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J B Flament

Publications and source records attributed to J B Flament.

At least 19 recordsLinked to original sources
PubMed2006

[Functional anatomy of the abdominal wall].

The anterolateral abdominal wall covers a region defined cranially by the xiphoid process and ribs, laterally by the medial axillary line, and caudally by the anterior ilium and pubic bone. Knowledge of the various parts of the abdominal wall is essential to the surgeon for effective laparotomy and primary and secondary hernia care. The abdominal musculature, aponeuroses, vascularity, and innervation are examined in detail along with the according vascular and neural structures of the dermis.

Abdominal Muscles↗
PubMed2005

Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair.

BACKGROUND: Polymer mesh has been used to repair incisional hernias with lower recurrence rates than suture repair. A new generation of mesh has been developed with reduced polypropylene mass and increased pore size. The aim of this study was to compare standard mesh with new lightweight mesh in patients undergoing incisional hernia repair. METHODS: Patients were randomized to receive lightweight composite mesh, or standard polyester or polypropylene mesh. Outcomes were evaluated at 21 days, 4, 12 and 24 months from patient responses to the Short Form 36 (SF-36) and daily activity questionnaires. Complications and recurrence rates were recorded. RESULTS: A total of 165 patients were included in an intention-to-treat analysis (83 lightweight mesh, 82 standard mesh). Postoperative complication rates were similar. The overall hernia recurrence rate was 17 per cent with the lightweight mesh versus 7 per cent with the standard mesh (P = 0.052). There were no differences in SF-36 physical function scores or daily activities between 21 days and 24 months after surgery. CONCLUSION: The use of the lightweight composite mesh for incisional hernia repair had similar outcomes to polypropylene or polyester mesh with the exception of a non-significant trend towards increased hernia recurrence. The latter may be related to technical factors with regard to the specific placement and fixation requirements of lightweight composite mesh.

Activities of Daily Living↗
PubMed2004

Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial.

Intraperitoneal positioning of conventional parietal mesh provides efficient reconstruction but causes visceral adhesion formation in 80-100% of the cases. The purpose of this clinical trial was to assess the performance and tolerance of a new generation of polyester mesh protected by a hydrophilic resorbable film. Eighty patients were included in a prospective multicenter clinical trial. Patients were treated for ventral hernia via an open approach (64%) or laparoscopically (36%). All meshes were implanted in a midline intraperitoneal location. The main objective was to evaluate the anti-adhesive capability of the mesh in relation to the viscera. In order to assess the absence of visceral adhesion objectively, an ultrasound (US) specific examination was initially validated (pre-operative prediction vs. per-operative findings) and then used during the follow-up. The usual clinical parameters were also collected to follow the patients on a period up to 4 years. Pre-operative US prediction vs. per-operative macroscopic findings: sensitivity 79%, overall accuracy 76%, negative predictive value 85%. After 12 months, 86% of the patients were ultrasonically adhesion free. Early post-operative complications were: seroma/hematoma (16%), subcutaneous infection (4%), cutaneous necrosis (1%) and occlusions (outside the mesh) (2.5%). No mortality was reported. Clinically, after 12-month follow-up, no complication related to post-operative adhesions to the mesh was noted: (occlusion 0%, fistula 0%). Late complications were: mesh sepsis (1%), new defects (4%) and recurrence (2.5%). Finally, 56 patients (75.7%) were clinically evaluated with a mean follow-up of 48+/-6 months. One direct recurrence was noted while six patients experienced new defect outside the mesh. No long-term severe complication such as occlusion or enterocutaneous fistula was observed. Based on a mean clinical follow-up of 4 years, the results of this prospective multicenter clinical trial demonstrate the safety and the efficiency of this composite mesh in the intraperitoneal treatment of incisional and umbilical hernia. In particular there was no early or long-term main complication due to the intraperitoneal location of the mesh.

Cicatrix↗
PubMed2002

[Retromuscular prosthetic repair: experience from France].

Large incisional hernias cannot be cured without prosthetic material. A large pore size prosthetic tissue seems to be the best alternative, since connective invasion of the mesh provides a very strong fixation of the prosthesis. In our view, the mesh should be placed in the rectus sheath, in a position we have described as "retromuscular prefascial". With this technique, a good result can be achieved in 98% of very large incisional hernias.

