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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Tracanelli L, Fathallah N, Babin-Pigot E, Ferry M, Bouguen G, Laharie D, Cotte E, Panis Y, Peyrin-Biroulet L, Roblin X, Zerbib P. Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus. Tech Coloproctol 2022; 26:805-811. [DOI: 10.1007/s10151-022-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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Klapisz L, Marciniak C, Clement G, Zerbib P, Boleslawski E. Combined stoma reversal and liver resection for rectal metastatic cancer: A single center retrospective analysis. J Visc Surg 2021; 159:383-388. [PMID: 34116952 DOI: 10.1016/j.jviscsurg.2021.05.004] [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] [Indexed: 11/17/2022]
Abstract
GOAL OF THE STUDY Concomitant liver metastases are discovered at the time of diagnosis in 25% of patients with colorectal cancers. The appropriate time to restore digestive continuity after stoma creation during rectal surgery has not yet been established. The objective of this study is to assess the morbidity of stoma reversal during the secondary hepatectomy procedure. PATIENTS AND METHODS This was a single-center retrospective case-control study including patients who underwent ileostomy or colostomy reversal by a direct approach (REVERSAL group) compared to those who did not undergo stoma reversal (NON-REVERSAL group) during hepatic resection of rectal cancer metastasis between 2004 and 2016. Peri-operative data were collected. The primary outcome measure was the comprehensive complication index (CCI). The secondary outcomes were overall mortality, liver-related morbidity, duration of hospital stay and occurrence of gastrointestinal leaks. Statistical analysis was carried out using SPSS 23.0 software. RESULTS Thirty liver resections were included; 14 in the REVERSAL group (female/male=11/19, age=60 years). No statistically significant difference was observed in the CCI scores (15 vs. 20.8; P=0.6). Complications occurred in 9 (64%) and 8 (50%) patients in the REVERSAL and NON-REVERSAL groups, respectively (P=0.48). No gastro-intestinal leaks or post-operative mortality occurred. CONCLUSION Stoma reversal during hepatectomy for liver metastasis from a primary rectal cancer represents a safe alternative since post-operative outcome was not associated with additional morbidity in this series.
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Affiliation(s)
- L Klapisz
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.
| | - C Marciniak
- Department of general and endocrine Surgery, Lille University Hospital, Lille, France
| | - G Clement
- Medical Information Department, Lille University Hospital; EA 2694-évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - E Boleslawski
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
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Collard MK, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corté H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche R, Vicaut E, Panis Y, Brouquet A. A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort. J Crohns Colitis 2021; 15:409-418. [PMID: 33090205 DOI: 10.1093/ecco-jcc/jjaa217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Few prospective data exist on outcomes of surgery in Crohn's disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage. METHODS From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups. RESULTS Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159]. CONCLUSIONS Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.
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Affiliation(s)
- M K Collard
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - S Benoist
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - P Zerbib
- Digestive Surgery Department, University Hospital of Lille, Lille, France
| | - J H Lefevre
- Digestive Surgery Department, Saint-Antoine Hospital Saint-Antoine, APHP, Paris VI University, Paris, France
| | - Q Denost
- Digestive Surgery Department, Saint-Andre University Hospital, Bordeaux, France
| | - A Germain
- Digestive Surgery Department, University Hospital of Nancy, Nancy, France
| | - E Cotte
- Digestive Surgery Department, Lyon-Sud University Hospital, Pierre-Benite, France
| | - L Beyer-Berjot
- Digestive Surgery Department, Marseille-Nord University Hospital, Marseille, France
| | - H Corté
- Digestive Surgery Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - V Desfourneaux
- Digestive Surgery Department, University Hospital of Rennes, Rennes, France
| | - A Rahili
- Digestive Surgery Department, University Hospital of Nice, Nice, France
| | - J P Duffas
- Digestive Surgery Department, Rangueil University Hospital, Toulouse, France
| | - K Pautrat
- Digestive Surgery Department, Lariboisiere Hospital, Paris VII University, Paris, France
| | - C Denet
- Digestive Surgery Department, Montsouris Institute, Paris, France
| | - V Bridoux
- Digestive Surgery Department, University Hospital of Rouen, Rouen, France
| | - G Meurette
- Digestive Surgery Department, University Hospital of Nantes, Nantes, France
| | - J L Faucheron
