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1.
Tech Coloproctol ; 28(1): 67, 2024 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-38860990

RESUMEN

BACKGROUND: Retrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated. METHODS: We performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3. RESULTS: Of over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention. CONCLUSIONS: Minimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Centros de Atención Terciaria , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Anciano , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Centros de Atención Terciaria/estadística & datos numéricos , Adulto , Tempo Operativo , Resultado del Tratamiento , Cirugía Endoscópica Transanal/métodos , Anciano de 80 o más Años , Recto/cirugía
2.
Surg Endosc ; 34(1): 142-152, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30868323

RESUMEN

BACKGROUND: Intraoperative management based on thoracoscopy, prone position and two-lung ventilation could decrease the rate of postoperative pulmonary complications after esophagectomy. The aim of this study was to compare this multifaceted approach (MIE-PP) and conventional thoracotomy for Ivor Lewis procedure after a systematic laparoscopic dissection. METHODS: Data from 137 consecutive patients undergoing Ivor Lewis procedures between 2010 and 2017 at two tertiary centers was analyzed retrospectively. The outcomes of patients who underwent MIE-PP (n = 58; surgeons group 1) were compared with those of patients undergoing conventional approach (n = 79; surgeons group 2). Our primary outcome was major postoperative pulmonary complications. Our main secondary outcomes were anastomotic leak, quality of resection and mortality. RESULTS: Female patients were more prevalent in the MIE-PP group (p = 0.002). Other patient characteristics, cTNM staging and neoadjuvant treatment rate were not different between groups. Major postoperative pulmonary complications were significantly lower in the MIE-PP group compared to Conventional group (24 vs. 44%; p = 0.014). Anastomotic leak occurred in 31 versus 18% in MIE-PP group and Conventional groups, respectively (p = 0.103). Complete resection rate (98 vs. 95%; p = 0.303) and mean number of harvested lymph nodes (16 (4-40) vs. 18 (3-37); p = 0.072) were similar between the two groups. Postoperative mortality rates were 0 versus 2% at day 30 (p = 0.508) and 0 versus 7.6% at day 90 (p = 0.038). CONCLUSION: Short-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.


Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía , Complicaciones Posoperatorias/prevención & control , Posición Prona , Toracoscopía , Toracotomía , Anciano , Fuga Anastomótica/etiología , Esofagectomía/efectos adversos , Esofagectomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente/métodos , Estudios Retrospectivos , Toracoscopía/efectos adversos , Toracoscopía/métodos , Toracotomía/efectos adversos , Toracotomía/métodos , Resultado del Tratamiento
3.
Tech Coloproctol ; 24(2): 165-171, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31919601

RESUMEN

BACKGROUND: Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5 years) for patients with hemorrhoidal disease. METHODS: A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009-April 2013. Patients were followed clinically for 1 month and with a questionnaire until 5 years after surgery or until they underwent a second surgery for recurrent hemorrhoids. RESULTS: Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2 days (median = 2 days; range = 1-8 days). No major complications were described. There were no deaths. At 5 years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36 months (median 27.4 months). The majority (61.4%) of patients were satisfied with the procedure. CONCLUSIONS: Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation.


Asunto(s)
Hemorreoidectomía , Hemorroides , Adulto , Arterias/diagnóstico por imagen , Arterias/cirugía , Femenino , Hemorreoidectomía/efectos adversos , Hemorroides/diagnóstico por imagen , Hemorroides/cirugía , Humanos , Tiempo de Internación , Ligadura , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
4.
Tech Coloproctol ; 20(11): 759-765, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27699496

