References of "Acta Chirurgica Belgica"
     in
Bookmark and Share    
Full Text
Peer Reviewed
See detailThe usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: Review of the physiopathology and surgical implications
RADERMECKER, Marc ULg; CANIVET, Jean-Luc ULg; LANCELLOTTI, Patrizio ULg et al

in Acta Chirurgica Belgica (2005), 105(5), 475-481

Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease ... [more ▼]

Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease. Through a review of the morphological features and mechanisms in the different clinical situations, the anatomic, dynamic and mixed forms of subaortic obstruction are emphasized. Knowledge of the substrate of LVOTO, its physiopathology and natural history allows to plan accordingly the surgical repair and the postoperative management. [less ▲]

Detailed reference viewed: 37 (4 ULg)
Full Text
Peer Reviewed
See detailAbdominal aortic aneurysm due to Brucella melitensis
Quaniers, Janine ULg; DURIEUX, Rodolphe ULg; de Leval, Laurence ULg et al

in Acta Chirurgica Belgica (2005), 105(1), 93-95

Detailed reference viewed: 16 (0 ULg)
Full Text
Peer Reviewed
See detailFactors promoting rupture of abdominal aortic aneurysms
Van Damme, Hendrik ULg; Sakalihasan, Natzi ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2005), 105(1), 1-12

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of ... [more ▼]

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of the aortic wall. Basic research confirmed that peak wall stress and aortic wall biodegradation contribute to the mechanism of aneurysm rupture. In order to highlight the role of loss in wall strength and increase in focal peak stress, the authors reviewed recent literature. The clinical relevance of these recent insights in the etiopathogenesis of aneurysm rupture is analysed. [less ▲]

Detailed reference viewed: 15 (1 ULg)
Full Text
Peer Reviewed
See detailManagement of high blood pressure in peripheral arterial disease
Krzesinski, Jean-Marie ULg

in Acta Chirurgica Belgica (2005), 105

Arterial hypertension (HTA) is a promoter of peripheral arterial disease (PAD) in association with other atherosclerotic risk factors factors. Systolic HTA is the most frequently noted form in such ... [more ▼]

Arterial hypertension (HTA) is a promoter of peripheral arterial disease (PAD) in association with other atherosclerotic risk factors factors. Systolic HTA is the most frequently noted form in such disease, secondary to marked increase in large artery siffness. The existence of PAD confers on the hypertensive patient a very high cardiovascular (CV) risk, requiring an intensive global therapeutical approach. Treating HTA is one of such beneficial actions. The optimal blood pressure (BP) to be reached is at least < 140/90 mmHg but lower BP should be targeted if possible (< or = 130/80 mmHg). First of all, a modification of the lifestyle and diet should be proposed. But to reach such a low target, different antihypertensive agents must be very often used in association. The inhibitors of the renin-angiotensin system constitute one of the main axis of such drug treatment, after having avoided the pitfall of renal artery stenosis. [less ▲]

Detailed reference viewed: 28 (5 ULg)
Full Text
Peer Reviewed
See detailSurgical management of adrenal tumours lessons from a 10 years personal experience
Kotzampassakis, N.; Maweja, Sylvie ULg; Defechereux, Thierry ULg et al

in Acta Chirurgica Belgica (2005), 105

Objective : To review our personal experience of the last 10 years with adrenal surgery in order to define the indications of laparoscopic adrenalectomy (LA) and open adrenalectomy (OA), respectively ... [more ▼]

Objective : To review our personal experience of the last 10 years with adrenal surgery in order to define the indications of laparoscopic adrenalectomy (LA) and open adrenalectomy (OA), respectively. Patients and methods : From November 1993 to June 2003, we performed 105 adrenalectomies on 97 patients (29 males and 68 females). The lesions resected were preoperatively considered non-secreting in 47 cases (45%) and hormonally active in 58 cases (55%). In 78 patients (80%), LA was performed and 84 adrenal glands were resected. In 19 patients (20%), OA was considered the best modality of resection and 21 adrenal glands were resected. The average tumour size was 37.2 mm (range 25-90) in LA group and 82.6 mm (30-260) in the OA group. All the LA were performed using a trans-peritoneal approach. Depending on the particularities of the lesions and of the patients, the OA were performed by anterior or lumbar incisions. Results : There was no mortality. Conversion from LA to open surgery was necessary in two patients. Mean operating time was 110 minutes for LA and 135 minutes for OA. Two (2.6%) patients suffered complications after LA and 4 (19%) after OA. Conclusions : In our experience, trans-peritoneal LA proved to be a safe and reliable procedure for benign adrenal disease. In our institution, it has become the gold standard technique for the resection of adrenal tumours, except for those suspected or proven malignant. [less ▲]

