[Role of celioscopy in acute obstructions of the small intestine]. / Place de la coelioscopie dans les occlusions aiguës du grêle.

OBJECTIVES: The aim of this study was to evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute small bowel obstruction. METHODS: Thirty five patients, with less than three abdominal incisions, who had undergone initial laparoscopy for acute small bowel obstruction, were reviewed. The small bowel was mobilized to determine the cause and site of obstruction. RESULTS: In 31 cases, small bowel obstruction was caused by a single or numerous obstructing bands. Among 31 cases of adhesions, laparoscopic treatment of intestinal obstruction was possible in 16 cases (51.6%). In 15 cases, laparoscopy had to be completed by laparotomy: numerous adhesions could not be divided in 12 cases; intestinal ischemia which required resection was present in 3 cases. There was no hospital mortality and postoperative complications occurred in 19% of cases. Multivariate analysis demonstrated a relation between need to complete laparoscopy by laparotomy and two factors : presence of signs of peritoneal irritation (P < 0.05) and intestinal obstruction caused by numerous adhesions or bands (P < 0.05). Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the "laparoscopy + laparotomy" group. CONCLUSIONS: Laparoscopic treatment of acute small bowel obstruction is difficult and was possible in only half of the cases. The first port should be inserted by open technique to avoid the risk of perforation of distented small bowel. When laparoscopy shows numerous adhesions, laparoscopic treatment should not be pursued, and laparotomy should be recommended to avoid the risk of visceral perforation.

[Celioscopic treatment of cholelithiasis in benign acute biliary pancreatitis]. / Traitement coelioscopique de la lithiase biliaire au décours des pancréatites aiguës biliaires bénignes.

OBJECTIVES AND METHODS: To evaluate the laparoscopic treatment of cholelithiasis in mild acute gallstone pancreatitis, 35 patients with gallstone pancreatitis and less than 4 Ranson's prognostic signs at 48 h were retrospectively included. RESULTS: Eight patients underwent preoperative endoscopic retrograde cholangiopancreatography. Surgery was performed a median of 15 (range: 4-60) days after the onset of pancreatitis, and included laparoscopic cholecystectomy with intraoperative cholangiography that was successful in 30 out of 32 cases (93%). A common bile duct stone was present in 4 patients (11%). Conversion to open surgery was necessary in 3 patients (8%). Choledocholithiasis was successfully removed by laparoscopy in two cases, and by laparotomy and postoperative endoscopic sphincterotomy in one case each. CONCLUSION: Laparoscopic treatment can be recommended as the primary treatment within a few days after the onset of mild gallstone pancreatitis.

[Value of celioscopy in the diagnosis of abdominal wounds]. / Intérêt de la coelioscopie pour le diagnostic des plaies abdominales.

Gunshot or stab wounds with equivocal evidence of intraabdominal injury lead to negative laparotomy in 20% to 30% of cases. The aim of this prospective study was to evaluate, in hemodynamically stable patients, the role of laparoscopy in order to reduce the rate of unnecessary laparotomies for such wounds. This study was carried out in 21 patients. Laparoscopy revealed 15 penetrating wounds (71.4%) with two isolated diaphragmatic injuries. Eight laparotomies (38%) for visceral injuries were performed on the 15 penetrating wounds. The laparoscopic exploration was complete in 7 cases without laparotomy. Thirteen unnecessary laparotomies were avoided (62%). Laparoscopy was found to have a 100% specificity and sensitivity for the diagnosis of peritoneal effraction and diaphragmatic injury. Laparoscopy is very effective for evaluation of equivocal penetrating wounds.

[A trial of evaluation of cholecystectomy by celioscopic approach. Apropos of 2266 patients]. / Essai d'évaluation de la cholécystectomie par abord coelioscopique. A propos de 2,266 malades.

Facing enthusiasm and critics it is necessary to evaluate new surgical techniques. The aim of our study is to try to evaluate cholecystectomy by laparoscopy. 2266 patients operated on by laparoscopy in France are compared with 3390 patients operated on by laparotomy which were published in 1990 in American surgical revues. Both groups are comparable concerning age of patients and surgical indications. Even if 10% of the patients operated on by laparoscopy needed a laparotomy, the morbidity and the mortality were not significantly different in both techniques. This study allows to conclude that cholecystectomy done by laparoscopy offers the same security to patients than using laparotomy, with in addition a faster and better recovery and a much lower economic cost. However, some problems are not yet resolved, especially the one concerning main bile duct stones and the one concerning the necessity of a special training for these surgical laparoscopic technics.