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J Mouiel

Publications and source records attributed to J Mouiel.

At least 19 recordsLinked to original sources
PubMed2006

Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial.

BACKGROUND: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complications of laparoscopic Roux-en-Y gastric bypass (LRYGBP), ranging from 0.1-4.3% and from 0.8-4.5% respectively. The safety and efficacy of a fibrin glue (Tissucol) was assessed when placed around the anastomoses and over the mesenteric openings for prevention of anastomotic leaks and internal hernias after LRYGBP. METHODS: A prospective, randomized, multicenter, clinical trial commenced in January 2004. Patients with BMI 40-59 kg/m2, aged 21-60 years, undergoing LRYGBP, were randomized into: 1) study group (fibrin glue applied on the gastro-jejunal and jejuno-jejunal anastomoses and the mesenteric openings); 2) control group (no fibrin glue, but suture of the mesenteric openings). 322 patients, 161 for each arm, will be enrolled for an estimated period of 24 months. Sex, age, operative time, time to postoperative oral diet and hospital stay, early and late complications rates are evaluated. An interim evaluation was conducted after 15 months. RESULTS: To April 2005, 204 patients were randomized: 111 in the control group (mean age 39.0+/-11.6 years, BMI 46.4 +/- 8.2) and 93 in the fibrin glue group (mean age 42.9+/-11.7 years, BMI 46.9+/-6.4). There was no mortality or conversion in both groups; no differences in operative time and postoperative hospital stay were recorded. Time to postoperative oral diet was shorter for the fibrin glue group (P = 0.0044). Neither leaks nor internal hernias have occurred in the fibrin glue group. The incidence of leaks (2 cases, 1.8%) and the overall reoperation rate were higher in the control group (P=0.0165). CONCLUSION: The preliminary results suggest that Tissucol application has no adverse effects, is not time-consuming, and may be effective in preventing leaks and internal hernias in morbidly obese patients undergoing LRYGBP.

Adult↗
PubMed2005

Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation.

Subtotal colectomy with cecorectal anastomosis represents an interesting alternative to total colectomy with ileorectal anastomosis. Several technical variants to the methods for performing the anastomosis between the cecum and the rectal stump after subtotal colectomy have been reported. The mechanical, antiperistaltic, end-to-end cecorectal anastomosis is safe and easy to perform. The authors aimed to assess the safety and feasibility of this technique performed laparoscopically in a series of four patients. All the procedures were completed laparoscopically. The mean time for surgery was 200 min (range, 180-220 min). There was no mortality and no postoperative complications. The mean hospital stay was 4 days (range, 3-5 days). This technique can be performed laparoscopically with all the advantages inherent to the minimally invasive approach.

Adult↗
PubMed2001

[Morbid obesity, public health problem: laparoscopic surgical treatment].

Morbid obesity, commonly defined as a condition in which the weight exceed twice the ideal body weight, is a major public health concern, widely unrecognized in France whereas causing 55,000 deaths per year to compare to 8,000 deaths per year by traffic accidents. Its pathogenesis is discussed even if much attention in recent years has centered on genetic causes since the identification of the ob-gene and its protein product leptin. Due to the long term failure of medical treatments, the advent of laparoscopy had disrupted therapeutic and carried on exponential development of laparoscopic operations mainly by gastric banding using an adjustable ring not without complications. It is why we have performed a prospective study by laparoscopy in 100 patients comparing 3 operations with the aim that each indication could be adapted to the alimentary behaviour. The short term results are extremely favourable and comparable to international literature data. Moreover, the study is a plea for a multidisciplinary approach of morbid obesity and a core for a public health action.

Adolescent↗
PubMed2000

Caspase inhibition protects from liver injury following ischemia and reperfusion in rats.

