twenty patients (91%) underwent surgical procedure and two others received a colonic stent. Eleven patients (50%) underwent left colonic resection and intraoperative colonic cleansing was undertaken in 3 of these patients. One patient underwent a lateral colostomy, three patients (14%) underwent a right colectomy. A Hartmann's procedure was performed in six cases (27%). Morbidity occurred in 23% (50% were from anastomotic complication). Mortality rate was 27% (44% if aged more than 75 years old) (one superior mesenteric ischemia, and five heart and respiratory failures). Two-year survival rate was 61% and five year survival rate was 47%. Median survival was 24 months. CONCLUSION: Our study confirms that obstructed colonic cancer has a bad prognosis because it happens in elderly and not healthy patients. Priority must be given to the restoration of colonic permeability.

Adenocarcinoma↗
PubMed2005

[Value of surgical ampullectomy in the management of benign ampullary tumors].

AIM OF THE STUDY: To report the results of transduodenal excision (TDE) for tumors of the ampulla of Vater. PATIENTS AND METHODS: From 1998 to 2003, 10 patients underwent a transduodenal excision for presumed benign tumors of the ampulla of Vater. After resection, frozen sections were performed to ensure negative margins. RESULTS: There was no operative mortality. A postoperative pancreatitis occurred in one patient. For nine patients the postoperative course was uneventful. The mean duration of hospital stay was 18 +/-11 days. The final pathology showed adenoma in 8 patients, an adenocarcinoma in one patient and inflammatory lesions in other one. With a mean follow-up of 20 months, endoscopy did not show any recurrence in patients with benign lesion. Patient with an invasive cancer developed recurrence. CONCLUSION: Transduodenal excision is safe and effective treatment for benign ampullary tumors. TDE should be the operation of choice for patients with histologically-proven benign ampulloma, staged as uT1 by endoscopic ultrasound. This approach could reduce the rate of pancreaticaduodenoctomy performed for benign ampullomas.

Aged↗
PubMed2003

[Laparoscopic pancreatectomy: report of 22 cases].

OBJECTIVE: To evaluate results of laparoscopic pancreatectomy for benign lesions of the pancreas. Peri-operative data, surgical outcomes and techniques are presented. PATIENTS AND METHODS: Eighteen women and four men underwent laparoscopic pancreatectomy and were collected retrospectively from 1999 to 2003. RESULTS: Laparoscopic pancreatectomy was attempted in 22 patients and completed successfully in 18: 10 enucleations, three distal pancreatectomies, four left pancreatectomies and one total pancreatectomy for endocrine and cystic tumors. Left and distal pancreatectomies were performed with preservation of the spleen. Four patients were converted (one enucleation, one whipple procedure and two left pancreatectomy). There was no mortality; the post-operative morbidity included two pancreatic leaks and one case of half splenic infarction. The median length of hospital stay was 12 days. CONCLUSION: Patients appear to benefit from laparoscopic pancreatectomy for pancreatic benign tumors.

Adult↗
PubMed2002

Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients.

BACKGROUND: We undertook a retrospective multicenter study of elective laparoscopic sigmoidectomy for diverticulitis in order to assess the safety and the results of the procedure performed by a large number of surgeons. MATERIALS AND METHODS: Between January 1998 and April 1999, the French Society of Laparoscopic Surgery recruited retrospectively 179 patients from 10 surgical units, operated on for elective laparoscopic sigmoidectomy. There were 94 men and 85 women with a mean age of 58 years (range, 30-82). The indications for surgery were acute attacks in 123 cases, complicated diverticulitis in 47 cases, and miscellaneous in 9 cases. RESULTS: The performed procedure was a successful laparoscopic assisted sigmoidectomy in 154 cases (with totally intracorporeal anastomosis in 136 cases and hand-sewn anastomosis via small incision in 18 cases). The mean operation time was 223 min +/- 79 (range, 100-480). There was no mortality and 23 complications occurred in 23 patients (14.9%). Postoperative ileus lasted 2.5 +/- 0.9 days (range, 1-6), and oral intake started after 3.3 +/- 1.3 days (range, 1-12). The mean postoperative stay was 9.3 days (range, 4-50). Conversion to laparotomy was necessary in 25 cases (13.9%). The essential causes of conversion were obesity, severe adhesions, and colonic inflammation. The mean postoperative stay for the 25 converted patients was 13 +/- 8.5 days (range, 7-42). CONCLUSION: Elective laparoscopic sigmoidectomy for diverticulitis is feasible and is safe. The complication and mortality rates are similar to those observed after open procedures. For experienced surgical teams, laparoscopic colonic resection is a good approach for selected patients suffering from symptomatic diverticulitis.