- Digestive Surgery Department, Digestive Surgery Department, University Hospital of Grenoble, La Tronche, France
| | - J Loriau
- Digestive Surgery Department, Saint-Joseph Hospital, Paris, France
| | - R Souche
- Digestive Surgery Department, University Hospital of Montpellier, Montpellier, France
| | - E Vicaut
- Department of Clinical Research, Fernand Widal Hospital, APHP, Paris VII, Paris, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - A Brouquet
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
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Schneider Bordat L, El Amrani M, Truant S, Branche J, Zerbib P. Management of pancreatic ascites complicating alcoholic chronic pancreatitis. J Visc Surg 2021; 158:370-377. [PMID: 33461889 DOI: 10.1016/j.jviscsurg.2020.11.015] [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] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pancreatic ascites (PA) is an unusual and little studied complication of chronic alcoholic pancreatitis. Management is complex and is based mainly on empirical data. The aim of this retrospective work was to analyse the management of PA at our centre. PATIENTS AND METHODS A total of 24 patients with PA complicating chronic alcoholic pancreatitis were managed at the Lille University Hospital between 2004 and 2018. Treatment was initially medical and then, in case of failure, interventional (endoscopic, radiological and/or surgical). Data regarding epidemiology, therapeutic and follow-up data were collected retrospectively. RESULTS Twenty-four patients were analysed; median follow-up was 18.5 months [6.75-34.25]. Exclusively medical treatment was effective in three of four patients, but, based on intention to treat, medical therapy alone was effective in only two out of 24 patients. Of 17 patients treated endoscopically, treatment was successful in 15 of them. Of the 15 who underwent surgery, external surgical drainage was effective in 13. Multimodal treatment, initiated after 6.5 days [4-13.5] of medical treatment, was effective in 12 out of 14 patients. In total, 21 patients were successfully treated (87%) with a morbidity rate of 79% and a mortality rate of 12.5% (n=3). CONCLUSION PA gives rise to significant morbidity and mortality. Conservative medical treatment has only a limited role. If medical treatment fails, endoscopic and then surgical treatment allow a favourable outcome in more than 80% of patients.
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Affiliation(s)
- L Schneider Bordat
- Department of digestive surgery and transplantation, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, rue Michel-Polonowski, 59037 Lille, France.
| | - M El Amrani
- Department of digestive surgery and transplantation, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, rue Michel-Polonowski, 59037 Lille, France
| | - S Truant
- Department of digestive surgery and transplantation, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, rue Michel-Polonowski, 59037 Lille, France
| | - J Branche
- Gastroenterology department, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, 59037 Lille, France
| | - P Zerbib
- Department of digestive surgery and transplantation, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, rue Michel-Polonowski, 59037 Lille, France
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Frontali A, Cohen L, Bridoux V, Myrelid P, Sica G, Poggioli G, Espin E, Beyer-Berjot L, Laharie D, Spinelli A, Zerbib P, Sampietro G, Frasson M, Louis E, Danese S, Fumery M, Denost Q, Altwegg R, Nancey S, Michelassi F, Treton X, Panis Y. Segmental Colectomy for Ulcerative Colitis: Is There a Place in Selected Patients Without Active Colitis? An International Multicentric Retrospective Study in 72 Patients. J Crohns Colitis 2020; 14:1687-1692. [PMID: 32498084 DOI: 10.1093/ecco-jcc/jjaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA]. METHODS All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo's classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed. RESULTS: A TOTAL OF 72 UC patients underwent: sigmoidectomy [n = 28], right colectomy [n = 24], proctectomy [n = 11], or left colectomy [n = 9] for colonic cancer [n = 27], 'diverticulitis' [n = 17], colonic stenosis [n = 5], dysplasia or polyps [n = 8], and miscellaneous [n = 15]. Three patients died postoperatively and 5/69 patients [7%] developed early flare of UC within 3 months after SC. After a median followup of 40 months, 24/69 patients [35%] were reoperated after a median delay after SC of 19 months [range, 2-158 months]: 22/24 [92%] underwent total colectomy and ileorectal anastomosis [n = 9] or total coloproctectomy [TCP] [n = 13] and 2/24 [8%] an additional SC. Reasons for reoperation were: colitis [n = 14; 20%], cancer [n = 3] or dysplasia [n = 3], colonic stenosis [n = 1], and unknown reasons [n = 3]. Endoscopic score of colitis before SC was Mayo 23 in 5/5 [100%] patients with early flare vs 15/42 without early flare [36%; p = 0.0101] and in 9/12 [75%] patients with reoperation for colitis vs 11/35 without reoperation [31%; p = 0.016]. CONCLUSIONS After segmental colectomy in UC patients, postoperative early colitis is rare [7%]. Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis.
