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Biomedical subjects

J M Hay

Publications and source records attributed to J M Hay.

At least 55 records · Page 3Linked to original sources
PubMed1996

Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research.

BACKGROUND: Mechanical anastomosis has been claimed to reduce the rate of leakage compared with manual anastomosis. No randomized trials have been performed to date to prove this specifically in esophagogastric anastomosis. METHODS: One hundred fifty-four patients, 139 men and 15 women ranging in age from 36 to 83 years (mean, 50 +/- 10 years) and undergoing elective resection of esophageal or cardial carcinoma, were included in this multiinstitutional (14 centers) randomized study comparing the rate of anastomotic leakage after esophagogastric anastomosis performed manually or mechanically. Eligible for this study were patients with esophageal or cardial carcinoma located between the esophagogastric junction (included) and the upper border of the aortic arch. The choice between resection with or without thoracotomy was left to the discretion of the operating surgeon. Proximal resection of the fundus was mandatory. Intestinal tract continuity was reestablished in a one-stage procedure by an esophagogastric anastomosis without interposition of either the jejunum or the colon. The site of the anastomosis could be either intrathoracic or cervical. The principal end point was anastomotic leakage as judged by (1) egress of intestinal fluids or orally ingested methylene blue through drains, (2) sodium diatrozate swallow prescribed either routinely for all patients between postoperative days 3 and 8 or because of signs of leakage, or (3) reoperation or autopsy. RESULTS: After two patients were withdrawn for protocol violation, 152 patients, 74 in the manual group and 78 in the mechanical group, were studied. The number of anastomotic leakages was identical in both groups (n = 12, 16% and 15%, respectively). Overall 30-day mortality was 11%. Fewer deaths occurred in the manual group (7%), which had three anastomotic leakages, than in the mechanical group (15%), which had five anastomotic leakages, and fewer repeat operations were done in the manual group (n = 9) than in the mechanical group (n = 13), but both of these differences were not statistically significant. The duration of anastomosis and of operation was similar in both groups. In the mechanical group 16 anastomoses (20%) gave rise to technical mishaps (either in the fashioning of the purse-string, dilation of the esophagus, or in stapling). Among the factors recognized as potentially preventing leakage, only testing for airtightness was significantly correlated with less postoperative leakage (p < 0.05). Eight postoperative strictures were recorded at 3 months in 62 (13%) patients in the manual group, whereas seven strictures occurred in 53 (13%) patients in the mechanical group. CONCLUSIONS: When mechanical staples rather than manual sutures are chosen, the disadvantages (technical mishaps and higher costs) are not counterbalanced by a gain of time or a decrease in the rate or severity of anastomotic leakage.

Adult↗
PubMed1996

5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research.

BACKGROUND: The curative rate of surgical resection of squamous cell carcinoma of the esophagus is low. Reports on the efficacy of preoperative and postoperative chemotherapy are conflicting or have included limited disease or radical surgery alone. OBJECTIVE: The authors' objective was to study the results of chemotherapy on the duration and quality of survival in patients who have undergone palliative surgical resection for esophageal squamous cell carcinoma. PATIENTS AND METHODS: Of 124 patients with histologically proven esophageal squamous cell carcinoma situated more than 5 cm from the upper end of the esophagus, 4 patients were withdrawn for failure to comply with the protocol. The remaining 120 patients, 116 males and 4 females (mean age, 57 +/- 9 years), were randomly assigned to either a control group who were to receive no chemotherapy (68 patients) or to a group who were to be treated with chemotherapy (52 patients). Patients were subdivided into two strata as follows: (1) stratum I, complete resection of the tumor with lymph node involvement (62 patients) and (2) stratum ii, incomplete resection leaving macroscopic tumor tissue in situ or with metastases. Noninclusion criteria were histologically proven tracheobronchial involvement, esotracheal fistula, major alteration of general health status (Karnofsky score <50), cerebral or extensive (>30% of parenchyma) hepatic metastasis, peritoneal carcinomatosis, associated or previously treated upper airway cancer, or, conversely, complete resection of tumor without lymph node involvement. Chemotherapy was given in 5-day courses, every 28 days, with a maximum of 8 courses. Cisplatin was administered either as a single dose of 100 mg/m2 at the beginning of the course or as 20 mg/m2/day for 5 days given over 3 hours. 5- Fluorouracil (5-FU) (100 mg/m2/day) was infused over 24 hours for 5 days. The duration of treatment ranged from 6 to 8 months. The main aim was to establish median survival and actuarial survival curves. The subsidiary aim was to evaluate quality of survival as judged by complications due to treatment and the duration of autonomous oral feeding, that is, without palliative endoscopic treatment. No difference in survival was noted between the two groups, overall (median, 14 months), or between the strata. Conversely, significantly more patients in the treated group had hematologic, neurologic, and renal complications compared with the control group. Four patients died of complications of chemotherapy. The duration of autonomous oral alimentation was exactly the same in both groups (median, 12 + months). CONCLUSION: The results of this study suggest that 5-FU and cisplatin are not useful for patients with squamous cell carcinoma of the esophagus who have not undergone curative resection.