Adult↗
PubMed2001

Platelet function during pregnancy: an evaluation using the PFA-100 analyser.

In clinical practice, the only tests of platelet function are bleeding time and platelet number. Bleeding time lacks sensitivity and specificity but the PFA-100, an in vitro analyser of platelet function may be of value. This study aimed to evaluate any correlation between platelet number and function using the PFA-100 in pregnant women. During a 21-month period, platelet function was evaluated in whole blood as part of the pre-anaesthetic coagulation testing screen with the PFA-100 using collagen and epinephrine (PFA-EPI) or ADP (PFA-ADP) as platelet agonists. Thrombocytopenia was defined as a platelet number less than 150 G litre(-1). The patients were divided into four groups: Group I (n=110) normal pregnancy; Group II (n=38) thrombocytopenia of pregnancy; Group III (n=13) women with pre-eclampsia without thrombocytopenia; Group IV (n=19) women with pre-eclampsia and thrombocytopenia. Results are expressed as mean (SD). Platelet count was not statistically different between Groups II and IV (111.1 (23.1) vs 99.5 (28.0) G litre(-1)). PFA-EPI was statistically increased in Group II (124.0 (26.3) s), Group III (128.3 (17.9) s), and Group IV (143.6 (47.7) s) compared with normal pregnant patients (114.6 (27.3) s, P<0.05, Mann-Whitney U-test). PFA-ADP was statistically increased only in Group II compared with normal pregnant patients (90.5 (18.9) vs 80.2 (11.2) s, P<0.05). PFA values were increased above normal laboratory values in (four of 38) Group II patients and (six of 19) Group IV patients but in no patients in Group III. PFA-ADP results were correlated with platelet count only in Group IV (r=-0.74, P=0.0003). The increased PFA values and the correlation between PFA-ADP and platelet number in hypertensive thrombocytopenic women confirms that platelet function may be decreased in such patients. In patients with pregnancy-induced thrombocytopenia, platelet function may be preserved when the platelet count is as low as 60 G litre(-1).

Adolescent↗
PubMed2000

[Laparoscopic splenectomy for hematologic diseases. Study of 275 cases. French Society of Laparoscopic Surgery].

