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van Ramshorst TME, Giani A, Mazzola M, Dokmak S, Ftériche FS, Esposito A, de Pastena M, Lof S, Edwin B, Sahakyan M, Boggi U, Kauffman EF, Fabre JM, Souche RF, Zerbi A, Butturini G, Molenaar Q, Al-Sarireh B, Marino MV, Keck T, White SA, Casadei R, Burdio F, Björnsson B, Soonawalla Z, Koerkamp BG, Fusai GK, Pessaux P, Jah A, Pietrabissa A, Hackert T, D'Hondt M, Pando E, Besselink MG, Ferrari G, Hilal MA. Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods. Br J Surg 2022; 110:76-83. [PMID: 36322465 PMCID: PMC10364499 DOI: 10.1093/bjs/znac352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Benchmarking is an important tool for quality comparison and improvement. However, no benchmark values are available for minimally invasive spleen-preserving distal pancreatectomy, either laparoscopically or robotically assisted. The aim of this study was to establish benchmarks for these techniques using two different methods. METHODS Data from patients undergoing laparoscopically or robotically assisted spleen-preserving distal pancreatectomy were extracted from a multicentre database (2006-2019). Benchmarks for 10 outcomes were calculated using the Achievable Benchmark of Care (ABC) and best-patient-in-best-centre methods. RESULTS Overall, 951 laparoscopically assisted (77.3 per cent) and 279 robotically assisted (22.7 per cent) procedures were included. Using the ABC method, the benchmarks for laparoscopically assisted and robotically assisted spleen-preserving distal pancreatectomy respectively were: 150 and 207 min for duration of operation, 55 and 100 ml for blood loss, 3.5 and 1.7 per cent for conversion, 0 and 1.7 per cent for failure to preserve the spleen, 27.3 and 34.0 per cent for overall morbidity, 5.1 and 3.3 per cent for major morbidity, 3.6 and 7.1 per cent for pancreatic fistula grade B/C, 5 and 6 days for duration of hospital stay, 2.9 and 5.4 per cent for readmissions, and 0 and 0 per cent for 90-day mortality. Best-patient-in-best-centre methodology revealed milder benchmark cut-offs for laparoscopically and robotically assisted procedures, with operating times of 254 and 262.5 min, blood loss of 150 and 195 ml, conversion rates of 5.8 and 8.2 per cent, rates of failure to salvage spleen of 29.9 and 27.3 per cent, overall morbidity rates of 62.7 and 55.7 per cent, major morbidity rates of 20.4 and 14 per cent, POPF B/C rates of 23.8 and 24.2 per cent, duration of hospital stay of 8 and 8 days, readmission rates of 20 and 15.1 per cent, and 90-day mortality rates of 0 and 0 per cent respectively. CONCLUSION Two benchmark methods for minimally invasive distal pancreatectomy produced different values, and should be interpreted and applied differently.
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Affiliation(s)
- Tess M E van Ramshorst
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.,Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Alessandro Giani
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Mazzola
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Fadhel Samir Ftériche
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Alessandro Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Matteo de Pastena
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Sanne Lof
- Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, also Institute of Medicine, University of Oslo, Oslo, Norway
| | | | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa, Pisa, Italy
| | | | | | | | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giovanni Butturini
- Department of Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht Cancer Centre and St Antonius Hospital Nieuwegein, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Marco V Marino
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.,General Surgery Department, Istituto Villa Salus, Siracusa, Italy
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Steven A White
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, Newcastle, UK
| | - Riccardo Casadei
- Department of Surgery, Sant'Orsola Malphigi Hospital, Bologna, Italy
| | - Fernando Burdio
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre, Rotterdam, theNetherlands
| | - Giuseppe Kito Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free London, London, UK
| | - Patrick Pessaux
- Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, University Hospital, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Asif Jah
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Elizabeth Pando
- Department of Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc G Besselink
- Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Giani A, van Ramshorst T, Mazzola M, Bassi C, Esposito A, de Pastena M, Edwin B, Sahakyan M, Kleive D, Jah A, van Laarhoven S, Boggi U, Kauffman EF, Casadei R, Ricci C, Dokmak S, Ftériche FS, White SA, Kamarajah SK, Butturini G, Frigerio I, Zerbi A, Capretti G, Pando E, Sutcliffe RP, Marudanayagam R, Fusai GK, Fabre JM, Björnsson B, Timmermann L, Soonawalla Z, Burdio F, Keck T, Hackert T, Groot Koerkamp B, d’Hondt M, Coratti A, Pessaux P, Pietrabissa A, Al-Sarireh B, Marino MV, Molenaar Q, Yip V, Besselink M, Ferrari G, Hilal MA. Benchmarking of minimally invasive distal pancreatectomy with splenectomy: European multicentre study. Br J Surg 2022; 109:1124-1130. [DOI: 10.1093/bjs/znac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Benchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS).
Methods
This retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABC™) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk.
Results
A total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m2 (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87).
Conclusion
The benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes.
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Affiliation(s)
- Alessandro Giani
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
| | - Tess van Ramshorst
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam , Amsterdam , the Netherlands
| | - Michele Mazzola
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Alessandro Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Matteo de Pastena
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Mushegh Sahakyan
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Dyre Kleive
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Asif Jah
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Stijn van Laarhoven
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa , Pisa , Italy
| | | | - Riccardo Casadei
- Department of Surgery, Sant’Orsola Malpighi Hospital , Bologna , Italy
| | - Claudio Ricci
- Department of Surgery, Sant’Orsola Malpighi Hospital , Bologna , Italy
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital , Clichy , France
| | - Fadhel Samir Ftériche
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital , Clichy , France
| | - Steven A White
- Department of Surgery, Freeman Hospital Newcastle upon Tyne , Newcastle upon Tyne , UK
| | - Sivesh K Kamarajah
- Department of Surgery, Freeman Hospital Newcastle upon Tyne , Newcastle upon Tyne , UK
| | | | | | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - Elizabeth Pando
- Department of Surgery, Vall d’Hebron University Hospital , Barcelona , Spain
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Ravi Marudanayagam
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Giuseppe Kito Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free London , London , UK
| | | | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University , Linköping , Sweden
| | | | | | - Fernando Burdio
- Department of Surgery, University Hospital del Mar , Barcelona , Spain
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein , Campus Lübeck, Lübeck , Germany
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital , Heidelberg , Germany
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre , Rotterdam, the Netherlands
| | - Mathieu d’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital , Kortrijk , Belgium
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence , Italy
| | - Patrick Pessaux
- Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, University Hospital, Institut Hospitalo-Universitaire de Strasbourg , Strasbourg , France
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | | | - Marco V Marino
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello , Palermo , Italy
- General Surgery Department, Istituto Villa Salus , Siracusa , Italy
| | - Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Centre, University Medical Centre Utrecht , Utrecht , the Netherlands
| | - Vincent Yip
- Department of Hepatopancreatobiliary Surgery, Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Marc Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam , Amsterdam , the Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
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3
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Veziant J, Gagnière J, Gronnier C, Mariette C, Tzedakis S, Fuks D, Piessen G, Cabau M, Jougon J, Badic B, Lozach P, Cappeliez S, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Iuga BS, Contival N, Pappalardo E, Mantziari S, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Pasquer A, Baraket O, Poncet G, Vaudoyer D, Enfer PJ, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Petit GG, Karoui M, Tresallet C, Ménégaux F, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P. Non-occlusive Small Bowel Ischemia Related to Postoperative Feeding Jejunostomy Tube Use After Esophagectomy for Cancer: Propensity Score Analysis of the AFC-FREGAT Database. J Gastrointest Surg 2022; 26:1760-1763. [PMID: 35318593 DOI: 10.1007/s11605-021-05223-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/30/2021] [Indexed: 01/31/2023]
Affiliation(s)
- J Veziant
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - J Gagnière
- Department of Digestive and Hepato-Biliary Surgery, University Hospital Center of Clermont-Ferrand, Clermont-Ferrand, France
| | - C Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600, Pessac, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille Cedex, France
| | - S Tzedakis
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - D Fuks
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille Cedex, France.,University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance To Therapies, 59000, Lille, France
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4
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Fernandez B, Gautier A, Koumaré IB, Fabre JM, Coubes P, Poulen G. Transcutaneous ventriculo-peritoneal shunt catheter extrusion with silent bowel perforation following digestive surgery: a case report. Br J Neurosurg 2022:1-4. [PMID: 35174740 DOI: 10.1080/02688697.2022.2039373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
This case report provides an account of transcutaneous ventriculo-peritoneal (VP) shunt extrusion with silent bowel perforation occurring 2 years post digestive surgery. A 22-year-old man treated since childhood for post-infectious hydrocephalus was referred to our neurosurgery department for an inflammatory wound to the right hypochondrium caused by an abandoned calcified VP shunt. This VP shunt was surgically removed without complications. The perforated bowel required no direct repair. Progress is favorable at 1 year follow-up.