Actuarial Analysis↗
PubMed1996

Are routine preoperative chest radiographs useful in general surgery? A prospective, multicentre study in 3959 patients. Association des Chirurgiens de l'Assistance Publique pour les Evaluations médicales.

OBJECTIVE: To find out which patients about to undergo general or gastrointestinal operations could have the routine preoperative posteroanterior chest radiograph omitted. DESIGN: Prospective open multicentre study. SETTING: 8 Public hospitals, France. SUBJECTS: 3959 consecutive patients about to undergo operations for benign disease were divided into 4 groups depending on the number of risk factors for cardiopulmonary complications (coexisting bronchopulmonary or cardiac conditions, abnormal clinical cardiopulmonary findings): group 1 (n = 2092) had no risk factors, group 2 (n = 946) had 1, group 3 (n = 645) had 2, and group 4 (n = 276) had 3 risk factors or more. INTERVENTIONS: Routine posteroanterior chest radiographs. MAIN OUTCOME MEASURES: Whether the findings on the radiograph (read by the anaesthetist) led to modifications in the type of anaesthesia or operative technique, or both, and whether radiographs were helpful in the postoperative management. RESULTS: 912 (23%) of the radiographs showed some abnormality. Changes were made in anaesthetic or surgical policy in 22 (0.1%), 11 (0.3%), 8 (1%), and 4 (1%) of patients in groups 1-4, respectively. The preoperative films were of some help in the management of about half the patients who developed postoperative cardiopulmonary complications. CONCLUSIONS: Preoperative chest radiographs should be routine for patients about to undergo general and gastrointestinal operations with three or more risk factors, and done selectively for patients with one or two. Routine preoperative films are unnecessary for patients with no risk factors.

Anesthesia↗
PubMed1995

[Quantified semiology of acute sigmoid diverticulitis. Associations de Recherche en Chirurgie].

Using a data base of 7,000 acute abdominal pains, we have described the assessed clinical features of acute diverticulitis of the sigmoid colon. Percentages of sensitivities have been replaced by adverbs or adjectives, applying a scale of equivalence. The modifications of the positive predictive values have been also replaced by verbs or typical expressions. In this article, abscesses, fistulas, generalized peritonitis and hemorrhage arising from an acute diverticulitis of the sigmoid colon were not studied.

Acute Disease↗
PubMed1995

Budd-Chiari syndrome secondary to carcinoma: report of two cases.

In two patients who had Budd-Chiari syndrome secondary to carcinoma, the diagnosis was made intraoperatively at the time of emergency right atrial clearance required for severe cardiovascular distress. Curative resection was not possible and both patients died. As previously noted in the literature, it is extremely difficult to relate carcinoma to the origin of Budd-Chiari syndrome. Retro- and suprahepatic involvement of the vena cava is associated with a very poor prognosis. Complete resection of these tumors is the only potentially curative treatment. We suggest ways to obtain a simple and early histologic diagnosis before initiating appropriate and radical surgical treatment.

Adenocarcinoma↗
PubMed1995

Passive vs. closed suction drainage after perineal wound closure following abdominoperineal rectal excision for carcinoma. A multicenter, controlled trial. The French Association for Surgical Research.