RESUMEN

BACKGROUND: Prosthetic-related infection and erosion occurring after a laparoscopic ventral rectopexy (LVR) are rare complications, and their importance is often underestimated. The aim of this study was to compare the incidence rate and surgical management of these complications in LVR patients with polyester (PE) or polypropylene (PP) prostheses. METHODS: From January 2004 to June 2012, 149 patients underwent LVR with PE and 176 underwent LVR with PP. Surgical management and rate of infectious and erosive prosthesis-related complications, depending on the type of prosthesis, were described and compared. Functional results after complications were assessed. RESULTS: Five patients from the PE prosthesis group (3.3 %), compared with two patients from the PP prosthesis group (1.1 %), experienced prosthesis-related infection or erosion (p = 0.16). The rate of erosion alone was 3.3 % in patients with a PE prosthesis, and 0.55 % in patients with a PP prosthesis (p = 0.06). The average time until clinical diagnosis of a prosthesis-related complication was identical for both groups: 31 months (range 3-62 months). All patients underwent surgical removal of the prosthesis: For the five patients from the PE group, complete removal was performed by laparoscopy associated with a transanal procedure. For the two patients in the PP mesh group, laparoscopy was ineffective in removing the mesh which was partially removed through a subsequent transanal procedure. None of the patients had a protective stoma, and in all patients the complication had resolved 12 months after removal. Only one patient had worsening functional symptoms (fecal incontinence) after prosthesis removal. CONCLUSIONS: When a prosthesis-related infection or erosion occurs, treatment consists in the surgical removal of the prosthesis by laparoscopy/and/or a transanal procedure. Functional symptoms do not routinely recur after prosthesis removal.


Asunto(s)
Remoción de Dispositivos/métodos , Laparoscopía/instrumentación , Diseño de Prótesis/efectos adversos , Infecciones Relacionadas con Prótesis/epidemiología , Mallas Quirúrgicas/efectos adversos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Laparoscopía/métodos , Persona de Mediana Edad , Poliésteres/efectos adversos , Polipropilenos/efectos adversos , Periodo Posoperatorio , Falla de Prótesis/efectos adversos , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Prolapso Rectal , Rectocele , Recto/cirugía , Estudios Retrospectivos , Factores de Tiempo , Cirugía Endoscópica Transanal/métodos , Resultado del Tratamiento
5.
Ecotoxicol Environ Saf ; 75(1): 8-15, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21937112

RESUMEN

A hydroponic experiment was carried out to determine the root exudation patterns in two Cu-metallophytes (Oenothera picensis and Imperata condensata) and two agricultural plants (Lupinus albus and Helianthus annuus). Plants were grown in nutrient solution at increasing Cu doses (0, 0.125, 0.25, 0.5, 1 and 2mgCuL(-1)), and plant growth, root elongation, Cu accumulation and root exudates were measured. All plants showed a decrease of over 60% in root elongation at the highest Cu supply level, being O. picensis the most sensitive specie and showing the highest shoot and root Cu concentrations (116 and 2657µgCug(-1), respectively), which were six fold higher than the other species. Differences in root exudation patterns of low molecular weight organic acids were found, with extremely high amounts of succinic acid exuded by O. picensis (1049µmolg(-1)h(-1)), and citric acid by I. condensata (164µmolg(-1)h(-1)). In metallophytes, the organic acid exudation was increased even with no root elongation, meanwhile agricultural plants exuded citric acid at constant levels. Exudation of phenolic compounds was highly species-dependent, with catechin mainly exuded by I. condensata, (2.62µmolg(-1)h(-1)) cinnamic acid by O. picensis (5.08µmolg(-1)h(-1)) and coumaric acid exclusively exuded by H. annuus (13.6µmolg(-1)h(-1)) at high Cu levels. These results indicated that differences in root exudation patterns among metallophytes and agricultural plants could affect their Cu tolerance. Particularly, the higher exudation rate showed by I. condensata can be an effective exclusion mechanism to tolerate high Cu concentrations, supporting its use in Cu phytostabilization programs.


Asunto(s)
Cobre/toxicidad , Exudados y Transudados/metabolismo , Plantas/efectos de los fármacos , Contaminantes del Suelo/toxicidad , Ácido Cítrico/metabolismo , Productos Agrícolas/efectos de los fármacos , Productos Agrícolas/crecimiento & desarrollo , Productos Agrícolas/metabolismo , Helianthus/efectos de los fármacos , Helianthus/crecimiento & desarrollo , Helianthus/metabolismo , Raíces de Plantas/efectos de los fármacos , Raíces de Plantas/crecimiento & desarrollo , Plantas/metabolismo , Poaceae/crecimiento & desarrollo
6.
Gastroenterol Clin Biol ; 34(6-7): 397-402, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20570075

