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Biomedical subjects

H Johanet

Publications and source records attributed to H Johanet.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic cure of small ventral hernias with composite mesh.

BACKGROUND: The use of mesh is recommended to reduce the rate of recurrence after the curing of ventral hernias. METHODS: A multicentre prospective trial was conducted to assess the laparoscopic cure of small ventral hernias with a composite mesh. RESULTS: Around 222 patients entered the trial and received laparoscopic repair for ventral hernias of less than 5 cm. There was one conversion. The mean length of post-operative hospitalisation was 2.5 days. At 1 year, the recurrence rate was 2%. Two meshes were removed due to infection, 3% of the patients were using analgesics and 86.1% of the patients described no pain on EVA scoring. CONCLUSION: The laparoscopic cure of small ventral hernias with composite mesh is efficient. Further technical progress is warranted to reduce the rate of seroma formation.

Adult↗
PubMed2003

[Risk knowledge and management of blood exposure in operative room: results of a French national survey].

OBJECTIVES: To assess knowledge of risk factors of blood exposure in operative room and management after blood exposure. METHODS: A national survey was conducted towards 5000 surgeons drawn with hazard. RESULTS: The knowledge of the risk of viral contamination stay imperfect and the management after blood exposure is doubtful, and this last point is probably favoured by the absence of regulation in spite of guidelines from professional associations or societies. CONCLUSION: Knowledge of risk factors and more clear regulations could permit a better attitude in case of blood exposure.

Adult↗
PubMed2002

[Outpatient laparoscopic cholecystectomy].

UNLABELLED: OUTPATIENT LAPAROSCOPIC CHOLECYSTECTOMY: The laparoscopic technique is the procedure of choice for cholecystectomy. This procedure is done on ambulatory setting in the United States and Europe but no experience was reported in France. AIM OF THE STUDY: To report the organisation and results of our initial 100 consecutive patients operated for a laparoscopic cholecystectomy on an outpatient basis. PATIENTS AND METHODS: After assessment of the prevention of pain and nausea or vomiting after laparoscopic cholecystectomy on hospitalized patients, a prospective trial was done on our first 100 patients for outpatient laparoscopic cholecystectomy on routine basis. RESULTS: During the period, 27.4% of patients were entered on an ambulatory basis. 72% of patients did not need any medication post-operatively in the structure. 17 patients were admitted: in five cases, decision was done pre-operatively, one patient went back home against medical advising; in three cases, peroperatively, and in 10 cases postoperatively. Four patients were readmitted between the fifth and sixteenth post-operatoire day. CONCLUSION: An adequate organisation for day case surgery, a good selection of patients on medical, surgical and environmental criteria, simple procedures to prevent pain or nausea vomiting post-operatively allow use to assert that hospitalisation is unjustified for laparoscopic cholecystectomy in a quater of patients.

Adult↗
PubMed2002

[Incidence of surgical site infection in ambulatory surgery: results of the INCISCO surveillance network in 1999-2000].

OBJECTIVES: To estimate the incidence of surgical-site infections (SSI) in ambulatory surgery and to identify risk factors based on the surveillance network INCISO in 1999-2000. PATIENTS AND METHODS: Annually, during a three-month period, each surgical ward had to include 200 consecutive operations. Patients were surveyed over the month following surgery. For each patient, data including peri-operative factors, type of procedure and SSI occurrence were collected on a standardized form by a surgical staff committed for the study. RESULTS: Of the 5,183 patients who underwent an ambulatory surgery, the SSI incidence ratio was 0.4% (95% CI [0.3-0.7]). Orthopedic, gynecologic/obstetrics, head and neck, skin and soft tissues surgery accounted for 83% of all ambulatory procedures. 93% of patients belonged to the 0 risk category of the National Nosocomial Infections Surveillance system (NNIS) index. Emergency, age, american anesthesia risk score (ASA), Altemeier wound class, and procedure duration were not found to be risk factors for SSI in ambulatory surgery. CONCLUSION: Based on these surveillance data, infectious risk was low in ambulatory surgery and was not associated with known SSI risk factors.

Adult↗
PubMed2001

[Blunt force rupture of the thoracic aorta and diaphragm: an unusual association].

The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.

Accidents, Traffic↗
PubMed2000

[Protection methods in the operating room and risks of blood exposure. Results of a national survey].

A national survey was conducted with 5,000 randomly chosen surgeons in order to assess the methods of protection used or warranted in the operating room against blood-borne pathogens. The rate of complete vaccination against hepatitis B was 79.2%. The use of double gloves was constant for 72% of orthopedist surgeons but only reached 28.2% for the overall surgical population. Only 46.1% of the gowns used were coated, though the quality of the barrier when it is wet is very risky. The protections taken in the operating room against blood-borne pathogens can be improved.

Adult↗
PubMed2000

[Assessment of quality of life after antireflux surgery].

AIM OF THE STUDY: To assess the quality of life (QoL) of patients operated for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: This prospective study included 82 consecutive patients submitted to antireflux surgery between October 1998 and January 1999. A new questionnaire was used to assess their QoL: the Gastrointestinal Quality of Life Index (GIQLI) that includes 36 items concerning 5 dimensions: symptoms, vitality, emotions, social relations and medical treatment. The series consisted of 44 men and 38 women with a mean age of 47 years (range: 18-78). QoL was assessed before and 6 months after surgery; the follow-up rate was 94% (77/82). The pre- and postoperative GIQLI scores of the study group and the GIQLY score of a control group of 110 healthy patients were compared. RESULTS: Before surgery, the GIQLI score (90 +/- 23) was greatly impaired compared to the score (123 +/- 13) observed in the control group (p < 0.001). After surgery, the GIQLI score (110 +/- 23) increased significantly (p < 0.001), but remained statistically lower than the score of the control group (p < 0.001). The postoperative score recorded in the symptoms dimension was lower than the control group score: 55 +/- 11 versus 66 +/- 6 (p < 0.001), while no significant difference was observed in the other 4 dimensions. Univariate statistical analysis revealed that the postoperative GIQLI score (y) was correlated with the preoperative GIQLI score (x) according to the formula: y = 0.43 x + 71 (p < 0.001) and the sex of the patients, as the postoperative GIQLI score was higher in male patients (115 +/- 19) than in female patients (103 +/- 23) (p < 0.02). CONCLUSION: The QoL of the patients was greatly improved after antireflux surgery, but remained lower than that of a control group of healthy subjects. Better patient selection should improve the results. In our series, male patients or patients with a high preoperative GIQLI score were the best candidates for antireflux surgery.

