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Aim of the study: Digestive surgery is often necessary for surgical management of advanced ovarian carcinoma.Patients and methods: In a series of 62 patients with stage III ovarian carcinoma, postoperative morbidity and mortality, overall survival after 5 years and disease-free survival after 2 years were studied and corelated with several patients criteria (age, stage of the disease, residual disease, type of surgery, CA125 normalisation delay, postoperative complications and hospital stay). Patients were divided into two groups according to the surgical treatment. The first group (n=17) included patients treated by gynecologic and digestive surgery, the second group (n=45) included patients treated by gynecologic surgery only. All patients were proposed for chemotherapy included platyn salt. Mean age was 60 years (range: 20–83). The stage of the cancer was stage IIIa in 7 cases, stage IIIb in ten and stage IIIc in 45.Results: Postoperative mortality was 3.5% (2/62). Postoperative morbidity was 26% (13/62). No statistical differences were noted for hospital stay, general morbidity, surgical morbidity when a gastric resection or a colon resections or a splenectomy were performed. Overall survival at 5 years was 56%. Residual disease less than 2 cm3 is the only prognostic factor for overall survival (56% vs 23% ⟦P=0.03〉) and disease-free survival (86% vs 46% ⟦P=0.02〉).Conclusion: This study including 62 patients confirmed the prognostic significance of extensive cytoreductive surgery for treatment in advanced ovarian epithelial cancer without increasing the postoperative morbidy and mortality. [Copyright &y& Elsevier]

Objective: To evaluate prospectively the laparoscopic surgery for giant hiatal hernias treated by fundoplication and hiatal prosthesis.Patients and methods: Ten patients were included in this study. Surgical technic included the dissection of œsophageal hiatus, the sac excision and the dissection of the abdominal œsophagus to obtain a physiological length. The decision criterion for a prosthesis was the hiatus œsophagus diameter of 5 cm or more. The crura were closed and the hiatus was reinforce by a prosthesis of 15 × 15 cm. All patients underwent a fundoplication whether partial or complete.Results: Eight patients had a type III hernia, and 2 had a type II. The mean size for the hiatus was 6.5 cm (5,5–8). Eight patients underwent a total fundoplicature and 2 a partial one. The prosthesis was made of polypropylene in 5 cases. Average operating time was 182 min (78–240). One patient had postoperative morbidity, with gastroplagia wich resolved. There was no mortality. Mean hospitalisation duration was 7.7 days (5–12). No one case of recurrence have been noticed after a mean follow-up of 24 months (8–40).Conclusion: It appears that the large size hiatal hernia (more than 5 cm) can be treated with good results by using a prosthesis during laparoscopic fundoplication. [Copyright &y& Elsevier]

Introduction: The aim of this study was to evaluate the long term efficacy of laparoscopic treatment of gastroesophageal reflux disease (GERD)., Patient and Methods: Between 1(st) January 1992 and 31 December 1996, 161 patients underwent complete or partial laparoscopic fundoplication for a symptomatic GERD. One hundred and twenty three patients were submitted to Nissen-Rossetti fundoplication, 26 patients to Nissen fundoplication and 12 patients to a partial posterior Toupet fundoplication.141 patients were evaluated at 3 months, 2-years and 5-years. Since undergoing the operation, four patients died of unrelated causes, 16 patients could not be contacted for follow up (10%). pH monitoring and oesophageal manometry were performed preoperatively and at 3 months postoperatively. The patients were evaluated 2 and 5-years after surgery by specific phone questionnaire., Results: There was no mortality, the morbidity rate was 1.2% and the conversion rate was 5%. Incidence of dysphagia 3 months after surgery was 23.4%, and 5-years after 12%; 12% of patients had recurrent symptoms at 5 years., Conclusion: The overall satisfaction rate at 5 years was 91.4%. Nissen-Rossetti fundoplication seems to have better results at 5-years regarding postoperative dysphagia and symptoms recurrence.

