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Biomedical subjects

H Levard

Publications and source records attributed to H Levard.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Complications of celioscopic cholecystectomy in 2006 patients].

The development of laparoscopic cholecystectomy is only justified if it can ensure the good results obtained by laparotomy. The purpose of this work is to study all complications which occurred in a homogeneous group of patients. From May 1988 to January 1993, we operated on 2006 patients by laparoscopy (724 men and 1282 women) with a mean age of 50.6 years. Signs of stones in the common bile duct were noted in 4.1% and acute cholecystitis was detected in 12.5%. A conversion to normal laparotomy was necessary in 2.1% of patients. All complications were systematically investigated restrospectively in any patient hospitalised for more than five days. Residual stones in the common bile duct were not taken into consideration when they were not complications obviously related to the operation. We observed five intraoperative complications (4 hemorrhages, 1 ileum puncture) and 40 postoperative complications (25 non biliary and 15 biliary). The 25 non biliary complications consisted of: 1 death by pulmonary embolism, 9 hemorrhages, 4 cases of acute pancreatitis, 4 subphrenic abscesses, 2 colon punctures, 2 parietal complications, 1 ulcer perforation, 1 myocardial infarction and 1 phlebitis. The 15 biliary complications consisted of: 3 lateral punctures of the common bile duct, 9 fistulas of the cystic duct (4 with a residual stone in the common bile duct and 5 without), 2 punctures of an abnormal right hepatic duct, one of which was treated by "Roux en Y loop" intestinal diversion, and a late stenosis of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Extracorporeal lithotripsy associated with laparoscopic cholecystectomy: results of 60 patients.

Gallbladder extracorporeal lithotripsy was performed on 60 patients before laparoscopic cholecystectomy. Of the 44 cases with solitary stones (range, 17-45 mm; mean +/- SEM, 26.9 +/- 0.1 mm), satisfactory fragmentation was obtained in 77.2%. Of the 16 cases with multiple stones (range, 11-25 mm; mean +/- SEM, 14.9 +/- 0.7 mm), satisfactory fragmentation was obtained in 18.75%. Minimal adverse effects were observed both clinically and macroscopically during surgery. Upon histologic investigation, only two small gallbladder lesions could be attributed to extracorporeal lithotripsy. No changes in blood chemistry tests were recorded. When carried out with high performance equipment, extracorporeal lithotripsy appears to be an interesting procedure that permits an appreciable reduction in the number of parietal wall incisions that need to be widened, therefore simplifying laparoscopic cholecystectomy when dealing with large stones.

Adult↗
PubMed1993

[Cholecystectomy via laparoscopy in situs inversus totalis. A case report and review of the literature].

The authors report a case of symptomatic cholelithiasis in a patient with situs inversus totalis, in which the surgical treatment was performed by laparoscopy. They discuss the etiopathogenesis of this anomaly and malformations often associated, moreover related clinical and surgical problems. Finally, they describe operative technique stressing the real possibility to perform the operation by laparoscopy on condition that the surgeons have sufficiently experience of biliary and laparoscopic surgery.

Cholecystectomy, Laparoscopic↗
PubMed1993

[Celioscopic treatment of acute obstructions of the small intestine. Immediate results in 25 patients].

Laparoscopic treatment of small intestinal obstruction is associated with immediate advantages and it may be expected that the recurrence rate will be decreased because of the reduction of wound scars. Between september 1989 and september 1991, 25 patients (16 men and 9 women), mean age 53.8 years, underwent initial laparoscopy for acute small intestinal obstruction. These patients had undergone a total of 43 (1.7 per patient) laparotomies an average of 13 years previously. One patient had never been operated on, 13 had one previous laparotomy, five had two, four had three, and two had four previous laparotomies. Laparoscopic treatment of intestinal obstruction was possible in nine cases including three cases of bands and six cases of adhesions. In sixteen cases, laparoscopy had to be completed by laparotomy, 13 immediately and 3 secondarily. The cause of immediate failure was the impossibility of finding and/or treating the cause in seven instances, four cases of intestinal wounds, on case of intestinal necrosis which required resection, and one case of missed right colonic carcinoma. The cause of secondary failure were incomplete release of adhesions, volvulus, and missed left colonic carcinoma in one case each. Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the laparoscopy + laparotomy group (p < 0.001). Two complications, with one death, were noted in the laparoscopy + laparotomy group. In conclusion, laparoscopic treatment of intestinal obstruction seems possible but in less than half of cases. Failures are related to the difficulty with which the abdomen may be explored. Laparoscopic treatment should not be pursued in case of problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research.