AIM OF THE STUDY: To evaluate the results of laparoscopic splenectomy for hematologic diseases by a multicenter retrospective study. PATIENTS AND METHODS: Between 1991 and 1998, 275 patients (mean age: 40.4 years [18-93]) underwent splenectomy for idiopathic thrombocytopenic purpura (ITP) (n = 209, 76%), for hemolytic anemia (HA) (n = 37) including hereditary spherocytosis (n = 13) and auto-immune anemia (n = 24), lymphoma (n = 12), tumor (n = 6) and uncommon hematologic syndromes (n = 11). Laparoscopic splenectomy was attempted in every patient. The lateral approach was most commonly used with an anterior approach to the splenic hilar vessels, which were cut after hemostasis using a stapling gun; other techniques were also employed. RESULTS: The mean operating time was 165 minutes (45-360); it was shorter in the case of conversion (144 minutes) and became shorter with the operator's experience. Conversion was necessary in 55 patients (20%), due to hemorrhage in 2/3 of cases, related to splenic vessels (20 cases), short gastric vessels (9 cases), or injury of the spleen (8 cases). In ten cases (2%), conversion was necessary for extraction of the spleen. Conversion rate varied from 5.3 to 46.7%, depending on the surgical team. Univariate analysis of factors predisposing to conversion identified four causes: obesity; technique used to achieve hemostasis of the splenic hilar vessels; operator's experience; and presence of splenomegaly. An accessory spleen was found in 44 patients (16%). The weight of the spleen was more than 350 g in 43 patients (15.6%). There were no deaths. There were no significant complications in 236 patients (85.8%) and the mean hospital stay was 6.4 days. In comparison with patients who had a conversion, bowel function returned significantly earlier, use of analgesia was reduced and hospital stay was shorter. The overall morbidity rate was 13.8% (n = 38); morbidity rate was only 10.4% (n = 22) for laparoscopic splenectomy. In these 22 patients, the complications were: subphrenic collections (n = 5, 2.2%), abdominal wall infections (n = 5), thromboembolic events (n = 2), anemia (n = 2), pneumonia (n = 1), peptic ulcer (n = 1), bowel obstruction (n = 1), splenic vein thrombosis (n = 1). Re-operations were required in 4 patients (1.8%) because of hemorrhage, pancreatitis and bowel obstruction. Morbidity rate was significantly increased in the case of conversion (27%), obesity (20%), malignant disease (30%) and splenomegaly (21.8%). Forty-four patients (16%) received perioperative or postoperative blood transfusion and 23 (8.3%) received platelet transfusion. Mean time to return to normal activity was 21 days and was shorter in the absence of conversion (18.5 days versus 35 days). In patients with ITP, the mean platelet count was 240,000 after 3 months, and the failure rate was 8.3%. CONCLUSION: Laparoscopic splenectomy is a real alternative to conventional splenectomy for some hematologic diseases, particularly ITP and HA. The advantages are an uneventful postoperative course, a lower morbidity rate, a shorter hospital stay and an earlier return to normal activity. The limits of this technique are related to the operator's experience, the size of the spleen, the nature of the underlying disorders and patient characteristics, mainly obesity.

Adolescent↗
PubMed2000

[Dieulafoy's duodenal ulcer. Report of two cases].

Two cases of Dieulafoy's ulcer of the duodenum revealed by a severe digestive bleeding and histologically proved are reported. It is a rare localization of a rare disease which is particular by the presence of an abnormal vessel in the sub-mucosa layer of the digestive wall. Both patients were operated on and successfully treated by excision suture.

Adult↗
PubMed1999

UV Laser Spectroscopy Using the Velocity-Modulation Technique: New Hot Bands of the B(2)Sigma(+)(u)-X(2)Sigma(+)(g) System of N(+)(2).

The laser absorption spectroscopy of molecular ions using the velocity-modulation technique has been employed in the UV region. The absorption source was a cw single-mode laser beam from an extra-cavity frequency doubling unit associated with a dye laser. The high-resolution spectrum of the First Negative system B(2)Sigma(+)(u)-X(2)Sigma(+)(g) of N(+)(2) has been studied. The N(+)(2) ions were produced with an electric discharge in a flowing gas mixture of He/N(2). Seven vibrational bands of the Deltav = 2 sequence (v' = 2-8) have been observed in the region between 30 000 and 30 600 cm(-1), and five of them for the first time at high resolution (v' = 2-4, 6, 7). A set of 770 lines have been assigned; among them are several extra - lines belonging to the A(2)Pi(u)-X(2)Sigma(+)(g) system. A standard model has been used to consider the perturbations between the rovibrational levels of the B(2)Sigma(+)(u) and A(2)Pi(u) states. An improved set of deperturbed constants and effective interaction parameters were derived for the v(B) = 3-v(A) = 14 and v(B) = 7-v(A) = 20 complexes. Copyright 1999 Academic Press.

