Search PubMed⌕ Search

Biomedical subjects

K Slim

Publications and source records attributed to K Slim.

At least 109 records · Page 6Linked to original sources
PubMed1999

[Use of lanreotide in the prevention of pancreatic fistula after cephalic duodeno-pancreatectomy. Preliminary study].

STUDY AIM: Dehiscence of pancreatic anastomosis is the main complication after pancreatoduodenectomy. The efficacy of somatostatin analogue to prevent complications after pancreatic resections is at present well-established by several randomized trials. The aim of this preliminary prospective study was to assess the role of lanreotide (a long acting somatostatin analogue) in this field. PATIENTS AND METHOD: Forty patients with pancreatic head tumour have been included in a prospective study. Criteria for pancreatic fistula were: high concentration of amylase in the drainage fluid (> 3 times that in the serum), or intra-abdominal fluid collection adjacent to the pancreatic anastomosis, or reoperation (or postmortem verification) showing an anastomotic dehiscence. The patients received 12 h before the operation 30 mg of lanreotide intramuscularly. RESULTS: Of the 40 patients included prospectively, 34 underwent a pancreatic resection. Parenchyma of pancreatic remnant was crumbly in 28 cases. Six patients experienced a pancreatic fistula (17.6%) which healed in all cases. CONCLUSION: This preliminary study shows clearly the feasibility of a long acting somatostatin analogue (lanreotide) to prevent pancreatic fistula after pancreatectomy. This agent appears simple to use and its efficacy needs obviously to be assessed by randomized trials.

Humans↗
PubMed1999

[Laparoscopic treatment of small intestine obstruction].

Laparoscopic surgery for small bowel obstruction is still under evaluation. A review of the literature retrieved over 200 published cases. Technically, the open laparoscopy procedure seems mandatory to avoid bowel injuries. Grasping the enlarged bowel and using monopolar cautery should be avoided. The surgeon should also be sure that at the end of the procedure adhesiolysis was correct. Evaluation of the results must also take into account that most studies were retrospective and included few patients. The cumulative effectiveness rate of laparoscopy was 60%. Failures were mainly due to multiple adhesions, iatrogenic perforations to the intestine, and colonic cancers not recognized before the procedure. There was no prospective study comparing laparoscopy with laparotomy. Finally, it is not proved at present that laparoscopy prevents the recurrence of adhesions after digestive surgery. Owing to the results of the literature, laparoscopic surgery for acute small bowel obstruction does not appear as based on fact.

Colonic Neoplasms↗
PubMed1999

[First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI)].

AIM: Gastrointestinal quality of life index (GIQLI) was initiated in Germany. The aim of this study was to validate its French version (translation). METHODS: The questionnaire includes 36 items asking about symptoms, physical status, emotions, social dysfunction, and effects of medical treatment. The questionnaire has been applied to 615 persons: 335 healthy individuals and 280 patients. Responsiveness and absolute and relative scores were calculated in both groups. Psychometric analysis was done by measuring the validity (convergent and discriminant) and internal consistency. RESULTS: The responsiveness was 93%. The mean score was 126 for healthy individuals and 96 for patients (P < 0.00001). The validity of the questionnaire (both convergent and discriminant) and the internal consistency were demonstrated. Clinical validity was also suggested by the differences between healthy individuals and patients. CONCLUSION: This study allowed the psychometric validation of the French version of GIQLI. This index could be used in France as a reliable method for measuring quality of life related to gastrointestinal diseases.

Adult↗
PubMed1999

[Ruptures and injuries to the diaphragm].

Injury to the diaphragm is a marker of severe trauma yet remains one of the most misdiagnosed traumatic lesions. The mechanism may be penetrating (stab or gunshot wounds) or blunt (high velocity injuries). Rupture of the diaphragm may be overlooked due to common associated injuries. Diagnosis is based on strong clinical suspicion and repeated chest x-rays. Current diagnostic tools include CT scan and minimally invasive surgical techniques (laparoscopy or thoracoscopy) in stable patients. These relatively new methods could provide more accurate diagnosis. The main feature of diaphragmatic injury is the incidence of late presentation with the possibility of life-threatening complications such as strangulations may even occur late.

Algorithms↗
PubMed1999

[Laparoscopic surgery for obesity].

Bariatrics surgery has been a subject to a noteworthy revolution since the advent of the laparoscopic approach. This overview of the literature highlights on established scientific data in this field and the eventual evidence bases of laparoscopic surgery. Vertical banded gastroplasty and gastric bypass are now recognised as the gold-standards for the surgical treatment of morbid obesity by laparotomy. For the minimally invasive approach, the gastric banding appears now as a validated technique with a good level of evidence. The results of this approach appears to be comparable to those of other techniques (in terms of weight loss). But there is at present no randomized trial comparing the gastric banding with the gold-standards (gastric banding versus vertical banded gastroplasty). Some particular feature of this surgery are discussed (such as the association of a gastroesophageal reflux disease or a cholelithiasis). The criteria of patient's selection, the pre and post-operative management are also detailed in the light of literature data and guidelines of international societies.

Humans↗
PubMed1998

[Is laparoscopic surgical practice "factual" (evidence based)? Results of a prospective regional survey].

