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H Briandet

Publications and source records attributed to H Briandet.

6 recordsLinked to original sources
PubMed1996

[Treatment of common bile duct lithiasis under laparoscopy. A prospective multicenter study in 189 patients].

OBJECTIVES: The aim of this study was to assess the feasibility and results of common bile duct laparoscopic treatment and exploration in patients with choledocholithiasis. PATIENTS AND METHODS: From November 1991 to December 1994, 189 consecutive malades (120 females; mean age 68 years, range: 21-92) with choledocholithiasis identified during routine intraoperative cholangiogram underwent surgical exploration of common bile duct in 5 surgical centers. Twenty patients were referred to surgery after unsuccessful endoscopic sphincterotomy. RESULTS: Following laparoscopic exploration and intraoperative cholangiography, common bile duct stone extraction by laparoscopy was not attempted in 11 patients (5.8%). The common bile duct was successfully cleared of all stones in 153 patients (81% of the overall population and 86% of laparoscopic attempts), either via the transcystic route (n = 97) or through choledocotomy (n = 56). Eighteen patients required conversion to open surgery, 16 for unsuccessful stone extraction and 2 despite successful stone extraction. Postoperative endoscopic sphincterotomy was required in 7 patients (4.4%) for retained stones after laparoscopic treatment. There were no postoperative deaths (95% confidence interval 0-1.6%), and follow-up, ranging from 3 to 42 months, has shown no further clinical evidence of retained stones. CONCLUSION: Diagnosis and treatment of common bile duct stones is feasible by laparoscopy, and the results in this series compare favorably with those of conventional surgical treatment. Complete treatment of biliary lithiasis, in one operation, avoids the pitfalls of patient selection for preoperative endoscopic retrograde cholangiography and the risks of endoscopic sphincterotomy.

Adult↗
PubMed1995

Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic treatment of choledocholithiasis.

Laparoscopic common bile duct (CBD) exploration was attempted in 115 of 121 consecutive unselected patients with choledocholithiasis (mean age 69 (range 21-92) years) found during routine intraoperative cholangiography. The CBD was successfully cleared of all stones in 100 patients (87 per cent). Ten of 11 patients referred for surgery after failure of endoscopic sphincterotomy had complete laparoscopic choledocholithiasis. Eleven patients (10 per cent) required conversion to open CBD exploration, and laparoscopic exploration was not attempted in six (5 per cent) because of inflammation or fibrosis. Postoperative endoscopic sphincterotomy was required in four patients (4 per cent) for retained stones after laparoscopic exploration. There were no postoperative deaths (39 per cent of patients were aged 75 years or more). Routine intraoperative cholangiography, and when required laparoscopic CBD exploration, should be compared in randomized trials with preoperative endoscopic retrograde cholangiography in patients with suspected choledocholithiasis.

Adult↗
PubMed1990

Ex vivo evaluation in normal dogs of insulin released by a bioartificial pancreas containing isolated rat islets of Langerhans.

In bioartificial pancreatic systems, isolated islets of Langerhans are protected against immune rejection by an artificial membrane, permeable to glucose and insulin, but not to immunoglobulins and lymphocytes. Some of these devices, referred to as vascular systems, are set up to be connected to a vascular site in the recipient, with blood circulating in contact with one side of the membrane, and the islets on the other side. Such a bioartificial pancreas, containing isolated rat islets of Langerhans, was connected to an arteriovenous shunt of a normal anesthetized dog. The aim of this experiment was to investigate the kinetics of the insulin secretory response of the system to a glucose load. Glucose was infused upstream of the system, increasing the glucose concentration inside the bioartificial pancreas from 7 to 14 mmol/l, without altering the blood glucose concentration of the dog. Insulin concentration was determined simultaneously upstream and downstream of the bioartificial pancreas. Insulin production was calculated by multiplying the difference between these values by the blood flow rate. Blood flow rate (Q) was estimated from the change in the glucose concentration produced by the glucose infusion using a mass transfer analysis derived from Fick's principle. Insulin production increased from 20 +/- 8 to 59 +/- 15 microU/100 islets/min within 15 min following the beginning of the stimulation (n = 6, p less than 0.05). Five min after the end of the stimulation, insulin production decreased from 75 +/- 13 to 50 +/- 9 microU/100 islets/min (p less than 0.05) to reach the basal level (21 +/- 3 microU/100 islets/min) 30 min after the end of the glucose stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrylic Resins↗
PubMedDate not supplied

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients.

BACKGROUND/AIMS: Evaluation of the feasibility and results of the one-stage treatment combining routine intraoperative cholangiography and laparoscopic common bile duct exploration for choledocholithiasis. PATIENTS AND METHODS: Multicentric (5 centers-9 surgeons) prospective study in 247 consecutive patients (mean age 68 years; range 21-92) during a 50-month period (November 1991-December 1995). Laparoscopic treatment of choledocholithiasis was attempted irrespective of the circumstances leading to the diagnosis of biliary lithiasis or the preoperative suspicion of choledocholithiasis. RESULTS: One out of four patients (n = 61) had unsuspected choledocholithiasis disclosed by routine intraoperative cholangiography. A laparoscopic complete clearance of choledocholithiasis was achieved in 208 of 236 attempted cases (88%), with either transcystic duct extraction (n = 116) or choledochotomy (n = 92). Open surgery was required in 20 patients for failure of laparoscopic treatment and in 3 patients despite successful extraction. Twenty-one of 25 patients (84%) referred for failure of retrograde endoscopic stone extraction had successful laparoscopic choledocholithiasis clearance. The mean duration for the laparoscopic transcystic approach and choledochotomy were 108 min (range 50-300) and 173 min (range 70-480), respectively. Eleven patients had retained stones (4.4%). Minor and major complications were recorded in 9 and 22 patients respectively. The operative mortality was 0.4% (95% confidence interval: 0-1.2%). CONCLUSION: Intraoperative cholangiography during laparoscopic cholecystectomy and laparoscopic common bile duct exploration when required should be considered as the simplest and most efficient treatment for choledocholithiasis. The multicenter character of this study including consecutive patients from public and private practices, strengthens our conclusions and is consistent with a wide diffusion of this diagnostic and therapeutic strategy.

Adult↗