[Laparoscopic treatment of gastroesophageal reflux using fundoplication. Midterm results]. / Traitement laparoscopique du reflux gastro-oesophagien par fundoplicature. Résultats à moyen terme.

UNLABELLED: The aim of this study was to see whether the results of surgical treatment of gastroesophageal reflux disease (GERD) by laparoscopic fundoplication were satisfactory and stable over time. PATIENTS AND METHODS: From July 1992 to September 1996, 161 patients with medical treatment-dependent GERD were operated. 17 patients were excluded from the study (conversion or immediate laparotomy). The group of 144 patients included consisted of 92 men and 52 women with a mean age of 50 (25-77 years). The preoperative work-up included endoscopy, esophageal manometry and 24-hour pH monitoring. The surgical procedures were complete fundoplication without section of the short vessels (Nissen-Rossetti: 122 cases), with section of the shorts vessels (Nissen: 18 cases), or partial fundoplication of 270 degrees (Toupet: 4 cases). The patients were reviewed clinically 3 months after the operation, with repeat manometry and pH monitoring; yearly survey was performed. RESULTS: There was no postoperative mortality. The morbidity consisted of 2 respiratory complications (1.5%) with good recovery. With a follow-up of 3 and 21 months, the dysphagia rate was 24 vs 2% of patients (p < 0.05), the rate of gas bloat syndrome was 18% vs 21% (n.s.), and the GERD recurrence 6% vs 14% (p < 0.05). The mean time to recurrence was 8 months. 2 patients were reoperated: one for incisional hernia and one for slipped-Nissen. CONCLUSION: The results of laparoscopic treatment of GERD with fundoplication procedures at 2 years follow-up showed an 86% cure rate of GERD control and 94% satisfaction rate for the patients who were investigated.

[Results of fundoplication by laparoscopic approach in the treatment of gastroesophageal reflux. Apropos of 224 cases]. / Résultats de la fundoplicature par voie laparoscopique dans le traitement du reflux gastro-oesophagien. A propos de 224 cas.

STUDY AIM: The aim of this paper is to evaluate prospectively immediate and 2-year results of laparoscopic fundoplicature (LF) for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: Patients presenting GERD who had been previously submitted to a long-term medical treatment were included in this study. Preoperative workup included upper GI tract endoscopy, esophageal manometry and 24-hour pHmetry. Standard surgical procedure incorporated a Nissen-Rossetti 360 degrees fundoplicature. Short vessels division (Nissen operation) was performed in case of high strength of the wrap and a partial fundoplicature (Toupet 270 degrees) was performed when motility disorders of the esophagus were demonstrated by manometry. Postoperative morbidity and results were evaluated, with a clinical appreciation at 3 and 22 months, and by manometry and pHmetry at 3 months. RESULTS: Two hundred and thirty-five patients were observed, and 224 included in the study (143 men and 92 women). Nissen-Rossetti fundoplication was performed in 169 cases (80%), Nissen in 30 (14%) and Toupet in 13 (6%). In 12 cases (5%). LF was converted to an open Nissen-Rossetti procedure. There was no hospital mortality and complications were noted in three cases (1.5%): pneumonia (n = 2) and gastroplegia (n = 1). With a mean 22-month follow up, among the 103 patients who answered to a questionnaire, the rate of relapse of GERD was 14%, dysphagia was present in 2% and four patients had been reoperated on (one for a slipped Nissen, one for a stenosis of the esogastric junction and two incisional hernias). CONCLUSION: On the basis of this experience, LF for GERD is a safe and efficient operation, with 86% of good results at 2 years.

[Pancreatico-jejunal anastomosis with invagination on isolated loop after cephalic pancreatoduodenectomy]. / L'anastomosi pancreatico-digiunale con invaginazione su ansa esclusa dopo duodenopancreatectomia cefalica.

The most frequent and most dangerous complication of the duodenopancreatectomy is pancreatic fistula due to dehiscence of the pancreatic anastomosis. A technique that uses a separate Roux en Y loop for pancreatic anastomosis, to reduce the fatal risks of the pancreatic fistula, has been initially reported more than 50 years ago. With the development of the pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique is derived from those previously published, allowing a good intussuception of the pancreas in the intestinal loop. This method has been performed in 35 duodenopancreatectomy (malignant pancreatic disease: 32 patients, benign pancreatic disease: 3 patients). The mean age of the patients was 64 years (range 34-74). There were four operative deaths unrelated to the pancreaticojejunal anastomosis and two pancreatic fistulas with spontaneous healing. The pancreatico-jejunostomy using a separate Roux en Y loop represented in this short experience a safe procedure to prevent pancreatic fistula.