Normothermic ischemia and reperfusion of the liver results in microcirculatory failure followed by necrosis and cell death. Recently, another type of cell death, apoptosis or programmed cell death, was found to be activated during the early phase of reperfusion after liver ischemia. Caspases are cysteine proteinases specifically involved in the initiation and execution phases of apoptosis. The aim of this study was to demonstrate that inhibition of apoptosis by a specific inhibitor of caspases might protect the liver against ischemia/reperfusion injury. Rats were divided into three groups: group 1, control, PBS administration; group 2, Z-Asp-cmk (Z-Asp-2,6-dichlorobenzoyl-oxymethylketone) treatment; group 3, sham-operated control animals. Z-Asp-cmk (0.5 mg Z-Asp-cmk dissolved in 300 microl PBS solution containing 1% DMSO) was injected intravenously, 2 min prior to induction of 120 min ischemia. Survival rates were compared and serum activities of aspartate aminotransferases and alanine aminotransferases were assessed in the blood collected from the suprahepatic vena cava. Histology of the liver was assessed 6 h after the end of ischemia. Apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP-FITC nick end-labeling method (TUNEL method) and by electrophoresis for analysis of DNA fragmentation. Caspase activity was determined by measuring hydrolysis of the CPP32-like substrate Ac-DEVD-pNA and absorption of paranitroaniline. Z-Asp-cmk treatment significantly increased 7-day survival (95%) compared with that in nontreated rats (30%, P < 0.001). Serum activities of aminotransferases and the extent of liver congestion and necrosis were significantly (P < 0.001) decreased after treatment with Z-Asp-cmk. TUNEL-positive cells were detected 3-6 h after reperfusion in the control group. In Z-Asp-cmk pretreated rats, a dramatic decrease in the number of TUNEL-positive cells was observed. Analysis of DNA fragmentation of freshly isolated hepatocytes confirmed these results. Caspase activity was increased 3-6 h after reperfusion in the control group, but significantly (P < 0.001) decreased after treatment with Z-Asp-cmk. These findings demonstrate that liver injury following ischemia and reperfusion can be prevented by inhibition of caspases. Caspase inhibitors may have important implications for therapy in liver disease and after liver transplantation.

Alanine Transaminase↗
PubMed2000

Possibilities of laparoscopic liver resection.

The aim of this study was to report the results of our experience in liver surgery by laparoscopy. From 1989 to 1996, 30 patients (20 women, 10 men; age, 23-88 years; mean age, 53.9 years) underwent laparoscopic liver surgery at our Institute for the following pathology: 10 for biliary cysts, 7 for polycystic diseases, 8 for benign tumors, 3 for hydatid cysts, 1 for chronic abscess, and 1 for metastasis. The locations of these lesions were: 19 in the left lobe, 4 in the right lobe, and 7 in both lobes. Their average size was 8. 45 cm (range, 2.5-22 cm). The largest lesions were biliary cysts; among benign tumors, the maximum diameter was 8 cm. Surgical treatment was as follows: 17 deroofings, 3 pericystectomies, 7 tumorectomies, and 3 left lobectomies. The mean operative time was 79 min (range, 45-527 min). Three of the 30 laparoscopic procedures (10%) were converted to open surgery, because of bleeding in 2 patients with polycystic disease and because it was impossible to carry out the dissection in 1 patient with liver-cell adenoma adjacent to the left portal branch. There were no deaths in this series and 6 patients showed morbidity: 2 patients with polycystic disease developed ascites and required intensive care unit recovery, 1 patient had phlebitis, 1 had infection of the urinary tract, and 2 had local septic complications. Preliminary findings show that the laparoscopic approach to liver lesions may represent safe and effective treatment in selected patients, on condition that several technical details are respected. Of fundamental importance are the surgical equipment, the presence of two experienced operators to do four-hands surgery, and the careful selection of indications, reserving laparoscopic treatment only for those lesions located in easily accessible areas, mainly in the lateral and anterior hepatic segments.

Adult↗
PubMed2000

Laparoscopic management of benign cystic lesions of the liver.

We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31 patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size of the solitary liver cysts was 14 cm (range, 7-22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control bleeding. The median operative time was 141 min (range, 94-165 min) for patients with PLD and 179 min (range, 88-211 min) for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1-3 days), 3 days (range, 2-7 days), and 5 days (range, 2-17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range, 3-78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.

Adult↗
PubMed2000

[Surgical treatment of anterior rectoceles in women. The transanal approach].

Anterior rectocele is a herniation of the anterior rectal wall into the vagina, which may be either isolated or associated with other pelvic floor disorders. Rectocele could result in outlet obstruction with dyschezia, manual extraction of faeces and/or false incontinence. Rectocele is diagnosed clinically, and can be confirmed by defecography. Other tests may demonstrate associated causes of constipation. Symptomatic rectoceles can be treated via a transrectal route, with two or three layers of plication of the rectal wall and excision of the redundant mucosal flap. The results of transrectal repair are good: short hospital stay, no mortality, morbidity less than 5%, good short- and mid-term results in approximately 80% of cases. Selection criteria in favour of the transrectal approach have not been clearly identified.

Anal Canal↗
PubMed2000

Laparoscopic repair of chronic intrathoracic gastric volvulus.