Detailed reference viewed: 33 (6 ULg)
Full Text
Peer Reviewed
See detailIntrinsic structural failure of polyester (Dacron) vascular grafts. A general review.
Van Damme, Hendrik ULg; Deprez, Manuel ULg; Creemers, Etienne ULg et al

in Acta Chirurgica Belgica (2005), 105(3), 249-55

Intrinsic structural failure of Dacron prostheses is a late exceptional complication, resulting from a loss of structural integrity of the graft. The authors report six cases of non-anastomotic false ... [more ▼]

Intrinsic structural failure of Dacron prostheses is a late exceptional complication, resulting from a loss of structural integrity of the graft. The authors report six cases of non-anastomotic false aneurysms in the mid-portion of a vascular Dacron graft, observed at a mean of 12 years after insertion. It concerns four femoro-popliteal bypass grafts, one cross-over graft and a branch of a bifurcated aorto-bifemoral graft, implanted between 1980 and 1990. This represents 0.2% of all vascular Dacron grafts implanted in authors' department since 1980. The degenerated prosthesis was excised, and a new bypass graft was inserted. In three cases, histological analysis revealed a foreign body giant cell reaction against fragmented Dacron fibers. In none of the cases there was evidence of graft infection. The authors discuss the evidence and etiopathogeny of this late, unusual complication, inherent to the Dacron graft material. The most probable causative factor is material fatigue, leading to gradual breakdown and fragmentation of individual fibers, and subsequent biodegradation of the basic material. Such an intrinsic weakness of prosthetic fabric has only be observed in first and second generation Dacron grafts. [less ▲]

Detailed reference viewed: 36 (1 ULg)
Full Text
Peer Reviewed
See detailAcute Rehabilitation Program after Laparoscopic Colectomy using Intravenous lidocaine
Kaba, Abdourahmane ULg; Detroz, Bernard ULg; Laurent, S. R. et al

in Acta Chirurgica Belgica (2005), 105

The concept of postoperative acute rehabilitation was introduced to accelerate postoperative recovery and improve outcome. We investigated whether intravenous lidocaine infusion, which decreases ... [more ▼]

The concept of postoperative acute rehabilitation was introduced to accelerate postoperative recovery and improve outcome. We investigated whether intravenous lidocaine infusion, which decreases postoperative pain and speeds the return of bowel function, can be used instead of epidural analgesia in an acute rehabilitation protocol for patients undergoing laparoscopic colectomy. Methods : Twenty eight consecutive patients scheduled for laparoscopic colectomy were prospectively included in this case series study. Segmental colectomy was performed only for benign pathology. Intraoperative opioid use was restricted. After a bolus injection of lidocaine 1.5 mg·kg-1, an infusion (2 mg·kg-1·h-1, IV) was started before pneumoperitoneum. Balanced analgesia was used to reduce postoperative opioid consumption. Patients were allowed to drink 6 h postoperatively. The day after surgery, patients were allowed to eat a normal breakfast. Enforced mobilisation and ambulation were required from the patients. Our goal was to discharge patients within 3 days after surgery. Postoperative pain was measured. Time to first flatus, defecation, and hospital discharge were recorded. Results : Mean postoperative pain at rest and mobilisation remained below 30 mm on a 100 mm visual analogue scale. Time to first flatus, defecation, and hospital discharge were 29 ± 13 h, 38 ± 13 h, and 3.0 ± 1.0 days, respectively. Conclusion : Acute rehabilitation after laparoscopic colectomy using IV lidocaine gives similar outcomes to those reported using epidural analgesia. [less ▲]

Detailed reference viewed: 97 (14 ULg)
Full Text
Peer Reviewed
See detailLiving related liver transplantation in adults: First year experience at the University of Liege
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Acta Chirurgica Belgica (2004), 104(2, MAR-APR), 166-171

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative ... [more ▼]

