[Value of nicergoline in the prevention of postoperative thrombophlebitis].
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Biomedical subjects
Publications and source records attributed to L F Hollender.
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Mechanical sutures by stapled anastomoses represent a remarkable improvement in gastro-intestinal surgery. There are 3 types of stapling instruments: the G. I. A. for gastro-intestinal anastomosis, the E.E.A. a circular stapling apparatus for low colo-recto-anal, esophagojejunal or esophagocolic anastomoses, and the T. A. for everting closure and colonic anastomoses. These 3 types of apparatus have been used by the authors 402 times. Shortening of operating time, lessening of septic steps, high quality of the sutures and sinking risk of leakages allow postoperative mortality and morbidity to be diminished considerably.
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The results of cholangiography conducted pre-and post operatively (through Tatute), and during choledochotomy on 100 patients for confirmed or suspected bile duct stones are analyzed. Pre-operative opacification of the main bile ducts resulted in 13 p. cent of false positives and in a similar number of false negatives. Results of investigation during operation produced similar errors respectively in 14 and 2p. cent o of cases. Several recommendations are outlined to limit the proportion of unnecessary choledochotomies without increasing the number of neglected stones.
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Colon resection with immediate ileo-colonic or colo-colonic anastomosis without temporary praeternatural anus was carried out in 42 patients with serious complications of malignant and benign diseases of the colon. In 33% a leakage of the anastomosis occurred with a lethality of 16.6%. With regard to this high rate of complications and high lethality the authors hold that the so-called "ideal" colectomy has to be discarded with exception of very seldom cases and the two-stage operation has to be preferred absolutely.
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Presentation of a particularly evoking case of a post-opérative superior mesenteric arterio-venous fistula revealed by recurrent intestinal hemorrhages, diagnosed by selective arteriography and treated by resection of the anevrysmal pouch and the adjacent bowel. Review of the literature concerning 25 other cases from which it can be concluded that the digestive angiography was the only complementary examination that allowed the diagnosis. The curative surgical treatment has a 15% mortality rate in relation with hemorragic recurrences.
The authors analyse 40 cases of restoration of duodenal passage for severe functional sequelae after surgery for duodenal ulcer. The type of reoperation depended upon the initial operation and thus after gastric resection with gastro-jejunal anastomosis, 26 procedures involving transposition of the efferent loop to the duodenum (Soupault-Bucaille operation) were performed, 8 conversions of a gastro-jejunal anastomosis to a gastro-duodenal anastomosis and one interposition of a small intestinal loop according to the technique of Henley. After gastro-enterostomy with or without vagotomy, 3 gastric resections with gastro-duodenal anastomosis were performed, and one replacement of a gastro-enterostomy, by a pyloroplasty. Operative mortality was 3/40 cases and long term results proved to be good in 80% of the patients.
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