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D Glineur

Publications and source records attributed to D Glineur.

9 recordsLinked to original sources
PubMed2001

The surgical management of congenital liver cysts.

BACKGROUND: Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome. METHODS: Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2. RESULTS: There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression. CONCLUSIONS: When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.

Adult↗
PubMed2001

Surgical management of intraductal papillary mucinous tumors of the pancreas: the role of routine frozen section of the surgical margin, intraoperative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis.

HYPOTHESIS: Resection of intraductal papillary mucinous tumors of the pancreas (IPMTP) should be tailored to longitudinal spreading into the pancreatic ductal system and the presence of malignant transformation. OBJECTIVE: To review a single institutional experience with IPMTP, focusing on the operative strategy of tailoring resection to the extent of disease. DESIGN: Retrospective study. SETTING: Academic tertiary referral center. PATIENTS: Thirteen patients with IPMTP were referred for resection during the past 10 years. Malignant growth was present in 7 patients (54%). According to the determination of tumor extent, distal pancreatic resection was performed in 3 patients, pancreatoduodenectomy was done in 9 patients, and total pancreatectomy was performed in 1 patient. The median follow-up time in this series was 46 months (range, 3-104 months). MAIN OUTCOME MEASURES: Preoperative and perioperative diagnosis, final pathologic results, and long-term outcome. RESULTS: A correct preoperative or perioperative diagnosis of IPMTP was achieved in 9 patients (69%). Routine frozen section of the surgical margin was used in all patients, changing the operative strategy in 3 (23%) of 13 patients by extending resection or leading to total pancreatectomy in 2 patients and 1 patient, respectively. A perioperative endoscopic examination of the Wirsung duct was performed in 3 patients with a correct preoperative or perioperative diagnosis of IPMTP and a dilated pancreatic duct. This allowed the examination of the entire pancreatic ductal system and staged intraductal biopsies, changing the operative strategy in 1 of these patients. Finally, after pancreatoduodenectomy, pancreaticogastric anastomosis was constructed in 5 patients, allowing endoscopic assessment of the pancreatic stump during long-term follow-up. The 5-year actuarial survival rate was 56.8% in the whole series. All patients with benign or microinvasive malignant disease remained disease-free, whereas all patients with invasive malignant disease died of tumor recurrence. CONCLUSIONS: Accurate determination of the extent of ductal disease and residual malignant growth, when present, is critical during surgical exploration to achieve radical resection and cure. Operative strategy should be based on routine frozen section of the surgical margin and perioperative endoscopic examination of the Wirsung duct with staged intraductal biopsies when technically feasible. The routine use of pancreaticogastric anastomosis after pancreatoduodenectomy allows easy, safe, and efficient long-term endoscopic assessment of the pancreatic stump.

Aged↗
PubMed2001

Complementary saphenous grafting: long-term follow-up.

OBJECTIVE: Recently we reviewed the 10-year clinical and angiographic outcomes of sequential internal thoracic artery grafting. Most of the patients also received complementary saphenous grafts, and their overall long-term patency rates were surprisingly high. Therefore, we decided to analyze these results in more detail. METHODS: The first consecutive 500 patients having received at least one sequential internal thoracic artery graft between October 1985 and August 1991 were restudied retrospectively. The saphenous grafts were only used to achieve complete revascularization in addition to complex arterial grafting on less significant or remote coronary vessels. A total of 161 patients consented to a late angiographic restudy at a mean postoperative interval of 7.5 years (1-12.2 years). RESULTS: At 5 and 10 years postoperatively, freedom from angina was 96% and 82%, and freedom from any cardiac event was 92.8% and 69%, respectively. Only 15 (3.1%) patients needed additional revascularization (0.3% per patient-year): 4 coronary artery bypass grafting (0.8%) and 11 percutaneous transluminal coronary angioplasty (2.3%). The overall patency and intactness rates of saphenous anastomoses were 72.5% and 60.2%, respectively. There was a significant difference between the patency and intactness of sequential versus single anastomoses: 76% versus 60% and 64.5% versus 44.4%, respectively. There was no significant difference in either patency or intactness between right internal thoracic and sequential saphenous grafts anastomosed to the right coronary artery: 83.4% versus 75.2% and 77.8% versus 62.4%, respectively. The same was true for the anastomoses to the "remote area" (distal circumflex, distal right coronary artery). CONCLUSIONS: Complementary sequential saphenous grafting still deserves consideration in some patients below 70 years of age, particularly for those with disease in the "remote area": the distal circumflex and right coronary branches.

