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P Pattyn

Publications and source records attributed to P Pattyn.

At least 37 records · Page 2Linked to original sources
PubMed1999

High-dose preoperative radiotherapy does not alter the strength of unilaterally irradiated colon anastomoses in rats.

PURPOSE: We studied the influence of preoperative radiotherapy on the strength of colon anastomoses in rats. We compared a conventional (2 Gy/fraction; 1 fraction/day; 5 days/week; cumulative doses of 40.0, 60.0, and 80.0 Gy) and a hyperfractionated schedule (1.6 Gy/fraction, 2 fractions/day, 5 days/week, cumulative doses of 41.6, 60.8, and 80.0 Gy). We compared unilaterally with bilaterally irradiated anastomoses for two conventional radiation schedules. METHODS AND MATERIALS: The rectosigmoid was always irradiated. Depending on the experiment, the cecum was irradiated or not. A side-to-side anastomosis between rectosigmoid and cecum was constructed the day following the last irradiation. The strength of the anastomosis was evaluated by means of a bursting pressure (BP) measurement after 10 days. A control group and a sham-treated group were carried out. RESULTS: Compared to controls, the strength of unilaterally irradiated anastomoses was not altered and BP values were independent of the radiation schedule and of the cumulative dose. In case of bilaterally irradiated colon anastomoses, anastomotic strength was significantly reduced at 80 Gy, but not at 40 Gy. CONCLUSIONS: After high doses of preoperative radiotherapy, colon anastomoses in rats can be safely constructed if only one anastomotic segment is irradiated. The strength of bilaterally irradiated colon anastomoses is dose-dependent.

Anastomosis, Surgical↗
PubMed1999

[Liver transplantation preserving the vena cava and a temporary portocaval shunt].

The experience with laterolateral cavocavostomy for hepatovenous reconstruction in liver transplantation is reviewed with and without the use of a temporary portocaval shunt. A total of 65 liver transplantations were analyzed. In 49 transplantations a laterolateral cavocaval anastomosis was performed (group I). In group II (n = 16) the same technique was used after a temporary portal caval shunt was constructed. Mean arterial pressure (mmHg): group I 128 +/- 34; group II 109 +/- 32. Cardiac output (l/min) decrease during the anhepatic phase was 2.3 +/- 1.9 and 1.2 +/- 1.5, respectively (P < 0.05). The peroperative blood loss measured as the number of packed cells transfused was 16.4 +/- 15.8 versus 1.2 +/- 2.3 (P < 0.04) and fresh frozen plasma 19.0 +/- 14.7 versus 3.7 +/- 4.0 (P < 0.02). Course on ICU (days), liver function tests, renal function and the need for reoperation because of bleeding were not statistically significantly different between the groups. One-year patient survival was 82.7 and 85.7%, respectively. In conclusion, we found that despite preservation of the caval flow during hepatectomy, the additional use of a temporary portocaval shunt was advantageous with regard to peroperative hemorrhage and hemodynamic stability and can potentially facilitate implantation of the liver graft.

Adolescent↗
PubMed1999

Functional, life-threatening disorders and splenectomy following liver transplantation.

UNLABELLED: Splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 +/- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.

Acute Disease↗
PubMed1999

Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch. SURGICAL TECHNIQUE: A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described. CONCLUSION: A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.

Gastroplasty↗
PubMed1999

Retrospective analysis of laparoscopic gastric banding technique: short-term and mid-term follow-up.

BACKGROUND: Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications. METHODS: In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. RESULTS: Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II. CONCLUSION: The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.

Adult↗
PubMed1999

Laparoscopic adjustable silicone gastric banding leakage assessed by 99mTc-pertechnetate scintigraphy.

UNLABELLED: The purpose of this study was to assess the value of 99mTc-pertechnetate scanning in the diagnosis of gastric banding leaks. METHODS: Three patients with morbid obesity received laparoscopic adjustable silicone gastric banding (ASGB), but no significant weight reduction was obtained. To exclude band leakage as the cause, four scintigraphic procedures were performed, consisting of imaging the upper abdomen 30 min and 3 h after injection of 3 mL (111 MBq) pertechnetate solution into the ASGB reservoir. In one patient, the integrity of the ASGB device was first assessed radiologically after injection of a water-soluble contrast agent into the ASGB reservoir. RESULTS: In two normally functioning ASGB devices, radiotracer was observed within the device on both early and late images. In two patients with a surgically proven small leak in the reservoir or the connecting tube, late images showed little tracer in the reservoir and the connecting tube. However, intense tracer accumulation was observed in the stomach as a result of resorption of pertechnetate in the subcutaneous or peritoneal blood vessels and subsequent gastric uptake. In one of the latter patients, radiographic assessment of the ASGB device revealed no abnormalities. CONCLUSION: 99mTc-pertechnetate scanning is a valuable technique to diagnose small leaks in an ASGB device.

Adult↗
PubMed1997

The course of shipped livers used as full size, reduced or split grafts.

A total of 110 transplants, 66 in adults (8 retransplants) and 30 in children (6 retransplants) were analysed according to the origin of the graft (shipped n = 39-non-shipped i.e. self procured n = 71) and the way they were transplanted (as full size grafts (FS) n = 82, reduced size grafts (RED) n = 23 or split grafts (SG) n = 5). Twenty-nine transplants were performed for urgent and 81 for elective indications. There was a statistically higher incidence of 2 or more risk factors in the donors that were selfprocured (non shipped) than in donors from shipped livers (p = 0.025). The overall 3 months graft survival was 79.5% for shipped livers versus 69% for non-shipped livers and patients survival was 89.2% versus 79.0% respectively after 3 months and 82.9% versus 74.4% after 40 months. From these results that were analysed with risk factors of the donors, cold ischaemia time and liver function tests in recipients, transplanted for acute and elective indications, it is concluded that shipping of grafts is a practical and safe procedure even if size reduction or the use of SG is intended.

Adult↗
PubMed1996

Hepato-venous outflow complications following orthotopic liver transplantation with various techniques for hepato-venous reconstruction in adults and children.

Orthotopic end-to-end cavostomy following liver transplantation was without any complications in 63 cases as compared to latero-lateral cavostomy (14.2%) and the piggy-back technique of partial liver grafts (14.2%). Transjugular catheterangioplasty was a practical and successful treatment for the latter, while reoperation for thrombosis in the latero-lateral anastomosis resulted in lethal pulmonary embolism.

Adult↗