Systematic use of total vascular exclusion in 14 elective hepatic resections.

Between March 1992 and May 1995, 14 hepatic resections under total vascular exclusion were performed (10 major resections and 4 minor resections involving central segments). Mean age was 64 years (SD +/- 12). During hepatic resection, 4 patients required blood transfusion. The reason was a too low level of haemoglobin (< 10 gr/100 ml) to undergo Hepatic Vascular Exclusion (HVE) (1 patient), an unacceptable decrease in blood pressure following HVE leading to insertion of venovenous bypass (1 patient), or an extensive bleeding following removal of the clamps (2 patients). The 10 remaining patients did not need peroperative blood transfusion. Two patients were transfused after the 6th postoperative day. Complications usually described during HVE were not encountered except for one pleural effusion needing thoracocentesis.

[Study of the toxicity and results of intraperitoneal hyperthermic chemotherapy in 28 patients with peritoneal carcinomatosis]. / Etude de toxicité et résultats de la chimio-hyperthermie intra-péritonéale chez 28 patients en carcinose péritonéale.

Based on a few previous studies, intra-peritoneal hyperthermic perfusion (IPHP) with Mitomycin C could become a beneficial treatment for peritoneal carcinomatosis. Twenty eight patients with peritoneal carcinomatosis arising from intra-abdominal cancers were treated by IPHP, Mitomycin C, diluted in 3 liters of saline solution warmed to a mean temperature of 45 degrees C, was injected into the abdominal cavity for one hour. Median survival for the whole series (postoperative mortality included) was 260 days. For patients with incomplete resection, median survival was 104 days. For patients with complete resection of carcinomatous nodules larger than 3 mm (19 patients), it was 450 days. In this group, actuarial survival was 56% at 1 year and 42% at 2 years. Only 5 (18%) of the 28 patients developed ascitic effusion during follow-up. These results confirm the efficacity of IPHP on ascitic effusion and on survival rate in patients with nearly complete resection of peritoneal carcinomatosis.

Is laparoscopic splenectomy a justified approach in hematologic disorders? Preliminary results of a prospective multicenter study. Belgian Group for Endoscopic Surgery.

The feasibility and safety of laparoscopic splenectomy were evaluated in a prospective multicenter study of 50 patients operated on for idiopathic thrombocytopenic purpura (ITP) (n = 31), hereditary spherocytosis (n = 6), hemolytic anemia (n = 4), Hodgkin's disease or lymphoma staging (n = 5), benign splenic tumors (n = 3), and wandering spleen (n = 1). Conversion to laparotomy was required in 10%. An accessory spleen was routinely searched for, although the lesser sac was opened during surgery in only 10%; the overall incidence was 14%. Hospital mortality was 2% and postoperative morbidity 22%. Postoperative hospital stay and home rehabilitation were improved when exclusively laparoscopic splenectomy was performed. In ITP patients, at a mean follow-up of 8.2 months, 8 patients (27%) had recurrence of thrombocytopenia, which was transient in 7% and permanent in 20%. Laparoscopic splenectomy is feasible and safe when performed in selected patients by expert laparoscopic surgeons. Adequate selection of patients and routine, careful search for accessory spleen are critical. The recurrence rate (20%) for ITP was high at 8.2 months, and this factor is the major limitation of laparoscopic splenectomy at present.

Utilization of gas heater humidifier in the course of coelioscopies.

The increasing utilization of coelioscopic interventions has needed the use of a larger number of trocars, which involves in some cases (especially at the beginning of personal experience) longer operations. In our clinical experience we have met hypothermies that compelled us to modify our way of working. The use of conventional means (like warming cushion, warming of irrigation fluids) could limit the temperature loss only moderately. So we imagined to warm and moisten the gases insufflated into the peritoneal cavity. We give a description of the accessories and the results with some patients.

