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J L Brefort

Publications and source records attributed to J L Brefort.

15 recordsLinked to original sources
PubMed1999

[Laparoscopic treatment of common bile duct lithiasis. Study of 56 cases].

AIM OF THE STUDY: The aim of this retrospective study was to report the results of the laparoscopic management of common bile duct stones in an unicentric series of 56 patients. PATIENTS AND METHOD: From January 1993 to April 1998, 56 patients, 38 women, 18 men (mean age: 59.2 years), underwent a common bile duct exploration for lithiasis through a laparoscopic approach. The patients were hospitalised for angiocholitis (n = 13), cholecystitis (n = 11), biliary pain (n = 29, nine with jaundice), pancreatitis (n = 3), abnormality of hepatic profile (n = 1). All the patients underwent an intraoperative cholangiography. Removal of the stones was tried in 50 cases through a choledochotomy, in four through the cystic duct, using Mirrizi forceps, or Dormia and Fogarty catheters in case of failure. External biliary drainage and postoperative cholangiography were done systematically. The average diameter of the common bile duct was 10.5 mm (6-20 mm). RESULTS: In 41 patients, removal of the stones was laparoscopically successful. In 11 patients, a conversion into laparotomy was necessary for several reasons. In three patients with common bile duct of small diameter, the stones were abandoned for a further endoscopic sphincterotomy. There was no mortality and the morbidity rate was 7%. The mean postoperative hospital stay was 8.6 days (4-20) for all the series and 7.8 days in case of successful laparoscopic management. CONCLUSION: In 73% of the patients, the treatment of the common bile duct lithiasis could be achieved laparoscopically, but conventional approach and endoscopic sphincterotomy are still useful in case of failure of the laparoscopic management.

Adult↗
PubMed1999

[Long-term results of the treatment of eventrations by intraperitoneal non-absorbable prosthesis (149 patients)].

The authors report a series of 149 cases of incisional hernia, operated between 1983 and 1993, by insertion of a non-absorbable prosthetic mesh within the intraperitoneal cavity. This series consisted of 93 women and 56 men, with a mean age 57 years. One third of repairs were performed because of primary treatment failure. One or more operative risk factors were present in 127 patients. A non-absorbable intraperitoneal prosthetic mesh was inserted with tension to allow good musculo-aponeurotic repair. Postoperative mortality was 0.6%. All but 13 of the patients, were reviewed with a mean follow-up of 83 months. Twenty eight patients (20%) developed recurrence. In 8 cases, the cause of recurrence was failure of prosthetic mesh insertion because of excessive tension. Three patients (1.7%) developed a fistula in contact with the prosthetic mesh, that had to be removed. A small bowel fistula was observed in 2 cases after an intraoperative wound in 1 case, and a colonic fistula in 1 case. The results of incisional hernia repair with nonabsorbable intraperitoneal prosthetic mesh can be compared with these of other techniques using prosthetic materials. This technique does not require dissection of the intermediate planes and avoids undermining which causes substantial bleeding. The risk of sepsis is also decreased by deep placement of the prosthesis. The exceptional cases of fistula or the possibility of migration of the prosthesis are not exclusively observed with this technique, but must clearly encourage a very strict aseptic technique, with placement of omentum between the prosthetic mesh and the viscera.

Adult↗
PubMed1997

[Contribution of laparoscopy in the management of abdominal stab wounds].

Laparotomy is useless in 5 to 39% of patients suffering from penetrating abdominal trauma. The objective of this study is to try to determine the value of laparoscopy in the management of such patients. Thirteen patients underwent laparoscopy for abdominal wound. 11 of these patients had a penetrating abdominal trauma and only 4 of them suffered from lesions requiring surgical treatment (2 intestinal wounds, 1 gastric wound and 1 coeliac artery disruption). No treatment was required in 30 cases (1 wound of intestinal serosa and 2 superficial hepatic wounds). In the last 6 cases no intra-abdominal wound was found. There was no mortality or morbidity. No lesions were missed at laparoscopy. Laparoscopy avoided useless laparotomy in 9 out of 13 patients. This suggests that laparoscopy is a reliable method in the management of patients suffering from abdominal wounds, allowing a very sensitive and specific diagnosis of penetration and visceral injuries. In some cases, is allows laparoscopic treatment of the visceral injury.

Abdominal Injuries↗
PubMed1995

[Place of celio-video-surgery in splenectomy for hematologic diseases].

In order to evaluate the place of the laparoscopic approach in splenectomy for haematological disease, the authors prospectively studied a series of 25 consecutive patients requiring splenectomy. There were 11 cases of thrombocytopenic purpura, 9 lymphomas, 2 cases of herediary spherocytosis, 1 Felty syndrome, 1 idiopathic myelofibrosis and 1 Hodgkin disease. Twelve patients (48%) underwent an immediate conventional procedure for huge splenomegaly (10), obesity (1), unavailability of video-equipment. Thirteen patients (52%) underwent a laparoscopic approach. Five of these operations were converted into a conventional approach for various reasons. In the other 8 patients, the spleen was completely released laparoscopically. In two of these 8 patients, the spleen was removed via a sub-pubic Pfannenstiel incision due toits volume. The last 6 spleens (24%) were removed in a plastic bag, corresponding to 5 cases of one thrombocytopenic purpura and one Hodgkin disease. None of these patients were obese. These results suggest that the laparoscopic approach is indicated in case of moderate splenemegaly in non-obese patients.

