Peptic stenosis of the esophagus is no longer considered as an irreversible lesion. It may stabilize or even regress if gastro-esophageal reflux is suppressed. The treatment of these stenoses during the last decade has been progressively oriented towards conservative techniques, the only ones capable of conferring the necessary low degree of complexity on this type of surgery. The authors report their experience between 1965 and 1980 on 151 operations. Resection was performed in 1/3 of the cases and the remainder were treated conservatively, by either thoracic or abdominal routes. The route of choice is abdominal. Peroperative dilatation of the stenosis is done with a finger or a bougie. The anti-reflux configuration is a Nissen type fundoplicatio when the cardia can be lowered in the abdomen. If the cardia cannot be lowered because of a shortening of the esophagus, the authors utilize a complete wrapping of the gastric cone since 1969. This technique has been used 45 times, often in old and weak patients who would have tolerated no other procedure. Mortality was zero. Long-term results are satisfactory and longlasting in 75% of the cases. Secondary dilatations are sometimes (18%) necessary, especially during the first postoperative year. In case of failure, it remains possible to perform another conservative operation through the thoracic route. No late-arising adenocarcinoma has been observed in the stenotic zone.
Esophageal Stenosis/therapy , Dilatation/methods , Esophageal Stenosis/surgery , Humans , Reoperation
A case with bilateral pneumothorax in association with laparoscopy is described. Several hypotheses could explain this rare complication. 1. It could be an association of the induced pneumoperitoneum and a bilateral pneumothorax due to rupture of both mediastinal pleurae or emphysematous bullae secondary to positive pressure ventilation during anesthesia. 2. The pneumoperitoneum could be directly related to the pneumothorax by subperitoneal air extension to both pleurae with secondary rupture. Less likely is the hypothesis in which a pleuro-peritoneal communication exists, whether congenital or acquired, on both halfs of the diaphragm.
Laparoscopy/adverse effects , Pneumothorax/etiology , Adult , Anesthesia, General/adverse effects , Drainage , Female , Genital Diseases, Female/diagnosis , Humans , Pneumoperitoneum, Artificial/adverse effects , Pneumothorax/therapy
Three hundred and eighty-three patients underwent superficial femoral vein ligation and distal venous thrombectomy in the treatment of deep venous thrombosis of the lower extremities. Two hundred and forty-eight patients were reviewed clinically. The results are quite satisfactory; no surgical mortality and no fatal pulmonary embolism. On long term follow-up the clinical symptoms such as pain, swelling, varicosities and ulceration are much less marked in the operated group when compared with the post-phlebitis syndrome which develops when the deep venous thrombosis is allowed to extend into the deep pelvic veins.
Femoral Vein/surgery , Leg/blood supply , Thrombophlebitis/surgery , Adolescent , Adult , Aged , Female , Humans , Ligation , Male , Middle Aged
