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Biomedical subjects

J Boulez

Publications and source records attributed to J Boulez.

47 records · Page 3Linked to original sources
PubMed1977

[Value of conservative methods in the surgical treatment of peptic stenosis of the oesophagus in adults (author's transl)].

Out of a series of 103 patients operated on for peptic stenosis of the oesphagus, we carried out 63 conservative operations, 29 by the thoracic route, 34 by the abdominal route. The operation consists of retrograde dilatation, by finger or by instrument, combined with an anti-reflux arrangement. Among the various technics of the latter, plicature of the fundus has proved the most effective. Gradually, the indications for the abdominal approach have become dominant, even if the cardia cannot be lowered. One may then use a sleeve on the gastric cone, which until now, in 23 cases has given excellent results. One may thus carry out by an extremely benign operation without any mortality, a surgical cure not only of supple stenoses, but also of certain tight fibrous stenoses, considered insuperable. Postoperative dilation was rarely necessary. The results of which some are 8 years old, seem stable in the vast majority of cases. The proportion of excellent results was 81 p. cent of the series. It was higher in the group of plicatures of the fundus where there were only two failures. No case of cancer was observed in the remaining oesphagus.

Adult↗
PubMedDate not supplied

The advantages of palliative resection in squamous cell carcinoma of the esophagus.

A series of 223 resections for esophageal squamous cell carcinoma performed from 1975 to 1982 (70% were palliative or cleaning resections) is presented. Postoperative mortality and morbidity are not significantly different after palliative resection from those after curative resection. The long-term results are encouraging and clearly superior to those obtained with other medical and surgical palliative therapies. These findings lead the authors to support the use of palliative resection for esophageal carcinoma, except in cases of cervical tumors with a poor prognosis.

Adult↗
PubMedDate not supplied

[Surgical complications of the diverticular disease of the colon. Series of 110 cases (author's transl)].

The authors are reviewing a series of 110 cases of operated diverticulitis. Emergency operations mainly concerned cases of fecal peritonitis. Mortality is still fairly high (27 percent). In these cases, immediate resection (two-stages operation) brings better results than the classical three-stages operation. The latter, however, remains in some cases a safe solution. Concerning chronic patients, surgical procedures always require immediate resection, whatever the anatomic lesions can be. Hartmann operation has been given up by the authors. Presently, in every cases, continuity is carried out by ideal colectomy or by anastomosis protected by a transverse colostomy. In such cases, mortality has been, 2,6 percent and functional results are most satisfactory.

Adult↗
PubMedDate not supplied

[Multiple hydatidosis: hepatic, splenic, peritoneal and gynaecologic locations (author's transl)].

We report the case of a young Algerian female with a voluminous abdominal tumour suggestive of a hydatic cyst of the liver. Complementary examinations (radiography of adjacent organs, ultrasonography, coelio-mesenteric arteriography, hepatic scanning) revealed two additional abdominal cysts. Furthermore, gynaecologic examination and ultrasonography revealed one intra-uterine hydatic cyst. At laparotomy however, the surgeon removed sixteen abdominal and five pelvic cysts, all of them containing brood capsules. It should be noted that one eleven centimeters-diameter splenic cyst was discovered only at operation. The authors point out the rarity of the uterine location of hydatidosis and stress the difficulty of the preoperative localization of all the cysts. In these widespread forms of the disease, complementary flubendazole treatment could be useful.

Adult↗
PubMedDate not supplied

[Treatment of peptic stenosis of the esophagus. Conservative techniques (author's transl)].

Peptic stenosis of the esophagus is no longer considered as an irreversible lesion. It may stabilize or even regress if gastro-esophageal reflux is suppressed. The treatment of these stenoses during the last decade has been progressively oriented towards conservative techniques, the only ones capable of conferring the necessary low degree of complexity on this type of surgery. The authors report their experience between 1965 and 1980 on 151 operations. Resection was performed in 1/3 of the cases and the remainder were treated conservatively, by either thoracic or abdominal routes. The route of choice is abdominal. Peroperative dilatation of the stenosis is done with a finger or a bougie. The anti-reflux configuration is a Nissen type fundoplicatio when the cardia can be lowered in the abdomen. If the cardia cannot be lowered because of a shortening of the esophagus, the authors utilize a complete wrapping of the gastric cone since 1969. This technique has been used 45 times, often in old and weak patients who would have tolerated no other procedure. Mortality was zero. Long-term results are satisfactory and longlasting in 75% of the cases. Secondary dilatations are sometimes (18%) necessary, especially during the first postoperative year. In case of failure, it remains possible to perform another conservative operation through the thoracic route. No late-arising adenocarcinoma has been observed in the stenotic zone.

Dilatation↗
PubMedDate not supplied

Laparoscopic colo-rectal surgery: analysis of 113 cases.

BACKGROUND/AIMS: The aim of the study is to relate our five years experience with laparoscopic colorectal surgery. MATERIALS AND METHODS: One hundred-thirteen procedures were performed between October 1990 and February 1996, 7% of which were performed as emergencies. Elective indications (93%) included 45 cancers, 31 cases of diverticulosis, 18 cases of benign tumor, and 11 other reasons. Procedures performed were sigmoidectomy (61 cases), rectal resection (12 cases), segmental colectomy (15 cases), right hemicolectomy (14 cases) and restoration of continuity following a Hartmann's procedure (5 cases) and miscellaneous (6 cases). RESULTS: Operative complications occurred in 14% of the cases. The conversion rate to laparotomy was 6%. Post operative complications occurred in 14% of the patients. Reoperation was performed in 7% of the cases and overall mortality was 1.7%. Mean length of hospital stay was 9.6 days. Long-term oncology results demonstrated no recurrence for DUKES stage A disease followed-up from 5 to 65 months, and 2 recurrence on 11 DUKES B or C. All DUKES D patients died in an average of 17 months. No abdominal wall metastases were seen during the follow-up period in 45 patients with cancer who were treated. CONCLUSIONS: Laparoscopic colo-rectal surgery is technically feasible and has an acceptable complication rate. The best indications are treatment of benign disorders, principally excision of polyps and treatment of uncomplicated diverticulosis. This is also a good approach to treat degenerated polyps (DUKES A). The procedure should be assessed in curative excision of DUKES B or C disease.

Adolescent↗