[Enterocutaneous jejunal fistula. Late complication of a synthetic prosthesis in abdominal wall surgery].
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Abdominal Muscles↗
Biomedical subjects
J S Azagra
Publications and source records attributed to J S Azagra.
[Retroperitoneal liposarcoma. Apropos of 3 cases and a review of the literature].
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Aged↗
The current role of laparoscopic surgery in the treatment of benign gastroduodenal diseases.
BACKGROUND/AIMS: The impressive breakthrough in laparoscopic surgery has urged several authors to adopt such an approach in the treatment of both benign and malignant gastric diseases, even though laparoscopic gastric resection has not yet met with widespread enthusiasm. The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic (LGRs) and laparoscopic-assisted (LAGRs) gastric resections in the treatment of non-malignant gastric conditions. METHODOLOGY: As of April 1997, we performed LGRs or LAGRs on a total of 24 patients (M:F = 15:9; mean age: 43 years; range: 19-65 years), among whom 8 presented with chronic gastric ulcer, 4 had benign pyloric stenosis, 8 were affected with recurrent duodenal ulcers no longer amenable to treatment, and 4 with persistent symptomatic biliary reflux. Pre-operatively, all patients underwent blood tests, upper GI endoscopy coupled with biopsy, and barium swallow. Post-operatively, all patients were administered saline solution and water dextrane for the first 5 days; antibiotics (cefuroxim 4 g i.v. daily) and analgesics (paracetamol 6 g i.v. daily) for the first 48 hours. A hydrosoluble swallow was scheduled for the 5th post-operative day. RESULTS: The surgical procedure consisted of a Billroth II distal gastrectomy in 13 cases and total duodenal diversion with Roux-en-Y gastrojejunostomy in 11. Among such patients, 18 underwent a totally laparoscopic procedure, whereas 6 had laparoscopic-assisted gastrectomy, with the use of a Dexterity device in 1 case. The mean duration of the procedure was 150 min (range: 120-200), and blood losses were not remarkable. No intra-operative complication ever occurred. Post-operatively, we observed one case of retrogastric collection and incisional hernia in 1 patient who underwent a laparoscopic-assisted procedure. The abscess was drained percutaneously and hernia conventionally repaired 5 months post-gastrectomy. Post-operative hospital stay was 7 days on the average (range: 5-25). One patient was lost to follow-up. In the remaining cases, no major functional sequelae were observed at a mean follow-up of 19 months (range: 2-41), apart from 2 cases of transient diarrhea. CONCLUSIONS: Laparoscopic surgery appears to be an invaluable tool for the treatment of gastric diseases and LGRs are a valid option in experienced hands and in selected centers, allowing patients to benefit from a less cumbersome hospital stay and fewer functional sequelae. The economic impact of such a practice, however, needs better clarification.
Adult↗
[Burkitt's lymphoma of the appendix].
We report the case of a 12-year-old European boy presenting with an appendicular Burkitt's lymphoma. He complained of right lower abdominal pain mimicking acute appendicitis. Ultrasonography and abdominal CT showed an appendicular mass which features were strongly suspicious for malignancy. This case emphasizes the importance of medical imaging to characterize appendicular lesions and to select the surgical technique. Accurate diagnosis was obtained histologically on resected specimen.
Appendectomy↗
Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients.
BACKGROUND/AIMS: The objective of our paper is to report on the remote results of patients with gastric cancer treated by mini-invasive surgery as a surgical tool with the "intention to treat with laparoscopy". METHODOLOGY: Between June 1993 and January 2004, 101 patients comprising 72 men and 29 women with gastric adenocarcinoma were prospectively selected by two hospitals based on prior agreement (the CHU Charleroi, Belgium, and Zumárraga Hospital, the Basque Country, Spain). Patients with adenocarcinoma of the cardia were excluded. Average age of the patients was 67 (37-83). RESULTS: Postoperative mortality within 60 days of operation was of 5 patients; 87 patients were therefore properly followed-up for an average of 41 months (7-129). Average survival time for 10 non-resected patients was 4.5 months. Average survival rate of the 10 palliatively resected patients was 7.1 months. Actuarial 5-year survival rate RO-type surgery was 34%. The global actuarial 5-year survival rate after resective surgery was 29%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a heavy but safe operation, and produces acceptable mortality and morbidity rates in patients with advanced gastric cancer in a general poor condition. Laparoscopic gastrectomies for locally advanced cancers are equivalent to those reported by laparotomy as far as long-term oncological results are concerned.
