[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases]. / Complications des cholécystectomies par voie coelioscopique. A propos de 6,512 observations.

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

[Major cardiomegalies of the newborn]. / Les cardiomegalies massives du nouveau-ne.

Massive enlargement of the heart measured by cardio-thoracic ratio (C.T.R. greater than or equal to 0,75) was found in 17 neonates in the first ten days of their life. The diseases causing this rare anomaly (5% of all newborns with cardiac malformations) were: Ebstein's disease (6 cases), cerebral arterio-venous aneurism (6 cases), primary endocardial fibro-elastosis (2 cases), septic pericarditis, transposition of great arteries and pulmonary atresia with intact ventricular septum (1 case of each). A diagnosis scheme is proposed in order to recognize early tractable diseases and to avoid inadequate surgical indications.

[Congenital bundle-of-his focal tachycardias. Cooperative study of 7 cases]. / Tachycardies focales hissiennes congénitales. Etude coopérative de sept cas

The authors described seven cases of supraventricular tachycardia with atrio-ventricular dissociation, associated with the activity of an automatic focus in the bundle of His. These tachycardias, which appear at birth or are discovered at a very young age, appear to be congenital and sometimes familial, and are always isolated, having no associated cardiac abnormality. They give rise to cardiac failure, which is more marked when the rate is high (180-260/mn) and particularly resistant to treatment. The most effective form of treatment is amiodarone, almost always used in combination with digitalis. The anatomical abnormality, which was studied in the first case, is a contricting fibrosis around the main trunk of the bundle of His, and the appearances are reminiscent of those found in conditions of congenital atrio-ventricular block.