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Biomedical subjects

D Collet

Publications and source records attributed to D Collet.

61 records · Page 4Linked to original sources
PubMedDate not supplied

Conversions and complications of laparoscopic cholecystectomy. Results of a survey conducted by the French Society of Endoscopic Surgery and Interventional Radiology.

During 1991, 41 surgeons of the French Society of Endoscopic Surgery and Operative Radiology (SFCERO) performed 3,673 cholecystectome of which 2,955 were laparoscopic. Data for those patients in whom a conversion to laparotomy was necessary or a complication occurred were collected by a retrospective multicenter survey. Conversion was performed in 142 patients (4.8%): in 106 this was due to pathology in the subhepatic space; in 36 it was because of a complication related to the laparoscopy. There were 101 postoperative complications (morbidity 3.4%): 59 biliary and 42 non biliary complications and six deaths (mortality 0.2%). There were 18 bile duct injuries, one of which led to the death of the patient. Excluding conversions to laparotomy, these figures are comparable to those for open cholecystectomy. These results define the limits and advantages of laparoscopic cholecystectomy. Conversion to laparotomy remains a wise option in cases of technical difficulty or doubtful biliary anatomy.

Bile Ducts↗
PubMedDate not supplied

Laparoscopic cholecystectomy: the state of the art. A report on 700 consecutive cases.

Born in secret in 1987, developed in an atmosphere of skepticism and even hostility throughout 1988, the laparoscopic cholecystectomy triumphed in 1989-90 and caused a veritable revolution in the world of general surgery. The 700 consecutive cases that we report here reflect the spirit of these various periods. From prudently restrictive, our indications widened to include 90% of all patients with gallbladder lithiasis. Sclero-atrophic gallbladders constitute the greatest challenge for endoscopic maneuvers. This group of patients should be treated by the most experienced operators only. The figures for mortality (0.1%) and complications (3%) are very comparable and even better than those for traditional cholecystectomy. The quality of recovery is infinitely better; there is absence of pain, a short period of hospitalization, return to normal physical activity within 10 days, rapid return to work, and total preservation of the abdominal muscles for participation in sports activities. All these advantages are assets of the laparoscopic cholecystectomy which are not available to the 6% of patients for whom an intra-operative conversion to open surgery is necessary. These patients recover within the conditions of a traditional cholecystectomy which are far from being poor. The large multicenter studies, such as those carried out in France and Belgium recently involving 3,708 patients, arrive at identical conclusions. The laparoscopic cholecystectomy is on its way to becoming the gold standard of treatment for gallbladder lithiasis. It is the first successful step towards surgical techniques of the 21st century which will be carried out inside the musculo-cutaneous envelope of the unopened human body.

Adolescent↗
PubMedDate not supplied

Laparoscopic cholecystectomy in the obese patient.

Between September 1990 and September 1991 laparoscopic cholecystectomy (LC) was performed in 310 patients with symptomatic cholelithiasis by using a four-cannula technique. Of this group, 282 were normal or overweight (group A) and 28 were obese (group B) according to classification using the Body Mass Index. Forty-one patients had cholecystitis of varying degree. There were no deaths in this series. The conversion rate to laparotomy was 2.9% and the morbidity was 5.4%. There was no statistical difference between groups A and B in relation to the length of procedure, conversion rate, or morbidity. This small series suggests that laparoscopic access is still feasible, if at times difficult, in obese patients. Specific surgical techniques concerning instrument length and cannula placement that may be useful in obese patients are described.

Acute Disease↗
PubMedDate not supplied

Laparoscopic adjustable gastric banding results after 2 years with two different band types.

BACKGROUND: Laparoscopic gastric banding is the most common operation in Europe for morbid obesity. Many devices from different companies are now available. The aim of this study was to compare the results over a 2-year period of 2 types of band: the Lap-Band and the Minimizer band. METHODS: In a non-randomized study, 2 consecutive groups were prospectively analyzed. Group A consisted of 120 patients who received the Lap-Band, and group B consisted of 68 patients who received the Minimizer band which contains eyelets. All the bands were placed above the lesser sac by the perigastric approach. RESULTS: 4 early complications were observed in group A (1 phlebitis, 1 pneumopathy and 2 early displacements of the band); and 1 in group B (1 retention of urine). After a follow-up of 2 years, the displacement rate of the band was 10.8% in group A and 0% in group B. One gastric erosion was observed in group B, but not in group A. After 2 years, the average loss of excess weight was 50% in both groups. CONCLUSION: With the Minimizer band, we did not observe any slipping, and the efficacy with respect to weight loss was equivalent to the Lap-Band.

Adult↗
PubMedDate not supplied

[Cholecystectomy by laparoscopy. Operative technic. Results of the first 100 cases].

The authors describe their own technique for the treatment of gallbladder stones using a laparoscopic approach. They squeletonsie the cystic artery and duct. Their clamp them by clips. Next they introduce into the gallbladder an ultrasonic lithotriptor which fragments the stones into powder evacuated by aspiration. The empty and clear gallbladder is severed off the liver and extracted out of the abdomen through an 8 mm orifice formerly used for the introduction of the lithotriptor. Among the 104 first cases performed between November 1988 to December 1989 the mortality is zero. On three patients the laparoscopic procedure has had to be stopped and replaced by a traditional open cholecystectomy. 3 complications occurred postoperatively: 1 biliary fistula which cured spontaneously within 7 days and 2 intra abdominal abscess which were treated by a secondary laparoscopic drainage. In the other cases the postoperative time has been uneventful. The patients appreciate mostly the painless postoperative time the absence of skin scar the short hospital stay 4 days and the possibility to go working one week later.

Adolescent↗
PubMedDate not supplied

[Peridural analgesia in labor. Comparison between bupivacaine and 2-chloroprocaine].

The purpose of this study was the comparison of the effects on the labor and neonates of epidural analgesia conducted either with bupivacaine or 2-chloroprocaine. Hundred and three parturients were included in the study. They were randomly divided in two groups. Sixty-three patients received bupivacaine in 0.25% solution and 40 received 2-chloroprocaine in 2% solution. Epinephrine was not added to local anesthetics. The first dose was 25 mg of bupivacaine (10 ml) or 200 mg of 2-chloroprocaine (10 ml). Reinjections occurred every 30 min for 2-chloroprocaine (80 mg) and every hour for bupivacaine (10 mg). The time of onset of cutaneous analgesia was similar in both bupivacaine (12.5 +/- 4.7 min) and 2-chloroprocaine (13.8 +/- 5.1 min) patients. The incidence of incomplete or insufficient analgesia was significantly higher with 2-chloroprocaine. The number of parturients who required forceps for conclusion of childbirth was not statistically different with bupivacaine (n = 25, 40%) or 2-chloroprocaine (n = 11, 28%) (CHI2 = 1.5971, p = 0.2063). The second stage of labour was significantly longer in parturients who required forceps extraction in both groups. These patients also received significantly more local anesthetics. All newborns had an Apgar score performed before the third minute following birth. All observed Apgar scores except one of bupivacaine group were over eight. Umbilical cord blood was drawn for pH determination. Cord blood pH was slightly but significantly lower in bupivacaine (7.314 +/- 0.106) than in 2-chloroprocaine (7.345 +/- 0.06) patients (t = 1.6968, p = 0.046). Newborns extracted with forceps after maternal bupivacaine epidural analgesia had a significantly lower umbilical blood pH (7.278 +/- 0.117) than newborns who did not required forceps in the bupivacaine group (7.337 +/- 0.093) (t = 2.1986, p = 0.0159).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