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ABSTRACT: L’origine appendiculaire ou annexielle d’un syndrome douloureux aigu de la fosse iliaque droite chez la femme jeune est difficile
à établir, conduisant ainsi fréquemment à une appendicectomie inutile. Pour cette raison, nous proposons un traitement coelioscopique
permettant d’une part d’éviter ces erreurs diagnostiques, d’autre part de réaliser très simplement, chaque fois que cela est
nécessaire une appendicectomie.
For young women, adnex or appendicular origin in Right Iliac Fossa acute pain syndrom is not easy to establish, frequently
responsible of needless appendicectomy. For this reason, we propose a coelioscopic treatment allowing, on one hand avoiding
diagnosis mistakes, on the other hand realizing each time it is necessary an appendicectomy.
El origen apendicular o anexial de un sindrome doloroso agudo de la fosa ilíaca derecha en la mujer joven es difícil de establecer,
conduciendo así frecuentemente a una apendicectomia inútil. Por esta razön proponemos un tratamiendo celioscópico que permite
de una parte evitar estos errores diagnósticos y de otra parte realizar más simplemente cada vez que sea necesario, una apendicectomía.
Die Differentialdiagnose Appendizitis oder Adnexitis beim rechtsseitigen Unterbauchschmerz bei jungen Frauen ist schwierig
zu stellen und führt oft zu unnötigen Appendektomien.
Nella donna in giovane età è spesso difficile stabilire l’origine annessiale o appendicolare di una sindrome dolorosa acuta
localizzata in fossa iliaca destra: ciö comporta spesso il ricorso ad una appendicectomia inutile. Viene pertanto proposto
un approccio celioscopico sistematico in grado da un lato di evitare questi errori diagnostici e, dall’altro di realizzare
molto semplicemente l’appendicectomia ogniqualvolta necessaria.
Acta Endoscopica 04/1992; 22(1):53-63. · 0.09 Impact Factor
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ABSTRACT: The difficulties for evaluation of the perineal descent have always been linked to the choice of references and mostly with the incertitude of the measurement of length on the radiographic film. This present study was carried out to evaluate the perineal descent on the choice of an angular measurement: the posterior rectal inclination. The dynamic digitalized rectography was used to investigate the pelvic floor status of 134 women: 115 patients complaining of idiopathic constipation, and 19 healthy volunteers. Results have shown 3 populations with an increasing graduation of perineal impairment and led to propose a radiologic classification of pelvic floor impairment: stage I, or solid perineum, stage II, or descending perineum and stage III or descended perineum. This study has brought up that the first sign of a pelvic floor abnormality may be increased descent during straining, only later followed by perineal descent at rest. The relationship linking abnormal perineal descent and excessive opening of the ano-rectal angle suggested logically that fecal incontinence may be the end complication of the Descending Perineum Syndrom.
Journal de Radiologie 11/1991; 72(10):503-8. · 0.42 Impact Factor
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ABSTRACT: We propose an original technique of treatment of perforated peptic ulcer with celioscopic monitoring which has principles and indications similar to those of simple surgical suture via laparotomy. The procedure consists in obliterating the ulcerous perforation with the round ligament (RL) that has previously been predicled from its insertion on the liver, under celioscopy. The umbilical end of the RL is then caught with a Dormia probe inserted through the perforation with a fibrogastroscope. By pulling the probe, the RL is then inserted into the perforation and obturates it. Peritoneal washing and transcutaneous infrahepatic drainage complete the procedure. This was proposed to 9 patients (8 M, 1 F) with a mean age of 41 years (24-59) having ulcers perforated for less than 6 hours. The obliteration of the perforation using the RL was performed easily in 7 cases. In 3 cases, the procedure could not be carried out, either because the diameter of the perforation exceeded 1.5 cm (n = 2) or because of purulent peritonitis (n = 1). No postoperative complications occurred. The endoscopic control showed healed ulcers in all cases after 5 weeks of treatment with anti-H2 drugs. These still preliminary results suggest that the celioendoscopic treatment of perforated peptic ulcers might be proposed whenever vagotomy does not seem to be absolutely necessary, especially in cases of acute ulcer occurring in younger subjects. In comparison with laparotomy, this procedure prevents parietal sequellae and improves the postoperative comfort. This procedure might also be proposed as an alternative to Taylor's procedure, thus avoiding the diagnostic errors and delays in surgery that are inherent in this therapeutic method.
