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Lainas P, Triantafyllou E, Gugenheim J, Dagher I, Amor IB. Reply to "Innovative Endoscopic Approach for Staple Line Leaks Following Sleeve Gastrectomy: Promising Outcomes with Considerable Concerns". Obes Surg 2024; 34:1031-1032. [PMID: 38183595 DOI: 10.1007/s11695-023-07044-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, HEAL Academy, 9 Ethnarchou Makariou & 1 Venizelou Streets, GR-18547 Neo Faliro, Athens, Greece.
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, Clamart, France.
- Paris-Saclay University, Orsay, France.
| | - Evangelia Triantafyllou
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, HEAL Academy, 9 Ethnarchou Makariou & 1 Venizelou Streets, GR-18547 Neo Faliro, Athens, Greece
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France
- University of Nice-Sophia-Antipolis, Nice, France
- INSERM U1081, Nice, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, Clamart, France
- Paris-Saclay University, Orsay, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France
- University of Nice-Sophia-Antipolis, Nice, France
- INSERM U1081, Nice, France
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Amor IB, Triantafyllou E, Temime V, Chenaitia H, Benamran D, Vanbiervliet G, Dagher I, Gugenheim J, Lainas P. Endoscopic Administration of Combined Autologous Mesenchymal Stem Cells and Platelet-Rich Plasma for the Treatment of Gastric Staple Line Leaks After Sleeve Gastrectomy. Obes Surg 2024; 34:106-113. [PMID: 38017329 DOI: 10.1007/s11695-023-06942-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Gastric staple line leak treatment after laparoscopic sleeve gastrectomy (LSG) remains challenging. Regenerative medicine is gaining place in the accelerated treatment of damaged tissues. This study presents the first series of gastric leak treatment after LSG using endoscopic intragastric administration of combined autologous mesenchymal stem cells (MSC) and platelet-rich plasma (PRP). METHODS MSC-PRP harvesting and endoscopic administration techniques are described in detail. Data were prospectively gathered and analyzed. Primary endpoints were morbidity/mortality rates and fistula closure time. RESULTS Twelve patients (9 women, 3 men) were included. Median age was 41.5 years, median weight 105.5 kg and median BMI 38.9 kg/m2. Median time to gastric staple line leak detection was 10 days post-LSG. Median time between re-laparoscopy and MSC-PRP administration was 5 days. MSC-PRP endoscopic administration was successfully performed and tolerated by all patients, with median procedure duration of 27 min and minimal blood loss. Four postoperative complications were noted: two patients with increased tibial pain at tibial puncture site, one with tibial hematoma, and one with epigastric pain/dysphagia. Median length of hospital stay was 1 day. Gastric leak healing occurred after a median of 14 days, only two patients requiring a second MSC-PRP endoscopic injection. Median follow-up was 19 months, all patients being in good health at last contact. CONCLUSION Endoscopic administration of combined autologous MSC-PRP seems to be a good option for treatment of gastric leaks after sleeve gastrectomy. It is a challenging procedure that should be performed in specialized bariatric centers by expert bariatric surgeons and endoscopists after meticulous patient selection.
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Affiliation(s)
- Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France
- University of Nice-Sophia-Antipolis, Nice, France
- INSERM U1081, Nice, France
| | - Evangelia Triantafyllou
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, HEAL Academy, 9 Ethnarchou Makariou & 1 Venizelou Streets, Neo Faliro, 18547, Athens, Greece
| | - Victor Temime
- Department of Digestive Surgery, Archet II Hospital, Nice, France
| | - Hichem Chenaitia
- Department of Digestive Surgery, Archet II Hospital, Nice, France
| | - Dorith Benamran
- Department of Digestive Surgery, Archet II Hospital, Nice, France
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, Clamart, France
- Paris-Saclay University, Orsay, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France
- University of Nice-Sophia-Antipolis, Nice, France
- INSERM U1081, Nice, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, HEAL Academy, 9 Ethnarchou Makariou & 1 Venizelou Streets, Neo Faliro, 18547, Athens, Greece.
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, Clamart, France.
- Paris-Saclay University, Orsay, France.
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Drai C, Chierici A, Schiavo L, Amor IB, Schneider S, Iannelli A. Long-Term Results of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Individuals Older Than 60 Years with Morbid Obesity. Obes Surg 2023; 33:3850-3859. [PMID: 37840091 DOI: 10.1007/s11695-023-06851-5] [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: 05/22/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE An increasing Pnumber of individuals with obesity over the age of 60 years require bariatric surgery to treat obesity and its related medical problems. Sleeve gastrectomy and Roux-en-Y gastric bypass have already proven their efficacy in this population, but literature lacks reports of long-term results. The aim of this study is to compare long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years old. MATERIALS AND METHODS This is a single-center, retrospective, comparative study of 204 patients undergoing either sleeve gastrectomy (123, 60.3%) or Roux-en-Y gastric bypass (81, 39.7%) for morbid obesity with a mean follow-up of 44.5 ± 19.1 months and 54.6 ± 17.9 months, respectively. RESULTS Total weight loss was significantly increased for patients who underwent Roux-en-Y gastric bypass compared to sleeve gastrectomy from 12 to 48 months after surgery, while no significant difference was found after 60 (30.39% vs. 27.63%) and 72 (27.36% vs. 23.61%) months. Roux-en-Y gastric bypass was associated to a significant increased rate of early postoperative complications (22.2% vs. 4%; p < 0.0001), but no difference was found concerning late postoperative morbidity (6.2% vs. 1.6%). Both procedures were effective in obesity related medical problems. CONCLUSION Roux-en-Y gastric bypass confers an increased weight loss than sleeve gastrectomy in patients over the age of 60 in the mid-term, but it is associated with more early postoperative complications. Sleeve gastrectomy can be considered a valid alternative as long-term weight loss results are superposable to those ensured by Roux-en-Y gastric bypass.
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Affiliation(s)
- Céline Drai
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
- Université Côte d'Azur, Nice, France
| | - Andrea Chierici
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
| | - Luigi Schiavo
- Unit of General and Emergency Surgery, University Hospital San Giovanni Di Dio E Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
| | - Stéphane Schneider
- Université Côte d'Azur, Nice, France
- Department of Gastroenterology and Clinical Nutrition, CHU de Nice, University Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France.
- Université Côte d'Azur, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France.