OBJECTIVE: Evidence-based medicine is a growing paradigm in health care. We conducted a prospective study to determine whether laparoscopic surgery is truly evidence-based in everyday practice. METHODS: A prospective regional survey was performed in 11 French hospitals (one university and 10 district hospitals) to ascertain how general laparoscopic surgery was conducted during the last 3 months of 1997. We also searched the electronic databases for original articles on laparoscopic procedures. The methodology of randomized trials was analyzed and procedures were classed by level of evidence. We assumed that an evidence-based procedure was which had been validated by well-designed randomized controlled or prospective trials giving homogeneous results. RESULTS: One half of the procedures performed had been evaluated by randomized controlled trials. Among the 428 laparoscopic procedures, 334 (78%) were found to be evidence-based (CI 74.1-81.9%). Twelve of the 18 indications for laparoscopy (67%) were evidence based (CI: 62.5%-71.5). There was no difference between university teaching hospitals and general district hospitals. CONCLUSION: Contrary to initial criticisms, the practice of laparoscopic surgery appears to be truly evidence-based in the majority of cases.

Evidence-Based Medicine↗
PubMed1998

Laparoscopic or open appendectomy? Critical review of randomized, controlled trials.

PURPOSE: A randomized, controlled trial is considered to be the "gold standard" to evaluate a new procedure. Thus, this critical review assessed whether the published randomized trials on laparoscopic appendectomy show that it is superior to the open approach. METHODS: Twelve original articles involving a randomized, controlled trial on laparoscopic appendectomy in adults published between January 1990 and December 1996 were selected. We studied first whether each trial was positive (a procedure is superior to the other) or negative (no difference). We reviewed for each trial the methodology used and the following outcomes: operating time, intraoperative and postoperative complications, time until resumption of diet, postoperative pain, hospital stay, cost, and quality of life analyses. Postoperative morbidity was considered as the major primary outcome. RESULTS: There were six positive and six negative trials. Postoperative complication rates were similar, but the two approaches had specific potential complications, wound infections following open appendectomy, and intra-abdominal abscesses following laparoscopic appendectomy. This review failed to show a superiority of the laparoscopy for the other outcomes, particularly postoperative pain. CONCLUSION: Differences in positive trials concerned subjective and controversial outcomes, and the flaw in negative trials was their lack of power. Thus, nothing is definitively well established, even after 12 randomized trials.

Appendectomy↗
PubMed1998

Laparoscopic repair of missed blunt diaphragmatic rupture using a prosthesis.

A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair.

Hernia, Diaphragmatic, Traumatic↗
PubMed1998

[Does neoadjuvant radiochemotherapy augment the resectability of pancreatic cancers?].

PURPOSE OF THE STUDY: Pre-operative radiochemotherapy is the most recent therapeutic option in the pre-operative downstaging of pancreatic cancer and in decreasing the rate of positive resection margins. The purpose of the study was to evaluate tolerance and efficacy of pre-operative radiochemotherapy in unresectable pancreatic cancers. MATERIAL AND METHODS: This study included seven cases of pancreatic cancer considered unresectable. The patients received preoperatively 50 grays within a 5-week period associated with 5 FU and Platin during the 1st and 5th weeks. RESULTS: After radiochemotherapy, tomodensitometric evaluation showed a minor response in two cases. A pancreatico-duodenectomy could be performed in these two patients without any increase of pre- or post-operative morbidity or mortality. CONCLUSIONS: The results of the study suggest that preoperative radiochemotherapy may increase pancreatic cancer resectability. This hypothesis should be confirmed by a prospective randomised trial.

Adenocarcinoma↗
PubMed1998

[Laparoscopic surgery and pregnancy].

Laparoscopic surgery during pregnancy is still under evaluation. Most of published papers include few patients. The literature review reveals that laparoscopic cholecystectomy is the most performed procedure, followed by appendectomy and adnexal surgery. Intra-operative measures (surgical and medical) to prevent complications, appear of paramount importance. Results of published series suggest that laparoscopy during pregnancy is feasible and safe for both mother and fetus. Nevertheless, all studies are retrospective and included few patients, therefore drawing a definitive conclusion is questionable. On the other hand, experimental studies suggested a deleterious effect of pneumoperitoneum on fetus (fetal acidosis). But clinical relevance of these experiments is controversial and their results are conflicting. It would be tempting to conclude that laparoscopic surgery is the "gold standard" during pregnancy but the lack of strong scientific evidence does not allow, at present, to conclude that this conclusion is evidence based. Prospective trials or registries are needed to confirm the encouraging preliminary results in the literature.

Evidence-Based Medicine↗
PubMed1998

[Surgical treatment of gastroesophageal reflux. Which technique to chose?].

Several procedures can be performed for gastroesophageal reflux disease. The aim of this review is to answer two main questions what are the validated procedures? should the procedures be tailored to patient? Surgical treatment is now based on fundoplications. Several controlled trials compared different types of fundoplications, the analysis of their results shows that the total and posterior fundoplications were equally effective at short-term. Total fundoplications were however more effective at long-term but with a higher morbidity. Technical variants include the ligation of short gastric vessels, the crura repair, the extend of the oesophageal overlapping by the partial fundoplication (180 degrees, 270 degrees, or 300 degrees), and the dissection of the vagus nerves. The choice of a procedure should also take into account oesophageal manometry and possible associated diseases. Lower oesophageal sphincter pressure does not appear mandatory contrary to impaired oesophageal body motility which should contraindicate a total fundoplication. For oesophageal stricture, current agreement is to perform a total fundoplication together with an endoscopic dilatation when it is feasible.

Fundoplication↗