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Affiliation(s)
- Benjamin Fernandez
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Haut-Lévêque Hospital, CHU Bordeaux, France
| | | | - Izoudine B Koumaré
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
| | | | - Philippe Coubes
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
| | - Gaëtan Poulen
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
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5
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, Scatton O. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. Br J Surg 2021; 108:419-426. [PMID: 33793726 DOI: 10.1093/bjs/znaa110] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). METHODS Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. RESULTS In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). CONCLUSION The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.,Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - D Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Université Paris V, Paris, France
| | - L Barbier
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - J M Fabre
- Department of Digestive, Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - O Farges
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - F R Pruvot
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - P Pessaux
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Salamé
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris and Université Paris XI, Paris, France
| | - O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
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6
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Rouanet P, Rivoire M, Gourgou S, Lelong B, Rullier E, Jafari M, Mineur L, Pocard M, Faucheron JL, Dravet F, Pezet D, Fabre JM, Bresler L, Balosso J, Lemanski C. Sphincter-saving surgery after neoadjuvant therapy for ultra-low rectal cancer where abdominoperineal resection was indicated: 10-year results of the GRECCAR 1 trial. Br J Surg 2021; 108:10-13. [PMID: 33640922 DOI: 10.1093/bjs/znaa010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/17/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022]
Abstract
This phase III trial included patients with ultra-low rectal adenocarcinoma that initially required abdominoperineal resection. The surgical decision was based on clinical tumour status after preoperative treatment. The overall sphincter-saving resection rate was 85 per cent, with 72 per cent rate of intersphincteric resection. Long-term results showed that changing the initial abdominoperineal resection indication into a sphincter-saving resection according to tumoral response is oncologically safe.
Saving the sphincter
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Affiliation(s)
- P Rouanet
- Department of Surgical Oncology, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France
| | - M Rivoire
- Department of Surgical Oncology, Centre Léon Berard, Lyon, France
| | - S Gourgou
- Biometrics Unit, Montpellier Cancer Institute, Montpellier, France
| | - B Lelong
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - E Rullier
- Colorectal Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - M Jafari
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - L Mineur
- Department of Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - M Pocard
- Department of Surgical Oncology, Gustave Roussy (Hôpital Lariboisière Assistance Publique-Hôpitaux de Paris), Paris, France
| | - J L Faucheron
- Colorectal Department, Centre Hospitalier Universitaire Grenoble, Grenoble, France
| | - F Dravet
- Department of Surgical Oncology, Centre René Gauducheau, Nantes, France
| | - D Pezet
- Colorectal Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - J M Fabre
- Colorectal Department, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - L Bresler
- Colorectal Department, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - J Balosso
- Department of Radiotherapy, Centre Hospitalier Universitaire Grenoble, Grenoble, France
| | - C Lemanski
- Department of Radiotherapy, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France
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7
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Balduzzi A, van Hilst J, Korrel M, Lof S, Al-Sarireh B, Alseidi A, Berrevoet F, Björnsson B, van den Boezem P, Boggi U, Busch OR, Butturini G, Casadei R, van Dam R, Dokmak S, Edwin B, Sahakyan MA, Ercolani G, Fabre JM, Falconi M, Forgione A, Gayet B, Gomez D, Koerkamp BG, Hackert T, Keck T, Khatkov I, Krautz C, Marudanayagam R, Menon K, Pietrabissa A, Poves I, Cunha AS, Salvia R, Sánchez-Cabús S, Soonawalla Z, Hilal MA, Besselink MG. Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surg Endosc 2021; 35:6949-6959. [PMID: 33398565 DOI: 10.1007/s00464-020-08206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. METHODS An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. RESULTS Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. CONCLUSION The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
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Affiliation(s)
- A Balduzzi
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. .,General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - J van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - M Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - A Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P van den Boezem
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - U Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Dokmak
- Department of Surgery, Hospital of Beaujon, Clichy, France
| | - B Edwin
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - M A Sahakyan
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - G Ercolani
- Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - J M Fabre
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - M Falconi
- San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy
| | - A Forgione
- Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - B Gayet
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - D Gomez
- Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - T Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Keck
- Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - C Krautz
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Marudanayagam
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - K Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - A Pietrabissa
- Department of Surgery, University Hospital Pavia, Pavia, Italy
| | - I Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - A Sa Cunha
- Department of Surgery, Hôpital Paul-Brousse, Villejuif, France
| | - R Salvia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Sánchez-Cabús
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - M Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. .,HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK.
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
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8
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Rouanet P, Rivoire M, Gourgou S, Lelong B, Rullier E, Jafari M, Mineur L, Pocard M, Faucheron JL, Dravet F, Pezet D, Fabre JM, Bresler L, Balosso J, Taoum C, Lemanski C. Sphincter-saving surgery for ultra-low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long-term follow-up? J Surg Oncol 2020; 123:299-310. [PMID: 33098678 DOI: 10.1002/jso.26249] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR). METHODS ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection. RESULTS Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%). CONCLUSION GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.
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Affiliation(s)
- Philippe Rouanet
- Department of Surgical Oncology, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Berard, Lyon, France
| | - Sophie Gourgou
- Montpellier Cancer Institute, Biometrics Unit, Montpellier, France
| | - Bernard Lelong
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Eric Rullier
- Colorectal département, CHU Bordeaux, Bordeaux, France
| | - Merhdad Jafari
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - Laurent Mineur
- Department of Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Marc Pocard
- Department of Surgical Oncology, Gustave Roussy (hopit Mal Lariboisiere APHP), Paris, France
| | | | - François Dravet
- Department of Surgical Oncology, Centre René Gauducheau, Nantes, France
| | - Denis Pezet
- Colorectal département, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Christophe Taoum
- Department of Surgical Oncology, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France
| | - Claire Lemanski
- Department of Radiotherapy, Institut régional du Cancer de Montpellier (ICM) - Val d'Aurelle, Montpellier, France
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9
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Cubisino A, Guillon F, Fabre JM. Laparoscopic right partial adrenalectomy (with video). J Visc Surg 2020; 157:439-440. [PMID: 32868259 DOI: 10.1016/j.jviscsurg.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Cubisino
- Digestive and Mini-invasive Surgery unit, Department of digestive surgery and transplantation, St Eloi Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France; Université de Montpellier-Nîmes, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
| | - F Guillon
- Digestive and Mini-invasive Surgery unit, Department of digestive surgery and transplantation, St Eloi Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France; Université de Montpellier-Nîmes, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - J M Fabre
- Digestive and Mini-invasive Surgery unit, Department of digestive surgery and transplantation, St Eloi Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France; Université de Montpellier-Nîmes, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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10
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Souche R, Nayeri M, Chati R, Huet E, Donici I, Tuech JJ, Borie F, Prudhomme M, Jaber S, Fabre JM. Thoracoscopy in prone position with two-lung ventilation compared to conventional thoracotomy during Ivor Lewis procedure: a multicenter case-control study. Surg Endosc 2019; 34:142-152. [PMID: 30868323 DOI: 10.1007/s00464-019-06742-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraoperative management based on thoracoscopy, prone position and two-lung ventilation could decrease the rate of postoperative pulmonary complications after esophagectomy. The aim of this study was to compare this multifaceted approach (MIE-PP) and conventional thoracotomy for Ivor Lewis procedure after a systematic laparoscopic dissection. METHODS Data from 137 consecutive patients undergoing Ivor Lewis procedures between 2010 and 2017 at two tertiary centers was analyzed retrospectively. The outcomes of patients who underwent MIE-PP (n = 58; surgeons group 1) were compared with those of patients undergoing conventional approach (n = 79; surgeons group 2). Our primary outcome was major postoperative pulmonary complications. Our main secondary outcomes were anastomotic leak, quality of resection and mortality. RESULTS Female patients were more prevalent in the MIE-PP group (p = 0.002). Other patient characteristics, cTNM staging and neoadjuvant treatment rate were not different between groups. Major postoperative pulmonary complications were significantly lower in the MIE-PP group compared to Conventional group (24 vs. 44%; p = 0.014). Anastomotic leak occurred in 31 versus 18% in MIE-PP group and Conventional groups, respectively (p = 0.103). Complete resection rate (98 vs. 95%; p = 0.303) and mean number of harvested lymph nodes (16 (4-40) vs. 18 (3-37); p = 0.072) were similar between the two groups. Postoperative mortality rates were 0 versus 2% at day 30 (p = 0.508) and 0 versus 7.6% at day 90 (p = 0.038). CONCLUSION Short-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.
