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Romain B, Villemin A, Suciu S, Brigand C, Rohr S, Manfredelli S. Parastomal hernia repair according to Modified Stapled Mesh Stoma Reinforcement Technique (mSMART): which are the results ? Hernia 2024:10.1007/s10029-024-03005-z. [PMID: 38607609 DOI: 10.1007/s10029-024-03005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/23/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Parastomal hernia repair is a real surgical challenge because of the high rate of recurrence. The Stapled Mesh Stoma Reinforcement Technique (SMART) is a keyhole-like technique in which the mesh is stapled to the fascia using a circular mechanical stapler. METHODS A prospective study from January 2021 to February 2023 was conducted including all patients operated with the SMART technique. Primary endpoint was the recurrence rate during the follow-up. Secondary endpoints were reoperation, Surgical site Occurrence (SSO) and deep (mesh) surgical site infection (SSI) within 30 days postoperatively. RESULTS Sixteen patients operated on SMART procedures were included. The mean follow-up was 11.3 ± 9.2 months. The SSO rate was 18.7% (n = 3). A seroma was drained radiologically (IIIa), one haematoma was evacuated surgically (IIIb) and one patient presented a postoperative lesion of a ureter after a parastomal Bricker's hernia repair. In addition, there was one death due to multiple organ failure (V). There was no SSI. The recurrence rate was 57.1% during the follow-up. CONCLUSION This study shows disappointing results for this SMART technique, with a high recurrence rate.
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Affiliation(s)
- B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France.
| | - A Villemin
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Suciu
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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Louis V, Alhammadi F, Sauvinet G, Charleux-Muller D, Rohr S, Brigand C, Romain B, Delhorme JB. How I do it: using a hammock mesh in the reconstruction of inguinal ligament during a wide en-bloc resection of a groin mesenchymal tumor. Hernia 2024; 28:261-267. [PMID: 37368184 DOI: 10.1007/s10029-023-02829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE In case of soft tissue sarcomas (STS), an en-bloc resection with safe margins is recommended. To ensure safe removal without tumor rupture, STS of the groin area, retroperitoneal or pelvic mesenchymal tumors may require incision or resection of the inguinal ligament. Solid reconstruction is mandatory to prevent early and late postoperative femoral hernias. We present here a new technique of inguinal ligament reconstruction. METHODS Between September 2020 and September 2022, patients undergoing incision and/or resection of inguinal ligaments during a wide en-bloc resection of STS of the groin area in the Department of General Surgery in Strasbourg were included. All patients had an inguinal ligament reconstruction with biosynthetic slowly resorbable mesh shaped as a hammock, pre- or intraperitoneally, associated or not with loco-regional pedicled muscular flaps. RESULTS A total of 7 hammock mesh reconstructions were performed. One or several flaps were necessary in 57% of cases (4 patients): either for inguinal ligament reconstruction only (n = 1), for recovering of femoral vessels (n = 1), and for both ligament reconstruction and defect covering (n = 2). The major morbidity rate was 14.3% (n = 1), related to a thigh surgical site infection due to sartorius flap infarction. After a median follow-up of 17.8 months (range 7-31), there was neither early nor late occurrence of post-operative femoral hernia. CONCLUSIONS This is a new surgical tool for inguinal ligament reconstruction with the implementation of a biosynthetic slowly resorbable mesh shaped as a hammock, which should be compared to other techniques.
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Affiliation(s)
- V Louis
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.
| | - F Alhammadi
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - G Sauvinet
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
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Tomassi M, Romain B, Passot G. Commentary on "Eventration: Treatment by the intraperitoneal braced prosthesis technique", by F. Sok, R. Cohen and F. Mauvais. J Visc Surg 2023:S1878-7886(23)00063-2. [PMID: 37028954 DOI: 10.1016/j.jviscsurg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- M Tomassi
- Hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, Pierre-Bénite, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France; Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (interface recherche fondamental et appliquée à la cancérologie), 67200 Strasbourg, France
| | - G Passot
- Hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, Pierre-Bénite, France; CICLY, University of Lyon 1 and hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Louis V, Diab S, Villemin A, Brigand C, Manfredelli S, Delhorme JB, Rohr S, Romain B. Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study. Hernia 2023:10.1007/s10029-023-02768-1. [PMID: 36959525 DOI: 10.1007/s10029-023-02768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair. METHODS A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1 month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon's discretion. All patients were included in the enhanced recovery program. RESULTS One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9 days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5 days for group 3 (p < 0.005). CONCLUSION Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.
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Affiliation(s)
- V Louis
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - S Diab
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - A Villemin
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France.
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France.