PURPOSE: Because evacuation of effusion or collection could depend on the type of drainage, we compared the effects of closed suction drainage with passive drainage through tubes or undulated drains after abdominoperineal rectal excision for carcinoma on early and late perineal wound healing. METHODS: Of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma between January 1983 and August 1990, unsatisfactory hemostasis or gross intraoperative septic contamination were recorded in 48 patients who were not included in the trial. After rectal excision and closure of the perineum, the remaining 186 patients were randomized to receive passive drainage (PD; n = 96) or closed suction drainage (SD; n = 90). Eighteen patients were withdrawn because of protocol violation, and three were lost to follow-up, leaving 165 (89 PD and 76 SD) patients for analysis. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of ascites), intraoperative and pathologic findings (Dukes stage), and postoperative courses (recurrence, late mortality) were similar in both groups. All patients were followed up for 12 months or until death. RESULTS: The rate of perineums healed at one month was significantly lower (P < 0.05) in PD (55/89 = 61 percent) compared with SD (54/72 = 75 percent) patients. At three months, the rate of healed perineums no longer differed between the two groups (70/87 = 81 percent vs. 60/72 = 84 percent). The number of vaginal fistulas, secondary reopenings, and perineums not healed at 12 months was similar in both groups. Median duration to complete healing was similar in both groups (23 vs. 21 days, respectively). On the other hand, three retained drains were seen in PD patients only. The median duration of hospital stay was identical in both groups (22 days). Seven patients died in the early postoperative period, including one in the PD group and six in the SD group. There was no significant difference in the number of late deaths (3 vs. 7) in PD and SD patients, respectively. CONCLUSION: These results suggest that closed suction drainage should be used after abdominoperineal rectal excision with satisfactory hemostasis or absence of gross introperative septic contamination.

Adult↗
PubMed1995

A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research.

BACKGROUND: Several retrospective and four prospective reports have questioned the need for routine preoperative hemostatic screening tests (PHST) in general surgery. PATIENTS AND METHODS: The results of four standard tests (prothrombin time, activated partial thromboplastin time, platelet count, and bleeding time) were prospectively compared with patient history and clinical data in a multicenter study of 3,242 consecutive patients. The patients were divided into four groups: group A (n = 1,951) had no clinical or PHST abnormalities; group B (n = 340) had no clinical and one or more PHST abnormalities; group C (n = 779) had one or more clinical and no PHST abnormalities; group D (n = 172) had both clinical and PHST abnormalities. RESULTS: Preoperative modifications of guidelines (postponed operations and ordering of additional hemostatic tests) were significantly more frequent in both groups of patients with PHST abnormalities (groups B and D), but specific treatment to correct hemostatic disorders was prescribed only when clinical abnormalities were also present (group D). Intraoperatively, modifications of anesthetic and surgical vigilance (planning of increased number of blood units, vascular catheter placement, and number of patients requiring transfusion) were significantly more frequent in group D. Postoperatively, all groups had similar incidences of hematoma or bruises, volumes of blood loss per drainage, reoperations to control hemorrhage, and mortality due to bleeding (n = 5). CONCLUSIONS: Our results suggest that PHST should not be performed routinely, but only in patients with abnormal clinical data. Such a policy necessitates a thorough history--including answers to a specific questionnaire like those used in prospective studies--and a rigorous, well-conducted physical examination.

Adolescent↗
PubMed1995

Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples--a controlled clinical trial. French Associations for Surgical Research.

BACKGROUND: Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. METHODS: One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8 +/- 12.1 years) were randomized to undergo hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal colorectal anastomosis after left colectomy. RESULTS: Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS). CONCLUSIONS: According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis.

Adult↗
PubMed1995

Phylogenetic relationships of amphibian families inferred from DNA sequences of mitochondrial 12S and 16S ribosomal RNA genes.

