ABSTRACT
AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.
Subject(s)
Abdominal Injuries/surgery , Hemorrhage/surgery , Laparotomy/methods , Multiple Trauma/surgery , Resuscitation/methods , Traumatology/methods , Abdominal Injuries/complications , Abdominal Injuries/diagnosis , Abdominal Injuries/mortality , Adolescent , Adult , Age Distribution , Aged , Belgium/epidemiology , Child , Decompression, Surgical/methods , Female , France/epidemiology , Hemorrhage/etiology , Hemorrhage/mortality , Humans , Injury Severity Score , Male , Middle Aged , Multiple Trauma/complications , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Patient Selection , Retrospective Studies , Risk Factors , Surgical Stapling/methods , Survival Analysis , Suture Techniques , Time Factors , Treatment Outcome , Tunisia/epidemiologyABSTRACT
Three patients with pancreatic pseudocysts were treated laparoscopically by cysto-enteric by pass. Two developed a large cyst in the course of acute biliary pancreatitis. The third patient had chronic pancreatitis of unknown etiology. The mean size of the collection was 12 cm (8-20). Treatment was performed with a delay of 80 days (30-300) after the onset of the disease. Two patients underwent laparoscopic cysto-gastrostomy using laparoscopic ultrasound. Stapling anastomosis appears easy and safe. The third patient underwent operating laparoscopically assisted cysto-jejunostomy with an-Y loop. Mean time was 120 minutes (90-200) and hospital stay was 7 days (5-8) without morbidity. The follow-up was 18 months without radiological recurrence and with excellent clinical results.
Subject(s)
Laparoscopy , Pancreatic Pseudocyst/surgery , Adult , Drainage , Female , Follow-Up Studies , Gastrostomy , Humans , Jejunostomy , Male , Pancreatic Pseudocyst/etiology , Treatment OutcomeSubject(s)
Duodenal Ulcer/complications , Peptic Ulcer Perforation/surgery , Adult , Aged , Aged, 80 and over , Female , Fibrin Tissue Adhesive , Humans , Laparoscopy , Male , Middle AgedSubject(s)
Colic/complications , Kidney Diseases/complications , Peritoneal Cavity , Urine , Adult , Humans , MaleSubject(s)
Mucocele/pathology , Peritoneal Diseases/pathology , Female , Humans , Peritoneal Diseases/therapyABSTRACT
A so-called "phase II" clinical trial was carried out in 89 patients with digestive carcinomas who were treated either by chemotherapy alone or by a combination of surgery and chemotherapy. Thirty-five patients with inoperable tumours received chemotherapy alone without any noticeable improvement. Thirty-two patients had tumours which were operable but with inoperable extension. Palliative chemotherapy, given after surgery to reduce the size of the tumour, resulted in a prolongation of survival. Twenty-two patients with operable tumours without inoperable extension benefited from routine adjuvant chemotherapy.
