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J J Tuech

Publications and source records attributed to J J Tuech.

69 records · Page 4Linked to original sources
PubMed1997

[The role of pancreatojejunostomy in the treatment of chronic pancreatitis].

From 1978 to 1995, 120 patients (105 males, 15 females, mean age: 46 years) underwent pancreatico jejunostomy (PJ) for chronic pancreatitis (CP). Alcohol abuse was presented in 105 cases (87.5%). PJ was the unique procedure in 67 cases; it was associated with a biliary or a duodenal diversion in respectively 38 cases and 5 cases. In ten cases, three diversions were performed. Postoperative mortality was 1.6% (n = 2), postoperative morbidity was 10% (n = 12). Mean hospital stay was 16 days. Fifteen patients (13%) required a second operation some years subsequent to the PJ, due to the progress of the CP or alcohol abuse. In the late postoperative course 22 deaths occurred (18.5%), 8 of them were directly related to alcohol abuse. Mean follow-up was 7 years. Good and medium results for pain were evaluated to 92%, but the progression of exocrine or endocrine pancreatic insufficiency indicates that wirsung decompression was insufficient to stop the progressive sclerosis. In conclusion, PJ was our preferred surgical procedure in CP treatment, when the wirsung was dilated.

Adolescent↗
PubMed1997

[Splanchnicectomy using thoracoscopy].

A technique of thoracic splanchnicectomy under video thoracoscopic control is reported. This simple and non aggressive procedure is indicated for very painful forms of pancreatic cancer and for some cases of chronic pancreatitis. It should relieve pain for a longer period than splanchnic nerve injection or radiotherapy.

Aged↗
PubMed1996

[Lesions of the iliac arteries secondary to closed traumas. Apropos of 5 cases].

Lesions of the iliac arteries after blunt trauma is uncommon. We observed 5 cases in our unit from 1992 to 1995. This pathology usually is seen in young men and the diagnosis often is made late. A Doppler examination and arteriography should be made in case of clinical doubt. Treatment is exclusively surgical. We present the mechanism of the arterial lesions, the symptomatology caused by the lesions and the therapeutic modalities.

Accidents, Traffic↗
PubMed1996

[Posterior trans-anal-sphincter approach in the management of urethro-prostate-rectal fistula].

Uretroprostatorectal fistulas occur rarely, often due to trauma or iatrogenic causes. We observed a case caused by a gun wound and present our surgical route for treatment. The deep situation of these fistulae explains the difficulty in surgical access. Several routes have been described. We used the posterior transanosphincter route proposed by York Mason. This technique has the advantage of direct access for the fistula. Success rate is high and morbidity is limited. No fecal incontinence has been reported in the literature.

Adult↗
PubMed1996

[Volvulus of the right colon. Plea for right hemicolectomy. Apropos of a series of 23 cases].

Twenty-three patients with volvulus of the caecum were operated on from 1982 to 1995. There were 17 men and 6 women, mean age 63 years. Preoperative diagnosis was obtained in 48% of the cases. A right hemicolectomy was performed in 22 cases with immediate anastomosis; in one case, a double ilial and transverse stomy was required. Necrosis was observe in 12 patients (52%). Post-operative mortality was 8.6% (n = 2) due to circulatory shock in 2 patients with necrosis of the colon. Post-operative morbidity was 21% (n = 5) including one case with fistulization of the anastomosis requiring a double stomy. On the basis of this series and a review of the literature, it appears that right hemicolectomy is the treatment of choice for volvulus of the right colon, as it avoids all risk of recurrence and mortality is lower than conservative treatment.

Adult↗
PubMedDate not supplied

Evaluation of the permeability of pancreaticogastric anastomoses (PGA) with dynamic magnetic resonance pancreatography after secretin stimulation (secretin MRCP).