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Lainas P, Triantafyllou E, Ben Amor V, Savvala N, Gugenheim J, Dagher I, Amor IB. Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy. Surg Obes Relat Dis 2022; 19:585-592. [PMID: 36658084 DOI: 10.1016/j.soard.2022.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/12/2022] [Revised: 10/29/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging. OBJECTIVE To present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG. SETTING University hospitals; specialized bariatric surgery units. METHODS Data were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized. RESULTS Fourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m2. All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact. CONCLUSIONS LRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France; Paris-Saclay University, Orsay, France; Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece.
| | - Evangelia Triantafyllou
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France
| | | | - Natalia Savvala
- Department of Digestive Surgery, Archet II Hospital, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France; University of Nice-Sophia-Antipolis, Nice, France; INSERM U1081, Nice, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Clamart, France; Paris-Saclay University, Orsay, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France; University of Nice-Sophia-Antipolis, Nice, France; INSERM U1081, Nice, France
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Debs T, Iannelli A, Frey S, Petrucciani N, Korkmaz C, Ben Amor V, Chenaitia H, Vanbiervliet G, Gugenheim J, Ben Amor I. Mesenchymal Stem Cells and Platelet Rich Plasma Therapy to Treat Leak After Sleeve Gastrectomy. J Surg Res 2021; 268:405-410. [PMID: 34416412 DOI: 10.1016/j.jss.2021.06.066] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND One of the most feared and life-threatening complications after sleeve gastrectomy (SG) is staple line leak, with an incidence between 1 and 4%. Stable patients may be managed conservatively, with antibiotics, percutaneous drainage and endoscopy-based treatment. We propose mesenchymal stem cells (MSC) and platelet rich plasma (PRP) therapy as an innovative technique to treat leak after SG. MATERIAL AND METHODS Bone marrow MSCs is obtained by centrifugation of tibial puncture specimen. A peripheral whole blood sample is retrieved from the patient and centrifuged to obtain PRP. During endoscopy, the first 10 mL are injected in 4quadrants (equal volume) in the submucosae around the internal orifice. The second 10 mL are injected in the wall of the fistula tract. RESULTS The immediate course following the endoscopy was uneventful in both reported cases. The leaks healed in 30 and 42 D, respectively. Oral nutrition was progressively started during the third WK and fourth WK following the injection for both patients. No adverse event was noted during the follow-up period. CONCLUSION The management of fistulas post SG is controversial and actual available treatments present a relatively prolonged healing time. MSC administration retains a high potential value in the treatment of these fistulas. Further studies and wider clinical trials are mandatory to determine the impact of MSC administration.
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Affiliation(s)
- Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - Carine Korkmaz
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | | | | | | | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
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Lainas P, Kassir R, Benois M, Derienne J, Debs T, Safieddine M, Gugenheim J, Dagher I, Amor IB. Comparative analysis of robotic versus laparoscopic Roux-en-Y gastric bypass in severely obese patients. J Robot Surg 2021; 15:891-898. [PMID: 33484415 DOI: 10.1007/s11701-020-01181-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/25/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023]
Abstract
Benefits of robotic surgery for Roux-en-Y gastric bypass (RYGB) are still debated. We aimed to compare conventional laparoscopic (L-RYGB) to robotic RYGB (R-RYGB) and evaluate safety, efficacy, advantages and drawbacks of each procedure. A prospective cohort study with a retrospective review approach was conducted to analyze results of L-RYGB and R-RYGB performed at a bariatric center of excellence. Patient demographics, perioperative data, weight loss, comorbidities evolution and cost were assessed. One hundred and sixty-one severely obese patients underwent R-RYGB and L-RYGB, respectively. Patient's characteristics were similar between groups. Intraoperative blood loss was similar (p = 0.91), with no requirement for blood transfusion. Median operative time was significantly reduced for R-RYGB (127 vs 160 min; p < 0.001). Seven patients (11.4%) in the L-RYGB group and 15 patients (15%) in the R-RYGB group had early postoperative complications (p = 0.63), with more anastomotic leaks and stenosis for R-RYGB during initial learning curve (p = NS). Mortality was null. Median length of hospital stay was similar (6 days; p = 0.20). Mean hospital cost was non-significantly increased for R-RYGB ($5730 vs. $4879; p = 0.34). Two years after surgery, median BMI and mean EWL% were similar for both groups (26.1 vs 26.5 kg/m2 and 89.9% vs 90.9% for L-RYGB and R-RYGB groups, respectively; p = 0.71 and 0.85, respectively), with no statistically significant difference in comorbidities between the two groups (p = 0.80). R-RYGB is feasible and safe within the reach of every laparoscopic surgeon. In our series, it was associated with shorter operative time and equivalent length of stay and weight loss outcomes compared to L-RYGB. Further well-designed randomized studies are necessary to draw safe conclusions.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique-Hôpitaux de Paris, 157 rue de la Porte de Trivaux, 92141, Clamart cedex, France. .,Paris-Saclay University, 91405, Orsay, France.
| | - Radwan Kassir
- Department of Digestive and Bariatric Surgery, CHU Felix-Guyon, Saint-Denis, La Reunion, France
| | - Marine Benois
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France
| | - Joseph Derienne
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique-Hôpitaux de Paris, 157 rue de la Porte de Trivaux, 92141, Clamart cedex, France
| | - Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France
| | - Maissa Safieddine
- Methodological Support Unit, INSERM, CIC1410, CHU Felix-Guyon, Saint-Denis, La Reunion, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique-Hôpitaux de Paris, 157 rue de la Porte de Trivaux, 92141, Clamart cedex, France.,Paris-Saclay University, 91405, Orsay, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France
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Debs T, Petrucciani N, Frey S, Korkmaz C, Hufschmidt K, Sejor E, Bitar HE, Ben Amor I, Iannelli A, Gugenheim J. Outcomes of patients older than 55 years undergoing abdominoplasty after bariatric surgery. Surg Obes Relat Dis 2021; 17:901-908. [PMID: 33622603 DOI: 10.1016/j.soard.2021.01.009] [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] [Received: 08/11/2020] [Revised: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bariatric surgery has become widely performed for treating patients with morbid obesity, and the age limits are being pushed further and further as the procedure proves safe. After massive weight loss, many of those patients seek body-contouring surgery for excess skin and fat. OBJECTIVES To analyze the feasibility and the safety of abdominoplasty in patients older than 55 years old after bariatric surgery. SETTING University hospital medical center. METHODS We performed a retrospective review of prospectively collected data from patients aged older than 55 years who had undergone abdominoplasty following massive weight loss due to a bariatric surgery at a single institution from 2004 to 2017. The data analyzed included age, gender, preoperative body mass index, associated interventions, co-morbidities, and postoperative complications. RESULTS We retrieved records for 104 patients; 85.6% percent of them were female, and the mean age was 60.1 ± 3.9 years old. Of the 104 patients, 21 (20.2%) underwent a sleeve gastrectomy and 77 (74%) underwent a Roux-en-Y gastric bypass. The mean interval between the bariatric surgery and the abdominoplasty was 33.6 ± 26.9 months. The mean preoperative weight and body mass index were 76.1 ± 14.5 kg and 28.9 ± 4.5 kg/m2, respectively. A total complication rate of 20% was observed. The only factor significantly associated with postoperative morbidity was the associated procedure (P = .03), when we performed another procedure at the same time as the abdominoplasty. Complications included postoperative bleeding in 5 patients (4.8%), seromas in 5 patients (4.8%), surgical site infections in 12 patients (11.5%), and wound dehiscence or ischemia in 2 patients (1.9%). No mortality occurred. CONCLUSION Abdominoplasty can be safely performed in carefully selected patients older than 55 years old after weight loss surgery, and does not present increased morbidity or mortality. We recommend that surgeons avoid adding concomitant procedures when possible, to decrease the risk of complications. It is also important to look at the patient's previous maximum BMI levels, as a higher maximum BMI can predict higher postoperative risks and longer hospital stays.
