Biomedical subjects

C Barrat

Publications and source records attributed to C Barrat.

At least 19 recordsLinked to original sources

PubMed2000

[Laparoscopic splenectomy for hematologic diseases. Study of 275 cases. French Society of Laparoscopic Surgery].

AIM OF THE STUDY: To evaluate the results of laparoscopic splenectomy for hematologic diseases by a multicenter retrospective study. PATIENTS AND METHODS: Between 1991 and 1998, 275 patients (mean age: 40.4 years [18-93]) underwent splenectomy for idiopathic thrombocytopenic purpura (ITP) (n = 209, 76%), for hemolytic anemia (HA) (n = 37) including hereditary spherocytosis (n = 13) and auto-immune anemia (n = 24), lymphoma (n = 12), tumor (n = 6) and uncommon hematologic syndromes (n = 11). Laparoscopic splenectomy was attempted in every patient. The lateral approach was most commonly used with an anterior approach to the splenic hilar vessels, which were cut after hemostasis using a stapling gun; other techniques were also employed. RESULTS: The mean operating time was 165 minutes (45-360); it was shorter in the case of conversion (144 minutes) and became shorter with the operator's experience. Conversion was necessary in 55 patients (20%), due to hemorrhage in 2/3 of cases, related to splenic vessels (20 cases), short gastric vessels (9 cases), or injury of the spleen (8 cases). In ten cases (2%), conversion was necessary for extraction of the spleen. Conversion rate varied from 5.3 to 46.7%, depending on the surgical team. Univariate analysis of factors predisposing to conversion identified four causes: obesity; technique used to achieve hemostasis of the splenic hilar vessels; operator's experience; and presence of splenomegaly. An accessory spleen was found in 44 patients (16%). The weight of the spleen was more than 350 g in 43 patients (15.6%). There were no deaths. There were no significant complications in 236 patients (85.8%) and the mean hospital stay was 6.4 days. In comparison with patients who had a conversion, bowel function returned significantly earlier, use of analgesia was reduced and hospital stay was shorter. The overall morbidity rate was 13.8% (n = 38); morbidity rate was only 10.4% (n = 22) for laparoscopic splenectomy. In these 22 patients, the complications were: subphrenic collections (n = 5, 2.2%), abdominal wall infections (n = 5), thromboembolic events (n = 2), anemia (n = 2), pneumonia (n = 1), peptic ulcer (n = 1), bowel obstruction (n = 1), splenic vein thrombosis (n = 1). Re-operations were required in 4 patients (1.8%) because of hemorrhage, pancreatitis and bowel obstruction. Morbidity rate was significantly increased in the case of conversion (27%), obesity (20%), malignant disease (30%) and splenomegaly (21.8%). Forty-four patients (16%) received perioperative or postoperative blood transfusion and 23 (8.3%) received platelet transfusion. Mean time to return to normal activity was 21 days and was shorter in the absence of conversion (18.5 days versus 35 days). In patients with ITP, the mean platelet count was 240,000 after 3 months, and the failure rate was 8.3%. CONCLUSION: Laparoscopic splenectomy is a real alternative to conventional splenectomy for some hematologic diseases, particularly ITP and HA. The advantages are an uneventful postoperative course, a lower morbidity rate, a shorter hospital stay and an earlier return to normal activity. The limits of this technique are related to the operator's experience, the size of the spleen, the nature of the underlying disorders and patient characteristics, mainly obesity.

Adolescent↗

PubMed2000

[Laparoscopic treatment of perforated duodenal ulcers. Results of a retrospective multicentric study. French Society of Laparoscopic Surgery].