Adult↗
PubMed2001

Skeletonizing en bloc esophagectomy for cancer.

OBJECTIVE: To evaluate the long-term outcome of patients with esophageal cancer after resection of the extraesophageal component of the neoplastic process en bloc with the esophageal tube. SUMMARY BACKGROUND DATA: Opinions are conflicting about the addition of extended resection of locoregional lymph nodes and soft tissue to removal of the esophageal tube. METHODS: Esophagectomy performed en bloc with locoregional lymph nodes and resulting in a real skeletonization of the nonresectable anatomical structures adjacent to the esophagus was attempted in 324 patients. The esophagus was removed using a right thoracic (n = 208), transdiaphragmatic (n = 39), or left thoracic (n = 77) approach. Lymphadenectomy was performed in the upper abdomen and lower mediastinum in all patients. It was extended over the upper mediastinum when a right thoracic approach was used and up to the neck in 17 patients. Esophagectomy was carried out flush with the esophageal wall as soon as it became obvious that a macroscopically complete resection was not feasible. Neoplastic processes were classified according to completeness of the resection, depth of wall penetration, and lymph node involvement. RESULTS: Skeletonizing en bloc esophagectomy was feasible in 235 of the 324 patients (73%). The 5-year survival rate, including in-hospital deaths (5%), was 35% (324 patients); it was 64% in the 117 patients with an intramural neoplastic process versus 19% in the 207 patients having neoplastic tissue outside the esophageal wall or surgical margins (P <.0001). The latter 19% represented 12% of the whole series. The 5-year survival rate after skeletonizing en bloc esophagectomy was 49% (235 patients), 49% for squamous cell versus 47% for glandular carcinomas (P =.4599), 64% for patients with an intramural tumor versus 34% for those with extraesophageal neoplastic tissue (P <.0001), and 43% for patients with fewer than five metastatic nodes versus 11% for those with involvement of five or more lymph nodes (P =.0001). CONCLUSIONS: The strategy of attempting skeletonizing en bloc esophagectomy in all patients offers long-term survival to one third of the patients with resectable extraesophageal neoplastic tissues. These patients represent 12% of the patients with esophageal cancer suitable for esophagectomy and 19% of those having neoplastic tissue outside the esophageal wall or surgical margins.

Adenocarcinoma↗
PubMed2000

Reconstruction of the ascending aorta and aortic root: experience in 45 consecutive patients.

BACKGROUND: Patients with aneurysms of the ascending aorta or aortic root may have associated aortic insufficiency (AI). We reviewed our experience with aortic root remodeling and reconstruction of the sino-tubular junction. METHODS: Forty-five patients were operated on between July 1995 and September 1998. Transesophageal echocardiography showed AI grade III or IV in 15 patients. Twenty-seven patients had replacement of all three sinuses, 10 of one or two sinuses. Reconstruction of the sino-tubular junction alone was performed in 8 patients. RESULTS: There was one death at 28 days. Perioperative transesophageal echocardiography showed no or discrete AI in all patients. There has been one aortic valve replacement at day 4 postoperatively for cusp repair failure. Transesophageal echocardiography in 40 patients at a mean time of 12.5 months showed no progression of AI in 38 patients, and a grade II in 2. Clinical follow-up averaged 14.5 months. There have been three late, not procedure-related deaths. Thirty-six patients are in New York Heart Association functional class I. There have been no cases of endocarditis. CONCLUSIONS: Aortic remodeling is successful in eliminating AI in patients with aortic root disease with minimal mortality and morbidity. Early echocardiography (1 year) has shown no progression of AI in 95% of cases.

