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J H Alexandre

Publications and source records attributed to J H Alexandre.

At least 19 recordsLinked to original sources
PubMed1999

Parietal mesh abscess as an original presentation of cancer of the caecum.

We report a case of cancer of the caecum in a 71-year-old male who presented with parietal mesh abscess. Two years before, he was treated for a right inguinal hernia by insertion of a Dacron mesh. CT scan then colonoscopy determined the existence of a voluminous caecal tumor perforated in the abdominal wall with an important abscess around the mesh. Right colectomy and parietal muscles excision were performed completed with postoperative radiochemotherapy. At 2 years, there is no evidence of recurrence. Atypical features with a hernia mesh repair associated with a sudden change in the patient's condition should alert the clinician to the possibility of a further subjacent pathological process.

Abscess↗
PubMed1998

Elective laparoscopic-assisted colectomy for diverticular disease. A prospective study in 50 patients.

BACKGROUND: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question, we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid colon for diverticular disease. METHOD: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn anastomosis. RESULTS: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150-280 min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days. CONCLUSIONS: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.

Adult↗
PubMed1998

[Laparoscopic appendectomy in the adult].

AIM OF THE STUDY: The benefits of laparoscopic appendectomy remain controversial. The aim of the study was to evaluate the advantages and disadvantages of this technique. MATERIAL AND METHODS: Four hundred and forty-eight patients operated on for suspected appendicitis during a 5-year period were analysed in a retrospective study. The preoperative diagnosis was corrected in 21.4% of the cases (8.1% for males and 28.7% for females) and the conversion rate was 9.7%. There were 17 patients with generalized peritonitis and 28 with localized peritonitis. During the past year, this surgical method was introduced in another hospital and a prospective study included 92 consecutive patients operated on for appendicitis. The operating time was 53 minutes and the conversion rate was 7.6%. There were five patients with generalized peritonitis and eight with localized peritonitis. RESULTS: There were no postoperative deaths. In the first period, the morbidity rate was 2.3% in the laparoscopic group without conversion. After pathological examination, there was a 14.2% rate of normal appendix. The mean hospital stay was 4.3 days. In the second period, there were only three minor complications and the mean hospital stay was 4.19 days. CONCLUSION: The choice of laparoscopic approach is associated with some advantages: corrections of the diagnosis (mainly in young women) and simplification of the postoperative course, provided that the surgeon has sufficient experience.

Adolescent↗
PubMed1996

Dieulafoy's ulcer: combined endoscopic and laparoscopic treatment.

Dieulafoy's disease is a rare, but dangerous cause of upper gastrointestinal hemorrhage. We report here the case of a patient in whom the failure of endoscopic therapy necessitated a surgical approach by combining endoscopy and laparoscopy. The intraoperative endoscopic examination located the site of the lesion precisely, allowing a limited adapted wedge resection to be carried out laparoscopically.

Adult↗
PubMed1996

Endoscopic ultrasonography immediately prior to laparoscopic cholecystectomy: a prospective evaluation.

BACKGROUND AND STUDY AIMS: In patients who are highly likely to have common bile duct (CBD) stones, it seems necessary to image the biliary tract before laparoscopic cholecystectomy, and endoscopic ultrasonography (EUS) is one way of doing this. The aim of this study was to compare immediate preoperative EUS to intraoperative cholangiography for imaging the CBD and for the diagnosis of CBD stones, in a population with a high risk of choledocholithiasis (as assessed by clinical, biochemical, and ultrasound criteria). PATIENTS AND METHODS: From January 1993 to August 1995, EUS was carried out in the operating room in 50 patients (11 men, 39 women; mean age 57 years) before laparoscopic cholecystectomy for symptomatic choledocholithiasis. A diagnosis of CBD stones by EUS or intraoperative cholangiography was always confirmed by instrumental exploration. An absence of stones in the CBD was established by a negative EUS and intraoperative cholangiography, as well as normal findings at clinical monitoring three months after laparoscopic cholecystectomy. RESULTS: EUS visualized the CBD in 100% of cases. Intraoperative cholangiography was successful in 94% of cases (n = 47 of 50), and after conversion to open laparotomy in eight patients. CBD stones were found in 12 patients (24%). The sensitivity, specificity, and positive and negative predictive values for EUS were 100%, 97%, 92%, and 100%, respectively. CONCLUSIONS: Immediate preoperative EUS may make it possible to select the best form of treatment in patients with CBD stones, avoiding inappropriate laparoscopic instrumental CBD exploration.

