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de la Codre F, Jacobi D, Catheline JM, Khamphommala L, de Montrichard M, Blanchard C. Bariatric Surgery in Patients with Achondroplasia, a Feasibility Study of Two Case Studies. Obes Surg 2024; 34:1949-1953. [PMID: 38564174 DOI: 10.1007/s11695-024-07144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/12/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Achondroplasia is a common skeletal dysplasia with a high prevalence of obesity in adulthood. Bariatric surgery has been shown to be effective in treating obesity and related comorbidities, but its feasibility and effectiveness in patients with achondroplasia have not been clearly established. OBJECTIVES The objective of this study was to evaluate the feasibility and effectiveness of bariatric surgery in patients with achondroplasia. SETTING This study was performed in France, and bariatric surgeons from the Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (French Francophone Society of Surgery for Obesity or Metabolic Diseases) were asked to participate. METHODS Two adult women with confirmed achondroplasia and a high BMI were selected for laparoscopic sleeve gastrectomy. Preoperative data were collected, including demographic information, comorbidities, and follow-up at 1, 3, and 6 months and 1 year after surgery. Complications were monitored and recorded. RESULTS Both patients had good excess weight loss outcomes, with an average excess weight loss of 60.5% 1 year after surgery. One patient had a follow-up of 3 years and an excess weight loss of 44%. The surgery was well-tolerated, and no major complications were observed. CONCLUSIONS Bariatric surgery is feasible and effective in patients with achondroplasia, with good outcomes for excess weight loss and related comorbidities. These findings suggest that bariatric surgery should be considered a treatment option for patients with achondroplasia and obesity.
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Affiliation(s)
- Frédéric de la Codre
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Service de Chirurgie Viscérale Et Digestive, Santé Atlantique, Saint-Herblain, France
- Service de Chirurgie Viscérale Et Digestive, Clinique Brétéché, Nantes, France
| | - David Jacobi
- L'Institut du Thorax, Inserm UMR-S1087, CNRS, UNIV Nantes, Nantes, France
| | - Jean-Marc Catheline
- Département de Chirurgie Viscérale, Centre Hospitalier de Saint - Denis, Saint-Denis, France
| | - Litavan Khamphommala
- Département de Chirurgie Digestive Et Hépatobiliaire, Centre Hospitalier Privé Saint Grégoire, Saint Gregoire, France
| | - Marie de Montrichard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Centre Hospitalier Universitaire de Nantes, Nantes, France.
- Département de Chirurgie Viscérale, Centre Hospitalier de Saint - Denis, Saint-Denis, France.
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Urdapilleta I, El Khoury L, Catheline JM, Lahlou S, Demarchi S. Mediating factors explain anxiety experienced by women with obesity during the Covid-19 pandemic. PLoS One 2023; 18:e0295034. [PMID: 38117823 PMCID: PMC10732381 DOI: 10.1371/journal.pone.0295034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/14/2023] [Indexed: 12/22/2023] Open
Abstract
The Covid-19 pandemic could be a source of great anxiety, especially for those at higher risk, such as women experiencing obesity. The aim of this study was to measure how some personal characteristics such as BMI (from underweight to class 3 obesity), bariatric surgery (yes or no), comorbidities, or age (as antecedent variables), and mediating factors impacted state anxiety during the Covid-19 Pandemic. Mediating factors were related to subjective knowledge or attitudes (e.g. interest or beliefs and practices around Covid-19, subjective health perception, and confidence in the government). French women (N = 532) were invited to take part in a voluntary online health survey during lockdown in Paris and its suburbs. Results showed that women with higher BMI had higher anxiety scores, primarily because they feel less healthy than other people. Secondly, the larger the body size of the participants was (BMI), the less they reported that information about Covid-19 held their attention. This lack of interest resulted in feelings of anxiety not being generated. Thirdly, the larger their body size was, the less confidence they had in the effectiveness of the proposed measures by the government and therefore, the more anxious they were. Finally, older age predicted higher interest in the pandemic, higher subjective health, and higher confidence in the government. Identifying obesity as a potential risk factor for anxiety disorders is crucial, but measuring the relationship between state anxiety and personal characteristics (e.g. BMI) requires considering mediating variables (e.g. subjective health perception). To reduce anxiety in women with obesity, it appears necessary to focus on psychological programs that can help them improve their perception of their health, as well as the confidence they may have in institutions, especially for younger women.
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Affiliation(s)
- Isabel Urdapilleta
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
| | - Lionel El Khoury
- Digestive Surgery Department, Delafontaine Hospital, Saint-Denis, France
| | | | - Saadi Lahlou
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Paris Institute for Advanced Study, Paris, France
| | - Samuel Demarchi
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
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El Khoury L, Catheline JM, Taher M, Roussel J, Bendacha Y, Romero R, Dbouk R, Cohen R. Re-sleeve gastrectomy is a safe and sensible intervention in selected patients: retrospective cohort study. Int J Surg 2023; 109:4145-4150. [PMID: 37707529 PMCID: PMC10720822 DOI: 10.1097/js9.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Sleeve gastrectomy is a good treatment intervention to control the metabolic syndrome in patients with obesity worldwide. However, weight regain is of great concern and would usually necessitate a reintervention. In recent years, re-sleeve gastrectomy (ReSG) has been proposed to treat weight regain in the context of a large residual stomach. Our objective was to analyze the long-term results and safety profile of this intervention in a large case series. METHODS From September 2010 to March 2021, a retrospective cohort study in a tertiary nonuniversity hospital was performed. Seventy-nine patients received a ReSG by laparoscopy. Preoperative radiologic imaging showed a dilation of the gastric pouch exceeding 250 cc in all cases. RESULTS A total of 79 patients (87% females) with a mean age of 44.8 years old and a mean BMI of 40.0 kg/m 2 were enrolled in the study. The mean follow-up was 44.8 months. The ReSG indication was insufficient weight loss in 37 patients (46.8%) and weight regain in 39 patients (53.2%). The authors noticed a 10.1% complications rate: gastric stenosis (5.1%), bleeding (2.5%), and incisional site hernia in 2.5%, with no death. There was no gastric fistula detected. The mean BMI decreased to 33.1 kg/m 2 after ReSG (a decrease of 6.9 kg/m 2 ). CONCLUSION After insufficient weight loss or weight regain following sleeve gastrectomy and in the presence of localized or global gastric tube dilation, ReSG seems to be a good treatment choice and a safe procedure.
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Affiliation(s)
| | | | | | | | | | | | | | - Regis Cohen
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, Saint-Denis, France
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El Khoury L, Cohen R, Catheline JM. Letter to the Editor: Re-sleeve gastrectomy: weight loss, comorbidities and gerd evaluation in a large series with 5 years of follow-up. Updates Surg 2023:10.1007/s13304-023-01535-2. [PMID: 37389798 DOI: 10.1007/s13304-023-01535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Lionel El Khoury
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200, Saint-Denis, France
| | - Régis Cohen
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200, Saint-Denis, France.
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200, Saint-Denis, France
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Spota A, Cereatti F, Granieri S, Antonelli G, Dumont JL, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Tranchart H, Lainas P, Danan D, Tuszynski T, Pacini F, Arienzo R, Trelles N, Soprani A, Lazzati A, Torcivia A, Genser L, Derhy S, Fazi M, Bouillot JL, Marmuse JP, Chevallier JM, Donatelli G. Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm. Obes Surg 2021; 31:4327-4337. [PMID: 34297256 DOI: 10.1007/s11695-021-05577-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE. PATIENTS AND METHODS We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment. Clinical success (CS) was evaluated considering referral delay, healing time, surgery, and complications type. Logistic regression was performed to identify variables of CS. RESULTS In the study period, we treated 339 fistulae (33.2%), 324 leaks (31.8%), 198 post-sleeve gastrectomy twist/stenosis (19.4%), 95 post-RYGB stenosis (9.3 %), 37 collections (3.6%), 15 LAGB migrations (1.5%), 7 weight regains (0.7%), and 2 hemorrhages (0.2%). Main endoscopic treatments were as follows: pigtail-stent positioning under endoscopic view for both leaks (CS 86.1%) and fistulas (CS 77.2%), or under EUS-guidance for collections (CS 88.2%); dilations and/or stent positioning for sleeve twist/stenosis (CS 80.6%) and bypass stenosis (CS 81.5%). After a median (IQR) follow-up of 18.5 months (4.29-38.68), complications rate was 1.9%. We found a 1% increased risk of redo-surgery every 10 days of delay to the first endoscopic treatment. Endoscopically treated patients had a more frequent regular diet compared to re-operated patients. CONCLUSIONS Endoscopic treatment of BS-AEs following a standardized algorithm is safe and effective. Early endoscopic treatment is associated with an increased CS rate.
