Papers by Jean-marc Catheline
Surgical laparoscopy, endoscopy & percutaneous techniques, Apr 1, 2002
ABSTRACT The role of laparoscopic resection in the management of colorectal cancer is still uncle... more ABSTRACT The role of laparoscopic resection in the management of colorectal cancer is still unclear. It has been shown that laparoscopic colectomies can be accomplished with acceptable morbidity. Major concerns are port-site recurrences and neoplastic dissemination. The aims of this study were to compare perioperative results and long-term outcomes in a prospective, nonrandomized study of patients treated by laparoscopic versus open colorectal resection for cancer. In particular, the effects of an initial laparoscopic approach on survival and recurrence were examined. One hundred fifty-seven patients with colorectal carcinoma were included in the prospective trial: 74 underwent laparoscopic resection and 83 underwent conventional open surgery. The two groups were comparable in terms of characteristics, demographic data, stage of disease, and use of adjuvant or palliative chemoradiotherapy. All patients were observed at 1.3- and 6-month intervals. The median duration of follow-up was 60 months (range, 10–125 months). The mean operating time was significantly longer in the laparoscopic group. Six conversions (8.1%) were necessary. The passage of flatus and the restarting of oral intake (P = 0.0001) occurred earlier in the laparoscopic surgery group than in the open conventional surgery group. The mean postoperative stay was significantly shorter in the former group (P = 0.005), as was the length of the scar (P = 0.001). There were no deaths in either group. The overall morbidity was significantly lower (13% versus 33.7%;P = 0.001) in patients treated laparoscopically. No significant differences were observed between the groups in the length of specimens, the size of the tumor, or the number of nodes removed. Late complications were more frequent after open resection (12% versus 5.4%;P = 0.01). Two port-site metastases (2.6%) were seen in stage III and IV locally advanced carcinoma. There was no significant difference in recurrent disease between the groups (24.3% versus 25%) during the 60-month follow-up. Stage-for-stage comparisons showed that disease recurrence rates and crude death rates were comparable.
PubMed, Mar 25, 2000
The clinical diagnosis of appendicular pathology has an unacceptably high false-positive rate, pa... more The clinical diagnosis of appendicular pathology has an unacceptably high false-positive rate, particularly in premenopausal women. Diagnostic laparoscopy is a significant aid towards accurate diagnosis. Laparoscopic appendicectomy can be safely and economically performed as a logical sequel to diagnostic laparoscopy. We describe our method of safe and cost-effective laparoscopic appendicectomy.
PubMed, 1998
This aims of this study is to evaluate after laparoscopic exploration or treatment in digestive c... more This aims of this study is to evaluate after laparoscopic exploration or treatment in digestive cancers, the incidence of port site metastases and the incidence of unnecessary laparotomy in advanced disease. Patients: 109 patients were included in this study: 91 had localized digestive cancers and 18 had disseminated disease with hepatic and/or peritoneal metastases. Methods: All the patients underwent a laparoscopy and a laparoscopic ultra-sonography under general anesthesia prior to a definitive decision on therapeutic management. Depending on the circumstances, histological or cytological biopsies were performed. The puncture sites of the trocar were examined clinically and, if required, by ultrasonography, monthly through out the course of the disease. Chemotherapy was instigated in 60.5 per cent of patients. Results: 35 patients (32.1 per cent) only had one laparoscopic examination with a mean survival of 4.8 months, 22.9 per cent of patients had laparoscopic treatment of their lesion and 44.9 per cent had conventional treatment. Laparoscopic exploration allowed the detection of 52 lesions that had not been identified by conventional imaging techniques and thereby avoided 35 laparotomies (32.1 per cent). Tumor invasion of the peritoneum was present in 46 per cent of cases, most notably in the cases of pancreatico-biliary cancers. The overall mean survival was 32.7 months while it was 9.8 months in cases of palliative treatment. In total, 436 trocars were used. There was one case (0.9 per cent of patient or 0.02 per cent of port) of a metastasis occurring at the site of the trocar following treatment by right-sided, laparoscopic colectomy in a patient with disseminated cancer. Two factors seem to be involved peritoneal spread of the tumor and manipulation of the tumor. Conclusions: Laparoscopic exploration for digestive cancers is a legitimate technique. It allows the detection of lesions that are not identified by conventional imaging techniques, permits a more accurate assessment of the resectability of a tumor and reduces the number of unnecessary laparotomies. The incidence of metastases at the site of the trocar is low and is closely linked to the presence of disseminated disease and manipulation of the tumor.