Cholangiography↗
PubMed1996

Recurrent inguinal hernia: surgical repair with a sheet of Dacron mesh by the inguinal route.

In this report we describe our technique for repair of recurrent inguinal hernia, using a large sheet of Mersilene mesh placed by the inguinal route. After division of the epigastric vessels, the inguinal canal is opened widely. A large sheet of Dacron mesh is inserted and the muscles are closed without tension by the McVay technique. We have repaired 142 recurrent hernias by this method. One patient died (0.7%) and morbidity included hole in the bladder (n = 3), wound discharge-(n = 2), wound haematoma (n = 5), cardiac arrhythmia (n = 1), and urinary retention (n = 2). The mesh had to be removed in two cases. No further recurrences were observed. This technique, thanks the placement of a large "tension free" sheet of mesh, ensures solid, definitive repair and is recommended for initial treatment of recurrent inguinal hernia.

Female↗
PubMed1996

Extensive spread of a squamous cell carcinoma in situ of the esophagus: an unusual case.

A case of extensive squamous cell carcinoma in situ along the esophageal height in a 58-yr-old female is presented. After subtotal esophagectomy, the course was favorable 11 months later. The pathological study of the specimen showed that the tumor was confined to the epithelium. The lesion was located diffusely along the entire esophageal height and one-third of its circumference. Neither foci of dysplasia or inflammatory erosions nor metastatic nodes were observed. Problems pertaining to the terminology, histopathological interpretation, pathogenesis, and management of such unusual lesion are reviewed. The necessity of large radical resection of the esophagus was validated upon histological confirmation that the resected stump is cancer free.

Carcinoma in Situ↗
PubMed1996

[Laparoscopy-assisted colonic surgery. Initial experience. Apropos of 49 cases].

From November 1993 to December 1995, 49 colonic operations were performed by a videolaparoscopic assisted approach. Indications were malignant conditions in 10 cases, benign diseases in 39 cases (diverticular disease: 28, benign tumour: 9, reversal of Hartmann's procedure: 1, volvulus: 1). Conversion to a classical procedure was necessary in 6 patients. There was no mortality and 6 postoperative complications (3 reoperations). Colonic surgery this type of (laparoscopic-assisted operations) is technically feasible. It reduces the rate of post-operative wound complications and decreases the post-operative stay. It can be recommended for the surgical treatment of benign colonic diseases.

Adult↗
PubMed1996

[Treatment of inguinal hernias. Value of the insertion of an unsplit dacron mesh with parietalization of the cord elements by inguinal approach. Apropos of 1017 cases].

The authors describe an original technique for repair of groin hernia, using a large sheet of Dacron mesh placed by the inguinal route. Among 1613 procedures for hernia repair, this technique was used for 1017 repairs in 971 patients with a mean age of 63 years. The mortality rate was 0.1% and the morbidity 9%. The mesh had to be removed in one case because of infection. During follow-up, only 3 recurrences have been observed. This technique allows a solid and definitive repair thanks the procedure is correctly performed. The role of laparoscopic approach in the future is still debated.

Adult↗
PubMed1996

[Splenic infarction in a HIV-infected patient. Apropos of a case and review of the literature].

Incomplete ischemia of the celiac trunk due to arterial thrombosis occurred in a patient infected with the HIV. Ischemia led to infarct of the spleen and pancreatitis. Endoluminal desobstruction of the arterial trunk then medical management after exploratory laparoscopy were successful without splenectomy. The causes, diagnostic methods and treatments for splenic infarction in HIV-infected patients are discussed with a review of the literature.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Laparoscopic procedure for suspected appendicitis. A prospective study in 283 consecutive patients.

Between September 1990 and December 1993, 283 consecutive patients were admitted with clinical symptoms of acute appendicitis. These patients underwent primary laparoscopic approach so that an appendicectomy could be performed by this method. In 49 cases (17.3%), primary laparoscopic examination corrected the preoperative diagnosis and the appendix was left in situ. Appendicectomy was performed in 234 cases (149 women, 85 men) with a mean age of 30 years. Requirement for open surgery occurred in 29 cases. The main cause of unsuccessful procedures was inflammation due to local or generalized peritonitis. Median operative time for a successful procedure was 60 min (range, 25-160). Four postoperative complications (one related to laparoscopic procedure), one case of wound infection, and no mortality resulted. After laparoscopic appendicectomy, the median hospital stay was 3 days (range, 1-16). These results suggest that a laparoscopic approach for suspected appendicitis is reliable, allowing abdominal exploration and safe appendicectomy.