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Venkatasamy A, Guerin E, Reichardt W, Devignot V, Chenard MP, Miguet L, Romain B, Jung AC, Gross I, Gaiddon C, Mellitzer G. Morpho-functional analysis of patient-derived xenografts reveals differential impact of gastric cancer and chemotherapy on the tumor ecosystem, affecting immune check point, metabolism, and sarcopenia. Gastric Cancer 2023; 26:220-233. [PMID: 36536236 PMCID: PMC9950243 DOI: 10.1007/s10120-022-01359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Gastric cancer (GC) is an aggressive disease due to late diagnosis resulting from the lack of easy diagnostic tools, resistances toward immunotherapy (due to low PD-L1 expression), or chemotherapies (due to p53 mutations), and comorbidity factors, notably muscle atrophy. To improve our understanding of this complex pathology, we established patient-derived xenograft (PDX) models and characterized the tumor ecosystem using a morpho-functional approach combining high-resolution imaging with molecular analyses, regarding the expression of relevant therapeutic biomarkers and the presence of muscle atrophy. MATERIALS AND METHODS GC tissues samples were implanted in nude mice. Established PDX, treated with cisplatin or not, were imaged by magnetic resonance imaging (MRI) and analyzed for the expression of relevant biomarkers (p53, PD-L1, PD-1, HER-2, CDX2, CAIX, CD31, a-SAM) and by transcriptomics. RESULTS Three well-differentiated, one moderately and one poorly differentiated adenocarcinomas were established. All retained the architectural and histological features of their primary tumors. MRI allowed in-real-time evaluation of differences between PDX, in terms of substructure, post-therapeutic changes, and muscle atrophy. Immunohistochemistry showed differential expression of p53, HER-2, CDX2, a-SAM, PD-L1, PD-1, CAIX, and CD31 between models and upon cisplatin treatment. Transcriptomics revealed treatment-induced hypoxia and metabolic reprograming in the tumor microenvironment. CONCLUSION Our PDX models are representative for the heterogeneity and complexity of human tumors, with differences in structure, histology, muscle atrophy, and the different biomarkers making them valuable for the analyses of the impact of platinum drugs or new therapies on the tumor and its microenvironment.
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Affiliation(s)
- A Venkatasamy
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67200, Strasbourg, France
- Medizin Physik, Universitätsklinikum Freiburg, Kilianstr. 5a, 70106, Freiburg, Germany
| | - E Guerin
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - W Reichardt
- Medizin Physik, Universitätsklinikum Freiburg, Kilianstr. 5a, 70106, Freiburg, Germany
| | - V Devignot
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - M P Chenard
- Pathology Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - L Miguet
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - B Romain
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- Digestive Surgery Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - A C Jung
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- Laboratoire de Biologie Tumorale, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France
| | - I Gross
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - C Gaiddon
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - G Mellitzer
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France.
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Delhorme JB, Romain B, Manfredelli S, Liu D, Simeu Tamnou B, Steinmetz JP, Brigand C, Rohr S. Why and how to implement an electronic resident's surgical logbook to improve operating-room training? First 5-year feedback from a French center. J Visc Surg 2022; 159:450-457. [PMID: 36207269 DOI: 10.1016/j.jviscsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The evaluation of general surgery residents' operating room (OR)-training and technical skills progression may be difficult in the absence of a standardized evaluation tool. The aim of this study was to evaluate the impact of the implementation of an electronic "surgical logbook" for general surgery residents. METHODS A prospective single center study was conducted between May 2015 and October 2020. An electronic logbook was filled by all residents immediately after each surgical procedure and data were prospectively collected and analyzed. RESULTS Fifty-five students (34 men/21 women) reported their participation to 6917 surgical procedures, which corresponded to 55.5% of all procedures performed in our department. Residents performed the entire procedure as the operating surgeon in 28.5% of cases (n=1963), parts of the procedure as operating surgeon in 32.5% of cases (n=2230) and as operating-assistant in 38.5% (n=2672). Residents were more likely an operating surgeon for the entire procedure when they were assisted by a fellow or a practicing physician than an associate professor or a clinical professor (P<0.001). There was no significant difference in the major morbidity rate between different resident's contribution to the procedure (P=0.14). CONCLUSION We present here a simple, useful and cost efficient tool which offers easy data collection and reporting that could help improve OR-training, OR-supervision and certification at a local or national level.
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Romain B, Benammi S. Strangulated femoral hernia repair according to Rives’ modified technique (with video). J Visc Surg 2022; 159:520-522. [PMID: 36207268 DOI: 10.1016/j.jviscsurg.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B Romain
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France; Inserm UMR_S 1113 IRFAC (Interface recherche fondamental et appliquée à la cancérologie), Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, 67200 Strasbourg, France.
| | - S Benammi
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
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Moszkowicz D, Renard Y, Romain B, Gillion JF, Ortega-Deballon P, Passot G. P-077 SURGICAL TREATMENT OF LARGE INCISIONAL HERNIA WITH BOTULINUM TOXIN A INJECTION: STUDY PROTOCOL FOR A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
The best strategy for W3 incisional hernia (IH) repair is not known to date and is associated with high risks of recurrence and morbidity. We aim to demonstrate that preoperative Botulinum Toxin A (BTA) injection in the lateral abdominal wall muscles reduces the rate of postoperative morbimortality after large IH (EHS W3) repair with mesh, compared with placebo injection.
Material & Methods
This study will be a prospective, national multi-center, double-blinded, randomized (1:1) superiority phase III trial with two parallel arms: BTA versus placebo injection. Participants will be selected based on an abdomino-pelvic CT-scan without contrast injection performed in the 6 months preceding the patient's surgery. Main inclusion criteria will comprise midline anterior primary or recurrent IH (subxiphoidal to suprapubic), of width ≥ 10 cm, without loss of domain. Patients included will be randomized (1: 1 ratio), by using a computer-generated randomization scheme, and randomization will by stratified on the center and width of the IH (10–15 cm and > 15 cm). Participants will be randomized on the day of the injection, at least 4 weeks before the surgery.