Adolescent↗
PubMed2000

Laparoscopy for acute small-bowel obstruction secondary to adhesions.

BACKGROUND AND PURPOSE: Postoperative adhesions are the leading cause of small-bowel obstruction in developed countries. Several arguments suggest that laparoscopy may lead to fewer adhesions than does laparotomy. We report here the short-term results of laparoscopy in patients admitted on an emergency basis for acute small-bowel obstruction secondary to adhesions. PATIENTS AND METHODS: This prospective trial included 134 consecutive patients: 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis shortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place within 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions: 7% after elective laparoscopy and 36% after emergency laparoscopy. RESULTS: There were no operative deaths. One patient underwent a reoperation the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparoscopy and 59% after emergency laparoscopy. CONCLUSION: Emergency situations in acute small-bowel obstruction combine several circumstances unfavorable for laparoscopy: a limited work area and a distended and fragile small bowel. Laparoscopic adhesiolysis after the crisis has passed may produce better results, but only long-term follow-up can confirm the role of elective laparoscopy for this indication.

Acute Disease↗
PubMed2000

[Interest in several surgeries for serious abdominal trauma].

Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis.

Abdominal Injuries↗
PubMed1999

[Laparoscopic treatment of recurrent inguinal hernia after only mesh].

The recurrences of inguinal hernia after onlay mesh may cause technical difficulties for a new repair. The aim of our study was to assess intraoperative findings, feasibility and results of laparoscopic transpreperitoneal mesh onlay in this indication. Twenty-one repairs were performed. In all cases, direct, internal, inguinal recurrences were observed, associated in two cases with an external or femoral recurrence. In 16 cases, there were no adhesions in the peritoneal cavity. The were no conversions and peritonealisation was always completed. The mean length of hospitalization was 2.7 days. Our study suggests that technical errors during the first procedure, insufficient mesh or wrongly positioned are responsible for recurrence and allow reinsertion of a mesh laparoscopy via transpreperitoneal in this indication.

Adult↗
PubMed1999

[Time off of work after inguinal hernia repair. Results of a multicenter prospective study].

A multicentre prospective study was conducted to evaluate the effective duration of time off work following inguinal hernia repair. From 1st October to 30 November 1997, 14 surgeons repaired 459 hernias in 359 patients, corresponding to 28.8% of salaried workers, 10.9% self-employed and 4.8% civil servants. 46% of patients were retired. Only 6.9% of patients were treated by reconstruction of the inguinal floor without mesh, 59.6% were operated by laparoscopy and a conventional prosthesis repair was performed in 33.2%. There were 0.6% of complications or modifications of the postoperative course. The mean effective time off work was 17.5 days after unilateral repair and 24.7 days after bilateral repair. For unilateral repairs, no significant difference was observed between occupational groups in terms of effective time off work, in the absence of complications. In contrast, patients of these occupational groups presented a shorter time off work following an uncomplicated TAPP repair than after plug-Lichtenstein repair. In the group of salaried workers, a significant difference was observed between patients undergoing TAPP or TEP repair and those undergoing plug-Lichtenstein repair.

Adult↗
PubMed1999

[Laparoscopic cure of gastroesophageal reflux disease. Results of a multicenter trial].

OBJECTIVES: The aim of our trial was to assess preoperative assessment and short-term results of laparoscopic cure of gastroesophageal disease performed by digestive surgeons not specialized in this disease. METHODS: 335 consecutive cures were performed by 11 surgeons. RESULTS: 29% of patients had pH-metry, 52% had manometry. The procedure was: Nissen-Rossetti in 66% of cases, Toupet in 17%, and Nissen in 16% of cases. The conversion rate was 13%. The intraoperative complication rate was 3.28% and 2.08% of patients had a reoperation. One patient died. 5% of patients had dysphagia more than three months after the operation. CONCLUSION: Our results show an absence of consensus concerning preoperative assessment. They suggest that careful intraoperative management, with a high conversion rate, reflecting our initial experience, allows similar results to those of teams specialized in laparoscopic surgery and better than laparotomy series.

Adolescent↗
PubMed1999

[Acute occlusions of the small intestine caused by adhesions. Indications and results].

Postoperative adhesions are the first cause of small bowel occlusion in developed countries. Nevertheless no progress was done in prevention and treatment of this disease. The aim of this trial is to report results of 276 small bowel occlusions caused by adhesion recently operated and consecutive between first january 1993 and 31 december 1996. These patients had 400 previous surgical procedures, within 67.4% infra mesocolic or pelvic. 15.1% of previous surgical procedures took place less than one year before and 36% less than 5 years. Thirty five per cent of patients were operated during 24 hours following admission 23.2% of patients had a digestive resection, caused by necrosis or iatrogenic dissection. Operative mortality was 4.3% without resection and 16.6% with resection. Progress are warranted to reduce the rate of redux of occlusion and mortality and morbidity in this benign disease: more peri operative attention and place of laparoscopy should be considered.

Acute Disease↗