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H Vuilleumier

Publications and source records attributed to H Vuilleumier.

18 recordsLinked to original sources
PubMed2003

Implementation of robotic laparoscopic cholecystectomy in a university hospital.

BACKGROUND: Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. METHODS: The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. RESULTS: Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. CONCLUSION: Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed.

Adult↗
PubMed2003

Ruptured subcapsular hematoma after laparoscopic cholecystectomy attributed to ketorolac-induced coagulopathy.

Ketorolac is the first injectable nonsteroidal antiinflammatory drug used as an analgesic in the perioperative period. However, gastrointestinal bleeding is a risk associated with its perioperative administration. A 23-year-old woman was admitted for elective laparoscopic cholecystectomy. Her medical history was unremarkable except for a complaint of intermittent right upper quadrant pain for several months. The operative procedure was uneventful. Thirty milligrams of ketorolac were given intravenously just prior to termination of surgery. Eighteen hours after surgery, the patient developed right upper quadrant pain associated with tachycardia and hypotension. Abdominal computed tomography (CT) scan demonstrated a large subcapsular hematoma of the liver. A few hours later, the hemodynamic condition worsened, and the patient was taken to the operating room. Laparoscopic exploration showed a ruptured subcapsular hematoma with active bleeding. No evidence of parenchymal injury of the gallbladder bed was found. The hematoma was evacuated and hemostasis was performed laparoscopically. Ketorolac has a strong antiplatelet activity and further acts by the inhibition of platelet function, which may last as long as 24 h after the last administration. Surgeons and anesthesiologists should be aware that ketorolac may cause or aggravate bleeding.

Adult↗
PubMed2002

[Blind loop syndrome].

Malabsorption can raise from several causes, including post surgical conditions. Noticeably, ileo-ileal anastomosis can lead to bacterial stagnation in the caecum, with recirculation of the intestinal content, and intestinal spreading of the colonic flora. We review here nine cases who were operated on in our department in the last 20 years. In five patients the syndrome appeared after an intestinal resection due to a postsurgical intestinal infarction due to adhesions. In four patients it appeared after an ileo-transverse derivation motivated by post-surgical occlusion. We conclude that any type of malabsorption appearing after abdominal surgery, even remotely from the surgical procedure should suggest this uncommon diagnosis. Surgical treatment, i.e. replacement of the intestinal anastomosis with a new termino-terminal anastomosis, is necessary and sufficient.

Adult↗
PubMed2002

Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995.

AIMS: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. SUBJECTS AND METHODS: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. RESULTS: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. DISCUSSION AND CONCLUSION: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socioeconomical and comfort reasons.

Adolescent↗
PubMed2002

[Ultrasound examination of non-traumatic acute abdomen].

Amongst all imaging procedures available for the exploration of an acute non traumatic abdomen, ultrasound comprises the first line technology. Non ionising, easily accessible, cheap and usable at the bedside, this imaging technique also has the advantage of close contact with the patient, which may help to focus the exploration on painful regions. Moreover, ultrasound has not only diagnostic capabilities, but also therapeutic ones. Nevertheless, sonography has limitations, which have to be known in order to avoid misdiagnosis or inadequate reassurance. The aim of this review is to present and discuss the most recent opinions about ultrasound diagnosis of acute non-traumatic abdomen related to digestive system diseases.

Abdomen, Acute↗
PubMed2002

[Ultrasound of non traumatic acute abdomen: extra-digestive causes].

In recent years, management of abdominal pain in emergency care units (ECU) has undergone a radical change. Chronic work overload of ECU and increase in severity and complexity of cases required an optimal medical imaging method, such as ultrasound, to establish an accurate diagnosis as quickly as possible. A great variety of causes may cause acute abdominal pain and the role of sonography is to accurately distinguish between these aetiologies. For the application of sonography, perhaps more so than with other imaging methods, a perfect knowledge of sonographical characteristics and technical possibilities is essential to achieve an optimal answer. The purpose of this review is to present and discuss the sonographic characteristics of extra-digestive causes of acute abdominal pain such as splenic infarction, thoracic pathologies, urinary and gynaecologic diseases or retroperitoneal pathologies.

Abdomen, Acute↗
PubMed2001

Penetrating thoracic trauma in arrow injuries.

Arrow wounds are very rare. We present herein a case of hilar penetrating thoracic trauma caused by an arrow, and a review of the literature, to clarify the management of these cases and their indications for surgery. Depending on the type of arrowhead, the tissue elasticity can narrow the wound track around the shaft of the arrow, sometimes causing a tamponade effect. In the mediastinal or hilar area, an arrow should not be removed before an injury to the major blood vessels or the heart has been ruled out.

Humans↗
PubMed2001

Streptococcal toxic shock syndrome revealed by a peritonitis. Case report and review of the literature.

Group A streptococcus (GAS) or Streptococcus pyogenes cause a variety of life-threatening infectious complications including necrotizing fasciitis, purpura fulminans and streptococcal toxic shock syndrome (STSS). Exotoxins that act as superantigens are felt to be responsible for STSS. These exotoxins are highly destructive to skin, muscle and soft tissue. This syndrome has a rapid and fulminant course with frequently fatal outcome. GAS remains sensitive to penicillin but in serious infection a combination of clindamycin and ceftriaxone or meropenemum is recommended. Several studies have shown that mortality was dramatically reduced in STSS patients treated with immunoglobulin G given intravenously (IVIG). Early recognition of this most rapidly progressive infection and prompt operative debridement are required for successful management. This report presents a female patient at two month post-partum with a peritonitis and multi-organ failure.

