[Colectomy by combined resection-anastomosis using linear mechanical sutures]. / Colectomies par résection-anastomose intégrée pièce en place utilisant les sutures mécaniques linéaires.

In the technique described, anastomosis is started with a GIA mechanical stapler then completed with a TA stapler followed by resection of the segment involved. We prefer this technique to other mechanical procedures (triangulation, circular anastomosis) in all colectomies which do not require lower colorectal anastomosis. It is simple, economical and solves problems of incongruence. Finally--and this is the most important point in surgery of the colon--it considerably shortens the septic operative stages.

Budd-Chiari syndrome with thrombosis of the inferior vena cava: long-term patency of meso-caval and cavoatrial prosthetic bypass.

Portacaval or mesocaval shunts may relieve ascites that is caused by chronic forms of primary Budd-Chiari syndrome. When inferior vena cava stenosis is severe or is the site of thrombosis, another procedure has to be used. Portoatrial or cavoatrial shunting has been suggested, and a few reports have been made after only a short follow-up period. The case of a young woman with long-standing ascites caused by primary occlusion of the hepatic veins illustrates the incomplete relief of ascites after mesocaval shunt, which was caused by severe stenosis of the inferior vena cava. At 2 1/2-year follow-up, thrombosis of the retrohepatic inferior vena cava was documented and the mesocaval shunt remained patent. Cavoatrial bypass performed with the use of a long Dacron graft was successful as noted at a 4 1/2-year postoperative follow-up, and there was angiographic proof of patency. Budd-Chiari syndrome with stenosis or thrombosis of the inferior vena cava may be cured by prosthetic bypasses to the right atrium. Combined mesocaval and cavoatrial shunt should be encouraged in this specific situation.

[Paradoxical embolism through a patent foramen ovale. 4 cases]. / Embolies paradoxales à travers un foramen ovale perméable. Quatre observations.

Four cases of paradoxical embolism through a patent foramen ovale associated with massive pulmonary embolism are reported. In two cases, patency of the foramen ovale was demonstrated by a new technique: cross-sectional contrast echocardiography potentiated by coughing. The conventional surgical treatment included arterial embolectomy followed by insertion of a caval filter. Embolism recurred on three occasions under mechanical ventilation prior to insertion of the filter. A new sequence of investigations to facilitate detection of paradoxical embolism in patients with unexplained arterial embolism is suggested: (1) blood gas measurements, which reveal associated pulmonary embolism; (2) cough-potentiated cross-sectional contrast echocardiography, which demonstrates a patent foramen ovale and excludes emboligenic cardiopathies; (3) phlebography and pulmonary angiography which complete the diagnosis. To reduce the risk of recurrent embolism, it is recommended to begin treatment by blocking the vena cava without mechanical ventilation. This can be done by inserting a filter through the jugular vein under local anaesthesia. Arterial embolism can then be treated at lesser risk under mechanical ventilation.

[Patency of the foramen ovale in paradoxical embolism. Detection by contrast echocardiography and the cough provocation test]. / Perméabilité du foramen ovale dans l'embolie paraxodale. Détection par échocardiographie de contraste et test de provocation par la toux.

Five patients with suspected paradoxical embolism were investigated for patent foramen ovale by contrast echocardiography. Right-to-left shunting was demonstrated in 3 patients: during a Valsalva manoeuvre in one and during coughing fits in all three. Patency of the foramen ovale was confirmed by cardiac catheterization in these 3 patients. In 2 patients the foramen was not patent and the diagnosis of paradoxical embolism was not confirmed. In two other patients, the right and left atrial pressures were measured simultaneously during a Valsalva manoeuvre and during coughing. The normal pressure gradient between the two atria was suppressed during the relaxation stage, resulting in decreased curvature of the interatrial septum which facilitated the flow of blood from the inferior vena cava into the left atrium. Coughing appears to be a simpler and more sensitive test than the Valsalva manoeuvre to induce transient right-to-left atrial shunting.

[Total gastrectomy. Primary esophagojejunal anastomosis, the organ in place, using linear mechanical suture staplers]. / Gastrectomie totale. Anastomose oeso-jéjunale première, pièce en place, utilisant les pinces à suture mécanique linéaire.

In "mechanical" surgery, continuity of the digestive tract may be re-established with either circular (E.E.A. - I.L.S.) or linear stapled anastomosis (G.I.A. - T.A.). For oesophago-jejunal anastomosis, the authors prefer the second method which provides wider anastomosis without the risk of stenosis attached to circular sutures. The stomach is kept for traction, thus facilitating the procedure, which can be performed through the abdominal incision.

[Colonic occlusions. Retrospective cooperative study of 497 cases]. / Les occlusions coliques. Etude rétrospective coopérative de 497 cas.

A retrospective multicenter study involving 12 digestive surgery centers was conducted on 497 cases of colon obstruction. The most frequent cause of colon obstruction was colo-rectal cancer (71 p. cent of cases), but many other etiologies were involved, including 61 cases of torsion and 37 patients with occlusive sigmoiditis. Differential clinical and radiological features in each etiological group are discussed, the results of therapy undertaken analyzed, and a reasonable line of conduct proposed, adapted to each situation, with the objective of attempting to reduce mortality which still affects 25 p. cent of cases operated upon.

[Intestinal pouches for slowing transit after extensive enterectomy. Experimental study in the rat (author's transl)]. / Les poches intestinales de ralentissement aprs entérectomie étendues. Etude expérimentale chez le rat.

The experimental study of three types of intestinal pouch for slowing transit was carried out in the rat after resection of 75% of the small intestine. The consequences of these pouches are analysed compared with control animals have undergone the same resection alone. The slowing of the transit confirmed to opaque radiography of the small intestine was particularly marked in all three types of pouch. Statistical analysis of weight curves showed the existence of a favourable statistical difference for certain types of pouch from the fifth postoperative day onwards. Construction of pouches is in the rat one of the most effective procedures for slowing transit.

[Perforation of the abdominal esophagus and peritonitis (author's transl)]. / Perforations de l'oesophage abdominal et péritonites. Revue de la littérature. A propos d'un cas.

Perforation of the abdominal esophagus is not exceptional, either after endoscopy of the esophagus or after surgery of hiatus hernia. The clinical symptoms are not always clear especially during surgery. Immediate diagnosis is however essential for any delay in treatment causes the mortality to rise from 15% to more than 60% for repairs carried out under septic conditions. The best surgical attitude is difficult to determine under these conditions.