Journal de Chirurgie 03/1991; 128(2):91-3. · 0.50 Impact Factor
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Surgical Endoscopy 02/1991; 5(3):154-5. · 4.01 Impact Factor
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ABSTRACT: The authors propose a technique of fixation of the parietal prosthesis by metallic staples in order to reduce the operation time which is often long. The operation was performed according to J Rive's principles, using a Dacron patch (n = 65) or a polyglactin patch (n = 5). A mechanical stapler for aponeurotic suture was used for fixation of the patch. The bent shape of the stapler made it possible to very easily insert the lateral edge of the patch, previously hemmed, to slip it under the rectus abdominis muscle and to clamp it onto the lateral linea alba. We placed the patch under tension very easily with circular clamping. Seventy ruptures were treated by this technique. In 80% of cases, the rupture was frontal and in 20% of cases, it was fronto-lateral. The mean diameter of the parietal defect was 15 cm (E = 10-35 cm). The time for fixation of prosthesis was less than 5 min; the usual duration of the operation was therefore considerably reduced. In every case, we obtained optimal tension of the suture, without any folds, and this very easily. There was no mortality. Two postoperative hematomas, one consecutive to an injury of the epigastric artery required a second operation. We only had one case of superficial parietal sepsis. None of these complications required removal of the parietal prosthesis. The functional results were always satisfactory for the patients who suffered no pain induration over the metallic staples. A radiological follow-up of the position of the prosthesis encircled by the metallic staples was systematically performed after every operation. Only one relapse, due to a technical error, was observed. If we consider that the follow-up of these results is about two years (3 months-5 years), they suggest that the use of a stapler allows strong fixation, without any fold and with a regular tension, of the prosthetic patch used in the treatment of large incisional hernia. If we compare this technique with the usual techniques of fixation, we can say that this technique significantly reduces the duration of the operation which is often long. These technical advantages help to reduce the long operating time and the risk of sepsis, which is always serious, also minimizing recurrences of the rupture.
Annales de Chirurgie 02/1991; 45(10):882-8. · 0.35 Impact Factor
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La Presse Médicale 02/1991; 20(2):83. · 0.67 Impact Factor
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ABSTRACT: Rectopexy associated with anterior prolepsectomy was performed for 22 patients (19 females, 3 males), with solitary rectal ulcer syndrome (SRUS) surrounding internal rectal prolapse. The different lesions of SRUS were distributed among 3 main groups (G) according to the macroscopic appearance: G1: solitary ulcer (n = 7); G2: ulcerated proctitis (n = 7); G3: muco-hemorroidal prolapse (n = 3). A significant difference (P less than 0.05) was observed between each group, concerning mean age (G1: 34 years, G2 = 49, G3: 65) and the degree of perineal descent, which was more important in G3 and G2. Posterior intersphincteric rectopexy was performed for 6 patients in G3, with descending perineum and faecal incontinence, treated in the same time by perineoplasty (Parks). Abdominal rectopexy, mainly by the antero-posterior technique (Nicholls), was performed for the other patients (n = 6). Large anterior prolapsectomy reaching the top of the mucosal prolapse (4-7 cm), allowing ulcer resection in 3 cases, was combined with rectopexy. Associated operations were: sphincterotomy (n = 8) for narrow fibrous anal canal, sigmoidectomy (n = 4) for dolichocolon. Mean healing time for the solitary ulcer group (G1) was 2 months, 1 month for lesion of G2 and G3. Failures concerned 1 solitary ulcer after abdominal rectopexy and 1 ulcerative proctitis after rectopexy without prolapsectomy. Anorectal pain (81%), rectal bleeding (76%), faecal incontinence (27%), straining (81%), were cured or improved in 80% of cases. These results tend to confirm the efficacy of rectopexy, specially using the antero-posterior technique, for the treatment of SUSR with internal rectal prolapse. Nevertheless, rectopexy seems to be insufficient to correct the mucosal component of internal rectal prolapse, bearing the ulcerated lesion which needs to be treated by associated anterior prolapsectomy. Similarly all functional or organic disorders involving the perineum, anal canal or colon leading to anorectal dysfunction must also be considered to ensure complete treatment.