Adult↗
PubMed1994

[Celioscopic treatment of perforations of duodenal ulcers. 6 cases].

Traditionally, perforations of duodenal ulcers are managed by suturing followed by peritoneal lavage and the underlying cause is addressed secondarily. Laparoscopy provides a means of meeting the different therapeutic needs. From May to October 1993, we treated 6 consecutive perforations of duodenal ulcers laparoscopically. In 5 cases, the perforation was the first manifestation of acute duodenal ulceration and the other case was chronic. The laparoscopic operation included peritoneal lavage and simple suture of the ulcer. The immediate post-operative period was uneventful. With a current follow-up of 3.6 months, 5 patients are asymptomatic and ulcer cicatrization has been confirmed by fibroscopy. In the sixth case with a past history of chronic duodenal ulcer, re-operation was required after a delay of 2 months for acido-fundic vagotomy (performed laparoscopically). The local presentation was satisfactory in this patient. Extensive peritoneal lavage, which can be performed with laparoscopy together with suture when the ulcer is recent, allows managing such patients according to Taylor's method. The usefulness of vagotomy can then be addressed and performed later laparoscopically after the initial lavage. This new approach offers a means of complete cure and has all the advantages of the classical technique.

Acute Disease↗
PubMed1994

[Pelvic lymphoceles after kidney transplantation. Intraperitoneal marsupialization by celioscopy].

OBJECTIVES: The appropriate treatment for symptomatic pelvic lymphoceles occurring after renal transplantation is still debated. External drainage exposes to risk of recurrence, infection or graft sclerosis and laparotomy has been required for intraperitoneal marsupialization in patients at risk. We report our experience with two cases treated by laparoscopic intraperitoneal marsupialization. PATIENTS: From November 1986 to September 1992, 170 renal transplantations were performed at our University Hospital. Lymphoceles developed in 12 cases and percutaneous puncture and irrigation was performed in all, successfully in 10. Relapse occurred in 2 patients--one 50-year-old woman with chronic glomerulonephritis and one 41-year-old man on peritoneal dialysis for polycystic renal disease--recipients of cadaver kidneys. SURGICAL TECHNIQUE: The laparoscopy was conducted under general anaesthesia. Four trocars were inserted, a 10 mm via the umbilicus for the optical system and three 5 mm trocars via the right and left flank and the left iliac fossa. A long puncture needle was used to drain the lymphocele and a localized collection and a large peritoneal window was created. The abdominal cavity was abundantly washed before withdrawing. RESULTS: Operation time was 35 minutes and conversion to laparotomy was not required. The only complication was a haematoma at one insertion site. Patients were discharged on day 2 and on day 1 with an unchanged immunosuppressor regimen. At 10 months follow-up, the patients were symptom-free and echography was normal. CONCLUSIONS: Surgical treatment of lymphoceles can be successfully performed by laparoscopy. The choice between conservative treatment and laparoscopic surgery remains to be determined.

Adult↗
PubMed1991

[Short hospitalization in routine surgery. Experience with an unselected population].

Three hundred and ninety eight consecutive patients about to be operated upon for inguinal hernia (165), varicose veins (101) or thyroid gland hyperplasia (132) were offered short stay surgery. Patients who left the hospital at day 1 and those who left after day 1 for personal convenience were compared as regards age, sex, occupation, one-sided or two-sided pathology, assisted or non assisted convalescence, life style and drug consumption after discharge. Hernia patients showed no difference in all these parameters. Among varicose vein patients, the proportion of short stay refusals was significant only in women. As for patients undergoing thyroidectomy, only those who had simple lobectomy were in the short stay group. In all cases, short stay had no adverse effect. The main obstacle to short stay surgery might well be the patient himself, as he benefits from full social cover and has access to surgical treatment without being on a long waiting list.

Adolescent↗
PubMed1989

[Splenectomy in Gaucher's disease. Apropos of 2 cases, one of which was preceded by embolization].

Two cases of Gaucher's disease type I are reported Splenectomy was indicated because of hypersplenism and massive splenomegaly. In one case hypersplenism was treated with pre-operative selective embolization because of the volume of the spleen (20 kg). The embolization corrected the thrombopenia but not the size of the spleen. Four years after operation for case 1 and eight months for case two, there is an improvement in the clinical status.

Child↗
PubMed1987

[One-stage treatment of neoplastic occlusions of the left colon. Apropos of 3 cases. Review of the literature].

The authors report of 3 news of subtotal colectomy with immediate anastomosis in the treatment of neoplastic occlusion of the left colon. They review all the cases (153) actually published. The advantages of this technic are: treatment of the occlusion and of the cancer in one stage; quicker social rehabilitation (14.8 days) useful overall in patients whom survival is short, lower mortality rate (10.45%) lower morbidity rate (25.6%) and quite none sequellae.

Adult↗
PubMed1986

[Cancers of the left colon with occlusion. Treatment by subtotal colectomy with immediate ileo-sigmoid anastomosis].

The technique of subtotal colectomy with immediate ileo-sigmoid anastomosis in the treatment of the carcinoma of the left colon revealed by obstruction is described. This operation treats, in one stage, both the obstruction and the cancer. The mortality, morbidity and duration of stay in hospital are less than with the usual sequential treatment. Social rehabilitation is quicker, which is particularly valuable since the expected survival of these patients is short due to old age, poor general condition or spreading of the malignancy.

Aged↗