STUDY AIM: The aim of this multicentric retrospective study was to report procedures, mortality and morbidity rate in a series of patients operated on for perforated duodenal ulcer with a laparoscopic approach. PATIENTS AND METHODS: Four-hundred and nineteen patients from 18 centers were included. The duration of the study was ten years (1990 to 1999). There were 299 men and 120 women aged from 19 to 98 years (mean: 48 years). The ASA scores were as follows: I (48.7%), II (31.3%), III (17.5%), IV (2.5%). The mean duration between the onset of perforation and the time of operation was 13.4 hours (range: 1-70). The surgical procedures were suture (76.7%), epiploplasty (9.9%), only irrigation of the abdominal cavity (2.7%). RESULTS: Conversion into laparotomy was performed in 10.6% of the patients. Mean operative time was 85 minutes. The morbidity and mortality rates were 13.4 and 1.4% respectively. Seventeen patients were reoperated because of fistula (n = 5), intra-abdominal abscess (n = 5), small bowel obstruction (n = 4), bleeding ulcer (n = 1), iatrogenic perforation of the gallbladder (n = 1) and small bowel (n = 1). Mean hospital stay was 8.5 days. All patients were discharged with a medical treatment of the peptic ulcer disease and in most of the cases, with antibiotics for Helicobacter pylori eradication. Six patients out of 96 with a medical history of chronic peptic ulcer underwent a vagotomy. CONCLUSION: Laparoscopic repair of perforated duodenal ulcer is a safe option providing low rates of morbidity, reoperation and mortality, and can be considered the treatment of choice.

Adult↗

PubMed2000

Two-stage laparoscopic management of generalized peritonitis due to perforated sigmoid diverticula: eighteen cases.

The classic treatment of generalized peritonitis due to perforation of sigmoid diverticula is based on the principle of a two-stage surgery with a temporary derivation of the colonic transit. This procedure is associated with a prohibitively high immediate and delayed morbidity, especially associated with the abdominal wound. The laparoscopic approach to this complication is less aggressive and allows a second-stage elective laparoscopic resection. Eighteen consecutive patients (ten women and eight men; average age, 53.7 years) underwent emergency laparoscopic treatment for generalized peritonitis due to perforated diverticula. Eight of these patients had previously had diverticulitis attacks. By peritoneal cavity exploration and full peritoneal lavage (average, 15 L), the infected sigmoid lesion was stuck with biologic glue. A drain was inserted at the site of the lesion and in some cases also in other abdominal zones. No colostomy was necessary. Antibiotic treatment was started at diagnosis and continued for a minimum of 7 days. There was no mortality. Morbidity was limited to three patients (two cases of lymphangitis and one of pulmonary disease). No patient had a wound abscess or residual deep collections. The mean hospitalization was 8 days. Fourteen patients underwent elective laparoscopic sigmoid resection with a delay of 3.5 months. One conversion to laparotomy was necessary. The laparoscopic treatment of generalized peritonitis due to perforated sigmoid diverticula is an interesting alternative to the traditional treatment. It is associated with a lower morbidity, a shorter postoperative hospital stay, and an improvement in the patient's quality of life, because colostomy is avoided. It is also associated with economic savings.

Adult↗

PubMed1999

Intraperitoneal thermal variations during laparoscopic surgery.

BACKGROUND: The aim of this study was to measure thermal variations during laparoscopy in the vicinity of heat sources such as monopolar (MC) and bipolar coagulation (BC) and to evaluate their possible negative consequences for the patient. METHODS: This study included 43 patients who underwent laparoscopic cholecystectomy. The temperature measurements were taken with a sterile thermal probe (Mallinkrot Medical) introduced through a 5-mm trocar coupled with a recording monitor reading variations between 20 and 80 degreesC. The variation in temperature was measured as a function of the power applied to the electrodes (20 or 30 W) and in relation to the distance (1, 2, 3, 4, and 5 cm) from the electrodes. RESULTS: The temperature varied by 3 degrees for BC and 29 degrees for MC when the distance increased from 1 to 5 cm. With respect to the power delivered, 20 or 30 W, the variations were 1 degrees for BC and 17 degrees for MC. CONCLUSIONS: The minimal temperature variations associated with the use of BC makes it the option of choice for operating near structures such as the common bile duct or the gastrointestinal tract.

