[Perforation of duodenopyloric ulcers. Prognostic factors and therapeutic choices. Retrospective study of 140 patients]. / Perforations des ulcères duodéno-pyloriques. Facteurs pronostiques et choix thérapeutiques. Etude rétrospective de 140 malades.

The treatment of perforation of duodenopyloric ulcers varies according to the risks of immediate mortality and long-term recurrence. The authors carried out a retrospective study on 140 duodenopyloric ulcers which had been treated over a 13 year period. The study high identified 3 factors of immediate mortality. Age over 70 years, admission delayed by more than 24 h and preoperative hemodynamic shock. Global mortality in this series is 8.6% and varied between 2.3% and 66.7% according to the absence or presence of these 3 risk factors, respectively. The authors recommend a simple operative protocol guided exclusively by the risk factors for mortality. The presence of a single factor requires simple suture of the perforation. Suture of the perforation and vagotomy should be performed in the absence of risk factors.

[Technique of isoperistaltic esophageal gastroplasty. Comparative study of in vitro arterial vascularization]. / Technique de gastroplastie oesophagienne isopéristaltique. Etude comparative de la vascularisation artérielle in vitro.

Operative survival is impaired by anastomotic fistula after esophageal resection and reconstruction. Hypovascularisation of esophageal substitute is essential. Stomach is a useful esophageal substitute however proximal resection of lesser curvature compromises vascularisation of the highest point of fundus which is usually sutured to esophagus. To improve this a new S shape esophagoplasty with isoperistaltique stomach was achieved. Fifteen cadaveric stomachs were assigned to three equal groups prepared as follow: narrow J shape stomachs, large J shape stomachs, large S shape stomachs. The arterial tree was studied following injection of contrast media barium from the right gastroepiploic artery. Proximal arteries of the S shape stomachs were well filled comparing to the others. This was allowed by keeping intact the tronc of the left gastric artery branches, severing the left gastroepiploic artery close to the spleen, and dividing the proximal fundal region as a curve.

[Natural history of postoperative intraperitoneal adhesions. Surely, a question of the day]. / Histoire naturelle des adhérences intra-péritonéales post-opératoires. Une question vraiment à l'ordre du jour.

Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.

[Traumatic hemoperitoneum of splenopancreatic origin. Apropos of 155 cases. Can a non-surgical treatment be proposed?]. / Les hémopéritoines traumatiques d'origine spléno-hépatique. A propos de 155 cas. Peut-on proposer un traitement non opératoire?

From 1985 to 1990, we treated 155 patients presenting with a hemoperitoneum secondary to a splenic or hepatic injury (diagnosis established by sonography, puncture and washout and/or laparotomy). These were 39 children and 116 young adults (average age 33 years). Fifty-eight of them (37%) suffered from multiple injuries (11 children, 47 adults). Splenic lesions were observed in 110 cases and hepatic lesions in 45. Ninety-one patients were operated, 55 in emergency and 36 later, while a watch-and-wait policy was applied to 64 (42%), with repeated clinical and complementary (ultrasound and/or CT) examinations. The indication for surgery was based on the clinical findings and the necessity of blood transfusion (more than 40 ml/kg/24 h in children, more than 2 to 5 U/24 h in adults, according to the context). This attitude allowed us to avoid operating two-thirds of the children and one third of the adults. We assess the limitations of this method.