1
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Triolo J, Ris F, Toso C, Buchs NC. Laparoscopic restorative proctectomy with ileal J-pouch in a patient with ulcerative colitis - a video vignette. Colorectal Dis 2020; 22:1808-1809. [PMID: 32654318 DOI: 10.1111/codi.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 02/08/2023]
Affiliation(s)
- J Triolo
- Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - F Ris
- Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - C Toso
- Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - N C Buchs
- Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
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2
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Meyer J, Buchs NC, Ris F. Comment on: Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis. Br J Surg 2019; 107:153. [PMID: 31869470 DOI: 10.1002/bjs.11450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- J Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - N C Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - F Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Unit of Surgical Research, University of Geneva, Geneva, Switzerland
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3
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Meyer J, Roos E, Buchs NC, Ris F. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery ( BJS Open 2018; 2: 185-194). BJS Open 2019; 3:882-883. [PMID: 31832596 PMCID: PMC6887911 DOI: 10.1002/bjs5.50198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/15/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- J Meyer
- Division of Digestive Surgery University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 1211 Geneva 14 Switzerland.,Unit of Surgical Research, Division of Digestive Surgery, Medical School University of Geneva Geneva Switzerland
| | - E Roos
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
| | - N C Buchs
- Division of Digestive Surgery University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 1211 Geneva 14 Switzerland.,Unit of Surgical Research, Division of Digestive Surgery, Medical School University of Geneva Geneva Switzerland
| | - F Ris
- Division of Digestive Surgery University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 1211 Geneva 14 Switzerland.,Unit of Surgical Research, Division of Digestive Surgery, Medical School University of Geneva Geneva Switzerland
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4
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Tokoto PA, Buchs NC, Massalou D. Treatment of low colorectal anastomotic leaks with transanal negative pressure. J Visc Surg 2019:S1878-7886(19)30136-5. [PMID: 31810877 DOI: 10.1016/j.jviscsurg.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P-A Tokoto
- Université Nice Sophia-Antipolis, CHU de Nice, 06000 Nice, France
| | - N C Buchs
- Université Nice Sophia-Antipolis, CHU de Nice, 06000 Nice, France
| | - D Massalou
- Université Nice Sophia-Antipolis, CHU de Nice, 06000 Nice, France.
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5
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Popeskou SG, Ris F, Buchs NC, Meyer J, Liot E, Toso C. Laparoscopic splenectomy in the armamentarium of the colorectal surgeon - a video vignette. Colorectal Dis 2019; 21:1342-1343. [PMID: 31373154 DOI: 10.1111/codi.14802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S G Popeskou
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - F Ris
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland.,Colorectal Surgery, John Radcliffe Hospital, Oxford, UK
| | - N C Buchs
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - J Meyer
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - E Liot
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - C Toso
- Departement de Chirurgie, Visceral Surgery Department, Hopitaux Universitaires de Geneve, Geneva, Switzerland
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6
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Spinelli A, Carvello M, Kotze PG, Maroli A, Montroni I, Montorsi M, Buchs NC, Ris F. Ileal pouch-anal anastomosis with fluorescence angiography: a case-matched study. Colorectal Dis 2019; 21:827-832. [PMID: 30873703 DOI: 10.1111/codi.14611] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/02/2019] [Indexed: 12/12/2022]
Abstract
AIM An anastomotic leak in ileoanal pouch surgery may lead to pouch failure. Constructing a tension-free ileal pouch-anal anastomosis (IPAA) reduces this risk but can be technically challenging, balancing pouch vascularization with ileal mesenteric length and site of vessel ligation. Fluorescence angiography (FA) may help the clinician make a more balanced judgement. METHODS Thirty-two patients undergoing minimally invasive completion proctectomy with FA-guided IPAA at two academic centres were matched and compared on a 1:1 basis to a historical group undergoing the same procedure without the use of this technique. RESULTS Ligation of the ileocolic vessels was safely performed in 15/32 (47%) of FA patients compared with 5/32 (16%) of historical controls. One patient underwent intra-operative IPAA reconstruction after FA detected ischaemia. No anastomotic leak occurred with FA but there was only one in the historical controls (P = 0.31). The postoperative complication rate was similar between the two groups (P = 0.60). CONCLUSION FA is applicable to IPAA surgery and may help to reduce perfusion-related anastomotic leaks. A prospective randomized trial is warranted.
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Affiliation(s)
- A Spinelli
- Colorectal Surgery Unit, Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - M Carvello
- Colorectal Surgery Unit, Humanitas Research Hospital, Rozzano, Italy
| | - P G Kotze
- Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - A Maroli
- Colorectal Surgery Unit, Humanitas Research Hospital, Rozzano, Italy
| | - I Montroni
- Colorectal Surgery Unit, Humanitas Research Hospital, Rozzano, Italy
| | - M Montorsi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of General Surgery, Humanitas Research Hospital, Milan, Italy
| | - N C Buchs
- Service of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - F Ris
- Service of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
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7
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Douissard J, Meyer J, Ris F, Liot E, Morel P, Buchs NC. Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey. Colorectal Dis 2019; 21:595-602. [PMID: 30624852 DOI: 10.1111/codi.14552] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
AIM Iatrogenic ureteral injury (IUI) occurs rarely during colorectal surgery but is associated with significant mortality, morbidity and medicolegal issues. Few cases are reported, and recommendations regarding prevention are lacking. The aim of this study is to describe the current state of practice regarding IUI and its prevention among general surgeons in Switzerland. METHOD All Swiss general surgeons who are members of either the Swiss Association of Laparoscopic and Thoracoscopic Surgery or the Swiss Surgical Society were invited to participate in an anonymous online survey. Demographics, surgical practice, rate of IUI and methods used to prevent IUI were investigated. RESULTS All participants were board-certified general surgeons, 63.4% were certified visceral surgeons and 17.9% were certified colorectal surgeons. The mean level of experience in colorectal surgery was 15.6 ± 9.2 years. Formal ureter identification was considered mandatory during sigmoid or rectal surgery by 83.7% of participants, and 31.7% considered identification of the right ureter during right colectomy to be mandatory. In total, 61.8% of the participants and 78.4% of surgeons with more than 20 years of experience had encountered at least one IUI. Prophylactic ureteral stenting was considered useful in complex procedures by 93.5% of participants, and 56.9% had used stents at least once in the past 12 months. Noninvasive techniques for identifying ureters would be considered in regular daily practice by 54.5% of the participants. CONCLUSION Most general surgeons experience IUI. Ureter identification is widely integrated in colorectal procedures. Prophylactic stenting is widely used for difficult cases. Noninvasive methods to improve ureter identification are now needed.