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Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France; Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Sebastian Frey
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Carine Korkmaz
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Katharina Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Eric Sejor
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Houssam Eddine Bitar
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Antonio Iannelli
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
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Petrucciani N, Debs T, Rosso E, Addeo P, Antolino L, Magistri P, Gugenheim J, Ben Amor I, Aurello P, D'Angelo F, Nigri G, Di Benedetto F, Iannelli A, Ramacciato G. Left-sided portal hypertension after pancreatoduodenectomy with resection of the portal/superior mesenteric vein confluence. Results of a systematic review. Surgery 2020; 168:434-439. [PMID: 32600882 DOI: 10.1016/j.surg.2020.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension. METHODS A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection. RESULTS Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%). CONCLUSION Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.
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Affiliation(s)
- Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy.
| | - Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Edoardo Rosso
- Départment de Chirurgie Générale, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Paolo Aurello
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France; INSERM U1065, Mediterranean Center for Molecular Medicine, Team 8 Hepatic Complications of Obesity, Nice, France
| | - Giovanni Ramacciato
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
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Debs T, Frey S, Petrucciani N, Fortier Beaulieu C, Lame F, Iannelli A, Sejor E, Amor IB, Gugenheim J. Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:2851-2853. [DOI: 10.1007/s11695-020-04476-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sejor E, Debs T, Petrucciani N, Brige P, Chopinet S, Seux M, Piche M, Myx-Staccini A, Ben Amor I, Frey S, Prate F, Zenerino A, Gugenheim J. Feasibility and Efficiency of Sutureless End Enterostomy by Means of a 3D-Printed Device in a Porcine Model. Surg Innov 2020; 27:203-210. [PMID: 31941417 DOI: 10.1177/1553350619895631] [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] [Indexed: 11/16/2022]
Abstract
Objective. The aim of this study is to present a 3-dimensional (3D)-printed device to simply perform abdominal enterostomy and colostomy. Summary Background Data. Enterostomy and colostomy are frequently performed during abdominal surgery. 3D-printed devices may permit the creation of enterostomy easily. Methods. The device was designed by means of a CAD (computer-aided design) software, Rhinoceros 6 by MC Neel, and manufactured using 3D printers, Factory 2.0 by Omni 3D and Raise 3D N2 Dual Plus by Raise 3D. Colostomy was scheduled on a human cadaver and on 6 Pietrain pigs to test the device and the surgical technique. Results. The test on the cadaver showed that the application of the device was easy. Test on porcine models confirmed that the application of the device was also easy on the living model. The average duration of the surgical procedure was 32 minutes (25-40 minutes). For the female pigs, return to full oral diet and recovery of a normal bowel function was observed at postoperative day 2. The device fell by itself on average on the third day. Until day 10, when euthanasia was practiced, the stoma mucosa had a good coloration indicating a perfect viability of tissues. No complications were observed. Conclusions. This is the first study that describes the use of a 3D-printed device in abdominal surgery. End-type colostomy using a 3D-printed device can be safely and easily performed in an experimental porcine model, without postoperative complications. Further studies are needed to evaluate its utility in the clinical setting.
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Affiliation(s)
| | | | - Niccolo Petrucciani
- Department of Digestive Surgery, Henri Mondor University Hospital, Creteil, France
| | | | - Sophie Chopinet
- Aix-Marseille University, Marseille, France.,Hôpital de la Timone, Marseille, France
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11
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Gugenheim J, Ben Amor I, Gugenheim J, Kassir R, Casanova V. Volvulus of the Gallbladder: Case Reports. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.05.19] [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: 11/12/2022] Open
Abstract
The volvulus of the gallbladder can be considered a clinical curiosity. However, we herein report three
recent demonstrative consecutive cases. Female gender, advanced age and a thin constitution seem to
represent common predisposing factors. A brutal and excrutiatingly painful presentation in the right
hypochondrium contrast initially with seemingly normal vital parameters. Fever can be observed as well as
signs of peritoneal irritation. An X-Ray of the abdomen can show a complete emptiness of the right flank
and whole blood analysis can reveal an elevated leucocyte count predominantly neutrophilic. The torsion
of the gallbladder thus presents itself as an acute cholecystitis with particularities catching the clinician's
attention. The only anatomical predisposing factor resides in an anomaly of the mesocyst. The prognosis is
driven by the delay to cholecystectomy as a fatal toxinic syndrome can be dreaded in this fragile population.
Population's aging and possibilities to enlarge surgical indications in the elderly, enforces us to abandon the
pejorative qualifier of « rare curiosity » attached to the gallbladder volvulus and define it as a clear entity in
the gallbladder pathology.
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12
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Amor IB, Lainas P, Kassir R, Chenaitia H, Dagher I, Gugenheim J. Treatment of complex recurrent fistula-in-ano by surgery combined to autologous bone marrow-derived mesenchymal stroma cells and platelet-rich plasma injection. Int J Colorectal Dis 2019; 34:1795-1799. [PMID: 31455971 DOI: 10.1007/s00384-019-03367-2] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE We report a case of successful management of complex recurrent cryptoglandular fistula-in-ano by surgery combined with autologous bone marrow-derived mesenchymal stroma cells (MSCs) and platelet-rich plasma (PRP) injection. METHODS Clinical, radiological, and surgical data of the patient were reviewed, as well as the current literature on complex fistula-in-ano. RESULTS A 37-year-old man with a recurrent cryptoglandular perianal fistula was addressed to our department. Inflammatory bowel disease was excluded by clinical history, endoscopy, and blood tests. Physical examination and MRI showed an anterior external orifice on the midline, 5 cm from the anal verge, with an internal orifice on the same line. Surgery combined to injection of MSC-PRP solution was successfully performed. MSC-PRP solution was prepared while the patient was under general anesthesia: bone marrow MSCs were obtained by centrifugation of a tibial puncture specimen and PRP from a peripheral whole blood sample of the patient. There were no adverse events post-operatively. Clinical and MRI examination 4 months after treatment confirmed the absence of perianal fistula. More than 2 years after surgery, there has been no recurrence. CONCLUSIONS Treatment of complex recurrent cryptoglandular fistula-in-ano by surgery combined to autologous bone marrow-derived MSCs and PRP injection seems safe in selected patients, allowing long-term healing. This procedure seems promising but further evaluation by clinical trials is warranted.
