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D Collet

Publications and source records attributed to D Collet.

At least 19 recordsLinked to original sources
PubMed1992

Laparoscopic cholecystectomy: an analysis of 777 cases.

Born in secret in 1987 and developed in an atmosphere of scepticism throughout 1988, laparoscopic cholecystectomy triumphed in 1989 and 1990, causing a veritable revolution in the world of general surgery. The 777 consecutive cases that are reported in this chapter reflect the spirit of these various periods. From conservatively restrictive, our indications widened to include 90% of gallstone cases. For us the sclero-atrophic gallbladder still constitutes the greatest endoscopic challenge and should be reserved for the most experienced operators. The rates for mortality (0.1%) and complications (3.3%), which include three common bile duct injuries (0.4%), are comparable to, if not better than, those for traditional cholecystectomy. The quality of recovery is markedly better: near absence of pain, short hospitalization, return to normal physical activity within 10 days, rapid return to work and preservation of the abdominal musculature in sportspeople. These advantages are unavailable to the 5.5% of patients for whom an intraoperative conversion to an open procedure is necessary. Their recovery is that of traditional cholecystectomy, which itself is far from being poor. The large multicentre studies, such as those carried out in France and Belgium recently, reporting 3708 cases, have reached identical conclusions. Laparoscopic cholecystectomy is set to become the gold standard for treatment of gallstones and is the first step towards surgical techniques of the 21st century which will be performed within the musculocutaneous envelope of the intact human body.

Adolescent↗
PubMed1992

A new biodegradable elastin-fibrin material; its use in urological, digestive and cardiovascular surgery.

A new original artificial connective matrix mainly made of elastin and fibrin-like product is used to reinforce damaged tissues and to close and restore a loss of substance in several domains of surgery: all sites in the digestive system and urinary tract; besides, it can substitute for the pericardium in iterative heart operations. In all cases, the original tissue is restored ad integrum while the biodegradable material disappears completely, without any complications.

Animals↗
PubMed1992

[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

Adolescent↗
PubMed1992

[Celioscopic cholecystectomy. A survey of the French Society of Endoscopic Surgery and Operative Radiology. Apropos of 937 cases].

Twenty-eight surgeons, members of the Société Française de Chirurgie Endoscopique et de Radiologie Opératoire, took part in this multicenter study, carried out between March 1989 and January 1991. Nine hundred and thirty-seven patients were entered into the study, 934 of whom presented with biliary lithiasis and 3 with gallbladder polyps. Biliary colic was found in 918 (98 percent) of patients. One hundred and twenty-five patients (13.3 percent) presented with acute cholecystitis. Laparoscopic cholecystectomy had to be converted to traditional laparotomy in 50 cases (5.3 percent). The most frequent causes of conversion were the presence of cholecystitis (34 percent) and the occurrence of hemorrhage which could not be controlled laparoscopically (18 percent). There was one death (mortality rate: 0.1 percent) and there were 37 postoperative complications (morbidity rate: 3.9 percent) which required reoperation in 11 instances: 4 laparatomies, 5 laparoscopies and 2 ultrasonography guided drainages. The mean duration of postoperative hospital stay for patients without complications or conversion was 3.8 days. These results show both the limits and the advantages of laparoscopic cholecystectomy. This new technique is now well established and should be added to other therapies used in the treatment of patients with biliary lithiasis.

Adolescent↗
PubMed1992

[Substitution for an experimental duodenal substance loss in the dog with an original bioreactive material].

The aim of this study was to evaluate the suitability of the Elastin Fibrin material as a patch to close a full thickness 1.5 cm diamater duodenal wall defect in the dog. This material originates from a reaction between elastin and fibrin monomers and is available in sheet form of differing thickness. Three Beagles underwent surgical creation of a duodenal defect ant the patch closure with elastin fibrin. Coelioscopic check of the patch was performed at day 8, 15, 39, 60, 90, 120. There was no morbidity or mortality. Macroscopic and histologic examination showed complete disappearance of the patch material and restitution of the duodenal wall at 6 months. These results suggest that in selected cases, evaluation in human may be justified.

Animals↗
PubMed1991

Laparoscopic cholecystectomy using intracorporeal lithotripsy.

Over a 13-month period (November 1988 to December 1989), we performed our first 104 laparoscopic cholecystectomies using an intracorporeal ultrasonic lithotripsy technique. The procedure in three of these patients was converted to an open operation because of hemorrhage with unexpected findings of cirrhosis in two patients and dense subhepatic adhesions in a third. Endoscopic retrograde cholangiopancreatography was successfully used in three other patients in whom common bile duct stones were identified. We encountered only three postoperative complications out of all the laparoscopic cholecystectomies performed. One complication was a biliary fistula that closed spontaneously 1 week after surgery. The remaining complications were attributable to abscesses, one subhepatic and one pelvic, which were aspirated and drained laparoscopically. There were no deaths. Advantages of the laparoscopic approach included decreased perioperative pain, shortened hospitalization, absence of scar, and more rapid return to prehospitalization activities.

