Biomedical subjects
Publications and source records attributed to J Giuly.
The transvaginal sacrospinous fixation, called Richter operation was initially aimed to cure vaginal vault prolapse after hysterectomy. The results are as good as those of the abdominal promontory fixation with the well known advantages of the vaginal route. Indications way be extended to V3 U3 R3 prolapse and cure of elytrocele with good results in our practice. In few cases remnant cystocele may be a trouble some problem.
Osteitis pubis is a well known complication of urologic procedures but its association with herniorraphy is poorly documented in the literature. We report a case of osteitis pubis after coelioscopic cure of hernia. It is too early to know its frequency in coelioscopic repair. The choice of this technic might be discussed if it appears that with this technic the frequency is higher than in traditional surgery where it was rare.
Segmental infarction of the great omentum is a possible aetiology of acute abdominal pain. The diagnosis was difficult before operation and, generally the patient was operated upon with the diagnosis of appendicitis, or less often by laparotomy. The laparoscopy appears to be nowadays the ideal way of diagnosis, as this was the case in two of our patients. The treatment is also possible by laparoscopy (one of our patients). Generally speaking the laparoscopy should be of great help in the diagnosis of some acute abdominal pain, and could reduce the number of the so called non specific abdominal pain.
Though very different, aberrant bile ducts and cysto-hepatic ducts are often confused. Aberrant bile ducts are abnormal ducts which do not drain any segment or sector of the liver. They are filled of bile counter-flow and can be injured not only in the gallbladder bed, but also elsewhere on the surface of the liver. Cysto-hepatic ducts are normal ducts, draining segment or sector of the liver, but because of an embryologic sliding, their branching is on the gallbladder or on the cystic duct. All these ducts can be injured during cholecystectomy, and it would be of importance to recognize the true type of duct one has to deal with, by radiologic explorations. The management is different as aberrant bile ducts need only to be ligated, instead, the cysto-hepatic ducts may require a reimplantation in the common bile duct or Roux en y loop. We discuss all these problems on the basis of 1200 traditional cholecystectomies where 1 aberrant bile duct, 3 cysto-hepatic ducts, and 3 external biliary fistulas were encountered.
Owing to the wide diffusion of the coelioscopic cholecystectomy some problems are worth studying. From a technical standpoint they are important changes: use of monopolar current for coagulation, suppression of intra-operative cholangiography, absence of suture of the gallbladder bed, systematic retrograde dissection. Theoritically these modifications are important enough to increase the biliary risk. As a matter of fact, comparison with traditional cholecystectomy data as well as results of preliminary studies on coelioscopic cholecystectomy does not confirm such a risk. This operation appears safe, at least if indications are limited to non complicated cholelithiasis.
Massive hiatal hernia is a lesion at risk of incarceration, volvulus, and obstruction. The true paraesophageal type is a very rare condition and probably often mistaken with end-stage slidind hernia. Furthermore reflux and oesophagitis are always possible. In this case report a small bowel loop was incarcerated with a massive hiatal hernia. This association was only possible because of the existence of an associated transverse mesocolis hernia giving way to the small bowel. An emergency operation was necessary. The need of surgical treatment of such lesions is stressed, if possible before acute complication, even if they are asymptomatic at the time of diagnostic, which is a quite common condition.
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Early detection of residual stones in the main biliary pathways during external drainage following surgery has, until recently, required a repeat operation with all its associated technical and psychological problems. Currently, however, Burhenne-Mazariello's nonoperative extraction technique is a very reliable therapeutic measure, as shown by results in 8 cases and those reported by the authors. Furthermore, this technique can be applied by a surgeon isolated in a small centre with the minimum of material, with a high probability of success. Other conservative techniques, particularly instillations through the external drain, are still valid and can be complementary to Burhenne's method, which for the authors, however, remains the therapy of choice.
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