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Affiliation(s)
- Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France.,INSERM U1081, Nice, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, F-92140, Clamart, France. .,Paris-Saclay University, F-91405, Orsay, France.
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Felix Guyon, Saint-Denis La Reunion, France
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, Nice, France.,University of Nice-Sophia-Antipolis, Nice, France.,INSERM U1081, Nice, France
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13
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Amor IB, Kassir R, Petrucciani N, Almunifi A, Debs T, Gugenheim J. An Alternative Technique of Reversal of Roux-en-Y Gastric Bypass: the Small Bowel Limb Transposition. Obes Surg 2019; 29:4142-4143. [PMID: 31468304 DOI: 10.1007/s11695-019-04158-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) is recently the second most frequent operation worldwide and is only preceded by sleeve gastrectomy. We present an alternative technique of reversal of RYGB. There is no need to dissect or resect the gastrojejunal anastomosis. This dissection might be difficult as the gastrojejunal anastomosis might be adherent to the residual stomach. The 2 anastomoses performed are technically easy and done on healthy non-inflammatory tissue.
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Affiliation(s)
- Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint-Denis, La réunion, France. .,Department of Bariatric Surgery, CHU Felix-Guyon, Saint-Denis, La réunion, France.
| | - Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France.,Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.,Department of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, UPEC, Creteil, France
| | - Abdullah Almunifi
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
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Debs T, Petrucciani N, Kassir R, Sejor E, Karam S, Ben Amor I, Gugenheim J. Complications after laparoscopic sleeve gastrectomy: can we approach a 0% rate using the largest staple height with reinforcement all along the staple line? Short-term results and technical considerations. Surg Obes Relat Dis 2018; 14:1804-1810. [PMID: 30316829 DOI: 10.1016/j.soard.2018.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe the results of a single center's experience with SG, revealing a low complication rate. OBJECTIVES The aim of the study was to analyze the short-term results of laparoscopic SG using exclusively black staples with staple-line reinforcement. SETTINGS University hospital, tertiary referral center for bariatric surgery. METHODS SG was performed in 434 consecutive patients from December 2014 to March 2017. A technique is described where all operations were performed with attention to avoiding strictures at the incisura angularis and not stapling near the esophagus at the angle of His. All the interventions were performed using black cartridges and staple-line reinforcement using bioabsorbable Seamguard. A prospective chart review was conducted to determine the occurrence of early complications. RESULTS Follow-up data were collected for all patients at 90 days postoperatively. A total complication rate of 4.4% was observed. No leaks occurred in any of the patients. One case of bleeding occurred that necessitated a surgical exploration, which found the origin of the bleeding to be a diaphragmatic vessel. The 90-day mortality rate was 0%. CONCLUSION SG can be performed with a low complication rate. Selection of the appropriate staple height and reinforcement of the staple line could play a major role in optimizing the results of SG.
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Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France.
| | - Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, UPEC University, Henri Mondor Hospital, Creteil, France
| | - Radwan Kassir
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Eric Sejor
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Sami Karam
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
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Kassir R, Gugenheim J, Amor IB, Kassir R, Sauvat F. Trends in BMI, Glycaemic Control and Obesity-Associated Comorbidities After Explantation of the Duodenal-Jejunal Bypass Liner (DJBL). Obes Surg 2018; 28:3629-3630. [PMID: 30145630 DOI: 10.1007/s11695-018-3438-y] [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: 10/28/2022]
Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Félix Guyon, La Réunion, Saint-Denis, La réunion, France.
| | - Jean Gugenheim
- Department of Bariatric Surgery, CHU Archet 2, Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, CHU Archet 2, Nice, France
| | - Rani Kassir
- Department of Pediatric Surgery, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Frédérique Sauvat
- Department of Pediatric Surgery, CHU Félix Guyon, Saint-Denis, La Réunion, France
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Kassir R, Le Moullec N, Coueffe X, Chouillard E, Amor IB, Gugenheim J. Comments on the Article: The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Japanese Patients with BMI < 35 kg/m 2 on Type 2 Diabetes Mellitus and the Prediction of Successful Glycemic Control. Obes Surg 2018; 28:2528-2529. [PMID: 29675636 DOI: 10.1007/s11695-018-3266-0] [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: 11/26/2022]
Affiliation(s)
- Radwan Kassir
- Departement of Digestive Surgery, CHU Félix Guyon, Saint-Denis, Réunion, France.
- Department of Bariatric Surgery, CHU Felix Guyon, Saint-Denis, Réunion, France.
| | - Nathalie Le Moullec
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU la réunion sud, Saint Pierre, France
| | - Xaviera Coueffe
- Department of Digestive Surgery, CHU la réunion sud, Saint Pierre, France
| | - Elie Chouillard
- Department of Digestive and Minimally Invasive Surgery, Saint-Germain-en-Laye Medical Center, Poissy, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
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Petrucciani N, Debs T, Nigri G, Giannini G, Sborlini E, Kassir R, Ben Amor I, Iannelli A, Valabrega S, D'Angelo F, Gugenheim J, Ramacciato G. Pancreatectomy combined with multivisceral resection for pancreatic malignancies: is it justified? Results of a systematic review. HPB (Oxford) 2018; 20:3-10. [PMID: 28943396 DOI: 10.1016/j.hpb.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multivisceral resections combined with pancreatectomy have been proposed in selected patients with tumor invasion into adjacent organs, in order to allow complete tumor resection. Some authors have also reported multivisceral resection combined with metastasectomy in very selected cases. The utility of this practice is debated. The aim of the review is to compare the postoperative results and survival of pancreatectomies combined with multivisceral resections with those of standard pancreatectomies. METHODS A systematic literature search was performed to identify all studies published up to February 2017 that analyzed data of patients undergoing multivisceral and standard pancreatectomies. Clinical effectiveness was synthetized through a narrative review with full tabulation of results. RESULTS Three studies were retrieved, including 713 (80%) patients undergoing standard pancreatectomies and 176 (20%) undergoing multivisceral resections (MVR). Postoperative morbidity ranged from 37% to 50% after standard resections and from 56% to 69% after MVR. In-hospital mortality ranged from 4% after standard pancreatectomies to 10% after MVR. Median survival ranged from 20 to 23 months in standard resections and from 12 to 20 months after MVR, without significant differences. DISCUSSION The current literature suggests that multivisceral pancreatectomies are feasible and may increase the number of completely resected patients. Morbidity and mortality are higher than after standard pancreatectomies, and these procedures should be reserved to selected patients in referral centers. Further studies on the role of neoadjuvant therapy in this setting are advisable.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy; Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France.