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Affiliation(s)
- J Douissard
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - J Meyer
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - F Ris
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - E Liot
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - P Morel
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - N C Buchs
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
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8
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Colucci N, Schiltz B, Liot E, Buchs NC, Morel P, Ris F. Laparoscopic treatment of ileocaecal herniation through the foramen of Winslow - a video vignette. Colorectal Dis 2019; 21:122. [PMID: 30382598 DOI: 10.1111/codi.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 09/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
- N Colucci
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - B Schiltz
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - E Liot
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - N C Buchs
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - P Morel
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - F Ris
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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9
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Ris F, Liot E, Buchs NC, Kraus R, Ismael G, Belfontali V, Douissard J, Cunningham C, Lindsey I, Guy R, Jones O, George B, Morel P, Mortensen NJ, Hompes R, Cahill RA. Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 2018; 105:1359-1367. [PMID: 29663330 PMCID: PMC6099466 DOI: 10.1002/bjs.10844] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/28/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreasing anastomotic leak rates remain a major goal in colorectal surgery. Assessing intraoperative perfusion by indocyanine green (ICG) with near-infrared (NIR) visualization may assist in selection of intestinal transection level and subsequent anastomotic vascular sufficiency. This study examined the use of NIR-ICG imaging in colorectal surgery. METHODS This was a prospective phase II study (NCT02459405) of non-selected patients undergoing any elective colorectal operation with anastomosis over a 3-year interval in three tertiary hospitals. A standard protocol was followed to assess NIR-ICG perfusion before and after anastomosis construction in comparison with standard operator visual assessment alone. RESULTS Five hundred and four patients (median age 64 years, 279 men) having surgery for neoplastic (330) and benign (174) pathology were studied. Some 425 operations (85·3 per cent) were started laparoscopically, with a conversion rate of 5·9 per cent. In all, 220 patients (43·7 per cent) underwent high anterior resection or reversal of Hartmann's operation, and 90 (17·9 per cent) low anterior resection. ICG angiography was achieved in every patient, with a median interval of 29 s to visualization of the signal after injection. NIR-ICG assessment resulted in a change in the site of bowel division in 29 patients (5·8 per cent) with no subsequent leaks in these patients. Leak rates were 2·4 per cent overall (12 of 504), 2·6 per cent for colorectal anastomoses and 3 per cent for low anterior resection. When NIR-ICG imaging was used, the anastomotic leak rates were lower than those in the participating centres from over 1000 similar operations performed with identical technique but without NIR-ICG technology. CONCLUSION Routine NIR-ICG assessment in patients undergoing elective colorectal surgery is feasible. NIR-ICG use may change intraoperative decisions, which may lead to a reduction in anastomotic leak rates.
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Affiliation(s)
- F Ris
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - E Liot
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N C Buchs
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.,Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - R Kraus
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - G Ismael
- Department of Surgery, Mater Misericordiae University Hospital, and Section of Surgery and Surgical Sciences, University College Dublin, Dublin, Ireland
| | - V Belfontali
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - J Douissard
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - C Cunningham
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - I Lindsey
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - R Guy
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - O Jones
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - B George
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - P Morel
- Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N J Mortensen
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - R Hompes
- Departments of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - R A Cahill
- Department of Surgery, Mater Misericordiae University Hospital, and Section of Surgery and Surgical Sciences, University College Dublin, Dublin, Ireland
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Meier RPH, Piller V, Hagen ME, Joliat C, Buchs J, Nastasi A, Ruttimann R, Buchs NC, Moll S, Vallée J, Lazeyras F, Morel P, Bühler L. Intra-Abdominal Cooling System Limits Ischemia-Reperfusion Injury During Robot-Assisted Renal Transplantation. Am J Transplant 2018; 18:53-62. [PMID: 28637093 PMCID: PMC5763420 DOI: 10.1111/ajt.14399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/24/2017] [Revised: 06/04/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
Abstract
Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p-values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia-reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot-assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra-abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia-reperfusion injuries.
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Affiliation(s)
- R. P. H. Meier
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - V. Piller
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - M. E. Hagen
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - C. Joliat
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - J.‐B. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - A. Nastasi
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - R. Ruttimann
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - N. C. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - S. Moll
- Division of Clinical PathologyDepartment of Pathology and ImmunologyGeneva University Hospital and Medical SchoolGenevaSwitzerland
| | - J.‐P. Vallée
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - F. Lazeyras
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - P. Morel
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - L. Bühler
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
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Giudicelli G, Rossetti A, Scarpa C, Buchs NC, Hompes R, Guy RJ, Ukegjini K, Morel P, Ris F, Adamina M. Prognostic Factors for Enteroatmospheric Fistula in Open Abdomen Treated with Negative Pressure Wound Therapy: a Multicentre Experience. J Gastrointest Surg 2017; 21:1328-1334. [PMID: 28536807 DOI: 10.1007/s11605-017-3453-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reductions in mortality were reported with negative pressure wound therapy for laparostomy. However, some authors have voiced concern over an increased risk of enteroatmospheric fistulae. In this retrospective study, we hypothesized that surgical and metabolic derangements could increase the incidence of enteroatmospheric fistulae. We aimed to assess our experience and report long-term outcomes. METHODS A multicentre review of all patients with a laparostomy managed with negative pressure wound therapy between 2005 and 2015 was undertaken. Features associated with enteroatmospheric fistulae were included in multivariate logistic regression. RESULTS Fifty-seven patients were treated according to uniform protocol. Fourteen per cent (8/57) presented enteroatmospheric fistulae. Mesenteric ischaemia and preoperative arterial serum lactate >3.5 mmol/L were associated with a significantly increased risk of enteroatmospheric fistulae. Preoperative arterial serum lactate >3.5 mmol/L was an independent predictor of enteroatmospheric fistulae with an odds ratio of 12.41 (95% CI 1.54-99.99). All mesenteric ischaemia patients with anastomosis (5/15) presented enteroatmospheric fistulae. In-hospital mortality was 26.3% (15/57). One-year mortality was 33.3% (19/57). Incisional hernia rate was 5.2% (2/38) after 14.2 (2.4-56.3) months of follow-up. DISCUSSION Mesenteric ischaemia increases the risk of enteroatmospheric fistulae. Anastomosis should only be created in revascularized patients. When mesenteric vascularization is not restored, diversion is advised.