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Affiliation(s)
- R Souche
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - M Nayeri
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - R Chati
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - E Huet
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - I Donici
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - J J Tuech
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - F Borie
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - M Prudhomme
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - S Jaber
- Department of Reanimation and Anesthesiology, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - J M Fabre
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
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11
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Nedelcu M, Loureiro M, Skalli M, Galtier F, Jaussent A, Deloze M, Gagner M, Fabre JM, Nocca D. Laparoscopic sleeve gastrectomy: Effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up. Surgery 2017; 162:857-862. [PMID: 28739091 DOI: 10.1016/j.surg.2017.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 01/06/2023]
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12
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Mercier G, Loureiro M, Georgescu V, Skalli EM, Nedelcu M, Ramadan M, Fabre JM, Lefebvre P, Nocca D. Surgical glue in laparoscopic sleeve gastrectomy: An initial experience and cost-effectiveness analysis. J Eval Clin Pract 2017; 23:614-619. [PMID: 28322488 DOI: 10.1111/jep.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 01/06/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric procedures. Gastric leaks and bleeding are the most frequent complications, associated with a high clinical and economic burden. The best method of staple line reinforcement in LSG is debated. Surgical glue is one of the options available. The aim of this study was to assess the safety, efficiency, and relative cost-effectiveness of surgical glue used to perform LSG in morbid obese adults as compared with standard stapling. METHODS A prospective, observational, and comparative before-after study was conducted. All consecutive patients undergoing LSG at Montpellier University Hospital in 2011 and 2012 were included and treated according to 2 groups: standard stapling (n = 99, group 1) and surgical glue reinforcement (n = 94, group 2). Clinical and economic outcomes were measured after 6 months. RESULTS The duration of intervention was significantly shorter in group 2 (68 vs 82 minutes, P = .001). There was no significant difference regarding complications, but leaks in group 1 were more severe. Group 2 was also associated with a reduced initial length of stay (4.8 vs 5.2 days, P = .01). Six-month readmissions and total length of stay were also shorter in group 2 (5.5 vs 6.1 days, P = .003). Surgical glue use was associated with a significant reduction in the initial inpatient cost (€5488 vs €6152, P = .005) and in the 6-month total inpatient cost, including readmissions (€6006 vs €6754, P = .005). The incremental cost of glue to avoid a severe complication was -€5446.33 (95 confidence interval, -8202.01 to -2690.66). CONCLUSIONS Surgical glue might be a safe and cost-effective intervention in laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Gregoire Mercier
- Department d'Information Médicale, CHU de Montpellier, Montpellier, France.,UMR LAMETA, Université de Montpelier, Montpellier, France
| | - Marcelo Loureiro
- Departamento de Biotecnologia, Universidade Positivo, Curitiba, Brazil.,Université Montpellier 1, Montpellier, France.,CHU de Montpellier, Montpellier, France
| | - Vera Georgescu
- Department d'Information Médicale, CHU de Montpellier, Montpellier, France
| | | | | | | | - Jean Michel Fabre
- Université Montpellier 1, Montpellier, France.,CHU de Montpellier, Montpellier, France
| | - Patrick Lefebvre
- Université Montpellier 1, Montpellier, France.,CHU de Montpellier, Montpellier, France
| | - David Nocca
- Université Montpellier 1, Montpellier, France.,CHU de Montpellier, Montpellier, France
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13
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Loureiro M, Ramadan M, Skalli EM, Blanc P, Fabre JM, Nocca D. A multicentric prospective study evaluating the safety and efficacy of Kii ® Fios ® First Entry Trocar in laparoscopic bariatric surgery. Surg Endosc 2017; 31:4680-4687. [PMID: 28389805 DOI: 10.1007/s00464-017-5536-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/25/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery. METHODS In the period between December 2013 and June 2014, 588 patients were included by 18 surgeons from several French hospitals to undergo laparoscopic surgery using Kii Fios First Entry Trocar as a first-entry trocar. The surgeons filled out a questionnaire assessing the safety and efficacy of the trocar for every patient. RESULTS There were no mortality and no major complications. However, 11 cases (1.87%) of minor complications (liver and greater omentum injuries) were reported. The surgeons reported successful entry in less than 1 min for 70.58% of the cases. CONCLUSIONS Kii Fios First Entry Trocar (Applied) is a safe and efficient method to establish first entry in laparoscopic bariatric surgery when all the recommendations are followed and respected.
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Affiliation(s)
- Marcelo Loureiro
- CHU de Montpellier, Montpellier, France.
- University Montpellier 1, Montpellier, France.
- Universidade Positivo, Rua Angelo Bom 315 casa 1, Curitiba, 81210340, Brazil.
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
| | - David Nocca
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
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14
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Souche R, Addeo P, Oussoultzoglou E, Herrero A, Rosso E, Navarro F, Fabre JM, Bachellier P. First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma. Am J Surg 2016; 212:221-9. [DOI: 10.1016/j.amjsurg.2015.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/21/2022]
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15
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Nedelcu M, Verhaeghe P, Skalli M, Champault G, Barrat C, Sebbag H, Reche F, Passebois L, Beyrne D, Gugenheim J, Berdah S, Bouayed A, Michel Fabre J, Nocca D. Multicenter prospective randomized study comparing the technique of using a bovine pericardium biological prosthesis reinforcement in parietal herniorrhaphy (Tutomesh TUTOGEN) with simple parietal herniorrhaphy, in a potentially contaminated setting. Wound Repair Regen 2016; 24:427-33. [DOI: 10.1111/wrr.12386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/19/2015] [Accepted: 11/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Marius Nedelcu
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - Pierre Verhaeghe
- Department of Digestive and General Surgery, University Hospital, Amiens Nord
| | - Mehdi Skalli
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - Gerard Champault
- Department of Digestive and General Surgery, University Hospital, Bondy
| | - Christophe Barrat
- Department of Digestive and General Surgery, University Hospital, Bondy
| | - Hugues Sebbag
- Department of Digestive and General Surgery, Community Hospital, Aix en Provence
| | - Fabian Reche
- Department of Digestive and General Surgery, University Hospital, Grenoble
| | - Laurent Passebois
- Department of Digestive and General Surgery, Community Hospital, Beziers
| | - Daniel Beyrne
- Department of Digestive and General Surgery, Community Hospital, Avignon
| | - Jean Gugenheim
- Department of Digestive and General Surgery, University Hospital, Nice
| | - Stephane Berdah
- Department of Digestive and General Surgery, Hopital Nord Marseille, Marseille
| | - Amine Bouayed
- Department of Digestive and General Surgery, Community Hospital, Salon de Provence, France
| | - Jean Michel Fabre
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - David Nocca
- Department of Digestive and General Surgery, University Hospital, Montpellier
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16
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Nocca D, Skalli EM, Boulay E, Nedelcu M, Michel Fabre J, Loureiro M. Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis 2016; 12:1832-1837. [PMID: 27234340 DOI: 10.1016/j.soard.2016.02.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/02/2016] [Accepted: 02/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is one of the most frequently performed bariatric procedures worldwide. Despite its impressive results, there is a growing concern about the relationship between SG and gastroesophageal reflux disease (GERD). OBJECTIVES We present our pilot study of patients operated with a Nissen anti-reflux valve added to a standard SG. SETTING University hospital in Montpellier, France. METHODS A prospective monocentric study including 25 consecutive patients operated with a laparoscopic Nissen-Sleeve (N-Sleeve) gastrectomy was carried out between September 2013 and March 2014. Inclusion criteria were indication for bariatric surgery for patients with GERD (Montreal's definition and classification). All patients were followed postoperatively for 1 year. RESULTS There were 13 (54%) females and 12 (46%) males with mean age of 41±12 (20-65) years. Mean body mass index was 42±4.8 (35-53) kg/m2. Preoperatively, all patients had esophageal syndromes. Twenty-three (92%) patients had typical symptoms of GERD, but 2 were asymptomatic; however, they had esophageal injury. Esophagitis grade I-III presented in 10 (40%) patients and Barrett's esophagus in 8 (32%) cases. Two (8%) patients also had extraesophageal syndrome represented by asthma. Nineteen (76%) patients previously took proton pump inhibitors, regularly and 22 (88%) had experienced a hiatal hernia. There was no conversion to the open technique. Operative time was 84±13 (54-106) minutes. There were no deaths. Complications included one case of staple line bleeding and one Nissen valve perforation without recognized ischemia. No staple line failure was observed. Three months after N-Sleeve, 19 (76%) patients remained asymptomatic without proton pump inhibitor use. At 6 months and 1 year, 3 (12%) patients were still experiencing reflux. Excess weight loss at 1 year was 58±23%, total weight loss was 27±10%, and body mass index change was -11±4 kg/m². CONCLUSION The N-Sleeve seems to be a safe procedure that provides an adequate reflux control with no clear interference on the expected bariatric results of a standard SG.
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Affiliation(s)
- David Nocca
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France
| | - Marcelo Loureiro
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France; Universidade Positivo, Curitiba, Brazil.
