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Biomedical subjects

P Boutelier

Publications and source records attributed to P Boutelier.

At least 19 recordsLinked to original sources
PubMed1991

[Severe upper gastrointestinal hemorrhages due to peptic ulcer. A plea for admission to a surgical unit].

Despite improvements in exploratory methods and the introduction of endoscopic haemostasis procedures, bleeding remains a severe complication of peptic ulcers. A retrospective study of 142 cases collected over a 10-year period showed an overall mortality rate of 12.76 percent: 9.2 percent in non surgical patients and 17.1 percent in patients operated upon. The latter figure fell to 9 percent when cirrhotic patients were excluded. The criteria required for surgical treatment and the choice of the most appropriate operative technique are defined. In elderly people and/or in patients with underlying diseases, when the blood pressure is kept stable the risk of surgery is lower than the risk of cardiovascular collapse. This type of surgery is justified only if it eliminates all risk of recurrent bleeding.

Adolescent↗
PubMed1991

[Evaluation of the efficacy of a new generation of hemostatic collagen compresses. Results of a multicenter prospective study in visceral surgery and neurosurgery].

The hemostatic potential, tolerance and handiness of a new generation of hemostatic sheets (Hemostagene) were compared with those of reference collagen sheets in a randomized parallel-group multicenter study. Both types of hemostatic sheets, issued from calf derm, have been evaluated in digestive and neurosurgical pathologies. The comparability of both groups (52 patients in the Hemostagene group A, 54 in the reference group B) has been verified on morphological data, coagulation records and hemostasis conditions. The time required to achieve hemostasis was slightly, yet not significantly, shorter in group A (3 min 27 sec) than with the reference sheet (4 min 10 sec). This new sheet was judged significantly handier than the reference sheet. Adherence to the gloves and instruments was very significantly (p less than 0.0001) more frequent in the reference group B than in the group A. Both collagen sheets have quite similar clinical, biological and immunological tolerances which confirms the literature data. So, this new sheet, together with an hemostasis at least as good as the one obtained with the reference sheet, brings a highly improved handiness.

Bandages↗
PubMed1990

[A new method of surgical treatment of gastro-esophageal reflux. Retro-esophageal fundoplication associated with peritoneal tying of the cardia].

The technique proposed consists in tying the cardia with a strip of pre-esophageal peritoneum, along with performing a retro-esophageal fundoplication in proportion to the degree of hypotonia of the lower esophageal sphincter. The physiopathological bases of strip tying are described. A prospective study on 8 consecutive operated patients states the clinical, radiological and manometric results achieved.

Adult↗
PubMed1986

[Endoscopic sclerosis of esophageal varices].

The increasing popularity of treatment of esophageal varices by endoscopic sclerosis is the result of two factors. First, the principle underlying the procedure, which tends towards selective occlusion of the submucous venous network at the esophagogastric junction, where the risk of rupture is maximal, while respecting other periesophageal bypass pathways of portal blood. Second, the improvement of the apparatus used, thus simplifying the operation and reducing risks, and the improved definition of the limitations of medicosurgical treatment of portal hypertension. Results may be altered by several variables: protocol of injections, particularly intra- or paravascular site of injection, nature of sclerosing agent, type of endoscopy performed, size of varices, etiology of portal hypertension and severity of hepatic lesion and especially the relation between time of operation and the hemorrhagic episode. Hemostasis of a ruptured esophageal varix was obtained in 75 to 100% of cases. Adequate follow up and repeat injections are essential for varicose recurrences (long-term relapse rate = 50%) to avoid hemorrhagic complications.

Emergencies↗
PubMed1986

[Surgery of duodenal ulcer. In decline?].

The authors report their experience of the surgical treatment of duodenal ulcer disease and its complications over a 10 year period (1976-1986), i.e. 336 cases from a group of 10748 digestive tract endoscopies performed and 1126 duodenal ulcers identified (10.4%). The efficacy of new types of medical treatment (anti-secretory drugs, endoscopic hemostasis techniques, prostaglandins) and the improved follow-up of patients tend, despite the value and proven safety of Parietal-cell Vagotomy (elective procedure in 76% of the group), to modify: the epidemiological aspect of the disease in the sense of a decrease in the rate of ulcers with complications related to stenosis and perforation; the therapeutic aspect with more limited surgical indications. Is this the end of surgery for duodenal ulcer and its complications?

Duodenal Ulcer↗
PubMed1983

[Common bile duct lithiasis. Reflections apropos of 1000 cases].