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Affiliation(s)
- Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milan, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Giulio Antonelli
- Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint - Denis, Saint - Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Maurizio Fazi
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Jean-Luc Bouillot
- Service de Chirurgie Digestive et Obésité, Hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
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Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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7
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Donatelli G, Cereatti F, Dumont JL, Trelles N, Lainas P, Dammaro C, Tranchart H, Pacini F, Arienzo R, Chevalier JM, Danan D, Catheline JM, Dagher I. Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series. Obes Surg 2020; 30:4636-4642. [PMID: 32808166 DOI: 10.1007/s11695-020-04928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g., leiomyomas), a smaller portion may have a malignant potential (e.g., gastrointestinal stromal tumor (GIST)). Preoperative diagnosis of SMT in bariatric patients may arise challenging clinical dilemmas. Long-term surveillance may be difficult after bariatric surgery. Moreover, according to SMT location, its presence may interfere with planned surgery. Submucosal tunneling endoscopic resection (STER) has emerged as an effective approach for minimally invasive en bloc excision of SMTs. This is the first case series of STER for SMTs before bariatric surgery. METHODS Seven female patients underwent STER for removal of SMTs before bariatric surgery. All lesions were incidentally diagnosed at preoperative endoscopy. STER procedural steps comprised mucosal incision, submucosal tunneling, lesion enucleation, and closure of mucosal defect. RESULTS En bloc removal of SMT was achieved in all cases. Mean procedural time was of 45 min (SD 18.6). No adverse event occurred. Mean size of the lesions was 20.6 mm (SD 5.8). Histological diagnoses were 5 leyomiomas, 1 lipoma, and 1 low grade GIST. Bariatric procedure was performed after a mean period of 4.1 months (SD 1.6) from endoscopic resection. CONCLUSION STER is a safe and effective treatment for the management of SMT even in bariatric patients awaiting surgery. Preoperative endoscopic resection of SMTs has the advantages of reducing the need for surveillance and removing lesions that could interfere with planned surgery. STER did not altered accomplishment of bariatric procedures.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Nelson Trelles
- Service de Chirugie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital AP-HP, Clamart, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital AP-HP, Clamart, France
| | - Hadrian Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital AP-HP, Clamart, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevalier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital AP-HP, Clamart, France
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8
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El Khoury L, Benvenga R, Roussel J, Romero R, Cohen R, Habib N, Catheline JM. Fetal spina bifida in a pregnant woman following omega gastric bypass: Case report and literature review. Int J Surg Case Rep 2020; 70:137-139. [PMID: 32417729 PMCID: PMC7229410 DOI: 10.1016/j.ijscr.2020.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Nutritional status in a pregnant woman is crucial. It determines the fetal outcome. We added a case of spina bifida after Omega Gastric Bypass. Biochemical and ultrasound monitoring should be performed regularly in pregnant women with a history of bariatric surgery. Vitamins, minerals and trace metals deficiencies after bypass bariatric surgery could be prevented by adequate supplementation administered before and during pregnancy.
Introduction Bariatric surgery has been increasingly popular during the last years because of its proven efficacy on obesity and related complications. However, nutrient deficiency is common after surgery, in particular after Roux-en-Y gastric bypass (RYGB) or omega gastric bypass (OGB), due to iatrogenic malabsorption. All vitamins and minerals could be involved, including vitamin B9 which plays an important role in the prevention of neural tube defects during pregnancy. We present a case of a spina bifida in the fetus of a pregnant woman following OGB. Case presentation A twenty-six years old young woman underwent OGB five years after weight loss failure post sleeve gastrectomy. Her initial body mass index (BMI) was 42.7 kg/m2. Two years after OGB, she became pregnant. On her gynecologist’s advice, the patient discontinued daily vitamin intake before the end of the first trimester, as obstetrical follow-up had been considered appropriate. Regrettably, second trimester ultrasound showed myelomeningocele and surgical abortion was decided during the 25th week of pregnancy. Discussion Nutritional status in a pregnant woman is crucial, since it determines the fetal outcome. Biochemical and ultrasound monitoring should be performed regularly, especially in pregnant women with a history of bariatric surgery. Conclusion Vitamins, minerals and trace metals deficiencies after bypass bariatric surgery could be prevented by adequate supplementation administered before and during pregnancy.
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Affiliation(s)
- Lionel El Khoury
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - Rosa Benvenga
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - Joel Roussel
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - Rodolfo Romero
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - Regis Cohen
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
| | - Nassir Habib
- Department of Gynaecology and Obstetrics, Centre Hospitalier Francois Quesnay, 78200 Mantes La Jolie, France.
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Delafontaine, 93200 Saint-Denis, France.
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9
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Urdapilleta I, Lahlou S, Demarchi S, Catheline JM. Women With Obesity Are Not as Curvy as They Think: Consequences on Their Everyday Life Behavior. Front Psychol 2019; 10:1854. [PMID: 31474907 PMCID: PMC6707138 DOI: 10.3389/fpsyg.2019.01854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022] Open
Abstract
Two studies explore the impact of body size on daily life activities of women with obesity. In the first study, ethnographic techniques (first-person perspective video recordings) and subsequent interviews based on the video recordings were used. Results showed atypical behavior of women with obesity and ex-obese women related to memories of embarrassing experiences regarding personal body size (sitting, passing doors sideways, over-careful navigation in public space, and choosing clothes sizes too large.) Women with obesity seem to behave as if they thought they had a larger body than it actually was. These atypical behaviors are related to memories of embarrassing experiences regarding personal body size and stigma. Overweight women exhibit the same behavior but to a lesser and less systematic degree. In the second study, the represented (imagined) body size was compared to the perceived (in a mirror) body size with digital morphing techniques. In the mirror condition, the perceived image is accurate, while in the absence of a mirror women with obesity overestimate their body size by about 30%. Moreover, overestimation of imagined body size increased according to the weight status. Finally, women who had bariatric surgery had poorer estimates than women who had not. This would result of being continuously reminded of obesity and its stigma by daily embarrassing experiences, by being confronted with an environment designed for normal weight (e.g., narrow seats, turnstiles etc.) that makes obesity salient. We suggest that body size overestimation is a case of accentuation where things that matter are perceived bigger. These results could also been explained by the allocentric lock theory.
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Affiliation(s)
| | - Saadi Lahlou
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Paris Institute for Advanced Study, Paris, France
| | - Samuel Demarchi
- Department of Psychology, Paris 8 University, Saint-Denis, France
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10
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Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, De Angelis N, Ouaissi M, Sielezneff I, Karoui M, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Regimbeau JM, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer L, Bege T, Corte H, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Lefevre JH, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, De la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21:782-790. [PMID: 30884089 DOI: 10.1111/codi.14614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - D Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - V Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - A Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - T Voron
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint Antoine Hospital, Sorbonne Université, Paris, France
| | - N De Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - M Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
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11
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Carette C, Levy R, Eustache F, Baron G, Coupaye M, Msika S, Barrat C, Cohen R, Catheline JM, Brugnon F, Slim K, Barsamian C, Chevallier JM, Bretault M, Bouillot JL, Antignac JP, Rives-Lange C, Ravaud P, Czernichow S. Changes in total sperm count after gastric bypass and sleeve gastrectomy: the BARIASPERM prospective study. Surg Obes Relat Dis 2019; 15:1271-1279. [PMID: 31147284 DOI: 10.1016/j.soard.2019.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The massive weight loss induced by bariatric surgery is associated with major benefits, but the effect on semen variables is still uncertain. OBJECTIVES To explore semen modifications with gastric bypass and sleeve gastrectomy. SETTING Five French University Hospitals. METHODS Male candidates for bariatric surgery with no history of infertility were recruited in this controlled prospective study. Sperm characteristics were collected before surgery and then 6 months and up to 12 months after surgery. RESULTS Forty-six adult men who underwent gastric bypass (n = 20) or sleeve gastrectomy (n = 26) were included. Total sperm count tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups, at -69.5 million (-96.8 to -42.2 million; P = 0.0021). Total sperm count at 12 months relative to baseline was -41.4 million (P = .0391) after gastric bypass and -91.1 million (P = .0080) after sleeve gastrectomy. This was counterbalanced by an associated resolution of hypogonadism and decrease of DNA fragmentation in most patients with time after surgery. CONCLUSION Improvement in some semen variables after bariatric surgery observed in 3 previous studies is in contrast to the lower mean total sperm count found in this study at 1 year. The possible reversibility of this effect in the long term and the impact of surgery on fertility both remain unknown.
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Affiliation(s)
- Claire Carette
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France.