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Affiliation(s)
- Guillaume Giudicelli
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - A Rossetti
- Department of Visceral Surgery, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland
| | - C Scarpa
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - N C Buchs
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - K Ukegjini
- Department of Visceral Surgery, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland
| | - P Morel
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - F Ris
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - M Adamina
- Division of Visceral and Thoracic Surgery, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
- University of Basel, Basel, Switzerland
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12
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Ris F, Gorissen KJ, Ragg J, Gosselink MP, Buchs NC, Hompes R, Cunningham C, Jones O, Slater A, Lindsey I. Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception. Tech Coloproctol 2017; 21:627-632. [PMID: 28674947 DOI: 10.1007/s10151-017-1643-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) has become a well-established treatment for symptomatic high-grade internal rectal prolapse. The aim of this study was to identify proctographic criteria predictive of a successful outcome. METHODS One hundred and twenty consecutive patients were evaluated from a prospectively maintained pelvic floor database. Pre- and post-operative functional results were assessed with the Wexner constipation score (WCS) and Fecal Incontinence Severity Index (FISI). Proctogram criteria were analyzed against functional results. These included grade of intussusception, presence of enterocele, rectocele, excessive perineal descent and the orientation of the rectal axis at rest (vertical vs. horizontal). RESULTS Ninety-one patients completed both pre- and post-operative follow-up questionnaires. Median pre-operative WCS was 14 (range 10-17), and median FISI was 20 (range 0-61), with 28 patients (31%) having a FISI above 30. The presence of an enterocele was associated with more frequent complete resolution of obstructed defecation (70 vs. 52%, p = 0.02) and fecal incontinence symptoms (71 vs. 38%, p = 0.01) after LVMR. Patients with a more horizontal rectum at rest pre-operatively had significantly less resolution of symptoms post-operatively (p = 0.03). CONCLUSIONS These data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms.
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Affiliation(s)
- F Ris
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK. .,Department of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
| | - K J Gorissen
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - J Ragg
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - M P Gosselink
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - N C Buchs
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - R Hompes
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - C Cunningham
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - O Jones
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
| | - A Slater
- Department of Radiology, John Radcliffe Hospital, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK
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13
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Balaphas A, Buchs NC, Naiken SP, Hagen ME, Zawodnik A, Jung MK, Varnay G, Bühler LH, Morel P. Incisional hernia after robotic single-site cholecystectomy: a pilot study. Hernia 2017; 21:697-703. [PMID: 28488073 DOI: 10.1007/s10029-017-1621-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/01/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Robotic LaparoEndoscopic Single-Site Surgery Cholecystectomy has been performed for 5 years using a dedicated platform (da Vinci® Single-Site®) with the da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). While short-term feasibility has been described, long-term assessment of this method is currently outstanding. The aim of this study was to assess long-term parietal complications of this technique. METHODS In this retrospective study, patients operated between 2011 and 2013 were evaluated. Parietal incision was assessed with ultrasonography and patients screened for residual pain from scar tissue. Demographic and perioperative data were also collected. RESULTS We evaluated 48 patients [38 female, 79.2%; median age 49 years (range: 24-81 years)]; mean BMI 25.9 kg/m2 [±SD 4.1 kg/m2]. After a median follow-up of 39 months (range: 25-46 months), six incisional hernias (two patients had a positive echography but a negative clinical examination) were found (12.5%, 95% CI 7.5-30.2), and two patients had a surgical repair. The overall rate of incisional hernia was 16.7% (95% CI 7.5-30.2). Residual pain was observed in 5 of 48 patients. CONCLUSION This preliminary study suggests that a clinically significant rate of incisional hernias can occur after R-LESS-C. Larger studies comparing R-LESS-C to alternative methods with long-term follow-up are necessary.
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Affiliation(s)
- A Balaphas
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
| | - N C Buchs
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - S P Naiken
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - M E Hagen
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - A Zawodnik
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - M K Jung
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - G Varnay
- Division of Radiology, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - L H Bühler
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - P Morel
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
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14
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Buchs NC, Bloemendaal ALA, Wood CPJ, Travis S, Mortensen NJ, Guy RJ, George BD. Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre. Colorectal Dis 2017; 19:O153-O161. [PMID: 28304125 DOI: 10.1111/codi.13658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 08/23/2016] [Accepted: 12/22/2016] [Indexed: 02/08/2023]
Abstract
AIM Subtotal colectomy (STC) is a well-established treatment for complicated and refractory ulcerative colitis (UC). A laparoscopic approach offers potentially improved outcomes. The aim of the study was to report our experience with STC for UC in a single large centre. METHOD From January 2007 to May 2015, all consecutive patients undergoing STC for UC were retrospectively analysed from a prospectively managed database. Patients with known Crohn's disease or those undergoing one-stage procedures were excluded. Demographics, perioperative outcomes and second-stage procedures were analysed. RESULTS During the study period, 151 STCs were performed for UC [100 emergency (66%) and 51 elective (34%)]. Acute severe colitis refractory to therapy was the most common indication (62%). Overall, 117 laparoscopic (78%) and 34 open STCs were performed, with a conversion rate of 14.5%. Mortality and morbidity rates were 0.7% and 38%, respectively. Whilst operative time was shorter for open STC (by 75 min; P = 0.001), there were fewer complications (32% vs 62%; P = 0.002) and a shorter hospital stay (by 6.9 days; P = 0.0002) following laparoscopic STC. Fewer complications and shorter hospital stay were also observed after elective STC. Patients undergoing laparoscopic STC were more likely to undergo a restorative second-stage procedure than those having open STC (75% vs 50%; P = 0.03). CONCLUSION Laparoscopic STC for UC is feasible and safe, even in the emergency situation. A laparoscopic approach may offer advantages in terms of lower morbidity and reduced length of stay. Elective resection may offer similar advantages and is best performed whenever possible.