Adolescent↗
PubMed2000

Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting.

OBJECTIVE: Sequential internal thoracic artery (ITA) grafting allows a more complete arterial revascularization of the myocardium. We wanted to verify whether the excellent clinical and angiographic short term results reported by us before where maintained over 10 years and more. METHODS: the first consecutive 500 patients having received at least one sequential ITA graft between October 1985 and August 1991 were reviewed. Age averaged 61 years. Fifty-three patients had a left ventricular ejection fraction less than 40%, 117 were not elective, 35 (7%) were reoperations, 56 (11%) had diabetes. In total 2156 anastomoses were constructed (4.3/patient), among them 1367 arterial anastomoses (2.7/patient) and 1150 sequential ITA anastomoses (2.3/patient). The clinical follow-up was 97.4% complete and averaged 9.6 (range 8.6-13.6) years. One hundred and sixty-one patients consented to a late angiographic restudy after a mean interval of 7.4 (range 1-12.2) years. RESULTS: At 5 and 10 years, 89 and 72% of the patients were still alive. At 10 years 82% are still asymptomatic and 71% free of any type of ischaemia. Only four patients (0.8%) needed a repeat surgical revascularization, and 11 (2.3%) a percutaneous coronary angioplasty. At 5 and 10 years, 92.8 and 69% of the patients remained free of any cardiac event. Overall, 95.5% of the arterial anastomoses were patent and 96.1% of the sequential ITA were patent. There was a significant difference between the patency rate of pedicled ITA and free ITA anastomoses: 96.3 vs. 86.5% (P=0.02). There was no difference in patency between left ITA and right ITA anastomoses for the LAD and Cx areas. Sequential ITA anastomoses showed excellent patency rates to all coronary vessels but the very distal circumflex and the distal branches of right coronary artery (85%). There was no significant difference between the patency of the proximal and the distal sequential ITA anastomoses. The sequential anastomoses constructed in the length tend to remain more patent than the diamond-shaped ones: 97.2 vs. 91.5% (P=0.004). CONCLUSIONS: Sequential ITA grafting optimizes arterial revascularization. The long-term patency is excellent, is identical to that of single ITA grafting, and appears not much different from postoperative patency. The need for repeat surgical and interventional revascularization has been extremely low: 3.1% over the whole follow-up.

Adult↗
PubMed1999

Recycling of arterial grafts during reoperative coronary artery operations.

BACKGROUND: To overcome problems of lack of conduit and to maximize the number of arterial anastomoses in coronary reoperations we reused previously placed arterial grafts. METHODS: Sixteen patients were identified from February 1994 to July 1997. Mean age was 62.8 years (range, 44 to 75 years). Fifteen (94%) were in Canadian Cardiovascular Society angina class III or IV. The mean interval from primary to secondary operation was 8.5 years (range, 3 to 12 years). Eleven patients had a patent internal mammary artery graft used as the recipient for a proximal Y anastomosis. In 3 cases an arterial graft was reimplanted distally on the same coronary vessel and in 2 onto different coronary vessels. One patient had a combination of these techniques. Five patients required venous conduit. RESULTS: There were no deaths. Mean length of intensive care stay was 69 hours (range, 24 to 144) and mean hospital stay was 14 days (range, 10 to 28 days). All patients were discharged home. Follow-up averages 13 months (range, 2 to 43 months). Twelve patients (75%) are now in Canadian Cardiovascular Society angina class I and 3 (19%) in class II. CONCLUSIONS: Reusing arterial conduits during coronary reoperations is possible with minimal in-hospital morbidity and satisfactory results in terms of freedom from angina. Using these techniques can help overcome the problems of inadequate conduit and maximize the number of arterial anastomoses that can be made per patient.

Adult↗