Acute Disease↗
PubMed1995

Role of laparoscopic surgery in the management of acute abdomen in the HIV-positive patients.

Emergency open laparotomy in patients infected with HIV is accompanied by high mortality. The authors investigated the potential role of a laparoscopic approach for the management of acute abdomen in such patients. Prospectively, 10 patients with HIV disease (9 with AIDS) underwent laparoscopy for acute abdomen. The treatment was exclusively laparoscopic in 6 patients. A conversion to laparotomy was necessary in 4 patients but through guided elective incision in 3 of them. The postoperative course was uneventful in all patients but 1, who died. We advocate a laparoscopic approach, when feasible, as an initial step in the management of acute abdomen in HIV-positive patients.

Abdomen, Acute↗
PubMed1995

[Intraoperative systematic cholangiography in celiopscopic cholecystectomy].

OBJECTIVES: Laparoscopic cholecystectomy has become the therapeutic gold standard in uncomplicated cases of cholelithiasis. This study evaluated the feasibility and the results of intra-operative cholangiography during laparoscopic cholecystectomy. METHODS: Intra-operative cholangiography was attempted in 126 consecutive patients undergoing laparoscopic cholecystectomy. Common bile duct stones were detected according to the following criteria: a) clinically (history of jaundice or pancreatitis); b) biologically (aminotransferase > 2 N, alkaline phosphatase > 2 N, total bilirubin > 20 mumol/L); c) ultrasonographically (diameter of the common bile duct > 12 mm, presence of gallbladder stones < 10 mm); d) calculation of the multifactorial score of Huguier. RESULTS: An intraoperative cholangiography was performed in 116 patients (92%), for a mean duration of 16 minutes (range: 9-25 min). Two anomalies of the biliary tree were detected. Ten common bile duct stones were detected (8.6% with 50% success of laparoscopic extraction). One false positive case had justified a surgical exploration of the common bile duct. The sensitivity of preoperative criteria was 80%. No morbidity or postoperative biliary complications were related to the intraoperative cholangiography. CONCLUSIONS: Routine intraoperative cholangiography should be systematically performed during laparoscopic cholecystectomy, providing anatomical information of the biliary tree and detecting, in 1.7% of cases, unsuspected common bile duct stones which could be treated during the same operative procedure.

Adolescent↗
PubMed1993

[Celioscopic appendectomy. Results in 137 consecutive patients].

Between September 1990 and August 1992, laparoscopic appendicectomy was attempted in 137 patients: 98 females and 39 males (sex-ratio: 2.5:1) with a mean age of 31 years (range: 15-85). The patients were operated on by 9 surgeons. Laparoscopic appendicectomy was possible in 120 patients (87.6%). In 19 patients the procedure was converted into open surgery. The main causes of unsuccessful laparoscopic procedures were: retrocaecal appendix (n = 5) and injury of appendiceal artery (n = 4). The rate of unsuccessful procedures was 31% in retrocaecal appendix and 9.4% in the other cases (P < 0.02). In exclusively laparoscopic procedures, the mean operating time was 63 (2.9) minutes. It was 49 (3) minutes for experienced surgeons and 69 (3.3) for other surgeons (P < 0.05). Histological examination of the appendix revealed inflammatory signs in 97 specimens (71%). There were no wound infections after successful laparoscopic appedicectomy. One female patient developed an abscess in the pouch of Douglas. The median postoperative hospital stay was 3 days (range: 1-16). These results suggest that laparoscopic appendicectomy is a safe technique, with low morbidity allowing short postoperative hospital stay.

Adolescent↗
PubMed1993

[Vital prognosis in acute pancreatitis. Study of 5 clinicobiological indices].

The values of the Acute Physiology and Chronic Health Enquiry (Apache II) and the Simplified Acute Physiology Scores (SAPS) were compared with Ranson and Imrie scores to predict death after acute pancreatitis. Fifty-five (ten deaths) patients were evaluated. Patients who died had a mean score greater than those who survived. The accuracy of all scores was similar after 48 hours. The ICU (Intensive Care Unit) available at the time of admission may facilitate the early selection of patients for appropriate management.

Acute Disease↗