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J P Lechaux

Publications and source records attributed to J P Lechaux.

At least 19 recordsLinked to original sources
PubMed2004

[Transperineal repair of rectocele with prosthetic mesh. A prospective study].

PURPOSE: To assess the long term results of a transperineal repair of rectocele with a prosthetic mesh and the criteria for selecting the patients. METHODS: Twenty-five consecutive patients (median age: 60 years) with a symptom-giving rectocele have been operated upon. Indication for surgery was: an obstructed defecation (N = 22); a fecal incontinence (N = 1); a pelvic heaviness with dyspareunia (N = 1) or a severe rectal syndrome (N = 1). Patients were evaluated by physical examination and, preoperatively, by defecography and anorectal manometry. The rectovaginal septum was repaired, through a perineal approach, with an absorbable (N = 5) or non absorbable (N = 20) prosthetic mesh. Long term results were assessed after a median follow-up of 45 (range 12-120) months by physical examination and a standardized questionnaire. The presence of the following three symptoms was evaluated: feeling of incomplete emptying, prolonged and unsuccessful straining at stool, digital assistance. Outcome was considered as successful when none of these symptoms were present, as good when minor emptying difficulties persisted, as moderate when emptying difficulties were associated with straining, as a failure when the symptomatic triad was unchanged. A general satisfaction score was established. RESULTS: All the patients had the defect of the rectovaginal septum corrected. Four patients had a low residual rectocele associated, in two cases, with a rectal prolapse subsequently treated by a Delorme's operation. Outcome in patients complaining of obstructed defecation was considered excellent or good in 80% of patients, moderate in 9% and poor in 9%. Subjective scoring showed a significantly better result in cases of success. Among 11 incontinent patients, seven (63.5%) improved or regained full continence. Dyspareunia in three cases was corrected. Age, parity, digital assistance, previous gynecologic surgery, use of laxatives, size of rectocele, type of mesh, anatomical result of repair had no significant prognostic value. On the other hand, in patients with obstructed defecation, clinical and manometric signs of anal hyperactivity of the pelvic floor or anismus (N = 4) were significantly related to a poor result (P < 0.001). CONCLUSION: Surgical repair with a prosthetic mesh is an efficient therapy in patients with obstructed defecation and/or incontinence caused by a rectocele. Clinical and defecographic parameters have no influence on outcome. Preoperative manometric data may help in selecting patients. In case of anal hyperactivity or anismus, given the risk of functional failure, behavioral retraining must be considered as first-line treatment.

Adult↗
PubMed2001

Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse.

BACKGROUND: Full thickness rectal prolapse in young adults with normal pelvic floor is a disease in which the rectum is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, which is expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. METHODS: Thirty-five patients (30 women) of median age 44 years (range 18 to 74) were operated on for full thickness rectal prolapse with normal pelvic floor. The rectum was mobilized posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired with a nonabsorbable mesh. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in 1 patient. Mean hospital stay was 8 days (range 6 to 14). Mean follow-up was 34 months (range 10 to 93). No recurrence was seen. Preoperatively, 33 patients (94%) complained of constipation mainly with emptying problems (21 patients) and 25 patients (71.5%) were incontinent. Postoperatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 17 patients (81%). Eighteen incontinent patients (72%) regained full continence. On the other hand, 2 patients with normal bowel function worsened and 1 patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal pelvic floor undergoing prosthetic rectopexy and sigmoid resection (a) morbidity was low, (b) anatomical control was obtained in all cases, (c) emptying problems were corrected, and (d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adolescent↗
PubMed1998

[Treatment of complete rectal prolapse with rectopexy to the pelvic floor with prosthesis and sigmoid resection. Anatomoclinical results of a prospective study].

