[Diagnosis of Caroli's disease by non-invasive radiological studies: value of cholangio-scanner. Apropos of 3 cases].
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Biomedical subjects
Publications and source records attributed to J Escat.
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Two hundred and eighty-four patients who underwent highly selective vagotomy for duodenal or prepyloric ulcer were followed up for at least 1 year, and 47.9% of them for at least 5 years (mean : 58 months). The actuarial recurrence rates were 4.7% at 3 years, 9.6% at 5 years and 13.1% at 7 years. These results do not agree with the recently published figure of 20%. The authors insist on the necessity to dissect the lower oesophagus on a length of at least 5 cm. In duodenal ulcers, this technical detail should result in a cure rate of about 90% at 5 years.
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For operations on the biliary tract the transverse horizontal incision has the same advantages as the subcostal approach: strong abdominal wall, little influence on ventilation and wide access to the subhepatic region. But in addition, the abdominal wall nerves are preserved as much as possible, post-operative evisceration, it is occurs, can easily be repaired and subsequent surgery can be performed using the same route.
Two hundred hospital patients with gallstones who had been cholecystectomized on account of typical biliary colics were investigated for migraine, headache, malaise, vertigo, flatulence, diarrhoea or constipation 2, 6, 12 and 24 months after the operation. The study showed that these symptoms are common in patients with biliary lithiasis, particularly women, and that their frequency increases with the duration of the disease. The beneficial effects of cholecystectomy are uncertain and appear to decrease with time ; only 30% of the patients seemed to improve after surgery. It is concluded that these symptoms betray real functional disorders, that cholecystectomy is not the appropriate treatment for them and that any improvement observed may be credited to the placebo effects of the operation.
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Between 1975 and 1983, 441 choledochoscopy were performed in a series of 451 consecutive patients undergoing surgical common biliary duct exploration for choledocholithiasis. In 127 patients (27.8%), no stones were found. Forty-five cases (10%) of choledocholithiasis missed by surgical and radiologic exploration methods were found by choledochoscopy. Therefore the retained stone rate decreased from 10 per cent to 2 per cent. Fourteen patients (3%) died at surgery, ten of whom (2%) were over 70. Postoperative biliary tract was drained in 98 patients (8%) using external drainage. Biliary tract patency was checked on the tenth postoperative day by the tube cholangiography. When retained stones were not found, T-tube was removed on the 20th day after surgery. When retained stones were found (11 patients, 2%) an endoscopic papillotomy was performed. Choledochoscopy is a significant addition in biliary surgery. It reduces operative mortality and morbidity, decreases retained stone rate, diminishes indications for biliary anastomosis and sphincterotomy, and is easy to perform without specific training. Its extensive and systematic use is advocated when- ever common bile duct patency has to be surgically demonstrated in choledocholithiasis.
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Choledochoscopy is a definite advance in biliary surgery as it simplifies the operative procedure and decreases the retained stone rate. Easy to perform without special training, its use is cost-effective. Therefore, we agree with Kappes et al [10] recommendation that routine intraoperative biliary endoscopy be performed in all patients undergoing common bile duct exploration.
The authors report the results of the surgical removal of bilestones in 139 patients over 75 years of age, taken from a series of 1 179 cases. The low mortality (4.3%) and morbidity rates are due to a non-aggressive protocol, especially in the treatment of choledocholithiasis. They conclude that advanced age does not necessarily imply a need for systematic alteration of the therapeutic approach.
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A retrospective multicenter study involving 12 digestive surgery centers was conducted on 497 cases of colon obstruction. The most frequent cause of colon obstruction was colo-rectal cancer (71 p. cent of cases), but many other etiologies were involved, including 61 cases of torsion and 37 patients with occlusive sigmoiditis. Differential clinical and radiological features in each etiological group are discussed, the results of therapy undertaken analyzed, and a reasonable line of conduct proposed, adapted to each situation, with the objective of attempting to reduce mortality which still affects 25 p. cent of cases operated upon.
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