PubMed, 1997
From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were inclu... more From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were included in a prospective study, in order to compare intraoperative cholangiography and laparoscopic ultrasound. The biliary tree was successively explored by the two methods in the systematic detection of common bile duct stones. The feasibility of laparoscopic ultrasound was 100 per cent. Cholangiography was performed in only 125 cases (83 per cent). The duration of the laparoscopic ultrasound exam was significantly shorter (11.6 vs 17.6 minutes, p = 0.0001). In this study, common bile duct stones were found in 14 cases (9 per cent). The detection rates with laparoscopic ultrasound and intraoperative cholangiography were similar. For laparoscopic ultrasound, sensitivity was 80 per cent and specificity was 99 per cent, versus 78 per cent and 97 per cent for cholangiography, respectively. The combination of the 2 examinations had a 100 per cent sensitivity and specificity. Laparoscopic ultrasound failed to recognize the intrapancreatic part of the bile duct (25 cases: 17 per cent), did not show anatomical abnormalities detected by cholangiography, but detected unsuspected digestive lesions. Laparoscopic ultrasound is safe repeatable, and non invasive, but a learning curve is necessary to increase this efficacy. Comparison of cost must be evaluated.
PubMed, 1998
The aim of this study was to evaluate the late (4 years) recurrence rate after laparoscopic total... more The aim of this study was to evaluate the late (4 years) recurrence rate after laparoscopic totally preperitoneal (TPP) approach, to Shouldice and Stoppa procedures. All patients were reviewed at one, six months, one year and yearly there after. The mean follow-up was 4 years: the follow-up was 100 per cent at one month, 98 per cent at 6 months, 95 per cent at one year, 91 per cent at 2 years, 84 per cent at 3 years, 79 per cent at 4 years and 61 per cent at 5 years. At one year, the recurrence rate was 2.2 per cent in the laparoscopic group, 1.2 per cent for Shouldice and 0 per cent for Stoppa procedure (ns). At 3 years, the recurrence rate was comparable and 3.6 per cent for laparoscopy, 5.1 per cent for Shouldice and 5.2 per cent for Stoppa respectively (ns). At 4 years, the recurrence rate was lower (but ns) for the laparoscopic group 7.4 per cent versus 12.5 and 10.5 per cent. Two predictive factors for recurrence in laparoscopic treatment were the size of the mesh and the surgeon's experience.
PubMed, Dec 1, 1997
In a prospective randomized trial comparing the totally preperitoneal (TPP) laparoscopic approach... more In a prospective randomized trial comparing the totally preperitoneal (TPP) laparoscopic approach and the Stoppa procedure (open), 100 patients with inguinal hernias (Nyhus IIIA, IIIB, IV) were followed over a 3-year period. Both groups were epidemiologically comparable. In the laparoscopic group, operating time was significantly longer (p = 0.01), but hospital stay (3.2 vs. 7.3 days) and delay in return to work (17 vs. 35 days) were significantly reduced (p = 0.01). Postoperative comfort (less pain) was better (p = 0.001) after laparoscopy. In this group, morbidity was also reduced (4 vs. 20%; p = 0.02). The mean follow-up was 605 days, and 93% of the patients were reviewed at 3 years. There were three (6%) recurrences after TPP, especially at the beginning of the surgeon's learning curve, versus one for the Stoppa procedure (NS). For bilateral hernias, the authors suggest the use of a large prosthesis rather than two small ones to minimize the likelihood of recurrence. In the conditions described, the laparoscopic (TPP) approach to inguinal hernia treatment appears to have the same long-term recurrence rate as the open (Stoppa) procedure but a real advantage in the early postoperative period.
Hernia, Mar 1, 1998
Summary The aim of this study is to estimate, at a mean follow up period of 1464 days (4 years), ... more Summary The aim of this study is to estimate, at a mean follow up period of 1464 days (4 years), the incidence of hernial recurrence after initial treatment by a laparoscopic approach (using a totally pre-peritoneal route-TPP) as compared with the Shouldice operation, and that of Stoppa. The patients were submitted to rigorous controls of inclusion and exclusion and were divided into two controlled studies. The operations were reviewed at one month, six months, one year and every year thereafter. The follow-up rate was 100% at one month, 90% at six months, 95% at one year, 92% at two years, 84% at three years, 79% at four years and 61% at five years. The incidence of early recurrence (one year) seems to be higher in the laparoscopic group (2.2%) as compared with the two other techniques (Shouldice 1.2% and Stoppa 0%) though this is not significant. At three years, the recurrence rate is comparable (not significant) in the three groups: 3.6% for laparoscopy, 5.1% for Shouldice, 5.2% for Stoppa. At four years, the incidence of recurrence was lower (not significant) for the laparoscopic approach 7.4% and for the two other techniques 12.5% and 10.5% respectively. Analysis of the factors for recurrence in the laparoscopic approach (TPP) made clear the determining role of the experience of the operator and of the size of the prosthesis which was used.
