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Biomedical subjects

G Champault

Publications and source records attributed to G Champault.

At least 217 records · Page 12Linked to original sources
PubMed1975

[Postoperative ileus. Measurement of the changes in intragastric pressure immediately after abdominal operations (practical deductions)].

During the post-operative period, there is no intestinal paralysis, but simply a transient disorder of motility, the duration and intensity of which are different in the stomach, small intestine and colon. The asynchronism between regularisation of motor activity of the small intestine, which is almost immediate, and that of the colon, which occurs later, is responsible for the clinical picture usually noted. In the light of these new findings, the author analyses the various factors liable to modify the course of post-operative and attempts to suggest appropriate management of the immediate post-operative period.

Abdomen↗
PubMedDate not supplied

[Treatment of pancreatic pseudocysts by laparoscopic cystogastrostomy].

AIM: To evaluate the clinical results of laparoscopic cystogastrostomy and to determine the potential advantages of this new therapeutic option. PATIENTS AND METHODS: This study concerned 12 patients presenting with pancreatic pseudocyst and operated on by laparoscopic cystogastrostomy between 1997 and 2002. There were five men and seven women with a median age of 46 years (range: 30-72). In ten patients, the pseudocyst developed after acute pancreatitis and the median delay between the acute onset and surgery was 7 months (range: 2-24). In two patients, the pseudocyst was associated with chronic pancreatitis. All the patients had a single cyst bulging into the posterior wall of the stomach and the median cyst diameter was 9 cm (range: 5-14). RESULTS: Endoluminal gastric laparoscopy was used in six patients and intraperitoneal transgastric laparoscopy in six patients. Conversion to open surgery was required in one patient because the cyst could not be correctly localised by laparoscopy. The median size of the cystogastrostomy was 3 cm (range: 2-5). In eight patients, necrotic debris were still present within the cyst. The median operative time was 90 min (range: 60-140) and the median postoperative hospital stay was 6 days (range: 4-24). No mortality was recorded and postoperative morbidity was limited to one haematoma of the rectus sheath on a port site. One patient was readmitted on the 20th postoperative day because of cyst infection due to partial closure of the cystogastrostomy and was treated by endoscopic placement of a stent. One patient was lost for follow-up 2 months after surgery. With a median clinical and radiological follow-up of 12 months (range: 6-36), no recurrence of pancreatic pseudocyst was observed. CONCLUSIONS: In this series, laparoscopic cystogastrostomy is associated with a low postoperative morbidity and an effective permanent result. Laparoscopy has two main advantages: an excellent control of haemostasis and the creation of a wide communication with debridement of the cyst contents thus minimizing the risk of infection or recurrence of the pseudocyst.

Adult↗
PubMedDate not supplied

[Comparison of laparoscopic ultrasound and cholangiography during laparoscopic cholecystectomies. Results of a prospective study].

AIM: Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies. METHODS: The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography. RESULTS: Laparoscopic ultrasound was performed in all 600 cases. Cholangiography was performed in 498 (83%). Laparoscopic ultrasound required less time than cholangiography: 10.2 minutes versus 17.9 minutes (P=0.0001). Common bile duct stones were detected intraoperatively in 40 cases (7%). Both methods were equally effective. The sensitivity of laparoscopic ultrasound was 80% and its specificity 99%. For cholangiography these values were 75% and 98% respectively. For laparoscopic ultrasound, false positives and false negatives were noted in the first 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15. CONCLUSION: Laparoscopic ultrasound can be performed rapidly and in all cases. Results are comparable to cholangiography in the detection of common duct stones. Individual training is necessary to optimize efficacy. Anatomical anomalies are often missed.

Adult↗
PubMedDate not supplied

[Is laparoscopic treatment of adhesions a valid approach for postoperative abdominal pain?].

The role of post-operative adhesions in chronic abdominal pain remains controversial. The aim of this study was to assess the value of laparoscopic treatment of adhesions for chronic post-operative abdominal pain in 32 patients. Over a period of 8 years, 32 patients (25 women and 7 men) with a mean age of 41.5 years (18-69) were hospitalized for chronic abdominal pain of more than 6 months duration, without an obvious underlying neoplasm or psychiatric disorder. They had all undergone at least one previous abdominal operation (mean, 1.9; range, 1-5), with a mean follow-up of 28 months (6-82). The mean duration of the pain was 18 months (6-65) and in 24 of the 32 cases it was mainly hypogastric. Other than the presence of a scar, the clinical examination was completely normal. Prior to hospitalization, 163 different laboratory tests, 162 radiological investigations, including 13 CT scans and 3 MRIs, and 25 endoscopies had been performed. A pneumoperitoneum was made by "open laparoscopy" in 23 cases and with Verres needle in 9 cases. Eight patients (25%) did not have any adhesions, but 6 of them were found to have a gynecological problem (endometriosis). In this group, the laparoscopy lasted 34 minutes (15-45) and the mean hospital stay was 48 hours. In 24 cases, adhesions were found and selected. This was thought to be complete in 22 cases (91.6%). There was a strict correlation between the adhesions and the scar in 85% of cases. In 5 cases, the adhesions were associated with another intervention. There were no conversions. The mean duration of surgery and hospitalization was respectively 56 minutes (32-120) and 3.2 days. There was no mortality and the morbidity rate was 4.1% (1 monopolar injury). The average follow-up was 26.7 months: 22 of the 24 patients who had freeing of adhesions were evaluated after at least 6 months of follow-up. In 10 cases, the pain had completely resolved (45%), in 6 it had decreased (27%) and in 6 cases it was unchanged or had even worsened (1 case of endometriosis). Laparoscopic exploration for chronic post-operative abdominal pain, after an extensive work-up performed after a suitably long delay post-surgery, can be used to detect and treat adhesions in 3/4 cases. In the absence of another lesion, the pain is lessened in 72% cases. However, if there is another lesion, laparoscopic treatment of adhesions is less effective with respect to the pain, but it nevertheless can identify an.