Body Temperature↗

PubMed1999

The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer.

BACKGROUND: Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic cancer. METHODS: In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16 cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases). RESULTS: The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection. Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative resection. CONCLUSIONS: Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases; thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical procedure.

Endosonography↗

PubMed1999

[Systematic peroperative cholangiography during laparoscopic cholecystectomy].

STUDY AIM: The aim of this study was to assess the feasibility of routine intra operative cholangiography during laparoscopic cholecystectomy (LC) and to evaluate its impact in the detection of common bile duct stones or iatrogenic bile duct injuries. PATIENTS AND METHOD: From January 1991 to January 1999, 1,050 patients (mean age: 52.5 years) with symptomatic or complicated cholelithiasis were operated on laparoscopically. Intraoperative cholangiography was attempted in all patients before cholecystectomy, performed with an ureteral catheter (diameter: 5 F) introduced into the cystic duct under control of intensifier screen. In case of detection of common bile duct stones (CBDS) or bile duct injury, a surgical management was routinely attempted laparoscopically. RESULTS: Cholangiography was successfully performed in 840 cases (82.4%). The mean duration of this examination was 15 min (7-45). The success rate was significantly higher in patients with uncomplicated cholelithiasis (90.4%), compared to patients with acute cholecystitis (61.9%) (p = 0.01). The failure rate decreased with experience, falling from 23% for the first 100 attempts to 1% for the last 100. CBDS were identified in 62 patients (7.4%) in 18% of those with acute cholecystitis and 4.6% of those with uncomplicated cholelithiasis. In 21 cases (33%), there were no predictive factors to suggest CBDS. There were 8 false positive (0.9%). Among the 6 cases of bile duct injury observed in this series (0.57%), four patients had an intraoperative cholangiography and the injury was diagnosed peroperatively in two patients and immediately repaired. There was no postoperative death in this series. CONCLUSIONS: Routine intraoperative cholangiography appears to be the best method for the detection of common bile duct stones and improves prognosis of bile duct injuries when they are immediately detected and peroperatively repaired.

Adolescent↗

PubMed1999

[Impact of learning and experience on the laparoscopic treatment of gastroesophageal reflux].

STUDY AIM: Laparoscopic treatment of gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the most appropriate surgical treatment after failure of medical treatment. The aim of this study was to compare the results of the same series in three consecutive periods in order to determine the effects of the learning curve and experience on the technique and outcome. PATIENTS AND METHODS: From January 1993 to January 1998, 150 patients (84 men and 66 women) with a mean age of 52.2 years (18 to 78) were included. Three groups of 49, 50 and 51 patients were chronologically defined. The comparison was established on the following criteria: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results with short and medium follow-up. RESULTS: The three groups were comparable with respect to patients and GERD characteristics. One hundred and thirty two patients had a TF and 18 had a PF. Rossetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 min). The rate of conversion decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. Seven cases of recurrence occurred (4.6%), 5 in group I (10.2%), 2 in group II (4%), and 0 in group III, (with a shorter follow-up). CONCLUSION: The effect of the learning curve has to be taken into account in the training of surgeons (within experienced departments, with "guidance" during initial interventions) and also in the evaluation of results, in order to allow a more accurate comparison between the different treatments for GERD.

Adolescent↗

PubMed1999

[Post mortem diagnostic laparoscopy].

The authors report a case of laparoscopy post mortem for unexplained inpatient death. It is minimally invasive, easy to perform, accurate, and not disfiguring. As well, it is easy to accept among mourning families. It should be considered when consent for conventional autopsy is lacking.

Aged↗

PubMed1999

[Effects of surgical education and training on the results of laparoscopic treatment of inguinal hernias].