UNLABELLED: BACKGROUND, AIM OF THE STUDY: Full thickness rectal prolapse in young adults with normal perineal structures is a disease of the rectum which is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. PATIENTS AND METHODS: Twenty patients (16 women and four men) of median age 41 years were operated on for full thickness rectal prolapse with normal perineal structures. The rectum was mobilised posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired, with a semi-absorbable prosthesis. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in one patient. Mean hospital stay was 8.7 days. Mean follow up was 30 (range 9-75) months. No recurrence was seen. Pre-operatively, 18 patients (90%) complained of constipation mainly with emptying problems (15 patients) and 13 patients (65%) were incontinent. Post-operatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 13 patients (86.5%). Eight incontinent patients (61.5%) regained full continence. On the other hand, two patients with normal bowel function worsened and one patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal perineal structures undergoing prosthetic rectopexy and sigmoid resection: a) morbidity was low, b) anatomical control was obtained in all cases, c) emptying problems were corrected, d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adult↗
PubMed1997

[The Pfannenstiel incision in colorectal surgery].

A parietal incision derived from Pfannenstiel's incision has been used since 1983 for surgery of the left colon and rectum. We conducted a prospective study in 100 patients with a mean age of 61 years who underwent surgery from 1984 to 1987 to assess the parietal outcome, postoperative pain and respiratory impact. The most frequent procedures were: sigmoidectomy (n = 48), anterior resection of the rectum (n = 24), rectopexia (n = 12), amputation of the rectum (n = 5) and total colectomy (n = 5). The splenic angle was mobilized in 23 cases. The operation also included a procedure to relieve occlusion in 4 patients. Operative mortality was nil. Parietal complications were bleeding (n = 4) or infection (n = 8). Seven early reoperations used the same access. Mean follow-up for 61 patients was 75 months. No cases of eventration were observed despite factors predictive of failure. Ventilatory impact, as measured by spirometry showed ventilatory peak-flow and blood gases comparable to those observed after a medial hypogastric incision. Pain, assessed on the bases of a visual analog scale and use of antalgesics, was considered to be mild on day 1, low on day 2 and absent on day 5. Sixty-five percent of the patients did not require antalgesics. In conclusion, this incision creates a hypogastric minilaparotomy allowing midline sub- and peri-umbilical, or even xyphoidial access with little pain and operative risk as the parietal risk is eliminated. Oral nutrition and activity can be resumed rapidly, reducing surgical stress in a protocol for minimally-invasive surgery.

Adult↗
PubMed1995

Results of Delorme's procedure for rectal prolapse. Advantages of a modified technique.

PURPOSE: A retrospective study was undertaken to assess the results of Delorme's procedure for rectal prolapse and to determine the advantages of an innovative extended transrectal repair, which aims at performing a total pelvic floor repair. METHODS: A total of 85 patients, ranging in age from 21 to 97 years, were operated on. Sixty-five (82 percent) patients had varying degrees of fecal incontinence. Similar groups of patients were compared with regard to control of the prolapse and restoration of continence according to 1) age and medical condition and 2) operative technique: original vs. extended operation. RESULTS: Twelve patients (14 percent) developed postoperative complications. There was one perioperative death (1.2 percent). Eighty patients were followed for 6 to 136 (median, 33) months. Eleven (13.5 percent) developed recurrent full-thickness prolapse. The recurrence rate was significantly different 1) between 44 elderly and poor operative risk patients not suitable for abdominal surgery (22.5 percent) and 41 younger patients without concurrent medical conditions, electively submitted to perineal repair (5 percent) (P < 0.05), and 2) between the original procedure (21 percent of 44 patients) and the modified technique (5 percent of 41 patients) (P < 0.05). Forty five patients (69 percent) improved or regained full continence. No patient worsened. No residual dysfunction was induced. Restoration of continence was not influenced by selection of patients or surgical technique. CONCLUSIONS: Despite increased morbidity (22 percent; P < 0.05), advantages of the modified technique were 1) over the original procedure, a reduced recurrence rate, 2) over perineal proctectomy, the absence of coloanal anastomosis and better functional outcome, and 3) over abdominal rectopexy, a less aggressive approach without disturbing effects on bowel habits.

