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Biomedical subjects

J Himpens

Publications and source records attributed to J Himpens.

49 records · Page 3Linked to original sources
PubMed1995

Balloon dissection in extended retroperitoneoscopy.

The anatomy of the retroperitoneum, including the high retroperitoneum, was studied as it appears with balloon dissecting techniques. We used fresh cadavers in this study. A relatively unknown fascia that is located between the lateral aspect of the perirenal fascia and the posterior parietal peritoneum, called the paraconal fascia, was a constant finding. This structure is important because it protects delicate retroperitoneal organs: the duodenum, pancreas, celiac axis, and superior mesenteric artery. Locating this fascia is an important step in the dissection of the high retroperitoneum, which is of interest in advanced videoendoscopic procedures involving retroperitoneal organs.

Aorta, Abdominal↗
PubMed1995

[Nissen's fundoplication by celiovideoscopy].

One hundred and sixty two laparoscopic fundoplications were performed between may 1991 and december 1993 by the first author. No perioperative death was observed. There were 4 intraoperative complications (3%): 1 gastric perforation, 2 pleural perforations and 1 liver laceration. There were 3 conversions to laparotomy: 2 for left liver hypertrophy and 1 for needle holder defect. The duration of the operation ranged from 40 minutes to 5 hours (median 120 minutes). The median postoperative stay was 2 days. Five postoperative complications occurred: 2 cases of pneumonia and 3 cases necessitating second-look laparatomy (1 necrosis of the valve, 1 small bowel perforation and 1 obstruction due to migration of the entire stomach into the chest). The follow-up ranges from 4 to 897 days (median 10 months). Long-term complications were: one recurrence of heartburn reoperated laparoscopically and two cases of long-term postoperative dysphagia.

Adolescent↗
PubMed1995

Totally preperitoneal laparoscopic approach combined with minianterior dissection in the treatment of indirect inguinal hernias.

Totally preperitoneal laparoscopic hernioplasty has become more popular recently and will possibly replace the transabdominal preperitoneal procedure. This procedure, however, is more demanding for the surgeon, especially in large indirect hernias. We describe an alternative technique derived from Darzi's anterior endoscopic approach. To date, it has been used in 15 patients, all with good success. The technique results in a shorter operative time and is easier for the surgeon.

Adult↗
PubMed1994

Laparoscopic Nissen fundoplication: technique and preliminary results.

Between May 1991 and November 1992, 80 consecutive patients with gastro-oesophageal reflux disease underwent laparoscopic Nissen fundoplication. The technique used was exactly the same as for the conventional open approach. There were no deaths but there were four peroperative complications: one gastric perforation, two pleural perforations and one hepatic laceration. Three conversions to laparotomy were necessary, one because of a defective needle holder and two as a result of left hepatic lobe hypertrophy. The duration of operation ranged from 40 to 300 (median 150) min. The median postoperative stay was 3 days, but increased to 10 days in two patients who developed pulmonary infection. One major postoperative complication (necrosis of the wrap) required a laparotomy on day 8 after operation. No recurrence of heartburn has been observed and there were no instances of long-term dysphagia after surgery. These findings indicate that laparoscopic Nissen fundoplication can be performed safely if the team is well trained.

Adolescent↗
PubMed1994

Operative strategy in laparoscopic nephrectomy.

Nephrectomy is a debilitating procedure because of the trauma to the abdominal wall. Laparoscopy could be a solution in this matter. Four patients underwent laparoscopic nephrectomy. In 3 patients with renal cancer, the transperitoneal route was used in order to obtain quicker access to the hilus. In the fourth patient with benign disease, a retroperitoneal route was chosen. There was no morbidity or mortality. Mean hospital stay was 5 days. Laparoscopic nephrectomy is safe and effective. Larger series are needed for evaluation of the long-term results in the treatment or renal cancer.

Abdomen↗
PubMed1994

Operative strategy in laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy was attempted in 17 consecutive patients and was successful in 15. STUDY DESIGN: This study is a critical analysis of the operative strategy in laparoscopic splenectomy, as reviewed in the operative video recordings and operative summaries of the 17 patients discussed. RESULTS: The 15 successful laparoscopic splenectomies were all conducted according to the same strategy: mobilization of both the upper and lower pole of the spleen, division of the short gastric vessels close to the spleen, and dissection and separate ligation of the main trunk of the splenic artery and vein. An erroneous strategy that diverged from the one proposed, resulted in parenchymatous hemorrhage and open conversion in two patients. CONCLUSIONS: In this series of 15 successful laparoscopic splenectomies, the most important technical aspect seems to be full mobilization of the spleen before the hilum is dissected.

Adolescent↗
PubMed1994

Laparoscopic proximal gastric vagotomy.

Proximal gastric vagotomy, considered the conventional surgical treatment of choice for peptic ulcer disease, is now performed laparoscopically. Thirty-three patients underwent the procedure. Seven patients were treated on an emergency basis for perforated peptic ulcer. Morbidity and mortality of the procedure were zero. Patient acceptance (Visick staging) was good to excellent in 22 of 25 patients in follow-up. Laparoscopic proximal gastric vagotomy appears to be a good treatment in chronic peptic ulcer disease even when complicated by an acute perforation.