Nucleotide sequence comparisons were used to investigate ordinal and familial relationships within the class Amphibia. Approximately 850 base pairs of the mitochondrial 16S ribosomal RNA (rRNA) gene from representatives of 28 of the 40 families of extant amphibians were sequenced. Phylogenetic analyses of these data together with published data of the 12S rRNA gene for the same families and both genes for three more taxa (approximately 1,300 base pairs total for 35 taxa) support the monophyly of each of the three amphibian orders: Anura (confidence value with the interior-branch test: P(c) = 99%), Caudata (P(c) = 100%), and Gymnophiona (P(c) = 99%). An analysis using the four-cluster method cannot discriminate significantly between all three possible unrooted trees involving the three orders of amphibians and an outgroup. Within the Anura, there is support for the monophyly of the two suborders: Neobatrachia (P(c) = 100%) and Archaeobatrachia (P(c) = 97%); the latter was believed to be paraphyletic on the basis of morphology. Within the Archaeobatrachia, the following pairs of taxa cluster: Pelobatidae + Pelodytidae (P(c) = 99%), Pipidae + Rhinophrynidae (P(c) = 99%), Ascaphus + Leiopelmatidae (P(c) = 89%), and Bombina + Discoglossidae (P(c) = 99%). The latter six taxa cluster (P(c) = 94%) such that Pelobatidae + Pelodytidae forms a basal lineage within the Archaeobatrachia. Three major lineages are distinguished within the Neobatrachia: the superfamily Bufonoidea sensu Duellman (P(c) = 86%), the superfamily Ranoidea sensu Lynch (P(c) = 99%), and the Sooglossidae. Basal within the Bufonoidea, Myobatrachidae + Heleophrynidae cluster at P(c) = 96%. The enigmatic Dendrobatidae clusters with the bufonoid families (P(c) = 92%) and is excluded from the ranoid families (P(c) = 99%). (ABSTRACT TRUNCATED AT 250 WORDS)

Amphibians↗
PubMed1995

Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients.

BACKGROUND: Hernia repair is the second most frequently performed operation in France and in the United States, the prevalence being 36 for every 1000 males. Lowering the recurrence rate by 1% would mean 1000 fewer operations for hernia repair per year in France. METHODS: Between 1983 and 1989, 1578 adult males with a total of 1706 nonrecurrent inguinal hernias were prospectively and randomly allotted to undergo either a Bassini's repair, Cooper's ligament, or Shouldice repair with polypropylene or a Shouldice repair with stainless steel for determination of which technique was associated with the lowest recurrence rate. Fifty-nine hernia repairs were withdrawn after inclusion. Of the 1647 remaining hernias, 52.2% were indirect, 25.6% were direct, and 23.2% were combined. Patients were seen every 6 months for 3 years and then every year. Median follow-up was 5 years 8 months (range, 3 months-8.5 years). RESULTS: At 8.5 years, 5.6% of hernias were lost to follow-up. Ninety-seven hernia repairs failed, 50% during the first 2 years. The actuarial recurrence rate was 7.94% at 8.5 years. The Shouldice repair (stainless steel or polypropylene) was associated with fewer recurrences (6.1%) than either the Bassini's (8.6%) or Cooper's ligament repair (11.2%) technique (p < 0.001). This difference remained significant even when the maximal bias test was used. Fewer recurrences (5.9%) were observed with the stainless steel wire Shouldice repair than with polypropylene version (6.5%), but the difference was not significant. CONCLUSIONS: Shouldice hernia repair provides the patient with the best chances of nonrecurrence regardless of the anatomical type of hernia. The Shouldice hernia repair should be the gold standard for inguinal hernia repair in men and serves as the basis for comparison with all other techniques, be they prosthetic or laparoscopic.

Follow-Up Studies↗
PubMed1995

Preoperative evaluation of the probability of common bile duct stones. French Association for Surgical Research.

BACKGROUND: This study was done to determine if certain criteria could predict the presence of common bile duct stones in patients with symptomatic gallstones. It was hoped that patients could be identified in whom intraoperative cholangiography was unnecessary. STUDY DESIGN: One hundred seventy-five patients, from 15 surgical centers, were prospectively enrolled. For each patient, the preoperative score (Huguier score) previously published was calculated according to clinical and ultrasound data: age, diameter of the common bile duct, diameter of the smallest gallstone, history of biliary colic, and acute cholecystitis. All patients underwent an open cholecystectomy and an intraoperative cholangiography. The absence or presence of a common bile duct stone was evaluated during the operation, if necessary, after an instrumental investigation of the common bile duct. RESULTS: Ultrasound was not interpretable in eight (5 percent) of 175 patients. Final analysis was made from the charts of the 167 remaining patients. Thirty (18 percent) had common bile duct stones. When the score was equal to or greater than 3.5, the risk of having a common bile duct stone was 24 percent (27 of 111). When the score was less than 3.5, this risk was 5 percent (three of 56). CONCLUSIONS: Huguier's score is well assessed and can be safely used. Intraoperative cholangiography could be avoided in 33 percent of patients when the score is less than 3.5 (56 of 167).