RESUMEN

PURPOSE: This was a prospective quality-of-life (QoL) assessment of gastrointestinal symptoms before laparoscopic Nissen fundoplication and during the 6-year postoperative follow-up. METHODS: Over a 15-month period, 35 consecutive patients with gastroesophageal reflux disease (GERD) underwent surgery after failure of medical treatment with proton pump inhibitors. QoL was assessed using the Gastrointestinal Quality of Life Index (GIQLI) preoperatively, and at 3, 6, 12, 24, 48 and 72 months postoperatively. RESULTS: The preoperative GIQLI score was lower than the 'normal' score (126 points), as were the scores overall and for each dimension (social integration, physical function, emotions and gastrointestinal symptoms; all P<0.001). Also, although the GIQLI increased significantly (P<0.0001) at 3, 6, 12, 24, 48 and 72 months, it remained below normal (P<0.01). The symptom score also remained below that of the normal population (57 vs 67; P<0.0001), while the percentages of patients with abdominal pain, dysphagia, modified eating habits and belching decreased non-significantly. However, GERD symptoms were significantly reduced (51% vs 4%; P=0.01), although 20% of patients started taking proton pump inhibitors again during the follow-up period. Surgery eliminated 50% of the dysphagia symptoms reported preoperatively and, after 6 years, only 8% of patients still complained of dysphagia. CONCLUSION: Patients who undergo surgery after failure of medical treatment for GERD can expect an improved QoL, although they may not be able to achieve normal levels. Preoperative symptoms should be carefully recorded in order to better inform patients of the expected outcome following surgery.


Asunto(s)
Fundoplicación , Reflujo Gastroesofágico/cirugía , Calidad de Vida , Dolor Abdominal/etiología , Dolor Abdominal/psicología , Adulto , Anciano , Trastornos de Deglución/etiología , Trastornos de Deglución/psicología , Femenino , Estudios de Seguimiento , Reflujo Gastroesofágico/psicología , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Estudios Prospectivos
7.
Colorectal Dis ; 11(6): 572-83, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19508514

RESUMEN

OBJECTIVE: Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. METHOD: Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. RESULTS: We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. CONCLUSION: We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.


Asunto(s)
Canal Anal/inervación , Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Guías de Práctica Clínica como Asunto , Electrodos Implantados , Medicina Basada en la Evidencia , Humanos , Región Sacrococcígea/inervación
8.
Gastroenterol Clin Biol ; 33(10-11): 971-6, 2009.
Artículo en Francés | MEDLINE | ID: mdl-19647386

RESUMEN

INTRODUCTION: Intrahepatic cholangiocarcinoma (ICC) is a rare tumor with a poor prognosis. The aim of this study was to evaluate current management and prognosis of ICC in nine French administrative areas, which are covered by population-based cancer registries. METHODS: Between 1997 and 1998, 1100 cases of primary liver cancer were observed in nine French departments: 68 were ICC. Clinicopathological characteristics and applied treatments were recorded and a comparative analysis and a 5-year survival study were performed. RESULTS: In most cases (85%), the presence of symptoms was the principal mode of discovery. Histological confirmation revealed ICC in two thirds of cases. The remaining liver was normal in 72% of cases (patients with cirrhosis: 12%). The mean size of tumours was 6 cm. Metastases were present in one out of four cases. Surgical management, chemotherapy and radiotherapy were performed in 40%, 20% and 11.5% of patients, respectively. Hepatic surgical resection was correlated with age and bilirubin level. One third of the patients were treated for symptoms. Five-year survival rate was 7.4% and median survival was 7 months. Patients with hepatic surgical resection had 5-year survival rate of 24.5%. CONCLUSION: At present, complete resection is the only therapy offering possible long-term survival in this entity. New adjuvant chemotherapy after surgery must be offered to these patients.


Asunto(s)
Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/terapia , Conductos Biliares Intrahepáticos/patología , Colangiocarcinoma/mortalidad , Colangiocarcinoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/patología , Conductos Biliares Intrahepáticos/cirugía , Quimioterapia Adyuvante , Colangiocarcinoma/patología , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Radioterapia Adyuvante , Sistema de Registros , Análisis de Supervivencia
9.
J Chir (Paris) ; 146(4): 336-46, 2009 Aug.
Artículo en Francés | MEDLINE | ID: mdl-19766213

RESUMEN

Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.


