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Biomedical subjects

J L Faucheron

Publications and source records attributed to J L Faucheron.

30 records · Page 2Linked to original sources
PubMed1998

[Surgical morbidity of segmental colectomy ideally performed via laparotomy for complicated colonic diverticulosis].

OBJECTIVES: The appraisal of morbidity and mortality for one stage elective colectomy for complicated diverticulosis is difficult and often overestimated, due to the rarity of reports addressing this question. Our results for 100 patients on a recent 30 month period were studied retrospectively. METHODS: One hundred patients were electively operated in a one-stage procedure for complicated diverticulosis in a single institution from January 1993 to June 1995. There were 66 females and 34 males (range: 31-81 years) with a mean age of 61 years. Main indications for surgery were repeated attacks (34 patients), chronic inflammatory mass (26 patients) and stenosis (22 patients). Seventy-eight patients had already been admitted for diverticulitis prior to surgery. There were 13 surgeons including 6 seniors and 7 fellows. RESULTS: There was no mortality. Morbidity was 14% surgical and medical complications accounting for 8% and 6% respectively. One patient had an anastomotic fistula treated conservatively and another patient was reoperated on for early postoperative occlusion There was no perioperative bleeding requiring transfusion. There were no surgical trauma of spleen or uretera. Mean hospital stay was 10 days. CONCLUSION: This study of a collective surgical experience demonstrates that elective one stage left colectomy for benign disease is safe, without mortality and with low morbidity.

Adult↗
PubMed1996

Non-steroidal anti-inflammatory drug-induced colitis.

Non-steroidal anti-inflammatory drugs (NSAIDs) may adversely affect the colon, either by causing a non-specific colitis or by exacerbating a preexisting colonic disease. Patients with NSAID-induced colitis present with bloody diarrhoea, weight loss, iron deficiency anaemia and sometimes abdominal pain. Colonoscopy may be normal or may show inflammation, ulceration or diaphragm-like stricture. Histology often concludes to non-specific colitis. NSAIDs may cause perforation or bleeding of colonic diverticula, may cause relapse to inflammatory bowel disease and may exacerbate bleeding of colonic angiodysplasia. Pathogenesis of NSAID-induced colitis is still controversial. Local and/or systemic effects of NSAIDs on mucosal cells might lead to an increased intestinal permeability, which is a prerequisite for colitis. Treatment of NSAID-induced colitis should be to discontinue the drug, or at least, to reduce the dose as much as possible. Sulphasalazine and Metronidazole have been successfully used in few studies. Surgery is often indicated in case of life threatening complications or untractable symptoms.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

Long-term seton drainage for high anal fistulas in Crohn's disease--a sphincter-saving operation?

METHODS: Forty-one consecutive patients with Crohn's disease who underwent long-term seton drainage for high transsphincteric, suprasphincteric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), secondary fistulotomy (7), rectal flap advancement (3), and proctectomy (2). Eleven patients still had the seton in place. RESULTS: Recurrence developed in seven patients (39 percent) undergoing simple seton removal and in one patient undergoing rectal flap advancement. None of the patients treated by secondary fistulotomy developed a recurrence. At the end of follow-up, five patients (12 percent) required proctectomy mainly for severe proctitis, and five patients (12 percent) developed anal incontinence, which was severe in two. CONCLUSION: Long-term seton drainage for high and fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function.

Adolescent↗
PubMed1996

Placebo-controlled clinical trial of mesalazine in the prevention of early endoscopic recurrences after resection for Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: Endoscopic postoperative recurrences occur early after 'curative' surgery for Crohn's disease. Pentasa has been shown to be effective in the maintenance treatment of quiescent Crohn's disease. The aim of this study was to test the efficacy of a 12-week oral intake of Claversal in the prevention of endoscopic recurrences after 'curative' resection for ileal, colonic or ileocolonic Crohn's disease. We conducted a multicentre double-blind controlled trial comparing Claversal (1g tid) with placebo, starting within 15 days after surgery. The macroscopic normality of the two anastomotic segments was assessed at surgery. Patients were clinically and biologically evaluated twice (6-week interval), and colonoscopy was performed at 12 weeks. Endoscopic relapse was defined by any anastomotic ulcerations or stenosis and staged according to a four-grade score. RESULTS: Between May 1989 and May 1991 12 centres included 126 patients, 70 women and 56 men, aged 33 +/- 12 years (range 16-70) in the study. Disease locations were ileal, colonic and ileocolonic in 45, 6 and 49%, respectively. Claversal and placebo groups were similar at inclusion, except for ESR (37 +/- 26 vs. 27 +/- 23 mm/h in the Claversal and placebo groups, respectively; P < 0.05). Nine patients were withdrawn from the study. Adverse reactions occurred only in six patients. Five patients were excluded for protocol violation. Finally, 106 patients could be evaluated at 12 weeks (55 Claversal and 51 placebo). An endoscopic relapse was observed in 50% and 63% of the Claversal and placebo groups, respectively (P = 0.16), with a similar grade distribution. Claversal was well tolerated. CONCLUSIONS: Our study confirms that a large proportion of endoscopic recurrences occur within 3 months of resection in Crohn's disease. There was a slight trend towards greater efficacy of Claversal; it could be worthwhile trying higher dosages and/or 5-ASA compounds with different intestinal release profiles.