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative complications, or even death. The aim of this paper is to report the prospective evaluation of the initial experience of adult LRLT at the University of Liege. From March 2002 till March 2003, in a consecutive series of 35 adult liver transplantations, five recipients (mean age : 51 years) underwent LRLT, including one retransplantation. Indications for transplantation were autoimmune hepatitis, hepatitis B virus related cirrhosis with hepatocarcinoma (two cases), hepatitis C virus related cirrhosis with hepatocarcinoma, and ischemic intrahepatic bile duct necrosis 10 years after primary liver transplantation. Mean age of the donors was 34 years (range : 21-53 years). All donation cases were intra familial at first degree. The right lobe was used as a graft in four cases and the left lobe in one case. All right lobe donors developed transient hyperbilirubinemia and hypocoagulation for 4 to 6 days. No severe complication (transfusion, bile duct fistula, reintervention, rehospitalization) nor significant long-term sequelae were observed in the donors. In the recipients, graft function was immediate, and there was no small-for-size syndrome. One recipient developed biliary fistula treated by reoperation. One recipient died from invasive aspergillosis 11 days after the procedure. The four other recipients were alive without recurrence of the disease at follow-up. This report confirmed that LRLT may be a valuable alternative to cadaveric liver transplantation in the era of organ donor shortage. However, even if there was no severe complication for the donors in our preliminary experience, LRLT puts healthy living donors at risk of significant morbidity and even death. [less ▲]

Detailed reference viewed: 47 (15 ULg)
Full Text
Peer Reviewed
See detailSpontaneous tracheal rupture: a case report
Rousie, Céline ULg; Van Damme, Hendrik ULg; Radermecker, Maurice ULg et al

in Acta Chirurgica Belgica (2004), 104(2), 204-208

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis ... [more ▼]

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed. [less ▲]

Detailed reference viewed: 72 (2 ULg)
Full Text
Peer Reviewed
See detailCrural or pedal artery revascularisation for limb salvage: is it justified
Van Damme, Hendrik ULg

in Acta Chirurgica Belgica (2004), 104(2), 148-157

With the ageing of population, the incidence of limb-threatening ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and ... [more ▼]

With the ageing of population, the incidence of limb-threatening ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and infragenicular vessels. Fortunately, recent advances in vascular surgery made arterial reconstruction of crural and pedal vessels possible. Should crural or pedal bypass surgery be offered to these frail, polyvascular patients, or is primary amputation a preferable treatment option in case of advanced limb-threatening ischemia? In order to answer this controversial question, the author analysed recent literature data on the feasibility and durability of infrapopliteal bypasses. The quality of life was also considered as an outcome measure. Finally, the cost-effectiveness of both treatment modalities (limb-saving distal bypass versus primary amputation) was assessed. [less ▲]

Detailed reference viewed: 41 (0 ULg)
Full Text
Peer Reviewed
See detailInvited comment concerning the article entitled "A pratical approach to ethical problems in surgical emergencies"
Lamy, Maurice ULg

in Acta Chirurgica Belgica (2004), 104(2, MAR-APR), 129-130

Detailed reference viewed: 17 (3 ULg)
Full Text
Peer Reviewed
See detailRationale for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the treatment or prevention of peritoneal carcinomatosis
Detroz, Bernard ULg; Laurent, Stanislas; Honore, Pierre ULg et al

in Acta Chirurgica Belgica (2004), 104

Up to now, the prognosis of peritoneal carcinomatosis from GI tract cancers remains very poor. Intraperitoneal hyperthermic chemotherapy has been proposed in the prevention or treatment of peritoneal ... [more ▼]

Up to now, the prognosis of peritoneal carcinomatosis from GI tract cancers remains very poor. Intraperitoneal hyperthermic chemotherapy has been proposed in the prevention or treatment of peritoneal carcinomatosis. The rationale for this locoregional approach comes from a better knowledge of the physiopathology of the disease. Intraperitoneal chemotherapy achieves high local drug concentration with limited systemic toxicity. It should be performed during or immediately after surgery to be effective towards microscopic residual tumor cells. A synergistic cytotoxic effect has been demonstrated when heat is combined with antineoplastic drugs. Intraperitoneal hyperthermic chemotherapy might not be regarded as the panacée but as a promising step in the management of peritoneal carcinomatosis. Some randomized studies of gastric cancer with macroscopic serosal invasion have suggested the efficacy of hyperthermic intraperitoneal chemotherapy for the prevention of peritoneal carcinomatosis. In patients with peritoneal carcinomatosis, some studies suggest, in selected cases, the positive effect of hyperthermic intraperitoneal chemotherapy on survival, when combined with cytoreductive surgery. [less ▲]

