[Laparoscopic cholecystectomy. Surgical technique and results of the first 100 operations].
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Biomedical subjects
Publications and source records attributed to J Perissat.
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From November 1988 to February 1990 157 patients with gallbladder stones have been treated by a laparoscopic surgical procedure. They are 28 males and 129 females from 13 to 81 years old, 18 have had a cholecystostomy after intracorporeal lithotripsy (Lus Ultrasonic Olympus). They were placed on bile acids during 3 months. The average follow up time is 11 months. The mortality is zero and 2 mild complications occurred medically cured. 3 patients have a recurrent stone 6 month after surgery. 139 patients have had a cholecystectomy 89 after the same lithotripsy procedure seen above, 50 without prior lithotripsy. In 3 cases the laparoscopic procedure was abandoned, twice because of a sever bleeding, one for too compact surrounding adhesions. The mean follow up is 9 months. 123 were drained 1 day 16 had no drain. The mortality is zero. 2 patients without drainage developed a sub hepatic and douglas pouch abscess. They were cured by a lavage drainage laparoscopically made. 1 patient with drainage had a 7 days bile leak which disappeared spontaneously. The 136 others have had a short stay in the hospital (2-4 days) a painless post operative time. They could go back to work and sport within 1 week. They have minimal scars and no danger of incisional herniae. The magnification of the optical system enables the dissection of the cystic duct and artery easier and safer than it is by mini laparotomy mostly in obese people. At the beginning of our experience only the patients with frequent biliary colics have been selected for the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors describe a personal technique for the treatment of gallbladder stones using a laparoscopic approach. They first evacuate the stones with the aid of an intracorporeal ultrasonic lithotriptor (L.U.S. Olympus). They next perform a cholecystostomy or a cholecystectomy. The first 40 cases are reported, and good results were obtained.
Extracorporeal shock waves represent a new method to treat gallstones. This study was designed to evaluate: 1) the effectiveness of a recently available lithotripter (EDAP LT 01) for gallstone fragmentation; 2) adverse tissue reactions after treatment; 3) the optimum conditions for use of this apparatus in man. A human cholesterol stone was surgically implanted into the gallbladder of ten 20-25 kg mongrel dogs. One dog was used as a control. The other nine animals were divided into three groups (A, B and C). Two 60 min sessions of lithotripsy were carried out twice a week. Sonographic and CT examinations were performed 9 and 16 days after operation. The animals were killed 21 days after operation. Satisfactory fragmentation was obtained in 4 of the 9 animals, and in 2 dogs no stone fragments were detected. Fragments were found in the common bile duct in 5 dogs. In 2 animals a pathologic aspect of the papilla of Vater was observed. Marked hematoma was observed in the animals treated at 5 and 10 pulses/sec. In 5 cases, hematoma was observed in the gallbladder and in one case the gallbladder was ruptured. Hematoma was also noted in the hepatic vascular bed in 3 animals. Except for microscopic hemorrhagic lesions observed at the base of the right lung, no lesions were detected in any other organ. Shock waves produced by the EDAP LT 01 are effective for fragmentation of gallstones. However, in view of the tissue reactions observed at the higher pulse rates, the pulse rate should not exceed 2.5 pulses/s for use in man.
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The availability of continuous low rate enteral and parenteral feeding has enlarged the indications of enterostomy, notably in patients with multiple operations. However, closing an enterostomy, which may be high up in the small bowel, rises technical problems and is not always without risk. In this study a new technique of gun-barrel enterostomy easily closed with automatic sutures and without reopening of the abdominal wall is presented.
Of 79 patients surviving after amputation of the rectum for cancer, local and regional recurrences occurred in 23 cases, in 3 out of 4 of these during the 2-year period following operation. Only 3 patients survived. This illustrates the frequency and serious nature of these recurrent lesions. Based on their experience, the authors consider the risk of recurrence to be doubled if one of the following factors is present : patient under 60 years of age, cancer located in the lower rectum, tumour over 4 cm in diameter, stages B or C according to Dukes' classification, an anaplastic or colloid structure. Enzyme assay and computed tomography are unfortunately not determining factors for early diagnosis and effective therapy of pelvic-peritoneal recurrences. the authors suggest, therefore, though it was never employed in their own series, that pre-operative irradiation could be of value, in those patients that have a high risk of developing local or regional recurrences. The general use of this technique is not suggested because its known inconveniences.
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The effect of arterialization (ART) of the distal stump of the portal vein after portacaval shunt (PCS) on bile formation and liver ultrastructure was assessed. ART using the left gastric artery was performed in male Wistar rats. Animals were sacrificed 3 weeks later. ART prevented body and liver atrophy. However, the liver weight to body weight ratio was significantly decreased when compared to sham PCS (2.5 +/- 0.36 vs 3.22 +/- 0.15). Reduction in total bile secretion (microliter/min) seen following PCS is reversed by ART. ART partly corrected hepatocyte size atrophy and the major ultrastructural abnormalities, namely the irregularity of the nucleus and dilation of the nuclear envelope and of the rough endoplasmic reticulum appearing after PCS. However, mitochondria remained swollen, deformed and enlarged with scission figures. No lesions in connection with ART were seen. This result confirms, at the ultrastructural level, the beneficial effect of ART in PCS.
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