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Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients. Surg Endosc 2020; 35:4315-4320. [DOI: 10.1007/s00464-020-07921-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
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Moritz C, Scheiwe C, Malgras B. Colonic volvulus after laparoscopic left colectomy. J Visc Surg 2020; 157:493-494. [PMID: 32389393 DOI: 10.1016/j.jviscsurg.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Volvulus of the mobilized colon after laparoscopic left colectomy is rare. Contributing factors seem to be excessive length of the mobilized colon, absence of peritonization and absence of adhesions due to laparoscopy. Onset of colonic volvulus after laparoscopic left colectomy should lead to routine computerized tomography (CT), searching for an image suggestive of small intestinal incarceration under the neo-mesocolon, which might be an additional risk factor. Treatment consists of disincarceration of the small intestines while closing the mesocolic defect remains a subject of controversy.
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Affiliation(s)
- C Moritz
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Scheiwe
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - B Malgras
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
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Portale G, Popescu GO, Parotto M, Cavallin F. Internal hernia after laparoscopic colorectal surgery: an under-reported potentially severe complication. A systematic review and meta-analysis. Surg Endosc 2019; 33:1066-1074. [PMID: 30680656 DOI: 10.1007/s00464-019-06671-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Internal hernia following laparoscopic colorectal surgery is often under-reported. The aim of this review was to evaluate the occurrence rate of internal hernia following laparoscopic colorectal surgery, and to describe clinical presentation and management strategies. METHODS A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through April 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed using a random effects model. Studies reporting data on internal hernia after laparoscopic colorectal surgery were included. RESULTS Ten observational studies with a total of 8453 patients were included. All included articles were non-comparative prospective or retrospective cohort studies with an average MINORS score of 8.3 (range 6-11). Summary estimate of proportion of patients developing internal hernia after laparoscopic colorectal resection was 0.5% (95% CI 0.3-0.8%). Heterogeneity was moderate (I2 46%, p = 0.03) and study size (> 1000 vs. <1000 patients) was found to have a significant contribution to heterogeneity (p = 0.002). Thirty patients (90.9%) required surgery, with 5 non-fatal and 3 fatal postoperative complications. Quality of some studies was limited; some patients were followed up for less than 1 year; primary surgical procedures included different laparoscopic approaches. CONCLUSIONS Occurrence rate of internal hernia after laparoscopic colorectal resection is around 5 per 1000 patients. Small-sized studies are likely to overestimate the occurrence of internal hernia. Need for reoperation is high with a substantial risk of mortality.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero 40, 35013, Cittadella, Padua, Italy.
| | - George Octavian Popescu
- Department of General and Visceral Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Matteo Parotto
- Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Prevention of internal hernias and pelvic adhesions following laparoscopic left-sided colorectal resection: the role of fibrin sealant. Surg Endosc 2016; 31:3048-3055. [PMID: 28039651 DOI: 10.1007/s00464-016-5328-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant diseases. This growing experience has also resulted in more reports of postoperative complications from the minimally invasive approach to primary colorectal resection. Small bowel obstruction from internal hernias and pre-sacral adhesions is an uncommon but not negligible complication. However, there is little literature specific to this topic with recommendations for different methods to prevent it. We report our original technique of closing the mesenteric defect and covering the pre-sacral fascia by using fibrin sealant to prevent this complication. METHODS From January 2005 to December 2014, a total of 1079 patients underwent elective laparoscopic left colorectal resection (left hemicolectomy or anterior rectal resection) in our department. In the first 298 procedures, the mesenteric defect was left open, while in the following 781 procedures, it was closed using fibrin sealant with the aim of preventing postoperative small bowel obstruction. RESULTS Among the first 298 patients, three (1%) required reoperation for small bowel obstruction due to internal hernia (0.33%) or critical pre-sacral adhesions (0.66%). These complications did not occur in the subsequent series in which all 781 patients were treated with fibrin sealant prophylactic closure of the mesenteric defect. CONCLUSION In our experience, fibrin sealant closure of the mesenteric defect has demonstrated to be safe and effective in preventing postoperative small bowel obstruction that remains a complication both in open and in laparoscopic colorectal surgeries.