Adult↗
PubMed1994

[Rupture of a scarred gravid uterus at 28 weeks of amenorrhea. Conservative surgical management and results].

Rupture of a scarred uterus during pregnancy is unusual, but remains a complication with serious consequences for both mother and fetus. It usually occurs towards the term of gestation and the case reported here is of interest because, atypically, the rupture of the uterus occurred some time before term in a scarred uterus and the immediate care provided was conservative surgery. The rest of the pregnancy proceeded to a successful outcome at term under clinical and obstetrical follow-up. The authors also highlight the additional precautions required in medically-assisted pregnancies in patients over 40 years of age.

Adult↗
PubMed1991

[Pre-peritoneal inguinal hernioplasty using Rhodergon's prosthesis. Study of a series of 282 hernia operations].

282 acquired inguinal hernias in 183 adult patients were treated between 1974 and 1986 by means of a pre-peritoneal prosthesis. Posterior herniorrhaphy with reconstruction of the internal inguinal ring was associated with this procedure from 1981 onwards. 75% of the patients were reviewed with a mean follow-up of 58 months. Analysis of the results demonstrated a significant correlation between recurrences and the use of a single midline prosthesis for bilateral hernias and parietalisation of the spermatic cord and between septic complications and the use of a silicone-coated velvet prothesis, which subsequently had to be abandoned. Age, sex, obesity, type of hernia and a history of herniorrhaphy did not have any influence on the results. In group of 150 hernias treated with a single, lateralised Rhodergon prosthesis with a transprosthetic cord and reconstruction of the internal inguinal ring, the recurrence rate was 1.3% (2 cases) and the deep infection rate was 0.6% (1 case). Apart from early recurrences due to technical errors, the long-term efficacy of this technique appears to be permanent.

Adult↗
PubMed1987

Treatment of rectal prolapse by Delorme's operation.

Rectopexy in the sacral hollow or to the promontory with synthetic material is the most efficient method of reducing and fixing a complete rectal prolapse. However, this distressing condition occurs frequently in elderly patients, often with high operative risk. In these some surgeons have advocated a perineal approach. Eighteen female patients (mean age 74 years) with complete rectal prolapse have been treated by a modified Delorme's procedure which involves a mucosal stripping of the prolapse and longitudinal plication of the muscular wall of the rectum. There was no postoperative mortality or morbidity. After a mean follow-up of 18 months, two complete recurrences occurred. These were treated by the same technique with a good result at 3 years. One other patient presented a partial and intermittent recurrence. Incontinence has improved in four patients and was not made worse in the others. Our results and those previously published show that this procedure is safe in elderly high risk patients considered too unfit for transabdominal surgery.

Aged↗
PubMed1984

[Delorme's operation in the treatment of rectal prolapse].

The Delorme operation for complete rectal prolapse is a mucosal stripping and longitudinal plication of the muscular wall of the rectum. It is a safe and easy procedure using peridural or local anesthesia with no post-operative morbidity or mortality. In the largest series published, the recurrence rate was 10 per cent. In our view, this operation, superior to the Thiersch procedure, is mainly recommended for elderly and poor risk patients who are unsuitable for a transabdominal approach.

Humans↗
PubMed1981

[Abdominal traumas due to the safety belt (author's transl)].

The use of motorcar safety belts has reduced mortality in road accidents but has given rise to the so-called "safety belt syndrome", a new pattern of lesions the most common and most severe of which are lesions of the abdominal wall and viscera. A case of transsection of the whole abdominal wall with mesenteric tear is reported here and numerous cases of intestinal perforation have been published. Diagnosis is often difficult and delayed. Analysis of the pathophysiology of these lesions shows that most of them are caused by incorrectly placed or adjusted belts. Prevention can only result from improved education of car drivers and passengers and from the development of more efficient safety devices.

Abdominal Injuries↗