[Feasibility of prosthesis insertion by laparotomy as palliative treatment for malignant duodenal stenosis]. / Faisabilité de l'insertion des prothèses par laparotomie comme traitement palliatif des sténoses duodénales malignes.

The authors report a preliminary series assessing the feasibility of duodenal stenting using a surgical approach. The study included 16 patients with a malignant duodenal outlet obstruction for whom a biliaryobstruction necessitated a laparotomyor following an endoscopic stenting failure. The stent was efficient in 15 patients with a complete relieve of obstruction. These patients could have oral intake at the end of the first postoperative week. No stent obstruction occurred. The duodenal stenting by laparotomy could be a good alternative to palliative gastroenteral anasotomosis.

[Conversion laparatomies during cholecystectomies under laparoscopy. Apropos of 285 consecutive cholecystectomies]. / Les laparotomies de conversions au cours des cholécystectomies par laparoscopie. A propos de 285 cholécystectomies consécutives.

Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.

[How to reduce morbidity in celioscopic biliary surgery. Apropos of a series of 446 consecutive operations]. / Comment réduire la morbidité en chirurgie biliaire par voie coelioscopique. A propos d'une série de 446 interventions consécutives.

We reported a series of 446 consecutive cholecystectomies performed laparoscopically between June 1990 and January 1993. There were 354 females and 92 men, mean age 53 +/- 17 years. Laparoscopic cholangiography was attempted in 410 cases (92%) and led to the discover of a stone in the main bile duct in 18 cases (4%) and an abnormal insertion of the bladder duct in 30% (6.7%). Conversion to laparotomy was required in 84 patients (18.8%) due to difficult dissection (52), peroperative incidents or accidents (15) and abnormal hepatogram (17). No accident inherent to the operation was encountered in this series. One death occurred after laparotomic conversion for acute angiocholitis. The rate of post-operative complications was 5.6% and reoperations were required in 7 patients (1.5%).