Adult↗
PubMed2001

A large bullet in the bladder.

All manner of foreign bodies have been extracted from the bladder. Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimise bladder and urethral trauma. We report a case of a bullet injury to the bladder, which finally presented as a gross hematuria after remaining asymptomatic for four years. We present here an alternative to suprapubic cystostomy with a large bladder foreign body treated via a combined transurethral unroofing followed by removal using a grasper passed through a suprapubic laparoscopic port.

Adult↗
PubMed2000

Columnar cuff cancer after restorative proctocolectomy for familial adenomatous polyposis.

AIMS: Restorative proctocolectomy with ileoanal anastomosis is one of the treatments of choice for patients suffering from familial adenomatous polyposis (FAP). However, any residual rectal mucosa left behind after mucosectomy is at risk for the development of neoplasia. CASE REPORT: A 31 year old male patient with FAP underwent restorative proctocolectomy with a pelvic ileal pouch-anal anastomosis. Seven years later he presented with right inguinal and perianal pain. A diagnosis of invasive columnar cuff carcinoma was made. DISCUSSION: Islets of columnar epithelium may be left behind after restorative proctocolectomy, exposing the patient to later malignant change. This risk must be emphasised and prevented by regular surveillance of the anastomosis.

Adenocarcinoma↗
PubMed2000

Agenesis of the vermiform appendix.

Agenesis of the vermiform appendix is very rare. The incidence is estimated to be one in 100,000 laparotomies for suspected appendicitis. Several criteria have to be met before the investigator can conclude that the appendix is congenitally absent. This case is reported to bring this entity to the attention of surgeons who may encounter a similar situation during celioscopy. A 29-year-old patient was admitted through the emergency room with the chief complaint of abdominal pain. Acute appendicitis was suspected, and he was accordingly prepared for celioscopy. This report presents a patient with vermiform appendix agenesis diagnosed at celioscopy with concomitant mesenteric lymphadenitis. Agenesis of the vermiform appendix is very rare, and the diagnosis should not be made unless the ileocecal and retrocecal area are thoroughly explored.

Abdomen, Acute↗
PubMed1995

[Gastric rupture secondary to barotrauma in the framework of a diving accident. Apropos of a case report and literature review].

Gastric perforation secondary to barotrauma is rare. The case of a diver suffering from gastric rupture due to a decompression accident is presented here. This rupture was a linear one, localized on the lesser curvature and responsible for a large pneumoperitoneum. Rupture occurs with an excluded stomach, a condition implying cardio-pyloric occlusion. The expansion of intra-gastric air, further worsened by accelerated surfacing provokes excessive gastric dilatation leading to partial or complete rupture (by virtue of the Boyle-Mariotte law: Pressure x Volume = constant). The lesion is always on the lesser curvature. However, it is often difficult to locate, even when peroperative gastroscopy is performed.

Adult↗
PubMed1995

[Value of duplex ultrasound in diagnosis of ergotism of the legs].

Ergot's derivatives are widely used in the treatment of migraine and in the prophylaxy of deep venous thrombosis in association with heparin. Clinical ergotism is rarely observed and can affect all the arteries, especially of the inferior limbs. Vasospasm of the peripheral arteries and collateral formation are specific findings on angiography. We report the illustrative case of a 38 years old woman hospitalized for a small bowel occlusion. She suffers from chronic migraine treated by ergotamine tartrate. During her hospitalization, she develops an acute ischemia of the lower limbs. An ergotism was clinically suspected and confirmed by Duplex sonography which demonstrate multiple vasospasm. Under iv sodium nitroprusside and peridural analgesia the spasm resolved in 24 hours. The control Duplex sonography confirm the normality of the lower limb arteries. This examination modality allow a non-invasive diagnosis and evolution control of arteriospasm.

Adult↗
PubMed1994

[The role of emergency laparoscopy in abdominal pain syndrome and in the assessment of abdominal trauma].

From January 1991 to June 1993 we performed 106 emergency laparoscopies. The patients' mean age was 31 years (17-90). There were 73 females (69%) and 33 males (31%). 8 (8%) laparoscopic evaluations of abdominal traumas were performed. Laparoscopy yielded a diagnosis in 89% of the cases. In 12 cases (11%) the laparoscopy was negative. Morbidity was 2% and mortality 3%. The mean hospital stay was 4.5 days. Today emergency laparoscopic evaluation of abdominal syndromes is performed routinely in most centers. The diagnostic rate is reported to be between 87-96% according to individual series. Laparoscopy may shorten the diagnostic delay, diminish the number of paraclinical investigations and in particular reduce the number of negative laparotomies.

Abdominal Injuries↗
PubMed1994

[Adenocarcinoma of the duodenum. Contribution to the study of a rare pathology].

Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum. The incidence of these tumors has been estimated to be 0.03%. The diagnosis is usually made at a very late stage because the symptoms are often non-specific. The mean diagnostic delay between beginning of symptoms and the diagnosis is of 10 months. Oesogastroduodenoscopy is the diagnostic procedure of choice and upper GI series is still of interest since it permits a topographic analysis of the lesion. Pancreatico-duodenectomy is recognized by a majority of authors as the standard curative procedure, in the absence of regional nodes. Survival after pancreaticoduodenectomy in the absence of local lymph node invasion is 68% at 5 years whereas there is no survivor after 3 years when there is regional invasion of the lymph nodes. Survival rates after palliative excisions are generally of 15 months, after bilio-digestive derivation of 6 months. Radical excision is preferable in as much as it is technically feasible.

Adenocarcinoma↗