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Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - A L A Bloemendaal
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - C P J Wood
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - S Travis
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - B D George
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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15
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Bloemendaal ALA, Lovegrove R, Buchs NC, Guy RJ, George BD. Continent ileostomy (Kock pouch) formation - a video vignette. Colorectal Dis 2017; 19:85-86. [PMID: 27860124 DOI: 10.1111/codi.13562] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023]
Affiliation(s)
- A L A Bloemendaal
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Lovegrove
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - N C Buchs
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - B D George
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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16
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Buchs NC, Wynn G, Austin R, Penna M, Findlay JM, Bloemendaal ALA, Mortensen NJ, Cunningham C, Jones OM, Guy RJ, Hompes R. A two-centre experience of transanal total mesorectal excision. Colorectal Dis 2016; 18:1154-1161. [PMID: 27218423 DOI: 10.1111/codi.13394] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 12/16/2022]
Abstract
AIM Transanal total mesorectal excision (TaTME) offers a promising alternative to the standard surgical abdominopelvic approach for rectal cancer. The aim of this study was to report a two-centre experience of this technique, focusing on the short-term and oncological outcome. METHOD From May 2013 to May 2015, 40 selected patients with histologically proven rectal adenocarcinoma underwent TaTME in two institutions and were prospectively entered on an online international registry. RESULTS Forty patients (80% men, mean body mass index 27.4 kg/m2 ) requiring TME underwent TaTME. Procedures included low anterior resection (n = 31), abdominoperineal excision (n = 7) and proctocolectomy (n = 2). A minimally invasive approach was attempted in all cases, with three conversions. The mean operation time was 368 min and 16 patients (40%) had a synchronous abdominal and transanal approach. There was no mortality and 16 postoperative complications occurred, of which 68.8% were minor. The median length of stay was 7.5 (3-92) days. A complete or near-complete TME specimen was delivered in 39 (97.5%) cases with a mean number of 20 lymph nodes harvested. R0 resection was achieved in 38 (95%) patients. After a median follow-up of 10.7 months, there were no local recurrences and six (15%) patients had developed distant metastases. CONCLUSION TaTME appears to be feasible, safe and reproducible, without compromising the oncological principles of rectal cancer surgery. It is an attractive option for patients for whom laparoscopy is likely to be particularly difficult. These encouraging results should encourage larger studies with assessment of long-term function and the oncological outcome.
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Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - G Wynn
- ICENI Centre, Colchester Hospital University Foundation Trust, Colchester, UK
| | - R Austin
- ICENI Centre, Colchester Hospital University Foundation Trust, Colchester, UK
| | - M Penna
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - J M Findlay
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - A L A Bloemendaal
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - O M Jones
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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17
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Bloemendaal ALA, Kraus R, Buchs NC, Hamdy FC, Hompes R, Cogswell L, Guy RJ. Double-barrelled wet colostomy formation after pelvic exenteration for locally advanced or recurrent rectal cancer. Colorectal Dis 2016; 18:O427-O431. [PMID: 27620339 DOI: 10.1111/codi.13512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022]
Abstract
AIM In advanced pelvic cancer it may be necessary to perform a total pelvic exenteration. In such cases urinary tract reconstruction is usually achieved with the creation of an ileal conduit with a urinary stoma on the right side of the patient's abdomen and an end colostomy separately on the left. The potential morbidity from a second stoma may be avoided by the use of a double-barrelled wet colostomy (DBWC), as a single stoma. Another advantage is the possibility of using a vertical rectus abdominis muscle flap for perineal reconstruction. METHOD All patients undergoing formation of a DBWC were included. RESULT A DBWC was formed in 10 patients. One patient underwent formation of a double-barrelled wet ileostomy. CONCLUSIONS In this technical note we present our early experience in 11 cases and a video of DBWC formation in a male patient.
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Affiliation(s)
- A L A Bloemendaal
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - R Kraus
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N C Buchs
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Cogswell
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R J Guy
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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18
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Bloemendaal ALA, Wood CPJ, Buchs NC, Hompes R, Guy RJ. Laparoscopic component separation as part of a large incisional hernia repair - a video vignette. Colorectal Dis 2016; 18:628-9. [PMID: 27148962 DOI: 10.1111/codi.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/22/2016] [Indexed: 02/08/2023]
Affiliation(s)
- A L A Bloemendaal
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - C P J Wood
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
| | - N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
| | - R J Guy
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
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19
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Abstract
Perforated colonic cancers are not rare and leave patients at risk of developing peritoneal carcinomatosis. We present a 68-year-old male patient with a perforated transverse colonic tumour who underwent emergency extended right hemicolectomy. He made an uneventful postoperative recovery, and received adjuvant chemotherapy. Unfortunately, a routine positron emission tomography-computed tomography scan 16 months later demonstrated an fluorodeoxyglucose-avid nodule in the left scrotum associated with an irreducible left inguinal hernia that contained sigmoid colon. At laparotomy, the discovery of isolated peritoneal recurrence in the hernia sac was unexpected, given the absence of local recurrence in the region of the original transverse colon cancer perforation. The etiology therefore remains uncertain, but one may speculate that cell implantation occurred within the hernia sac at the initial emergency laparotomy.