STUDY AIM: The aim of this retrospective study was to compare two concurrent series of patients operated on for inguinal hernia with the same laparoscopic procedure, the first one in a teaching hospital with a number of trained surgeons and the second one in a private center with only one trained surgeon. PATIENTS AND METHOD: Five hundred and forty-one patients with 757 hernias were operated on over a period of six years by a totally pre-peritoneal laparoscopic approach. Two hundred and sixteen patients were operated on in a teaching hospital by 48 surgeons (six senior and 42 trainee surgeons; group I), 325 were operated on in a private center by one surgeon who had been trained in the same teaching hospital (group II). The two groups of patients and their hernias were comparable. The comparison was established on the following criteria: duration of operation, rate of conversion, length of hospitalization, morbidity and mortality rate, recurrence rate and costs. RESULTS: Operations performed by surgical trainees were associated with: (1) a mean operative time significantly (P = 0.01) longer for both unilateral (68 vs. 41 min) and bilateral (108 vs. 68 min) hernias. The operative time did not change in the teaching hospital and decreased with experience in private practice (from 62 to 25 min for unilateral hernias); (2) more frequent per-operative complications, particularly opening of the peritoneum (28% vs. 3%, P = 0.001); (3) a mean duration of hospitalization significantly (P = 0.05) longer, on average by 1.6 d; (4) a morbidity rate after 30 days significantly higher (16.2% vs. 4.9%, P = 0.01); and, (5) higher costs. There was no significant difference concerning mortality rate (nil), conversion rate (1.5%) and recurrence rate (1.3% vs. 0.6%, non significant). CONCLUSION: Surgical training for laparoscopic treatment of inguinal hernias was associated with a longer operation time and hospital stay, and with higher morbidity and costs. After a good initial training in a teaching hospital, surgeons were capable of performing laparoscopic repair of inguinal hernias with good results.

Adolescent↗

PubMed1999

[Laparoscopy in the staging of cancer of the stomach].

Prognosis of gastric carcinoma is closely related to extension. Laparoscopic staging of digestive cancers is proposed to evaluate the regional cancer spreading (TNM). The aim of this procedure is to avoid unnecessary laparotomy, and to reduce mortality and morbidity of these procedures. Laparoscopic staging can also make easier the selection of patients of preoperative treatment. In most of the series about laparoscopic staging, efficacy of the usual staging tools (computed tomography, ultrasonography, endoscopic ultrasonography) is weak and before operation 20 to 30% of the metastases, particularly peritoneal and hepatic, are missed. Laparoscopic staging is technically easy: no more than 3 trocars are necessary, laparoscopic ultrasonography may be performed during the same procedure, as well as peritoneal cytology. Feasibility is about 100%. Usual contraindications of the laparoscopy are contraindications of laparoscopic staging. The main difficulty is its utility. Staging of advanced lesions remains the best indication of laparoscopic staging in gastric cancer. Metastatic spread, particularly to the peritoneum, and resectability may be evaluated with sensitivity and specificity close to 90%. Morbidity (1 to 3%) is usually low and mainly represented by wound complications.

Carcinoma↗

PubMed1999

The effect of the learning curve on the outcome of laparoscopic treatment for gastroesophageal reflux.

The laparoscopic treatment for gastroesophageal reflux (GR) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period, during which the rate of complications, conversions, and duration of surgery and hospitalization are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in three groups of consecutive patients to determine the effect of the learning period on outcome. One hundred and fifty-six patients (88 men and 68 women) with an average age of 52.3 years (range, 18-78) were included. Surgery was indicated for failure or early relapse after the end of medical treatment or a symptomatic sliding hernia. The preoperative workup (endoscopy, barium meal, or esophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of patients were chronologically defined. The parameters that were examined were the type of preoperative exploration, the type of fundoplication, the operative technique, the conversion rate, the mortality and morbidity rates, the duration of surgery and hospitalization, and the results at short- and medium-term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GR. All patients had an endoscopy, 91% had a barium meal, 77.5% underwent esophageal manometry, and 67% had pH monitoring. One hundred and thirty-six patients had a TF and 20 had a PF. Rossetti type TF became the reference procedure (67% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between groups I and groups II and III (140, 100, 80 minutes, respectively). The rate of conversion, due to a variety of causes, decreased from 9.8% to 3.8%, and then to 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 15% to 3.8%, and then to 0%. There were seven cases of relapse (4.6%), five in group I (10%) and two in group II (4%), with no cases in group III, although the follow-up in group III was shorter. There is an effect of the learning curve on the outcome of treatment for GR, and this must be taken into account in the training of surgeons (training within experienced departments and guidance during their initial interventions) and also in publications to allow a more accurate comparison of this technique with other treatments for GR.