Asunto(s)
Laparoscopía , Esplenectomía/métodos , Enfermedades del Bazo/cirugía , Profilaxis Antibiótica , Ensayos Clínicos como Asunto , Contraindicaciones , Quistes/cirugía , Estudios de Seguimiento , Humanos , Laparotomía , Complicaciones Posoperatorias , Radiografía Abdominal , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Esplenectomía/efectos adversos , Enfermedades del Bazo/diagnóstico por imagen , Neoplasias del Bazo/diagnóstico por imagen , Neoplasias del Bazo/mortalidad , Neoplasias del Bazo/cirugía , Esplenomegalia/cirugía , Análisis de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
10.
J Chir (Paris) ; 145(3): 247-51, 2008.
Artículo en Francés | MEDLINE | ID: mdl-18772733

RESUMEN

AIM: To compare the management of colorectal cancer (CRC) before and after the French consensus conferences of rectal cancer (RC) in 1994 and colonic cancer (CC) in 1998. METHODS: From 344 CCR incident cases in 1992 and 545 in 2000, patient characteristics, tumor data, and diagnostic and treatment modalities were collected to compare the management of CRC. RESULTS: Post-operative mortality did not change significantly (4% in 1992 and 2.8% in 2000). No trends were observed in disease stage at diagnosis or rate of resection. For patients with CC (n=244 in 1992 and n=396 in 2000), the number of resection specimens with at least 12 lymph nodes increased from 11% in 1992 to 27% in 2000 (p<0.001). For CC with Dukes stage C and D, the use of chemotherapy increased significantly: for Dukes Stage C from 45% in 1992 to 55% in 2000; for Dukes Stage D from 37% in 1992 to 67% in 2000. For patients with RC (n=100 in 1992 and n=149 in 2000), no change in use of adjuvant radiotherapy was observed: 59% in 1992 versus 53.4% in 2000. Preoperative radiotherapy for RC was performed in 63% in 1992 and 75% in 2000 (p=0.7). CONCLUSION: The consensus guidelines appear to have moderately influenced management practices. A better diffusion of guidelines to practitioners and a systematic evaluation of actual practices would be helpful to improve their impact.


Asunto(s)
Neoplasias Colorrectales/cirugía , Conferencias de Consenso como Asunto , Guías de Práctica Clínica como Asunto , Anciano , Francia , Humanos
11.
J Chir (Paris) ; 145(3): 247-51, 2008 May.
Artículo en Francés | MEDLINE | ID: mdl-22805258

RESUMEN

UNLABELLED: Impact of the French consensus guidlines on the management of colonic and rectal cancer: A population-based study F. Borie, M. El Nasser, A. Herrero, C. Gras-Aygon, CRISAP-LR, J.-P. Daures, B. Tretarre Aim: To compare the management of colorectal cancer (CRC) before and after the French consensus conferences of rectal cancer (RC) in 1994 and colonic cancer (CC) in 1998. METHODS: From 344 CCR incident cases in 1992 and 545 in 2000, patient characteristics, tumor data, and diagnostic and treatment modalities were collected to compare the management of CRC. Résults: Post-operative mortality did not change significantly (4% in 1992 and 2.8% in 2000). No trends were observed in disease stage at diagnosis or rate of resection. For patients with CC (n=244 in 1992 and n=396 in 2000), the number of resection specimens with at least 12 lymph nodes increased from 11% in 1992 to 27% in 2000 (p<0.001). For CC with Dukes stage C and D, the use of chemotherapy increased significantly: for Dukes Stage C from 45% in 1992 to 55% in 2000; for Dukes Stage D from 37% in 1992 to 67% in 2000. For patients with RC (n=100 in 1992 and n=149 in 2000), no change in use of adjuvant radiotherapy was observed: 59% in 1992 versus 53.4% in 2000. Preoperative radiotherapy for RC was performed in 63% in 1992 and 75% in 2000 (p=0.7). CONCLUSION: The consensus guidelines appear to have moderately influenced management practices. A better diffusion of guidelines to practitioners and a systematic evaluation of actual practices would be helpful to improve their impact.