Abdominal Muscles↗
PubMed2001

Classification and surgical treatment of incisional hernia. Results of an experts' meeting.

BACKGROUND: The treatment of incisional hernia (IH) is a current problem in modern surgery. Many important aspects of incisional hernia surgery are yet to be answered, especially the choice of surgical technique and its adaptation to the individual patient. The aim of this experts' meeting was to resolve some current questions in incisional hernia surgery and to organise an international hernia register. METHODS: An international panel of ten experts met under the auspices of the European Hernia Society (GREPA) to investigate the classification and therapeutic alternatives for incisional hernia. Prior to the conference, all experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The information from this correspondence was used as a basis for panel discussion. The personal experiences of the participants and other aspects of individualised therapy were also considered. RESULTS: The expert panel suggested a new classification of incisional hernia based on localisation, size, recurrences and symptoms. All experts agreed that the fascia duplication and the fascia adaptation should only be used for small incisional hernias. Fascia duplication is of value only in the horizontal direction. The technical details and the pros and cons of each procedure were discussed for prosthetic implantation using onlay and sublay techniques and the technique of autodermal hernioplasty. CONCLUSIONS: The management of incisional hernia is currently not standardised. In order to answer relevant questions of incisional hernia surgery, an international hernia register should be established.

Hernia, Ventral↗
PubMed2001

[Arterial blood supply and innervation of the rectus muscles of the eyeball].

UNLABELLED: The authors report on the arterial blood supply and the innervation of the rectus muscles of the eyeball from human orbital dissections. MATERIAL AND METHODS: Hundred human orbits were dissected using a superior approach after arterial injection with colored latex. The different arterial pedicles for each muscle were noted and the nervous supply was studied. RESULTS: The arterial blood supply of the rectus muscles comes from different branches of the ophthalmic artery, usually the inferior muscular artery, the lacrimal artery, the superior muscular artery when it exists, and by small branches arising from the ophthalmic artery. The superior rectus is supplied by branches of the ophthalmic artery and the lacrimal artery (1 to 5 pedicles). The medial rectus is supplied by branches of the ophthalmic artery and the inferior muscular artery (5 to 9 branches). The inferior muscle rectus is principally supplied by the inferior muscular artery (4 pedicles) and the lateral muscle is supplied by the lacrimal artery or the lateral muscular artery (3 to 6 branches). For innervation, the abducens nerve supplies the lateral rectus; the other muscles are supplied by the oculomotor nerve whose superior branch supplies the superior rectus and whose inferior branch, supplies the inferior and medial rectus. DISCUSSION: The arterial blood supply is variable. The arteries which lie near the rectus muscles usually supply one or more branches to the muscles. The arteries go into the muscles through their conal side. This arterial supply is at the posterior part of the muscle. Innervation, in contrast, is very constant and fixed. CONCLUSION: The arterial blood supply to the rectus muscles is variable but always substantial. The pedicles are numerous, often 3 to 5 for each muscle. Innervation is fixed and constant.

Arteries↗
PubMed2000

The inguinofemoral area from a laparoscopic standpoint. History, anatomy, and surgical applications.

No significant difference has been found between early and new diagrams of the posterior anatomy of the inguinofemoral area from a laparoscopic standpoint because anatomy is unique to each individual. But new dangers can arise from new approaches, even if the anatomic structures are well known, so anatomic research is still useful. It provides, relative to new surgical techniques, new vision of structures known for centuries.

Female↗
PubMed2000

The inguinal rings.

The inguinofemoral area constitutes the frontier between the abdomen and the lower limb. Because of the human standing position, the inguinal region is a zone supporting the abdominal thrust, and is weakened by the orifice of the inguinal and femoral passages. Peritoneal diverticula may externalize into these orifices, leading to the formation of hernias. This article reviews the anatomic constituents of the inguinofemoral region and the anatomic basis for the treatment of hernias.

Female↗
PubMed2000

Ampulla of Vater. Anatomic, embryologic, and surgical aspects.