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Alline M, Colombo PE, Quenet F, Jarlier M, Portales F, Llacer C, Fabre JM, Ychou M, Rouanet P. Surgical resectability after neo-adjuvant FOLFIRINOX for borderline or locally advanced pancreatic adenocarcinoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
421 Background: FOLFIRINOX has already demonstrated its efficiency in metastatic pancreatic cancer (PC). This combination need to be assessed in a neoadjuvant situation for locally advanced non metastatic PC. Methods: From 2009 to 2013, 31 patients with borderline or locally advanced PC received a neoadjuvant treatment with FOLFIRINOX so as to get them to a resectable situation. According to the tumoral response, chemoradiotherapy with gemcitabine was done. The primary analysis endpoint was the resecability rate. Pathologic response, chemotherapy’s toxicity and surgical morbidity were also evaluated. Results: Among the 31 PC, 17 were borderline resectable and 14 locally advanced according to NCCN classification. 16 (52%) received complete chemotherapy with a median of 4 cycles. Toxicity lead to treatment modification or interruption for 9 patients (29%). Grade 3-4 toxicity occurred in 7 patients (24%). 22 patients (71%) underwent chemoradiotherapy after FOLFIRINOX chemotherapy. 13 patients (42%) had disease progression under treatment whereas 18 patients with objective radiologic response or at least stable disease were surgically explored with a resection completed in 13 cases (42%). Surgical morbidity was controlled with grade 1-2 complications for 9 patients (69%) and no mortality. 11 patients (35%) demonstrated a significant pathologic response. Resected patients had a global survival median of 36 months. Conclusions: FOLFIRINOX in a neoadjuvant setting seems feasible with limited morbidity in locally advanced PC with encouraging resecability and pathologic response rates. Resected patients’ survival is promising but need to be confirmed in larger series.
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Affiliation(s)
| | | | - François Quenet
- Surgery Department, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Fabienne Portales
- Institut régional du Cancer de Montpellier, Val d'Aurelle, Montpellier, France
| | | | | | - Marc Ychou
- Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
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Abstract
Laparoscopic sleeve gastrectomy (LSG) has become one of the most common bariatric procedures. Even so, the gastric leak remains the most feared complication with a difficult, non-standardized treatment. The purpose of this study was to assess the feasibility of a new classification of leakage after LSG used in Montpellier University Hospital. We have studied the correlations between radiological findings and therapeutic outcome for the 20 gastric leaks. The presence of a leak was evaluated according to the day of appearance, the symptomatology, the location, severity on the CT scan, and the management. From May 2010 to September 2012, we prospectively collected data from 20 patients diagnosed with gastric leak after LSG. There were 16 women and 4 men with a mean age of 34 years old (range 21-52 years old). The fistula was diagnosed at postoperative day 28.1 days (range 3-77 days). Patients were grouped by the new classification in: 11-type I, 6-type II, 3-type III fistula, and 0-type IV. The visualization of leakage was observed for five cases (25 %). The initial surgical drainage was performed for 11 cases and the conservative treatment was preferred in 9 cases. Three cases necessitated a delayed surgical drainage after 1 week of conservative treatment. The surgical drainage was performed by laparoscopy in 12 cases and by laparotomy in 2 cases. The new CT scan classification of gastric leak could serve as a working basis for a consensus on the therapeutic management of this dreaded complication.
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Affiliation(s)
- M Nedelcu
- Department of Surgery, Saint Eloi Hospital-CHRU Montpellier, 80 Av. Augustin Fliche, 34295 Cedex 5 Montpellier, France.
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Nougaret S, Reinhold C, Chong J, Escal L, Mercier G, Fabre JM, Guiu B, Molinari N. Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol 2014; 24:1020-9. [PMID: 24569848 DOI: 10.1007/s00330-014-3112-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/16/2014] [Accepted: 01/29/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up. METHODS Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories. RESULTS Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value. CONCLUSION Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up. KEY POINTS Significant growth of pancreatic cysts occurred in a minority of patients only. No lesion <2 cm demonstrated any change during the first year of follow-up. Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions.
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Affiliation(s)
- Stephanie Nougaret
- Department of Abdominal Imaging, Saint Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France,
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Nocca D, Nedelcu M, Nedelcu A, Noel P, Leger P, Skalli M, Lefebvre P, Coisel Y, Laurent C, Lemaitre F, Fabre JM. Laparoscopic Sleeve Gastrectomy for Late Adolescent Population. Obes Surg 2014; 24:861-5. [DOI: 10.1007/s11695-014-1200-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Nedelcu AM, Skalli M, Deneve E, Fabre JM, Nocca D. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis 2013; 9:879-84. [DOI: 10.1016/j.soard.2013.02.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/24/2013] [Accepted: 02/26/2013] [Indexed: 01/07/2023]
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Nedelcu M, Andreica A, Skalli M, Pirlet I, Guillon F, Nocca D, Fabre JM. Laparoscopic approach for retrorectal tumors. Surg Endosc 2013; 27:4177-83. [PMID: 23728916 DOI: 10.1007/s00464-013-3017-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Retrorectal tumors are uncommon and may represent a surgical challenge. Laparoscopic excision has been reported in very few papers. We present our experience of nine cases operated by a transabdominal laparoscopic approach, between 2005 and 2011. METHODS There were two males and seven females with a mean age of 35 years (range 19-48). The tumors were discovered incidentally in four cases or because of nonspecific clinical signs. All patients have had an MRI preoperatively. RESULTS Only one patient required open conversion due to a huge tumor >7 cm of diameter. Postoperative mortality was nil. One patient developed a hematoma in the pelvic area. The median hospital stay was 4.7 days (range 4-8). Final diagnostic were as follows: four schwannomas, one ganglioneuroma, two tailgut cysts, one anterior meningocele, and one paragangliomas. During the follow-up showed no recurrences, but four of nine patients developed neurologic complications as parenthesis and sciatic pain and one patient developed retrograde ejaculation. CONCLUSIONS Our case series shows that the laparoscopic approach is a feasible and safe option. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space to minimize the vascular and neurological injuries.
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Affiliation(s)
- Marius Nedelcu
- Department of Surgery A, Saint Eloi Hospital, CHRU Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier Cedex 5, France,
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Nocca D, Guillaume F, Noel P, Picot MC, Aggarwal R, El Kamel M, Schaub R, de Seguin de Hons C, Renard E, Fabre JM. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg 2011; 21:738-43. [PMID: 21468625 DOI: 10.1007/s11695-011-0385-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastric bypass (GBP) has proved its efficacy 30 years ago in the management of diabetes mellitus (T2DM) for severe obese patients. More recently, interesting results have been published after sleeve gastrectomy (SG) in the same indication. Between 2005 and 2008, three bariatric centers have prospectively collected the data of T2DM patients treated by laparoscopic gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Effects on hemoglobin A1c (HbA1c), pharmacological treatment and excess weight loss after 1 year of surgery have been analyzed. All patients (35 LGBP and 33 LSG) were treated with oral anti-diabetics (OAD) or insulin before surgery (32 OAD and three insulin in LGBP group and 27 OAD and six insulin in LSG group). The average body mass index (BMI) in the LGBP group was 47.9 and 50.6 kg/m² in the LSG group. At 1 year after surgery, the average HbA1c lost was 2,537 in the GBP group and 2,175 in the SG group. T2DM had resolved (withdrawal of pharmacological treatment) in 60% of the LGBP group and 75.8% of the LSG group. Reduced use of pharmacological therapy was noted in 31.42% of the LGBP group and 15.15% of the LSG group. Percentage excess weight loss and BMI lost were 56.35% and 29.75% in the LGBP group and 60.11% and 29.80% in the LSG group, respectively. During short-term follow-up, the impact on regulation of HbA1c blood level of LGBP or LSG is important. At 1 year after surgery, LSG seems to be as effective as LGBP for the management of T2DM in severely obese patients.
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Affiliation(s)
- David Nocca
- Faculty of Medicine of Montpellier, CHRU Montpellier, Montpellier, France.
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Fezzi M, Kolotkin RL, Nedelcu M, Jaussent A, Schaub R, Chauvet MA, Cassafieres C, Lefebvre P, Renard E, Bringer J, Fabre JM, Nocca D. Improvement in Quality of Life After Laparoscopic Sleeve Gastrectomy. Obes Surg 2011; 21:1161-7. [DOI: 10.1007/s11695-011-0361-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Blanc PM, Lagoutte JM, Picot MC, Denève E, de Seguin C, Fabre JM, Nocca D. Preliminary results of the laparoscopic adjustable gastric banding procedure by a new generation of silicone band: MIDBAND. Obes Surg 2008; 18:569-72. [PMID: 18340499 DOI: 10.1007/s11695-008-9441-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 01/17/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The surgical treatment of morbid obesity by laparoscopic adjustable gastric banding has become a "gold standard" in Europe. Currently, five types of silicone bands are used in the majority of countries performing bariatric surgery. METHODS The MIDBAND was introduced to the European market in 2000. It is placed around the stomach using the Pars Flaccida technique described by Forsell. A prospective multicentric study on 113 cases was carried out to evaluate technical feasibility, complications, and the midterm weight loss outcomes (2 years). RESULTS The percentage of excess body weight loss was 52.58% at 2 years. Perioperative mortality was nil and the complication rate was low (slippage <2%). CONCLUSION These encouraging results require longer-term studies to validate this procedure.