Annales de Chirurgie 02/1990; 44(10):807-16. · 0.35 Impact Factor
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ABSTRACT: We report the results of a procedure aimed at correcting the disorders of rectal and perineal tone responsible for the descending perineum syndrome (DPS). The procedure, carried out by the perineal approach, combines a posterior intersphincteric sacro-rectopexy, an anterior perineoplasty via a pre-anal levator myorraphie, a posterior perineoplasty using a post anal repair technique and a mucosal resection aimed at freeing the anal canal. 22 F and 1 M, mean age 68 years, with DPS were operated on. Digitised rectography demonstrated pathological perineal descent (greater than 3 cm) in all cases and posterior rectal angulation at rest of more than 25 degrees (normal less than 10 degrees) confirming an important deterioration in perineal tone. Results after a mean follow up of 12 months (6 to 30 months) were excellent, with objective improvement in rectal bleeding, pain, mucosal prolapse and anal incontinence. In spite of an almost constant return to normal in the number of stools and their facility of evacuation improvement in the dyschesic syndrome (78% of patients) was subjectively variable. Improvement was judged to be very good in 34%, good in 33%, fair in 11%. Healing of mucosal lesions: solitary ulcer (n = 2), rectal inflammation (n = 2), ulcerated mucosal prolapse (n = 3) occurred in all cases within 1 month. Post operative rectography demonstrated a significant decrease in posterior rectal angulation and ano-coccygeal distance confirming the efficacy of the anatomical correction. No serious complications, in particular, infections, were noted under appropriate prophylactic antibiotic cover (Piperacillin) continued up to D5.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal de Chirurgie 05/1989; 126(4):265-73. · 0.50 Impact Factor
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ABSTRACT: We report the results of 30 antero-posterior rectopexies (APR) for rectal kinetic disorders with descending perineum syndrome. All patients were investigated by digital subtraction defecography and ano-rectal manometry. The associated surgical procedures were: sphincterotomy (n = 13) for outlet obstruction demonstrated by anal manometry or balloon expulsion test: hypertonic sphincter (n = 7), narrow fibrous sphincter (n = 6); 10 cases of prolapsectomy with extended anterior mucosectomy to reduce anterior rectal prolapse; 2 sigmoidectomy for dolichosigmoid. Best results (mean follow-up: 12 months, 3-26) were observed for ano-rectal or pelvic pain and rectal bleeding, which were cured in more than 80% of cases. Faecal incontinence (n = 5) was cured in all cases. Although normalisation of bowel movements and easier defecation were observed in 78% of cases, improvement in the dyschezic syndrome was differently perceived by the patients. Postoperative investigation demonstrated the probable cause of surgical failures (23%): impairment of rectal sensitivity (n = 2), anismus (n = 3), motor constipation (n = 4), with dolichosigmoid (n = 3). Severe perineal deficiency was also noted in 4 cases. Solitary ulcer (n = 6), anterior proctitis (n = 8), were cured within 2 months. Postoperative defecography showed correction of rectal intussusception without impairment of anterior rectal motility during defecation. These results confirm the efficacy of ARP for treatment of rectal intussusception or anterior rectocele. This functional rectopexy avoids the rectal "sling effect" of standard rectopexy which usually increases rectal dysfunction. Nevertheless, ARP alone seems to be insufficient when the associated functional or organic disorders implicated in rectal dysfunction are not also corrected, essentially outlet obstruction and dolichosigmoid.
Annales de Chirurgie 02/1989; 43(9):733-43. · 0.35 Impact Factor
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Gastroentérologie Clinique et Biologique 03/1988; 12(2):176-7. · 0.80 Impact Factor
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Annales de Chirurgie 02/1988; 42(7):482-7. · 0.35 Impact Factor
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La Presse Médicale 11/1987; 16(35):1762. · 0.67 Impact Factor
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La Presse Médicale 03/1986; 15(6):257-8. · 0.67 Impact Factor
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Chirurgie 02/1985; 111(8):708-14.
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Journal de Chirurgie 124(6-7):403. · 0.50 Impact Factor