One thousand case reports of patients treated in eleven French surgical departments for stones in the common bile duct between 1975 and 1982 were analyzed. One in three cases were asymptomatic and detected by peroperative radiology during treatment of a simple or complicated gallstone, most forms were painful, with jaundice in 9 p. cent, an angiocholitis in 12 p. cent, and biliary pancreatitis in 2 p. cent. The most reliable exploratory procedure for gallstones is ultrasound imaging, as positive results were obtained in 90 p. cent of cases, but it enabled the diagnosis of choledocholithiasis in only one out of five patients. Intravenous cholangiography is a useful diagnostic tod for painful forms (60 p. cent). The failure of these two methods to establish the diagnosis in forms complicated by jaundice, pancreatitis, or angiocholitis has to be compared with the good results (85 p. cent) observed with endoscopic retrograde cholangiography. Treatment was surgical in 99 p. cent of patients, peroperative radiology being performed in 95 p. cent of these cases and endoscopy in 30 p. cent. In one out of two cases a single large stone was present while multiple stones were present in 8 p. cent. A "ideal" choledochotomy was carried out in 77 patients (7,7 p. cent) without mortality. External biliary drainage in 702 cases resulted in a 1.7 p. cent mortality rate, this increasing to 8 p. cent after 192 biliodigestive shunt operations, and 7 p. cent after 146 sphincterotomies, including 18 under endoscopic control. Unrecognized lithiasis, detected during follow-up radiography two weeks after external biliary drainage, accounted for 2-8 p. cent of cases. Of the 30 patients with residual stones and open biliary pathways, 6 were treated by mechanical removal, 6 by endoscopic sphincterotomy, and the others by repeat surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Colonic occlusions. Retrospective cooperative study of 497 cases].

A retrospective multicenter study involving 12 digestive surgery centers was conducted on 497 cases of colon obstruction. The most frequent cause of colon obstruction was colo-rectal cancer (71 p. cent of cases), but many other etiologies were involved, including 61 cases of torsion and 37 patients with occlusive sigmoiditis. Differential clinical and radiological features in each etiological group are discussed, the results of therapy undertaken analyzed, and a reasonable line of conduct proposed, adapted to each situation, with the objective of attempting to reduce mortality which still affects 25 p. cent of cases operated upon.

Adult↗
PubMed1982

[Surgical treatment of acute complicated colitis. Report on twenty-eight cases (author's transl)].

Experience with 28 patients with acute diffuse complicated colitis operated on in emergency or semi emergency by the same surgical team is reviewed. The forms with colonic dilatation are the most numerous but do not resume the serious complications which may occur in the course of non specific inflammatory diseases of the colon. The operative mortality in this series was 10,7% (3/28). Peritoneal sepsis was the most significant factor contributing to mortality. It appears that the keystone to successful management is to prevent colonic perforation. Protracted medical management may be at last partly responsible for this complication. Failure of intensive medical therapy to induce rapid improvement constitutes an indication for definitive surgical treatment.

Acute Disease↗
PubMed1982

An alternative fundoplicative maneuver for gastroesophageal reflux.

Twenty-two patients with gastroesophageal reflux undergoing an original antireflux operative procedure are presented. The mean time between operation and follow-up was 19 months. The technique consists of a semifundoplicative maneuver with firm intraabdominal fixation of the esophagus by suturing the fundoplication to the diaphragm. There was no mortality. The patients were free of reflux symptoms and complications, and the standard reflux test was negative in all cases. All patients had postoperative lower esophageal sphincter pressure within the normal range. The phenomenon of gas-bloat as not observed, nor was inability to vomit or belch. These results confirm the observations made earlier in a series of 110 patients operated on with the same method. A long-term prospective randomized study is in progress, with the aim of comparing the technique described herein and the Nissen fundoplication.

Adult↗
PubMed1982

[Indications and future of the Hartmann operation. Cooperative study of 126 cases (author's transl)].

The main indications for the Hartmann operation are cancer and sigmoiditis. It is done as an emergency in 70% of the time, more often for peritonitis, generally from diverticulitis. (45% of the time) than for occlusion usually due to cancer (30% of the time). The high mortality (33%) is due to the precarious condition of the patients, and only 25% are due to the operation, usually from disruption of the rectal stump. The reestablishment of the intestinal continuity, now facilitated by the clip forceps, was possible in 37 cases with no mortality. This represents 28.9% of the group, but only 52.1% were alive six months later. Only 6.8% of the cancer cases were benefited; however, 51% of the sigmoiditis cases and 87.5% of the cases of traumatic perforation were benefited. These results plus the advantages furnished by the autosuturing forceps justify renewal of interest in this operation first described 60 years ago.

Adult↗