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Biomedical subjects

D Pezet

Publications and source records attributed to D Pezet.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Bowel endometriosis. Eight cases of colorectal resection].

Colo-rectal endometriosis requiring colon resection are reported in 8 patients to illustrated the diagnostic and therapeutic problems encountered in the management of this uncommon localisation. Pericatamenial or catamenial bowel symptoms associated with pelvic genital involvement were encountered in all cases. Clinical examination, barium enema and colonoscopy are essential to guide surgical management looking for multiple localisations. However their diagnostic value is low as endometriosis rarely involves the mucosa. Endosonography appears to be very promising in evaluating the depth of infiltration of the bowel. The treatment of bowel endometriosis is controversial and varies greatly according to the patient's complaints and clinical data. The indications and limits of all treatment modalities including abstention, medical, and surgical treatment are discussed. From the cases reported we conclude that symptomatic bowel endometriosis should be fully excised whenever possible, and the surgical procedure should be adapted to the depth of infiltration. A full thickness excision or bowel resection is mandatory in patients with deep muscularis involvement. These procedures, which are often difficult due to extensive fibrosis and adhesions, may be achieved by laparoscopy in selected patients.

Adult↗
PubMed1995

High morbidity rate after converted laparoscopic colorectal surgery.

Sixteen of 65 laparoscopically assisted colorectal operations were converted to an open procedure, usually because of dissection difficulties. Conversion was decided early in the procedure in four cases without perioperative morbidity and later in 12 cases, after a mean of 56 min. The results in patients undergoing converted operation were compared with those in 252 having a planned open colorectal procedure during the same period. The groups were comparable with regard to age, health status, factors influencing intestinal healing and grade of surgeon. A higher postoperative morbidity rate (50 versus 21 per cent) and more anastomotic leakages (25 versus 8 per cent) were apparent in the converted group. Operating time, postoperative ileus and hospital stay were longer in those requiring a converted operation. These poor results suggest that careful preoperative patient selection for laparoscopic procedures and a rapid decision to convert in case of difficulty are important.

Adolescent↗
PubMed1995

[Heller's myotomy by laparoscopic approach for megaesophagus].

The development of laparoscopic surgery has allowed the indications of this technique to be extended to the management of achalasia. Four patients were operated for achalasia confirmed by esophageal manometry. The procedure consisted of laparoscopic Heller's myotomy. The purpose of this paper is to detail the technical principles of this procedure and to evaluate its feasibility. There were no intra-operative incident and no conversion to open procedure. The postoperative course was uneventful in every case. The mean postoperative stay was 5 days. The postoperative manometry (n = 3), performed an average of 14.5 months after the operation, showed a normal lower esophageal sphincter pressure in all cases. Only one patient complained of intermittent dysphagia without food restriction and with normal postoperative manometry. The feasibility of laparoscopic Heller's myotomy is therefore obvious. Consequently, this procedure could replace repeated balloon dilatations in the management of achalasia.

Adult↗
PubMed1995

[Actinomycosis: value of percutaneous drainage of intra-abdominal abscesses].

Abdominal actinomycosis was localized in the liver with intra-abdominal abscesses. The disease had evolved for several years before diagnosis. Percutaneous interventional radiology allowed taking biopsies which confirmed the diagnosis. Percutaneous drainage of the intra-abdominal abscesses with antibiotherapy was successful without iterative surgery.

Abdominal Abscess↗
PubMed1995

Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.

BACKGROUND: We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment. STUDY DESIGN: From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant. RESULTS: Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14). CONCLUSIONS: Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.

Actuarial Analysis↗
PubMed1994

[Large eventrations of the abdominal wall. A technique of aponeurotic plasty associated with a prosthesis].

Surgical repair of major incisional hernia of the abdominal wall is a technically challenging operation. It is not exceptional to be faced with major loss of parietal tissue requiring associated aponevrosis plasty and prosthesis implantation. We report a new technique involving transposition of the aponevrosis sheaths of the rectus abdominis creating a new muscular sheath. The prosthesis thus becomes extra-peritoneal and is inserted deep into the new muscular sheath thus protecting both the intestine and the skin. This technique can be used as an alternative when the size of the defect makes it impossible to bring the two borders of the rectus sheath together. Due to the transposition of the aponevroses, the sutures are placed laterally to the rectus abdominis so the plasty can also be applied when prosthesis implantation is contraindicated.

Fascia↗
PubMed1994

[Celioscopy in digestive oncology].