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - Giulia Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - Elena Sborlini
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - Radwan Kassir
- Department of General and Thoracic Surgery, St Etienne University Hospital, St Etienne, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Antonio Iannelli
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Stefano Valabrega
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Giovanni Ramacciato
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
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18
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Amor IB, Petrucciani N, Kassir R, Al Munifi A, Piche T, Debs T, Gugenheim J. Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass. Obes Surg 2017; 27:1398. [PMID: 28303507 DOI: 10.1007/s11695-017-2646-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/20/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) demonstrated results similar to traditional Roux-en-Y procedures [1-3], in terms of weight loss and resolution of obesity-related comorbidities. The main controversy regarding OAGB is the concern for an association between biliary alkaline gastritis and esophageal or gastric cancer raised by some studies [4]. METHODS We present the case of a 51-year-old woman with a BMI of 41 kg/m2 who underwent a laparoscopic OAGB in 2014. One year later, she consulted for recurrent heartburns. An upper GI endoscopy showed pouchitis and bile reflux in the esophagus. Medical treatment of gastroesophageal reflux disease was ineffective. We decided to convert the OAGB to a Roux-en-Y gastric bypass (RYGB). RESULTS In this video, we show how to revise an OAGB to treat chronic bile reflux, by converting the procedure to a standard RYGB. The intervention starts by restoring the normal anatomy of the small bowel, with the resection of the gastrojejunal anastomosis, which was located at 250-cm du Treitz's ligament. Then, the gastric pouch is created. A standard Roux-en-Y gastric bypass is performed. CONCLUSIONS The resection of the gastrojejunal anastomosis allows fashioning the Roux-en-Y limb with the classical measures. This technique allows a conversion to a standard RYGB and is effective in treating the biliary reflux.
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Affiliation(s)
- Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
| | - Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France
| | - Abdullah Al Munifi
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Thierry Piche
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice Sophia Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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Affiliation(s)
- Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France. .,Department of Medical and Surgical Sciences of Translational Medicine, Sapienza University, Rome, Italy.
| | - Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Radwan Kassir
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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Debs T, Petrucciani N, Kassir R, Vanbiervliet G, Ben Amor I, Staccini AM, Sejor E, Gugenheim J. Migration of an Endoscopic Double Pigtail Drain into the Abdominal Wall Placed as a Treatment of a Fistula Post Revisional Bariatric Surgery. Obes Surg 2017; 27:1335-1337. [PMID: 28303506 DOI: 10.1007/s11695-017-2580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
| | - Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Saint-Etienne, France
| | - Geoffrey Vanbiervliet
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Aline Myx Staccini
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Eric Sejor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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Debs T, Ben Amor I, Gugenheim J. Multirevisional Bariatric Surgery: What Is the Diagnosis? Gastroenterology 2017; 152:704-705. [PMID: 28157518 DOI: 10.1053/j.gastro.2016.09.056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
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Debs T, Petrucciani N, Sejor E, Ben Amor I, Gugenheim J. Iatrogenic venous air embolism from central venous catheterization after blunt liver trauma. Surgery 2017; 162:1179-1180. [PMID: 28041743 DOI: 10.1016/j.surg.2016.11.023] [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] [Received: 11/09/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France.
| | - Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Eric Sejor
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
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Amor IB, Debs T, Petrucciani N, Martini F, Kassir R, Gugenheim J. A Simple Technique of Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass. Obes Surg 2016; 27:273-274. [DOI: 10.1007/s11695-016-2424-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kassir R, Gugenheim J, Debs T, Amor IB, TIffet O. Endobarrier® in Grade I Obese Patients with Long-Standing Type 2 Diabetes: Role of Gastrointestinal Hormones in Glucose Metabolism. Obes Surg 2016; 27:196-197. [PMID: 27726044 DOI: 10.1007/s11695-016-2406-7] [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: 10/20/2022]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France. .,Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Tarek Debs
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Olivier TIffet
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Kassir R, Gugenheim J, Debs T, Tiffet O, Amor IB, Boutet C. Staple Line Bleeding in Sleeve Gastrectomy: a Simple and Cost-Effective Solution. Obes Surg 2016; 26:3021-3022. [PMID: 27704338 DOI: 10.1007/s11695-016-2394-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Tarek Debs
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Olivier Tiffet
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Claire Boutet
- Department of Radiology, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Abstract
Laparoscopic conversion of vertical banded gastroplasty (VBG) into Roux-en-Y gastric bypass is a technically demanding procedure. This article demonstrates the feasibility of conversion of failed VBG to Roux-en-Y gastric bypass (RYGBP).We have a series of 15 patients who underwent conversion from VBG to RYGBP, and the results were satisfactory regarding the percent excess weight loss and the resolution of the comorbidities, without a significant increase in the complications. In patients with a difficult anatomy below the cardia, dividing the esophagus just above the esophagogastric junction and performing an esophagojejunostomy may be a safe alternative to converting to a Scopinaro-BPD. Laparoscopic conversion of failed VBG to RYGBP is safe and feasible.
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Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Pierre Blanc
- Department of Digestive Surgery, Clinique Chirurgicale Mutualiste, Saint Etienne, France
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Tarek Debs
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Olivier TIffet
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France
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Debs T, Petrucciani N, Kassir R, Iannelli A, Amor IB, Gugenheim J. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005-2014. Surg Obes Relat Dis 2016; 12:1602-1609. [PMID: 27516221 DOI: 10.1016/j.soard.2016.05.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND During the past decade, the field of bariatric surgery has changed dramatically. OBJECTIVES The study aims to summarize and perform a periodic assessment of the current trends in the use of bariatric surgery in France and review findings on the long-term progression of bariatric surgery. The data were extracted from the national registry Programme de Médicalisation des Systèmes d׳Information from 2005 to 2014. SETTING National health system and private practice in France. METHODS We identified all hospitalizations during which a bariatric procedure was performed for the treatment of morbid obesity from 2005 to 2014 in France. Data were reviewed for patient characteristics and the number and types of bariatric procedures. We also analyzed the setting and the characteristics of the centers and the difference of the activity between the public and private sector. RESULTS Between 2005 and 2014, the number of bariatric operations increased fourfold. Sleeve gastrectomy became the most performed bariatric intervention, representing 60.7% of bariatric activity in 2014. There was a concomitant steep increase in sleeve gastrectomy, with Roux-en-Y gastric bypass increasing slightly overall and a substantial decrease in adjustable gastric banding. In 2014, 481 centers performed bariatric surgery. Among them, one third performed<30 operations/yr. We observed an overall in-hospital mortality ranging from .038% to .05% during the last 3 years. CONCLUSION Bariatric surgery is increasing in France, with a fourfold augmentation of interventions in the last 10 years. The number of sleeve gastrectomies has increased considerably. This activity is performed in numerous centers, one third of them performing<30 interventions/yr.