Journal Article↗
PubMed1998

Observation of TiF+ by Velocity Modulation Laser Spectroscopy and Analysis of the

The molecular ion TiF+ has been observed for the first time using high-resolution spectroscopy. The ions were produced in the positive column of an AC glow discharge with a gas mixture of He/TiF4. A single-mode cw dye laser along with the velocity modulation detection technique was used to record an absorption spectrum in the spectral region 16 800-18 600 cm-1. The observed system was assigned to the 0-0 and 1-1 bands of the [17.6]3Delta-X3Phi transition of TiF+. The rotational analysis of the main subbands has been performed up to J values equal to 77 and 56 for the 0-0 and 1-1 bands, respectively. Despite a careful search, no intercombination band was observed. A set of effective molecular parameters has been determined, characterizing the v = 0, 1 levels of the [17.6]3Delta and X3Phi states. The spin-orbit constants Ae and the vibrational constants omegae, omegaexe have been estimated for both electronic states, as well as their equilibrium distances Re (1.7509 and 1.7800) Å for the [17.6]3Delta and X3Phi states, respectively). Copyright 1998 Academic Press.

Journal Article↗
PubMed1998

[Functional results of the laparoscopic treatment of gastroesophageal reflux (followup greater than 2 years)].

STUDY AIM: The of this study was to evaluate functional results in 70 patients operated on for gastroesophageal reflux disease with a follow-up > 2 years, by means of a questionnaire sent to them. PATIENTS AND METHODS: Functional results were evaluated in the 60 patients who answered the questionnaire. The fundoplication (Nissen = 27, Nissen-Rosseti = 21, Toupet (n = 12) was laparoscopically performed with a mean follow-up of 3.4 years (range: 2-6.6 years). A circular wrap (either Nissen or Nissen-Rossetti) had been systematically performed except in patients who had an esophageal motility disorder, who had a partial wrap according to Toupet. RESULTS: Three patients experienced recurrent symptoms of reflux (failure rate: 5%). Thirteen patients had mild dysphagia, requiring modification of the oral intake in two cases. No patient required dilatation. Fifty patients complained of postoperative side effects: flatulence (n = 40), meteorism (n = 24), abdominal pain (n = 16), diarrhea (n = 12), impossibility either to vomit (n = 16) or to belch (n = 20). Ten patients were symptom free and had neither symptoms of reflux nor side effects. Despite undesirable side effects, 46 patients (78%) were very satisfied with the operation, six (10%) were satisfied and five (8%) were disappointed. CONCLUSION: Recurrent symptoms of reflux were rarely observed (5%) but postoperative side effects were frequent (67%). Side effects when present provide less discomfort than reflux itself. Patients must be aware of it prior to surgery. These results should be confirmed by further assessments.

Abdominal Pain↗
PubMed1998

Advances in laparoscopic surgery.

After a brief account of the origins of laparoscopy and of its development into an interventional technique thanks to technical improvement, the author gives a dynamic state of the art in laparoscopic surgery, beginning with a description of his original classification method for laparoscopic procedures according to their level of use. Before tackling the highly controversial issue of laparoscopic surgery for cancer, he reviews in detail the various operations successfully performed by laparoscopy for the treatment of nonmalignant abdominal disorders and acute syndromes, all the while checking their results against those obtained with their open counterparts. As the various procedures are described, the interest of the laparoscopic approach becomes clearly visible, based on the excellent view of the operative field that allows diagnostic accuracy, thus avoiding unnecessary operations, and precise dissection with minimal damage. However, the laparoscopic approach is highly dependent on the surgeon's proficiency, itself depending on experience and therefore on the frequency of occurrence of the disorder, and on the progress in and availability of adequate equipments. The last chapter looks into the future of this ever-expanding approach and defines two great trends in its evolution, one accessible to the individual surgeon, the gradual adaptation of open procedures into laparoscopic ones, the other at the institutional level, in view of the huge financial support involved if high technologies are to be systematically integrated in this new surgery. What will the future be like?

Digestive System Diseases↗
PubMed1997

Laparoscopic cholecystectomy in 1994. Results of a prospective survey conducted by SFCERO on 4,624 cases. Société Française de Chirurgie Endoscopique et Radiologie Opératoire.

