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J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 55 records · Page 3Linked to original sources
PubMed1999

Gastrointestinal injuries during gynaecological laparoscopy.

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.

Adult↗
PubMed1999

Magnetic resonance imaging characteristics of deep endometriosis.

The aim of this study was to describe magnetic resonance (MR) imaging findings in histopathologically proven deep endometriosis infiltrating the uterosacral ligaments, the pouch of Douglas, the rectum or the bladder. Twenty patients presenting with a clinical suspicion of deep endometriosis underwent preoperative MR imaging. Sagittal and axial fast T2- and axial T1-weighted spin echo MR sequences were performed. Four patients had post-contrast images. MR results, including morphology and signal intensity of each lesion, were compared to intraoperative gross appearance and histopathology. Histopathology diagnosed 24 lesions of deep endometriosis in the uterosacral ligaments (n = 12), the pouch of Douglas (n = 2), the rectum (n = 3), the bladder (n = 7). Uterosacral ligaments with deep endometriosis were statistically different from normal uterosacral ligaments for proximal nodularity (P = 0.001). There was no difference in signal intensity between normal and abnormal uterosacral ligaments. Contrast-enhanced SE images in four patients with detrusor invasion showed an interruption of the hypointense detrusor by the enhancing bladder endometriosis. Rectal endometriosis was missed in two of three patients and showed non-specific rectal wall thickening in one patient. It is concluded that MR imaging can diagnose deep endometriosis of uterosacral ligaments, the bladder and the pouch of Douglas, but lacks sensitivity in detecting rectal endometriosis without rectal distension.

Adult↗
PubMed1999

[Endothelin receptors in benign human tumours of uterine muscle].

The endothelins (ET1, ET2, ET3) are a family of peptides that exert vasoactive and mitogenic effects. ETs bind to at least two subtypes of receptors: the ETA subtype is ET1 selective whereas the ETB subtype binds ET1, ET2 and ET3. By RT-PCR, we detected ETA receptor mRNA and ETB receptor mRNA in leiomyoma and in homologous myometrium distal from the tumor. Despite the presence of four spliced variants of ETA receptors, we identified a single class of ETA-binding sites. The level of ETB receptor mRNA was found to be higher in myometrium versus leiomyomas. Using complementary pharmacologic approach, we demonstrated the predominance of ETA receptors in normal myometrium (75% of total receptors). Both ETA and ETB transcripts coexist in leiomyomas, but we have reported only ETA binding sites. Because of growth properties of ET1, we suggest a role for this peptide in the tumoral development of human uterine smooth muscle.

Female↗
PubMed1999

Laparoscopic management of bladder endometriosis.

BACKGROUND: To assess the methods, indications and results of operative laparoscopy for patients presenting with bladder endometriosis. METHODS: Descriptive retrospective study. All the patients presenting with bladder endometriosis infiltrating the bladder muscularis between January 1, 1993 and June 30, 1998 were included in this series. RESULTS: It was possible to treat bladder endometriosis in all the patients by performing a laparoscopic partial cystectomy. With an average follow-up of 31.6 months (range 6-61) the results are satisfactory. Neither per- nor postoperative complications were observed. The patients experienced an improvement in their condition, with complete disappearance of the urinary symptoms in every case. No recurrence of the functional urological symptoms occurred. CONCLUSIONS: Provided the surgeons are skilled and the lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.

Adult↗
PubMed1998

[Are there still indications for tubal surgery in infertility?].

In vitro fertilization (IVF) has revolutionalized management strategies proposed for infertility to the point where some have suggested that tubal surgery is no longer indicated. The objective being to obtain the largest number of viable births at minimum cost and maximum patient comfort, we strongly believe that tubal surgery and IVF are complementary tools for patients with tubal infertility. The choice depends on the severity and the localization of the lesions. For example, in patients with hydrosalpinx (the most frequent tubal lesion) and healthy or moderately altered mucosa, the rate of in utero pregnancies after tubal plasty by laparoscopic salpingostomy (53% in our series) is quite comparable with the rate after IVF. In this large group, tubal surgery should be proposed first. Tubal surgery may also be indicated in other less frequent lesions such as proximal obstructions where we have obtained excellent results (56% live births within 2 years of surgery). Of course, the final decision is made by the couple, well informed of the advantages and disadvantages of each technique. Performed by a well-trained team with extensive experience in reproduction, tubal surgery, particularly with the development of micro-instruments for laparoscopy, remains a treatment of choice for patients with tubal infertility.

Adult↗
PubMed1998

Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis?

Only benign ovarian cysts can be treated by laparoscopic surgery. Although clinical examination and the results of pre-operative work-up do make a real contribution in indicating the benign or malignant nature of cysts, only histology can provide the absolute diagnosis. In this context, the goal of this study was to establish whether there is any advantage in performing frozen section during laparoscopic surgical management of organic ovarian cysts. Between January 1989 and March 1996, 228 patients underwent an adnexectomy for an ovarian mass. After the pre-operative work-up and the diagnostic phase of laparoscopy, 26 patients (11.4%) presented with suspected signs of malignancy restricted purely to the ovary. These 26 patients underwent a laparoscopic adnexectomy with extraction of the excised tissues using an endoscopic bag, followed by frozen section. For all these patients the results of the frozen section concluded that the lesion was benign. In every case the definitive histological results confirmed the frozen section findings. This strategy enabled us to avoid laparotomy, especially for the nine post-menopausal patients whose adnexal masses appeared to be complex by ultrasound. These encouraging preliminary results need to be confirmed by a larger series of patients, so as to specify the place of frozen section in the laparoscopic surgical management of organic ovarian cysts.

Adult↗
PubMed1998

Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases.