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Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France.
| | - Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Antonio Iannelli
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
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Kassir R, Gugenheim J, Amor IB, Debs T, Tiffet O. What Causes Late Perforation of the Jejuno-jejunal Anastomosis After Roux-en-Y Gastric Bypass Surgery? Obes Surg 2016; 26:1586-7. [PMID: 27067909 DOI: 10.1007/s11695-016-2171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Jean Gugenheim
- Department of Digestive Surgery, CHU Hospital, Archet Hospital, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, CHU Hospital, Archet Hospital, Nice, France
| | - Tarek Debs
- Department of Digestive Surgery, CHU Hospital, Archet Hospital, Nice, France
| | - Olivier Tiffet
- Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France
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Iannelli A, Debs T, Martini F, Benichou B, Ben Amor I, Gugenheim J. Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results. Surg Obes Relat Dis 2016; 12:1533-1538. [PMID: 27425833 DOI: 10.1016/j.soard.2016.04.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/25/2016] [Accepted: 04/06/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) has gained popularity as a standalone procedure. However, long-term complications are reported, mainly weight loss failure and gastroesophageal reflux disease (GERD). Therefore, demand for revisional surgery is rising. OBJECTIVES The aim of this study was to report preliminary results within the 2 main indications for laparoscopic conversion of SG to Roux-en-Y gastric bypass (RYGB). SETTING University Hospital, France. METHODS Data from all patients who underwent laparoscopic conversion from SG to RYGB were retrospectively analyzed as to indications for revisional surgery, weight loss, and complications. RESULTS Forty patients underwent conversion, 29 cases (72.5%) for weight loss failure and 11 cases for refractory GERD (27.5%). The mean interval from SG to RYGB was 32.6 months (range 8-113). Revisional surgery was attempted by laparoscopy in all cases, and conversion to laparotomy was necessary in 3 patients (7.5%). Mean length of follow-up was 18.6 months (range 9-60) after conversion. Follow-up rate was 100%. Mean percent total weight loss and percent excess weight loss were 34.7% and 64%, respectively, when calculated from weight before SG. Remission rate for GERD was 100%. Improvement was observed for all co-morbidities after conversion. There was no immediate postoperative mortality. The postoperative complication rate was 16.7%. According to the Clavien-Dindo classification, there were 5 grade II and 2 grade IIIa complications. CONCLUSION Laparoscopic conversion of SG to RYGB is safe and feasible. In the short term, it appears to be effective in treating GERD and inducing significant additional weight loss and improvement of co-morbidities.
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Affiliation(s)
- Antonio Iannelli
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France; Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France
| | - Tarek Debs
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France.
| | - Francesco Martini
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France
| | - Benjamin Benichou
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France
| | - Imed Ben Amor
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France
| | - Jean Gugenheim
- Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France; Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France
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Kassir R, Debs T, Blanc P, Gugenheim J, Ben Amor I, Boutet C, Tiffet O. Complications of bariatric surgery: Presentation and emergency management. Int J Surg 2016; 27:77-81. [DOI: 10.1016/j.ijsu.2016.01.067] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 01/05/2023]
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Affiliation(s)
- Radwan Kassir
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
| | - Pierre Blanc
- Department of Digestive Surgery Clinique Chirurgicale Mutualiste de Saint-Etienne France
| | - Jean Gugenheim
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Tarek Debs
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Olivier Tiffet
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
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Kassir R, Blanc P, Gugenheim J, Ben Amor I, Debs T, Tiffet O. Sleeve Gastrectomy: Exposure of the Left Pillar. Am Surg 2016; 82:E47-E48. [PMID: 26874124] [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: 06/05/2023]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Kassir R, Gugenheim J, Tiffet O, Blanc P, Lointier P, Debs T, Amor IB. Gastric Bypass with Unknown Intestinal Malrotation: How I Do It. Am Surg 2015. [DOI: 10.1177/000313481508101105] [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)
- Radwan Kassir
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
| | - Jean Gugenheim
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
| | - Olivier Tiffet
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
| | - Pierre Blanc
- Department of Bariatric Surgery Clinique chirurgicale mutualiste Saint Etienne, France
| | - Patrice Lointier
- Department of Bariatric Surgery Clinique de la Chataigneraie Beaumont, France
| | - Tarek Debs
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
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Kassir R, Blanc P, Lointier P, Debs T, Ben Amor I, Gugenheim J, Tiffet O. Four Tips and Tricks for Performing Laparoscopic Gastric Bypass. Am Surg 2015; 81:E388-E389. [PMID: 26672575] [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: 06/05/2023]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Kassir R, Gugenheim J, Tiffet O, Blanc P, Lointier P, Debs T, Amor IB. Gastric Bypass with Unknown Intestinal Malrotation: How I Do It. Am Surg 2015; 81:E356-E358. [PMID: 26672563] [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: 06/05/2023]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Kassir R, Blanc P, Lointier P, Debs T, Amor IB, Gugenheim J, Tiffet O. Four Tips and Tricks for Performing Laparoscopic Gastric Bypass. Am Surg 2015. [DOI: 10.1177/000313481508101117] [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)
- Radwan Kassir
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
| | - Pierre Blanc
- Department of Bariatric Surgery Clinique chirurgicale mutualiste Saint Etienne, France
| | - Patrice Lointier
- Department of Bariatric Surgery Clinique de la Châtaigneraie Beaumont, France
| | - Tarek Debs
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
| | - Jean Gugenheim
- Department of Bariatric Surgery Hospital Archet 2 Nice, France
| | - Olivier Tiffet
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
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Debs T, Ben Amor I, Gugenheim J, Kassir R. Resected stomach after sleeve gastrectomy. ANZ J Surg 2015; 85:890-1. [PMID: 26498564 DOI: 10.1111/ans.13209] [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: 11/28/2022]
Affiliation(s)
- Tarek Debs
- Department of Bariatric Surgery, Archet 2 Hospital, Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery, Archet 2 Hospital, Nice, France
| | - Jean Gugenheim
- Department of Bariatric Surgery, Archet 2 Hospital, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
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Kassir R, Tiffet O, Bourbon M, Meyer A, Gugenheim J, Debs T, Amor IB, Blanc P. Laparoscopic Hernia Repair With 3-Millimeter Instruments: A Point of Technique and Illustrative Case Video. Surg Innov 2015; 22:366-7. [PMID: 25975780 DOI: 10.1177/1553350615585416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
The repair of inguinal hernia has been a controversial issue in surgical practice since its conception. The article demonstrates that use of 3 mm instruments can be incorporated in Laparoscopic hernia repair. The second aim of this article is that use of TAP block (Transverse abdominal plane block) without curare is efficient, safe and reproducible.