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Nocca D, Krawczykowsky D, Bomans B, Noël P, Picot MC, Blanc PM, de Seguin de Hons C, Millat B, Gagner M, Monnier L, Fabre JM. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg 2008; 18:560-5. [PMID: 18317859 DOI: 10.1007/s11695-007-9288-7] [Citation(s) in RCA: 253] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 08/08/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND Good results obtained after laparoscopic sleeve gastrectomy (LSG), in terms of weight loss and morbidity, have been reported in few recent studies. Our team has designed a multicenter prospective study for the evaluation of the effectiveness and feasibility of this operation as a restrictive procedure. METHODS From January 2003 to September 2006, 163 patients (68% women) with an average age of 41.57 years, were operated on with a LSG. Indications for this procedure were morbid obese [body mass index (BMI)>40 kg/m2] or severe obese patients (BMI>35 kg/m2) with severe comorbidities (diabetes, sleep apnea, hypertension...) with high-volume eating disorders and superobese patients (BMI>50 kg/m2). RESULTS The average BMI was 45.9 kg/m2. Forty-four patients (26.99%) were superobese, 84 (51.53%) presented with morbid obesity, and 35 (21.47%) were severe obese patients. Prospective evaluations of excess weight loss, mortality, and morbidity have been analyzed. Laparoscopy was performed in 162 cases (99.39%). No conversion to laparotomy had to be performed. There was no operative mortality. Perioperative complications occurred in 12 cases (7.36%). The reoperation rate was 4.90% and the postoperative morbidity was 6.74% due to six gastric fistulas (3.66%), in which four patients (2.44%) had a previous laparoscopic adjustable gastric banding. Long-term morbidity was caused by esophageal reflux symptoms (11.80%). The percentage of loss in excessive body weight was 48.97% at 6 months, 59.45% at 1 year (120 patients), 62.02% at 18 months, and 61.52% at 2 years (98 patients). No statistical difference was noticed in weight loss between obese and extreme obese patients. CONCLUSIONS The sleeve gastrectomy seems to be a safe and effective restrictive bariatric procedure to treat morbid obesity in selected patients. LSG may be proposed for volume-eater patients or to prepare superobese patients for laparoscopic gastric bypass or laparoscopic duodenal switch. However, weight regained, quality of life, and evolution ofmorbidities due to obesity need to be evaluated in a long-term follow up.
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Affiliation(s)
- D Nocca
- CHU Montpellier, Montpellier, France.
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Aufort S, Molina E, Assenat E, Rigole H, Bauret P, Calvet C, Navarro F, Fabre JM, Blanc P, Taourel P, Larrey D, Bruel JM, Pageaux GP, Gallix BP. [Value of MRCP for diagnosis of biliary complications after liver transplantation]. ACTA ACUST UNITED AC 2008; 89:221-7. [PMID: 18354352 DOI: 10.1016/s0221-0363(08)70397-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation. MATERIALS AND METHODS 27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography. RESULTS 216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris. CONCLUSION MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.
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Affiliation(s)
- S Aufort
- Service d'Imagerie Médicale, CHU Montpellier, Hôpital Saint-Eloi, 80, rue Augustin Fliche, 34295 Montpellier Cedex 5
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Puche P, Jacquet E, Borie F, Colombo PE, Bouyabrine H, Herrero A, Guillon F, Carabalona JP, Fabre JM, Millat B, Domergue J, Navarro F. [Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients]. J Chir (Paris) 2007; 144:403-408. [PMID: 18065895 DOI: 10.1016/s0021-7697(07)73995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%. AIM OF THE STUDY Describe the management of biliary injuries after laparoscopic cholecystectomy in our center. PATIENTS Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%). RESULTS Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2). CONCLUSION Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.
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Affiliation(s)
- P Puche
- Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique, Hôpital Saint Eloi - Montpellier, France.
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Nocca D, Aggarwal R, Blanc P, Gallix B, Di Mauro GL, Millat B, Seguin des De Hons C, Deneve E, Rodier JG, Tincani G, Pierredon MA, Fabre JM. Laparoscopic vertical banded gastroplasty. A multicenter prospective study of 200 procedures. Surg Endosc 2006; 21:870-4. [PMID: 17103270 DOI: 10.1007/s00464-006-9048-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 05/15/2006] [Accepted: 06/07/2006] [Indexed: 02/01/2023]
Abstract
BACKGROUND The commonest surgical procedure for management of morbid obesity in Europe is laparoscopic adjustable gastric banding (LAGB), even though laparoscopic vertical banded gastroplasty (LVBG) is still considered to be a gold standard restrictive option in bariatric surgery. A multicenter prospective study was designed to to assess the efficacy of LVBG in terms of weight loss and complication rates for obese patients who have indications for a restrictive procedure. PATIENTS AND METHODS Two-hundred morbidly obese patients (84.5% female) with a mean age of 41 years and mean body mass index (BMI) of 43.2 kg/m(2) underwent LVBG as described by MacLean. Five trocars were placed in standard positions as per laparoscopic upper gastrointestinal surgery. A vertical gastric pouch (30 ml) was created with circular (21 or 25mm) and endolinear stapling techniques, enabling definitive separation of the two parts of the stomach. The gastric outlet was calibrated with either a polypropylene mesh (5.5 cm in length and 1cm in width) or a nonadjustable silicone band. The median follow-up period was 30 months (range, 1-72 months). RESULTS One case had to be converted to open surgery (gastric perforation) and there was one death secondary to peritonitis of unknown etiology. The morbidity rate was 24%, comprising the following complications: gastric outlet stenosis (8%); staple line leak (2.5%); food trapping (1.5%); peritonitis (1%); thrombophlebitis (1.5%); pulmonary embolism (0.5%); and gastroesophageal reflux (9%). The excess weight loss achieved was 56.7% (1 year), 68.3% (2 years), and 65.1% (3 years). CONCLUSIONS Laparoscopic vertical banded gastroplasty is an effective procedure for the surgical management of morbid obesity, especially for patients who present hyperphagia but are unable to manage the constraints of adjustable gastric banding. Laparoscopic vertical banded gastroplasty is safe, as demonstrated by an acceptable complication rate, of which gastric outlet stenosis, staple line leakage, and gastroesophageal reflux predominate.
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Affiliation(s)
- D Nocca
- Department of Digestive Surgery Pr Fabre, Hopital Saint Eloi, University Hospital of Montpellier, Montpellier, France.
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Denève E, Sebbane M, Chanque G, Bapin C, Jaber S, Fabre JM, Nocca D. [Bacterial meningitis from a gastrointestinal source]. J Chir (Paris) 2006; 143:408-11. [PMID: 17285089 DOI: 10.1016/s0021-7697(06)73738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Champault G, Descottes B, Dulucq JL, Fabre JM, Fourtanier G, Gayet B, Johanet H, Samama G. [Laparoscopic surgery. The recommendations of specialty societies in 2006 (SFCL-SFCE)]. ACTA ACUST UNITED AC 2006; 143:160-4. [PMID: 16888601 DOI: 10.1016/s0021-7697(06)73644-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- G Champault
- Société Française de Chirurgie Laparoscopique (SFCL), Service de Chirurgie Digestive, CHU Jean Verdier, Bondy.
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Nocca D, Frering V, Gallix B, de Seguin des Hons C, Noël P, Foulonge MAP, Millat B, Fabre JM. Migration of adjustable gastric banding from a cohort study of 4236 patients. Surg Endosc 2005; 19:947-50. [PMID: 15920690 DOI: 10.1007/s00464-004-2183-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 01/17/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND Experience was gained management of intra-gastric migration of adjustable gastric banding. METHODS From July 1996 to January 2003, 4236 patients who underwent laparoscopic adjustable gastric banding were proposed for routine follow-up. Gastrograms were performed in case of band adjustment. Radiological controls and endoscopy were performed according to symptoms. RESULTS A total of 45 cases of band migration (1.6%) were diagnosed during follow-up. All but one of the migrated bands were removed laparoscopically either by a dissection outside the stomach or through a short gastrotomy. Mortality was 0% and morbidity 8% (n = 4). CONCLUSION The risk of an intragastric band migration remains low in the literature but could grow on account of the longer follow-up of patients. The retrieval of the band is the gold standard and must be planned promptly or delayed according to symptoms.
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Affiliation(s)
- D Nocca
- Centre Hospitalier Universitaire, Hôpital St Eloi, 2 Av Emile Bertin Sans, 34000 Montpellier, France
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Affiliation(s)
- J M Fabre
- Laboratoire de chimie organique: Hétérochimie et matériaux organiques, UMR 5076, ENSCM, 8 rue de l'école normale, 34296 Montpellier Cedex 5, France.