A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29,966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, together with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100,000 laparoscopies. The overall complication rate was 4.64 per 1000 laparoscopies (n = 139). The rate of complications requiring laparotomy was 3.20 per 1000 (n = 96). The complication rate was significantly correlated with the complexity of the laparoscopic procedure (P = 0.0001). One in three complications (34.1%; n = 43) occurred while setting up for laparoscopy, and one in four (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (P = 0.001). Increased experience by the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (P = 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures that are well defined (P = 0.01), and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (P = 0.0001).

Female↗
PubMed1998

Second look after laparoscopic myomectomy.

The goal of this study was to assess the risk of adhesions after laparoscopic myomectomy. To this end our enquiry was based on observations with a prospective collection of data. Between October 26, 1990 and October 1, 1996, 45 patients underwent a second look after laparoscopic myomectomy. Seventy-two myomectomy sites were checked. The overall rate of postoperative adhesion was 35.6% per patient. The rate of adhesions per myomectomy site was 16.7%. The factors which influenced the occurrence of an adhesion on the myomectomy site were posterior location of the myoma and the existence of sutures. The rate of adhesions on the adnexa after laparoscopic myomectomy was 24.4%. The factors which influenced the occurrence of adnexal adhesions were another surgical procedure carried out at the same time, the existence of adhesions prior to the operation and posterior location of the myoma. The rate of adhesions after laparoscopic myomectomy is low and the adhesions rarely involved the adnexa. We recommend that a second-look laparoscopy be carried out systematically after laparoscopic myomectomy in patients desiring pregnancy.

Adnexal Diseases↗
PubMed1998

Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis.

The objective of this work was to assess the advantages and the role of rectal endoscopic ultrasonography (EUS) when establishing evidence of infiltration of the rectal wall in patients with proven deep pelvic endometriosis. To this end we performed a retrospective study between July 1993 and December 1996 of a continuous series of 38 patients who presented with deep pelvic endometriosis which was confirmed histologically. The EUS results were considered normal in nine cases (23.7%). In 12 cases (31.6%) EUS revealed an image compatible with infiltration of the uterosacral ligaments and/or the rectovaginal septum without any associated bowel infiltration. In 17 cases (44.7%) EUS revealed an image compatible with deep infiltration of the intestinal wall. Sixteen of these 17 patients underwent laparotomy with bowel resection. The histological results confirmed in each of these 16 patients (100%) that there was deep infiltration of the intestinal wall by endometriotic lesions. The seventeenth patient refused such major surgery by laparotomy, and underwent partial laparoscopy due to the risk of bowel injury. For the 21 patients with no EUS evidence of rectal infiltration complete laparoscopic surgical exeresis was achieved in every case (100%) without broaching the intestinal wall. These preliminary results enable us to state that EUS, which is a simple and non-invasive technique, provides a reliable indication as to the presence of deep bowel infiltration in patients with retroperitoneal endometriotic lesions. EUS used pre-operatively enables patients to be selected for treatment via laparotomy or by laparoscopic surgery.

Adult↗
PubMed1998

Single suture laparoscopic tubal re-anastomosis.

The goal of this article is to report our experience and review recent articles obtained for laparoscopic tubal sterilization reversal. The technique we describe is 'single suture laparoscopic tubal re-anastomosis'. This technique is simple and atraumatic and requires only one stitch in the tube. After preparing the tube stumps and bringing the edges of the mesosalpinx together, laparoscopic anastomosis is achieved by one stitch placed at '12 o'clock' on the antimesial edge of the tube. Between May 1994 and June 1997 we operated on 32 patients using this technique and carried out 48 tubal sterilization reversals. For the patients who underwent postoperative hysterosalpingography during the first or second month after the operation, the rate of patency was 87.5% (42/48). The overall intrauterine pregnancy rate was 53.1% (17 out of 32 patients). The overall delivery rate was 40.6% (13 out of 32 patients). The intrauterine pregnancy rate for the 17 patients who were aged 38 years or under was 58.8% (10 out of 17 patients). Laparoscopic tubal sterilization reversal is feasible with a simplified technique. Review of the publications concerning laparoscopic microsurgical tubal anastomosis confirms satisfactory fertility results. The surgeon should be experienced in microsurgical tubal anastomosis by laparotomy as well as operative laparoscopic procedures.

Humans↗
PubMed1998

[Total hysterectomy for benign pathologies. Laparoscopic surgery does not seem to increase the risk of complications].

OBJECTIVE: To assess the risk of complications of total laparoscopic hysterectomy (TLH). SETTING: University Hospital, Surgical Gynecological team. DESIGN: Retrospective study of 313 patients. For all the patients a total laparoscopic hysterectomy was performed. Every part of the operation was carried out via laparoscopy, from the adnexal phase (conservative or radical) to the colpotomy. All hemostasis was carried out by electrosurgery (bipolar coagulation). All the instruments are reusable. RESULTS: The rate of conversion to laparotomy was 6.7% (21 patients). For the patients who underwent a TLH (292 cases; 92.3%) the overall complication rate was 9.95% (29 patients). The rate of patients presented a complication which required a further operation was 1.4% (4 patients). The rate of patients presented a complication which required a re-hospitalization was 2.0% (6 patients). The rate of major urinary injury was 2.5% (6 cases): bladder injury (4 patients; 1.35%); vesico-vaginal fistula (1 case; 0.35%); ureteral complication (1 case; 0.35%). The rate of postoperative febrile morbidity was 5.8% (17 patients). CONCLUSIONS: These encouraging results mean that, provided the surgeons are experienced in laparoscopic surgery, total laparoscopic hysterectomy technique would appear not to have a higher rate of complications than hysterectomy via laparotomy or the vaginal route.

Adult↗