[Complications of laparoscopic cholecystectomy. Free intraperitoneal calculi]. / Complications de la cholécystectomie par coelioscopie. Devenir des calculs intra-péritonéaux libres.

With the use of laparoscopic cholecystectomy, increasing numbers of gallstones are being left in the peritoneal cavity. To our knowledge, the rarely cause complications. We present two cases with stone spillage after laparoscopic cholecystectomy, with a different outcome.

Cholelithiasis: a serious complication after total gastrectomy.

To establish the incidence of cholelithiasis after total gastrectomy, patients operated on between 1979 and 1985 were reviewed. The study group consisted of 30 patients, all free of gallstones at the time of their gastrectomy. The median age of the patients was 56 years, the average follow-up 40 months. Cholelithiasis developed in 47 per cent of patients (14/30) and always within 2 years of total gastrectomy. The incidence of cholelithiasis was not related significantly to the sex or age of the patients. Morbidity from cholelithiasis was not negligible. Three of the fourteen patients presenting with gallstones required medical treatment in hospital and later came to cholecystectomy because of specific biliary symptoms. Cholelithiasis appears to be a significant complication after total gastrectomy. It may be related to the vagotomy which is performed at the time of gastrectomy.

[Value of automatic sutures in total gastrectomy for cancer: apropos of 81 patients]. / Apport de la suture automatique dans la gastrectomie totale pour cancer: à propos de 81 patients.

We reviewed the results of stapled circular (EEA) and linear (TA 30 or 55) anastomoses in a prospective study of 40 total gastrectomies for cancer, using an interposed jejunal limb (Henley technique). There were 63 circular anastomoses: 40 esophago-jejunal, 20 jejuno-duodenal and 3 jejuno-jejunal anastomoses. Forty patients were submitted to 41 linear stapled closures of the jejunal stump. Technical failure rate with stapled anastomoses was 5% (3 out of 63). Incidence of anastomotic leak was 6.3% for all the circular stapled anastomoses tried and 5% if the 3 technical failures were excluded. Anastomotic leakage is more often associated to splenopancreatectomy. One patient (1% of all the anastomoses) presented gastro-intestinal bleeding, related to the suture line. A conservative treatment was carried out successfully. The mean follow-up time of the surviving patients was 27 +/- 20 months: there was a 5.5% rate of late anastomotic stenosis; all the patients were cured by esophageal dilations. Late anastomotic stenosis is directly related to associated cobalt therapy. Analysis of an older retrospective series of 41 hand-sutured total gastrectomies allowed a comparison to be made between stapled and sutured anastomoses in total gastrectomy for cancer.

[Pancreatitis and choledochal cyst]. / Pancréatite et kyste du cholédoque.

A six years old girl was rushed to hospital with an acute abdomen. Because of the age of the patient, the clinical examination and the usual biology we diagnose an acute appendicitis. The fortuitous measuring out of the pancreatic enzymology allows us to correct our first diagnostic into the one of pancreatitis with angiocholitis. The check-up shows a congenital choledochal cyst with an abnormality of the choledochus-Wirsung junction explaining the physiological pathology presented. The surgical operation was made up of an cystectomy with cholecystectomy and hepatico-jejunostomy according to an Y shaped loop from Roux. Pancreatitis diagnostic is unusual in childhood, there is a good reason to suspect in those circumstances the existence of a choledochal cyst.

[Preoperative localization of parathyroid adenomas: significance, indications and results]. / Localisation pré-opératoire des adénomes parathyroïdiens: intérêt, indications et résultats.

Preoperative localizing technics of a parathyroid tumour. The authors present a limited experience about preoperative localizing technics of a parathyroid tumour. Oesophagography and selenomethionine 75 scintigraphy were not useful. Ultrasonography and computed tomography localised 50% of the tumours. Selective thyroïd venous catheterization and radioimmunoassay are correctly predictive in 87,5% of the studied cases. The interest, morbidity and results of these different technics are discussed.