Results
The primary endpoint will be the occurrence of Clavien-Dindo classification grade II or higher post-operative complication during the 90-day postoperative period. Secondary endpoints will include the rates of primary fascial closure, occurrence of component separation techniques, radiological response to injections, consumption of analgesics and pain, and occurrence of clinical and radiological recurrences.
Conclusions
Protocol version 2.0 is currently being assessed for funding by the French Ministry of Health.
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Affiliation(s)
- D Moszkowicz
- Visceral surgery, Hôpital Louis-Mourier , AP-HP, Colombes , France
| | - Y Renard
- Visceral surgery , CHU Reims, Reims , France
| | - B Romain
- Visceral surgery , CHU Strasbourg Hautepierre, Strasbourg , France
| | | | | | - G Passot
- Visceral surgery , CHU Lyon Sud, HCL, Lyon , France
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Louis V, Layer T, Romain B. Diverticulopexy using left cervical incision for Zenker diverticulum (with video). J Visc Surg 2022; 159:343-344. [PMID: 35701299 DOI: 10.1016/j.jviscsurg.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- V Louis
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
| | - T Layer
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
| | - B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France.
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Poussot B, Sauvinet G, Romain B. Hybrid Sugarbaker technique for parastomal hernia repair (with video). J Visc Surg 2022; 159:433-435. [PMID: 35701300 DOI: 10.1016/j.jviscsurg.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B Poussot
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg Cedex, France
| | - G Sauvinet
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg Cedex, France
| | - B Romain
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg Cedex, France; Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France.
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Layer T, Benammi S, Dubuisson V, Manfredelli S, Passot G, Charleux-Muller D, Renard Y, Ortega-Deballon P, Romain B. Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study. Hernia 2022; 27:387-394. [PMID: 35536373 DOI: 10.1007/s10029-022-02616-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field. METHODS This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients' surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate. RESULTS One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41 months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula. CONCLUSIONS At the 3 year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.
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Affiliation(s)
- T Layer
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Benammi
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - V Dubuisson
- Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France.,Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - G Passot
- Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du grand Revoyet, Pierre Bénite, 69495, Lyon, France.,EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France
| | - D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - Y Renard
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - P Ortega-Deballon
- Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France. .,Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France.
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Tenaudier M, Moszkowicz D, Passot G, Romain B, Perrenot C, Borraccino B, Renard Y. Botulinum toxin injection before giant incisional hernia repair: Surgical technique. J Visc Surg 2022; 159:55-58. [PMID: 35074296 DOI: 10.1016/j.jviscsurg.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Tenaudier
- General and digestive surgery department, Louis Mourier Hospital, DMU ESPRIT - GHU AP-HP, Université de Paris, 178, rue des Renouillers, 92700 Colombes, France
| | - D Moszkowicz
- General and digestive surgery department, Louis Mourier Hospital, DMU ESPRIT - GHU AP-HP, Université de Paris, 178, rue des Renouillers, 92700 Colombes, France.
| | - G Passot
- Department of digestive Surgery, Lyon Sud Hospital center, 165, chemin du grand revoyet, 69310 Pierre Benite, France
| | - B Romain
- Department of digestive Surgery, Hautepierre Hospital center, 1, avenue Molière, 67200 Strasbourg, France
| | - C Perrenot
- Department of digestive surgery, university hospital center, rue du general Koenig, 51092 Reims, France
| | - B Borraccino
- Digestive Surgery Department, Hospital center, 2, boulevard de Verdun, 89011 Auxerre, France
| | - Y Renard
- Department of digestive surgery, university hospital center, rue du general Koenig, 51092 Reims, France
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Romain B, Wieser M, Rohr S. Surgical treatment of a recto-urinary fistula using the York Mason procedure (with video). J Visc Surg 2022; 159:252-254. [DOI: 10.1016/j.jviscsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Romain B, Bertin JB, Manfredelli S. Open Stoppa technique for the management of a bilateral inguinoscrotal hernia (with video). J Visc Surg 2021; 158:443-444. [PMID: 34556449 DOI: 10.1016/j.jviscsurg.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France.
| | - J B Bertin
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
| | - S Manfredelli
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
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Manfredelli S, Delhorme JB, Romain B. Laparoscopic jejunostomy (with video). J Visc Surg 2021; 158:364. [PMID: 34167906 DOI: 10.1016/j.jviscsurg.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Manfredelli
- Department of general and digestive surgery, Hautepierre hospital, University hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg Cedex, France.
| | - J-B Delhorme
- Department of general and digestive surgery, Hautepierre hospital, University hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg Cedex, France
| | - B Romain
- Department of general and digestive surgery, Hautepierre hospital, University hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg Cedex, France
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Charleux-Muller D, Romain B, Boisson C, Velten M, Brigand C, Lejeune C. Cost-effectiveness analysis of resorbable biosynthetic mesh in contaminated ventral hernia repair. J Visc Surg 2021; 159:279-285. [PMID: 34116953 DOI: 10.1016/j.jviscsurg.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to compare, in terms of cost and serious complications, the use of biosynthetic resorbable parietal mesh with biologic mesh in patients undergoing contaminated ventral hernia repair (modified Ventral Hernia Working Group grade 3). Poly-4-hydroxy-butyrate (P4HB) biosynthetic mesh has rarely been the subject of comparative studies in the context of contamination. Data are required to confirm the effects of a transition from biological mesh to biosynthetic resorbable mesh. PATIENTS AND METHODS A cost-effectiveness analysis was conducted. It was based on a decision analysis model built with clinical and economic data issued from a before-after study that included 94 patients hospitalized for ventral hernia repair at the University Hospital of Strasbourg (France) from June 2011 to February 2018. The effectiveness endpoint was the number of patients presenting with a serious specific complication or a general complication at 6 months. Data for surgical hospitalization stays, home hospitalizations and ambulatory care costs were included. RESULTS We found fewer serious complications with biosynthetic mesh: 21% versus 33% with biologic mesh. A cost savings of US $5146 was determined. Deterministic sensitivity analyses and a probabilistic analysis confirmed our findings and the robustness of the model. CONCLUSION P4HB biosynthetic resorbable mesh appeared to be the most effective and the least costly option. Additional data will be needed to confirm the superiority of biosynthetic mesh in terms of the recurrence risk reduction over a longer period.