The current randomized study was done to compare the results of choledochoduodenostomy (CD) and choledochojejunostomy (CJ) for choledocholithiasis, with special reference to long term results and the risk of ascendant cholangitis. From January 1978 to January 1990, 130 patients were included in the study--64 with CD (side to side, in all patients) and 66 with CJ (side to side in 25 patients and end to side in 41). No significant difference was observed between the CD and CJ groups for postoperative mortality (3.8 percent) and morbidity rates. One hundred and twenty patients (58 CD and 62 CJ) were available for long term follow-up evaluation (mean follow-up period of 29 +/- 11 months). One hundred and seven patients had no symptoms attributable to biliary disease or operation. Five patients in this group died of unrelated causes. Thirteen patients experienced biliary symptoms suggestive of cholangitis, or at least related to the bilioenteric anastomosis--six patients in the CD group and seven in the CJ group. Cholangitis was observed in the first postoperative year in eight of these 13 patients and during the second year for the five others. In the CD group, cholangitis was the result of sump syndrome (n = 3), anastomotic stricture (n = 1) and unknown causes (n = 2). In the CJ group, cholangitis was the result of anastomotic stricture (n = 3), residual intrahepatic stones (n = 1) and unknown causes (n = 3). The results of the current study confirm the good long term results of both procedures. However, it suggests that CD is preferable for choledocholithiasis for two reasons--it is technically easier and faster to perform than CJ and, unlike CJ, CD permits easy access to further endoscopic exploration or treatment if necessary.

Aged↗
PubMed1992

[Appendectomies by celioscopy. Results in 78 patients].

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.

Acute Disease↗
PubMed1991

Laparoscopic cholecystectomy: historic perspective and personal experience.

Operative laparoscopy has been an important diagnostic and therapeutic method in gynecological surgery for more than 15 years. Laparoscopic gastrointestinal surgery has only recently become accepted among general surgeons. Laparoscopic appendectomy was the first such procedure performed, in 1983, followed by cholecystectomy in 1987. Laparoscopic biliary tract surgery has been shown to offer the patient a number of advantages in patient care, such as reducing the length of hospitalization and recovery, minimizing postoperative pain and discomfort, and nearly eliminating the disfigurement associated with a major abdominal operation. Although initially offered only to those patients with uncomplicated biliary tract disease, this procedure is now safely performed in individuals with acute cholecystitis and choledocholithiasis. We describe the development of laparoscopic gastrointestinal surgery in Europe as well as our method of performing endoscopic cholecystectomy. The current results of 690 laparoscopic cholecystectomies performed at our institution are included.

Animals↗
PubMed1990

Coelioscopic cholecystectomy. Preliminary report of 36 cases.

Intra-abdominal endoscopy, routinely used for gynecologic operations can be extended safely for cholecystectomy in uncomplicated cholelithiasis. Thirty-six patients underwent coelioscopic cholecystectomy with few and only benign complications. The main advantages are cosmetic preservation, reduction of postoperative pain, shortening of hospital stay, and early recovery of a normal activity.

Abdominal Pain↗
PubMed1990

[Cholecystectomy with celioscopy. 330 cases].

Laparoscopic cholecystectomy is possible. Under general anesthesia, the optic and the instruments are introduced through 4 trocarsheaths. The cystic duct and artery are dissected and clipped. The gallbladder freed by the retrograde way is removed through the umbilicus. 330 laparoscopic cholecystectomies were done with few and only benign complications. The advantages are the simple post-operative course, the short hospital stay and the minimal parietal traumatism. Some limits remains in case of too much peritoneal adhesions.

Adult↗
PubMed1990

[Cholecystectomy under celioscopy].

Cholecystectomy which is the best treatment for gallstones can be performed via laparoscopy in cases of uncomplicated stones. Thirty patients have been operated upon by this technique. The advantages are: small scars, easy recovery and short hospital stay. Nevertheless there are some risks, particularly hemorragic and traumatic complications in the biliary tract, so that operation must be done by a surgeon trained in biliary surgery.

Adult↗
PubMed1989

[Cholecystectomy by coelioscopy].