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Affiliation(s)
- A Frontali
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université de Paris, France
| | - L Cohen
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Bridoux
- CHU Rouen, Digestive Surgery, Rouen, France
| | - P Myrelid
- Department of Biomedical and Clinical Sciences, Linköping University and Department of Surgery, Linköping University Hospital, Linköping Sweden
| | - G Sica
- Policlinico Tor Vergata, Digestive Surgery, Roma, Italy
| | | | - E Espin
- Hospital Universitari Val d'Hebron, Digestive Surgery, Barcelona, Spain
| | | | - D Laharie
- Department of Gastroenterology, CHU Bordeaux, Bordeaux, France
| | - A Spinelli
- Department of Colorectal Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - P Zerbib
- CHU Lille, Digestive Surgery, Lille, France
| | - G Sampietro
- Department of Surgery, IBD Unit, Luigi Sacco University Hospital, Milano, Italy
| | - M Frasson
- University Hospital La Fe, Digestive Surgery, Valencia, Spain
| | - E Louis
- CHU Liege, Gastroenterology, Liege, France
| | - S Danese
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IBD center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M Fumery
- Department of Gastroenterology, CHU Amiens Picardie, Amiens, France
| | - Q Denost
- Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France
| | - R Altwegg
- Department of Gastroenterology, CHU Montpellier, Montpellier, France
| | - S Nancey
- Department of Gastroenterology, CHU Lyon, Lyon, France
| | - F Michelassi
- Department of Surgery, New York Presbyterian Hospital Weill Cornell Medical Centre, New York, NY, USA
| | - X Treton
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université de Paris, France
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7
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Noiret B, Bentaleb A, Oughriss M, Chambon J, Zerbib P. Cecal distension on non-tumoral left colonic obstacle: Management strategy in two cases. J Visc Surg 2020; 157:211-213. [DOI: 10.1016/j.jviscsurg.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Neoplastic gallbladder polyps (NGP) are rare; the prevalence in the overall population is less than 10%. NGP are associated with a risk of malignant degeneration and must be distinguished from other benign gallbladder polypoid lesions that occur more frequently. NGP are adenomas and the main risk associated with their management is to fail to detect their progression to gallbladder cancer, which is associated with a particular poor prognosis. The conclusions of the recent European recommendations have a low level of evidence, based essentially on retrospective small-volume studies. Abdominal sonography is the first line study for diagnosis and follow-up for NGP. To prevent the onset of gallbladder cancer, or treat malignant degeneration in its early phases, all NGP larger than 10mm, or symptomatic, or larger than 6mm with associated risk factors for cancer (age over 50, sessile polyp, Indian ethnicity, or patient with primary sclerosing cholangitis) are indications for cholecystectomy. Apart from these situations, simple sonographic surveillance is recommended for at least five years; if the NGP increases in size by more than 2mm in size, cholecystectomy is indicated. Laparoscopic cholecystectomy is possible but if the surgeon feels that the risk of intra-operative gallbladder perforation is high, conversion to laparotomy should be preferred to avoid potential intra-abdominal tumoral dissemination. When malignant NGP is suspected (size greater than 15mm, signs of locoregional extension on imaging), a comprehensive imaging workup should be performed to search for liver extension: in this setting, radical surgery should be considered.
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Affiliation(s)
- C Valibouze
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France.
| | - M El Amrani
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - S Truant
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - C Leroy
- Department of Radiology and Digestive and Endocrine Imaging, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, 59037 Lille, France
| | - G Millet
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - F R Pruvot
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - P Zerbib
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
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Abstract
INTRODUCTION Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. PATIENTS AND METHODS In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. RESULTS Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. CONCLUSION CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.
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Affiliation(s)
- A Mensier
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France
| | - T Onimus
- Pôle anesthésie et réanimation, université Lille Nord de France, hôpital Roger-Salengro, CHU de Lille, 59037 Lille, France
| | - O Ernst
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - C Leroy
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France.
