Skeletonizing en-bloc gastrectomy for adenocarcinoma in Caucasian patients.

Background: The prognostic relevance of a Japanese-like lymphadenectomy for gastric adenocarcinoma is Caucasian patients is not well establishes.

Methods: Skeletonizing en-bloc gastrectomy (SEBG) (including removal of the stomach, excision of the potentially involved lymph nodes, and skeletonization of the main anatomic structures in the upper abdominal floor) was attempted in 216 consecutive patients with adenocarcinoma of the stomach. Gastrectomy was total in 143 patients, and subtotal in 72.

Skeletonizing en bloc esophagectomy for cancer.

Objective: To evaluate the long-term outcome of patients with esophageal cancer after resection of the extraesophageal component of the neoplastic process en bloc with the esophageal tube.

Summary Background Data: Opinions are conflicting about the addition of extended resection of locoregional lymph nodes and soft tissue to removal of the esophageal tube.

Methods: Esophagectomy performed en bloc with locoregional lymph nodes and resulting in a real skeletonization of the nonresectable anatomical structures adjacent to the esophagus was attempted in 324 patients.

Erythromycin enhances early postoperative contractility of the denervated whole stomach as an esophageal substitute.

Objective: To determine whether early postoperative administration of erythromycin accelerates the spontaneous motor recovery process after elevation of the denervated whole stomach up to the neck.

Summary Background Data: Spontaneous motor recovery after gastric denervation is a slow process that progressively takes place over years.

Methods: Erythromycin was administered as follows: continuous intravenous (i.

Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy.

Background: The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture.

Methods: A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GIA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture.

Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases.

Background: The ultimate goal of surgery for hematological disorders is the complete removal of both the spleen and accessory spleens in order to avoid recurrence of the disease. Whereas splenectomy by open surgery provides excellent results, the validity of laparoscopic splenectomy in this regard remains unknown.

Objective: The purpose of this study was to evaluate the detection of accessory spleens during laparoscopic splenectomy for hematologic diseases.

The denervated stomach as an esophageal substitute is a contractile organ.

Objective: To determine whether the denervated stomach as an esophageal substitute is an inert conduit or a contractile organ.

Summary Background Data: The motor response of gastric transplants to deglutition suggests that the stomach pulled up to the neck acts as an inert organ.

Methods: The gastric motility of 11 healthy volunteers and 33 patients having either a gastric tube (GT) (n = 10) or their whole stomach (WS) (n = 23) as esophageal replacement was studied with perfused catheters during the fasting state, after a meal, and after intravenous administration of erythromycin lactobionate.

A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones. Lessons and limits from an initial experience of 92 patients.

Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration (CBDE) for CBDS.

Laparoscopic treatment of gallbladder duplication. A plea for removal of both gallbladders.

Background: Gallbladder duplication is a rare congenital condition, which can now be detected preoperatively by imaging studies.

Methods: We report a case of duplicated gallbladder with symptomatic unilobar gallstones. Appropriate biliary workup (ultrasound, oral cholecystography, and intravenous cholangiography) allowed a correct preoperative diagnosis.

Adult polycystic liver disease: is fenestration the most adequate operation for long-term management?

Objective: The aim of this study was to evaluate the immediate and long-term results in a retrospective series of patients with highly symptomatic adult polycystic liver disease (APLD) treated by extensive fenestration techniques. A classification of APLD was developed as a stratification scheme to help surgeons conceptualize which operation to offer to patients with APLD.

Summary Background Data: Treatment options for APLD remain controversial, with partisans of fenestration techniques or combined liver resection-fenestration.

Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery.

A Heller-Dor procedure was performed by laparotomy (group A: n = 8) or by laparoscopy (group B: n = 12) after failure of one to 17 sessions of intraluminal dilatations (n = 13) or as a primary treatment of oesophageal achalasia (n = 7). The oesophagomyotomy was extended over the thoracic oesophagus by thoracoscopy in two patients having vigorous achalasia. Injury to the oesophageal mucosa occurred in two group A patients who had previously been dilated.

Laparoscopic splenectomy in adults and children: experience with 31 patients.

Background: Open surgery is the standard approach for splenectomy in hematologic disorders, but a few cases of successful laparoscopic splenectomy have been reported.

Methods: Thirty-one patients (18 adults, group 1; and 13 children, group 2) underwent laparoscopic splenectomy. Indications for surgery included idiopathic thrombocytopenic purpura (25 patients), congenital spherocytosis (4 patients), and hemolytic anemia (2 patients).

Elective Laparoscopic Splenectomy: Person Experience and Literature Review.

Laparoscopic splenectomy has become an attractive treatment for patients with selected hematologic disorders. Almost 200 observations have been reported. The rate of conversion to laparotomy is 10% to 15%, and the complication rate is between 0% and 30%.