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Affiliation(s)
- N C Buchs
- Churchill Hospital, University Hospitals of Oxford , Oxford , UK
| | | | - R J Guy
- Churchill Hospital, University Hospitals of Oxford , Oxford , UK
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20
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Buchs NC, Nicholson GA, Yeung T, Mortensen NJ, Cunningham C, Jones OM, Guy R, Hompes R. Transanal rectal resection: an initial experience of 20 cases. Colorectal Dis 2016; 18:45-50. [PMID: 26639062 DOI: 10.1111/codi.13227] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/23/2015] [Accepted: 07/14/2015] [Indexed: 12/11/2022]
Abstract
AIM Low anterior resection (LAR) can present a formidable surgical challenge, particularly for tumours located in the distal third of the rectum. Transanal total mesorectal excision (taTME) aims to overcome some of these difficulties. We report our initial experience with this technique. METHOD From June 2013 to September 2014, 20 selected patients underwent transanal rectal resection for various malignant and benign low rectal pathologies. All patients with rectal cancer were discussed at a multidisciplinary team meeting. Data were entered into a prospective managed international database. RESULTS Of the 20 patients (14 male), seventeen (85%) had rectal cancer lying at a median distance of 2 cm (range 0-7) from the anorectal junction. The operations performed included LAR (16). Abdominoperineal excision (2) and completion proctectomy (2), all of which were performed by a minimally invasive approach with three conversions. The mean operation time was 315.3 min. There were six postoperative complications of which two (10%) were Clavien-Dindo Grade IIIb (pelvic haematoma and a late contained anastomotic leakage). The median length of stay was 7 days. The TME specimen was intact in 94.1% of cancer cases. The mean number of harvested lymph nodes was 23.2. There was only one positive circumferential resection margin (tumour deposit; R1 rate 5.9%). One patient developed a distant recurrence (median follow-up 10 months, range 6-21). CONCLUSION TaTME was safe in this small series of patients. It is especially attractive in patients with a narrow and irradiated pelvis and a tumour in the lower third of the rectum. TaTME is technically demanding, but the good outcomes should prompt randomized studies and prospective registration of all taTME cases in an international registry.
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Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - G A Nicholson
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - T Yeung
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - O M Jones
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Guy
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
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21
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Buchs NC, Mortensen NJ, Guy RJ, George BD. Persistent colitis after emergency laparoscopic subtotal colectomy for ulcerative colitis: a cautionary note. Colorectal Dis 2016; 18:106-7. [PMID: 26588436 DOI: 10.1111/codi.13218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/24/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Old Road, Oxford, OX3 7LE, UK.
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Old Road, Oxford, OX3 7LE, UK
| | - R J Guy
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Old Road, Oxford, OX3 7LE, UK
| | - B D George
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Old Road, Oxford, OX3 7LE, UK
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22
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Buchs NC, Kraus R, Mortensen NJ, Cunningham C, George B, Jones O, Guy R, Ashraf S, Lindsey I, Hompes R. Endoscopically assisted extralevator abdominoperineal excision. Colorectal Dis 2015; 17:O277-80. [PMID: 26454256 DOI: 10.1111/codi.13144] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/04/2015] [Indexed: 02/08/2023]
Abstract
AIM Extralevator abdominoperineal excision (ELAPE) has been advocated to optimize clearance of lower third rectal cancers with an involved or threatened circumferential resection margin. ELAPE could reduce positive margins and specimen perforation compared with standard abdominoperineal excision. However, there can be difficulties with ELAPE, particularly in identifying the anterior plane in male patients. Usually, the dissection is performed in the prone position, which can be hazardous, particularly in obese patients in whom wound problems are commonly encountered. We describe an endoscopically assisted approach for ELAPE in the lithotomy position. METHOD Three male patients with a rectal tumour located at the anorectal junction underwent an endoscopically assisted ELAPE in the lithotomy position after preoperative radiotherapy. RESULTS All the procedures were performed successfully with operation times of 180, 390 and 420 mins. There were no instances of intra-operative perforation or other complications. One patient developed postoperative intestinal obstruction which resolved on conservative management. There were no wound complications. Histopathological examination demonstrated clear margins and intact mesorectal planes in each patient. CONCLUSION We report a good outcome in three patients after endoscopically assisted ELAPE. This approach allows the patient to be operated on in the lithotomy position giving excellent views of the anterior dissection.
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Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Kraus
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - B George
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - O Jones
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Guy
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - S Ashraf
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
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23
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Ris F, Buchs NC, Morel P, Mortensen NJ, Hompes R. Discriminatory influence of Pinpoint perfusion imaging on diversion ileostomy after laparoscopic low anterior resection. Colorectal Dis 2015; 17 Suppl 3:29-31. [PMID: 26394740 DOI: 10.1111/codi.13029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/23/2022]
Abstract
While still debated, it was advised to perform a protective temporary ileostomy after a low anterior resection (LAR). This might help to decrease the leak rate and therefore offers the patient better outcomes. Anastomotic leak can occur in many situations after a LAR and the control of the risk factors helps to adapt the need of an ileostomy. Near infrared technology allows assessing the microvascularisation of the anastomosis at the time of surgery and therefore might be an important tool to avoid a stoma in given situation. This article reviews the evidences with the use of this technology.
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Affiliation(s)
- F Ris
- Division of Visceral Surgery, Departments of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N C Buchs
- Division of Visceral Surgery, Departments of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.,Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - P Morel
- Division of Visceral Surgery, Departments of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N J Mortensen
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
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24
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James DRC, Ris F, Yeung TM, Kraus R, Buchs NC, Mortensen NJ, Hompes RJ. Fluorescence angiography in laparoscopic low rectal and anorectal anastomoses with pinpoint perfusion imaging--a critical appraisal with specific focus on leak risk reduction. Colorectal Dis 2015; 17 Suppl 3:16-21. [PMID: 26394738 DOI: 10.1111/codi.13033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Anastomotic dehiscence is one of the most feared complications in colorectal surgery leading to significant morbidity and mortality. Progressively lower anastomoses are associated with a greater leak rate. One of the key factors is the perfusion of the bowel to be joined. Presently, surgeons rely on a variety subjective measures to determine anastomotic perfusion and mechanical integrity however these have shortcomings. The aim of this paper is to appraise the literature on the use of fluorescence angiography (FA) in laparoscopic rectal surgery. MATERIALS AND METHODS A Pubmed search was undertaken using terms 'fluorescence angiography' and 'rectal surgery'. The search was expanded using the related articles function. Studies were included if they used FA specifically for rectal surgery. Outcomes of interest including anastomotic leak rate, change of operative strategy and time taken for FA were recorded. RESULTS Eleven papers detailing the use of FA in rectal surgery are outlined demonstrating that this technique may change operative strategy and lead to a reduction in anastomotic leak rate. CONCLUSION In this paper, we discuss assessment of colorectal blood supply using FA and how this technique holds great potential to detect insufficiently perfused bowel. In so doing, the operator can adjust their operative strategy to mitigate these affects with the aim of reducing the complications of anastomotic leak and stenosis. However, it is highlighted that there is a clear need for randomised controlled trials in order to determine this definitively.
