[Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients]. / Traitement des complications biliaires après cholécystectomie par coelioscopie: étude rétrospective de 27 patients.

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.

[Spontaneous haemoperitoneum due to a ruptured intra-abdominal varix with cirrhosis: report of two cases]. / Hémopéritoine spontané par rupture de varices intra-abdominales chez le patient cirrhotique.

Spontaneous haemoperitoneum due to ruptured intra abdominal varices with cirrhosis is rare and the diagnosis is generally difficult. Two cases of spontaneous intraperitoneal bleeding due to ruptures varices with cirrhosis are reported. One case is a ruptured portal cavernome and the other one is a ruptured varix of the gastrosplenic ligament. The combination of hypovolemic shock with increasing abdominal girth should impose the diagnosis. This is a surgical emergency and the mortality rate is high.

[Surgical management of a preaortic paraganglioma: Report of one case]. / Prise en charge chirurgicale d'un paragangliome préaortique: à propos d'un cas.

Paragangliomas (PG) are rare and often diagnosed in the young adult. One case of retroperitoneal preaortic paraganglioma localised between the celiac trunk and the superior mesenteric artery is reported. The management of paraganglioma involves endocrinologists, geneticists and surgeons but the only potentially curative treatment remains surgical resection. Pathology reports can not always discriminate between benign or malignant tumors. Hereditary in paraganglioma occurs in approximately 25% of cases. Genetic investigation is therefore mandatory in all patients with PG. Since the type of genetic mutation is correlated with tumoral aggressiveness, genetic investigation results should be taken into account when a surgical procedure is planned.

[Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases]. / Colectomie élective laparoscopique pour sigmoïdite diverticulaire. Etude prospective de 56 cas.

OBJECTIVE: The aim of this prospective study was to assess the feasibility and postoperative advantages of the laparoscopic-assisted elective colectomy for diverticular disease. PATIENTS AND METHODS: From january 1989 to december 1997, among the 114 patients electively operated on for diverticulitis, 56 patients were treated by laparoscopic approach. Evaluated parameters included: gender, age, weight, size, ASA score, operating time, duration of hospital stay, of analgesic treatment, and of postoperative ileus, morbidity and mortality rate. RESULTS: The study group consisted of 35 women and 21 men. Mean age was 59 years (34-81 years); 29 patients were ASA 1 and 27 ASA 2. Overall postoperative mortality rate was 0% and morbidity rate 16% (n = 9). There were no complications directly related to laparoscopic technique. The conversion rate was 14% (n = 8). Mean operating time was 300 min (200-600 min). Mean duration of postoperative ileus was 2.4 days. Mean duration of hospital stay was 9.4 days. CONCLUSION: This study demonstrates the feasibility of elective laparoscopic-assisted colonic resection for diverticular disease in more than 80% of cases with a postoperative morbidity and mortality rate comparable to those of conventional surgery.

[Painful rib syndrome (or Cyriax syndrome). Study of 100 patients]. / Le syndrome douloureux du rebord costal (ou syndrome de cyriax). Etude de 100 malades.

OBJECTIVE: To analyse clinical expression and outcome of painful rib syndrome in a large series of 100 cases. METHODS: From 1978 to 1993, 100 consecutive patients with chronic anterior chest pain or supramesocolic abdominal pain of unknown origin underwent complete physical examination, laboratory tests and complementary explorations as required. RESULTS: Among the first 100 patients the sex ratio was 3.34 and mean age 50.6 years (21-80). Chronic pain had persisted for an average 41.2 months (15 days-30 years), predominantly on the right (81%) and exceptionally bilaterally (1%). No evidence of a cause could be identified from laboratory tests or complementary explorations. A past history of direct trauma was found in 71 patients and indirect trauma in 21. Seventy-three patients were given 1% lidocaine infiltrations (20 to 40 ml) including 14 who received 2 or 3 infiltrations. Six patients underwent surgical resection of a luxated cartilage with curative effect in 5. CONCLUSION: The diagnosis of painful rib syndrome is based solely on the presence of pain upon applying pressure to the anteroinferior border of the rib cage and is related to often neglected or forgotten trauma.

[Isolated traumatic perforations of the gallbladder. 2 case reports]. / Perforations traumatiques isolées de la vésicule biliaire. Deux observations.

The first case is a classic perforation, the second case is a sub-serosal rupture with dissection of the gall bladder wall. Cured by cholecystectomy. The heavy ethanol impregnation of both injured patients is emphasized as a contributing factor. Sonogram, peritoneal tap-lavage and eventually a retrograde cholangiogram are recommended for the diagnosis.

[Hemorrhage in angioterebrant duodenal ulcers]. / Les hémorragies des ulcères duodénaux angiotérébrants.

Over half the 42 patients seen with severe hemorrhage from antioterebrant posterior duodenal ulcers were 60 years or more. Mortality is still high but has been lowered by the use of routine emergency fibroscopy and subsequent earlier operation. The preferred surgical solution is by weinberg's technique (hemostasis, vagotomy, pyloroplasty).

[Calculous stenosis of the duodenum. Five observations (author's transl)]. / Les obstructions duodénales lithiasiques. A propos de cinqu observations.

Five observations of calculous stenosis of the duodenum after cholecysto-duodenal fistulization are reported. Four times, the pre-operative diagnosis has been made out by an opaque gastro-duodenal transit. The treatment is usually surgical, and its modalities are discussed about, but it is pointed out that the endoscopic duodenal desobstruction on patients running high operative risks presents a real interest.