12.
J Visc Surg ; 155(4): 259-264, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29289460

RESUMEN

Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. PATIENTS AND METHODS: Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. RESULTS: Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. CONCLUSION: This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices.


Asunto(s)
Electrocoagulación/efectos adversos , Electrocoagulación/instrumentación , Complicaciones Intraoperatorias/etiología , Gestión de Riesgos , Procedimientos Quirúrgicos Ultrasónicos/efectos adversos , Procedimientos Quirúrgicos Ultrasónicos/instrumentación , Bases de Datos Factuales , Francia/epidemiología , Humanos , Complicaciones Intraoperatorias/epidemiología
13.
J Chir (Paris) ; 144(5): 403-8, 2007.
Artículo en Francés | MEDLINE | ID: mdl-18065895

RESUMEN

UNLABELLED: Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%. AIM OF THE STUDY: Describe the management of biliary injuries after laparoscopic cholecystectomy in our center. PATIENTS: Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%). RESULTS: Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2). CONCLUSION: Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.


Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Conducto Colédoco/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fístula Biliar/etiología , Fístula Biliar/terapia , Colangiografía/estadística & datos numéricos , Constricción Patológica/etiología , Constricción Patológica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
J Natl Cancer Inst ; 87(3): 183-90, 1995 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-7707405

RESUMEN

BACKGROUND: Prophylactic cranial irradiation in patients with small-cell lung cancer decreases the overall rate of brain metastases without an effect on overall survival. It has been suggested that this treatment may increase neuropsychological syndromes and brain abnormalities indicated by computed tomography scans. However, other retrospective data suggested a beneficial effect on overall survival for patients in complete remission. PURPOSE: Our purpose was to evaluate the effects of prophylactic cranial irradiation on brain metastasis, overall survival, and late-occurring toxic effects in patients with small-cell lung cancer in complete remission. METHODS: We conducted a prospective study of 300 patients who had small-cell lung cancer that was in complete remission. The patients were randomly assigned to receive either prophylactic cranial irradiation delivering 24 Gy in eight fractions during 12 days (treatment group) or no prophylactic cranial irradiation (control group). A neuropsychological examination and a computed tomography scan of the brain were performed at the time of random assignment and repeatedly assessed at 6, 18, 30, and 48 months. Patterns of failure were analyzed according to total event rates and also according to an isolated first site of relapse, using a competing-risk approach. RESULTS: Two hundred ninety-four patients who did not have brain metastases at the time of random assignment were analyzed. The 2-year cumulative rate of brain metastasis as an isolated first site of relapse was 45% in the control group and 19% in the treatment group (P < 10(-6)). The total 2-year rate of brain metastasis was 67% and 40%, respectively (relative risk = 0.35; P < 10(-13)). The 2-year overall survival rate was 21.5% in the control group and 29% in the treatment group (relative risk = 0.83; P = .14). There were no significant differences between the two groups in terms of neuropsychological function or abnormalities indicated by computed tomography brain scans. CONCLUSIONS: Prophylactic cranial irradiation given to patients with small-cell lung cancer in complete remission decreases the risk of brain metastasis threefold without a significant increase in complications. A possible beneficial effect on overall survival should be tested with a higher statistical power. IMPLICATIONS: The results of the trial favor, at present, the indication of prophylactic cranial irradiation for patients who are in complete remission. A longer follow-up and confirmatory trials are needed to fully assess late-occurring toxic effects. The possible effect on overall survival needs to be evaluated with a larger number of patients in complete remission, and a meta-analysis of similar trials is recommended.


