[Bilio-digestive bypass using gallbladder in chronic pancreatitis. 85 cases of cholecystoplasty ]. / Dérivation bilio-digestive par anse vésiculaire pour pancréatite chronique. 85 cholécysto-plasties.

For a group of 368 cases of chronic pancreatitis (CP) operated on since 1975, the authors have performed 85 biliary intestinal anastomoses using the gallbladder, for treatment of biliary obstruction. (These were cases not needing resection of the head of the pancreas). This original biliary-intestinal by-pass comprises resection of the cystic duct then bridging the gallbladder between the common bile duct and the duodenum (in 2 cases the jejunum). This anastomosis of common bile duct to infundibulum was termino-terminal except in 15 where portal vein dilatation necessitated a latero-terminal anastomosis. The gallbladder-intestinal anastomoses were termino-lateral. One patient with multi-system disease died on the 20th post-op day from cardio-respiratory problems not directly related to the procedure. No fistulae, biliary or intestinal occurred. The average hospitalization was 13.6 days. The average follow-up period is now 46 months (2 patients only have been lost to follow-up). One patient (not abstaining from alcohol) has presented with recurrent febrile episodes and transient alkaline phosphatase elevations. Two patients only have been re-operated (9th and 72nd months) for cholangiocholitis necessitating a re-do of the anastomosis infundibulum to bile duct. These 2 patients are well at 20 and 45 months respectively. No biliary calculi have been observed, with 22% of patients now being more than 5 years post-op. The authors have progressively left aside the anastomosis to a jejunal loop in favour of the gallbladder interposition described. This appears a better procedure for treating biliary obstruction in chronic pancreatitis even when complicated by portal vein dilatation. This procedure enables drainage of bile into its natural site at the 2nd part of the duodenum, so reducing the risk of ulceration. It also saves extending the operating field below the mesocolon and importantly in the already poorly nourished patient, it does not remove from function a segment of jejunum.

An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia.

This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.