| | - Rachel Levy
- Hôpital Tenon, Service de Biologie de la Reproduction, APHP, Université Pierre et Marie Curie, Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, Sorbonne Universités, Université Pierre et Marie Curie, IHU ICAN, Paris, France
| | - Florence Eustache
- Hôpital Jean-Verdier, Hôpitaux Universitaires Paris Seine-Saint-Denis, Biologie de la Reproduction, CECOS, APHP, Bondy, France
| | - Gabriel Baron
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
| | - Muriel Coupaye
- Service des Explorations Fonctionnelles, Centre Integre Nord Francilien de prise en charge de l'Obesite (CINFO), Hopital Louis Mourier, APHP, Colombes, France
| | - Simon Msika
- Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier, APHP, Colombes, France
| | - Christophe Barrat
- Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, Service de Chirurgie Générale et Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), APHP, Bobigny, France
| | - Régis Cohen
- Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, Chirurgie de l'Obésité, Saint-Denis, France
| | - Jean-Marc Catheline
- Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, Chirurgie de l'Obésité, Saint-Denis, France
| | - Florence Brugnon
- CHU Clermont Ferrand, Pole Femme Enfants, CECOS, AMP, 1 place Aubrac Clermont Ferrand & IMoST, INSERM 1240, Faculté de médecine, Place Henri Dunand, Clermont Ferrand, France
| | - Karem Slim
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service de Chirurgie Générale et Digestive, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Charles Barsamian
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Hôpital Européen Georges Pompidou, Service de Chirurgie Digestive, APHP, Université Paris Descartes, Paris, France
| | - Marion Bretault
- Hôpital Ambroise Paré, Service de Nutrition, APHP, Université Versailles Saint Quentin, Boulogne-Billancourt, France
| | - Jean-Luc Bouillot
- Hôpital Ambroise Paré, Service de Chirurgie Digestive, APHP, Université Versailles Saint Quentin, Boulogne-Billancourt, France
| | - Jean-Philippe Antignac
- Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), UMR 1329 Oniris-INRA, Nantes, France
| | - Claire Rives-Lange
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France
| | - Philippe Ravaud
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
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Benhalima B, Benhalima Z, Catheline JM, Khayat Z, Saifi R. 0480 Echocardiographic Study In Obese Patients With And Without Sleep Apnea, Hypoventilation Syndrome, Or Both. Sleep 2019. [DOI: 10.1093/sleep/zsz067.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Rachid Saifi
- Centre du sommeil, Le Bourget, France, Le Bourget, France
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13
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Fysekidis M, Bouchoucha M, Bihan H, Reach G, Cohen R, Benamouzig R, Catheline JM. Decreased Prevalence of Nonspecific Functional Bowel Disorders and Increased Constipation in Patients after Sleeve Gastrectomy or Gastric Banding. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0030] [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] [Indexed: 12/30/2022] Open
Affiliation(s)
- Marinos Fysekidis
- Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, Bobigny, France
| | - Michel Bouchoucha
- Gastroenterology Department, Avicenne Hospital, Bobigny, France
- Physiology Department, Université René Descartes, Paris V, Paris, France
| | - Hélène Bihan
- Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, Bobigny, France
| | - Gérard Reach
- Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, Bobigny, France
| | - Regis Cohen
- Diabetes, Nutrition and Endocrinology Department, Delafontaine Hospital, Saint Denis, France
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Donatelli G, Dumont JL, Pourcher G, Tranchart H, Tuszynski T, Dagher I, Catheline JM, Chiche R, Marmuse JP, Dritsas S, Vergeau BM, Meduri B. Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos). Surg Obes Relat Dis 2016; 13:943-950. [PMID: 27955962 DOI: 10.1016/j.soard.2016.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 07/01/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%-4% of cases. OBJECTIVES To report our experience, results, and long-term follow-up after pneumatic dilation of late functional helix stenosis after laparoscopic sleeve gastrectomy. SETTING Multicenter study led by an endoscopic tertiary referral center. METHODS Thirty-five patients were dilated initially at 30 mm. Thirteen out of 35 patients underwent a second dilation up to 35 mm. Only 8 patients underwent a third pneumatic dilation up to 40 mm. The stricture was localized in the mid-body of the sleeve in 32 patients overall; 3 had narrowing adjacent to the cardia. Eleven twists formed an acute angle between the 2 segments of the stomach, whereas 24 angles were obtuse. Seven out of 35 patients presented with persistent dilated pouch above the twist. Two patients were lost to follow-up. Overall outcome at an average follow-up of 15.5 months after primary surgery (range 7-49 mo) was as follows: 12 clinical failures and 1 technical failure (40%) and 60% (20 out of 33) clinical success. CONCLUSION Pneumatic dilation of late functional helix stricture is an effective technique for treatment of dysphagia in the majority of patients treated. Complete helix stricture, defined in function of the angle within twist, as well as the presence of a persistently dilated gastric pouch above the kinking, seems to be correlated with higher failure rates.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Guillame Pourcher
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Hadrien Tranchart
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Ibrahim Dagher
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Jean-Marc Catheline
- Service de Chirurgie Viscérale, Centre Hôspitalier de Saint-Denis, Saint-Denis, France
| | - Renaud Chiche
- Service de Chirurgie Viscérale, Clinique Geoffry Sant Hilaire, Ramsay Générale de Santé, Paris, France
| | - Jean-Pierre Marmuse
- Service de Chirurgie Digestive et Viscérale, Hôpital Universitaire Bichat - Claude Bernard - AP-HP, Paris, France
| | - Stavros Dritsas
- Service de Gastroenterologie, Hôpital René Dubos, Pontoise, France
| | | | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
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15
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Bouchoucha M, Fysekidis M, Julia C, Airinei G, Catheline JM, Reach G, Benamouzig R. Functional Gastrointestinal Disorders in Obese Patients. The Importance of the Enrollment Source. Obes Surg 2016; 25:2143-52. [PMID: 25904236 DOI: 10.1007/s11695-015-1679-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity is frequently associated to many functional gastrointestinal disorders. The aim of the present study was to assess the prevalence of functional gastrointestinal disorders in obese patients, according to their body mass index and their recruitment source. METHODS Five hundred ninety-six obese patients (body mass index (BMI) > 30) filled out a standard questionnaire in order to evaluate the presence of functional gastrointestinal disorders. They were divided into four groups according to the Rome III criteria and their BMI: OF, obese patients from functional gastrointestinal disorder (FGID) enrollment; OO, obese patients from obesity management enrollment; MF, morbid obesity patients from FGID enrollment; and MO, morbid obesity patients from obesity management enrollment. Data analysis was performed using multivariate logistic regression. RESULTS Out of the 596 obese patients included in the present study, 183 (33 %) were complaining of FGIDs, while 413 (67 %) were consulting for obesity management. Compared to the OF group, the OO patients had a higher prevalence of females (P = 0.008) and a younger age (P < 0.001). Clinically, they reported a lower incidence of regurgitation (P = 0.044), of chest pain (P = 0.004), of irritable bowel syndrome (IBS; P = 0.035), and of functional diarrhea (P = 0.030). Compared to the MF group, the MO patients had an older age (P = 0.001), a higher BMI (P = 0.013), and clinically by a high frequency of functional dyspepsia (P = 0.006). There were symptoms that had similar prevalence in all groups (OF, OO, MF, MO) such as epigastric pain, postprandial distress, constipation, diarrhea, bloating, abdominal pain soiling, or nonspecific anorectal disorders. CONCLUSIONS This study has shown that the recruitment source accounted for marked and specific differences in the prevalence of functional gastrointestinal disorders in obesity and morbid obesity. Symptoms with similar prevalence in all groups should be systematically detected in all patients.
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Affiliation(s)
- Michel Bouchoucha
- Physiology Department, Université René Descartes, Paris V, Paris, France. .,Gastroenterology Department, Avicenne Hospital, Bobigny, France.
| | - Marinos Fysekidis
- Diabetes, Nutrition and Endocrinology Department, Avicenne Hospital, Bobigny, France
| | - Chantal Julia
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), UFR SMBH 74 rue Marcel Cachin, 93017, Bobigny, France
| | | | | | - Gérard Reach
- Diabetes, Nutrition and Endocrinology Department, Avicenne Hospital, Bobigny, France
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16
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Bekheit M, Abdelsalam WN, Sgromo B, Catheline JM, Katri K. Is conservative management for gastric perforation secondary to intragastric balloon possible? Case report and review of literature. Obes Surg 2015; 24:968-70. [PMID: 24737311 DOI: 10.1007/s11695-014-1244-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intragastric balloon (IGB) is one of the available options for the management of morbid obesity. The procedure is generally safe and of moderate efficacy in most of the cases. One of the reported complications of IGB is gastric perforation. The management of this complication is classically surgical. To our knowledge, conservative management for gastric perforation secondary to IGB has not been reported. A 27-year-old female patient presented with sudden abdominal pain in the left upper quadrant, 2 months after having an IGB placed. The provisional diagnosis was gastric perforation. Balloon extraction was performed and a conservative management of the gastric perforation was pursued successfully. We therefore propose that this sort of management might be adopted in carefully selected cases.
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Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt,
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Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Obes Surg 2015; 24:1400-7. [PMID: 24898719 DOI: 10.1007/s11695-014-1298-7] [Citation(s) in RCA: 36] [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: 02/08/2023]
Abstract
BACKGROUND Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved. METHODS In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4-98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation. RESULTS Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26-45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25-42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26- 180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20-276). CONCLUSIONS EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, 8 Place de l'Abbé G. Henocque, 75013, Paris, France,
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Bekheit M, Katri K, Ashour MH, Sgromo B, Abou-ElNagah G, Abdel-Salam WN, Catheline JM, El Kayal ES. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc 2014; 28:2406-11. [PMID: 24648106 DOI: 10.1007/s00464-014-3489-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/14/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying factors that influence weight loss after bariatric surgery is one way to predict a successful surgical outcome. Knowledge of the effect of gender on weight loss after bariatric surgery has not been well demonstrated in the literature despite being noted in every day practice. The aim of this study was to find the influence of gender on long-term weight loss after bariatric surgery. METHODS A retrospective analysis of data retrieved from a prospectively maintained bariatric database was conducted. RESULTS The study included 640 consecutive patients. Their mean age was 38 ± 10 years, mean preoperative body mass index was 44.9 ± 8.4 kg/m2, and mean preoperative excess weight (EW %) was 108.3 ± 38.4%. The mean of the average excess weight loss (EWL %) was 43.3 ± 42.4%. Three procedures were utilized: Roux-en-Y gastric bypass (RYGB), vertical banded gastroplasty (VBG), and gastric banding (GB). Both VBG and RYGB induced significantly more EWL % than GB (d = 22.1%, p < 0.001 and d = 16, p = 0.02, respectively). In patients who underwent VBG and GB, males had significantly lower preoperative EW % (Student t = -4.86, p < 0.001, and Student t = 4.69, p < 0.001, respectively), and postoperative mean of the average EWL % (Student t = -2.43, p = 0.016, and Student t = -3.33, p = 0.002, respectively) than females. In patients who underwent RYGB, there were no differences in the preoperative EW % (t = -1.03, p = 0.309) or the mean of the average EWL % (t = 0.406, p = 0.688). The simple linear regression model used to explain the variability in EWL %, accounted for by the variability in the preoperative EW %, was significant (F = 180, p < 0.001). Analysis of the residual errors in predicting the EWL % revealed no significant difference between males and females after VBG and after RYGB (t = 0.117, p = 0.907 and t = 1.052, p = 0.3, respectively), while it was significant after GB (t = -2.999, p = 0.003). CONCLUSION From our experience, we suggest that GB not to be offered as a first choice for obese male patients.