The region of the ampulla of Vater constitutes a complex anatomic and functional entity, the biliopancreaticoduodenal confluence, of which the essentials of this rapid review are the: Variation in site of implantation of the greater duodenal papilla, whereas the relations between the common bile duct and the main pancreatic duct are relatively constant Presence at this site of a weak point in the duodenal wall, commonly the site of mucosal diverticula Interdependence of the parietal duodenal mucosa and the sphincteric system of Oddi Existence of an extramural zone of this sphincter, which should be the only one involved in sphincterotomy Danger of wide excisions of the papilla, which, apart from the risk for hemorrhage, cause a breach of the digestive barrier The ampulla of Vater corresponds to the dilated junction of the common bile duct and main pancreatic duct, if present. The ampulla is an extensive anatomic and functional region that includes not only the choledochopancreatic junction but also the sphincter of Oddi, the whole traversing the duodenal wall to open at the greater duodenal papilla. The chief anatomic features of this biliopancreaticoduodenal junction have been reviewed, forming the basis of techniques of surgical or endoscopic sphincterotomies and localized excisions of vaterian tumors.

Ampulla of Vater↗
PubMed2000

Functional anatomy of the gastroesophageal junction.

The study of the functional anatomy of the gastroesophageal junction allows for the demonstration of a double mechanism that combats the conflict of pressures that tends to lead to gastroesophageal reflux. On one hand, the LES, an intrinsic structure, is directly related to the muscle fibers of the organ and responds to a neurohormonal physiologic command. On the other hand is an anatomic entity, centered by the crura of the diaphragm, closely related to the movements of respiration. These structures constitute a second, extrinsic sphincter that gives rise to the zone of high pressure in the terminal esophagus. This role is difficult to assess, and its importance is underestimated. The proper functioning of these two mechanisms implies that the gastroesophageal junction remains in place within the diaphragmatic channel of the esophagus. Also important are the postural phenomena associated with the sloping position of the fundus. In patients with gastroesophageal reflux, the decrease of the pressure measured in the terminal esophagus accounts for the occurrence of reflux. Investigators concede that, under the influence of abdominal straining, the gastroesophageal junction tends to ascend into the diaphragmatic channel. The results are twofold: (1) the muscle fibers of the lower esophagus relax, explaining the incompetence of the intrinsic sphincter, and (2) the sphincteric zone is withdrawn from its muscular diaphragmatic environment. Physicians should consider these structures as a whole in approaching the surgical treatment of reflux. The construction of a periesophageal valve has no anatomophysiologic basis. A gastropexy procedure must be added to replace the gastroesophageal junction in its anatomic setting and keep it there. This procedure also allows retightening of the muscle fibers of the esophageal wall, which is essential in long-term surgical correction.

Esophagogastric Junction↗
PubMed2000

Anatomic basis of hepatic surgery.

Modern hepatic surgery is based on precise anatomic foundations. The importance of this information applies to all levels of the diagnostic and therapeutic chain. Modern methods of imaging--CT scanning, MR imaging, and preoperative sonography--help physicians to detect variations and plan surgical excision.

Hepatectomy↗
PubMed2000

Surgical anatomy and embryology of the adrenal glands.

Gross anatomy explains the different surgical approaches to adrenalectomy and the difficulties encountered by surgeons during this procedure. Development of the adrenal glands explains the location of the ectopic sites and excess hormone production by adrenal tumors. The choice of a surgical approach is sometimes difficult and is dependent on (1) the morphology of the body; (2) the volume of the tumor, which necessitates immediate vascular control; and (3) the type of disease, which may necessitate a complete exploration of the abdominal cavity.

Adrenal Gland Diseases↗
PubMed2000

Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication. Société Française de Chirurgie Laparoscopique.