Adenocarcinoma↗
[One-stage subtotal colectomy in the emergency treatment of occlusive left colonic neoplasms].
The authors present a series of 17 emergency subtotal colectomies as treatment of malignant occlusions of the left colon. They insist on the advantages of this operation as well as for the short term results (morbidity, mortality) and for the rare functional disease (diarrhea).
Aged↗
[Belgian experience in percutaneous peritoneal dialysis in the treatment of acute alcoholic necrotizing-hemorrhagic pancreatitis].
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Acute Disease↗
[Treatment of large midline eventration with aponeurosis autograft and retromuscular prosthesis. Apropos of 40 case reports].
Forty patients presenting midline incisional hernias either recurring or larger than 10 cm in transversal diameter were treated using Teflon prosthesis. Implantation site was the retromuscular space following the J. Rives technique. There were no postoperative deaths. Nor have we observed any recurrence among the 40 patients for a period of 6 to 56 months. Three wound infections completely exposing the prosthesis were recorded. These infections healed and it was necessary in only one case to remove a portion to the prosthesis. The low percentage of pulmonary complications can be attributed to 1) an intensive preoperative respiratory therapy, 2) standardized surgical technique, 3) epidural anesthesia permitting early effective postoperative respiratory therapy.
Adult↗
[The contribution of anterior seromyotomy with posterior truncal vagotomy in the treatment of chronic duodenal ulcer].
Contribution to the anterior seromyotomy and posterior truncal vagotomy in the treatment of chronic duodenal ulcer. The authors report a technique of anterior seromyotomy of the gastric lesser curvature with posterior truncal vagotomy for the surgical treatment of chronic duodenal ulcer disease. This technique offers more advantages than the highly selective vagotomy: it is an easier operation to perform, less time consuming and reproducible. Our results are similar to those following highly selective vagotomy.
Adult↗
Spontaneous rupture of the esophagus after coronary artery bypass.
Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.
Coronary Artery Bypass↗
[94 inguinal hernias treated by interposition of a prosthesis using medial and preperitoneal approach].
Having chosen the utilization of a Teflon prosthesis, interposed in preperitoneal position by medial incision, in a series of 58 patients presenting 94 hernias, the authors wish to express a preference to this method for reoccurring and bilateral hernias. They underline the simplicity of the technique, its reduced morbidity, and they focus on the infrequency of reoccurrence in 47 patients reseen 6 months to 4 1/2 years in follow up. The authors have not observed a difference in the local results, recent and long term, after intervention using this technique under general or local-regional anesthesia. But they do appreciate however, a low percentage of general complications encountered in the group operated without general anesthesia, which thus permits an enlarged spectrum of indications for patients at risk. Previous operations by low midline incisions (prostatectomy, etc...) do not constitute a contra-indication.
Adult↗
Gallbladder volvulus: a case report.
Gallbladder volvulus, a rare disease generally affecting older aged women, is generally due to an abnormal anatomical fixation of the gallbladder. As clinical and radiological signs are poor the diagnosis is generally made at laparotomy. The prognosis is excellent when early surgical treatment is performed.
Aged↗
[Pyostercoral peritonitis of diverticular origin. Retrospective analysis of 22 cases].
Twenty-two cases of diverticulitis with perforation and peritonity have been treated whether by colostomy (13 cases) or primary resection (9 cases). Primary resection reduces mortality and morbidity of the emergency operation and the combined mortality and morbidity of all operative procedures.
Adult↗
[Diverticular and instrumental perforations of the colon].
From july 1976 to july 1982, two groups of patients consisting of eleven peritonitis due to acute perforated diverticulitis, and five instrumental colonic perforations were treated in our department. None of the patients died in both groups. The relative infrequency, the important morbidity and the inaugural aspect of the perforation in the diverticular disease are in agreement with the literature. The ideal surgical attitude is still controversial. With the majority of the authors, we prefer the Hartmann's operation. The frequency of iatrogenic perforations is not negligible, and could increase in the future, with the development of endoscopic investigations. The morbidity is lower than in the first group, provided that the surgical treatment is applied early.
Adult↗