Age Factors↗
PubMed1995

Surgical mortality and morbidity in malignant obstructive jaundice: a prospective multivariate analysis.

OBJECTIVE: To construct prognostic scores using multivariate analysis for morbidity and mortality in jaundiced patients with malignant biliary obstruction. DESIGN: Prospective study. SETTING: 16 university and 12 general hospitals affiliated to the French Association for Surgical Research. MAIN OUTCOME MEASURES: Results of application of severity indexes for mortality and morbidity constructed from 17 variables. That for mortality was: 0.0497 x age + 0.9219 x American Society of Anesthesiologists' (ASA) grade + 0.0037 x serum bilirubin concentration minus 0.0239 x prothrombin time + 0.0001 x white cell count minus 5.593. That for morbidity was: minus 0.7499 x ASA grade + 0.0294 x prothrombin time + 1.4220 x cause (0 = carcinoma of bile duct, 1 = pancreatic cancer) minus 1.5080 x operation (0 = bypass, 1 = resection) minus 1.537. RESULTS: The scores correctly predicted mortality in 77% and morbidity in 65% (infective morbidity in 73%). CONCLUSIONS: We recommend that when the mortality index is negative operation should be the treatment of choice, and when it is positive the patient should be advised to have non-surgical palliative treatment. When the morbidity index is negative the risk of complications is high, and when it is positive the risk is low. The application of these indexes allows for better choice of patients suitable for operative treatment of malignant biliary obstruction.

Adult↗
PubMed1994

Perineal wound management after abdominoperineal rectal excision for carcinoma with unsatisfactory hemostasis or gross septic contamination: primary closure vs. packing. A multicenter, controlled trial. French Association for Surgical Research.

PURPOSE: This study was designed to compare the results of two methods on the rate of postoperative perineum healing. PATIENTS AND METHODS: In this prospective, randomized, multicenter trial of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma, 48 had unsatisfactory hemostasis or intraoperative gross septic contamination. Three patients were withdrawn because of protocol violation. Of the 45 remaining patients, 21 were randomized to undergo primary closure of the perineum with drainage while 24 underwent packing. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of ascites), intraoperative findings (Dukes stage, degree of hemostasis, gross septic contamination), and postoperative oncologic courses (recurrence, mortality rate) were similar in both groups. All patients were followed for at least 12 months or until their demise. RESULTS: There was no significant difference in the number of early (one vs. zero) or late (five vs. four) deaths between primary closure and packing groups, respectively. Median duration of hospital stay was 25 and 27 days, respectively. Primary closure was associated with a significantly higher rate of healed perineums at one month (30 percent vs. 0 percent) (P = 0.01) and a shorter delay to complete cicatrization (median, 47 vs. 69 days) (P < 0.01). From three months onward, there was no difference in healing between the two groups, but two patients in the packing group had not healed at one year. Conversely, hematoma, perineal abscess, and reoperations were significantly more frequent (P < 0.01) in the primary closure group. CONCLUSION: Primary closure associated with drainage after abdominoperineal resection for carcinoma expedites perineal healing but morbidity is higher.

Adult↗
PubMed1994

Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research.

PURPOSE: This study was developed to compare median and actuarial survival after left hemicolectomy vs. left segmental colectomy. METHODS: Between January 1980 and January 1985, 270 consecutive patients (133 males and 137 females; mean age, 64 +/- 12 (range, 18-91) years with left colonic carcinoma located between the left third of the transverse colon and (but not, including) the colorectal juncture were randomly allotted to undergo either left hemicolectomy or left segmental colectomy. Left hemicolectomy removed the entire left colon along with the origin of the inferior mesenteric artery and the dependent lymphatic territory. Left segmental colectomy removed a more restricted segment of the colon and left the origin of the inferior mesenteric artery unmolested. RESULTS: After elimination of 10 patients for protocol violation, 131 patients with left hemicolectomy and 129 with left segmental colectomy were analyzed. Both groups were similar with regard to preoperative risk factors (age, sex, obesity, weight loss, anemia, diabetes, cirrhosis, kidney failure, steroid therapy or radiation therapy performed for any cause other than cancer), pathology findings (size, degree of differentiation, Dukes stage, invasion of lymph nodes at the origin of the inferior mesenteric artery), and associated lesions. Only the length of tumor-free margins of colon removed was significantly longer in left hemicolectomy. The number of early postoperative abdominal and extra-abdominal complications was similar in both groups. Overall, early postoperative mortality was 4 percent higher, but not significantly in left hemicolectomy (eight deaths, 6 percent) than in left segmental colectomy (three deaths, 2 percent). Median survival was 10 years and nearly equivalent in both groups. The two actuarial survival curves were similar. Bowel movement frequency was significantly increased after left hemicolectomy during the first postoperative year. Our results suggest that survival after left segmental colectomy is equivalent to that of left hemicolectomy. Notwithstanding the observation of other carcinologic rules, left segmental colectomy rather than left hemicolectomy may theoretically be performed under laparoscopy without compromising the carcinologic outcome.