Operative coelioscopy, widely used in gynaecological surgery and appendicectomy, can be helpful in cholecystectomy. Sixty-three patients have been operated upon by this technique which has the advantages of small scars and rapid recovery with shortening of hospital stay. At the moment, its sole indication is cholecystolithiasis without acute complication. The risks associated with this new technique justify a careful selection of its indications and make it imperative for the operator to be a surgeon with wide experience of biliary tract surgery.

Adult↗
PubMed1988

Closed peritoneal lavage in the diagnosis of non traumatic acute abdomen.

The records of 22 consecutive patients with a non-traumatic ill-defined acute abdomen having diagnostic closed peritoneal lavage, were reviewed retrospectively. All patients had one or more risk factors. Peritoneal lavage was performed under visual control and its diagnostic value was based on the comparison with the definitive diagnosis, based on laparatomy and complementary tests. There were 12 positive results with 11 true positives (7 cases of peritonitis, and 4 of visceral necrosis) and 1 false positive. There were 10 negative results with 9 true negatives and 1 false negative. Sensitivity of peritoneal lavage was 0.91%, specificity 0.90%, positive predictivity 0.91% and negativity 0.90%. Overall mortality was 45%. The limits of the procedure appear to be the infections or localized abscesses. Peritoneal lavage as a simple and easy method, is suitable for high-risk patients when the choice is between immediate operation with possible side-effects or delay with possible adverse course of the abdominal lesion, and permits immediate indication for surgery in case of positivity.

Abdomen, Acute↗
PubMed1985

[Choledochoduodenal fistula of ulcerous origin. 2 cases].

Two cases of choledochoduodenal fistula due to a duodenal ulcer located below the bulb are reported. Both patients were operated upon. Truncular vagotomy and antrectomy were performed, followed by gastro-duodenal anastomosis; the fistula itself was left untouched. Subject to some technical precautions, this operation, feared by most authors, is perfectly adequate, as it provides optimal conditions for healing of the ulcer, which is the main purpose of any surgical intervention in such cases.

Aged↗
PubMed1984

[Treatment of inguinal hernia with unsplit mersylene prosthesis. Significance of the parietalization of the spermatic cord and the ligation of epigastric vessels].

The authors describe their technique of "thorough" dissection of the spermatic cord by the inguinal route. After parietalization of the cord and ligature of the epigastric vessels, a wide prosthesis of unsplit mersylene can be inserted through the groin behind the muscular layer brought down to Cooper's ligament. From their experience of 120 patients operated upon and without relapse at follow-up, they feel able to recommend this method in cases of recurrent hernias with weak walls and large sac and of hernias occurring in elderly of obese subjects.

Hernia, Inguinal↗
PubMed1982

[Repair of hiatus hernia in adults by double gastropexy (author's transl)].

Hiatus hernia was repaired in 108 adult patients by a technique combining posterior gastropexy, as described by Toupet, with anterior gastropexy on the lesser curvature. The purpose of the anterior gastropexy is to avoid intra-hiatal reascension of the anti-reflux montage, a complication which seldom results in recurrence of clinical symptoms but is reflected in radiological images of relapse with often troublesome psychosomatic effects.

Female↗
PubMed1981

[Endoscopic internal urethrotomy. Retrospective study of 47 cases (author's transl)].

The authors report their experience of 58 patients undergoing endoscopic internal urethrotomy for urethral stenosis. In 47 with a follow up of 6 months or more, the following information has been obtained : - deep longitudinal section of the urethral stenosis, at 12 o'clock, passing widely beyond the diseased area, usually suffices; - the essential aetiology of the stenoses treated was represented by iatrogenic urethral trauma in 17 cases out of 47 (36%). The particularly harmful role of urethral catheterisation should be noted. Stenosis of undetermined origin was more common than stenosis of an infectious or non-iatrogenic traumatic origin; - the stenosis was bulbar in almost half the cases and was double in 1/4 of cases. In most instances the length was less than 1.5 cm; - morbidity was slight and mortality nil; - results were considered to be good in 57.5% of cases and no recurrent stenosis occurred beyond the 18th month. Good results were seen essentially in cases of stenosis of infectious origin situated in the penile or bulbar urethra, less than 1.5 cm in length and having undergone calibration by a urethral catheter after endoscopic section for a period of more than three days. Amongst the 12 patients undergoing a second urethrotomy, 5 obtained a lasting successful result. Endoscopic internal urethrotomy is thus a procedure which may recommended, insofar as it offers a high percentage of good results and that in the cases of failure there is no interference with any other urethroplasty procedure.

Adult↗