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Affiliation(s)
- Radwan Kassir
- CHU Hospital, Jean Monnet University, Saint Etienne, France
| | - Olivier Tiffet
- CHU Hospital, Jean Monnet University, Saint Etienne, France
| | | | | | - Jean Gugenheim
- Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Tarek Debs
- Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Imed Ben Amor
- Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Pierre Blanc
- Clinique chirurgicale mutualiste, Saint Etienne, France
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Kassir R, Debs T, Blanc P, Gugenheim J, Lointier P, Bachir E, Ben Amor I, Tiffet O. Performing sleeve gastrectomy. Int J Surg 2015; 13:131-132. [DOI: 10.1016/j.ijsu.2014.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
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Debs T, Kassir R, Amor IB, Martini F, Iannelli A, Gugenheim J. Solitary fibrous tumor of the liver: Report of two cases and review of the literature. Int J Surg 2014; 12:1291-4. [DOI: 10.1016/j.ijsu.2014.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 12/15/2022]
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Kassir R, Abboud K, Dubois J, Baccot S, Debs T, Favre JP, Gugenheim J, Gastaldi P, Amor IB, Tiffet O. Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema. Int J Surg Case Rep 2014; 5:1190-2. [PMID: 25437673 PMCID: PMC4275823 DOI: 10.1016/j.ijscr.2014.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Although diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature. PRESENTATION OF CASE We report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated. DISCUSSION Subcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes. CONCLUSION This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis.
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Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
| | - Karine Abboud
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Joelle Dubois
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Sylviane Baccot
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Tarek Debs
- Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France
| | - Jean-Pierre Favre
- Department of Cardiac Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Jean Gugenheim
- Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France
| | - Pauline Gastaldi
- Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France
| | - Imed Ben Amor
- Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France
| | - Olivier Tiffet
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
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Kassir R, Debs T, Ben Amor I, Tiffet O, Blanc P, Caldwell J, Iannelli A, Gugenheim J. Management of complications following bariatric surgery: summary. Int J Surg 2014; 12:1462-4. [PMID: 25463767 DOI: 10.1016/j.ijsu.2014.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/23/2014] [Accepted: 11/05/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
| | - Tarek Debs
- Department of Digestive Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Olivier Tiffet
- Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France
| | - Pierre Blanc
- Department of Digestive Surgery, clinique Mutualiste chirurgicale de Saint Etienne, France
| | - Juliet Caldwell
- Department of Emergency Medicine, University Hospital of Columbia and Cornell, Weill Cornell Medical Center, New York - Presbyterian, USA
| | - Antonio Iannelli
- Department of Digestive Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France
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Kassir R, Blanc P, Lointier P, Tiffet O, Berger JL, Amor IB, Gugenheim J. Laparoscopic Entry Techniques in Obese Patient: Veress Needle, Direct Trocar Insertion or Open Entry Technique? Obes Surg 2014; 24:2193-4. [DOI: 10.1007/s11695-014-1452-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kassir R, Gugenheim J, Blanc P, Tiffet O, Lointier P, Berger JL, Debs T, Amor IB, Iannelli A. The hand-sewn gastrojejunostomy: braided suture or monofilament suture? Obes Surg 2014; 25:545-6. [PMID: 25308114 DOI: 10.1007/s11695-014-1453-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France,
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Iannelli A, Schneck AS, Noel P, Ben Amor I, Krawczykowski D, Gugenheim J. Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg 2012; 21:832-5. [PMID: 20924713 DOI: 10.1007/s11695-010-0290-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been rapidly accepted as a valuable bariatric procedure before its effectiveness on weight loss in the long-term is clearly demonstrated. We report a feasibility study including 13 patients undergoing a redo LSG for either progressive weight regain after initial weight loss of insufficient weight loss. METHODS From October 2005 to April 2010, 13 patients underwent a re-sleeve gastrectomy procedure for progressive weight regain or insufficient weight loss (<50% of excess weight (EW)) associated with the persistence of the gastric fundus on upper gastrointestinal series. RESULTS Mean initial body mass index (BMI) and EW were 44.6 (37-52.9) kg/m(2) and 61.8 (38.2-93.9) kg, respectively. There were ten comorbid conditions in five out of the 13 patients. The revision resulted in a mean BMI, percent of excess weight loss (%EWL), and percentage of excess BMI loss (%EBL) of 32.3 kg/m(2), 50.3%, and 57% at 1 month; 32 kg/m(2), 47.9%, and 54.5 at 6 months; and 27.5 kg/m(2), 71.4%, and 82.8% at 12 months, respectively. There was no morbidity. CONCLUSIONS Laparoscopic revision of LSG is safe and effective in the short term to obtain substantial loss of weight and improvement in comorbidities.
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Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Transplantation d'Hépatique, Hôpital Archet 2, 151 route Saint Antoine de Ginestière, BP 3079, 06202, Nice, France.
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Iannelli A, Addeo P, Dahman M, Buratti MS, Ben Amor I, Piche T, Gugenheim J. Laparoscopic conversion of vertical banded gastroplasty with an antireflux wrap into Roux-en-Y gastric bypass. Obes Surg 2007; 17:901-4. [PMID: 17894149 DOI: 10.1007/s11695-007-9167-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) is associated with a significant rate of revision because of regain of weight due to staple-line disruption, gastric pouch and stoma dilation, change to sweet eating, outlet stenosis with vomiting and reflux. To avoid reflux, some surgeons added an antireflux wrap. METHODS We report laparoscopic revision of VBG with antireflux wrap to Roux-en-Y gastric bypass (RYGBP) in 4 patients. The indication for revision was insufficient weight loss in all 4 patients, with stenosis of the stoma resistant to endoscopic balloon dilation in one and reflux esophagitis in one, who shifted to high-calorie liquids. Revision was performed 73.5 months (range 57-84) after the primary procedure, at mean BMI 39.5 (range 37-41). RESULTS Mean operative time was 193.7 min (165-220). There was no conversion to open surgery. There was no mortality. One patient developed a stenosis at the gastrojejunostomy that was managed successfully with endoscopic balloon dilation. Mean length of stay was 6.8 days (range 4-9). At mean follow-up of 11.2 months (range 11-18), mean BMI is 28.5 (range 27-30), and all patients were free of co-morbidities. CONCLUSIONS Laparoscopic revision of VBG with an antireflux wrap into an LRYGBP is feasible and effective in achieving weight loss, but the safety requires assessment by a larger series.
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Affiliation(s)
- Antonio Iannelli
- Université de Nice-Sohpia-Antipolis, Faculté de Médecine, Nice, F-06107, France.
