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Biomedical subjects

P Breil

Publications and source records attributed to P Breil.

32 records · Page 2Linked to original sources
PubMed1981

Mirizzi syndrome and biliobiliary fistulas: roentgenologic appearance.

Five cases of extrahepatic cholestasis caused by impaction of a voluminous gallstone in the neck of the gallbladder or the cystic duct are reported. The formation of a biliobiliary fistula is the rule. Percutaneous transhepatic cholangiography visualizes the fistulas and permits their classification into 2 groups: gallbladder to hepatic duct, and cystic to hepatic duct. Preoperative diagnosis permits the best resolutions of 2 problems encountered during surgery: (1) the tumor-like feature often produced by the cholecystitis can be ascribed to benign lithiasic etiology if the biliobiliary fistula is diagnosed in the preoperative phase; and (b) treatment by biliary plasty, which requires first opening the gallbladder and partial cholecystectomy, has to be achieved.

Adult↗
PubMed1981

EEA stapler and omental graft in esophagogastrectomy: experience with 30 intrathoracic anastomoses for cancer.

Experience with the EEA stapler device used in 30 esophagogastric resections for cancer with intrathoracic anastomosis, is reported. The mortality rate was 13.3%. The anastomotic failure rate was 3.3% (1/30) with only one death; three asymptomatic blind fistulas were found on a routine contrast examination of the anastomosis. It is felt that esophagogastric EEA stapled anastomosis associated with an omental graft is a very safe technique.

Adenocarcinoma↗
PubMedDate not supplied

[Surgical treatment of failures or recurrences after Heller cardiomyotomy (author's transl)].

A Heller cardiomyotomy has been realized in 406 cases of achalasia. The indications for operation are defined. Surgery must be preferred to dilatation: the results are favorable in 96% of cases. The failures or so-called failures are detailed. In failures or recurrences due to an insufficient cardiomyotomy, a new myotomy is indicated. Gastro-esophageal reflux is frequently an indication for oesogastric resection. Failures have been observed in 70 cases. The insufficient initial myotomy was completed in 36 cases. The etiology of postmyotomy sclerosis (15 perioesophageal, 3 interstitial) is discussed. Severe peptic oesophagitis, observed in 15 cases, stresses the importance of restoring the anti-reflux mechanism, rather than using a thoracic approach with the risk of a myotomy too limited towards the stomach. Other causes of failures (atypical mega-oesophagus, limited peptic stenosis) are due to an erroneous interpretation of preoperative X-rays, endoscopy and manometric data: in such cases, the original treatment should have been adapted to the lesion. Finally, 8 postoperative oesophageal asystolias and 4 cancers stress the importance of an early myotomy, correctly realized through an abdominal approach.

Diverticulum, Esophageal↗
PubMedDate not supplied

Reoperation after Heller's operation for achalasia and other motility disorders of the esophagus: a study of eighty-one reoperations.

Most failures or pseudo-failures of Heller's operation are due to an imperfect surgical technique. The procedure should include the entire muscular layer, extend as far upwards as possible and at least two to three cm downwards onto the stomach. Furthermore, it should be associated with an anti-reflux procedure. Eighty-one operations were performed in 70 patients who had previously undergone Heller's operation. Of the 42 patients presenting with recurrent achalasia, 21 had an insufficient Heller procedure upwards, 10 downwards and 11 in depth. Twenty-three patients had peptic esophagitis and three had periesophageal sclerosis. The management of these 70 reoperated patients included 36 iterative esophageal myotomies, 32 resections, four total duodenal diversions and two hiatal reconstructions. Repeated cardiomyotomies gave excellent results in 75% of cases and esophagogastric resection in 79%.

Esophageal Achalasia↗