Updates in Surgery, Jun 30, 2023
Chirurgie, Nov 1, 1999
... World J Sum 1992 : 16 : 1133-6. 21 Bagnafo JV, McGer GI, Halt LI, Verner JE, Culpepper JP. Ju... more ... World J Sum 1992 : 16 : 1133-6. 21 Bagnafo JV, McGer GI, Halt LI, Verner JE, Culpepper JP. Justification for routine cholangiography during lapardscopic cholecvstectomv. ... Br J Surg 1994 ; 81 : 1786-8. 24 Traverso LW, Hamptman EM, Lynge DC. ...
PubMed, Feb 13, 2004
The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1... more The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1999, out of which 271 were preoperatively considered as acute cholecystitis (25.8%). The clinical, biological and ultrasound criteria were rigorously respected. The preoperative period of 1 to 5 days (mean--2.5) was used for re-equilibration and antibiotic and antithrombotic therapy. The intraoperative criteria were clinical, echolaparoscopical, cholangiographical and bacteriological and established in 219 cases the diagnostic of acute cholecystitis. The final diagnostic, on histopathological basis, confirmed the preoperative diagnosis of acute cholecystitis in 224 cases. The microscopical reexamination in the remainding controversy cases reclassified other 18 as acute cholecystitis (final concordance ratio--242:271). The preoperative overvaluation may be consecutive to a too rapid (before the constitution of specific lesions) or too delayed intervention (the aspect becoming chronical). The elements of diagnostic discordance are raising the problem of case selection and the necessity for standard classification of histological lesions in acute cholecystitis.
Annales D Endocrinologie, Oct 1, 2006
PubMed, 1999
The aim of this study was to evaluate the impact of laparoscopic appendicectomy on the incidence ... more The aim of this study was to evaluate the impact of laparoscopic appendicectomy on the incidence of histologically normal appendices. Between 1987 and 1997, 1,220 patients (average age 23.5 years [17-73]; 841 women [69%]) had appendicectomy due to the presence of at least one of the following three criteria: right iliac fossa guarding, fever >38 degrees C, and leukocytosis >10,000. Patients were divided into two groups: one group of 930 patients were operated on using the classic Mac Burney approach and the other group of 355 patients underwent laparoscopic exploration, with an appendicectomy performed if macroscopic abnormalities were observed (290 cases). In all cases, the appendices were examined blind and classified as normal or pathologic, with the latter divided with respect to the nature and severity of the lesions. In the Mac Burney group, the incidence of histologically normal appendices was 25.1%. In the laparoscopic group, the incidence was only 8.2% (p=0.015). The types of pathologic appendices were identical between the two groups. In 65 cases (18.3%), a macroscopically normal appendix was left in place. In 56 cases the symptoms were due to another identified cause, however, in 10 cases no cause was found. All patients were followed-up for an average of 3 years. One patient (1.8%) had a second operation (an appendicectomy), which revealed minor histologic lesions. The problem is the inability of the operator to differentiate between a healthy and a pathologic appendix on laparoscopy. The risk of false-positives and false-negatives is approximately 10%. Diagnostic difficulties usually occur in the initial phase of the disease with acute mucosal involvement in a morphologically normal appendix. At this stage the outcome cannot be predicted, although appropriate antibiotic treatment can be effective. This study shows that laparoscopy significantly reduces the number of histologically normal appendices as compared to a conventional Mac Burney operation. This can only be achieved by not removing macroscopically normal appendices, a small proportion of which (5-10%) could be cases of early appendicitis with only mucosal involvement. In the absence of other causes of the symptoms, a 3-day course of antibiotics can be tried to treat possible mucosal lesions. This approach reduces costs without having adverse consequences on the outcome.
Education thérapeutique du patient - Therapeutic patient education, 2022
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Annales D Endocrinologie, Sep 1, 2013
Annales De Chirurgie, Apr 1, 2000
Chirurgie, Nov 1, 1999
ABSTRACT SituationIn spite of recent progress in medical imagery, the findings of preoperative in... more ABSTRACT SituationIn spite of recent progress in medical imagery, the findings of preoperative investigations of the liver are not always accurate and precise. Since the development of surgical laparoscopy, advantages of the laparoscopic examination are associated with advantages of laparoscopie ultrasonography.
Journal de chirurgie, Aug 1, 2009
Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this... more Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. This is a retrospective study including 446 patients undergoing surgery in 14 teaching, private, and public hospitals. The immediate post-operative course were uneventful in 83.3% of patients. Minor complications occurred in 10.9% of patients and major complications in 5.3%. Suture line leaks occurred in 4.3% of the whole series. There was no mortality and the rate of reoperation was 2%. Overall mean weight loss after two years was 32 kg and the mean excess weight loss was 62%. Weight loss was significantly greater in non super-obese patients (p=0.0003). This study confirms the feasibility of sleeve gastrectomy in a multicenter setting; it is efficacious at two years as an isolated bariatric procedure for non super-obese patients. It is possible that an additional second-stage procedure may be necessary for super-obese patients.
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Papers by Jean-marc Catheline