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E Husson

Publications and source records attributed to E Husson.

6 recordsLinked to original sources
PubMed2001

Effects of portal triad clamping on haemodynamic conditions during laparoscopic liver resection.

To evaluate the haemodynamic effects of portal triad clamping (PTC) during laparoscopic liver resection, 10 patients without cardiac disease were studied by invasive monitoring including a pulmonary artery catheter and were compared with a control group of 10 patients undergoing liver resection by laparotomy. During laparoscopic surgery, intra-abdominal pressure was kept below 14 mm Hg and minute ventilation was adjusted to prevent hypercapnia. Measurements were made before PTC (T1), 5 min after PTC (T2) and 5 min after clamp release (T3). During clamping with pneumoperitoneum, mean arterial pressure (MAP) remained stable (+2%; not significant), systemic vascular resistance (SVR) increased by 37% (P<0.01, T2 vs T1) and cardiac index (CI) decreased by 19% (P<0.01, T2 vs T1). During laparotomy and clamping, MAP increased by 18% (P<0.01, T2 vs T1), SVR increased by 36% (P<0.01, T2 vs T1) and CI decreased by 9% (not significant). We were unable to demonstrate a difference in haemodynamic changes during clamping with pneumoperitoneum vs the open surgical technique, but in a small number of patients this lack of difference could have been a result of inadequate statistical power. The haemodynamic changes that we found were well tolerated in these patients, who had normal cardiac function.

Adult↗
PubMed2000

Laparoscopic liver resections: a feasibility study in 30 patients.

OBJECTIVE: To assess the feasibility and safety of laparoscopic liver resections. SUMMARY BACKGROUND DATA: The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. METHODS: A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. RESULTS: From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. CONCLUSION: Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.

Aged↗
PubMed1998

[Treatment of complete rectal prolapse with rectopexy to the pelvic floor with prosthesis and sigmoid resection. Anatomoclinical results of a prospective study].

UNLABELLED: BACKGROUND, AIM OF THE STUDY: Full thickness rectal prolapse in young adults with normal perineal structures is a disease of the rectum which is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. PATIENTS AND METHODS: Twenty patients (16 women and four men) of median age 41 years were operated on for full thickness rectal prolapse with normal perineal structures. The rectum was mobilised posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired, with a semi-absorbable prosthesis. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in one patient. Mean hospital stay was 8.7 days. Mean follow up was 30 (range 9-75) months. No recurrence was seen. Pre-operatively, 18 patients (90%) complained of constipation mainly with emptying problems (15 patients) and 13 patients (65%) were incontinent. Post-operatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 13 patients (86.5%). Eight incontinent patients (61.5%) regained full continence. On the other hand, two patients with normal bowel function worsened and one patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal perineal structures undergoing prosthetic rectopexy and sigmoid resection: a) morbidity was low, b) anatomical control was obtained in all cases, c) emptying problems were corrected, d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adult↗