BACKGROUND: Because some investigators have reported the systematic occurrence of exocrine pancreatic insufficiency after pancreaticoduodenectomy with pancreaticogastric anastomosis (PGA), we assessed PGA patency after pancreaticoduodenectomy. METHODS: Nineteen patients underwent pancreaticoduodenectomy, and their PGAs were studied prospectively with secretin magnetic resonance cholangiopancreatography (MRCP). After administration of negative bowel contrast agent, single-shot fast spin-echo T2-weighted dynamic MR pancreatograms were obtained before and every minute for 12 min after secretin injection. Morphologic features of the pancreatic parenchymal and pancreatic duct were monitored (diameter and winding aspect of the pancreatic duct, pancreatic thickness, direct visualization of the anastomotic site). PGA permeability was classified into four grades, from 0 (obstruction) to 3 (good permeability). Pancreatic function was assessed by fecal-1 elastase concentration, fasting blood glucose, and fasting serum insulin level. RESULTS: MRCP grades were 0 in two patients, 1 in four, 2 in five, and 3 in eight. The anastomotic site was visualized in 10 patients. Pancreatic parenchymal atrophy was discovered in four patients. There were statistically significant relations between secretin MRCP permeability grade and fecal-1 elastase concentration (p < 0.03) and between secretin MRCP permeability grade and pancreatic atrophy (p < 0.005). In contrast, fecal-1 elastase concentration was lower than the normal value in all but one case. There was no statistically significant relation between fecal-1 elastase concentration and other morphologic data. CONCLUSION: Secretin MRCP may indicate PGA stenosis or dysfunction, but it is not the only factor suggesting exocrine pancreatic insufficiency. Thus the major role of PGA may be the preservation of long-term endocrine function.

Anastomosis, Surgical↗
PubMedDate not supplied

Early gastric cancer: univariate and multivariate analysis for survival.

BACKGROUND/AIMS: The aim of this retrospective study was to analyse the characteristics, treatment and prognosis of early gastric carcinoma, based on an analysis of our surgical results. METHODOLOGY: Between 1973 and 1994, 102 patients (68 males, 34 females) with a mean age of 65 years, were operated on for an early gastric carcinoma. Mean follow-up was 7 years. Survival was calculated using the Kaplan-Meier method. Prognosis was determined with univariate and multivariate analysis according to the Cox model. RESULTS: The carcinoma was limited to the mucosa in 57 patients (56%) and extended to the submucosa in 45 (44%). There was a lymph node invasion in 17 patients (16.5%). The post-operative mortality rate was 5.8% (n = 6). Secondary deaths occurred in relation with the gastric cancer in 10.4% (n = 10). The 5- and 10-year survival rates were 84% and 68.6%, respectively. Univariate analysis of prognosis factors showed a significant survival difference according to the age (p = 0.001); submucosal extension (p = 0.03), lymph node invasion (p = 0.0005) and type of gastric resection performed (p = 0.03). With multivariate analysis of prognostic factors, advanced patient age and lymph node metastases were the only independent factors for survival (p = 0.0002 and p = 0.002, respectively). CONCLUSIONS: Prognosis of early gastric cancer is usually excellent. Patients with high risk of recurrence may be identified in relation to lymph node invasion. We propose that lymph node dissection is necessary in addition to gastric resection, at least in patients with high risk of lymph node metastasis.

Adenocarcinoma↗
PubMedDate not supplied

Portal vein resection in pancreatic head carcinoma. Part 2: Clinical significance.

The prognosis of pancreatic carcinoma remains poor. Surgical resection provides the only chance for cure. Prognostic factors and survival are similar between patients who underwent portal vein resection compared with standard resection. Isolated portal vein involvement should not be a contraindication for pancreatic resection.

Adenocarcinoma↗
PubMedDate not supplied

Laparoscopic colectomy for sigmoid diverticulitis: a prospective study in the elderly.