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Affiliation(s)
- Mohamed Bekheit
- Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt,
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Bekheit M, Katri K, Abdel-Salam W, Abdelbaki T, Sgromo B, Catheline JM, ElNagah G, El Kayal ES. Technical tips associated with reduction in leak rate after laparoscopic sleeve gastrectomy: lessons to learn from a nested case-control study. Egypt J Surg 2014. [DOI: 10.4103/1110-1121.131682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fysekidis M, Bouchoucha M, Bihan H, Reach G, Benamouzig R, Catheline JM. Prevalence and co-occurrence of upper and lower functional gastrointestinal symptoms in patients eligible for bariatric surgery. Obes Surg 2012; 22:403-10. [PMID: 21503810 DOI: 10.1007/s11695-011-0396-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obesity is considered as a risk factor for many functional digestive disorders. The aim of the present study was to evaluate the prevalence and the association of functional digestive symptoms affecting the upper and the lower digestive tract in patients eligible for bariatric surgery. METHODS Before surgery, 120 consecutive patients with normal upper endoscopy (7.5% males, mean BMI 44 ± 6 m/kg(2)) have filled a standard questionnaire in order to evaluate the presence of depressive symptoms and functional digestive disorders according to the Rome criteria. The major symptoms (esophageal, gastroduodenal, anorectal, and abdominal pain) were coded as dichotomous variables. Data analysis was performed using multivariate logistic regression with a backwards selection procedure adjusted only for the variables that were significant in univariate analysis (p < 0.05). RESULTS Functional symptoms were present in 89% of the subjects (2.5 functional digestive symptoms/subject). Depression symptoms were found in 43% of the patients. Esophageal symptoms were independent predictors for the presence of gastric, bowel, and anorectal symptoms. Functional abdominal pain and bowel symptoms were present, respectively, in 19% and 84% of the patients. Approximately half of the patients have specific functional bowel disorders (28.6% constipation, 18% irritable bowel syndrome, 18% diarrhea, 1% bloating) and 35.7% have non-specific bowel disorders. Anorectal symptoms were found in 40% of the patients: difficult defecation in 32% and fecal incontinence in 9.8% of the patients. Depression was an independent predictor for anorectal symptoms. CONCLUSIONS This study shows the high prevalence of functional bowel symptoms in patients complaining of morbid obesity.
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Affiliation(s)
- Marinos Fysekidis
- Diabetes, Nutrition and Endocrinology Department, Avicenne Hospital, Bobigny, France
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Bihan H, Choleau C, Catheline JM, Reach G, Fournier JL, Garnier N, Robert F, Poulhès C, Sidotmane F, Bénichou J, Cohen R. Parcours multidisciplinaire du candidat à une gastroplastie. Presse Med 2008; 37:470-6. [PMID: 17618077 DOI: 10.1016/j.lpm.2007.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The decision to perform gastroplasty must be made by a multidisciplinary team. This organization ensures compliance with good practice guidelines. Multidisciplinary management after surgery is also essential but patients' adhesion to follow-up is relatively poor.
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Affiliation(s)
- Hélène Bihan
- Service d'endocrinologie et Université Paris XIII (Centre de recherche en nutrition humaine)
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Uzzan B, Catheline JM, Lagorce C, Airinei G, Bon C, Cohen R, Perret GY, Aparicio T, Benamouzig R. Expression of ghrelin in fundus is increased after gastric banding in morbidly obese patients. Obes Surg 2008; 17:1159-64. [PMID: 18074488 DOI: 10.1007/s11695-007-9197-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ghrelin, a 28 amino-acid acylated orexigenic peptide secreted by the stomach, acts on the hypothalamic arcuate nucleus which stimulates feeding behavior. Serum ghrelin level increases during fasting and decreases after a meal. Serum ghrelin is low in obese patients.Whether ghrelin is implicated in weight loss in obese patients after laparoscopic adjustable gastric banding (LAGB) is still debated. In this study, we assessed serum ghrelin level and gastric fundus expression before and 1 year after LAGB. METHODS Gastric fundus expression of ghrelin was assessed by immunohistochemistry using a rabbit anti-human ghrelin antibody simultaneously with serum total ghrelin levels (RIA) in 13 obese patients (2 men and 11 women) after an overnight fast, before LAGB and 1 year after. Immunostaining was "blindly" analyzed by a single pathologist, measuring the density of stained fundic cells near muscularis mucosa. RESULTS Mean age of the 13 patients was 41 years, and mean baseline BMI was 46 kg/m2. Pre- and post-LAGB gastric expression of ghrelin was analyzable in 11 patients. It was always identified, mostly with moderate or intense staining. Mean density of stained cells significantly increased 1 year after LAGB: 31/mm2 (21-38) before vs 38/mm2 (27-57) after surgery (P<0.01). This increase did not correlate with changes in BMI, nor did pre- or postoperative gastric expression of ghrelin correlate with the corresponding serum values. CONCLUSION We showed for the first time that ghrelin expression assessed by immunohistochemistry was present in the fundus of all 11 obese patients and that it was significantly increased 1 year after LAGB, which would exclude a pathogenetic role of ghrelin in weight loss after LAGB.
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Affiliation(s)
- Bernard Uzzan
- Department of Pharmacology-Hormonology, Hôpital Avicenne, Assistance Publique--Hôpitaux de Paris, Bobigny, France
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Catheline JM, Bihan H, Le Quang T, Sadoun D, Charniot JC, Onnen I, Fournier JL, Bénichou J, Cohen R. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg 2008; 18:271-7. [PMID: 18204992 DOI: 10.1007/s11695-007-9329-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 10/29/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Morbidly obese patients have a high prevalence of known and unknown cardiopulmonary diseases. The aim of this study was to assess the value of cardiopulmonary tests routinely performed before bariatric surgery. METHODS The population studied included 67 women and 10 men, aged 39 +/- 10 years, with a body mass index of 43 +/- 4 kg/m2. All patients, candidates for laparoscopic gastric banding, underwent after clinical evaluation: resting electrocardiography (ECG), Doppler-echocardiography, exercise stress testing, Epworth Sleepness Scale, and polysomnography, spirometry, blood gases, and chest x-ray. RESULTS The ECG demonstrated conduction or ST-T wave abnormalities in 48 patients (62%). Prolongation of the QT interval >10% was found in 13 patients (17%). Stress tests were negative in 56 patients (73%) and were not interpretable in the remaining 21 patients (27%). Doppler-echocardiography showed hypertrophy of the left ventricular posterior wall in 47 patients (61%) without any consequences on perioperative management. Polysomnography showed an obstructive sleep apnea-hypopnea syndrome (OSAHS) in 31 patients (40%), leading to preoperative continuous positive airway pressure (CPAP) treatment in 17 patients (22%). Nevertheless, the Epworth Sleepness Scale was pathological in only 17 patients (22%). Ten patients (13%) presented minor chest x-ray alterations. Spirometry demonstrated an obstructive respiratory syndrome in 13 patients (17%) and a restrictive syndrome in five patients (6%). Hypoxemia <80 mmHg was observed in 21 patients (27%) and hypercapnia >45 mmHg in six patients (8%), without any consequences on the management of the perioperative period. CONCLUSION We recommend the preoperative assessment by clinical evaluation, ECG, and polysomnography. For patients with cardiac or pulmonary histories and/or ECG abnormalities, we recommend echocardiography, spirometry, and blood gases.
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Affiliation(s)
- Jean-Marc Catheline
- Bariatric Surgical College, Hôpital Avicenne Assistance Publique - Hôpitaux de Paris, Bobigny, France.
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Abstract
UNLABELLED INTEREST OF WORK: The longitudinal or "sleeve" gastrectomy was recently introduced into the therapeutic arsenal of the bariatric surgeon. It is a restrictive procedure that reduces stomach capacity by 75%. We present here a preliminary experience with four patients. METHODS Four patients with super super obesity (body mass index (BMI)>60 kg/m2) underwent longitudinal or "sleeve" gastrectomy. Their average preoperative weight was 173 kg (range: 147-190 kg) and mean BMI 65 kg/m2 (range: 61-67 kg/m2). RESULTS The average post-operative follow-up was 6 months (range: 2-12 months). Average weight loss at 6 months was 40 kg (range: 20-60 kg) and average decrease in BMI at 6 months 16.3 kg/m2 (range: 6-23 kg/m2). We noted a postsurgical complication in only one patient (subdiaphragmatic abscess treated with drainage). PERSPECTIVES These preliminary results suggest that the sleeve gastrectomy is associated with few perioperative complications and offers rapidly effective treatment for super super morbid obesity. Long-term results require further investigation.