[Surgical treatment of chronic pancreatitis with predominant cephalic involvement by double Wirsung duct diversion and restoration of permeability of the cephalic duct].

The aim of this study is to assess the long-term results of an original surgical technique for the treatment of patients suffering from painful chronic pancreatitis. From 1981 to 1994, 54 patients with chronic painful pancreatitis were operated, by means of an original duct drainage procedure, named by the authors "double drainage" because it consists of a large transduodenal sphincterotomy and a long pancreatic duct, accompanied by repermeabilization of the cephalic pancreatic duct. This procedure was used exclusively for type I pancreatitis with major lesions in the head of the gland (calcified stones, narrowing of the ducts, inflammatory process).

Extensive lymph node clearance for cancer of the esophagus or cardia: merits and limits in reference to 5-year absolute survival.

Background/aims: The present study evaluates both merits and limits of extensive lymph node clearance in the mediastinum and upper abdomen on patients operated on more than 5 years ago.

Materials And Methods: One hundred forty-four esophageal cancer patients underwent subtotal (n = 97) or distal (n = 47) esophageal resection more than 5 years ago. Twenty-six patients operated on in a curative attempt were given radiotherapy (n = 14) or radiochemotherapy (n = 12).

Esophageal replacement: gastric tube or whole stomach?

Background: The stomach can be used either in its entirely or as a greater curvature tube for esophageal replacement.

Methods: The study compares the gastric tube (group A; n = 112) to the whole stomach whose lesser curvature is denuded (group B; n = 100) in terms of technical complication and alimentary comfort. The clinical results are substantiated by assessment of the eating performance of patients and control subjects at a test meal, measurement of the gastric dimensions before and after both tailoring procedures, and intraarterial staining of the gastric wall.

Acute colonic complications after kidney transplantation.

Over a 30-year period (1963-1993), 12 patients out of 2091 renal allograft recipients (0.5%) were identified for an acute colonic complication. They were 7 males and 5 females with a mean age of 43 years.

[Hepatic angiosarcoma developed 5 years following treatment for subacute glomerulonephritis].

A patient with hepatic angiosarcoma is described. This tumour, thought rare, still generates clinical interest, because of its characteristic association with occupational exposure to certain chemicals such as vinyl chloride and thorotrast. That association has led to extensive screening of high risk populations.

Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team.

Background: This study was performed to assess the exact performance of the conventional way of stapling colorectal anastomoses. Information collected from 1000 consecutive anastomoses performed by one surgical team could be considered as reliable reference with which results obtained by new approaches could be compared.

Methods: One thousand consecutive anastomoses were performed from 1979 to 1992.

Primary squamous-cell carcinoma of the colon: a case report.

We report a new case of S.C.C.

CT of the portal vein after portacaval shunt with arterialization.

Objective: Our goal was to assess the state of the portal vein in cirrhotic patients treated with a portacaval shunt associated with an arterialization of the portal vein.

Materials And Methods: We reviewed the follow-up CT of 23 patients treated by portacaval shunt with arterialization of the portal vein.

Results: Five patients demonstrated an aneurysm of the portal vein.

Laparoscopic antireflux surgery. What is real progress?

Objective: The authors aim to substantiate, with objective arguments, potential advantages of laparoscopic versus open antireflux surgery in the light of the recent crude experience of the Louvain Medical School Hospital.

Methods: Seventy-two consecutive patients with disabling gastroesophageal reflux disease ([GERD], n = 56), symptomatic hiatal hernia without GERD (n = 5), or unsatisfactory outcome after unsuccessful antireflux procedure (n = 11) were operated on by laparotomy (n = 28), laparoscopy (n = 39), or thoracotomy (n = 5). The antireflux procedure was a subdiaphragmatic Nissen fundoplication (n = 60), an intrathoracic Nissen fundoplication (short esophagus, n = 3), a subdiaphragmatic 240 degrees fundoplication (severe motility disorders, n = 3), a Lortat-Jacob repair (hiatal hernia without GERD, n = 5), and a duodenal diversion (delayed gastric emptying, n = 1).

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G gamma-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations.

[Ileo-anal anastomosis in hemorrhagic-ulcerative rectocolitis and familial adenomatous polyposis: is it mandatory to perform resection of the endo-anal mucosa?].

The aim of this study was to assess the clinical outcome after ileal pouch-anal anastomosis with mucosectomy for ulcerative colitis and for familial adenomatous polyposis, and to characterize the histology of the stripped endoanal mucosa with particular reference to the ulcerative colitis activity, adenomatous polyps and dysplasia. Twenty-eight patients were operated, 16 for ulcerative colitis (group I) and 12 for familial adenomatous polyposis (group II). In group I, there were no intraoperative complications, but mucosectomy was tedious in 10 patients (62%) and the anastomosis was performed under some degree of tension in 10 patients (62%).