[Immediate resection-anastomosis after intra-operative colonic irrigation in cancer of the left colon with obstruction]. / Résection-anastomose immédiate après lavage colique per-opératoire dans le cancer du côlon gauche en occlusion.

In a consecutive series of 38 patients over 5 years, who required emergency surgery for obstructing left colonic carcinoma, 24 had primary bowel resection with immediate anastomosis, after intraoperative anterograde colonic irrigation. Complete colonic obstruction was present in all cases. There were 7 Dukes B tumors, 11 Dukes C tumors and 6 Dukes D tumors. The operative mortality was 8.3% (2 patients, with one from anastomotic leakage), anastomotic leakage rate was 4%. Superficial wound infection occurred in 4% of patients. The median postoperative hospital stay was 19.5 days. The Kaplan-Meier survival curve showed a 41% survival rate after 5 years. This technique was found to be safe and effective to perform a primary anastomosis, without requiring temporary colostomies, after emergency resection of selected left colonic carcinoma obstruction.

[Acute pancreatitis treated in a surgery ward. Apropos of 57 cases]. / Pancréatites aiguës traitées en milieu chirurgical. A propos de 57 cas.

The aim of this study was to examine the results of a policy in the treatment of acute pancreatitis (AP): initial abstention, management in intensive care unit, surgery in cases of complication (infection and/or failure of medical treatment). The modalities of the surgical treatment were guided by CT scan findings: transperitoneal approach for diffuse lesions, posterior approach for localized lesions. From 1986 to 1994, 57 patients (32 males, 25 females, mean age 59.2 years) were referred to our department for AP. Etiology was gallstones in 29 cases, alcohol in 14 cases (Ranson < 3), moderate in 27 cases (Ranson < or = 5) and serious in 12 cases (Ranson > or = 6). According to the initial CT scan findings (56 cases), 9 patients were classified grade A, 11 grade B, 13 grade C, 8 grade D ans 15 grade E. Thirty eight patients were managed conservatively (mean Ranson stage 3.3), while 19 patients underwent surgical treatment (mean Ranson stage 4.6), in emergency for misdiagnosis (4 cases), or secondarily because of failure of medical management (15 cases). Surgery consisted in necrosectomy with active drainage in 13 cases and drainage alone in 6 cases. Associated maneuvers included: cholecystectomy in 8 cases, cholecystostomy in 2 cases, jejunostomy in 7 cases and colic resection for necrosis in 3 cases. Two patients (5%) managed conservatively died (multiple organ failure and cardiac insufficiency) while 4 patients (21%: NS) who underwent surgery died (2 multiple organ failures, 1 septic shock, 1 myocardic infarction). Mortality was correlated with the Ranson score: 42% for serious AP, 3.7% for moderate AP and nil for mild AP (p < 0.01). It was not correlated with CT scan grade, the onset or the type of operation. These results allow us to conclude that surgical treatment should be indicated only in cases of failure of conservative management, the best indication being uncontrolled sepsis. In this situation, active drainage provides good results since only one sepsis recurred among the 14 patients who underwent this procedure.

[Tonometric monitoring of the viability of free transplants of the jejunum and the stomach after total circulary pharyngolaryngectomy]. / Surveillance tonométrique de la vitalité des transplants libres de jéjunum et d'estomac après pharyngo-laryngectomie totale circulaire.

A prospective study concerning the tonometric viability supervision of 9 digestive free autografts after total pharyngolaryngectomy was conducted. This technic is based on the Henderson and Hasselbalch's equation which calculates the intramucosal pH (pHi) in the graft using a tonometric catheter. When the pHi is under 7.10, there is a graft ischemia. This invasive technique seems to be sensitive and specific provided that minimally rigorous measurement procedures are used. Late graft necrosis is the major limitation of the technique.

[Pancreaticojejunal anastomosis by intussusception of an isolated loop in pancreaticoduodenectomy]. / L'anastomose pancréatico-jéjunale par invagination sur anse isolée dans la duodénopancréatectomie céphalique.

The most frequent and severe complication of pancreaticoduodenectomy is pancreatic fistula due to dehiscence of the pancreas anastomosis. The technique that uses a separate Roux en Y loop for pancreas anastomosis, to reduce the fatal risks of pancreatic fistula, has been described for more than 50 years. With the development of pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique, derived from those previously described allows a good intussusception of the pancreatic stump into the intestinal loop. This method was performed in 22 pancreaticoduodenectomies. There were 2 operative deaths unrelated to the pancreaticojejunal anastomosis and one pancreatic fistula, which healed under medical treatment.