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Affiliation(s)
- Jean-Marc Catheline
- Service de Chirurgie Digestive, Centre de Recherche en Nutrition Humaine, Laboratoire de Pédagogie de la Santé Education et Observance, Hôpital Avicenne, Bobigny
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Catheline JM, Capelluto E, Gaillard JL, Turner R, Champault G. Thromboembolism prophylaxis and incidence of thromboembolic complications after laparoscopic surgery. Int J Surg Investig 2003; 2:41-7. [PMID: 12774337] [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: 03/02/2023]
Abstract
UNLABELLED The aim of this prospective study was to assess the clinical thrombo-embolic risk in laparoscopic digestive surgery. METHODS The study prospectively included 2384 patients, who underwent laparoscopic surgery between June 1992 and June 1997. All patients received peri-operative low molecular weight heparin (LMWH) thromboprophylaxis. This regimen was administered until the patient resumed normal ambulatory activity. RESULTS Eight cases (0.33%) of deep vein thrombosis (DVT) were observed, but no pulmonary embolism was noted. In 6 cases (5 cholecystectomies with reverse Trendelenburg position and 1 inguinal hernia repair), the pneumoperitoneum was more than 2 h, and in 2 cases (1 rectopexy and 1 sigmoid colectomy for diverticulitis), more than 3 h. In 6 out of the 8 cases, the diagnosis of DVT was established after cessation of LMWH delivery, after the patients were discharged home, and before post-operative day 10. CONCLUSION During laparoscopic surgery, long operations and reverse Trendelenburg position are potentiating factors to DVT. Heparin prophylaxis for laparoscopic procedures should continue at least until discharge, and continued prophylaxis after discharge should only be considered in individual patients at continued high risk. We also recommend using graduated compression stockings, maintaining a relatively low insufflation pressure, keeping use of the reverse Trendelenburg position to a minimum, and intermittently releasing the pneumoperitoneum in longer procedures.
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Affiliation(s)
- J M Catheline
- Department of Digestive Surgery, Paris University Hospital, Hôpital Jean Verdier AP-HP, 93143 Bondy, France.
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Catheline JM, Turner R, Paries J. Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy. Br J Surg 2002; 89:1235-9. [PMID: 12296889 DOI: 10.1046/j.1365-2168.2002.02198.x] [Citation(s) in RCA: 27] [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] [Indexed: 12/16/2022]
Abstract
Abstract
Background
Intraoperative cholangiography and laparoscopic ultrasonography are both used in the detection of common bile duct stones at laparoscopic cholecystectomy. The aim of this prospective study was to determine whether laparoscopic ultrasonography has an alternative or a complementary role with respect to cholangiography in achieving this end.
Methods
The biliary trees of 900 patients undergoing laparoscopic cholecystectomy were examined routinely by the two methods. The diagnostic power of each investigation and of the two techniques in combination was evaluated. The statistical non-random concordance between the two methods was also determined.
Results
Laparoscopic ultrasonography was performed in all 900 patients. Cholangiography was performed in 762 (85 per cent). The mean (range) duration was 9·8 (4–21) min for laparoscopic ultrasonography and 17·6 (7–42) min for cholangiography. For the detection of common bile duct stones, with a kappa coefficient of 0·57 (95 per cent confidence interval (c.i.) 0·43 to 0·71), the non-random concordance between the two methods was considered to be fair to good. The sensitivity of laparoscopic ultrasonography was 0·80 (95 per cent c.i. 0·65 to 0·91) and its specificity was 0·99 (95 per cent c.i. 0·98 to 1·00). The respective values for cholangiography were 0·75 (95 per cent c.i. 0·59 to 0·87) and 0·99 (95 per cent c.i. 0·98 to 1·00). The examinations combined had a sensitivity of 0·95 (95 per cent c.i. 0·86 to 0·99) and a specificity of 0·98 (95 per cent c.i. 0·96 to 1·00).
Conclusion
Laparoscopic ultrasonography and intraoperative cholangiography are complementary, as the combination of both methods maximizes the intraoperative detection of choledocholithiasis.
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Affiliation(s)
- J M Catheline
- Department of Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
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Catheline JM. [Laparoscopic ultrasonography of the liver and the biliary tract]. J Chir (Paris) 2002; 139:160-4. [PMID: 12391667] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- J M Catheline
- Service de Chirurgie Générale et Digestive, Hôpital Jean Verdier-Bondy.
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Abstract
The role of laparoscopic resection in the management of colorectal cancer is still unclear. It has been shown that laparoscopic colectomies can be accomplished with acceptable morbidity. Major concerns are port-site recurrences and neoplastic dissemination. The aims of this study were to compare perioperative results and long-term outcomes in a prospective, nonrandomized study of patients treated by laparoscopic versus open colorectal resection for cancer. In particular, the effects of an initial laparoscopic approach on survival and recurrence were examined. One hundred fifty-seven patients with colorectal carcinoma were included in the prospective trial: 74 underwent laparoscopic resection and 83 underwent conventional open surgery. The two groups were comparable in terms of characteristics, demographic data, stage of disease, and use of adjuvant or palliative chemoradiotherapy. All patients were observed at 1.3- and 6-month intervals. The median duration of follow-up was 60 months (range, 10-125 months). The mean operating time was significantly longer in the laparoscopic group. Six conversions (8.1%) were necessary. The passage of flatus and the restarting of oral intake (P = 0.0001) occurred earlier in the laparoscopic surgery group than in the open conventional surgery group. The mean postoperative stay was significantly shorter in the former group (P = 0.005), as was the length of the scar (P = 0.001). There were no deaths in either group. The overall morbidity was significantly lower (13% versus 33.7%; P = 0.001) in patients treated laparoscopically. No significant differences were observed between the groups in the length of specimens, the size of the tumor, or the number of nodes removed. Late complications were more frequent after open resection (12% versus 5.4%; P = 0.01). Two port-site metastases (2.6%) were seen in stage III and IV locally advanced carcinoma. There was no significant difference in recurrent disease between the groups (24.3% versus 25%) during the 60-month follow-up. Stage-for-stage comparisons showed that disease recurrence rates and crude death rates were comparable.
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Affiliation(s)
- Gerard G Champault
- Department of Digestive Surgery, Paris University Hopital J. Verdier, Paris, France.
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Barrat C, Capelluto E, Catheline JM, Champault GG. Quality of life 2 years after laparoscopic total fundoplication: a prospective study. Surg Laparosc Endosc Percutan Tech 2001; 11:347-50. [PMID: 11822856 DOI: 10.1097/00129689-200112000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was a prospective evaluation of the quality of life of 50 patients after laparoscopic total fundoplication surgery for gastroesophageal reflux disease. The quality of life of 50 consecutive patients who underwent laparoscopic total fundoplication was evaluated using the Gastrointestinal Quality of Life Index questionnaire, which included 36 items in five different areas: symptoms, physical well-being, psychologic well-being, social relationships, and effects of medical treatment. Twenty-seven men and 23 women with a mean age of 52.6 +/- 16 years (range, 31-68 years) with gastroesophageal reflux disease were treated by laparoscopic total fundoplication (Nissen-Rosetti) and were included in the study. The follow-up was at least 2 years after surgery. The quality of life was evaluated before the surgery and 1 month, 3 months, 6 months, 1 year, and 2 years after surgery with follow-up in 100% of the cases. A control group of 50 healthy volunteers representing an identical population to that of the patients operated on (with respect to age, sex, body mass index, profession, and smoking) anonymously completed the same questionnaire. The preoperative and postoperative Gastrointestinal Quality of Life Index questionnaire scores of patients who had laparoscopic total fundoplication were compared with the Gastrointestinal Quality of Life Index questionnaire scores of the control group. Before surgery, the Gastrointestinal Quality of Life Index questionnaire score (86.7 +/- 8.5) was much inferior to that of the control group (123.8 +/- 13.6) (P < 0.001). This score significantly improved 3 months after surgery and was comparable (not significant) to that of the healthy control population 3 months, 6 months, 1 year, and 2 years after surgery (119.3 +/- 7.8). Improvements were reported mainly with respect to gastrointestinal symptoms and physical well-being. Social relationships were not modified. The quality of life of patients after laparoscopic surgery for gastroesophageal reflux disease improved and was close to the level expected in a healthy individual.