Adolescent↗

PubMed1999

Does laparoscopy reduce the incidence of unnecessary appendicectomies?

The aim of this study was to evaluate the impact of laparoscopic appendicectomy on the incidence of histologically normal appendices. Between 1987 and 1997, 1,220 patients (average age 23.5 years [17-73]; 841 women [69%]) had appendicectomy due to the presence of at least one of the following three criteria: right iliac fossa guarding, fever >38 degrees C, and leukocytosis >10,000. Patients were divided into two groups: one group of 930 patients were operated on using the classic Mac Burney approach and the other group of 355 patients underwent laparoscopic exploration, with an appendicectomy performed if macroscopic abnormalities were observed (290 cases). In all cases, the appendices were examined blind and classified as normal or pathologic, with the latter divided with respect to the nature and severity of the lesions. In the Mac Burney group, the incidence of histologically normal appendices was 25.1%. In the laparoscopic group, the incidence was only 8.2% (p=0.015). The types of pathologic appendices were identical between the two groups. In 65 cases (18.3%), a macroscopically normal appendix was left in place. In 56 cases the symptoms were due to another identified cause, however, in 10 cases no cause was found. All patients were followed-up for an average of 3 years. One patient (1.8%) had a second operation (an appendicectomy), which revealed minor histologic lesions. The problem is the inability of the operator to differentiate between a healthy and a pathologic appendix on laparoscopy. The risk of false-positives and false-negatives is approximately 10%. Diagnostic difficulties usually occur in the initial phase of the disease with acute mucosal involvement in a morphologically normal appendix. At this stage the outcome cannot be predicted, although appropriate antibiotic treatment can be effective. This study shows that laparoscopy significantly reduces the number of histologically normal appendices as compared to a conventional Mac Burney operation. This can only be achieved by not removing macroscopically normal appendices, a small proportion of which (5-10%) could be cases of early appendicitis with only mucosal involvement. In the absence of other causes of the symptoms, a 3-day course of antibiotics can be tried to treat possible mucosal lesions. This approach reduces costs without having adverse consequences on the outcome.

Adult↗

PubMed1998

[Laparoscopic treatment of generalized peritonitis with diverticular perforation of the sigmoid colon. Report of 10 cases].

BACKGROUND: The classical treatment of perforated sigmoid diverticulitis with generalised peritonitis is based on the principle of two-stage surgical procedures with a temporary initial defunctioning colostomy. This approach is associated with significant morbidity, concerning mainly the abdominal wall. PATIENTS AND METHODS: Ten consecutive patients, eight female and two male, with a mean age of 54.6 years, underwent an emergency laparoscopy for generalised peritonitis secondary to perforated diverticula. Six had had previous infectious episodes; six were obese; four were diabetic and two had chronic lung disease. After exploration of the abdominal cavity and discovery of a purulent peritonitis (n = 8) or faecal peritonitis (n = 2), an extensive peritoneal lavage was performed (average 15 litres), the contaminating sigmoid lesion was covered with biological glue and a drain inserted at the site of the lesion. In some cases, drainage of dependent zones was also performed. No colostomies were performed. Antibiotic therapy instituted as soon as the diagnosis had been made was continued, on average, for 7 days. RESULTS: There was no mortality. There was a low morbidity: one case of lymphangitis on catheter and one of broncho-pulmonary infection. No cases of abdominal wall sepsis or residual deep collections were observed. The mean duration of hospitalisation was 8 days. Nine patients underwent a sigmoid resection (laparoscopic in eight cases) 3 to 4 months later, with a mean duration of hospitalisation of 6 days. One conversion to laparotomy was necessary. CONCLUSIONS: Laparoscopic treatment of generalised peritonitis secondary to perforated sigmoid diverticulitis constitutes an alternative to classical surgery. It is associated with a decreased morbidity and a marked reduction in duration of the hospitalisation. Colostomy can be avoided and the patient's quality of life is improved during the period previous to secondary colectomy, performed by laparoscopy eight times out of nine. In addition, the cost of this approach is significantly lower.