Adolescent↗
PubMed1991

Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients.

With a laparoscopic approach, patients can undergo cholecystectomy with a shorter hospitalization, minimal pain, and quicker recovery. It has not been demonstrated, however, that patients actually return to work after laparoscopic cholecystectomy faster than the traditional 4- to 6-week absence from work after a standard open procedure. A survey of 104 French and 84 American patients undergoing laparoscopic cholecystectomy revealed that postoperative discomfort was completely resolved in 2 weeks in 73% of French and 93% of American patients. All but 11 French and 5 American patients were back to normal home activities by 2 weeks after the operation. Of the 35 American and 40 French patients who had professional activity outside the home, 63% and 25%, respectively, returned to work within 14 days. Five (14%) of the American patients and 12 (30%) of the French patients returned to work 4 weeks or more after the operation. The amount of physical activity on the job correlated with the period off work, but, interestingly, at least six patients with very hard physical activity at work (including construction workers) were able to return to full work activity within 1 week. These data suggest that early return to work is possible and that pain resolves quickly after laparoscopic cholecystectomy. The economic benefit of having patients back on the job quickly, however, may be less than expected until cultural norms change with regard to leave of absence after major surgery.

Activities of Daily Living↗
PubMed1991

In vitro studies of elastin-fibrin biomaterial degradation: preservative effects of protease inhibitors and antibiotics.

The degradability of a new elastin-fibrin material was tested in vitro versus human pancreatic elastase (HPE) and plasmin (PL) activities. It is shown that aprotinine Iniprol, a well-known protease inhibitor and Eglin C, a new potent inhibitor of HPE, especially when used in synergy, efficiently protected the material. A small amount of specific antibiotics was incorporated into the material. The two products will allow the material to be used in digestive surgery with improved safety.

Adsorption↗
PubMed1991

Treatment of gallstones with piezoelectric lithotripsy and oral bile acids. A multicenter study.

The efficacy of the combination of piezoelectric lithotripsy and oral bile acids in the treatment of gallbladder stones was assessed. Three hundred and sixty-three patients with symptomatic radiolucent gallstones in functioning gallbladder were treated in five medical centers using the same protocol with the EDAP LT 01 lithotripter. No anesthesia, analgesia or sedation was used. After one session of lithotripsy, fragmentation was observed in 89% of the patients, and satisfactory fragmentation (fragments less than or equal to 5 mm) in 29%. The satisfactory fragmentation rate was higher in patients with solitary stones less than or equal to 20 mm than in patients with solitary stones 21-35 mm or multiple stones (p less than 0.001). After multiple sessions (mean 1.6 session/patient, range 1-5) the overall rate of satisfactory fragmentation was 50%. After 12 months on oral bile acid therapy, complete clearance of the gallbladder was observed in 69% of patients with solitary stones less than or equal to 20 mm, 25% of patients with solitary stones 21-35 mm and 37% of patients with multiple stones. No complication was observed during the lithotripsy. During follow-up under bile acid therapy, there were five complications (1.4%): four patients had acute cholecystitis and one had mild, self-limited pancreatitis. We conclude that piezoelectric lithotripsy with the EDAP lithotripter is a safe and effective treatment which can be performed in outpatients. Satisfactory fragmentation and rapid disappearance of stones are obtained mainly in patients with solitary stones less than or equal to 20 mm.

Administration, Oral↗
PubMed1991

Laparoscopic surgery for gallbladder stones.

The radical treatment of gallstones consists of removal of the calculi and prevention of their recurrence, and cholecystectomy is at present the common solution. Since Langebuch's first operation in 1882, Calot reporting the first French case in 1889, cholecystectomy has reached a high level of technical perfection. With a small access route and complete exploration of the common bile duct, the results are well known: global mortality is less than 0.1%. Frequently, specialised teams report series of patients under 50 years of age with zero mortality. Are there other techniques that permit the removal of calculi and the removal of the gallbladder with results comparable or better than the classic cholecystectomy? We have perfected an operative technique using laparoscopy that destroys the calculi with an ultrasonic lithotriptor followed by drainage or removal of the gallbladder. Our initial results are favourable.

Adolescent↗
PubMed1990

[Treatment of gallbladder lithiasis by piezoelectric extracorporeal lithotripsy].