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Affiliation(s)
- D Charleux-Muller
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France.
| | - B Romain
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - C Boisson
- Clinical Epidemiology Unit, Clinical Investigation Center, INSERM, CIC1432, Dijon University Hospital
| | - M Velten
- Department of Public Health, INSERM, UMR-S1113, University Hospital of Strasbourg, 1 place de l'hôpital, 67100 Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - C Lejeune
- Clinical Epidemiology Unit, Clinical Investigation Center, INSERM, CIC1432, Dijon University Hospital; INSERM, LNC UMR1231, University Bourgogne Franche-Comté, Dijon, France
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Liu D, Lang H, Romain B. Parastomal hernia repair using Pauli's technique (with video). J Visc Surg 2021; 158:358-359. [PMID: 34092527 DOI: 10.1016/j.jviscsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Liu
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - H Lang
- Service de Chirurgie Urologique, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg cedex, France
| | - B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Wieser M, Rohr S, Romain B. Inguinal hernia repair using the Lichtenstein technique under local anesthesia (with video). J Visc Surg 2021; 158:276-278. [PMID: 33992576 DOI: 10.1016/j.jviscsurg.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Wieser
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - S Rohr
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Romain
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Denost Q, Rouanet P, Faucheron JL, Panis Y, Meunier B, Cotte E, Meurette G, Portier G, Sabbagh C, Loriau J, Benoist S, Piessen G, Sielezneff I, Lelong B, Mauvais F, Romain B, Barussaud ML, Capdepont M, Laurent C, Rullier E. Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial. Br J Surg 2021; 108:605-608. [PMID: 33793764 DOI: 10.1093/bjs/znab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
Elevated C-reactive protein, should be used to prompt early detection of AL prior to the development of clinical symptoms. Early biochemical diagnosis and intervention of AL mitigates the negative impact of AL on oncological outcomes in patients with rectal cancer.
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Affiliation(s)
- Q Denost
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - P Rouanet
- Département de Chirurgie Oncologique, ICM Val d'Aurelle, Montpellier, France
| | - J-L Faucheron
- Service de Chirurgie Digestive, Hôpital A. Michallon, La Tronche, France
| | - Y Panis
- Service de Chirurgie Digestive, Hôpital Beaujon, AP-HP, Clichy, France
| | - B Meunier
- Service de Chirurgie Viscérale, CHU Pontchaillou, Rennes, France
| | - E Cotte
- Service de Chirurgie Digestive, Hôpital Lyon Sud, CHU Lyon, Pierre-Bénite, France
| | - G Meurette
- Service de Chirurgie Digestive, Site Hôtel Dieu, Nantes, France
| | - G Portier
- Service de Chirurgie Digestive, Hôpital Purpan, Toulouse, France
| | - C Sabbagh
- Service de Chirurgie Digestive et Métabolique, CHU d'Amiens, Amiens, France
| | - J Loriau
- Service de Chirurgie Digestive et Obésité, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Benoist
- Service de Chirurgie Générale et Digestive, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - G Piessen
- Service de Chirurgie Digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - I Sielezneff
- Service de Chirurgie Digestive et Viscérale, CHU Timone, Marseille, France
| | - B Lelong
- Service de Chirurgie Digestive, Institut Paoli Calmette Institut Paoli Calmette, Marseille, France
| | - F Mauvais
- Service de Chirurgie Viscérale, CH de Beauvais, Beauvais, France
| | - B Romain
- Service de Chirurgie Générale et Digestive, Hôpital Universitaire de Hautepierre, Strasbourg, France
| | - M-L Barussaud
- Service de Chirurgie Digestive, CHU de Poitiers, Poitiers, France
| | - M Capdepont
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - C Laurent
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - E Rullier
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
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Charleux-Muller D, Hurel R, Fabacher T, Brigand C, Rohr S, Manfredelli S, Passot G, Ortega-Deballon P, Dubuisson V, Renard Y, Romain B. Slowly absorbable mesh in contaminated incisional hernia repair: results of a French multicenter study. Hernia 2021; 25:1051-1059. [PMID: 33492554 DOI: 10.1007/s10029-020-02366-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field. METHODS All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients' surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study. RESULTS Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo-Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9). CONCLUSION The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results. TRIAL REGISTRATION The study is registered on Clinical Trial ID: NCT04132986.