Administration, Oral↗
PubMed1994

Is fecal continence improved by nonstimulated gracilis muscle transposition?

PURPOSE: Gracilis muscle transposition for treatment of fecal incontinence gives variable results. Electric stimulation of transposed muscle recently brought this technique to the surface. METHODS: We reviewed patients who had gracilis muscle transposition for fecal incontinence to determine who might benefit from electrostimulation. RESULTS: Between 1979 and 1991, 22 patients underwent gracilis muscle transposition. At six months, 18 patients had improved continence, but 12 of the 18 were stable with time, and only 1 was fully continent. Six patients were candidates for electrostimulation; four had a contractile but fatigable transposed muscle, and two had ineffective transposed muscle with a gaping nonfibrotic anus. CONCLUSION: Gracilis muscle transposition should be used first for severe incontinent patients, and electrostimulation should be used if there are unsatisfactory results.

Adolescent↗
PubMed1994

[Entero-enteral fistulas in Crohn disease: radical or conservative surgical treatment of the "victim" segment?].

OBJECTIVES AND METHODS: Entero-enteral fistulas join a segment affected by Crohn's disease to another which becomes a drainage route and a "victim" of the process. Surgical treatment can be radical (extensive resection of both segments) or conservative (resection of involved bowel and conservation of the "victim"). Fifty-nine patients operated on for Crohn's disease and having 80 entero-enteral fistulas were retrospectively studied. RESULTS: Main surgical indications were symptomatic intestinal stenosis (56%) or abdominal mass (20%) unresponsive to medical treatment. Fistula was discovered during operation in 33 patients (56%). Conservative treatment was performed in 39 fistulas (49%). In 41 fistulas (51%), proximity of fistulous ends, or Crohn's disease's extension, led to radical treatment. In 66 fistulas (82.5%), histologic examination revealed that Crohn's disease affected only one bowel segment, the other demonstrating only non specific features; in the 14 remaining fistulas (17.5%), Crohn's disease affected both segments. CONCLUSIONS: The clinical presentation of entero-enteral fistulas (non-specific symptoms, frequent peroperative diagnosis), their pathological features (victim segment often free of Crohn's disease) plead for a conservative surgical approach, i.e. adapted to real bowel involvement by Crohn's disease.

Adolescent↗
PubMedDate not supplied

Pelvic anatomy for colorectal surgeons.

INTRODUCTION: recent advances in rectal surgery include total mesorectal excision and preservation of the autonomic pelvic nerves, so that colorectal surgeons have to get some information on the embryology of the rectum, on the complex anatomy of the pelvic floor and on the distribution of lymphatic nodes. Embryology includes the formation of the hindgut during the first month of the embryo and the subsequent formation of the rectum and anal canal. The mesorectum contains the blood vessels and the lymphatic nodes. To totally excise the mesorectum, the surgeon should follow the "holy plane" described by Heald, between the perirectal fascia and the pelvic fascia. Doing this, the surgeon has the best chance to preserve the autonomic pelvic nerves that comprise the superior hypogastric plexus, the right and left hypogastric nerves and the right and left inferior hypogastric plexuses.

Colon↗
PubMedDate not supplied

[Influence of ano-perineal lesions on the outcome of the rectum in colonic and rectal Crohn disease].

Between 1960 and 1988, 83 patients (38 men, 43 women) underwent colectomy and ileorectal anastomosis (IRA) for severe colonic or rectal Crohn's disease. The mean age at IRA was 28.5 years. The mean interval from diagnosis was 4 years. There were two post-operative deaths. Among the 81 survivors 5 patients who had a covering ileostomy have never had their stomas closed and 24 patients required exclusion or excision of their IRA and rectum. (= 10 defunctioning IRA, 14 proctectomies with definitive ileostomy). The mean interval between IRA and the creation of a permanent ileostomy was 4.1 years. The mean interval between the onset of problems following IRA and permanent ileostomy was 2 years. 25 patients had perianal lesions prior to IRA. 5 of these patients had unhealed perianal disease at IRA and 7 required defunctioning ileostomy (28%). The need for rectal excision or exclusion following IRA was not related to the presence of perianal disease prior to IRA but functional results were worse. 33 patients developed perianal lesions following their IRA, among whom 19 required exclusion or excision of the rectum. Failure of IRA was then significantly higher amongst those who developed lesions following IRA. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior protectomy.

Adult↗