BACKGROUND: The aim of this retrospective study was to compare the results of Nissen, Nissen-Rossetti, and Toupet laparoscopic fundoplication in terms of gastroesophageal reflux disease (GERD). METHODS: From 1992 to 1996, 1,470 laparoscopic fundoplications were performed using one of three procedures: Nissen (n = 655), Nissen-Rossetti (n = 423), and Toupet (n = 392). Preoperative checkup included esophagogastroduodenoscopy in 1,437 patients (97. 7%), esophageal manometry in 934 patients (63.5%), and 24-h pH-metry in 799 patients (54.3%). The results were estimated at 1 month, 3 months, and 2 years. Patients unable to visit the hospital center were contacted by telephone. RESULTS: The three groups were quite similar regarding demographic data such as age, gender, preoperative clinical symptoms, and duration of GERD. One death (0.07%) occurred. At 3 months, there were no differences among the three groups concerning conversion, morbidity, dysphagia, early reintervention, or postoperative length of stay. The length of surgery was more important in the Toupet procedure. In the Nissen group, there were fewer Visick grade I patients but more Visick grade III patients. At 2 years, the recurrence and reintervention rates were similar. The overall residual severe dysphagia rate was 0.35% (n = 5). In the Nissen group, there were fewer Visick grade I patients but more in Visick grade II patients. There was no difference in Visick grade III and IV among the groups. More than 90% of the patients were satisfied (Visick I + Visick II), with no significant difference among the three groups. CONCLUSIONS: The results of this study do not differ significantly from the data reported in the literature, suggesting such surgical techniques are effective and well tolerated, and that both can be properly used in the treatment of GERD.

Adolescent↗
PubMed1999

[Laparoscopic fundoplication for gastro-esophageal reflux. Multicenter study of 1,470 cases].

STUDY AIM: The aim of this multicenter retrospective study was to evaluate the immediate and 2-year results of the laparoscopic fundoplication for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: From 1992 to 1996, 1,470 laparoscopic fundoplications were performed for symptomatic GERD. Preoperative workup included upper GI tract endoscopy in 1,437 patients (97.7%), 24-hour pHmetry in 799 patients (54.3%) and esophageal manometry in 934 patients (63.5%). Four procedures were performed: Nissen, Nissen-Rossetti, Toupet and Toupet with cardiopexy. The results were estimated at 1 month and 3 months. The patients were examined or called 2 years after surgery in order to evaluate the functional results with Visick classification. RESULTS: Mean length of hospital stay was 4.6 days (range 2-48 days). Morbidity and mortality rates were 3.2% (47 patients) and 0.07% (1 patient) respectively. Conversion rate into laparotomy was 6.5% (96 patients). After 3 months, 87 patients (5.9%) had severe dysphagia and 91.9% of the patients were satisfied. At 2 years, 78 patients (5.6%) had a clinical recurrence. Five patients (0.35%) had a persistent dysphagia, 90 patients (6.5%) had secondary side effects; 38 patients had been reoperated; 92.7% of the patients were satisfied. There was no significant difference between the results of the four procedures, 3 months and 2 years after surgery. CONCLUSIONS: Laparoscopic fundoplication for treatment of GERD is a safe and effective procedure; 92.7% of the patients were satisfied 2 years after surgery.

Adolescent↗
PubMed1999

[Rectal leiomyosarcoma. 4 new cases].

We report four cases of leiomyosarcoma of the rectum suspected by endoscopic ultrasonography. Three patients were treated by local excision and one by abdominoperineal resection. An excision of the mass via a Kraske's approach was used. Leiomyosarcoma confined to the rectum wall can be treated by local excision. Endosonography can provide exact estimation of the lesion and is of great value in selecting the appropriate treatment. The treatment is surgical excision with wide margins. The histological stage and the presence or absence of metastases determine the therapeutic. Two patients in our series underwent radiation therapy. Chemotherapeutic agents including doxorubicin have had beneficial effect on recurrence or survival, only for higher grade sarcomas.

Aged↗
PubMed1998

[Anatomo-clinical prognostic factors of papillary carcinoma of the thyroid. Multivariate analysis: report of a series of 52 cases].

A retrospective study about 52 cases of papillary thyroid carcinomas was carried out with emphasis on histopathological features. The mean follow up period was 10 years. The survival curves were estimated using the Kaplan-Meier method and compared using the log rank test. The multivariate analysis was performed using the Cox's regression model. In univariate analysis, age, Tp (histopathological extension of the tumor), histological differentiation, VAN score (Vascular invasion nuclear Atypia tumor Necrosis) of Akslen and the LeuM1 expression were significant prognostic factors. In multivariate analysis, the Tp and histological differentiation were associated with high risks of poor outcome.

Adult↗