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Mege D, Meurette G, Vitton V, Leroi AM, Bridoux V, Zerbib P, Sielezneff I. Sacral nerve stimulation can alleviate symptoms of bowel dysfunction after colorectal resections. Colorectal Dis 2017; 19:756-763. [PMID: 28181378 DOI: 10.1111/codi.13624] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 07/22/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022]
Abstract
AIM Poor functional results, such as faecal incontinence (FI), low anterior resection syndrome (LARS) or high stool frequency, can occur after colorectal resections, including proctocolectomy with ileal pouch-anal anastomosis (IPAA), rectal resection and left hemicolectomy. Management of such patients is problematic, and some case reports have demonstrated the effectiveness of sacral nerve stimulation (SNS) in these situations. Our aim was to analyse the effectiveness of SNS on poor functional results and on quality of life in patients after treatment with different types of colorectal resection. METHOD At five university hospitals from 2006 to 2014, patients with poor functional results after rectal resection, IPAA or left hemicolectomy underwent a staged SNS implant procedure. Failure was defined by the absence or insufficient improvement (< 50%) of FI episodes. RESULTS SNS for bowel dysfunction was performed in 16 patients after rectal resection with coloanal anastomosis, left hemicolectomy with colorectal anastomosis or IPAA. Two (13%) cases of primary failure were observed after the percutaneous stimulation test. Median frequency of stool, FI episodes and urgency were significantly improved in 14 patients. Wexner and LARS scores were also significantly improved for 14 patients. When we compared results according to the type of colorectal surgery (IPAA, rectal resection or left hemicolectomy), median frequencies of stool and urgency, Wexner and LARS scores were still significantly improved. Overall success rate was 75% (12/16 patients) in intention-to-treat analysis and 86% (12/14 patients with permanent electrode) in per-protocol analysis. CONCLUSION SNS seems to improve bowel dysfunction following rectal resection, left hemicolectomy or IPAA.
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Affiliation(s)
- D Mege
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
| | - G Meurette
- Department of Digestive and General Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - V Vitton
- Department of Gastroenterology, North Hospital, Aix-Marseille University, Marseille, France
| | - A-M Leroi
- Department of Digestive Physiology, Charles Nicolle Hospital, Rouen, France
| | - V Bridoux
- Department of Digestive and General Surgery, Charles Nicolle Hospital, Rouen, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Claude Huriez Hospital, Lille Cedex, France
| | - I Sielezneff
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
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11
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Abstract
Giant colonic diverticulum is defined by a diverticulum whose diameter is greater than 4 cm. This is a rare entity, arising mainly in the sigmoid colon. The diagnosis is based on abdominal computed tomography that shows a gas-filled structure communicating with the adjacent colon, with a smooth, thin diverticular wall that does not enhance after injection of contrast. Surgical treatment is recommended even in asymptomatic diverticula, due to the high prevalence and severity of complications. The gold standard treatment is segmental colectomy. Some authors propose a diverticulectomy when the giant diverticulum is unique.
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Affiliation(s)
- C Chater
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France.
| | - A Saudemont
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France
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12
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Khodari M, Ouzzane A, Marcelli F, Yakoubi R, Mitchell V, Zerbib P, Rigot JM. [Azoospermia and a history of inguinal hernia repair in adult]. Prog Urol 2015; 25:692-7. [PMID: 26184042 DOI: 10.1016/j.purol.2015.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 05/31/2015] [Accepted: 06/12/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. METHOD Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. RESULTS Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). CONCLUSION The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- M Khodari
- Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France.