Objective: Stapled end to end anastomosis makes the restoration of digestive continuity at the level of lower pelvis easier, but carries a certain risk. The aim of this report was to evaluate this risk in terms of immediate results and tumor recurrence after surgery for rectal cancer., Patients and Methods: The data of 301 patients operated on following this technique between 1980 and 2000 have been reviewed in order to analyse the tumor characteristics, the operation and associated complications, the immediate postoperative complications and recurrence rate., Results: Among the 301 patients (192 males and 109 females) with median age of 66 years, 19 (6.3%) received an emergency operation due to bowel obstruction. The rectal adenocarcinoma was located in the upper rectum in 132 cases (43.8%), in the middle rectum in 141 cases (46.8%) and in the lower rectum in 19 cases (9.4%). Preoperative radiotherapy was carried out in 148 cases (49%): between 1987 and 1996 with a dose of 30 Grays (Gy), later increased to 39 Gy and 45 Gy in 12 cases. From 1990, 113 patients have received adjuvant chemotherapy for stage III and IV tumors and in some position cases for stage II tumor. The excision left a safety margin under the tumor of less than 2 cm in 59 cases (19.6%), and the anastomosis was located at 5 cm or less from the anal verge in 178 cases (59%). Primary defunctioning stoma was formed in 39 cases (13%). An anastomotic defect was observed during the operation in 18 cases (6%) and 26 fistulas occured postoperatively (7.6%), significantly related to the location of the anastomosis with regard to the anal verge (P = 0.0009). The hospital mortality was 8 cases (2.6%). Cases of stenosis were uncommon : 11 cases (3.6%), significantly associated with preoperative radiotherapy (P =0.02). The local recurrence rate was 12% (37 cases) in a median time delay of 16 months, essentially related to the tumor stage (P = 0.004) and the considered period (P = 0.001)., Conclusion: Stapled end-to-end colorectal anastomosis after excision of rectum for cancer is a reliable technique with a low rate of complication and tumor recurrence, when the surgical procedure is included in the curative therapy management of cancer.

Hyperbaric oxygen therapy (HBO) is widely reported as highly favourable to wound healing. The experimental models generally used to investigate its effects are difficult to set up and reliable quantification of the results obtained is rarely achieved. The underlying pathophysiological mechanisms occurring during HBO remain poorly understood and its mode of application for clinical practice is difficult to standardise. Our study was carried out to assess the contributions of oxygen and hyperbaric pressure on the initial steps of wound healing. It was based on qualitative and quantitative analysis of the development of the angiogenic process in a granulation tissue bud, using animals implanted with fibrin chambers, an in vivo model initially described by Dvorak in guinea pigs. In our study, rats were further submitted to HBO (OHB group) or hyperbaric air (Air-HB group) treatments. The control group (Control group) consisted of rats maintained in the treatment tank under normal atmospheric conditions. Nine specific parameters were determined and analysed during the course of the angiogenic process by classical histological techniques. The vascular density and the height of the bud were particularly examined at day 7, 14 and 21 following chamber implantation. At D7 the neovessel density and bud height were significantly higher in OHB group than in Air-HB or Control groups, thus confirming the beneficial effects of this treatment on the initial steps of wound healing. Nevertheless, the results reported herein also suggest a possible inhibitory effect of hyperbaric therapy alone on this very early process, although the pathophysiological significance of this effect on wound healing remains to be determined.

The so-called pseudo-acute abdomen has been reported in acute leukemia, both at diagnosis or relapse. The clinical presentation may be misleading and life-threatening, due to the possible infiltration of any abdominal viscera. The authors present a series of eight patients and emphasize the management specificities of such patients and the possibility of long-term remissions, regardless of the severity of the initial presentation.

The most frequent and severe complication of pancreaticoduodenectomy is pancreatic fistula due to dehiscence of the pancreas anastomosis. The technique that uses a separate Roux en Y loop for pancreas anastomosis, to reduce the fatal risks of pancreatic fistula, has been described for more than 50 years. With the development of pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique, derived from those previously described allows a good intussusception of the pancreatic stump into the intestinal loop. This method was performed in 22 pancreaticoduodenectomies. There were 2 operative deaths unrelated to the pancreaticojejunal anastomosis and one pancreatic fistula, which healed under medical treatment.

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.

The Nissen fundoplication is the most widely used antireflux procedure. However this operation is associated with several specific complications. To prevent these complications, an alternative antireflux procedure ("floppy" Nissen) has been designed. This investigation was conducted to investigate the effects of the floppy Nissen performed on 117 patients, between 1978 and 1990. Indication for surgery was the endoscopic discovery of stage I and II oesophagitis (59 cases), III and IV oesophagitis (25 cases) or an associated disease (gallstones: 25 cases, duodenal ulcer: 8 cases), pH monitoring used preoperatively in 47 cases showed an important reflux in 33 cases (70%). Preoperative manometry exploration (71 cases) showed a low pressure of the low oesophageal sphincter (LOS) in 63 cases (89%). The "floppy" Nissen procedure was performed over a length 4 to 6 cm. The folds of the diaphragm were closed back behind the oesophagus in 40 cases. During the postoperative period the pH-data were restored to normal range in 73% (18/26 cases), and the value of the LOS was restored in 74% (19/26 cases). The mean duration of clinical follow-up study of 99 patients was 3.22 years. Improvement in clinical symptoms was noted for 86%; 13% had specific Nissen complications (9 gall-bloat syndrome, 4 intermittent dysphagia). Six patients had to be reoperated. This technique allowed good control of the reflux symptoms, with a low incidence of mechanical complications.