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Toh JWT, Lim R, Keshava A, Rickard MJFX. The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review. Colorectal Dis 2016; 18:1133-1141. [PMID: 27440227 DOI: 10.1111/codi.13464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/08/2016] [Indexed: 12/28/2022]
Abstract
AIM To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. METHOD Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. RESULTS The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). CONCLUSION Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered.
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Affiliation(s)
- J W T Toh
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - R Lim
- Bankstown Hospital, Bankstown, New South Wales, Australia
| | - A Keshava
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - M J F X Rickard
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
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Lee SY, Kim CH, Kim YJ, Kim HR. Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication. Hernia 2016; 21:299-304. [DOI: 10.1007/s10029-016-1532-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
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Clinical Significance of Closure of Mesenteric Defects in Laparoscopic Colectomy: A Single-Institutional Cohort Study. Surg Laparosc Endosc Percutan Tech 2015; 26:82-5. [PMID: 26679686 DOI: 10.1097/sle.0000000000000234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of closure of mesenteric defects to prevent complications, such as internal hernia, during laparoscopic colectomy remains controversial and is a subject of debate. PURPOSE This retrospective single-institution study aimed to clarify the clinical significance of mesenteric defect closure during a laparoscopic colectomy. METHODS We evaluated 58 patients who underwent laparoscopic right-side colectomy or transverse colectomy. The statistical relevance of complications, surgical maneuvers, and clinical factors was examined. RESULTS The mesenteric defects were closed in 30 patients and not closed in 28 patients. Two patients with ileus and 1 with a deep incisional surgical site infection required a second surgery. The reoperation rate was significantly higher in the nonclosure group than in the closure group (11% vs. 0%, respectively; P=0.033). CONSIDERATION Serious complications requiring reoperation occurred only in the nonclosure group. The procedure for closing the defect did not extend the operation time or increase the bleeding.
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Yoshida T, Kinugasa T, Oka Y, Mizobe T, Ishikawa H, Mori N, Isobe T, Katayama E, Akagi Y. Bowel obstruction caused by an internal hernia that developed after laparoscopic subtotal colectomy: a case report. J Med Case Rep 2014; 8:470. [PMID: 25547813 PMCID: PMC4320605 DOI: 10.1186/1752-1947-8-470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Laparoscopic surgery is a minimally invasive approach with good treatment outcomes and is currently the standard surgery for colorectal cancer in Japan. Mesenteric closure is considered unnecessary in laparoscopic colorectal surgery because it can damage the bowel and blood vessels. However, an internal hernia may develop if the mesentery is not repaired. Case presentation We report a case of internal hernia in a 61-year-old male of Japanese ethnicity. The patient had advanced sigmoid colon cancer, early-stage transverse colon cancer, and multiple adenomatous polyposis, and underwent laparoscopically-assisted subtotal colectomy. Bowel obstruction developed six days postoperatively and did not improve with conservative treatment. Abdominal computed tomography detected an internal hernia, prompting emergency surgery in which the ileum protruding into the mesenteric defect and an anastomotic stricture were detected. Reanastomosis, mesentery closure, and ileostomy were performed after hernia repair. Conclusion In this case, open surgery was necessary due to bowel obstruction after laparoscopic colectomy. This outcome indicated that mesenteric closure should have been performed. Thus, the benefits of mesenteric closure require assessment in future cases.
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Affiliation(s)
- Takefumi Yoshida
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka-ken 810-0023, Japan.