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Affiliation(s)
- C Barrat
- Department of Digestive and Laparoscopic Surgery, Paris XIII University Hospital J. Verdier, Bondy, France
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31
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Capelluto E, Barrat C, Catheline JM, Champault G. [Quality of life one year after laparoscopic fundoplication is close to that of a control group: prospective study]. Ann Chir 2001; 126:440-4. [PMID: 11447795 DOI: 10.1016/s0003-3944(01)00542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY Prospective evaluation of the quality of life of patients after laparoscopic fundoplication for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS The quality of life of 30 consecutive patients who underwent laparoscopic fundoplication was evaluated using the GIQLI (gastrointestinal quality of life index) questionnaire, which included 36 items in five different areas: digestive symptoms, physical condition, emotional reaction, social integration and medical treatment. Seventeen men and 13 women (mean age: 50.2 +/- 17 years (32-68) were included with a follow-up of at least 1 year and with complete data available. The quality of life was evaluated before surgery, and at 1 month, 3 months, 6 months and 1 year after surgery with a 100% follow-up. Thirty healthy volunteers representing an identical population (with respect to age, sex, BMI, profession, smoking, etc.) anonymously filled in the same questionnaire. The pre- and postoperative GIQLI scores of patients operated for GERD were compared with the GIQLI score of the control group. RESULTS Preoperatively, the GIQLI score (87 +/- 9.5) was much lower than that of the control group (123.4 +/- 13.6) (p < 0.001). This score significantly improved 3 months and 1 year after surgery and was comparable to that of the healthy population (115.3 +/- 9.6 vs 123.4 +/- 13.6 [ns]). Improvements were reported mainly with respect to digestive symptoms and physical condition. Social integration was slightly modified. CONCLUSION The quality of life of patients after laparoscopic antireflux surgery was greatly improved and was close to the level expected in an healthy population. However, the study demonstrated the possible presence of postoperative functional digestive disorders, although these symptoms were not considered as being uncomfortable, since the level of satisfaction was 96.6% (n = 29).
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Affiliation(s)
- E Capelluto
- Université Paris XIII, UFR de médecine Bobigny-Bondy, service de chirurgie générale et digestive, CHU Jean-Verdier, avenue du 14-juillet, 93143 Bondy, France
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Champault G, Voreux JP, Occelli G, Barrat C, Catheline JM. [Impact of surgery training upon the results of inguinal hernia treatment operated using laparoscopy (757 cases)]. Chirurgia (Bucur) 2001; 96:9-13. [PMID: 12731162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- G Champault
- Université Paris XIII, UFR de Médecine de Bobigny, CHU Jean-Verdier-Service, Chirurgie Générale et Digestive, France.
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Abstract
OBJECTIVE Despite recent advances in medical imaging, pre-operative evaluation of liver tumors, whether benign or malignant, is often lacking in accuracy and precision. With the development of surgical laparoscopy, the benefits of diagnostic laparoscopy have been combined with those of operative ultrasound. This article aims to describe the technique of laparoscopic ultrasound of the liver, and to define its applications and the role of its association with diagnostic laparoscopy in the localization and assessment for resectability of liver tumors. METHODS After an initial visual inspection with the laparoscope, laparoscopic ultrasound is utilized to further examine the liver. This relies largely on recognition of branches of the portal vein and tributaries of the hepatic veins. During this procedure, the hepatic parenchyma is also examined. Minimal displacement of the transducer, using clockwise and anti-clockwise rotatory movements, allows a full exploration of the liver. RESULTS The combination of visual with sonographic laparoscopy allows accurate localization of benign and malignant hepatic tumors, as well as ultrasound-guided biopsies of these. Laparoscopic ultrasound can detect small lesions previously unseen by pre-operative imaging techniques. The relationship of tumors to adjacent blood vessels can be defined. Portal vein thrombosis can be diagnosed. CONCLUSION Curability and liver tumor resectability can be determined and the appropriate surgical treatment thus planned.
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Affiliation(s)
- J M Catheline
- Department of Surgery, Hôpital Jean Verdier, 'AP-HP', Avenue du 14 juillet, F-93143, Bondy, France.
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Cueto-Rozon R, Bordea A, Barrat C, Gillion JF, Catheline JM, Fagniez PL, Champault G. [Is laparoscopic treatment of adhesions a valid approach for postoperative abdominal pain?]. G Chir 2000; 21:433-7. [PMID: 11227141] [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]
Abstract
The role of post-operative adhesions in chronic abdominal pain remains controversial. The aim of this study was to assess the value of laparoscopic treatment of adhesions for chronic post-operative abdominal pain in 32 patients. Over a period of 8 years, 32 patients (25 women and 7 men) with a mean age of 41.5 years (18-69) were hospitalized for chronic abdominal pain of more than 6 months duration, without an obvious underlying neoplasm or psychiatric disorder. They had all undergone at least one previous abdominal operation (mean, 1.9; range, 1-5), with a mean follow-up of 28 months (6-82). The mean duration of the pain was 18 months (6-65) and in 24 of the 32 cases it was mainly hypogastric. Other than the presence of a scar, the clinical examination was completely normal. Prior to hospitalization, 163 different laboratory tests, 162 radiological investigations, including 13 CT scans and 3 MRIs, and 25 endoscopies had been performed. A pneumoperitoneum was made by "open laparoscopy" in 23 cases and with Verres needle in 9 cases. Eight patients (25%) did not have any adhesions, but 6 of them were found to have a gynecological problem (endometriosis). In this group, the laparoscopy lasted 34 minutes (15-45) and the mean hospital stay was 48 hours. In 24 cases, adhesions were found and selected. This was thought to be complete in 22 cases (91.6%). There was a strict correlation between the adhesions and the scar in 85% of cases. In 5 cases, the adhesions were associated with another intervention. There were no conversions. The mean duration of surgery and hospitalization was respectively 56 minutes (32-120) and 3.2 days. There was no mortality and the morbidity rate was 4.1% (1 monopolar injury). The average follow-up was 26.7 months: 22 of the 24 patients who had freeing of adhesions were evaluated after at least 6 months of follow-up. In 10 cases, the pain had completely resolved (45%), in 6 it had decreased (27%) and in 6 cases it was unchanged or had even worsened (1 case of endometriosis). Laparoscopic exploration for chronic post-operative abdominal pain, after an extensive work-up performed after a suitably long delay post-surgery, can be used to detect and treat adhesions in 3/4 cases. In the absence of another lesion, the pain is lessened in 72% cases. However, if there is another lesion, laparoscopic treatment of adhesions is less effective with respect to the pain, but it nevertheless can identify an.
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Affiliation(s)
- R Cueto-Rozon
- Service de Chirurgie générale et digestive, CHU Jean Verdier, Université Paris XIII-UFR de Médecine Bobigny-Bondy
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Barrat C, Cueto Rozon R, Catheline JM, Rizk N, Champault G. [The effect of the learning curve and the experience on the technique and the outcome of laparoscopic treatment for gastroesophageal reflux]. Chirurgia (Bucur) 2000; 95:325-33. [PMID: 14870537] [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: 04/28/2023]
Abstract
The laparoscopic treatment for gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period during which the rate of complications, and failures are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in 3 groups of consecutive patients in order to determine the effect of the learning period and the experience on the technique and the outcome. One hundred and fifty patients (84 men and 66 women) with an average age of 52.2 years (18 to 78) were included. Surgery was indicated for failure or early relapse following the end of medical treatment. The preoperative work-up (endoscopy, barium meal or oesophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of 50 patients around were chronologically defined. The parameters that were examined were: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results at short and medium term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GERD. All patients had an endoscopy, 91% a barium meal, 77.5% underwent esophageal manometry and 67% pH monitoring. One hundred and thirty two patients had a TF and 18 had a PF. Rosetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 mn.). The rate of conversion, due to a variety of causes, decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. There was 7 cases of relapse (4.6%), 5 in group 1 (10.2%) and 2 in group II (4%), with no cases in group III although the follow-up is shorter. There is an effect of the learning curve on the outcome of treatment for GR and this must be taken into account in the training of surgeons (training within experienced departments and "guidance" during their initial interventions) and also in publications in order to allow a more accurate comparison of the different treatments for GERD.
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Affiliation(s)
- C Barrat
- Université Paris XIII-UFR de Bobigny-Bondy, France
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Faranda C, Barrat C, Catheline JM, Champault GG. Two-stage laparoscopic management of generalized peritonitis due to perforated sigmoid diverticula: eighteen cases. Surg Laparosc Endosc Percutan Tech 2000; 10:135-8; discussion 139-41. [PMID: 10872974 DOI: 10.1097/00019509-200006000-00007] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [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: 11/25/2022]
Abstract
The classic treatment of generalized peritonitis due to perforation of sigmoid diverticula is based on the principle of a two-stage surgery with a temporary derivation of the colonic transit. This procedure is associated with a prohibitively high immediate and delayed morbidity, especially associated with the abdominal wound. The laparoscopic approach to this complication is less aggressive and allows a second-stage elective laparoscopic resection. Eighteen consecutive patients (ten women and eight men; average age, 53.7 years) underwent emergency laparoscopic treatment for generalized peritonitis due to perforated diverticula. Eight of these patients had previously had diverticulitis attacks. By peritoneal cavity exploration and full peritoneal lavage (average, 15 L), the infected sigmoid lesion was stuck with biologic glue. A drain was inserted at the site of the lesion and in some cases also in other abdominal zones. No colostomy was necessary. Antibiotic treatment was started at diagnosis and continued for a minimum of 7 days. There was no mortality. Morbidity was limited to three patients (two cases of lymphangitis and one of pulmonary disease). No patient had a wound abscess or residual deep collections. The mean hospitalization was 8 days. Fourteen patients underwent elective laparoscopic sigmoid resection with a delay of 3.5 months. One conversion to laparotomy was necessary. The laparoscopic treatment of generalized peritonitis due to perforated sigmoid diverticula is an interesting alternative to the traditional treatment. It is associated with a lower morbidity, a shorter postoperative hospital stay, and an improvement in the patient's quality of life, because colostomy is avoided. It is also associated with economic savings.