Asunto(s)
Neoplasias Encefálicas/prevención & control , Carcinoma de Células Pequeñas/prevención & control , Irradiación Craneana , Neoplasias Pulmonares/patología , Anciano , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/secundario , Irradiación Craneana/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosificación Radioterapéutica , Inducción de Remisión , Análisis de Supervivencia , Resultado del Tratamiento
16.
Neurogastroenterol Motil ; 17(2): 302-9, 2005 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15787950

RESUMEN

UNLABELLED: Glicentin and glucagon-like peptide-1 (7-36) amide (GLP-1) are gut hormones released during digestion. Glicentin and GLP-1 slow down gastric emptying and glicentin can switch off the duodenojejunal fed motor pattern. The effect of glicentin on the motor activity of colon has never been reported in humans. Our aim was to determine if circular smooth muscle cells (SMC) from the human colon are target cells for glicentin or GLP-1, and if their motility is dependent upon these digestive hormones. METHODS: Twenty-two resections were performed on patients operated for colon adenocarcinoma. The SMC were isolated from colonic circular muscle layer and cell contraction was assessed. RESULTS: Glicentin caused a dose-related contraction of SMC, when GLP-1 determined a contraction of weak amplitude. Exendin-(9-39), described as a GLP-1 receptor antagonist, inhibited contraction due to glicentin or GLP-1. In contrast, on antral SMC from rabbit, GLP-1 exerts neither relaxation nor contraction; however, exendin-(9-39) dose dependently reduced the contractile activity of glicentin [glicentin EC(50) = 5 pM, exendin-(9-39) pA(2) = -9.36]. CONCLUSIONS: The circular muscle from the human colon is a target tissue for glicentin and GLP-1. Whereas glicentin is a long-life digestive hormone which would contribute to segmental contraction, the biological activity of GLP-1 remains unknown on this tissue. On the digestive smooth muscle, exendin-(9-39) behaved as an antagonist for two members of the glucagon-receptor family, GLP-1 and glicentin.


Asunto(s)
Colon/efectos de los fármacos , Glucagón/farmacología , Contracción Muscular/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Fragmentos de Péptidos/farmacología , Precursores de Proteínas/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Aminoácidos , Animales , Células Cultivadas , Colon/fisiología , Relación Dosis-Respuesta a Droga , Femenino , Glicentina , Glucagón/genética , Péptido 1 Similar al Glucagón , Péptidos Similares al Glucagón , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Contracción Muscular/fisiología , Músculo Liso/fisiología , Fragmentos de Péptidos/genética , Precursores de Proteínas/genética , Homología de Secuencia de Aminoácido
17.
Arch Surg ; 135(10): 1218-23, 2000 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11030885

RESUMEN

BACKGROUND: The prognosis of early gastric cancer (EGC) is considered better than that of invasive gastric carcinoma, with a 5-year survival rate of more than 90% after surgery. The prevalence of lymph node metastasis in EGC ranges from 8% to 20% and is associated with a poor prognosis. HYPOTHESIS: The main prognostic factor of EGC in patients in France is lymphatic involvement. DESIGN, SETTING, AND PATIENTS: From January 1979 to December 1988, 332 patients with EGC were operated on in 23 centers of 2 of the French Associations for Surgical Research. Clinical, pathological, and therapeutic data were reviewed, and the reckoning point was in June 1996. MAIN OUTCOME MEASURES: The cumulative 5- and 7-year specific survival rates of EGC with or without lymphatic involvement. RESULTS: The cumulative 5- and 7-year specific survival rates of 332 patients with EGC (mean follow-up time, 80 months), excluding both operative and unrelated mortality, were 92% and 87.5%, respectively. Thirty-four patients (10.2%) had metastatic lymphatic spread: 13 exclusively in the lymphatic vessels close to the tumor, 17 in at least 1 lymph node, and 4 in both the lymphatic vessels and nodes. The rate of lymph node involvement (regardless of lymphatic vessel involvement) correlated significantly with submucosal invasion (P =. 05) and histologic undifferentiation (P =.03). Lymphatic vessel involvement correlated positively with lymph node involvement (P =. 003). Since 5- and 7-year survival rates of the 13 patients with EGC who had lymphatic vessel involvement without lymph node involvement did not differ significantly from those of patients who had EGC with lymph node involvement (85% and 84% vs 72% and 63%, respectively [P =.42]), all patients with lymph node and/or lymphatic vessel involvement were considered unique. Prognosis was poorest in these patients according to both univariate analysis (94% for 298 without node or vessel involvement vs 78% for 34 with node and/or vessel involvement; P =.006) and multivariate analysis (P =.01). Submucosal invasion was a prognostic factor independent of lymphatic involvement (P =.05). Five- and 7-year survival rates did not differ when the group of 211 patients for whom less than 15 lymph nodes were retrieved were compared with those (n = 51) for whom 15 or more lymph nodes were retrieved (95.5% vs 92% and 95.5% vs 88%, respectively), whether according to univariate (P =.21) or multivariate (P =.31) analysis. CONCLUSIONS: Our results suggest that both lymph node and lymphatic vessel involvement are important prognostic factors in patients with EGC. Lymphadenectomy in EGC is important to identify the high-risk population for whom prognosis is worse. The extent of lymphadenectomy (at least 15 nodes) in these patients, however, does not alter prognosis.


