NEWS AND NOTES 1988, VOL.19, NO.3

https://digitalcommons.rockefeller.edu/news_and_notes_1988/1001/thumbnail.jp

Cancer de l'estomac restant après chirurgie pour maladie ulcéreuse bénigne.

13 cas après gastrectomie partielle type Billroth II (12 cas) ou gastroentérostomie (1 cas). Le diagnostic précoce est basé sur la complémentarité de l'examen radiologique et de l'endoscopi

Pancreatic pseudocyst. Analysis of surgical therapy in 58 patients.

From 1970 to 1981, 58 patients underwent surgery for pancreatic pseudocyst. The mean duration of follow-up was 37,6 +/- 34,4 SD months. The internal drainage (ID) (50% - 19/28 pat.) is the first choice therapy of pancreatic pseudocyst as it had no mortality, a low morbidity (20,7%) and a rare recurrence rate (3,4%). External drainage (ED) (18,9% - 11/58 pat.) had a high mortality (27,3%), recurrence rate (54,5%) morbidity rate (100%). 18 patients underwent an excisional therapy (31%). A total pancreatico-duodenal resection, realised because of a transmesenteric rupture of an isthmic pseudocyst was unsuccessful (1/18 patients - 5,6% mortality). Cyst recurrence (12,1% - 7 pat.) was increased by the number of urgent interventions, reflecting the higher incidence of ED in these patients (1/41 pat. - 2,4% in the elective operated pat. vs 6/17 pat. - 35.3% in the urgent operated pat.). All four fatal outcomes (6,9%) were related to gastro-intestinal (3) and intra-abdominal (1) bleeding

La valeur de la duodénopancréatectomie céphalique dans les tumeurs du carrefour bilio-pancréatique.

56 different ampullary and periampullary lesions were treated by pancreaticoduodenal resection (PDR). There were 26 ampullary, 25 pancreatic and 5 biliary duct tumors. A retrospective pathological study of the resected specimen allowed an exact analysis of type, size and loco-regional extension of all these tumors. These data are correlated with the survival rate following an identical surgical treatment. PDR is the first choice therapy of the ampullary tumor even if lymph node involvement is present. The results of this resectional therapy are very disappointing in pancreatic and biliary duct cancers. Presence of multiple risk factors and/or lymph node involvement in these lesions preclude PDR; palliative surgery will be preferred

Les traumatismes du pancréas.

During the period 1968-1982, thirteen patients were treated surgically for a posttraumatic lesion of the pancreas. Eleven of them had a blunt abdominal trauma. These series of 13 patients show the diagnostic difficulties of the pancreatic lesion, often minimised or even missed. An open abdominal trauma needs an immediate exploration; surgery in blunt abdominal trauma is guided by biology, ultrasonography and scanning. ERCP may be very useful in these difficult cases. All different types of pancreatic lesions, divided into immediate and late sequelae are illustrated. Their appropriate treatment will be discussed. Good results can only be achieved if primary treatment of the pancreatic trauma is adequate and radical

Modified Sugiura Operation for Idiopathic Portal Hypertension with Bleeding Oesophageal Varices. A Case Report.

A case of a 36 years old man presenting massive upper GI bleeding due to oesophageal varices developed in the context of an idiopathic portal cavernoma and extensive porto-splenic thrombosis is discussed. He underwent a successful modified Sugiura operation (oesophago-gastric devascularisation and splenectomy [OGDS]) completed with interventional endoscopic treatment of residual oesophageal varices. The benefit of the modified Sugiura procedure proposed for the treatment of upper GI variceal bleeding developed in the context of splanchnic venous thrombosis is discussed. The procedure is a valid therapy in the treatment of symptomatic extra-hepatic hypertension when other options are inapplicable

Fistules pancréatiques post-opératoires: étude clinique sur une série de 114 duodéno-pancréatectomies céphaliques consécutives.

The present study explores the incidence, the predisposing factors and the consequences of pancreatic fistulae in a series of 114 consecutive, non selected, pancreatico-duodenal resections performed during the period January 1967-December 1982 for malignant and benign diseases of the (peri)ampullary region and the head of the pancreas. Overall hospital mortality reached 10.8% (12/114 pat.). The most common surgical complication was pancreatic fistula (17 pat.-14.9%) responsible for half of the postoperative fatal outcomes. The incidence of the pancreatic fistula is significantly influenced by a patient age of over 65 years, a preoperative serum bilirubin level exceeding 6 mg %, urgent degree of the intervention, presence of a renal insufficiency and last but not least by the poor quality of the pancreatic remnant. As surgical treatment of this complication is compromised by a high mortality (40% - 4/10 pat.), surgery should be reserved to hemorrhagic or persistent local or systemic, septic complications. Therefore more attention should be given to the prevention of this complication by a careful patient selection, based on evaluation of the different mentioned risk factors and by an adequate technique based on a separation of the different anastomoses by the greater omentum and the transverse mesocolon

Les kystes hydatiques du foie.

The authors present a series of 33 cases of hydatid liver disease; 28 patients are operated upon. Ultrasound and parasitology permits an easy diagnosis. Surgical treatment has to be simple: resection of the cyst dome and subtotal pericystectomy guarantee low mortality and recurrence rate. The hospital mortality of this series is 7% (2/28 pat.); the cyst recurrence rate 2.7% (1/37 treated cysts). Surgery of the hydatid cyst necessitates a complete peroperative exploration of the bile duct and the residual cyst cavity by peroperative cholangiography and injection of methylene blue. Biliary fistulas have to be treated in accordance to their importance, by simple suture or intubation with transhepatic drainage. An adequate follow-up is only possible by repeated serological examinations