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Jacquet E, Giordan J, Puche P, Fabre JM, Domergue J, Navarro F, Eledjam JJ. Évaluation de la prise en charge des hernies inguinales en chirurgie ambulatoire. ACTA ACUST UNITED AC 2004; 129:138-43. [PMID: 15142810 DOI: 10.1016/j.anchir.2004.01.012] [Citation(s) in RCA: 8] [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] [Received: 12/08/2003] [Accepted: 01/24/2004] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the prospects of ambulatory surgery for inguinal hernia. PATIENTS AND METHODS From January 1995 to June 2001, 599 operations on inguinal hernias were performed. Patients were composed of 554 men and 45 women. The average age was 58 years (7-95). All patients were examined by their primary doctor on the first and the third day, and by the surgeon on the 10th day. RESULTS Four hundred and eighty-one patients were operated on by ambulatory surgery (80.3%). The "Tension-free" technique was carried out among 495 patients (82.6%). Loco-regional anaesthesia was used for 499 patients (83.3%). The postoperative rate of complications was 10.4% (62 patients). Only 201 patients presented postoperative painful symptomatology (33.6%), 341 a discomfort (56.9%), and 57 (10%) experienced no pain. The overall satisfaction rate was 92.9%. CONCLUSION Use of the "Tension-free" technique under loco-regional anaesthesia for inguinal hernias allows ambulatory surgery with a low rate of complications and high satisfaction for the patients.
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Affiliation(s)
- E Jacquet
- Service de chirurgie digestive, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
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Ourlin JC, Lasserre F, Pineau T, Fabre JM, Sa-Cunha A, Maurel P, Vilarem MJ, Pascussi JM. The small heterodimer partner interacts with the pregnane X receptor and represses its transcriptional activity. Mol Endocrinol 2003; 17:1693-703. [PMID: 12805410 DOI: 10.1210/me.2002-0383] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [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: 11/19/2022] Open
Abstract
SHP (small heterodimer partner, NR1I0) is an atypical orphan member of the nuclear receptor subfamily in that it lacks a DNA-binding domain. It is mostly expressed in the liver, where it binds to and inhibits the function of nuclear receptors. SHP is up-regulated by primary bile acids, through the activation of their receptor farnesoid X receptor, leading to the repression of cholesterol 7alpha-hydroxylase (CYP7alpha) expression, the rate-limiting enzyme in bile acid production from cholesterol. PXR (pregnane X receptor, NR1I2) is a broad-specificity sensor that recognizes a wide variety of synthetic drugs as well as endogenous compounds such as bile acid precursors. Upon activation, PXR induces CYP3A and inhibits CYP7alpha, suggesting that PXR can act on both bile acid synthesis and elimination. Indeed, CYP7alpha and CYP3A are involved in biochemical pathways leading to cholesterol conversion into primary bile acids, whereas CYP3A is also involved in the detoxification of toxic secondary bile acid derivatives. Here, we show that PXR is a target for SHP. Using pull-down assays, we show that SHP interacts with both murine and human PXR in a ligand-dependent manner. From transient transfection assays, SHP is shown to be a potent repressor of PXR transactivation. Furthermore, we report that chenodeoxycholic acid and cholic acid, two farnesoid X receptor ligands, induce up-regulation of SHP and provoke a repression of PXR-mediated CYP3A induction in human hepatocytes as well as in vivo in mice. These results reveal an elaborate regulatory cascade, tightly controlled by SHP, for both the maintenance of bile acid production and detoxification in the liver.
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Affiliation(s)
- Jean Claude Ourlin
- Institut National de la Santé et de la Recherche Médicale, Unité 128, Institut Fédératif de Recherche 24, Cedex 05, France
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Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J. Is laparoscopic left pancreatic resection justified? Surg Endosc 2002; 16:1358-61. [PMID: 11984672 DOI: 10.1007/s00464-001-9206-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Accepted: 12/20/2001] [Indexed: 12/12/2022]
Abstract
BACKGROUND We reviewed our experience of laparoscopic left pancreatectomy to establish the feasibility of this approach and the characteristics of the operating procedure. METHODS Thirteen patients with a mean age of 60 years were deemed for a left pancreatectomy. Preoperative diagnoses were: nine mucinous cystadenoma and one insulinoma, intraductal mucinous ectasia, chronic pancreatitis with ductal stenosis, and distal pancreatic tumor. RESULTS Operative mortality was nil. Two patients required conversion for bleeding from splenic vein injuries leading to a splenectomy in one case. The spleen was preserved in 10 cases. Postoperative course was uneventful in nine cases. Four patients experienced postoperative complications: one pancreatic fistula, two liquid cysts on the pancreatic margin, and one reoperation for bleeding from a trocar port. Length of stay ranged from 5 to 22 days. CONCLUSION These preliminary results confirm that in selected cases laparoscopic resection of the left pancreas is feasible and safe.
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Affiliation(s)
- J M Fabre
- Department of Surgery, Saint Eloi Hospital, 34295 Montpellier Cedex 5, France.
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Joomaye Z, Perney P, Pageaux GP, Perrigault PF, Souche B, Fabre JM, Domergue J, Le Quellec A, Blanc F. [Liver transplantation in a patient with cirrhosis and an uncontrolled extra-hepatic infectious focus]. Gastroenterol Clin Biol 2001; 25:1112-3. [PMID: 11910995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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38
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Pascussi JM, Drocourt L, Gerbal-Chaloin S, Fabre JM, Maurel P, Vilarem MJ. Dual effect of dexamethasone on CYP3A4 gene expression in human hepatocytes. Sequential role of glucocorticoid receptor and pregnane X receptor. Eur J Biochem 2001; 268:6346-58. [PMID: 11737189 DOI: 10.1046/j.0014-2956.2001.02540.x] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although CYP3A induction by dexamethasone has been extensively documented, its mechanism is still unclear because both the role of the glucocorticoid receptor and the ability of dexamethasone to activate the human pregnane X receptor have been questioned. In an attempt to resolve this problem, we investigated the response of CYP3A4 to dexamethasone (10 nm-100 microm) in primary human hepatocytes and HepG2 cells, using a variety of methods: kinetic analysis of CYP3A4 and tyrosine aminotransferase expression, effects of RU486 and cycloheximide, ligand binding assay, cotransfection of HepG2 cells with CYP3A4 reporter gene constructs and vectors expressing the glucocorticoid receptor, pregnane X receptor or constitutively activated receptor. In contrast to rifampicin (monophasic induction), dexamethasone produces a biphasic induction of CYP3A4 mRNA consisting of a low-dexamethasone component (nmol concentrations) of low amplitude (factor of 3-4) followed by a high-dexamethasone component (supramicromolar concentrations) of high amplitude (factor of 15-30). We show that the low-dexamethasone component results from the glucocorticoid receptor-mediated expression of pregnane X receptor and/or constitutively activated receptor which, in turn, are able to transactivate CYP3A4 in a xenobiotic-independent manner. At supramicromolar concentrations (>10 microm), dexamethasone binds to and activates pregnane X receptor thus producing the high-dexamethasone component of CYP3A4 induction. We conclude that, in contrast to the other xenobiotic inducers of CYP3A4, glucocorticoids play a dual role in CYP3A4 expression, first by controlling the expression of PXR and CAR under physiological conditions (submicromolar concentrations) through the classical glucocorticoid receptor pathway, and second by activating the pregnane X receptor under bolus or stress conditions (supramicromolar concentrations).
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Affiliation(s)
- J M Pascussi
- INSERM CNRS, Route de Mende, Montpellier, France
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Pouzeratte Y, Delay JM, Brunat G, Boccara G, Vergne C, Jaber S, Fabre JM, Colson P, Mann C. Patient-controlled epidural analgesia after abdominal surgery: ropivacaine versus bupivacaine. Anesth Analg 2001; 93:1587-92, table of contents. [PMID: 11726450 DOI: 10.1097/00000539-200112000-00055] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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: 10/26/2022]
Abstract
UNLABELLED In this randomized, double-blinded study we sought to assess the analgesic efficacy of ropivacaine and bupivacaine in combination with sufentanil and the efficacy of ropivacaine alone after major abdominal surgery. Sixty patients undergoing major abdominal surgery received standardized general anesthesia combined with epidural thoracic analgesia. They were allocated to one of three groups: the BS group received postoperative patient-controlled epidural analgesia with 0.125% bupivacaine plus 0.5 microg/mL sufentanil; the RS group received 0.125% ropivacaine plus 0.5 microg/mL sufentanil; and the R group received 0.2% ropivacaine, with the patient-controlled epidural analgesia device set at bolus 2-3 mL and background infusion 3-5 mL/h. Visual analog scale scores were significantly lower during coughing in the BS group compared with the RS and R groups and in the RS group compared with the R group. The BS group required significantly less local anesthetic (milligrams per day) during the first three postoperative days compared with the RS and R groups, and the RS group, significantly less than the R group. No major side effects were noted in any group. We conclude that, after major abdominal surgery, thoracic epidural analgesia was more effective with bupivacaine than with ropivacaine when these two local anesthetics are used in a mixture with sufentanil. Ropivacaine alone was less effective than ropivacaine in combination with sufentanil. IMPLICATIONS After major abdominal surgery, thoracic epidural analgesia was more effective with 0.125% bupivacaine than with 0.125% ropivacaine when these two local anesthetics were used in a mixture with 0.5 microg/mL sufentanil. Ropivacaine 0.2% alone was less effective than 0.125% ropivacaine combined with sufentanil.