BACKGROUND: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the beginning years in which the technique was being used. METHODS: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy started laparoscopically during 1994 have been included. RESULTS: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 +/- 19.8 years old) and 1,314 males (56.3 +/- 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while 4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N = 230)-4.7% in group I (N = 203) and 8.4% in group II (N = 27). Mortality was 0.2% (N = 9)--namely four intraabdominal complications (three cases of peritonitis and one biliary re-operation), two cardiac failures, and one brain infarction. The causes of death were not specified in two patients. CONCLUSIONS: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient and the biliary symptoms.

Adult↗
PubMed1997

[Laparoscopic fundoplication for gastroesophageal reflux. Apropos of our first 123 patients].

From July 1991 to March 1997, 123 patients underwent laparoscopic fundoplication. Surgical indications were as follows: either failure of medical therapy, or early recurrence of symptoms after interruption of medical treatment in young patients or large hiatal hernia associated with symptoms of reflux and/or symptoms of mediastinal compression. The type of the wrap was tailored to the preoperative manometry: circumferential fundoplication was achieved in patients with normal esophageal motility, and partial wrap in patients with altered motility. Short gastric vessels were not routinely divided. One hundred and eleven circumferential fundoplications were performed: 52 with division of short gastric vessels and 49 without, whereas there were 22 partial wraps. In 4 cases, it was necessary to switch to open surgery (conversion rate: 3.2%): 2 enlarged left liver lobes, one esophageal tear and one splenic injury. Six postoperative complications were observed (morbidity rate: 4.8%), one of whom was severe and led to the patient's death due to necrosis of the fundus. After a mean follow-up of 1.7 +/- 1.4 years, 4 patients have transient recurrent reflux, 3 patients have had annoying dysphagia requiring balloon dilatation in one case and reoperation in two cases. Four patients experienced a late thoracic migration: in one case after a violent physical effort, requiring urgent reoperation; in the other three cases, the migration remained asymptomatic. The pH- and manometric study performed in 41 consecutive patients before and after surgery allows objective evaluation of the results.

Adult↗
PubMed1997

[Ileocaecal tuberculosis. Apropos of a case].

The authors report a case of ileocaecal tuberculosis in a 27-year-old man with no particular risk factor for this disease. The initial diagnosis was terminal ileitis discovered at appendicectomy. The diagnosis of ileal tuberculosis was suspected in the presence of giant cell follicles on ileal biopsies, and was confirmed by the presence of AFB in the gastric intubation fluid. This patient presented known atypical pulmonary images for several years, which had never been investigated in more detail. A favourable course was observed in response to triple-agent, then double-agent antibiotic therapy. This case illustrates the fact that ileal tuberculosis still exists today, and that it does not exclusively affect "high-risk" patients.

Abdominal Pain↗
PubMed1996

[Laparoscopic cholecystectomy in 1994. Results of the survey of the SFCERO on 4624 cases].

UNLABELLED: This study aims to evaluate the results of laparoscopic cholecystectomy in 1994 performed by a large number of surgeons. The study was conducted prospectively and anonymously among the members of the SFCERO. All the patients who underwent cholecystectomy started laparoscopicaly during 1994 were included. RESULTS: 4.624 cholecystectomies were performed by 150 surgeons. There were 3310 females (42.5 +/- 19.8 years old) and 1314 males (56.3 +/- 16.1 years old). Conversion rate was 6.9%: 4261 purely laparoscopic operations (Group I) and 320 conversions (Group II). Morbidity was 5% (N = 230): 4.7% in Group I (N = 203) and 8.4% in Group II (N = 27). Mortality was 0.2% (N = 9): 4 intra-abdominal complications (3 cases of peritonitis and 1 biliary reoperation), 2 cases of cardiac failure and 1 cerebrovascular accident. The cause of the death was not reported for 2 patients. These results show that the morbidity and mortality rate have not dramatically changed since the beginning of the technique, whereas the frequency of CBD injuries has decreased. In contrast, the conversion rate has slightly increased.

Adult↗