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Affiliation(s)
- D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France.
| | - R Hurel
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - T Fabacher
- Department of Public Health, Biostatistic Laboratory, Strasbourg University Hospital, 1 place de l'Hôpital BP426, 67091, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Manfredelli
- Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - G Passot
- Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France
| | - P Ortega-Deballon
- Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France
| | - V Dubuisson
- Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Renard
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
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Voron T, Romain B, Bergeat D, Véziant J, Gagnière J, Le Roy B, Pasquer A, Eveno C, Gaujoux S, Pezet D, Gronnier C. Surgical management of gastric adenocarcinoma. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). J Visc Surg 2020; 157:117-126. [PMID: 32151595 DOI: 10.1016/j.jviscsurg.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastric adenocarcinoma (GA) is the 5th most common cancer in the world; in France, however, its incidence has been steadily decreasing. Twenty-five experts brought together under the aegis of the French Association of Surgery collaborated in the drafting of a series of recommendations for surgical management of GA. As concerns preoperative evaluation and work-up, echo-endoscopy aimed at clarifying lymph node status should be performed in all candidates for surgical resection and exploratory laparoscopy in cases of GA cT3/T4 and/or N+ for peritoneal carcinomatosis. On the other hand, PET-scan should not be performed systematically, but only when the other modalities for diagnosis prove insufficient. Laparotomy remains the route of choice to achieve total or partial gastrectomy with D2 lymph node lymphadenectomy for advanced lesions (>T2N0). To limit the risk of dumping syndrome and esophageal reflux and as a way of reestablishing continuity, construction of a jejunal pouch on Roux-en-Y following total gastrectomy is recommended. In cases of peritoneal carcinosis in GA with a low peritoneal cancer index (PCI) (<7) in a patient in good general condition whose disease is controlled by chemotherapy, macroscopically complete cytoreduction with intraperitoneal hyperthermal chemotherapy will probably be required, and it will have to take place in an expert center. Only in the event of Child A cirrhosis may gastrectomy with D2 lymphadenectomy be considered. Palliative gastrectomy or surgical bypass for distal stomach obstruction in a patient in good general condition may also be envisioned.
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Affiliation(s)
- T Voron
- General and Digestive Surgery Department, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
| | - B Romain
- General and Digestive Surgery Department, Hautepierre Hospital, Strasbourg, France.
| | - D Bergeat
- Hepato-biliary and digestive surgery Department, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France.
| | - J Véziant
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - J Gagnière
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - B Le Roy
- Digestive surgery and oncology Department, CHU Nord Saint-Etienne, Avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France.
| | - A Pasquer
- Digestive surgery Department, Édouard Herriot Hospital, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon cedex, France.
| | - C Eveno
- Digestive surgery and oncology Department, Claude Huriez Hospital, 59000 Lille, France.
| | - S Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Paris-Descartes University Hôpital Cochin-Pavillon Pasteur, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
| | - D Pezet
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - C Gronnier
- Digestive surgery Department, Medico-chirurgical Center Magellan, avenue de Magellan, 33604 Pessac, France.
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Romain B, Mielcarek M, Delhorme JB, Meyer N, Brigand C, Rohr S. Dialkylcarbamoyl chloride-coated versus alginate dressings after pilonidal sinus excision: a randomized clinical trial (SORKYSA study). BJS Open 2020; 4:225-231. [PMID: 32020765 PMCID: PMC7093794 DOI: 10.1002/bjs5.50259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings. Methods This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities. Results A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings. Conclusion The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 (
https://clinicaltrials.gov/).
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Affiliation(s)
- B Romain
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.,Laboratory of Stress Response and Innovative Therapies, Institut National de la Santé et de la Recherche Médicale (INSERM) IRFAC UMR_S1113, University of Strasbourg, Strasbourg, France
| | - M Mielcarek
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - J B Delhorme
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Meyer
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
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Delhorme JB, Klipfel A, D'Antonio F, Greget MC, Diemunsch P, Rohr S, Romain B, Brigand C. Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in an operating room without laminar airflow. J Visc Surg 2019; 156:485-488. [PMID: 31296454 DOI: 10.1016/j.jviscsurg.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY The safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) is often questioned when newly implemented in an operating room (OR); as it may increase the risk of exposure to cytotoxics for healthcare workers. There are no data on the risk of healthcare exposure in OR without laminar airflow. We aimed to ensure the safety of PIPAC for surgeons and their co-workers for newly implemented procedures in an OR without laminar airflow. PATIENTS AND METHODS Twenty-six samples with cellulosic wipes from surgeons and co-workers' environmental items and 5 specific polytetrafluoroethylene air-filtered collections were randomly performed for the first 2 cisplatin/doxorubicin-based PIPAC procedures in Strasbourg University Hospital. PIPAC was performed according to previously described safety protocol but without a laminar airflow and with an additional plastic cover and smoke evacuation device. Sampling and analyzes were performed by 2 accredited independent certified organizations. RESULTS All air measurements were negative for cisplatin and doxorubicin. Only one wipe sample out of 26 was positive for cisplatin (4%) on the outer surgeon's pair of gloves but dosages on the surgeon's inner pair and hands were negative. CONCLUSION When performed in approved security conditions, even without laminar airflow, PIPAC might seem harmless for surgeons and their co-workers with very limited risk of exposure to cytotoxics.