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Daskalaki A, Kaimasidis G, Xenaki S, Athanasakis E, Chalkiadakis G. Internal-mesocolic hernia after laparoscopic left colectomy report of case with late manifestation. Int J Surg Case Rep 2014; 6C:88-91. [PMID: 25528033 PMCID: PMC4334638 DOI: 10.1016/j.ijscr.2014.11.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/23/2014] [Accepted: 11/23/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction In contrast to right colectomy, closure of the mesocolic gap after laparoscopic left colectomy is not practiced, and reports of small gut herniation through this gap are scarce. Presentation of case A 73 year old male was admitted as an emergency with symptoms and clinical signs, suggesting obstruction of the small bowel. Abdominal imaging, including computed tomography confirmed the diagnosis. The patient had undergone laparoscopic left colectomy for cancer, three years ago. At laparotomy small bowel loops were found to herniate through the mesocolic defect at the level of the colonic anastomosis. The small bowel loops were reduced and their viability was ascertained. Because of an iatrogenic perforation of the colon at the anastomosis during small bowel loops mobilization, the colon was temporarily exteriorized in the form of a double barrel colostomy. The postoperative course was uneventful. Discussion Very few cases have been reported in the liteature indicating the need of sutuing the mesenterium. Despite the limited numbe of the reported cases, there is clearly a risk of intenal hernia after laparoscopic left colectomy. Conclusion Although rare internal hernia after laparoscopic left colectomy may occur, and this brings forward the question of mesocolic gap closure.
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Affiliation(s)
- Anna Daskalaki
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - George Kaimasidis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - Sofia Xenaki
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece.
| | - Elias Athanasakis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
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Masubuchi S, Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, Yamamoto M, Uchiyama K. Internal hernia projecting through a mesenteric defect to the lesser omental cleft following laparoscopic-assisted partial resection of the transverse colon: report of a case. Surg Today 2012; 43:814-7. [PMID: 22820993 PMCID: PMC3682091 DOI: 10.1007/s00595-012-0264-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
We herein report a case of an internal hernia projecting through a mesenteric defect following laparoscopic-assisted colectomy to the lesser omental cleft in a 61-year-old female. We performed laparoscopic-assisted partial resection of the transverse colon to treat transverse colon cancer. Three years and 6 months after the operation, the patient developed a bowel obstruction requiring surgical intervention. When we observed the intraperitoneal space under laparoscopy, we determined that the small intestine had passed into the bursa omentalis through the mesenteric defect. Additionally, an abnormal opening of the lesser omentum was present with a portion of the small intestine escaping into the space inferior to the liver. We performed reintegration of the escaped bowel and closed the mesenteric defect laparoscopically. This is the first case of an internal hernia projecting through a mesenteric defect following laparoscopic-assisted colectomy that we have experienced out of more than 2400 cases. Further research is needed to identify the patients who would benefit from the closure of mesenteric defects during laparoscopic-assisted colectomy.
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Affiliation(s)
- Shinsuke Masubuchi
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Saklani A, Naguib N, Tanner N, Moorhouse S, Davies CE, Masoud AG. Internal herniation following laparoscopic left hemicolectomy: an underreported event. J Laparoendosc Adv Surg Tech A 2012; 22:496-500. [PMID: 22568539 DOI: 10.1089/lap.2011.0413] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Laparoscopic colorectal surgery creates fewer adhesions compared with open colorectal resection. Small bowel obstruction after laparoscopic colorectal resection may be caused by internal herniation of the small bowel through a colomesenteric defect, probably related to a lack of adhesion formation. This is seen especially after left colonic resections. METHODS A literature review was conducted using the key words "intestinal obstruction" and "laparoscopic left colonic resection," and 9 documented case reports of obstruction following laparoscopic left colorectal resection were identified. We present 2 additional cases and discuss the etiology, diagnosis, management, and possible options for avoiding this complication. RESULTS In total, 167 consecutive laparoscopic procedures were performed in our study, and 8 were left hemicolectomies. Four of these patients (50%) developed intestinal obstruction, with 2 requiring surgical intervention for internal hernia. For the remaining 159 colorectal procedures, there were only 2 admissions with intestinal obstruction, with 1 patient requiring surgery (P = .006). CONCLUSIONS Laparoscopic left hemicolectomy carries a significant risk of internal herniation. Performing a laparoscopic subtotal colectomy or fashioning the colocolonic anastomosis through the small bowel mesentery may minimize this risk.