BACKGROUND/AIMS: The aim of this prospective study was to determine the feasibility and the complications or benefits of laparoscopic colectomy for sigmoid diverticulitis in patients aged 75 years or more. METHODOLOGY: From January 1993 to December 1999, 85 patients underwent an elective colectomy for sigmoid diverticulitis. Twenty-two patients over 75-years old (group 1) were compared to 63 younger patients (group 2). RESULTS: In group 1, there were 12 women and 10 men, with a mean age of 77.2 years (range: 75-82); In group 2, there were 35 women and 28 men, with a mean age of 53.7 years (range: 38-74) (P = 1.10-14). The operative time was shorter in group 2 (183 vs. 234 min). There was no difference between the 2 groups with regard to the postoperative period during which parenteral analgesics were required (5.4 vs. 5.2 days, P = 0.48) and the postoperative morbidity (18% vs. 14%, P = 0.06). Postoperative length of hospital stay (13.1 vs. 8.8 days, P = 0.003) was shorter in group 2 than in group 1. There was no perioperative mortality. Conversion rate was 9% (group 1) and 6% (group 2) (P = 0.6). CONCLUSIONS: In summary, data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older patients with fewer complications, less pain, shorter hospital stay and a rapid return to preoperative activity levels.

Aged↗
PubMedDate not supplied

Morbidity of laparoscopic fundoplication for gastroesophageal reflux: a retrospective study about 1470 patients.

BACKGROUND/AIMS: The aim of this retrospective study was to report and quantify the immediate and 3-year complications after laparoscopic anti-reflux surgery in order to understand the mechanism. METHODOLOGY: From 1992 to 1996, 1470 laparoscopic fundoplications were performed for symptomatic gastroesophageal reflux disease. Preoperative checkup included upper gastrointestinal tract endoscopy in 1437 patients (97.7%), esophageal manometry in 934 patients (63.5%), and 24-hour pHmetry in 799 patients (54.3%). Three procedures were performed: Nissen (n = 655), Nissen-Rossetti (n = 423), and Toupet (n = 392). The results were estimated at 1 and 3 months; thereafter they were evaluated at 3 years. Patients unable to return to the hospital center were contacted by telephone. RESULTS: Mean length of hospital stay was 4.6 days (range: 2-48 days). The preoperative complication rate was 2.1% (n = 31). The postoperative morbidity and mortality rates were 2.9% (43 patients) and 0.07% (1 patient), respectively. Conversion rate to laparotomy was 6.5% (96 patients). At 3 months, 87 patients (5.9%) had invalid dysphagia but there was no difference between the 3 procedures. Twelve patients have been reoperated (0.8%). At 3 years, 78 patients (5.6%) presented a clinical recurrence. The rate of dysphagia was 0.35%, and 38 patients were reoperated. CONCLUSIONS: Laparoscopic fundoplication is safe and effective with a low morbidity and mortality rate if junior surgeons commenced this procedure under the direct supervision of an experienced surgeon. Despite the advantage of this technique, we believe that indications for surgical management remain unchanged in the laparoscopic era.

Adolescent↗
PubMedDate not supplied

Intraoperative colonic lavage with primary anastomosis vs. Hartmann's procedure for perforated diverticular disease of the colon: a consecutive study.

BACKGROUND/AIMS: The ideal treatment for complicated diverticulitis is still controversial. The Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. A prospective study was carried out on 71 patients with peritonitis, comparing primary resection with intraoperative colonic lavage, and Hartmann's procedure. METHODOLOGY: Between January 1994 and September 1999, 71 patients underwent emergency laparotomy for diverticular peritonitis. Primary resection and anastomosis with intraoperative colonic lavage was performed in 29 patients (group I) and Hartmann's procedure in 42 patients (group II). All data were collected on standardized forms. RESULTS: There were no differences between the two groups according to clinical features, biology, severity of disease and operative delay. The mortality rate in group I and group II was, respectively, 7 and 10% (P = 0.6). The incidence of postoperative complication was higher after Hartmann's procedure (P < 0.05). The mean hospital stay was significantly longer for the Hartmann's procedure compared to primary resection with intraoperative colonic lavage. CONCLUSIONS: Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for local or diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to the Hartmann's procedure in stercoral peritonitis.

Adult↗