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Affiliation(s)
- J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France.
| | - A Klipfel
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - F D'Antonio
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - M-C Greget
- Department of Occupational Medicine, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - P Diemunsch
- Department of Anaesthesiology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
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Romain B, Gillion JF, Ortega-Deballon P, Meyer N. Patient's satisfaction at 2 years after groin hernia repair: any difference according to the technique? Hernia 2018; 22:801-812. [PMID: 29971566 DOI: 10.1007/s10029-018-1796-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term patient's satisfaction after groin hernia repair is rarely studied in the literature. The aim of this study was to compare the four main techniques of inguinal hernia repair in terms of patient's satisfaction and quality of life at the 2-year follow-up in a prospective registry. METHODS From September 2011 to March 2014, consecutive patients underwent groin hernia repair and were prospectively included in the Club Hernie registry, which also consisted of expert surgeons in parietal repair. The data on patient demographics, clinical presentation, initial workup, operative technique, postoperative course, clinical follow-up, and quality of life at 2 years (2Y-FU) were recorded. RESULTS Overall, 5670 patients were included in the study: 1092 undergoing Lichtenstein's technique, 1259 for trans-inguinal preperitoneal technique (TIPP), 1414 for totally extraperitoneal approach (TEP) and 1905 for transabdominal preperitoneal approach (TAPP). The patients undergoing Lichtenstein's technique were significantly older, with more inguinoscrotal hernias and co-morbidities than those undergoing other techniques. A total of 83% patients had a complete 2Y-FU. The patient's satisfaction at 2Y-FU was similar between the different techniques. In the univariate and multivariate analyses, pain on postoperative day 1 was the only independent prognostic factor of the patient's satisfaction at 2Y-FU. CONCLUSION In this large series, no statistical differences were found between the four studied techniques regarding the 2Y-Fu results and patients' satisfaction. Provided the technique has been done properly (expert surgeon) the results and the patients' satisfaction are fair and equivalent among the four studied techniques. In a multivariate analysis, the only factor predictive of bad late results was severe pain at D1.
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Affiliation(s)
- B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg Cedex, France. .,Université de Strasbourg, Inserm IRFAC UMR_S1113, Laboratory STREINTH (Stress Response and Innovative Therapies), 3 av. Molière, Strasbourg, France.
| | | | - P Ortega-Deballon
- Service de Chirurgie Digestive, Hôpital Universitaire de Dijon, Dijon, France
| | - N Meyer
- Groupe Méthodes en Recherche Clinique, CHRU, 67091, Strasbourg Cedex, France
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Romain B, Rohmer O, Schimchowitsch S, Hübner M, Delhorme JB, Brigand C, Rohr S, Guenot D. Influence of preoperative life satisfaction on recovery and outcomes after colorectal cancer surgery - a prospective pilot study. Health Qual Life Outcomes 2018; 16:16. [PMID: 29343246 PMCID: PMC5772718 DOI: 10.1186/s12955-017-0824-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/11/2017] [Indexed: 02/04/2023] Open
Abstract
Background Colorectal surgery has an important impact on a patient’s quality of life, and postoperative rehabilitation shows large variations. To enhance the understanding of recovery after colorectal cancer, health-related quality of life has become a standard outcome measurement for clinical care and research. Therefore, we aimed to correlate the influence of preoperative global life satisfaction on subjective feelings of well-being with clinical outcomes after colorectal surgery. Methods In this pilot study of consecutive colorectal surgery patients, various dimensions of feelings of preoperative life satisfaction were assessed using a self-rated scale, which was validated in French. Both objective (length of stay and complications) and subjective (pain, subjective well-being and quality of sleep) indicators of recovery were evaluated daily during each patient’s hospital stay. Results A total of 112 patients were included. The results showed a negative relationship between life satisfaction and postoperative complications and a significant negative correlation with the length of stay. Moreover, a significant positive correlation between life satisfaction and the combined subjective indicators of recovery was observed. Conclusion We have shown the importance of positive preoperative mental states and global life satisfaction as characteristics that are associated with an improved recovery after colorectal surgery. Therefore, patients with a good level of life satisfaction may be better able to face the consequences of colorectal surgery, which is a relevant parameter in supportive cancer care.
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Affiliation(s)
- B Romain
- Université de Strasbourg, EA 3430, Tumor progression and microenvironment. Translational approaches and epidemiology, 3 avenue Molière, 67200, Strasbourg, France.,Department of Digestive Surgery, Strasbourg University Hospital, 1 Avenue Moliere, 67000, Strasbourg, France
| | - O Rohmer
- Laboratoire de Psychologie des Cognitions, Strasbourg University, Strasbourg, France
| | - S Schimchowitsch
- Laboratoire de Psychologie des Cognitions, Strasbourg University, Strasbourg, France
| | - M Hübner
- Department of Visceral Surgery, University Hospital CHU, 1011, Lausanne, Switzerland
| | - J B Delhorme
- Department of Digestive Surgery, Strasbourg University Hospital, 1 Avenue Moliere, 67000, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, 1 Avenue Moliere, 67000, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, 1 Avenue Moliere, 67000, Strasbourg, France
| | - D Guenot
- Université de Strasbourg, EA 3430, Tumor progression and microenvironment. Translational approaches and epidemiology, 3 avenue Molière, 67200, Strasbourg, France.
