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S Benoist

Publications and source records attributed to S Benoist.

45 records · Page 3Linked to original sources
PubMed1996

[Role of celioscopy in acute obstructions of the small intestine].

OBJECTIVES: The aim of this study was to evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute small bowel obstruction. METHODS: Thirty five patients, with less than three abdominal incisions, who had undergone initial laparoscopy for acute small bowel obstruction, were reviewed. The small bowel was mobilized to determine the cause and site of obstruction. RESULTS: In 31 cases, small bowel obstruction was caused by a single or numerous obstructing bands. Among 31 cases of adhesions, laparoscopic treatment of intestinal obstruction was possible in 16 cases (51.6%). In 15 cases, laparoscopy had to be completed by laparotomy: numerous adhesions could not be divided in 12 cases; intestinal ischemia which required resection was present in 3 cases. There was no hospital mortality and postoperative complications occurred in 19% of cases. Multivariate analysis demonstrated a relation between need to complete laparoscopy by laparotomy and two factors : presence of signs of peritoneal irritation (P < 0.05) and intestinal obstruction caused by numerous adhesions or bands (P < 0.05). Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the "laparoscopy + laparotomy" group. CONCLUSIONS: Laparoscopic treatment of acute small bowel obstruction is difficult and was possible in only half of the cases. The first port should be inserted by open technique to avoid the risk of perforation of distented small bowel. When laparoscopy shows numerous adhesions, laparoscopic treatment should not be pursued, and laparotomy should be recommended to avoid the risk of visceral perforation.

Acute Disease↗
PubMed1995

[Value of selective clamping in major hepatectomies].

Charts of 100 consecutive patients who had undergone liver resection, performed by a single surgeon, during the 10 year period from 1983 to 1993 were reviewed. Liver trauma was excluded. The age of the patients ranged from 14 to 78 years, with a mean age of 52 +/- 12.3. Indications for liver resection were malignant tumors in 73 patients and benign disease in another 27 patients. The remnant liver was pathologic in 24 cases (21 cirrhosis, 3 chronic hepatitis). The extent of liver resection was major (> 3 segments) in 51 cases, and minor in 45 cases. Postoperative complications, including death, occurred in 24% of cases. Five complications required reoperation. Hospital mortality was 4%. Multivariate analysis demonstrated two major risk factors of morbidity: intraoperative blood transfusion, and cirrhosis. Age of patients was the only risk factor of mortality. In major resection, four categories of patients were established according to the type of hepatic inflow occlusion. Each group was comparable. Selective vascular clamping (selective control of the hilar vessels to the liver and selective hepatic vein occlusion) decreased the morbidity and post operative liver failure rate (p < 0.05). On the other hand, no correlation was observed between the type of hepatic inflow occlusion and the hospital mortality.

Adolescent↗
PubMedDate not supplied

Prolonged survival after resection of pancreatoblastoma and synchronous liver metastases in an adult.

Pancreatoblastoma is an uncommon pediatric neoplasm with distinct acinar and squamoid cell differentiation. Pancreatoblastoma is exceedingly rare in adults with only ten reported cases. Pancreatoblastoma in adults has a poor prognosis and no survival without recurrence exceeding 30 months has been reported. We report the first adult case of pancreatoblastoma revealed by gastric bleeding due to segmental hypertension. On computed tomography scan, the tumor appeared lobulated and extended from the splenic hilum to the portal vein. Two hypervascular centimetric hepatic metastases were observed in segments III and VII. The patient was operated and a distal pancreatectomy with splenectomy associated with two hepatic wedge resections was performed. The diagnosis of pancreatoblastoma was made on immunohistochemical examination. The patient received 6 cycles of adjuvant therapy. After three years of follow-up, the patient was well with no sign of recurrence on computed tomography scan. This case suggests that in the presence of pancreatic tumor of unknown origin, aggressive management including complete surgical resection and adjuvant chemotherapy should be attempted even in the presence of synchronous liver metastases.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Local excision of rectal cancer for cure: should we always regard rigid pathologic criteria?

BACKGROUND/AIMS: The purposes of this study were to assess the relationship between the incidence of recurrence and the pathologic criteria usually applied to the selection of patients for curative local excision of rectal carcinoma and to determine whether failure to fulfill one of these criterias is always an indication for secondary abdominoperineal resection (APR). METHODOLOGY: From 1982 to 1992, 30 patients with rectal carcinoma (mean age: 69 +/- 10 years) were treated by local excision (LE). Univariate analysis of the cancer recurrence rate according to pathologic criteria was performed. RESULTS: The mean follow-up was 57 +/- 40 months (range: 6-145). Five patients (17%) had recurrent disease (local in 3, distant in 1, and local and distant in 1). Two of the three local cases were successfully treated. At the end of follow-up, 90% of the patients had no evidence of recurrence, and the rectal cancer-specific death rate was 10%. Although not significant, tumor penetration beyond the submucosa and vessel or nerve invasion were associated with an increased incidence of cancer recurrence. Tumor size and differentiation, and the presence of a mucinous component were not associated with a significant increase in recurrence. According to the usual pathologic criteria proposed for curative LE, 20 patients should, theoretically, have undergone secondary APR. However, 16 of them (80%) were treated by LE only, and at the end of follow-up, 17 (85%) were alive without recurrence. CONCLUSIONS: The rigid rule of systematically performing secondary APR after LE for rectal carcinoma when one or more pathologic selection criteria are not met should perhaps be reconsidered, especially for tumors exceeding 3 cm in diameter, moderately differentiated tumors, and in incidences when a mucinous component is present. However, in cases of vessel, nerve or muscular invasion, secondary APR is probably the best choice for cure.

Aged↗
PubMedDate not supplied

Reversible hypersplenism after splenopexy for wandering spleen.

Wandering spleen is a rare condition characterized by a normal spleen with extreme mobility associated with an elongated pedicle. The most common presentation is an acute surgical abdomen related to acute torsion. A case of wandering spleen complicated by symptomatic hypersplenism in a 29 year-old woman is presented. The hypersplenism was diagnosed after bleeding delivery, requiring blood transfusion. Wandering spleen was suspected after pre-operatively performed CT scan. The patient was successfully treated by splenopexy. This report illustrates that conservative surgical management may result in complete reversal of hematological symptoms.

Adult↗