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Affiliation(s)
- D R C James
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - F Ris
- Division of Visceral Surgery, Departments of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T M Yeung
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - R Kraus
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - N C Buchs
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK.,Division of Visceral Surgery, Departments of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N J Mortensen
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
| | - R J Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS trust, Oxford, UK
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25
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Buchs NC, Hompes R. Stereotactic navigation and augmented reality for transanal total mesorectal excision? Colorectal Dis 2015; 17:825-7. [PMID: 26139308 DOI: 10.1111/codi.13058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK. .,Division of Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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26
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Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA. CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 2014; 15:1295-300. [PMID: 23710555 DOI: 10.1111/codi.12305] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/08/2013] [Indexed: 02/08/2023]
Abstract
AIM Prolonged ileus, low-grade fever and abdominal discomfort are common during the first week after colonic resection. Undiagnosed anastomotic leak carries a poor outcome and computed tomography (CT) scan is the best imaging tool for assessing postoperative abdominal complications. We used a CT scan-based model to quantify the risk of anastomotic leak after colorectal surgery. METHOD A case-control analysis of 74 patients who underwent clinico-radiological evaluation after colorectal surgery for suspicion of anastomotic leak was undertaken and a multivariable analysis of risk factors for leak was performed. A logistic regression model was used to identify determinant variables and construct a predictive score. RESULTS Out of 74 patients with a clinical suspicion of anastomotic leak, 17 (23%) had this complication confirmed following repeat laparotomy. In multivariate analysis, three variables were associated with anastomotic leak: (1) white blood cells count > 9 × 10(9) /l (OR = 14.8); (2) presence of ≥ 500 cm(3) of intra- abdominal fluid (OR = 13.4); and (3) pneumoperitoneum at the site of anastomosis (OR = 9.9). Each of these three parameters contributed one point to the risk score. The observed risk of leak was 0, 6, 31 and 100%, respectively, for patients with scores of 0, 1, 2 and 3. The area under the receiver operating characteristic curve for the score was 0.83 (0.72-0.94). CONCLUSION This CT scan-based model seems clinically promising for objective quantification of the risk of a leak after colorectal surgery.
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Affiliation(s)
- P Gervaz
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
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Fortuny JV, Buchs NC, Morel P, Ris F. [Right-sided colonic diverticular disease: quo vadis?]. Rev Med Suisse 2014; 10:1325-1330. [PMID: 25051594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Symptomatic diverticular disease of the right colon is a rare entity in our latitudes, where it represents only 1.5% of all diverticulitis. In contrary, this disease is endemic in Asian countries. Besides, it has several differences with its left counterpart. Indeed, a right-sided diverticular disease is more often symptomatic, while the risk of complicated episodes seems lower. Right-sided diverticular disease usually manifests as right iliac fossa pain or low gastrointestinal bleeding. First described on 1912, there are no clear guidelines. The approach is usually conservative in Asia; when surgery cannot be avoided, a limited resection is performed. In Western countries, a surgical approach is more often considered. We reviewed the current literature and propose a way to manage right diverticulitis.
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Hagen ME, Joliat C, Buchs JB, Nastasi A, Ruttimann R, Lazeyras F, Buchs NC, Iselin C, Morel P, Bühler L. [Robotic-assisted organ transplantation]. Rev Med Suisse 2014; 10:1356-1360. [PMID: 25051599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Advanced surgical procedures have traditionally been a domain of open surgery. However, minimally invasive approaches are evolving with the development of robotic technology which appears capable to overcome technical limitations of conventional laparoscopy. While traditionally perceived as impossible indications for minimally invasive surgery, reports on robotic organ transplantations have surfaced with promising results.
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Jung MK, Buchs NC, Azagury DE, Hagen ME, Morel P. Robotic distal pancreatectomy: a valid option? MINERVA CHIR 2013; 68:489-497. [PMID: 24101006] [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: 06/02/2023]
Abstract
Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach.
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Affiliation(s)
- M K Jung
- Clinic for Visceral and Transplantation Surgery Department of Surgery University Hospital of Geneva Geneva, Switzerland -
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Buchs NC, Konrad-Mugnier B, Jannot AS, Poletti PA, Ambrosetti P, Gervaz P. Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg 2013; 100:976-9; discussion 979. [PMID: 23592303 DOI: 10.1002/bjs.9119] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The natural history of sigmoid diverticulitis has been inferred from population-based or retrospective studies. This study assessed the risk of a recurrent attack following the first episode of uncomplicated diverticulitis. METHODS Patients admitted between January 2007 and December 2011 with a first episode of uncomplicated sigmoid diverticulitis confirmed on computed tomography were enrolled in this prospective study. After successful medical management of the first episode, follow-up was conducted through yearly telephone interviews. Cox proportional hazards regression was performed to model the impact of various parameters on eventual recurrences and complications. RESULTS During a median follow-up of 24 (range 3-63) months, 46 (16·4 per cent) of 280 patients experienced a second episode of diverticulitis. Six patients (2·1 per cent) subsequently developed complicated diverticulitis and four (1·4 per cent) underwent emergency surgery for peritonitis. In multivariable analysis, a raised serum level of C-reactive protein (over 240 mg/l) during the first attack was associated with early recurrence (hazard ratio 1·75, 95 per cent confidence interval 1·04 to 2·94; P = 0·035). CONCLUSION Uncomplicated sigmoid diverticulitis follows a benign course with few recurrences and little need for emergency surgery. REGISTRATION NUMBER NCT01015378 (http://www.clinicaltrials.gov).
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Affiliation(s)
- N C Buchs
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
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Buchs NC, Pugin F, Volonté F, Jung M, Hagen ME, Morel P. [Robotic single site surgery: current practice and future developments]. Rev Med Suisse 2012; 8:1316-1320. [PMID: 22792595] [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: 06/01/2023]
Abstract
Robotic surgery has been gaining increasing acceptance for several years now, establishing itself with success in all the surgical fields. Besides, since the introduction of single site surgery, the interest for the robotic technology is more than obvious, offering technical possibilities to overcome the natural limitations of laparoscopy. This article reviews the different devices available and the indications of robotic single site surgery. Moreover, the future developments of this new technology are discussed as well.
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Affiliation(s)
- N C Buchs
- Service de chirurgie viscérale et de transplantation, Département de chirurgie HUG, 1211 Genève 14.
