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Biomedical subjects

J Chipponi

Publications and source records attributed to J Chipponi.

At least 73 records · Page 4Linked to original sources
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

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↗
PubMed1993

Laparoscopic-assisted perineal rectosigmoidectomy with pullthrough.

We report for the first time the treatment of an early rectal cancer by laparoscopically assisted rectosigmoidectomy with pullthrough. The low colorectal anastomosis was constructed using a double-stapling technique. We believe that this procedure might offer a promising new option for the treatment of midrectal cancer with sphincter saving. Further investigation is recommended.

Adenocarcinoma↗
PubMed1993

[Subtotal colectomy under celioscopy].

Indications for laparoscopic surgery of digestive disease are increasing in scope and now include colorectal affections. A technique for subtotal colectomy with ileorectal anastomosis under laparoscopic control is described.

Anastomosis, Surgical↗
PubMed1992

[Complementary tests in acute appendicitis].

The incidence of appendicectomy is high in France and this operation is performed in 15 to 45% of the cases for a histologically normal appendix. White blood cell count has a very good sensitivity but a bad specificity. The same observation goes for plain abdominal X-rays, the use of while must be limited in children and young women. Barium enema, frequently performed in anglo-saxon countries, show in 90 to 100% of the cases an abnormal image of the caecum or a lack of visualisation of the appendix. Ultrasounds visualize the appendix with a good sensitivity, provided there is no perforation. Laparoscopy is a good diagnostic tool, but must not be considered as a routine procedure. Studies of diagnosis scores show that, except for the white blood cell count, biological and radiological investigations are particularly interesting to eliminate another pathology.

Acute Disease↗
PubMed1991

1,25-Dihydroxyvitamin D3 receptors and human colon adenocarcinoma.

Epidemiological evidence suggests that dietary calcium and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) might have a protective effect against colorectal cancers. Since the presence of receptors is required for steroid action, specific 1,25-(OH)2D3 receptors (RD3) were investigated in biopsies taken at different levels of the colon. The study involved 90 biopsies from patients operated on for colorectal adenocarcinoma. They were paired biopsies from adenocarcinoma tissue and adjacent normal mucosa. In addition, 26 normal intestinal mucosa biopsies from patients without cancer were examined. RD3 receptors were assayed in tissue extract by the dextran-coated charcoal technique and also characterized by sucrose density gradient sedimentation. Scatchard analysis showed a single class of specific high affinity-low capacity sites binding for 1,25-(OH)2D3. The incidence of RD3 was 86 per cent in normal mucosa (n = 77) and lower in carcinoma (n = 34), for which the incidence decreased significantly (P less than 0.001) from right colon (58 per cent) to left colon (37 per cent) and rectum (19 per cent). These data suggest that the normal colon is a potential target organ for 1,25-(OH)2D3 which might modulate calcium transport in the colon. Loss of receptivity to 1,25-(OH)2D3 is associated with malignant transformation.

Adenocarcinoma↗