Biomedical subjects
J J Sala
Publications and source records attributed to J J Sala.
[Surgical treatment of diverticula of the thoracic esophagus].
Pathogeny of thoracic esophageal diverticuli, divided into parabronchial and epiphrenic, appears to have been modified by development of functional esophageal motility measurement. We present 23 patients with epiphrenic diverticuli and 3 with parabronchial diverticuli (15 male and 11 female with a mean age of 61 years). Twenty-four underwent surgery: 4 isolated diverticulectomy, 7 diverticulectomy and associated myotomy, 5 myotomy alone, 3 antireflux procedure alone. Three patients required esophagectomy for carcinoma in a diverticulum, for a huge diverticulum adherent to the inferior pulmonary vein. One patient presenting with perforation of a carcinomatous diverticulum in the pleura was treated with pleurotomy and has died. No fistula has been notified. Long term results had been analysed with a mean follow up of 4 years. Special attention has been reported on development of gastro-esophageal-reflux. The finding of a thoracic diverticulum requires evaluation by barium swallow, fibroscopy and functional test which should indicate the operation required. Long term analysis should include functional manometric evaluation and a pHanalysis as long term results are reduced by the appearance of gastro-esophageal-reflux.
[Pericardio-peritoneal shunt with the automatic stapler EEA].
Transdiaphragmatic pericardio-peritoneal shunt is an effective answer to the problem of recurrent pericardial effusion. The EEA (end to end anastomosis) stapler is a perfect tool for this technique, being easy to handle and offering the possibility of a pathological examination of the pericardic fragment removed. Five patients underwent this type of surgery with satisfactory results on a 3 to 29 months' follow-up.
[Surgical treatment of pulsion diverticula of the esophagus].
A retrospective study of 53 patients, operated upon for esophageal pulsion diverticula, is used to compare results with those in the literature in an attempt to improve operative indications with the hope of reducing the number of only fair short and long term results. Findings showed that results were rated as good in 81% of the 35 patients with pharyngo-esophageal diverticula and 65% of the 18 with epiphrenic diverticula. Indications for operation for pharyngo-esophageal diverticula can be based on clinical and radiological signs. Cricopharyngeal manometry indicates that myotomy is a logical procedure but results show that it is not necessary for choice of indications for surgery. Our preference is for a diverticulectomy, with or without associated myotomy, of debatable value. In contrast, for epiphrenic diverticula, functional esophageal explorations provide greater precision of the type of dyskinesia and allow better adaptation of surgery to type of dyskinesia associated with diverticulum.
[Treatment of eventration after transverse laparotomy].
In the few cases of incisional hernia consecutive to transverse laparotomy the classical approximation of the rectus muscles cannot be performed due to the presence of transverse fibrotic scar tissue. An original technique using 4 aponeurotic quadrants cut out of the anterior surface of the rectus sheaths is described.
[Risk factors in gastric ulcer surgery after the age of 70 years. 34 cases].
Post-operative morbidity and mortality factors were investigated in a retrospective study of 34 patients aged over 70 operated upon for gastric ulcer. In two-thirds of the patients the operation was motivated by a complication of the ulcer. Two-thirds presented with an concurrent disease at the time of surgery. Fourteen patients died in hospital during the post-operative period, this mortality being related to the concurrent disease. Bleeding of the ulcer and emergency surgery were aggravating factors. The absence of post-operative abdominal complications had more influence on the prognosis than the type of operation performed.