[Quid? Intestinal invagination].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
G Lescure
Publications and source records attributed to G Lescure.
Quality of life before and after laparoscopic fundoplication.
BACKGROUND: Laparoscopic fundoplication is a well-established surgical option for the treatment of gastroesophageal reflux disease. The aim of this study was to assess the surgical outcomes from the patient's point of view by using a validated quality of life instrument. METHODS: Fifty patients have been prospectively included. All patients underwent a standardized 270-degree posterior fundoplication. Quality of life was measured by the Gastrointestinal Quality of Life Index (GIQLI), a 36-item-questionnaire. The patients received the questionnaire before surgery, and 3 months and 1 year after surgery. RESULTS: Preoperative score was 95.6+/-21 points. The score increased significantly (P <0.0005) at 3 months (103.6+/-16) and 1 year (111.4+/-22) after surgery. This improvement concerned the four domains of the questionnaire (symptoms, social functioning, physical status, and emotions). The score in patients at 1 year remained, however, significantly lower than that in healthy persons (126+/-18). CONCLUSIONS: GIQLI is a sensitive tool to assess surgical outcomes after fundoplication. The quality of life after surgery did not reach the level of healthy population, not because of failure of surgery to treat GERD but probably because of functional dyspepsia that was present prior to surgery and did not change after fundoplication.
Dyspepsia↗
Effect of CO(2) gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial.
BACKGROUND: Previous studies have suggested that gas temperature has an influence on postlaparoscopy pain. This trial therefore was conducted to study the effect of gas warming on pain after upper abdominal laparoscopic surgery. METHODS: Patients who underwent laparoscopic cholecystectomy, fundoplication, or Heller's myotomy were included and randomly allocated to receive either warm or cold gas. Primary end point was shoulder tip pain, and secondary end points were subcostal, trocar wound, and visceral pains, as well as other postoperative events. Criteria of pain assessment were the visual analog scale, verbal rating scale, and amount of analgesics. RESULTS: A total of 100 patients were suitable for postoperative evaluation. The groups were well matched. Shoulder tip and subcostal pains were significantly more intense after gas warming (p < 0.05). The three assessment criteria showed the same differences. No difference was observed concerning trocar wound and visceral pains and the other secondary end points. Subdiaphragmatic temperature was not significantly different (34.4 degrees with warming vs. 34 degrees without warming). CONCLUSIONS: Gas warming does not reduce, and probably increases, postoperative shoulder tip and subcostal pains.
Carbon Dioxide↗
[Use of lanreotide in the prevention of pancreatic fistula after cephalic duodeno-pancreatectomy. Preliminary study].
STUDY AIM: Dehiscence of pancreatic anastomosis is the main complication after pancreatoduodenectomy. The efficacy of somatostatin analogue to prevent complications after pancreatic resections is at present well-established by several randomized trials. The aim of this preliminary prospective study was to assess the role of lanreotide (a long acting somatostatin analogue) in this field. PATIENTS AND METHOD: Forty patients with pancreatic head tumour have been included in a prospective study. Criteria for pancreatic fistula were: high concentration of amylase in the drainage fluid (> 3 times that in the serum), or intra-abdominal fluid collection adjacent to the pancreatic anastomosis, or reoperation (or postmortem verification) showing an anastomotic dehiscence. The patients received 12 h before the operation 30 mg of lanreotide intramuscularly. RESULTS: Of the 40 patients included prospectively, 34 underwent a pancreatic resection. Parenchyma of pancreatic remnant was crumbly in 28 cases. Six patients experienced a pancreatic fistula (17.6%) which healed in all cases. CONCLUSION: This preliminary study shows clearly the feasibility of a long acting somatostatin analogue (lanreotide) to prevent pancreatic fistula after pancreatectomy. This agent appears simple to use and its efficacy needs obviously to be assessed by randomized trials.
Humans↗
[First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI)].
AIM: Gastrointestinal quality of life index (GIQLI) was initiated in Germany. The aim of this study was to validate its French version (translation). METHODS: The questionnaire includes 36 items asking about symptoms, physical status, emotions, social dysfunction, and effects of medical treatment. The questionnaire has been applied to 615 persons: 335 healthy individuals and 280 patients. Responsiveness and absolute and relative scores were calculated in both groups. Psychometric analysis was done by measuring the validity (convergent and discriminant) and internal consistency. RESULTS: The responsiveness was 93%. The mean score was 126 for healthy individuals and 96 for patients (P < 0.00001). The validity of the questionnaire (both convergent and discriminant) and the internal consistency were demonstrated. Clinical validity was also suggested by the differences between healthy individuals and patients. CONCLUSION: This study allowed the psychometric validation of the French version of GIQLI. This index could be used in France as a reliable method for measuring quality of life related to gastrointestinal diseases.
Adult↗
[Is laparoscopic surgical practice "factual" (evidence based)? Results of a prospective regional survey].
OBJECTIVE: Evidence-based medicine is a growing paradigm in health care. We conducted a prospective study to determine whether laparoscopic surgery is truly evidence-based in everyday practice. METHODS: A prospective regional survey was performed in 11 French hospitals (one university and 10 district hospitals) to ascertain how general laparoscopic surgery was conducted during the last 3 months of 1997. We also searched the electronic databases for original articles on laparoscopic procedures. The methodology of randomized trials was analyzed and procedures were classed by level of evidence. We assumed that an evidence-based procedure was which had been validated by well-designed randomized controlled or prospective trials giving homogeneous results. RESULTS: One half of the procedures performed had been evaluated by randomized controlled trials. Among the 428 laparoscopic procedures, 334 (78%) were found to be evidence-based (CI 74.1-81.9%). Twelve of the 18 indications for laparoscopy (67%) were evidence based (CI: 62.5%-71.5). There was no difference between university teaching hospitals and general district hospitals. CONCLUSION: Contrary to initial criticisms, the practice of laparoscopic surgery appears to be truly evidence-based in the majority of cases.
Evidence-Based Medicine↗
[Peroperative manometric evaluation of posterior fundoplication by celioscopy].
The aim of this prospective study was to evaluate objectively the effects of a laparoscopic posterior fundoplication on the pressure and length of the lower oesophageal sphincter (LOS) and to compare these results to those of a group of patient who underwent the same technique through a laparotomy. Fourty six patients were included in the laparoscopic group and 48 in the open group. Intraoperative manometry was performed using the same material before and after the posterior fundoplication (after evacuating the pneumoperitoneum). Criteria of assessment were the increases in pressure and length of the LOS. The two groups were comparable regarding age, rate of hiatal hernia, and stage of the oesophagitis. In the laparoscopic group, the mean pressure of LOS (mmHg) increased from 10.1 +/- 3.8 to 35.2 +/- 12 after the fundoplication (that is 3.5 times) and the length of LOS (cm) increased from 3.4 +/- 0.8 to 4.8 +/- 0.8 (that is 1.4 times). In the open group the increase was for the pressure and length respectively 3.3 times and 1.5 times the initial values. Thus by performing the same procedure we obtained the same effects on the pressure and length of the LOS. The effectiveness of laparoscopic posterior fundoplication should be similar to that of the open procedure.
Adult↗