Adult↗

PubMed1998

[Evaluation of pancreatic cancer by combined laparoscopy and echolaparoscopy].

STUDY AIM: This prospective study was undertaken to evaluate the efficiency of staging laparoscopy associated with laparoscopic ultrasonography in the assessment of tumoural extension and surgical resectability in patients with carcinoma of the pancreatic head. PATIENTS AND METHODS: From June 1995 to March 1997, 26 consecutive patients (11 male and 15 female patients), with a mean age of 62.5 years, were included in this study. The lesion was located in the pancreatic head with jaundice. Four staging methods were used: percutaneous ultrasonography (n = 26) computed tomography (n = 26), endoscopic ultrasonography (n = 26). The assessment of resectability by each procedure was verified by surgical exploration and histologic examination. RESULTS: Results of percutaneous ultrasonography and computed tomography were similar, predicting unresectability in 50% of the patients. Endoscopic ultrasonography performed in the 16 patients without visible metastases according to the previous procedures predicted surgical resectability in seven patients only. With staging laparoscopy associated with laparoscopic ultrasonography, undiscovered metastases were found and unresectability was predicted in 21 patients out of 26; the sensitivity was 100% for liver metastases, peritoneal metastases and vascular involvement, 90% for lymph node involvement and 88% for diagnosis of the primitive lesion. A Whipple procedure was performed in five patients and a palliative bypass in all the other patients except one. An unnecessary laparotomy was avoided in 12 patients. CONCLUSIONS: Staging laparoscopy associated with laparoscopic ultrasonography is superior to all other staging methods. It should be the first step of a potentially curative surgical treatment (five cases only in this series) or of a palliative bypass. Laparotomy was avoided in 12 cases.

Adult↗

PubMed1998

[Videolaparoscopic treatment of splenic injuries. A study of 5 cases].

BACKGROUND: When splenic trauma does not require an emergency splenectomy in order to achieve hemostasis, the current policy is either observation under close surveillance, with transfusions if necessary, or conservative surgical procedure through laparotomy. Videolaparoscopic approach has the advantage of achieving in the same procedure, complete evacuation of the hemoperitoneum, full investigation of the abdominal cavity and repair of the damaged spleen. PATIENTS AND METHODS: Over a 4-year period, five patients aged 27.3 years on average, with severe splenic trauma but no major hemodynamic disturbance, were operated on by emergency laparoscopy. The diagnosis of splenic lesion had been confirmed preoperatively by ultrasonography. The procedure performed by open laparoscopy included evacuation of the hemoperitoneum and blood clots and splenic hemostasis which was achieved by the use of electrocoagulation and biological glue, associated in three cases with omentoplasty. Drains were inserted systematically. RESULTS: The average length of operation was 75 min. There were no cases of conversion, nor mortality, no morbidity. The average duration of hospitalization was 10 days. No blood transfusions were required. A CT-scan was performed immediately in the postoperative course and served as the baseline for comparison during the follow-up. There were no reinterventions. The longest follow-up was 4 years and the mean follow-up 2.5 years. Laboratory tests or isotopic imaging did not detect any change in splenic function. CONCLUSION: In specific defined circumstances, videolaparoscopic repair of splenic trauma is justified provided that careful attention is paid to the patient's condition.

Adult↗

PubMed1998

[Video-parietoscopic surgery of the abdominal wall. A study of 15 cases].