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Delhorme JB, Sattler L, Severac F, Triki E, Gross I, Romain B, Rohr S, Grunebaum L, Brigand C. Prognostic factors of hemorrhagic complications after oxaliplatin-based hyperthermic intraperitoneal chemotherapy: Toward routine preoperative dosage of Von Willebrand factor? Eur J Surg Oncol 2017; 43:1095-1101. [PMID: 28209329 DOI: 10.1016/j.ejso.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC-ox) induces specific morbidity with hemorrhagic complications (HC). The aim of this study was to identify preoperative, intraoperative and postoperative HC predictive factors after HIPEC-ox. METHODS A prospective single center study that included all consecutive patients treated with curative-intent HIPEC-ox, whatever the origin of peritoneal disease, was conducted. All patients underwent systematic blood tests exploring primary hemostasis and endothelial activation before surgical incision (D0) and on postoperative days 2 (POD2) and 5 (POD5). RESULTS Between May 2012 and August 2015, 47 patients were enrolled in the study. The overall HC rate was 38%. Major morbidity was significantly higher in patients with HC. Patients presenting HC were significantly more often affected with pseudomyxoma peritonei and had less preoperative chemotherapy. Multivariate analysis showed that a higher plasmatic level of Von Willebrand factor antigen at D0 (D0 VWF:Ag) was a protective predictive factor for HC (p = 0.049, HR: 0.97 CI 95% [0.94-1.00]). A D0 VWF:Ag level below 138% had a sensitivity of 87.5%, a specificity of 67% and an area under the curve of 80.3% (CI 95% [66.5-94], p < 0.01) for predicting HC. CONCLUSIONS Through the identification of prognostic factors, this study highlighted a subgroup of patients with low risk of HC after HIPEC-ox. Based on these results, we propose a routine preoperative dosage of VWF that would help the surgeon to select the most suitable patients for HIPEC-ox.
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Affiliation(s)
- J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France; INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 avenue Molière, 67200, Strasbourg, France.
| | - L Sattler
- Biological Hematology Laboratory, Hemostasis Unit, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - F Severac
- Department of Public Health, Strasbourg University Hospital, 1 place de l'hôpital BP426, 67091, Strasbourg, France
| | - E Triki
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - I Gross
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 avenue Molière, 67200, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - L Grunebaum
- Biological Hematology Laboratory, Hemostasis Unit, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
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Renaud S, Falcoz P, Schaeffer M, Romain B, Olland A, Reeb J, Voegeli' A, Legrain M, Brigand C, Rohr S, Dominique G, Massard G. F-077PERIOPERATIVE BEVACIZUMAB IMPROVES SURVIVAL IN LUNG METASTASECTOMY OF COLORECTAL CANCER HARBORING KRAS EXON 2 CODON 12 MUTATIONS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nehmar RB, Romain B, Marisa L, Bour C, Duluc I, Pencreach E, Guenot D. Understanding loss of SDF1 expression in colon tumors. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Romain B, Story F, Meyer N, Delhorme J, Brigand C, Rohr S. Comparative study between biologic porcine dermal meshes: risk factors of postoperative morbidity and recurrence. J Wound Care 2016; 25:320-5. [DOI: 10.12968/jowc.2016.25.6.320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B. Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - F. Story
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - N. Meyer
- Département de Santé Publique, CHRU, 67091 Strasbourg Cedex, France
| | - J.B. Delhorme
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - C. Brigand
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | - S. Rohr
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
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Renaud S, Falcoz PE, Schaeffer M, Beau-Faller M, Romain B, Olland A, Reeb J, Santelmo N, Massard G, Voegeli AC. Prognostic Influence of Mutational Status in Resected Non-Small Cell Lung Cancer: the KRAS G12V Worse Value. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv048.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Renaud S, Romain B, Falcoz PE, Olland A, Santelmo N, Brigand C, Rohr S, Guenot D, Massard G. F-077 * KRAS AND BRAF MUTATIONS ARE PROGNOSTIC BIOMARKERS IN PATIENTS UNDERGOING LUNG METASTASECTOMY OF COLORECTAL CANCER. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Serradori T, Germain A, Scherrer ML, Ayav C, Perez M, Romain B, Palot JP, Rohr S, Peyrin-Biroulet L, Bresler L. The effect of immune therapy on surgical site infection following Crohn's Disease resection. Br J Surg 2013; 100:1089-93. [PMID: 23649458 DOI: 10.1002/bjs.9152] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Crohn's disease are increasingly receiving antitumour necrosis factor α (anti-TNF-α) therapy. Whether anti-TNF-α therapy increases the risk of postoperative infectious complications in Crohn's disease is a matter of debate. METHODS This was a retrospective study of three referral centres. The charts of patients who underwent ileocaecal or ileocolonic resection for Crohn's disease between 2000 and 2011 were reviewed. The impact of baseline characteristics and Crohn's disease-related medications on the risk of postoperative intra-abdominal infectious complications was investigated by univariable and multivariable analysis. RESULTS A total of 217 patients were included in the study. Median age at the time of surgery was 36·8 (range 15-78) years. A postoperative intra-abdominal infection occurred in 24 (11·1 per cent) of 217 patients. No deaths were reported. On univariable analysis, age less than 25 years (P = 0·023), steroid use (P = 0·017), anti-TNF-α therapy (P = 0·043) and anti-TNF-α treatment in combination with steroids (P = 0·004) were associated with an increased risk of postoperative intra-abdominal infectious complications. On multivariable analysis, only anti-TNF-α therapy in combination with steroids significantly increased this risk (odds ratio 8·03, 95 per cent confidence interval 1·93 to 33·43; P = 0·035). CONCLUSION Combined use of steroids and anti-TNF-α therapy was associated with an increased risk of postoperative intra-abdominal infectious complications.