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Affiliation(s)
- C Faranda
- Paris University Hospital, Jean Verdier Hospital, Department of Digestive and Laparoscopic Surgery, Bondy, France
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37
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Catheline JM, Capelluto E, Turner R, Rizk N, Barrat C, Cazacu F, Champault G. [Comparison of laparoscopic ultrasound and cholangiography during laparoscopic cholecystectomies. Results of a prospective study]. Gastroenterol Clin Biol 2000; 24:619-25. [PMID: 10962383] [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: 02/17/2023]
Abstract
AIM Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies. METHODS The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography. RESULTS Laparoscopic ultrasound was performed in all 600 cases. Cholangiography was performed in 498 (83%). Laparoscopic ultrasound required less time than cholangiography: 10.2 minutes versus 17.9 minutes (P=0.0001). Common bile duct stones were detected intraoperatively in 40 cases (7%). Both methods were equally effective. The sensitivity of laparoscopic ultrasound was 80% and its specificity 99%. For cholangiography these values were 75% and 98% respectively. For laparoscopic ultrasound, false positives and false negatives were noted in the first 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15. CONCLUSION Laparoscopic ultrasound can be performed rapidly and in all cases. Results are comparable to cholangiography in the detection of common duct stones. Individual training is necessary to optimize efficacy. Anatomical anomalies are often missed.
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Affiliation(s)
- J M Catheline
- Service de Chirurgie Générale et Digestive, Hôpital Jean-Verdier, Bondy
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Catheline JM, Champault G. [Future prospects of laparoscopic ultrasonography]. Ann Chir 2000; 125:209-12. [PMID: 10829498 DOI: 10.1016/s0001-4001(00)00141-0] [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: 11/30/2022]
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Capelluto E, Barrat C, Catheline JM, Champault G. [Is it necessary to perform an perioperative cholangiography for laparoscopic cholecystectomies?]. Chirurgia (Bucur) 2000; 95:119-25. [PMID: 14768316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- E Capelluto
- Université Paris XIII-UFR de Médecine de Bobigny, Bondy Service de Chirurgie Générale et Digestive
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40
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Cresienzo D, Perrot L, Barrat C, Catheline JM, Champault G. [Laparoscopic treatment of acute cholecystitis. Incidence of anatomo-clinical variations (271 cases)]. Chirurgia (Bucur) 2000; 95:11-5. [PMID: 14959637] [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: 04/28/2023]
Abstract
The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1999, out of which 271 were preoperatively considered as acute cholecystitis (25.8%). The clinical, biological and ultrasound criteria were rigorously respected. The preoperative period of 1 to 5 days (mean--2.5) was used for re-equilibration and antibiotic and antithrombotic therapy. The intraoperative criteria were clinical, echolaparoscopical, cholangiographical and bacteriological and established in 219 cases the diagnostic of acute cholecystitis. The final diagnostic, on histopathological basis, confirmed the preoperative diagnosis of acute cholecystitis in 224 cases. The microscopical reexamination in the remainding controversy cases reclassified other 18 as acute cholecystitis (final concordance ratio--242:271). The preoperative overvaluation may be consecutive to a too rapid (before the constitution of specific lesions) or too delayed intervention (the aspect becoming chronical). The elements of diagnostic discordance are raising the problem of case selection and the necessity for standard classification of histological lesions in acute cholecystitis.
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Affiliation(s)
- D Cresienzo
- Université Paris XIII-UFR de Médecine Léonard de Vinci
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41
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Barrat C, Cueto-Rozon R, Catheline JM, Rizk N, Champault G. [Impact of learning and experience on the laparoscopic treatment of gastroesophageal reflux]. Chirurgie 1999; 124:675-80. [PMID: 10676031 DOI: 10.1016/s0001-4001(99)00072-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY AIM Laparoscopic treatment of gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the most appropriate surgical treatment after failure of medical treatment. The aim of this study was to compare the results of the same series in three consecutive periods in order to determine the effects of the learning curve and experience on the technique and outcome. PATIENTS AND METHODS From January 1993 to January 1998, 150 patients (84 men and 66 women) with a mean age of 52.2 years (18 to 78) were included. Three groups of 49, 50 and 51 patients were chronologically defined. The comparison was established on the following criteria: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results with short and medium follow-up. RESULTS The three groups were comparable with respect to patients and GERD characteristics. One hundred and thirty two patients had a TF and 18 had a PF. Rossetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 min). The rate of conversion decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. Seven cases of recurrence occurred (4.6%), 5 in group I (10.2%), 2 in group II (4%), and 0 in group III, (with a shorter follow-up). CONCLUSION The effect of the learning curve has to be taken into account in the training of surgeons (within experienced departments, with "guidance" during initial interventions) and also in the evaluation of results, in order to allow a more accurate comparison between the different treatments for GERD.
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Affiliation(s)
- C Barrat
- Service de chirurgie générale et digestive, université Paris XIII, UFR de Bobigny-Bondy, CHU Jean-Verdier, France
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Champault GG, Barrat C, Rozon RC, Rizk N, Catheline JM. The effect of the learning curve on the outcome of laparoscopic treatment for gastroesophageal reflux. Surg Laparosc Endosc Percutan Tech 1999; 9:375-81. [PMID: 10872617] [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: 02/16/2023]
Abstract
The laparoscopic treatment for gastroesophageal reflux (GR) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period, during which the rate of complications, conversions, and duration of surgery and hospitalization are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in three groups of consecutive patients to determine the effect of the learning period on outcome. One hundred and fifty-six patients (88 men and 68 women) with an average age of 52.3 years (range, 18-78) were included. Surgery was indicated for failure or early relapse after the end of medical treatment or a symptomatic sliding hernia. The preoperative workup (endoscopy, barium meal, or esophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of patients were chronologically defined. The parameters that were examined were the type of preoperative exploration, the type of fundoplication, the operative technique, the conversion rate, the mortality and morbidity rates, the duration of surgery and hospitalization, and the results at short- and medium-term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GR. All patients had an endoscopy, 91% had a barium meal, 77.5% underwent esophageal manometry, and 67% had pH monitoring. One hundred and thirty-six patients had a TF and 20 had a PF. Rossetti type TF became the reference procedure (67% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between groups I and groups II and III (140, 100, 80 minutes, respectively). The rate of conversion, due to a variety of causes, decreased from 9.8% to 3.8%, and then to 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 15% to 3.8%, and then to 0%. There were seven cases of relapse (4.6%), five in group I (10%) and two in group II (4%), with no cases in group III, although the follow-up in group III was shorter. There is an effect of the learning curve on the outcome of treatment for GR, and this must be taken into account in the training of surgeons (training within experienced departments and guidance during their initial interventions) and also in publications to allow a more accurate comparison of this technique with other treatments for GR.
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Capelluto E, Barrat C, Catheline JM, Champault G. [Systematic peroperative cholangiography during laparoscopic cholecystectomy]. Chirurgie 1999; 124:536-41; discussion 542. [PMID: 10615782 DOI: 10.1016/s0001-4001(00)88277-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY AIM The aim of this study was to assess the feasibility of routine intra operative cholangiography during laparoscopic cholecystectomy (LC) and to evaluate its impact in the detection of common bile duct stones or iatrogenic bile duct injuries. PATIENTS AND METHOD From January 1991 to January 1999, 1,050 patients (mean age: 52.5 years) with symptomatic or complicated cholelithiasis were operated on laparoscopically. Intraoperative cholangiography was attempted in all patients before cholecystectomy, performed with an ureteral catheter (diameter: 5 F) introduced into the cystic duct under control of intensifier screen. In case of detection of common bile duct stones (CBDS) or bile duct injury, a surgical management was routinely attempted laparoscopically. RESULTS Cholangiography was successfully performed in 840 cases (82.4%). The mean duration of this examination was 15 min (7-45). The success rate was significantly higher in patients with uncomplicated cholelithiasis (90.4%), compared to patients with acute cholecystitis (61.9%) (p = 0.01). The failure rate decreased with experience, falling from 23% for the first 100 attempts to 1% for the last 100. CBDS were identified in 62 patients (7.4%) in 18% of those with acute cholecystitis and 4.6% of those with uncomplicated cholelithiasis. In 21 cases (33%), there were no predictive factors to suggest CBDS. There were 8 false positive (0.9%). Among the 6 cases of bile duct injury observed in this series (0.57%), four patients had an intraoperative cholangiography and the injury was diagnosed peroperatively in two patients and immediately repaired. There was no postoperative death in this series. CONCLUSIONS Routine intraoperative cholangiography appears to be the best method for the detection of common bile duct stones and improves prognosis of bile duct injuries when they are immediately detected and peroperatively repaired.
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Affiliation(s)
- E Capelluto
- Université Paris XIII, UFR de médecine de Bobigny, Bondy, France
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Abstract
A case of laparoscopic autopsy for unexplained inpatient death is reported. The procedure is minimally invasive, easy to perform, accurate, and not disfiguring, rendering it easy to accept among mourning families.