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Affiliation(s)
- Y Pouzeratte
- Department of Anesthesia, Hôpital Saint-Eloi, Montpellier, France.
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Drocourt L, Pascussi JM, Assenat E, Fabre JM, Maurel P, Vilarem MJ. Calcium channel modulators of the dihydropyridine family are human pregnane X receptor activators and inducers of CYP3A, CYP2B, and CYP2C in human hepatocytes. Drug Metab Dispos 2001; 29:1325-31. [PMID: 11560876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
The expression of three cytochromes P450 (CYP3A4, CYP2C9, and CYP2B6) was investigated in primary human hepatocyte cultures following treatment with four calcium channel modulators (CCM) of the dihydropyridine family, three antagonists (nifedipine, nicardipine, and isradipine), and one agonist (BK8644). Induction of CYP3A4 was studied by Northern blot, Western blot, and enzymatic activity. Induction began between 1 and 10 microM CCM and was dependent on the presence of dexamethasone (100 nM) in the medium. CYP3A4 mRNA accumulation started only after 16 h of treatment because pregnane X receptor (hPXR) synthesis was needed. Cotransfection experiments showed that the proximal and the distal PXR response elements of the CYP3A4 promoter and hPXR (HepG2 cells) or dexamethasone-induced hPXR (primary hepatocytes) were necessary to obtain full induction. Furthermore, glutathione S-transferase pull-down assays demonstrated that the CCM tested can act as hPXR ligands. In addition, cotransfection experiments in CV1 cells showed that these compounds failed to reverse CAR (constitutively activated receptor) inactivation by androstenol. Finally, 10 microM CCM induced both CYP2C9 and CYP2B6, strengthening the evidence that hPXR is involved in the regulation of these genes. All together, these results widen the field of hPXR activators to a new class of ligand, namely the CCM of the dihydropyridine family.
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Affiliation(s)
- L Drocourt
- Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Montpellier, France
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Vandĵme A, Pageaux GP, Bismuth M, Fabre JM, Domergue J, Perez C, Makeieff M, Mourad G, Larrey D. Nocardiosis revealed by thyroid abscess in a liver--kidney transplant recipient. Transpl Int 2001; 14:202-4. [PMID: 11499912 DOI: 10.1007/s001470100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nocardiosis is a life-threatening infection, particularly among immunocompromised patients, which usually affects lungs, skin and central nervous system. We report a case of disseminated nocardiosis revealed by suppurative thyroiditis in a liver-kidney transplant recipient with poor nutritional status at the time of infection. Nocardia Asteroides was isolated from fine-needle aspiration material of the thyroid abscess. Clinical manifestations resolved after surgical drainage of the thyroid abscess, prolonged antibiotherapy and diminution of immunosuppressive regimen. Clinicians should be aware of this entity, as Nocardia Asteroides may need more than 5 days of culture to be isolated.
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Affiliation(s)
- A Vandĵme
- Fédération Médicochirurgicale, Hôpital Saint Eloi, Montpellier, France
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Gerbal-Chaloin S, Pascussi JM, Pichard-Garcia L, Daujat M, Waechter F, Fabre JM, Carrère N, Maurel P. Induction of CYP2C genes in human hepatocytes in primary culture. Drug Metab Dispos 2001; 29:242-51. [PMID: 11181490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
The expression and inducibility of four CYP2C genes, including CYP2C8, -2C9, -2C18, and -2C19, was investigated in primary cultures of human hepatocytes. By the use of RNase protection assay and specific antibodies, each CYP2C mRNA and protein were quantified unequivocally. The four CYP2C mRNAs were expressed in human livers and cultured primary hepatocytes, but only the CYP2C18 protein was not detected. Compounds known to activate the pregnane X receptor (PXR) such as rifampicin, or the constitutively activated receptor (CAR) such as phenobarbital, induced CYP2C8, CYP2C9, and to a lesser extent CYP2C19 mRNAs and proteins. CYP2C18 mRNA was expressed but not inducible. The concentration dependence of CYP2C8 and CYP2C9 mRNAs in response to rifampicin and phenobarbital paralleled that of CYP3A4 and CYP2B6, the maximum accumulation being reached with 10 microM rifampicin and 100 microM phenobarbital. In contrast, dexamethasone produced maximum induction of CYP2C8 and CYP2C9 mRNAs at 0.1 microM while in these conditions neither CYP3A4 nor CYP2B6 was significantly induced. Moreover, the concentration dependence of CYP2C8 and CYP2C9 mRNAs in response to dexamethasone paralleled that of tyrosine aminotransferase. Furthermore, dexamethasone, which has been recently shown to up-regulate PXR and CAR expression through the glucocorticoid receptor, potentiated CYP2C8 and CYP2C9 mRNA induction in response to rifampicin and phenobarbital. Collectively, these results suggest the possible implication of at least three receptors in the regulation of CYP2C8 and CYP2C9 expression, i.e., glucocorticoid receptor, PXR, and/or CAR.
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Affiliation(s)
- S Gerbal-Chaloin
- INSERM U128, IFR24, Campus Centre National de la Recherche Scientifique, 1919 Route de Mende, 34293 Montpellier, France
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Friend RH, Jerome D, Fabre JM, Giral L, Bechgaard K. Stabilisation of the metallic state at low temperatures in HMTTF-TCNQ under pressure. ACTA ACUST UNITED AC 2001. [DOI: 10.1088/0022-3719/11/2/012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pascussi JM, Gerbal-Chaloin S, Fabre JM, Maurel P, Vilarem MJ. Dexamethasone enhances constitutive androstane receptor expression in human hepatocytes: consequences on cytochrome P450 gene regulation. Mol Pharmacol 2000; 58:1441-50. [PMID: 11093784 DOI: 10.1124/mol.58.6.1441] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [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: 11/22/2022] Open
Abstract
The barbiturate phenobarbital induces the transcription of cytochromes P450 (CYPs) 2B through the constitutive androstane receptor (CAR; NR1I3). CAR is a member of the nuclear receptor family (NR1) mostly expressed in the liver, which heterodimerizes with retinoid X receptor (RXR) and was shown to transactivate both the phenobarbital responsive element module of the human CYP2B6 gene and the CYP3A4 xenobiotic response element. Because previous studies in rodent hepatocyte cultures have shown that the phenobarbital-mediated induction of CYP2B genes is potentiated by glucocorticoids, we examined the role of activated glucocorticoid receptor in this process. We show that submicromolar concentrations of dexamethasone enhance phenobarbital-mediated induction of CYP3A4, CYP2B6, and CYP2C8 mRNA in cultured human hepatocytes. In parallel, we observed that glucocorticoid agonists, such as dexamethasone, prednisolone, or hydrocortisone, specifically increase human car (hCAR) mRNA expression. Accumulation of hCAR mRNA parallels that of tyrosine aminotransferase: both mRNAs reach a maximum at a concentration of 100 nM dexamethasone and are down-regulated by concomitant treatment with the glucocorticoid antagonist RU486. Moreover, the effect of dexamethasone on hCAR mRNA accumulation appears to be of transcriptional origin because the addition of protein synthesis inhibitor cycloheximide has no effect, and dexamethasone does not affect the degradation of hCAR mRNA. Furthermore, dexamethasone increases both basal and phenobarbital-mediated nuclear translocation of CAR immunoreactive protein in human hepatocytes. The up-regulation of CAR mRNA and protein in response to dexamethasone explains the synergistic effect of this glucocorticoid on phenobarbital-mediated induction of CYP2B genes and the controversial role of the glucocorticoid receptor on phenobarbital-mediated CYP gene inductions.