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Affiliation(s)
- T Serradori
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Nancy, France.
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Romain B, Chemaly R, Meyer N, Brigand C, Steinmetz JP, Rohr S. Value of a preoperative checklist for laparoscopic appendectomy and cholecystectomy. J Visc Surg 2012; 149:408-11. [PMID: 23164526 DOI: 10.1016/j.jviscsurg.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Laparoscopy is a complex technique where incidents related to equipment failure/malfunction commonly occur. The purpose of the WHO preoperative safety checklist is to significantly reduce surgically associated complications and mortality. GOAL The goal of this study was to show that a preoperative checklist for laparoscopy could improve procedure efficiency by reducing lost time due to these incidents. MATERIAL AND METHODS This prospective study compared the occurrence of incidents related to equipment, patient installation and the time loss attributed to these incidents, before and after the initiation of a preoperative checklist. Two hundred consecutive laparoscopic procedures (appendectomies and cholecystectomies) were studied; the first hundred without the preoperative checklist and the second hundred after the initiation of this laparoscopic checklist. RESULTS The risk of at least one incident to occur during the procedure was increased 3-fold ([1.36 vs. 6.64], P=0.007) when the checklist was not used compared to when the preoperative checklist was used. Likewise, the number of incidents increased 2.4-fold ([1.15; 5.01], P=0.02), compared to when the preoperative checklist was used. The checklist significantly reduced the proportion of incidences during which time was lost from 22% to 10% (P=0.03). CONCLUSION A preoperative checklist for laparoscopic procedures is feasible and seems useful to prevent adverse events in the operating room.
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Affiliation(s)
- B Romain
- Service de chirurgie générale et digestive, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Romain B, Lucidarme O, Dauguet J, Mulé S, Souedet N, Chenoune Y, Guibal A, Delzescaux T, Frouin F. Registration and functional analysis of CT dynamic image sequences for the follow-up of patients with hepatic tumors undergoing antiangiogenic therapy. Ing Rech Biomed 2010. [DOI: 10.1016/j.irbm.2010.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Keller P, Romain B, Nicolae MA, Perrin P, Meyer C. [Is laparoscopic gastric bypass a dangerous procedure during the early phase of the learning curve? A prospective study of the first 50 cases]. ACTA ACUST UNITED AC 2009; 146:373-81. [PMID: 19766214 DOI: 10.1016/j.jchir.2009.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Among the various bariatric procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is widely considered to be the gold standard. However, a majority of bariatric surgeons in France do not perform LFYGBP, perhaps because of its reputation as a technically demanding procedure with a long learning curve. This study evaluates the outcomes and the learning curve for the first 50 LFYGBP performed by one surgeon in a French non-university hospital. MATERIAL AND METHOD Between April 2007 and February 2009, we performed our first 50 cases of LRYGBP. Surgical outcomes and the learning curve were measured by prospective criteria including length of stay, operative time, complications, percentage weight loss and reduction of obesity-related co-morbidities. RESULTS The mean patient age was 41.8+/-9.8 years. The mean BMI was 47.7+/-7.1 kg/m(2). The mean operative time was 146+/-51 minutes and the mean hospital stay was 5.3+/-1.4 days. Three cases (6%) were converted to open surgery. Early complications occurred in 4% and late complications occurred in 6%. The average follow-up was 6.3+/-1.3 months. Overall excess weight loss was 39.5, 50, 62, and 63% at 3, 6, 9, and 12 months. CONCLUSION LRYGBP can be performed with acceptable morbidity and short-term results, even during the early phase of a surgeon's learning curve. It is a feasible procedure for bariatric surgeons with previous experience in gastric banding.
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Affiliation(s)
- P Keller
- Département de chirurgie, hôpital Pasteur, hôpitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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Romain B, Schneider M, Jung JL, Detloff H, Krzisch S, Chartier-Kastler E. [Renal metastasis of an esophagus epidermoid carcinoma]. Prog Urol 2009; 19:348-50. [PMID: 19393541 DOI: 10.1016/j.purol.2008.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/21/2008] [Accepted: 10/29/2008] [Indexed: 11/19/2022]
Abstract
Renal metastases in the evolution of an esophagus epidermoid carcinoma are rare and are frequently bilateral or associated with many other metastases. The authors present an original article of a single metastasis. They discuss the importance of imagery and locoregional status in the management of patient.
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Affiliation(s)
- B Romain
- Service de chirurgie urologique, hôpitaux Civils-de-Colmar, Colmar, France.
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Lair D, Romain B, Bernadet R, Meynard JA, Sanchez MF. [Manic-depressive disorders. Current concepts]. Soins Psychiatr 1997:5-9. [PMID: 9295788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D Lair
- Centre hospitalier général, La Rochelle
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Lair D, Romain B, Sanchez MF, Bernadet R, Meynard J. [Electroshock therapy in 1993]. Soins Psychiatr 1993:3-7. [PMID: 8122172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Malrieu C, Nguyen P, Dupeyron G, Romain B. [Posttraumatic Cogan syndrome apropos of a case. Diagnostic and medico-legal problems]. Bull Soc Ophtalmol Fr 1986; 86:1205-8. [PMID: 3581330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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