Publications (8)3.13 Total impact

  • J.J. Tuech · P. Pessaux · J.P. Arnaud
    Annales de Chirurgie 10/2002; 127(8). · 0.52 Impact Factor
  • Annales de Chirurgie 12/2001; 126(10). · 0.52 Impact Factor
  • P. Pessaux · J.J. Tuech · J.P. Arnaud
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    ABSTRACT: Prevention of fistula formation Pancreatic fistulae occur in about 10-20% of patients undergoing pancreaticoduodenectomy and are a leading cause of morbidity. We reviewed trials devoted to prevention. Surgical procedures for reduction of pancreatic secretion and modification of the remnant pancreas could be useful as preventive measures. Innovating surgery Several surgical procedures have been proposed to decrease the rate of complications, but none have demonstrated efficacy in a prospective randomized trial. Pancreatogastrostomy (PG) or pancreatojejuneostomy (PJ) have been compared in nine studies: seven retrospective series and two prospective randomized trials. The one trial using a correct randomization method found equivalent early results for PG and PJ. Inhibitors of pancreas secretion Eleven randomized trials have assessed the use of somatostatin or octreotide for the prevention of fistulae after pancreaticoduodenectomy. There has been significant heterogenity in these trials concerning the definition of fistula, dosage of octreotide, starting time and duration of treatment. Six studies have concluded that these drugs are effective while 5 concluded that there is no significant difference. Perspectives There is no convincing argument to affirm the superiority of PG or PJ. For the present, the use of somatostatin or octreotide cannot be recommended in routine practice for the prevention of postoperative complications of pancreatic surgery.
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    ABSTRACT: Study aim: The aim of this retrospective study was to evaluate the short and long term results of abdominoperineal resection for local recurrence following low anterior resection of a rectal adenocarcinoma and to determine the prognostic factors.Patients and methods: From January 1978 to December 1996, 35 patients (17 women, 18 men) with a mean age of 59.4 years, underwent an abdominoperineal resection for local recurrence after low anterior resection of a rectal adenocarcinoma. The primary tumor was below the peritoneum in 29 cases, and the mean security marge was 3 cm under the tumor. Tumor staging at the time of primary surgery included 23 Dukes B, 11 Dukes C, and 1 Dukes D. The mean time elapsed between low anterior resection and local recurrence was 16.4 months. The histological diagnosis of recurrence was obtained preoperatively in 29 cases (82.8%).Results: Resection was curative in 12 patients and palliative only in 23 patients. The recurrence was intramural in 3 cases, extramural in 10 cases, and mixed in 22 cases. Ten patients had an extended « en bloc » resection including one or several adjacent organs, and a synchronous metastasis was resected in 2 cases. The mortality rate was 2.8% (n=1) and the morbidity rate was 23% (n=8). The 1-year and 5-year survival rates were respectively 77 and 30.2% with the univariate analysis of prognosis factors of survival, there were four pretherapeutic factors (age, staging of the primary tumor, delay of the recurrence, CEA rate) and four therapeutic factors (curative resection, extramural recurrence, staging of the recurrence, postoperative radiotherapy). The curative or not curative type of resection was the only independent predictor of survival with multivariate analysis.Conclusion: The results of this study seem to justify an abdominoperinal resection for local recurrence after low anterior resection whenever possible. Long-term results may possibly be improved by using adjuvant treatment.
    Annales de Chirurgie 07/2001; 126(6):541-548. DOI:10.1016/S0003-3944(01)00571-5 · 0.52 Impact Factor
  • Annales de Chirurgie 01/2001; 126(6). · 0.52 Impact Factor
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    ABSTRACT: Aim of the study: The aim of this retrospective study was to report the results of percutaneous cholecystostomy in a selected group of high-risk patients with contraindications of general anesthesia.Patients and methods: From October 1995 to December 1999, a percutaneous cholecystostomy was performed in 29 patients with acute cholecystitis. There were 20 women and nine men with a mean age of 80.6 years (range: 59 to 95 years). All the patients were ASA III (N = 23) or ASA IV (N = 6). Ultrasound-guided percutaneous cholecystostomy was performed in 24 cases and computed tomography-guided cholecystostomy in five cases.Results: Percutaneous cholecystostomy was easily performed in 28 cases; there was one failed procedure. The drainage was not efficient in three patients who were operated on with one postoperative death of a patient who had a necrotic cholecystitis. There was no mortality in relation with cholecystostomy. One patient died at day 15 from myocardic infarction. The morbidity rate was 3.4% (one case). Postoperative length of hospital stay was 13 days (range: 7–30 days). The duration of the entire procedure ranged from 9 to 60 days (mean: 20 days). The mean follow-up of patients was 17 months (range: 4–40 months). One patient had recurrent acute cholecystitis and another one had angiocholitis; two patients underwent delayed elective laparoscopic cholecystectomy; 20 patients remained asymptomatic and 16 were still alive at the time of this study (13 with biliary stones and three without).Conclusion: Percutaneous cholecystostomy is a valuable alternative procedure for high-risk patients with acute cholecystitis. It’s a safe and usually effective procedure without mortality and with a low morbidity. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy.
    Annales de Chirurgie 10/2000; 125(8-125):738-743. DOI:10.1016/S0003-3944(00)00273-X · 0.52 Impact Factor
  • Annales de Chirurgie 06/2000; 125(5). · 0.52 Impact Factor
  • C Cervi · C Aube · J.J Tuech · P Pessaux · N Regenet · P Burtin · J.P Arnaud
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    ABSTRACT: Purpose: The aim of this prospective study was to evaluate a new MR cholangiography sequence, with thick slices, single shot fast spin echo (SSFSE) in biliary obstructive diseases.Patients and methods: This study included 60 patients (36 males and 24 females, mean age: 69 years) with cholestatic syndrome and suspected bile duct obstruction. All patients were prospectively investigated with MR cholangiography using SSFSE sequence with thick slices. The gold standard was ERCP (n = 47), per cutaneous cholangiography (n = 1), and surgical intervention (n = 12). According to this gold standard, 22 patients had obstructive gallstones, 23 had neoplastic obstruction, eight had inflammatory or postoperative stenosis and 7 had normal bile ducts.Results: The sensitivity and specificity of MR cholangiography were 100 and 94% in the diagnosis of obstructive gallstones, and 95 and 97% in the diagnosis of neoplastic obstruction, respectively. A good agreement was observed between MR cholangiography and the gold standard, regardless of the site of obstruction (range of kappa value: 0.79–1).Conclusion: MR cholangiography with SSFSE sequence is an effective and easy technique. Acquisition of thick slices in a very short time (< 2 sec) limits cardiorespiratory artefacts and eliminates the need for post-processing.