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MESH Headings
- Active Transport, Cell Nucleus/drug effects
- Aryl Hydrocarbon Hydroxylases
- Cells, Cultured
- Constitutive Androstane Receptor
- Cytochrome P-450 CYP2B6
- Cytochrome P-450 CYP2C8
- Cytochrome P-450 CYP3A
- Cytochrome P-450 Enzyme System/biosynthesis
- Cytochrome P-450 Enzyme System/genetics
- Dexamethasone/pharmacology
- Gene Expression Regulation, Enzymologic/drug effects
- Hepatocytes/drug effects
- Hepatocytes/physiology
- Humans
- Liver/metabolism
- Mixed Function Oxygenases/biosynthesis
- Mixed Function Oxygenases/genetics
- Oxidoreductases, N-Demethylating/biosynthesis
- Oxidoreductases, N-Demethylating/genetics
- Phenobarbital/pharmacology
- RNA, Messenger/biosynthesis
- RNA, Messenger/drug effects
- Receptors, Cytoplasmic and Nuclear/biosynthesis
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Glucocorticoid/physiology
- Steroid 16-alpha-Hydroxylase
- Steroid Hydroxylases/biosynthesis
- Steroid Hydroxylases/genetics
- Transcription Factors/biosynthesis
- Transcription Factors/genetics
- Transcriptional Activation
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Affiliation(s)
- J M Pascussi
- Institut National de la Santé et de la Recherche Médicale U128-IFR24, Centre National de la Recherche Scientifique, Montpellier, France
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Vaca P, Granier T, Gallois B, Coulon C, Gouasmia A, Fabre JM. Physical properties of (DMCTTF)2X salts and their selenium analogues. ACTA ACUST UNITED AC 2000. [DOI: 10.1088/0022-3719/21/34/009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pascussi JM, Gerbal-Chaloin S, Pichard-Garcia L, Daujat M, Fabre JM, Maurel P, Vilarem MJ. Interleukin-6 negatively regulates the expression of pregnane X receptor and constitutively activated receptor in primary human hepatocytes. Biochem Biophys Res Commun 2000; 274:707-13. [PMID: 10924340 DOI: 10.1006/bbrc.2000.3219] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [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: 01/20/2023]
Abstract
The marked impairment of hepatic drug metabolism during inflammation and infections has been known for many years and shown to result from down-regulation of cytochrome P450s (CYP) by cytokines. However, the mechanism of this repression is unknown. Using primary cultures of human hepatocytes, we show here that interleukin-6 (IL-6) rapidly and markedly decreases the expression of PXR (pregnane X receptor) and CAR (constitutively activated receptor) mRNAs, but does not affect the levels of dioxin receptor and glucocorticoid receptor mRNA. In parallel, IL-6 decreases both rifampicin- and phenobarbital-mediated induction of CYP2B6, CYP2C8, CYP2C9, and CYP3A4. As the transcriptional activity of PXR and CAR is not affected by IL-6 in cell-based reporter assays, our data suggest that the loss of CYP2 and CYP3 inducibility results from the negative regulation of PXR and CAR gene expression by this cytokine.
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Affiliation(s)
- J M Pascussi
- INSERM U128, IFR24, 1919 Route de Mende, Montpellier, 34293, France
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Pascussi JM, Drocourt L, Fabre JM, Maurel P, Vilarem MJ. Dexamethasone induces pregnane X receptor and retinoid X receptor-alpha expression in human hepatocytes: synergistic increase of CYP3A4 induction by pregnane X receptor activators. Mol Pharmacol 2000; 58:361-72. [PMID: 10908304 DOI: 10.1124/mol.58.2.361] [Citation(s) in RCA: 265] [Impact Index Per Article: 11.0] [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: 12/12/2022] Open
Abstract
In this report we show that submicromolar concentrations of dexamethasone enhance pregnane X receptor (PXR) activator-mediated CYP3A4 gene expression in cultured human hepatocytes. Because this result is only observed after 24 h of cotreatment and is inhibited by pretreatment with cycloheximide, we further investigated which factor(s), induced by dexamethasone, might be responsible for this effect. We report that dexamethasone increases both retinoid X receptor-alpha (RXRalpha) and PXR mRNA expression in cultured human hepatocytes, whereas PXR activators such as rifampicin and clotrimazole do not. Accumulation of RXRalpha and PXR mRNA reaches a maximum at a concentration of 100 nM dexamethasone after treatment for 6 to 12 h and is greatly diminished by RU486. A similar pattern of expression is observed with tyrosine aminotransferase mRNA. Moreover, the effect of dexamethasone on PXR mRNA accumulation seems to be through direct action on the glucocorticoid receptor (GR) because the addition of cycloheximide has no effect, and dexamethasone does not affect the degradation of PXR mRNA. Furthermore, dexamethasone induces the accumulation of a RXRalpha-immunoreactive protein and increases the nuclear level of RXRalpha:PXR heterodimer as shown by gel shift assays with a CYP3A4 ER6 PXRE probe. This accumulation of latent PXR and RXRalpha in the nucleus of hepatocytes explains the synergistic effect observed with dexamethasone and PXR activators together on CYP3A4 induction. These results reveal the existence of functional cross talk between the GR and PXR, and may explain some controversial aspects of the role of the GR in CYP3A4 induction.
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MESH Headings
- Adult
- Aged
- Biological Transport
- Cell Extracts
- Cells, Cultured
- Cytochrome P-450 CYP3A
- Cytochrome P-450 Enzyme System/biosynthesis
- Dexamethasone/pharmacology
- Enzyme Induction
- Female
- Gene Expression/drug effects
- Glucocorticoids/pharmacology
- Humans
- Liver/cytology
- Liver/drug effects
- Liver/metabolism
- Male
- Middle Aged
- Mixed Function Oxygenases/biosynthesis
- Nucleic Acid Conformation
- Pregnane X Receptor
- RNA, Messenger/drug effects
- RNA, Messenger/metabolism
- Receptors, Cytoplasmic and Nuclear/agonists
- Receptors, Cytoplasmic and Nuclear/biosynthesis
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- Receptors, Retinoic Acid/biosynthesis
- Receptors, Retinoic Acid/genetics
- Receptors, Steroid/agonists
- Receptors, Steroid/biosynthesis
- Receptors, Steroid/genetics
- Retinoid X Receptors
- Signal Transduction
- Transcription Factors/biosynthesis
- Transcription Factors/genetics
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Affiliation(s)
- J M Pascussi
- Institut National de la Santé et de la Recherche Médicale U128, Institut Federatif de Recherche 24, Centre National de la Recherche Scientifique, Montpellier, France
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Michel J, Navarro F, Montpeyroux F, Burgel JS, Le Moine MC, Daures JP, Drouard F, Berthou JC, Fabre JM, Domergue J. [Treatment of common bile duct stones with laparoscopy. Retrospective multicenter study with 612 patients]. Gastroenterol Clin Biol 2000; 24:404-8. [PMID: 10844285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To analyse retrospectively the results of one-stage laparoscopic treatment for common bile duct stones in 19 surgical centers in France. PATIENTS From January 1991 to July 1996, 612 patients with choledocholithiasis underwent laparoscopic treatment. RESULTS Overall duct clearance was obtained in 489 of the 612 patients (80%): through the cystic duct in 222 of 380 patients (58.4%), by secondary choledochotomy (after unsuccessful transcystic duct extraction) in 77 of 96 (80%), and in 190 of 232 (82 %) by primary choledochotomy. The overall duct clearance rate increased from 65% in 1991 to 84% in 1996. The use of the choledochotomy approach increased from 43% in 1991 to 69% in 1996 (P<0.01), due to a substantial increase in primary choledochotomy. In contrast, the use of the transcystic approach decreased from 57% to 31% (P<0.01). The mean time for surgery was shorter for cystic duct exploration than for primary choledochotomy (101+/-51 vs. 155+/-62 min, P<0.0001). The mean hospital stay decreased from 7.7+/-3.6 days in 1991 to 4.1+/-2 days in 1996 (P<0.001). The main biliary complications were related to biliary drainage (2,8%) and retained stones (3.1%). CONCLUSION This study confirms that laparoscopy is a good alternative with a low complication rate, a short hospital stay, and is an effective and safe option for the management of common bile duct stones.
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Affiliation(s)
- J Michel
- Service de Chirurgie Digestive C, Hôpital Saint-Eloi, CHU, Montpellier
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Burgel JS, Navarro F, Lemoine MC, Michel J, Carabalona JP, Fabre JM, Domergue J. [Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases]. Ann Chir 2000; 125:231-7. [PMID: 10829501 DOI: 10.1016/s0001-4001(00)00129-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this prospective study was to assess the feasibility and postoperative advantages of the laparoscopic-assisted elective colectomy for diverticular disease. PATIENTS AND METHODS From january 1989 to december 1997, among the 114 patients electively operated on for diverticulitis, 56 patients were treated by laparoscopic approach. Evaluated parameters included: gender, age, weight, size, ASA score, operating time, duration of hospital stay, of analgesic treatment, and of postoperative ileus, morbidity and mortality rate. RESULTS The study group consisted of 35 women and 21 men. Mean age was 59 years (34-81 years); 29 patients were ASA 1 and 27 ASA 2. Overall postoperative mortality rate was 0% and morbidity rate 16% (n = 9). There were no complications directly related to laparoscopic technique. The conversion rate was 14% (n = 8). Mean operating time was 300 min (200-600 min). Mean duration of postoperative ileus was 2.4 days. Mean duration of hospital stay was 9.4 days. CONCLUSION This study demonstrates the feasibility of elective laparoscopic-assisted colonic resection for diverticular disease in more than 80% of cases with a postoperative morbidity and mortality rate comparable to those of conventional surgery.
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Affiliation(s)
- J S Burgel
- Service de chirurgie C, hôpital Saint-Eloi, Montpellier, France
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