We report the results of extracorporeal piezoelectric lithotripsy of gallbladder stones, using the EDAP LT 01 device, in 60 patients treated without anaesthesia or analgesia. Fragmentation was satisfactory (i.e. with fragments less than 5 mm wide) in 31 patients (52 per cent) after multiple sessions (mean: 1.6). The satisfactory fragmentation rate was higher in patients with stones smaller than 20 mm (63 vs 8 per cent; P less than 0.01) and not different in patients with solitary or multiple stones (53 vs 50 per cent). After bile acid dissolution treatment during 3, 6 and 12 months, the stone-free rates were 23, 41 and 64 per cent respectively, and significantly better at 3 and 6 months in patients with satisfactory fragmentation (42 vs 4 per cent; P less than 0.05, and 71 vs 9 per cent; P less than 0.01). Fourteen patients (23 per cent) reported biliary colic, but only one required cholecystectomy. No severe complication was observed. Piezoelectric lithotripsy is safe, requires short hospitalization and gives interesting results when the stones are less than 20 mm wide.

Adult↗
PubMed1990

Laparoscopic treatment for gallbladder stones and the place of intracorporeal lithotripsy.

An ultrasonic lithotriptor (U.S. Olympus) introduced into the gallbladder under visual control of a laparoscope permits fragmentation of the stones and complete clearance of the gallbladder in one session of 10-20 min. The empty, clean gallbladder can be drained (cholecystostomy) or removed (cholecystectomy) by passing it through an 8-10 mm orifice of the abdominal wall. A series of 18 cholecystostomies and 200 cholecystectomies shows that intracorporeal lithotripsy prior to these procedures is efficient, safe, and elegant. It is the guarantee of a real laparoscopic procedure in cases of cholecystectomy.

Cholecystectomy↗
PubMed1990

[Laparoscopic surgery of gallstones--report of treatment of 157 patients].

From November 1988 to February 1990 157 patients with gallbladder stones haven been treated by a laparoscopic surgical procedure. They are 28 males and 129 females from 13 to 81 years old. 18 have had a cholecystostomy after intracorporeal lithotripsy (Lus Ultrasonic Olympus). They were placed on bue acids during 3 months. The average follow up time is 11 months. The mortality is zero and 2 mild complications occurred medically cured. 3 patients have a recurrent stone 6 months after surgery. 139 patients have had a cholecystectomy 89 after the same lithotripsy procedure seen above, 50 without prior lithotripsy. In 3 cases the laparoscopic procedure was abandoned, twice because of a sever bleeding, one for too compact surrounding adhesions. The mean follow up is 9 months. 123 were drained 1 day 16 had no drain. The mortality is zero. 2 patients without drainage developed a sub hepatic and douglas pouch abscess. They were cured by a lavage drainage laparoscopically made. 1 patient with drainages had a 7 days bile leak, which disappeared spontaneously. The 136 others have had a short stay in the hospital (2-4 days) a painless post operative time. They could go back to work and sport within 1 week. They have minimal scars and no danger of incisional herriae. The magnification of the optical system enables the dissection of the cystic duct and artery easier and safer than it is by mini laparotomy mostly in obese people. At the beginning of our experience only the patients with frequent biliary colics have been selected for the laparoscopic procedure. At that time 13 patients with subacute cholecystitis and 9 patients with stones in the commun bile duct have had a laparoscopic cholecystectomy associated with an endoscopic sphincterotomy in the last cases without complications.

Adolescent↗
PubMed1990

[Cholelithiasis. Laparoscopic treatment with intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy. Personal technique].

From November 1988 to February 1990 157 patients with gallbladder stones have been treated by a laparoscopic surgical procedure. They are 28 males and 129 females from 13 to 81 years old, 18 have had a cholecystostomy after intracorporeal lithotripsy (Lus Ultrasonic Olympus). They were placed on bile acids during 3 months. The average follow up time is 11 months. The mortality is zero and 2 mild complications occurred medically cured. 3 patients have a recurrent stone 6 month after surgery. 139 patients have had a cholecystectomy 89 after the same lithotripsy procedure seen above, 50 without prior lithotripsy. In 3 cases the laparoscopic procedure was abandoned, twice because of a sever bleeding, one for too compact surrounding adhesions. The mean follow up is 9 months. 123 were drained 1 day 16 had no drain. The mortality is zero. 2 patients without drainage developed a sub hepatic and douglas pouch abscess. They were cured by a lavage drainage laparoscopically made. 1 patient with drainage had a 7 days bile leak which disappeared spontaneously. The 136 others have had a short stay in the hospital (2-4 days) a painless post operative time. They could go back to work and sport within 1 week. They have minimal scars and no danger of incisional herniae. The magnification of the optical system enables the dissection of the cystic duct and artery easier and safer than it is by mini laparotomy mostly in obese people. At the beginning of our experience only the patients with frequent biliary colics have been selected for the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