Asunto(s)
Carcinoma/mortalidad , Carcinoma/secundario , Causas de Muerte , Neoplasias Gástricas/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/cirugía , Intervalos de Confianza , Femenino , Francia/epidemiología , Gastrectomía/métodos , Gastrectomía/mortalidad , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Oportunidad Relativa , Prevalencia , Modelos de Riesgos Proporcionales , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Análisis de Supervivencia
18.
Eur J Surg Oncol ; 29(6): 511-4, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12875857

RESUMEN

AIM: Early gastric cancer (EGC) may have a 5-year survival rate of over 90% following surgery. Early multifocal gastric cancer (EMGC) accounts for between 8.3 and 17% of all EGCs. A multicenter retrospective study is reported of prevalence, characteristics, prognosis and type of resection for EMGC patients. METHOD: 333 patients with EGC were operated on, between January 1979 and December 1988, and followed to June 1996. RESULTS: 33 EGC patients had EMGC. There was no significant difference in clinico-pathological features between EGC and EMGC. 21 cases of EMGC underwent a subtotal gastrectomy and 12 underwent a total gastrectomy. Recurrences after subtotal gastrectomy were, respectively, 10 and 18% for EGC and EMGC patients (p=0.2). The cumulative 5 years specific survival rate for 298 EGC and 34 EMGC were 94 and 90%, respectively (p=0.9). Five-year survival rates after subtotal gastrectomy were 92 and 90% for EGC and EMGC patients, respectively (p=0.8). CONCLUSION: EGC and EMGC had the same clinico-pathological features and prognosis. A careful follow up of the stomach remnant is essential.


Asunto(s)
Gastrectomía/métodos , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/cirugía , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Adulto , Anciano , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/etiología , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Prevalencia , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Análisis de Supervivencia , Resultado del Tratamiento
19.
Surg Endosc ; 17(8): 1175-80, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12632123

RESUMEN

Current practices for diagnosis and treatment of common bile duct stones are not evidence-based. Acute biliary pancreatitis (ABP) is a specific situation in which endoscopic procedures are either overused or misused. Pancreatitis is a poor marker for choledocholithiasis. Prognostic systems are accurate to discern those patients with ABP who do not need aggressive procedures. Patients with a benign ABP do not need an endoscopic approach. Laparoscopic common bile duct exploration is an underrated treatment for patients with choledocholithiasis. Laparoscopic approach to infected necrotic collections and pseudocysts warrant further investigations.


Asunto(s)
Colangiografía , Coledocolitiasis/complicaciones , Endoscopía del Sistema Digestivo , Laparoscopía , Pancreatitis/cirugía , Radiografía Intervencional , Enfermedad Aguda , Conductos Biliares/lesiones , Colangiopancreatografia Retrógrada Endoscópica , Colangitis/etiología , Colangitis/cirugía , Colecistectomía Laparoscópica , Coledocolitiasis/diagnóstico por imagen , Contraindicaciones , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Seudoquiste Pancreático/cirugía , Pancreatitis/etiología , Pancreatitis Aguda Necrotizante/etiología , Pancreatitis Aguda Necrotizante/cirugía , Índice de Severidad de la Enfermedad , Esfinterotomía Endoscópica
20.
Surg Endosc ; 17(1): 12-8, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12364990

RESUMEN

BACKGROUND: Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. METHODS: Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). RESULTS: The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1-26). No patient required additional CBD procedures during follow-up. CONCLUSIONS: In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Biliar/métodos , Enfermedades del Conducto Colédoco/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Conducto Colédoco/cirugía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Resultado del Tratamiento
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