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Biomedical subjects

K Slim

Publications and source records attributed to K Slim.

At least 91 records · Page 5Linked to original sources

[Surgical hand washing].

Hand washing is required to prevent nosocomial infection. We reviewed the literature, analyzing controlled randomized trials providing the best level of evidence. The different products and techniques evaluated in these trials are detailed. Compliance with hand washing protocols is also discussed.

Anti-Infective Agents, Local↗

[Tumor seeding on trocar scars: epidemiology, clinical significance and prevention].

A comprehensive literature review was conducted to study the epidemiology, clinical significance and preventive measures for port site recurrence following laparoscopic procedures performed for a colorectal or unrecognised gallbladder cancers. The incidence of this complication is difficult to evaluate, it is estimated in most large current series at about 1% after colorectal resections. Parietal recurrence involves a definite poor prognosis. But it is not demonstrated whether this is due to a worsening of a curable disease or to a disease with an initially poor prognosis. Since this complication has a multifactorial pathogenesis, preventive measures are multiple mainly a rigorous surgical technique according to a prospective operative protocol.

Cicatrix↗

A simple laparoscopic method to provide access to the gastroesophageal junction in obese patients.

By now, the feasibility of laparoscopic surgery in obese patients is well established; a conversion rate of 1.4-4.3% has been reported [1, 2]. The main reason for conversion in these cases is the difficulty encountered in exposing the gastroesophageal junction due to a huge fatty liver that covers the entire upper abdomen ("the invisible stomach" [1]). We report here a simple method that allows easy access to the upper stomach in such cases. This technique involves the exposure of the gastroesophageal junction using a laparoscopic suprahepatic route.

Esophagogastric Junction↗

Quality of life before and after laparoscopic fundoplication.

BACKGROUND: Laparoscopic fundoplication is a well-established surgical option for the treatment of gastroesophageal reflux disease. The aim of this study was to assess the surgical outcomes from the patient's point of view by using a validated quality of life instrument. METHODS: Fifty patients have been prospectively included. All patients underwent a standardized 270-degree posterior fundoplication. Quality of life was measured by the Gastrointestinal Quality of Life Index (GIQLI), a 36-item-questionnaire. The patients received the questionnaire before surgery, and 3 months and 1 year after surgery. RESULTS: Preoperative score was 95.6+/-21 points. The score increased significantly (P <0.0005) at 3 months (103.6+/-16) and 1 year (111.4+/-22) after surgery. This improvement concerned the four domains of the questionnaire (symptoms, social functioning, physical status, and emotions). The score in patients at 1 year remained, however, significantly lower than that in healthy persons (126+/-18). CONCLUSIONS: GIQLI is a sensitive tool to assess surgical outcomes after fundoplication. The quality of life after surgery did not reach the level of healthy population, not because of failure of surgery to treat GERD but probably because of functional dyspepsia that was present prior to surgery and did not change after fundoplication.

Dyspepsia↗

[French randomized trials in general and digestive surgery in the last decade].

STUDY AIM: To study the characteristics of randomized trials published by general and digestive French surgeons over the last decade. MATERIAL AND METHODS: An extensive electronic and manual literature search was performed. Trials published as original articles compared two surgical techniques or a surgical procedure with a nonsurgical treatment. The characteristics of the trials and their methodology were assessed. At the same time, a survey was conducted among authors to assess the impact of application of the Huriet-Sérusclat law (ethics related to the protection of individuals subjected to bioclinical research) on the conduct of the trial. RESULTS: Forty trials (including 22 multicentre trials) were found. Twelve trials (30%) addressed a key-question and twenty (50%) addressed a particular step of the procedure (anastomosis, drainage, etc). Most trials (83%) were published in English language journals. The 18 trials with a good methodological quality mainly had a multicentre design (n = 16). The survey showed that 10 trials were conducted prior to the publication of Huriet-Sérusclat law and that 14 trials were conducted in compliance with this law. CONCLUSION: This study revealed the large number of well designed multicentre trials in France. But most trials assessed technical steps of the surgical procedures. Application (without prerequisite) of the Huriet-Sérusclat law could probably explain the rarity and the difficulties of conducting trials comparing two different procedures or a surgical with a medical treatment.

France↗

Effect of CO(2) gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial.

BACKGROUND: Previous studies have suggested that gas temperature has an influence on postlaparoscopy pain. This trial therefore was conducted to study the effect of gas warming on pain after upper abdominal laparoscopic surgery. METHODS: Patients who underwent laparoscopic cholecystectomy, fundoplication, or Heller's myotomy were included and randomly allocated to receive either warm or cold gas. Primary end point was shoulder tip pain, and secondary end points were subcostal, trocar wound, and visceral pains, as well as other postoperative events. Criteria of pain assessment were the visual analog scale, verbal rating scale, and amount of analgesics. RESULTS: A total of 100 patients were suitable for postoperative evaluation. The groups were well matched. Shoulder tip and subcostal pains were significantly more intense after gas warming (p < 0.05). The three assessment criteria showed the same differences. No difference was observed concerning trocar wound and visceral pains and the other secondary end points. Subdiaphragmatic temperature was not significantly different (34.4 degrees with warming vs. 34 degrees without warming). CONCLUSIONS: Gas warming does not reduce, and probably increases, postoperative shoulder tip and subcostal pains.

Carbon Dioxide↗