Adult↗
PubMedDate not supplied

Laparoscopic highly selective vagotomy.

BACKGROUND/AIMS: Ten percent of our population has had a gastroduodenal ulcer. Medical treatment heals ulcers in 90% of the cases but they recur in 50-70% of the patients. We present a proposal of surgical treatment for patients with recurrent ulcer after a long-term medical treatment or whose ulcer reappears as soon as medical treatment ceases. METHODOLOGY: Thirty-three patients underwent highly selective vagotomy (HSV) laparoscopic between April 1992 and March 1993. There were 26 male patients and 7 female patients aged 19-65 years (mean age: 38 years). Twenty-six patients were operated electively and preliminary medical treatment lasted an average 5.4 years (range: 0.5-26 years) and the disease had lasted 1-30 years (mean duration: 8.4 years). For patients with a chronic peptic ulcer disease, pre-operative assessment involved a recent gastroscopy, isotopic gastric study and a selection test. RESULTS: HSV proved feasible in 100% of the cases in spite of a history of previous surgery and peritonitis in patients with a perforated ulcer. There were neither conversions nor intra-operative complications. There was no mortality or morbidity. The mean hospital stay was 2 days (range: 1-5 days) for selectively operated patients and 7 days (range: 6-10 days) for patients operated for a perforated ulcer. Twenty-two patients were rated Visick I and II and 3 with Visick III after re-examining. The BAO had decreased by 61% to 89% and the MAO by 60% to 80%. CONCLUSIONS: The treatment of choice for gastro-duodenal ulcer is highly selective vagotomy. The laparoscopic approach shortens the hospital stay and improves patient's comfort.

Adult↗
PubMedDate not supplied

[Traumatic rupture of the diaphragm: a diagnostic problem].

About 5% of the heavy abdominal traumas present a traumatic diaphragm rupture (14). A correct diagnosis of such a rupture is usually not obvious. A collective review by Alivisatos concluded that only 1/3 of the diaphragm ruptures was recognized within the first 24 hours (2). In the department of general surgery of the academic hospitals St-Raphaël and St-Pieter, 38 cases were seen during the last ten years (1970-1980). The diagnosis was made within the first 24 hours (pre- or peroperatively) in 28 cases. In 34 cases, diagnosis was achieved within a week of time and in 36 cases within a year. In only 2 of the cases it was achieved after 1 years time. In this paper two points are especially emphasized, first why a correct diagnosis sometimes is so difficult to reach and second which dangers can result from an unseen diaphragm tear. These points of interest are illustrated by a few remarkables case.

Abdominal Injuries↗
PubMedDate not supplied

An unusual case of small bowel obstruction.

A patient with small bowel obstruction due to a fruit pith (peach) is presented. The diagnostic work up, the treatment and a review of the literature in the matter of obstructions due to swallowed goods are presented. Intestinal obstruction due to ingested organic material is a clinical entity on its own, and careful history taking can give a clue for diagnosis.

Aged↗
PubMedDate not supplied

Laparoscopic Nissen fundoplication: laparoscopic dissection technique and results.

BACKGROUND/AIMS: Proton Pump inhibitors and laparoscopic techniques have had a dramatic impact on the therapy of gastroesophageal reflux disease. These techniques have introduced new complications associated with the treatment. This study compares the results of a laparoscopic Nissen fundoplication with life-long proton pump inhibitor treatment. MATERIALS AND METHODS: Between May 1991 and February 1996, 274 patients were treated by laparoscopic Nissen fundoplication (LNF). Two hundred twenty-four patients were included in this prospective study. Thirteen patients presented stage V esophagitis (Barrett); 4 had esophagitis stage IV; 16 had stage III, 181 had stage II and 11 had stage I. Five trocars were needed for the operation. After mobilization of the greater curvature, a fundic wrap of 5 cm was created and fixed on the esophagus. RESULTS: Median operating time was 60 min (39-300). There were 5 perioperative complications (a gastric perforation, three pleural perforations, and one liver laceration treated by coagulation). Three conversions to laparotomy were necessary. There were 4 early complications: two pulmonary infections and two re-operations; one case of wrap necrosis with peritonitis, and one case of small bowel perforation. Gastroscopy was performed in 133 cases. The esophagus was normal in 121 cases, an esophagitis stage I was present in 9, esophagitis stage II in 2, esophagitis stage III in one. Median lower esophageal sphincter pressure was 10 mmHg (2.9-30) preoperatively and 19 mmHg (9-40) post-operatively. Median reflux time was 10% (0-65) preoperatively and 1% (0-38) post-operatively. One hundred fifty-four patients were interviewed with a median follow up of 30 months (1-58). One hundred thirty patients were Visick I, 11 Visick II, 8 Visick III and 5 patients needed re-operation; three reoperations because of dysphagia, 1 because of epigastric pain and 1 for heartburn recurrence. CONCLUSIONS: From these results, we conclude that LNF seems to be an attractive alternative to long term medical treatment.

Adolescent↗