Detailed reference viewed: 56 (4 ULg)
Full Text
Peer Reviewed
See detailLiver resection for noncolorectal, nonneuroendocrine metastases
Detry, Olivier ULg; Warzee, Fabian ULg; Polus, Marc ULg et al

in Acta Chirurgica Belgica (2003), 103(5), 458-462

In noncolorectal, nonendocrine liver metastases, the role of surgery is less define than in colorectal or neuroendocrine cancer. This role is marginal as liver is not the primary site of metastases of ... [more ▼]

In noncolorectal, nonendocrine liver metastases, the role of surgery is less define than in colorectal or neuroendocrine cancer. This role is marginal as liver is not the primary site of metastases of these cancers. Less than 2 to 5% of the patients with these malignancies might be one day considered as potential candidates for liver resection, as most patients suffer from extra hepatic tumour spread at the time they develop liver involvement. However, in these few cases with liver metastases only, as no other therapeutic option may provide mid- or long-term tumour-free survival, liver resection is indicated in resectable liver metastases. Some prognostic factors have been established in the literature from the few published series : unique versus multiple hepatic metastases, unilobar vs bilobar, metachronous vs synchronous, R0 vs R1 or R2 liver resections. The type of primary tumour is also of great importance, as cutaneous melanoma, pancreatic and gastric adenocarcinoma have a very bad prognosis for liver resection of metastases, even after R0 resection. In these cases, percutaneous or laparoscopic radiofrequency ablation may find its place. In sarcoma, breast carcinoma, uveal melanoma, and genitourinary cancers, liver resection may provide satisfactory long-term results in selected cases, and is the standard of care for isolated, resectable metastasis. However, due to the scarcity of indication of liver resection for noncolorectal, nonneuroendocrine metastases, the decision should be multidisciplinary, and the patients should be informed of the advantages and pitfalls of the surgical procedure. [less ▲]

Detailed reference viewed: 49 (6 ULg)
Full Text
Peer Reviewed
See detailEvaluation, severity and prognostic significance of silent myocardial ischaemia in vascular patients
Sprynger, Muriel ULg

in Acta Chirurgica Belgica (2003), 103(3), 255-261

This paper intends to make an update of recent publications and guidelines for evaluation in coronary symptom-free patients undergoing vascular surgery. It emphasizes the role of preoperative clinical ... [more ▼]

This paper intends to make an update of recent publications and guidelines for evaluation in coronary symptom-free patients undergoing vascular surgery. It emphasizes the role of preoperative clinical evaluation that should identify the most appropriate testing, and treatment strategies to optimize care of the patient and avoid unnecessary testing in this era of cost containment. Selective preoperative coronary artery disease screening and revascularization achieve excellent perioperative and late results after high-risk vascular surgery. Supplemental preoperative evaluation is discussed (exercise ECG, stress echocardiography and stress tomoscintigraphy). Asymptomatic patients with good functional capacity can undergo intermediate-risk surgery without further non-invasive testing. Conversely, further noninvasive testing is often considered for patients with poor functional capacity or moderate functional capacity but higher-risk surgery especially for patients with 2 or more intermediate risk predictors. Additional testing may be considered on an individual basis for patients without clinical markers but with poor functional capacity prior to vascular surgery, particularly those with several minor clinical risk predictors. Because of a higher prevalence of silent myocardial ischaemia in diabetes mellitus, these patients require specific care. Until further data are available, indications for myocardial revascularization in the perioperative setting are similar to those in the ACC/AHA guidelines for use of myocardial revascularization in general. General practioners, cardiologists, angiologists, vascular surgeons and anaesthesiologists should collaborate and aim to slow down the progression of atherosclerosis by giving their patients an optimum secondary cardiovascular prevention. [less ▲]

Detailed reference viewed: 26 (2 ULg)
Full Text
Peer Reviewed
See detailPeripheral vascular surgery: Update on the perioperative non-surgical management for high cardiac risk patients
Stammet, P.; Senard, Marc ULg; Roediger, Laurence ULg et al

in Acta Chirurgica Belgica (2003), 103(3), 248-254

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative ... [more ▼]