Abdominal Pain↗
PubMedDate not supplied

Morbidity of laparoscopic fundoplication for gastroesophageal reflux: a retrospective study about 1470 patients.

BACKGROUND/AIMS: The aim of this retrospective study was to report and quantify the immediate and 3-year complications after laparoscopic anti-reflux surgery in order to understand the mechanism. METHODOLOGY: From 1992 to 1996, 1470 laparoscopic fundoplications were performed for symptomatic gastroesophageal reflux disease. Preoperative checkup included upper gastrointestinal tract endoscopy in 1437 patients (97.7%), esophageal manometry in 934 patients (63.5%), and 24-hour pHmetry in 799 patients (54.3%). Three procedures were performed: Nissen (n = 655), Nissen-Rossetti (n = 423), and Toupet (n = 392). The results were estimated at 1 and 3 months; thereafter they were evaluated at 3 years. Patients unable to return to the hospital center were contacted by telephone. RESULTS: Mean length of hospital stay was 4.6 days (range: 2-48 days). The preoperative complication rate was 2.1% (n = 31). The postoperative morbidity and mortality rates were 2.9% (43 patients) and 0.07% (1 patient), respectively. Conversion rate to laparotomy was 6.5% (96 patients). At 3 months, 87 patients (5.9%) had invalid dysphagia but there was no difference between the 3 procedures. Twelve patients have been reoperated (0.8%). At 3 years, 78 patients (5.6%) presented a clinical recurrence. The rate of dysphagia was 0.35%, and 38 patients were reoperated. CONCLUSIONS: Laparoscopic fundoplication is safe and effective with a low morbidity and mortality rate if junior surgeons commenced this procedure under the direct supervision of an experienced surgeon. Despite the advantage of this technique, we believe that indications for surgical management remain unchanged in the laparoscopic era.

Adolescent↗
PubMedDate not supplied

[The effect of the learning curve and the experience on the technique and the outcome of laparoscopic treatment for gastroesophageal reflux].

The laparoscopic treatment for gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period during which the rate of complications, and failures are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in 3 groups of consecutive patients in order to determine the effect of the learning period and the experience on the technique and the outcome. One hundred and fifty patients (84 men and 66 women) with an average age of 52.2 years (18 to 78) were included. Surgery was indicated for failure or early relapse following the end of medical treatment. The preoperative work-up (endoscopy, barium meal or oesophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of 50 patients around were chronologically defined. The parameters that were examined were: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results at short and medium term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GERD. All patients had an endoscopy, 91% a barium meal, 77.5% underwent esophageal manometry and 67% pH monitoring. One hundred and thirty two patients had a TF and 18 had a PF. Rosetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 mn.). The rate of conversion, due to a variety of causes, decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. There was 7 cases of relapse (4.6%), 5 in group 1 (10.2%) and 2 in group II (4%), with no cases in group III although the follow-up is shorter. There is an effect of the learning curve on the outcome of treatment for GR and this must be taken into account in the training of surgeons (training within experienced departments and "guidance" during their initial interventions) and also in publications in order to allow a more accurate comparison of the different treatments for GERD.

Adolescent↗
PubMedDate not supplied

[Laparoscopic treatment of acute cholecystitis. Incidence of anatomo-clinical variations (271 cases)].

The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1999, out of which 271 were preoperatively considered as acute cholecystitis (25.8%). The clinical, biological and ultrasound criteria were rigorously respected. The preoperative period of 1 to 5 days (mean--2.5) was used for re-equilibration and antibiotic and antithrombotic therapy. The intraoperative criteria were clinical, echolaparoscopical, cholangiographical and bacteriological and established in 219 cases the diagnostic of acute cholecystitis. The final diagnostic, on histopathological basis, confirmed the preoperative diagnosis of acute cholecystitis in 224 cases. The microscopical reexamination in the remainding controversy cases reclassified other 18 as acute cholecystitis (final concordance ratio--242:271). The preoperative overvaluation may be consecutive to a too rapid (before the constitution of specific lesions) or too delayed intervention (the aspect becoming chronical). The elements of diagnostic discordance are raising the problem of case selection and the necessity for standard classification of histological lesions in acute cholecystitis.

Adult↗