AIM: The aim of videoparietoscopic surgery is to repair an abdominal wall weakness or defect without affecting the overlying skin, mainly for cosmetic reasons, and especially in young women. PATIENTS AND METHOD: A supra-pubic or umbilical approach was used, depending on the site of the lesion to be repaired. A 10 mm trocar with a sponge mandrin was placed in contact with the aponeurosis. After an initial dissociation of the cellular tissue, progressive insufflation with CO2 produced extensive detachment of the cutaneous plane upwards and laterally. Using one or two 5 mm trocars, the aponeurotic plane was progressively freed and the pathological zones were identified and repaired with standard endoparietal sutures or with percutaneous sutures using a Reverdin needle. Fifteen patients (14 females, one male) with a mean age of 30 years (19-36), were treated by parietoscopy for a diastasis of the rectus abdominis (five cases), an eventration (three cases) or an epigastric or linea alba hernia (seven cases). RESULTS: A conversion to a classical technique was necessary in one man with a diastasis of the rectus abdominis, due to fibrous tissue which did not allow a subcutaneous plane of detachment to be obtained. Successful repair was possible in 14 cases. The mean operating time was 1 h 20 min; the mean duration of hospitalisation was 2 days (1-3). There was no mortality or morbidity. With a mean 18-month follow-up (range: 4-40), cosmetic and functional results were excellent. CONCLUSION: Abdominal videoparietoscopy allows repair of minor parietal pathologies while preserving the overlying skin. It is indicated for cosmetic reasons in young women with normal skin overlying a localised abdominal wall defect or weakness.

Abdominal Muscles↗

PubMed1998

[Port site metastasis. Prospective study of 131 cases].

Laparoscopic staging and laparoscopic treatment of gastrointestinal malignancy is still controversial because some studies report port sites metastases. The aim of the study is to determine in 131 patients, with prospective follow-up, after laparoscopic staging or laparoscopic treatment, the incidence of port site metastases. 131 patients with localized a gastrointestinal malignancy or other advanced malignant tumors were included. In 57 cases only laparoscopic staging was performed, in 25 cases the laparoscopic staging was followed by a laparoscopic resection and in 49 cases after laparoscopic staging a traditional laparotomic treatment was performed. In 57 cases (43.5%) the tumor invaded the serosal layer. The median follow-up was 17.7 months (3 to 62 months). 502 port-sites were controlled. One patients (0.7%) presented one port site metastases after right colectomy for carcinoma with local carcinomatosis. This study confirm that port sites metastases are rare, and that are favorised by serosal invasion and support the laparoscopic staging of malignant abdominal tumors in order to recognize occult lesions which are not detected by conventional preoperative clinical, biological and radiological explorations (44.2% in this study). In addition, selected patients can be submitted to laparoscopic treatment of the disease (20%).

Adult↗

PubMed1998

Evaluation of the biliary tree during laparoscopic cholecystectomy: laparoscopic ultrasound versus intraoperative cholangiography: a prospective study of 150 cases.

From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were included in a prospective study, to compare intraoperative cholangiography (IOC) and laparoscopic ultrasonography (LU). The biliary tree was successively explored by these two methods in the routine detection of common bile duct stones. The feasibility of LU was 100%. Cholangiography was performed only in 125 cases (83%). The time taken for LU was significantly shorter (11.6 vs. 17.6 minutes, p = 0.0001). In this study, common bile duct stones were found in 14 cases (9%). For their detection, results were comparable to LU and IOC. For LU, sensitivity was 80% and specificity 99%; and for IOC, 78 and 97%, respectively. Both examinations combined had a 100% sensitivity and specificity. Laparoscopic ultrasonography failed to recognize the intrapancreatic part of the common bile duct in 25 cases (17%) and did not show anatomic abnormalities detected by IOC. It did, however, detect other unsuspected intraabdominal abnormalities. Although LU is safe, repeatable, and noninvasive, a considerable learning curve is necessary to optimize its efficacy. Comparison of relative cost must be undertaken.

Adult↗