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative care for these high cardiac risk patients. The most adapted preoperative cardiac evaluation for each patient is guided by its individual risk factors and clinical history. Perioperative medication should nowadays consist of pre- and postoperative beta-blockers and acetyl salicylic acid, both reducing cardiac morbidity and mortality. Neuraxial locoregional anaesthesia techniques are reasonable alternatives to general anaesthesia because of their potential advantages, by reducing postoperative inflammatory response and reducing procoagulating activity, and increasing peripheral vascular graft patency, but the individual benefit/risk balance has always to be evaluated for patients submitted to aggressive antithrombotic therapy. During the postoperative course, early detection and treatment of postoperative myocardial ischemia or infarction by ST wave changes and/or cardiac enzyme control has to be considered. [less ▲]

Detailed reference viewed: 48 (8 ULg)
Full Text
Peer Reviewed
See detailHistory of solid organ transplantation at the University of Liege
Lejeune, Georges ULg; Limet, Raymond ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (2003), 103(3 Sp. Iss. SI), 32-36

Detailed reference viewed: 44 (15 ULg)
Full Text
Peer Reviewed
See detailStrictureplasty in Crohn's disease : Short- and long-term follow-up
Laurent, Stanislas; Detry, Olivier ULg; Detroz, Bernard ULg et al

in Acta Chirurgica Belgica (2002), 102(4, JUL-AUG), 253-255

Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection ... [more ▼]

Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection, hoping for fewer complications and a lower recurrence rate. In this paper, the authors reports their strictureplasty experience. They performed a systematic retrospective review of the patients suffering from Crohn's disease who underwent strictureplasties during a 10-year period in the abdominal surgery department of the University Hospital of Liege Sart Tilman, and studied the short- and long-term clinical results of 68 strictureplasties performed in 18 patients. Median follow-up was 63 months (range 12 to 144). Mortality was 0% and septic morbidity was 11% (one wound abscess and one leakage). Among the 16 patients available for the latest follow-up, symptomatic stenotic recurrence had to be medically treated in hospital for 4 patients (25%) with a recurrence delay range of 19 to 49 months. Stenosis recurrence needed re-intervention in one patient 48 months after surgery: stenosis occurred at a distance from the corrected site. These results confirmed that strictureplasty is a safe and efficient procedure in selected patients undergoing surgery for obstructive Crohn's disease. [less ▲]

Detailed reference viewed: 83 (4 ULg)
Full Text
Peer Reviewed
See detailDiagnostic criteria for renovascular hypertension
Krzesinski, Jean-Marie ULg

in Acta Chirurgica Belgica (2002), 102(3), 159-166

Renovascular hypertension is a clinical situation characterized by high blood pressure in the presence of renal ischemia mainly related to atherosclerotic or fibromuscular dysplasic narrowing of the renal ... [more ▼]

Renovascular hypertension is a clinical situation characterized by high blood pressure in the presence of renal ischemia mainly related to atherosclerotic or fibromuscular dysplasic narrowing of the renal artery (ies). This diagnosis is often "a posteriori" validated, because the discovery of a significant renal artery stenosis is not obligatory responsible of the blood pressure elevation. This article proposes a diagnostic strategy for exploring patient with this suspected secondary cause of hypertension before proposing an invasive approach (intra-arterial angiography) possibly followed by a revascularization. However, the methods for exploring such population are mainly based on patient characteristics and local expertise and habits. These must thus be individualized. First, clinical symptoms or signs frequently associated with hypertension and renal artery stenosis must be searched. If present, a non invasive and functional exploration of the renal arteries is to be proposed (Captopril radioisotope renography, colour duplex sonography) followed by magnetic resonance angiography or spiral computer tomography angiography if the clinical suspicion index is moderate or high. If this is very high, an intra-arterial arteriography could immediately be performed if not too dangerous. On the opposite site, if the clinical index is low, it is recommended to follow clinically and to treat risk factors. [less ▲]

Detailed reference viewed: 33 (1 ULg)
Full Text
Peer Reviewed
See detailEnucleation of a giant hepatic hemangioma in a Jehovah's Witness
Detry, Olivier ULg; Honore, Pierre ULg; Joris, Jean ULg et al

in Acta Chirurgica Belgica (2002), 102(1), 54-56

Detailed reference viewed: 32 (5 ULg)