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Affiliation(s)
- J M Catheline
- Department of Surgery, Hôpital Jean Verdier, F-93143 Bondy Cedex, France
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Abstract
SITUATION In spite of recent progress in medical imagery, the findings of preoperative investigations of the liver are not always accurate and precise. Since the development of surgical laparoscopy, advantages of the laparoscopic examination are associated with advantages of laparoscopic ultrasonography. OBJECTIVE The purpose of this work is to report the technique of staging laparoscopy with laparoscopic contact ultrasonography in the intraoperative assessment of patients with liver tumors, and to analyse its impact on the selection of patients for hepatic resection with curative intent. METHODS The basic exploration follows at first portal branches and then hepatic veins. During the course of vascular exploration, the corresponding liver parenchyma is examined. A mobilization of the probe with clockwise or anticlockwise rotation movements allows full exploration of the liver. RESULTS The association of laparoscopic examination and laparoscopic ultrasonography allows to localize with accuracy malignant and benign lesions and to perform ultrasound guided biopsy. Liver tumors not visible on preoperative imagery may be identified, relationships with adjacent vessels and presence of tumoral thrombi in major vascular structures may be assessed. Resectability of the liver tumors is at the best specified. CONCLUSION Staging laparoscopy with laparoscopic ultrasonography improves selection of patients for liver resection and facilitates choice and performance of the most appropriate resection.
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Affiliation(s)
- J M Catheline
- Service de chirurgie générale et digestive, Hôpital Jean-Verdier, Bondy, France
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Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, Campion JP, Sutherland F, Meunier B. Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg 1999; 230:266-75. [PMID: 10450742 PMCID: PMC1420870 DOI: 10.1097/00000658-199908000-00018] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years. BACKGROUND Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative procedures. The authors adopted a radical surgical approach aimed at definitive cure in 1974. Recent reports suggest that resection improves outcome. METHODS The records of 40 of 94 patients (23 men, 17 women, age range 34-81 years) diagnosed with proximal bile duct carcinoma who underwent resection between 1968 and 1993 were reviewed. According to the Bismuth classification, there were five type I, four type II, 25 type III, and six type IV lesions; 11 patients underwent tumor resection alone, and 25 patients had combined tumor and liver resection (seven of these also underwent an associated regional vascular resection). In 3 patients, venous allografts were harvested from cadaveric donors and used to reconstruct the portal vein. Four patients underwent liver transplantation; in two, organ cluster-type resections including the liver with porta hepatitis and pancreas were performed. RESULTS The resectability rate in the more recent period of the study was 49.4%. Most type I, three (of four) type II, T in situ, T1a, T1b, and all stage 0 tumors were resected without hepatectomy. In the other subgroups of tumors, the main surgical procedure was hepatectomy. Thirty-day mortality was 12.5%. After tumor resection alone, survival at 1, 3, and 5 years was 81.8%, 45.5%, and 27.3%, respectively. After tumor resection and hepatectomy without vascular resection, 1-, 3-, and 5-year survival was 66.7%, 16.7%, and 6%, respectively. With vascular resection, survival rates were similar: 64%, 20%, and 4%, respectively. CONCLUSION The type of surgery required to achieve cure is closely related to tumor location, TNM classification, and staging. Increasing resectability through the use of hepatectomy improves survival and offers a chance of cure in patients with more advanced disease.
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Affiliation(s)
- B Launois
- Department of Surgery and Transplant Unit, Hôpital Pontchaillou, Centre Hospitalo-Universitaire de Rennes, France
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Santoro R, Barrat C, Catheline JM, Faranda C, Champault G. [Port site metastasis. Prospective study of 131 cases]. CHIRURGIA ITALIANA 1999; 50:15-22. [PMID: 10392189] [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: 02/13/2023]
Abstract
Laparoscopic staging and laparoscopic treatment of gastrointestinal malignancy is still controversial because some studies report port sites metastases. The aim of the study is to determine in 131 patients, with prospective follow-up, after laparoscopic staging or laparoscopic treatment, the incidence of port site metastases. 131 patients with localized a gastrointestinal malignancy or other advanced malignant tumors were included. In 57 cases only laparoscopic staging was performed, in 25 cases the laparoscopic staging was followed by a laparoscopic resection and in 49 cases after laparoscopic staging a traditional laparotomic treatment was performed. In 57 cases (43.5%) the tumor invaded the serosal layer. The median follow-up was 17.7 months (3 to 62 months). 502 port-sites were controlled. One patients (0.7%) presented one port site metastases after right colectomy for carcinoma with local carcinomatosis. This study confirm that port sites metastases are rare, and that are favorised by serosal invasion and support the laparoscopic staging of malignant abdominal tumors in order to recognize occult lesions which are not detected by conventional preoperative clinical, biological and radiological explorations (44.2% in this study). In addition, selected patients can be submitted to laparoscopic treatment of the disease (20%).
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Affiliation(s)
- R Santoro
- Hôpital Jean Verdier, Service de Chirurgie, Université Paris XIII UFR de Bobigny, Bondy
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Barrat C, Voreux JP, Occelli G, Catheline JM, Champault G. [Effects of surgical education and training on the results of laparoscopic treatment of inguinal hernias]. Chirurgie 1999; 124:298-303. [PMID: 10429304 DOI: 10.1016/s0001-4001(99)80096-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
STUDY AIM The aim of this retrospective study was to compare two concurrent series of patients operated on for inguinal hernia with the same laparoscopic procedure, the first one in a teaching hospital with a number of trained surgeons and the second one in a private center with only one trained surgeon. PATIENTS AND METHOD Five hundred and forty-one patients with 757 hernias were operated on over a period of six years by a totally pre-peritoneal laparoscopic approach. Two hundred and sixteen patients were operated on in a teaching hospital by 48 surgeons (six senior and 42 trainee surgeons; group I), 325 were operated on in a private center by one surgeon who had been trained in the same teaching hospital (group II). The two groups of patients and their hernias were comparable. The comparison was established on the following criteria: duration of operation, rate of conversion, length of hospitalization, morbidity and mortality rate, recurrence rate and costs. RESULTS Operations performed by surgical trainees were associated with: (1) a mean operative time significantly (P = 0.01) longer for both unilateral (68 vs. 41 min) and bilateral (108 vs. 68 min) hernias. The operative time did not change in the teaching hospital and decreased with experience in private practice (from 62 to 25 min for unilateral hernias); (2) more frequent per-operative complications, particularly opening of the peritoneum (28% vs. 3%, P = 0.001); (3) a mean duration of hospitalization significantly (P = 0.05) longer, on average by 1.6 d; (4) a morbidity rate after 30 days significantly higher (16.2% vs. 4.9%, P = 0.01); and, (5) higher costs. There was no significant difference concerning mortality rate (nil), conversion rate (1.5%) and recurrence rate (1.3% vs. 0.6%, non significant). CONCLUSION Surgical training for laparoscopic treatment of inguinal hernias was associated with a longer operation time and hospital stay, and with higher morbidity and costs. After a good initial training in a teaching hospital, surgeons were capable of performing laparoscopic repair of inguinal hernias with good results.
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Affiliation(s)
- C Barrat
- Université Paris XIII, UFR de médecine de Bobigny, CHU Jean-Verdier, Bondy, France
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Catheline JM, Turner R, Gaillard JL, Rizk N, Champault G. Thromboembolism in laparoscopic surgery: risk factors and preventive measures. Surg Laparosc Endosc Percutan Tech 1999; 9:135-9. [PMID: 11757541] [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: 02/23/2023]
Abstract
The aim of this study was to assess the risk of clinical thromboembolism in laparoscopic digestive surgery. From June 1992 to June 1997, 2,384 consecutive patients were studied. All received perioperative prophylaxis with low-molecular-weight heparin (LMWH), which was continued until full mobility was regained. Eight cases (0.33%) of deep venous thrombosis were noted, but there were no cases of pulmonary embolus. In six cases (five cholecystectomies with reverse Trendelenburg position and one inguinal hernia repair), release of the pneumoperitoneum took longer than 2 hours, and in two cases (one rectopexy and one sigmoid colectomy for diverticulitis), longer than 3 hours. In six of the eight cases, the diagnosis of DVT was made after LMWH had been ceased and the patient had been discharged. All cases were diagnosed before the 10th postoperative day. Pneumoperitoneum is felt to predispose to deep venous thrombosis. Long operations and reverse Trendelenburg position are further potentiating factors. Thromboprophylaxis for laparoscopy should be the same as for conventional surgery, i.e., tailored to individual risk and continued for a minimum of 7 to 10 days. We also recommend using graduated compression stockings, maintaining a relatively low insufflation pressure, keeping use of the reverse Trendelenberg position to a minimum, and intermittently releasing the pneumoperitoneum in longer procedures.
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Affiliation(s)
- J M Catheline
- Department of Digestive Surgery, Paris University Hospital, Hĵpital Jean Verdier, Bondy, France
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Catheline JM, Turner R, Rizk N, Barrat C, Champault G. The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer. Surg Endosc 1999; 13:239-45. [PMID: 10064755 DOI: 10.1007/s004649900954] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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: 10/28/2022]
Abstract
BACKGROUND Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic cancer. METHODS In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16 cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases). RESULTS The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection. Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative resection. CONCLUSIONS Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases; thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical procedure.
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Affiliation(s)
- J M Catheline
- Department of Surgery, Hopital Jean Verdier "AP-HP," Avenue du 14 Juillet, 93143 Bondy, France
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