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Gervaz P, Bandiera-Clerc C, Buchs NC, Eisenring MC, Troillet N, Perneger T, Harbarth S. Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg 2012; 99:589-95. [PMID: 22231649 DOI: 10.1002/bjs.8656] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is no dedicated scoring system for predicting the risk of surgical-site infection (SSI) after resection of the colon or rectum. Generic scores, such as the National Nosocomial Infections Surveillance index, are not used by colorectal surgeons. METHODS Multivariable analysis of risk factors for SSI was performed in patients who underwent resection of the colon or rectum, and were followed during the first month after operation. A logistic regression model was used to identify determinant variables and construct a predictive score. RESULTS There were 534 patients of whom 114 (21·3 per cent) developed SSI. In multivariable analysis, four parameters correlated with an increased risk of SSI: obesity (odds ratio (OR) 2·93, 95 per cent confidence interval 1·71 to 5·03), contamination class 3-4 (OR 3·33, 2·08 to 5·32), American Society of Anesthesiologists grade III-IV (OR 1·82, 1·14 to 2·90) and open surgery (OR 2·22, 1·01 to 4·88). Each of these contributed 1 point to the risk score. The observed risk of SSI was 5 per cent for a score of 0, 12·0 per cent for a score of 1 point, 18·7 per cent for 2 points, 44 per cent for 3 points and 68 per cent for 4 points. The area under the receiver operating characteristic curve for the score was 0·729. CONCLUSION A simple clinical score based on four preoperative variables was clinically useful in predicting the risk of SSI in patients undergoing colorectal surgery.
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Affiliation(s)
- P Gervaz
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland.
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Buchs NC, Volonte F, Pugin F, Bucher P, Jung M, Morel P. Robotic pancreatic resection: how far can we go? MINERVA CHIR 2011; 66:603-614. [PMID: 22233666] [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: 05/31/2023]
Abstract
Minimally invasive pancreatic resection remains one of the most challenging abdominal procedures. A wide diffusion of the laparoscopic approach for pancreatic resection is still waited. However, interest is growing since the introduction of robotics in this field and many reports have been published so far. Distal pancreatectomy with or without spleen-preservation, pancreaticoduodenectomy, total and middle pancreatectomy and even extended resections or reconstructions have been reported with good outcomes. This review reports and evaluates the robotic approach for such advanced pancreatic resections. While complex pancreatic resections are feasible and safe by a robotic approach, it is still very early to draw definitive conclusions. Further randomized and controlled studies are required to support a routine use of the robotic technology for pancreatic resection.
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Affiliation(s)
- N C Buchs
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 2011; 98:1695-702. [PMID: 21964736 DOI: 10.1002/bjs.7689] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Conventional laparoscopy with three or more ports remains the 'gold standard' for cholecystectomy, but a laparoendoscopic single-site (LESS) approach is emerging, designed to decrease parietal trauma and improve cosmesis. This study compared conventional laparoscopic (CL) with LESS cholecystectomy, with short-term clinical results as the main outcomes. METHODS A randomized trial of CL and LESS cholecystectomies involving 150 patients was undertaken. Follow-up was for 1 month after surgery. The primary endpoint was body image results evaluated by means of validated scales. Secondary endpoints were: postoperative pain measured on a visual analogue scale, analgesia requirement, morbidity, quality of life (QoL) measured with Short Form 12, duration of operation, hospital stay, time to return to work and cost analysis. RESULTS Operating times and complications were similar in the two groups. Two LESS procedures (3 per cent) were converted to two-port laparoscopy owing to difficulties with exposure, and one CL operation was achieved through a single port because extensive fibrous peritoneal adhesions prevented placement of other ports. There were three and four port-site seroma/haematomas in the LESS and CL groups respectively. Better pain profiles and lower analgesia requirements were recorded in the LESS group (P < 0·001). QoL, body image and scar scale results were also better (P < 0·001). Operative costs were higher for LESS procedures (P < 0·001), although median time to return to work was shorter (P = 0·003). CONCLUSION LESS is an alternative to CL cholecystectomy associated with better cosmesis, body image, QoL and an improved postoperative pain profile.
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Affiliation(s)
- P Bucher
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
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Buchs NC, Bucher P, Pugin F, Morel P. Robot-assisted gastrectomy for cancer. MINERVA GASTROENTERO 2011; 57:33-42. [PMID: 21372768] [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: 05/30/2023]
Abstract
Minimally invasive approach for gastric cancer has gained increasing acceptance. Introduction of the da Vinci robotic system has allowed overcoming the technical limitations of standard laparoscopy. To date, several studies have been published reporting the feasibility of robot-assisted gastrectomy (RAG). The aim of this study is to extensively review all the published literature concerning RAG and to assess its value. Since 2003, this systematic review of the literature shows that 10 original studies reporting 199 RAG for cancer have been published worldwide. The authors analyzed operative time, blood loss, conversion rate, lymph nodes retrieval, complications, mortality, length of hospital stay and follow-up through a systematic review. Mean age was 63 years (range: 25-96). Mean operative times were 265 minutes and 334 minutes for total and subtotal gastrectomy respectively. Mean blood loss reported was 113 mL (range: 12-1400). Conversion rate was 2.5%. Average lymph nodes retrieval was 32 (range: 11-83). Twenty-nine complications were reported (14.6%). Mortality rate was 1.5%. Mean length of stay was 10 days (range: 3-175).This review demonstrates that RAG for cancer is not only feasible but also seems to be safe, with low mortality and acceptable morbidity. However, due to the lack of long-term follow-up and the limited number of published studies, it is relatively too early to draw definitive conclusions and/or to recommend the use of RAG for oncologic gastrectomy. Randomized controlled trials with long-term follow up are needed before this promising approach can eventually be generalized.