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Bekri S, Gual P, Anty R, Luciani N, Dahman M, Ramesh B, Iannelli A, Staccini-Myx A, Casanova D, Ben Amor I, Saint-Paul MC, Huet PM, Sadoul JL, Gugenheim J, Srai SKS, Tran A, Le Marchand-Brustel Y. Increased adipose tissue expression of hepcidin in severe obesity is independent from diabetes and NASH. Gastroenterology 2006; 131:788-96. [PMID: 16952548 DOI: 10.1053/j.gastro.2006.07.007] [Citation(s) in RCA: 332] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 05/23/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS & AIMS Hepcidin is an acute-phase response peptide. We have investigated the possible involvement of hepcidin in massive obesity, a state of chronic low-grade inflammation. Three groups of severely obese patients with or without diabetes or nonalcoholic steatohepatitis were investigated. METHODS Hepcidin expression was studied in liver and adipose tissue of these patients. Hepcidin regulation was investigated in vitro by adipose tissue explant stimulation studies. RESULTS Hepcidin was expressed not only in the liver but also at the messenger RNA (mRNA) and the protein levels in adipose tissue. Moreover, mRNA expression was increased in adipose tissue of obese patients. The presence of diabetes or NASH did not modify the hepcidin expression levels in liver and adipose tissue. In adipose tissue, mRNA expression correlated with indexes of inflammation, interleukin-6, and C-reactive protein. Interleukin-6 also promoted in vitro hepcidin expression. A low transferrin saturation ratio was observed in 68% of the obese patients; moreover, 24% of these patients presented with anemia. The observed changes in iron status could be due to the role of hepcidin as a negative regulator of intestinal iron absorption and macrophage iron efflux. Interestingly, a feedback control mechanism on hepcidin expression related to low transferrin saturation occurred in the liver but not in the adipose tissue. CONCLUSIONS Hepcidin is a proinflammatory adipokine and may play an important role in hypoferremia of inflammation in obese condition.
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Affiliation(s)
- Soumeya Bekri
- Laboratoire d'Hépato-Gastroentérologie, EA1186, Faculté Médecine de Nice, Nice, France.
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Anty R, Bekri S, Luciani N, Saint-Paul MC, Dahman M, Iannelli A, Amor IB, Staccini-Myx A, Huet PM, Gugenheim J, Sadoul JL, Le Marchand-Brustel Y, Tran A, Gual P. The inflammatory C-reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic syndrome, Type 2 diabetes, and NASH. Am J Gastroenterol 2006; 101:1824-33. [PMID: 16790033 DOI: 10.1111/j.1572-0241.2006.00724.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE C-Reactive Protein (CRP), a nonspecific marker of inflammation that is moderately elevated in obesity, metabolic syndrome (MS), and type 2 diabetes, has been proposed as a surrogate marker of nonalcoholic steatohepatitis (NASH). Its clinical usefulness in the diagnosis of NASH was evaluated in severely obese patients without or with MS, diabetes, and NASH and the potential roles of the liver and of the adipose tissue in CRP production were characterized. METHODS Severely obese patients without NASH (without MS [N = 13], with MS [N = 11], or with MS and diabetes [N = 7]) and with NASH (without [N = 8] or with [N = 7] MS) were studied. For each patient, liver and adipose tissue biopsies were collected during a bariatric surgery and were used to determine the CRP gene expression by real-time PCR. The role of interleukin-6 (IL6) and lipopolysaccharide in CRP expression was also evaluated in subcutaneous adipose tissue obtained during cosmetic abdominoplasty. RESULTS Plasma CRP levels were elevated in severely obese patients independently from the presence or absence of MS, diabetes, or NASH. CRP gene expression was not only increased in livers but also in adipose tissues of obese patients compared with controls subjects. In human adipose tissue, CRP mRNA levels were positively correlated with those of IL-6 and the CRP expression was enhanced in vitro by IL-6 and lipopolysaccharide. CONCLUSION Plasma CRP levels are not predictive of the diagnosis of NASH in severely obese patients. The liver but also the adipose tissue can produce CRP, a process which could be dependent on IL6. Therefore, both tissues might contribute to the elevated plasma CRP levels found in obesity. In addition, the large amount of body fat may well produce an important part of the circulating CRP, further limiting its clinical usefulness in the evaluation of NASH in severely obese patients.
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Hauet T, Baumert H, Amor IB, Goujon JM, Gibelin H, Godart C, Vandewalle A, Carretier M, Eugene M. Protection of autotransplanted pig kidneys from ischemia-reperfusion injury by polyethylene glycol. Transplantation 2000; 70:1569-75. [PMID: 11152217 DOI: 10.1097/00007890-200012150-00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury (IRI) is often responsible for graft rejection and leads to delayed graft function of cadaveric kidneys. We have shown that adding polyethylene glycol (PEG 20M) to the preservation solutions helps protect isolated perfused pig kidneys against cold ischemia and reperfusion injury. METHODS We compared the effects of adding PEG to a simplified high-K+ perfusion solution of cold-stored kidneys to Euro-Collins or University of Wisconsin solutions on the function of reperfused autotransplanted pig kidneys. The left kidney was cold-flushed with the preservation solutions and stored for 48 hr at 4 degrees C before reimplantation. Creatinine clearance and fractional excretion of sodium were analyzed 2 days before surgery and over 7 days after transplantation. Histological sections were obtained 40 min after reperfusion and on day 7 after surgery. RESULTS Adding PEG to the perfusate significantly reduced IRI from autotransplanted pig kidneys. Creatinine clearance was significantly higher and fractional excretion of sodium was significantly lower in pigs transplanted with kidneys cold-flushed with PEG-supplemented perfusate than in those flushed with Euro-Collins or University of Wisconsin solutions. PEG supplementation also better preserved the integrity of kidney cells and markedly reduced interstitial cell infiltrates. CONCLUSION PEG protects against IRI and reduces early cellular inflammation. PEG may impair the recruitment and migration of leukocytes into retransplanted pig kidneys. Cold preservation of donor organs with PEG-supplemented solutions may therefore help limit IRI in human renal transplantation.
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Affiliation(s)
- T Hauet
- Département de Génétique Animale, Institut National de Recherche Agronomique, Domaine du Magneraud, Surgères, France.
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Richer JP, Baumert H, Gibelin H, Faure JP, Hebrard W, Amor IB, Carretier M, Eugene M, Tillement JP, Hauet T. Limitation of ischemic damage to the renal medulla by trimetazidine added to Euro-Collins solution: evaluation in an autotransplant model. Transplant Proc 2000; 32:477-8. [PMID: 10715485 DOI: 10.1016/s0041-1345(00)00823-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- J P Richer
- Laboratoire de Transplantation Expérimentale, INRA, Surgéres, France
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