BACKGROUND: Totally intrathoracic gastric volvulus is an uncommon presentation of hiatal hernia, in which the stomach undergoes organoaxial torsion predisposing the herniated stomach to strangulation and necrosis. This may occur as a surgical emergency, but some patients present with only chronic, non-specific symptoms and can be treated electively. The aim of this study is to describe a comprehensive approach to laparoscopic repair of chronic intrathoracic gastric volvulus and to critically assess the pre-operative work-up. METHODS: Eight patients (median age, 71 years) underwent complete laparoscopic repair of chronic intrathoracic gastric volvulus. Symptoms of epigastric pain and early satiety were universally present. Five patients had reflux symptoms. The diagnostic evaluation included a video esophagogram, upper endoscopy, 24-hour pH measurement, and esophageal manometry in all patients. Operative results and postoperative outcome were recorded and follow-up at 1 year included a barium swallow in all patients. RESULTS: All patients had documented intrathoracic stomach. Five of 8 patients had a structurally normal lower esophageal sphincter. All 4 patients with reflux esophagitis on upper endoscopy had a positive 24-hour pH study, and 2 of these patients had a structurally defective lower esophageal sphincter on manometry. None of the patients had preoperative evidence of esophageal shortening. All procedures were completed laparoscopically. The procedure included reduction of the stomach into the abdomen, primary closure of the diaphragmatic defect, and the construction of a short, floppy Nissen fundoplication. There were no major complications. One patient required repair of a trocar site hernia 6 months postoperatively. At 1-year follow-up, there were no radiologic recurrences of the volvulus. One patient complained of temporary swallowing discomfort and another had recurrent gastroesophageal reflux disease (GERD) symptoms caused by a breakdown of the wrap. All other patients remained asymptomatic during follow-up. CONCLUSIONS: The repair of chronic gastric volvulus can be accomplished successfully with a laparoscopic approach. A preoperative endoscopy and esophagogram are crucial to detect esophageal stricture or shortening, and manometry is needed to access esophageal motility; pH measurements do not affect operative strategy. The procedure should include a Nissen fundoplication to treat preoperative GERD, to prevent possible postoperative GERD, and to secure the stomach in the abdomen. The procedure is safe but technically challenging, requiring previous laparoscopic foregut surgical expertise.

Aged↗
PubMed1999

Laparoscopic management of benign solid and cystic lesions of the liver.

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.

Adult↗
PubMed1998

Improvement of normothermic rat liver ischemia/reperfusion by muramyl dipeptide.

Normothermic ischemia and reperfusion (I/R) of the liver remains a major problem after liver surgery and transplantation. Activation of Kupffer cells (KCs) after normothermic I/R is responsible for a massive release of various monokines such as tumor necrosis factor alpha (TNF-alpha) and a decrease in phagocytic activity. Muramyl dipeptide (MDP) is an immunostimulant that increases phagocytic activity of KCs. The aim of this study was to demonstrate that MDP pretreatment might protect the liver against I/R injury by a modification of KC functions. Rats were divided into three groups: group 1, control, Ringer's lactate administration; group 2, MDP (N-acetyl-muramyl-d-alanyl-d-isoglutamine) treatment; group 3, sham-operated control animals. MDP (500 microg/250 g) was injected intravenously 5 min before the induction of 90 min ischemia. Survival rates were compared and serum activities of TNF-alpha, aspartate aminotransferase, and alanine aminotransferase were assessed in the blood collected from the suprahepatic vena cava. Histology of the liver and KC activity were assessed 6 and 9 h after the end of ischemia, respectively. MDP treatment significantly increased 7-day survival (86.6%) compared with nontreated rats (40%, P < 0.001). Serum activities of TNF-alpha and aminotransferases were significantly decreased after MDP treatment, whereas phagocytic capacity of KCs was partially restored. The extent of liver necrosis was decreased after MDP administration. A significant difference was observed for other histological parameters studied, except for steatosis. Our findings have demonstrated that MDP is able to protect the liver from ischemic insult by modulation of KC activity (TNF-alpha release and phagocytic capacity). Control of macrophage activity may offer a new strategy to reduce ischemic injury of the liver.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1998

Laparoscopic liver surgery. A report on 28 patients.