In patients with suspected or patent cancer involving digestive tract organs, laparoscopy can be successfully used both as a diagnostic tool for initial diagnosis or evaluation of cancer extension and as a therapeutic tool, either in successive or in a single operation. For diagnosis, the main aim of laparoscopy is to confirm the clinical diagnosis or search for neoplastic diffusion. Diagnostic laparoscopy is particularly important in cases of advanced cancer when extension may render laparotomy unjustifiable. Needle biopsies of the liver can be obtained under visual control and non-resectable tumours can be identified. For cancer of the pancreas laparoscopic findings are highly specific, reaching 100% in cases with peritoneal carcinoma. Laparoscopy has similar advantages for staging cancer of the gall bladder which is often discovered after extension to other organs. There are few indications for cancer of the digestive tract itself although laparotomy would be more sensitive than echography or computed tomography for recognizing hepatic or peritoneal metastasis. Palliative treatment via laparoscopy is just at its beginnings and will require continued development in techniques and material. Currently, palliative hyperthermia for peritoneal carcinoma is under clinical evaluation. The future role of curative laparoscopy for abdominal cancers must be evaluated on the basis of prospective protocols.

Digestive System Neoplasms↗
PubMed1994

Adenocarcinoma of the duodenum: factors influencing survival. French Association for Surgical Research.

The records of 66 patients with histologically proven adenocarcinoma of the duodenum were reviewed retrospectively to determine factors influencing survival. The parameters studied were age, sex, weight loss, jaundice, anaemia, duodenal stenosis, type of surgical procedure, tumour size and location, depth of parietal invasion, presence and location of lymph node metastases, and pancreatic invasion. These factors were assessed in a group of 46 patients who underwent curative resection of the tumour; 20 patients who received palliative procedures were excluded from statistical analysis. Survival curves were established by the Kaplan-Meier method and compared by the Mantel-Haentszel test. The actuarial 3- and 5-year survival rates of patients undergoing curative resection were 59 and 45 per cent respectively. None of the prognostic factors studied influenced survival. These results indicate that resection of adenocarcinoma of the duodenum should be performed whenever possible, even in the presence of lymph node metastasis and pancreatic spread.

Adenocarcinoma↗
PubMed1994

Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.

The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.

Colectomy↗
PubMed1994

[Surgical treatment of severe acute pancreatitis. Results of a prospective multicenter study of the Associations of Research in Surgery].

OBJECTIVES: The aim of this prospective study was to appreciate, in severe acute pancreatitis, the therapeutic choice of the surgeons for the treatment of pancreatic necrosis and the timing of operation in biliary pancreatitis. METHODS: Forty-six centers participated in the study. For every included patient, cause and severity criteria of the pancreatitis, timing of surgery, surgical management and necrosis features were recorded. Mortality and morbidity, number of surgical operations and clinical course were analyzed depending on necrosis infection. RESULTS: From August 1986 to January 1990, 143 patients were included in the present study. The main causes of pancreatitis were gallstones in 66 patients and alcohol in 45. Other causes were found in 32 patients. Overall mortality was 23.8%. Mortality was higher in 38 patients with infected necrosis than in 41 patients with sterile necrosis (39% vs 27%). In patients with severe acute biliary pancreatitis operated on within the first seven days of pancreatitis, mortality and number of reoperations were higher than in patients operated on later (30% vs 14% and 40% vs 21% respectively). CONCLUSIONS: These results suggest that clinical trials on the treatment of pancreatic necrosis and on the timing of the treatment of biliary pancreatitis are needed. The analysis of mortality shows that it will be difficult to organize these trials.

Acute Disease↗
PubMed1994

Prognostic value of early computed tomographic scans in severe acute pancreatitis. French Association for Surgical Research.

BACKGROUND: The prognostic value of computed tomographic (CT) scans in differentiating mild from severe forms of acute pancreatitis is well established. Nonetheless, in patients with a severe form of the disease, some will have a relatively uneventful course while others will have severe complications. This prospective, multicenter study was done to evaluate the prognostic value of early CT scan in a homogenous group of patients with a first attack of severe acute pancreatitis. STUDY DESIGN: Dynamic CT scans were performed within 48 hours after admission. A standardized form was completed for each CT scan, recording the following data: abnormal enhancement of the pancreas itself, characteristics of extrapancreatic collections, and visualization of the portal and splenic veins. Statistical analysis was based on the log rank test and Cox's model and used death and abscess occurrence as the two end points. RESULTS: Two hundred twenty-eight patients from 46 centers were included in the study. The median Ranson and Imrie scores were 3 and 4, respectively. Forty-seven patients died and 72 had an abscess. The CT scan findings indicating an increase in mortality rate were nonenhancement of the neck of the pancreas (p = 0.04) and extrapancreatic collections within the left (p = 0.001) and right (p = 0.02) pararenal posterior spaces. The risk of abscess increased when there was nonvisualization of the splenic vein (p = 0.0001), in the presence of extrapancreatic collections in the right pararenal posterior space (p = 0.03) and when the extrapancreatic collections were heterogenous (p = 0.003). CONCLUSIONS: This study demonstrated that the location of extrapancreatic collections and nonvisualization of the splenic and portal veins on CT scans were not previously recognized prognostic factors of complicated outcome in patients with severe acute pancreatitis.

Abdominal Abscess↗