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J Mouiel

Publications and source records attributed to J Mouiel.

113 records · Page 7Linked to original sources
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Posterior vagotomy and anterior seromyotomy as elective surgery for duodenal ulcer disease.

BACKGROUND/AIMS: The introduction of acid-reductor drugs in the treatment of duodenal ulcer has led to a drastic reduction in surgical indications. The role of Helicobacter pylori in recurrence and persistence of ulcer has added antibiotics to H2-receptor blockers and proton pump inhibitors. As this triple drug therapy always involves long and short-term side effects and ulcer recurrence is frequent once medication is stopped, surgical treatment with its recognized long-term efficacy has a role to play in prevention of complications. Posterior truncal vagotomy and anterior seromyotomy will guarantee complete denervation of the posterior territory and hence post-vagotomy diarrhea is avoided and motility is maintained in the pyloric and antral regions. METHODOLOGY: Elective posterior vagotomy and anterior seromyotomy was performed on 75 patients (14 F, 61 M) aged 19-61 years with a duodenal ulcer refractory to medical treatment. Sixty-two of them were followed-up for at least 2 years. Vagotomy is performed with the patient in the same position as for cholecystectomy. Five trocars are routinely inserted. The procedure involves three steps: approach for the hiatal region, posterior vagotomy, and anterior seromyotomy. RESULTS: Mean operative time was 140 min (range: 120-220 min). There was no mortality and only one case of pneumothorax which was treated successfully by a chest drainage. As for long-term, one patient developed reflux esophagitis. Fifty-nine patients had healing of their ulcer and 3 other patients had presence of scars 2 months after the operation. Post-operative BAO decreased to 78% and pentagastrin-stimulated acid secretion to 80%. Two pre-pyloric ulcer recurrences occurred 2 years after surgery, which responded to medical therapy. At 2 years, a 65% reduction in both BAO and pentagastrin-stimulated acid secretion was recorded. CONCLUSIONS: Posterior truncal vagotomy with anterior seromyotomy combines the rapidity and effectiveness of truncal vagotomy, which has the advantage of maintaining the gastric antral pump with ultra selective vagotomy. This minimally invasive surgical approach has opened up a new era in effective treatment of ulcer disease, and from now on must represent an alternative to long-term medical therapy.

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[Angiodysplasias or vascular ectasias of the intestine. Report on 8 personal cases].

Angiodysplasia or vascular ectasia of the intestine is a new pathological entity which was initially revealed by arteriography. More recently it has been found by coloscopy and is considered to be responsible for many cases of intestinal bleeding, especially in older patients The present study is based on eight patients including 2 cases of microscopic bleeding, 4 of massive hemorrhage, and 2 asymptomatic cases. There is a clear difference between intestinal angiodysplasia and other forms of vascular malformations, even though its pathogenesis is still in question. Whereas in older patients it is acquired, typically in the caecum. It can also exist congenitally in younger patients and in other locations. However, identical lesions may be observed at all levels of the digestive tract in association with certain diseases, most often vascular atheroma, but also diverse intestinal diseases (diverticulitis, colitis, polyps, cancer) and even iatrogenic diseases. Even though these malformations are frequent, the lesions often go unrecognized because special histological technics are required to reveal the arteriovenous fistulas. The major circumstance leading to this diagnosis is anemia due either to occult intestinal bleeding or massive hemorrhage (after exclusion of prevalent associated disease such as diverticulosis). Occasionally latent angiodysplasia is revealed during studies undertaken for associated disease. Positive diagnosis is based on selective angiography during massive bleeding and on endoscopic examination in case of anemia from occult bleeding. Surgical treatment should be undertaken in case of major blood loss. This usually consists of resection of the ascending colon, the most frequent site of the lesion. It is recommended that an even longer colonic segment be resected in case of associated diverticulosis. The preferred treatment of limited forms with few symptoms depends on more recent technics such as endoscopic electrocoagulation. In conclusion, many cases if occult intestinal bleeding can be explained by angiodysplasia which thus deserves better understanding and recognition.

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