BACKGROUND: An effort was made to evaluate the indications, safety, and therapeutic efficacy of laparoscopic liver surgery. METHODS: Between 1989 and 1996, 28 patients, 23 to 88 years old were operated upon laparoscopically. Pathology consisted of simple cyst (ten), polycystic liver disease (seven), hydatid cyst (three, two of them calcified), abscess (one), focal nodular hyperplasia (six), and metastatic breast cancer (one). RESULTS: Operations included 17 fenestrations, three pericystectomies, and eight resections (two lateral lobes). Operative time was 45 to 525 min with only four cases longer than 4 h. There was a 21% morbidity rate. There were no mortalities. Follow-up was 1-67 months with one asymptomatic recurrence. CONCLUSIONS: Laparoscopic hepatic surgery can be performed safely with good results by surgeons with hepatic and laparoscopic experience when careful selection criteria are followed. We advocate the "four-hands technique" for simultaneous dissection and control of bleeding and bile ducts during resections.

Adult↗
PubMed1998

An improved technique for laparoscopic highly selective vagotomy using harmonic shears.

BACKGROUND: Results from classic highly selective vagotomy (HSV) are technique dependent because an incomplete operation will result in early recurrence of duodenal ulcer. Few reports describe laparoscopic completion of the procedure. All techniques use clips for division of neurovascular branches, making the laparoscopic approach tedious and thus the results, uncertain. METHODS: Ten patients with intractable duodenal ulcer and negative Helicobacter pylori status underwent an extended HSV. All procedures were performed laparoscopically using a new surgical tool, the harmonic shears. RESULTS: All procedures were completed laparoscopically and took approximately 1 h. There were no deaths and no postoperative complications. Patients were discharged the next day. Follow-up endoscopy at 2 months showed healing of duodenal ulcer in all cases, and postoperative acid secretion studies demonstrated a decrease in basal acid output (BAO) by 74% (8.2 meq/h to 2.16 meq/h) and maximal acid output (MAO) by pentagastrin stimulation by 79.2% (40 to 8.32). CONCLUSIONS: Harmonic shears expedite laparoscopic HSV. The operation can be taught safely, yields good results in early follow-up, and represents an acceptable option in patients with intractable duodenal ulcers who are H. pylori negative.

Adult↗
PubMed1998

Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients.

OBJECTIVE: To study the safety and efficacy of laparoscopic splenectomy (LS) in patients with predominantly benign hematologic disorders. SUMMARY BACKGROUND DATA: The technical feasibility of LS has been recently established. However, data regarding the efficacy of the procedure in a large cohort of patients are scarce. METHODS: One hundred three consecutive patients underwent LS between June 1992 and October 1997. Data were collected prospectively on all patients. RESULTS: Indications were idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura, and others. Mean spleen size was 14 cm and mean weight was 263 g. Accessory spleens were found in 12 patients with ITP and in 5 patients without ITP. There were no deaths. Complications occurred in six patients, one requiring a second procedure for small bowel obstruction. Six patients received transfusions, and four procedures were converted to open splenectomy for bleeding. Mean surgical time was 161 minutes and was greater in the first 10 cases than the last 10. Mean postsurgical stay was 2.5 days. Thrombocytopenia resolved after surgery in 84% of patients with ITP, and hematocrit levels increased significantly in 70% of patients with chronic hemolytic anemias. A positive response was noted in 92% of patients with hereditary spherocytosis, without relapse for the duration of the observation. ITP relapsed in four patients during follow-up, three within 12 months. CONCLUSIONS: LS can be performed safely and effectively in a teaching institution. Rigorous technique will minimize capsular fractures, reducing the risk of splenosis. Accessory spleens can be successfully localized, thus improving response and limiting recurrence of ITP. LS should become the technique of choice for treatment of intractable benign hematologic disease.

Adult↗
PubMed1998

Outcome of laparoscopic transabdominal preperitoneal inguinal hernia repair.

The long-term efficacy of laparoscopic inguinal hernia repair is unknown. This retrospective study was conducted to determine the efficacy of this operation in comparison with the open technique and to evaluate the possible factors of recurrence. We have evaluated the clinical outcome in a group of patients who underwent laparoscopic procedures between January 1995 and December 1996, with the aim of assessing the incidence of recurrence and of long-term complications. Sixty-three patients underwent laparoscopic transabdominal preperitoneal repair by use of a large mesh. We were able to examine 58 of these patients at a median follow-up time of 15 months since their operation. Four patients had developed a recurrence, and two patients had significant symptoms consistent with nerve damage. The recurrence rate of 7% is similar to that reported for open operations but higher than that reported for early follow-up after laparoscopic operations. Our study illustrates the value of long-term follow-up for the assessment of efficacy following laparoscopic inguinal hernia surgery.

Adolescent↗