Adenocarcinoma↗
PubMed1994

Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. French Associations for Surgical Research.

BACKGROUND: Disagreement continues among several studies as to the relative advantages and disadvantages of stapled versus sutured colorectal anastomoses. METHODS: One hundred and thirteen consecutive patients (48 men and 65 women, mean age: 67 +/- 12 years) were randomized to either hand-sewn (n = 59) or stapled (n = 54) infraperitoneal colorectal anastomosis. Both groups had similar patient demographics except that fewer patients (4 versus 15) had chronic disease (p < 0.02) and were undergoing side-to-end (11 versus 39) and more patients were undergoing end-to-end (37 versus 20) anastomosis in the stapled group (p < 0.001). RESULTS: Overall mortality was 6% (7 of 113 patients), with no difference found between the two types of anastomosis. Fewer anastomotic leaks occurred in the stapled group (11 versus 7), with an a posteriori gamma error of 11%, whereas the other early postoperative complications occurred with similar frequency in the two groups. Nine mishaps occurred in the stapled group. Stapled anastomoses took less time (median, 42 versus 30 minutes) to perform (p < 0.02). At 8 months, two strictures occurred in the hand-sewn group (n = 52) compared with eight strictures in the stapled group (n = 50) (p < 0.001). CONCLUSIONS: It was not possible to prove that lower anastomosis can be achieved with the stapling device. Routine or regular use of stapling instruments for infraperitoneal colorectal anastomosis cannot be advocated because of higher incidence of mishaps and strictures, even though the operation takes less time to perform and anastomotic leakage occurs less often.

Adult↗
PubMed1993

[Acute intestinal obstructions in adults: quantified semiology (signs and their value) and surgical treatment].

The prevalence of signs and symptoms of acute intestinal obstruction in the adult was studied in a prospective study of 600 cases extracted from a data base on acute abdomen in 7,000 patients. This study of prevalence allows a precise definition of intestinal obstruction syndrome and to differentiate two types of presentations according to the site of obstruction on the small bowel or the colon. However, it is more difficult to differentiate simple bowel obturation from vascular strangulation. Surgical treatment depends mainly on the cause of obstruction.

Acute Disease↗
PubMed1993

Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. A randomized multicenter controlled trial. The French Association for Surgical Research.

Patients undergoing elective left colectomy for colonic carcinoma or diverticulosis (n = 341) were randomly assigned to three groups. Patients in groups 1 (102 patients) and 2 (122 patients) had two 5% povidone-iodine enemas whereas those in group 3 (117 patients) had saline enemas. Groups 1 and 3 received 24-hour intravenous cefotaxime sodium and metronidazole hydrochloride. Group 2 received single injections of ceftriaxone sodium (1 g) and ornidazole (1 g). Senna concentrate was administered the evening before surgery. There was no statistically significant difference found between groups 1 and 2 concerning the number of infected patients (eight vs 11), anastomotic leakages (four vs four), extra-abdominal complications (32 vs 29), or infection-related deaths (one vs zero). Despite poorer tolerance, povidone-iodine enema was more effective than saline enemas, as there were less infected patients in group 1 (8%) or groups 1 + 2 (8.5%) than in group 3 (13%). Single-dose ceftriaxone-ornidazole combined with povidone-iodine enemas is effective against infective complications in elective left colonic surgery for carcinoma or diverticular disease. Single-dose antibiotic prophylaxis reduces costs and work for the nursing staff.

Adult↗