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Affiliation(s)
- N C Buchs
- Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Giulianotti PC, Buchs NC, Addeo P, Bianco FM, Ayloo SM, Caravaglios G, Coratti A. Robot-assisted adrenalectomy: a technical option for the surgeon? Int J Med Robot 2010; 7:27-32. [DOI: 10.1002/rcs.364] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2010] [Indexed: 11/05/2022]
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Buchs NC, Dembe JC, Robert-Yap J, Roche B, Fasel J. Optimizing electrode implantation in sacral nerve stimulation--an anatomical cadaver study controlled by a laparoscopic camera. Int J Colorectal Dis 2008; 23:85-91. [PMID: 17704926 DOI: 10.1007/s00384-007-0367-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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] [Accepted: 07/26/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Sacral nerve stimulation is the therapy of choice in patients with neurogenic faecal and urine incontinence, constipation and some pelvic pain syndromes. The aim of this study is to determine the best insertion angles of the electrode under laparoscopic visualization of the sacral nerves. MATERIALS AND METHODS Five fresh cadaver pelvises were dissected through an anterior approach of the presacral space, exposing the ventral sacral roots. Needles and electrodes were inserted into the S3 foramen. Both right and left sides were used, with the traditional percutaneous procedure. The validation was done by a laparoscopic camera controlling the position of the needle and electrode on the nerve. The angles were assessed with a goniometer and were confirmed in two living patients. RESULTS The mean angle of insertion in the sagittal plane was 62.9+/-3 degrees (range, 59-70). In the axial plane, the mean angle for the left side was 91.7+/-13.5 degrees (range, 80-110) and 83.2+/-7.7 degrees for the right side (range, 75-95). These angles resulted in the optimal placement of the leads along the S3 sacral root, in all these cases. CONCLUSIONS This study allows direct visualization during the placement of the needle and electrode, thus permitting accurate calculations of the best angle of approach during the surgical procedure in sacral nerve stimulation. These objective findings attempt to standardize this technique, which is often performed with the aid of intra-operative fluoroscopy but still leaving a lot to chance. These insertion angles should help to find more consistent and reproducible results and thus improved outcome in patients.
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Affiliation(s)
- N C Buchs
- Unit of Proctology, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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Buchs NC, Frossard JL, Rosset A, Chilcott M, Koutny-Fong P, Chassot G, Fasel JHD, Poletti PA, Becker CD, Mentha G, Bühler L, Morel P. Vascular invasion in pancreatic cancer: evaluation of endoscopic ultrasonography, computed tomography, ultrasonography, and angiography. Swiss Med Wkly 2007; 137:286-91. [PMID: 17594541 DOI: 2007/19/smw-11701] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PRINCIPLES Current methods for detecting vascular invasion in pancreatic cancer can be inaccurate, invasive, and expensive. The aim of this study is to assess the value of current imaging modalities in determining vascular invasion by pancreatic cancer. METHODS The results of Endoscopic Ultrasonography (EUS), Computed Tomography (CT), Ultrasonography (US), and Angiography performed in 170 patients, suffering from pancreatic cancer, were retrospectively studied and correlated with intra-operative findings and surgical anatomopathological diagnosis after resection. We assessed sensitivity, specificity, positive and negative predictive values, and accuracy for detecting vascular invasion. RESULTS EUS turned out to be the most reliable imaging technique for detecting vascular invasion in pancreatic cancer, with a sensitivity of 55%, specificity of 90%, positive predictive value of 61.1%, negative predictive value of 87.5%, and accuracy of 82.2%. CT results were 39.4%, 90%, 52%, 84.4%, and 79.1% for the respective categories, with however, better results with multislice CT. The US results were 3.7% for the sensitivity, 96.3% for the specificity, 25% for the positive predictive value, 75.2% for the negative predictive value, and 73.4% for the accuracy. For angiography, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 52.6%, 72.3%, 43.5%, 79.1%, and 66.7% respectively. CONCLUSION In this study, EUS was the most valuable imaging modality in assessing vascular invasion (especially for venous invasion) for pancreatic cancer, with an accuracy of more than 80%. A further prospective study should be carried out to evaluate the combination of imaging modalities for the detection of vascular involvement, especially with multi-slice CT which almost reached the performances obtained by EUS.
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Affiliation(s)
- N C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Buchs NC, Azagury D, Chilcott M, Nguyen-Tang T, Dumonceau JM, Morel P. Bouveret's syndrome: management and strategy of a rare cause of gastric outlet obstruction. Digestion 2007; 75:17-9. [PMID: 17429202 DOI: 10.1159/000101561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Buchs NC, Frossard JL, Rosset A, Chilcott M, Koutny-Fong P, Chassot G, Fasel JHD, Poletti PA, Becker CD, Mentha G, Bühler L, Morel P. Vascular invasion in pancreatic cancer: evaluation of endoscopic ultrasonography, computed tomography, ultrasonography, and angiography. Swiss Med Wkly 2007; 137:286-91. [PMID: 17594541 DOI: 10.4414/smw.2007.11701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PRINCIPLES Current methods for detecting vascular invasion in pancreatic cancer can be inaccurate, invasive, and expensive. The aim of this study is to assess the value of current imaging modalities in determining vascular invasion by pancreatic cancer. METHODS The results of Endoscopic Ultrasonography (EUS), Computed Tomography (CT), Ultrasonography (US), and Angiography performed in 170 patients, suffering from pancreatic cancer, were retrospectively studied and correlated with intra-operative findings and surgical anatomopathological diagnosis after resection. We assessed sensitivity, specificity, positive and negative predictive values, and accuracy for detecting vascular invasion. RESULTS EUS turned out to be the most reliable imaging technique for detecting vascular invasion in pancreatic cancer, with a sensitivity of 55%, specificity of 90%, positive predictive value of 61.1%, negative predictive value of 87.5%, and accuracy of 82.2%. CT results were 39.4%, 90%, 52%, 84.4%, and 79.1% for the respective categories, with however, better results with multislice CT. The US results were 3.7% for the sensitivity, 96.3% for the specificity, 25% for the positive predictive value, 75.2% for the negative predictive value, and 73.4% for the accuracy. For angiography, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 52.6%, 72.3%, 43.5%, 79.1%, and 66.7% respectively. CONCLUSION In this study, EUS was the most valuable imaging modality in assessing vascular invasion (especially for venous invasion) for pancreatic cancer, with an accuracy of more than 80%. A further prospective study should be carried out to evaluate the combination of imaging modalities for the detection of vascular involvement, especially with multi-slice CT which almost reached the performances obtained by EUS.
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Affiliation(s)
- N C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Buchs NC, Maffei M, Robert-Yap J, Zufferey G, Roche B. An unusual retrorectal tumour in adults: the teratoma. Tech Coloproctol 2006; 10:366-7. [PMID: 17228493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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