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Affiliation(s)
- Avanish Saklani
- Colorectal Surgery Department, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
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Abstract
PURPOSE The controversy regarding closing the mesenteric defect after laparoscopic right colectomy remains a subject of debate. This study describes the consequences of not closing the mesenteric defect. METHODS A 7-year prospective database revealed 530 consecutive patients who underwent laparoscopic right colectomy for neoplasia. No mesenteric defects were closed. Small bowel obstruction was determined by clinical assessment and diagnostic imaging. Statistical analysis included the Student t test and Mann-Whitney U test. RESULTS On average, the 530 patients (44% male) were 69.6 years old +/- 12.5 years with American Society of Anesthesiologists' category 2, body mass index 26.6 +/- 5.7, operative time 175 +/- 65 minutes, incision length 5.7 +/- 3.0 cm. Thirty-six patients (6.8%) were converted. Median length of stay was 5 days (interquartile range 4-7). Median follow-up was 20 months (interquartile range 8-45). Four patients (0.8%) had complications attributed to the mesenteric defect: 2 had small bowel obstruction due to internal herniation and 2 had torsion of the anastomosis through the defect. Twenty-six patients (4.9%) had a small bowel obstruction during the follow-up period. Nonoperative treatment was successful in 12 patients. In the 14 patients who were operated on, small bowel obstruction was due to adhesions (4), incarcerated abdominal wall hernias (4), mesenteric defect (4), and cancer recurrence (2). The small bowel obstruction group (n = 26) had a significantly higher percentage of males than the non-small bowel obstruction group (n = 504; 69% vs 43%; P = .008). CONCLUSIONS These data do not support routinely closing the mesenteric defect after laparoscopic right colectomy for neoplasia. Additional studies with extended long-term follow-up are needed.
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Sereno Trabaldo S, Anvari M, Leroy J, Marescaux J. Prevalence of internal hernias after laparoscopic colonic surgery. J Gastrointest Surg 2009; 13:1107-10. [PMID: 19291336 DOI: 10.1007/s11605-009-0851-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 02/26/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection. MATERIAL AND METHODS During a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention. RESULTS A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h. DISCUSSION Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific. CONCLUSION All mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.
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Affiliation(s)
- Stefano Sereno Trabaldo
- Servicio de Cirugía Bariátrica y Metabólica, Real San José Hospital, Tarascos 3514-6, Fracc. Monraz, CP 44670, Guadalajara, Jalisco, México.
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Ferguson L, Higgs Z, Brown S, McCarter D, McKay C. Intestinal Volvulus Following Laparoscopic Surgery: A Literature Review and Case Report. J Laparoendosc Adv Surg Tech A 2008; 18:405-10. [DOI: 10.1089/lap.2007.0027] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Louise Ferguson
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Zoe Higgs
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Sylvia Brown
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Douglas McCarter
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Colin McKay
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Díez Tabernilla M, Die Trill J, López Hervás P, Fresneda Moreno V. [Internal hernia after laparoscopic sigmoidectomy]. Cir Esp 2008; 83:45-7. [PMID: 18208755 DOI: 10.1016/s0009-739x(08)70502-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sabbagh C, Vibert E, Renou M, Yzet T, Regimbeau JM. [Internal hernia after laparascopic left colectomy; a simple method of prevention]. ACTA ACUST UNITED AC 2005; 142:44-5. [PMID: 15883508 DOI: 10.1016/s0021-7697(05)80835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Sabbagh
- Service de Chirurgie Digestive, Centre Hospitalier et Universitaire Amiens Nord, Amiens
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