| | - A Ouzzane
- Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France
| | - F Marcelli
- Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France; Service d'andrologie, université de Lille, CHRU de Lille, 59000 Lille, France
| | - R Yakoubi
- Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France
| | - V Mitchell
- Laboratoire de biologie de la reproduction, université de Lille, CHRU de Lille, Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université de Lille, CHRU de Lille, 59000 Lille, France
| | - J-M Rigot
- Service d'andrologie, université de Lille, CHRU de Lille, 59000 Lille, France
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13
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Mariette C, Wind P, Micelli Lupinacci R, Tresallet C, Adham M, Arvieux C, Benoist S, Berdah S, Berger A, Briez N, Brigand C, Caiazzo R, Carrere N, Casa C, Collet D, Deguelte S, Dousset B, Dubuisson V, Glehen O, Gineste JC, Hamy A, Lacaine F, Laurent C, Lehur PA, Mabrut JY, Mathieu P, Mathonnet M, Meunier B, Michot F, Ouaissi M, Palot JP, Parc Y, Pattou F, Paye F, Pezet D, Piessen G, Pocard M, Regenet N, Regimbeau JM, Sabbagh C, Zerbib P, Toussaint JM. Practice patterns in complex ventral hernia repair and place of biological grafts: A national survey among French digestive academic surgeons. J Visc Surg 2014; 151:9-16. [DOI: 10.1016/j.jviscsurg.2013.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Zerbib P, Caiazzo R, Piessen G, Rogosnitzky M, Séquier C, Koriche D, Truant S, Boleslawski E, Chambon JP, Pruvot FR. Outcome in porcine acellular dermal matrix reinforcement of infected abdominal wall defects: a prospective study. Hernia 2013; 19:253-7. [DOI: 10.1007/s10029-013-1153-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 08/23/2013] [Indexed: 11/24/2022]
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15
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Lebas A, Rogosnitzky M, Chater C, Colombel JF, Nachury M, Cortot A, Zerbib P. Efficacy of sacral nerve stimulation for poor functional results of J-pouch ileoanal anastomosis. Tech Coloproctol 2013; 18:355-60. [DOI: 10.1007/s10151-013-1058-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/29/2013] [Indexed: 12/29/2022]
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Bauters A, Holt DJ, Zerbib P, Rogosnitzky M. Gallium nitrate induces fibrinogen flocculation: an explanation for its hemostatic effect? Biometals 2013; 26:935-9. [DOI: 10.1007/s10534-013-9669-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/09/2013] [Indexed: 11/27/2022]
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17
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Affiliation(s)
- H Marin
- Chirurgie digestive et transplantations, hôpital Claude-Huriez, université Nord-de-France, CHU de Lille, 59000 Lille, France
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Chambon JP, Bianchini A, Massouille D, Perot C, Lancelevée J, Zerbib P. Ischemic gastritis: a rare but lethal consequence of celiac territory ischemic syndrome. MINERVA CHIR 2012; 67:421-428. [PMID: 23232480] [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: 06/01/2023]
Abstract
AIM Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. Here, we report on the clinical, endoscopic and imaging features and treatment outcomes for five ischemic gastritis patients. METHODS This was a retrospective, single-centre study of patients treated for ischemic gastritis between January 2009 and April 2012. All patients underwent transluminal angioplasty or open revascularization surgery. RESULTS Five patients (4 men, 1 female) were included in the present study. The condition was diagnosed in two cases of peritonitis with gastric or duodenal perforation, two cases of acute epigastric pain and one case of gastric bleeding, profuse vomiting and hypovolemic shock. Three of the five patients had endoscopically proven gastric ulcerations or necrosis. A computed tomography scan contributed to the diagnosis in all cases. The symptoms resolved in all cases after gastric revascularization via an aortohepatic bypass (N.=1), a renohepatic bypass (N.=1), a retrograde iliosuperior mesenteric bypass (N.=2) with associated celiac artery angioplasty (N.=1) and celiac and superior mesenteric artery angioplasty (N.=1). During follow-up, three patients died of starvation due to short bowel syndrome (N.=1) or metastatic lung cancer (N.=2). CONCLUSION Ischemic gastritis is a component of celiac territory ischemia syndrome and is closely associated with chronic or acute mesenteric ischemia. Computed tomography always informs the diagnosis. The rapid healing observed here after revascularization confirmed the ischemic nature of the condition and the inappropriateness of gastric resection in this context.
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Affiliation(s)
- J P Chambon
- Department of Vascular and General Surgery, University of Lille Nord de France, Lille, France
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19
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Truant S, Boleslawski E, Duhamel A, Bouras AF, Louvet A, Febvay C, Leteurtre E, Huet G, Zerbib P, Dharancy S, Hebbar M, Pruvot FR. Tumor size of hepatocellular carcinoma in noncirrhotic liver: a controversial predictive factor for outcome after resection. Eur J Surg Oncol 2012; 38:1189-96. [PMID: 22863304 DOI: 10.1016/j.ejso.2012.07.112] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/24/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients. METHODS From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥ 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome. RESULTS Five patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥ 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%). CONCLUSIONS Although patients with NC-HCC ≥ 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.
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Affiliation(s)
- S Truant
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue M. Polonovski, CHU, Univ Nord de France, F-59000 Lille, France.
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20
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Truant S, Boleslawski E, Duhamel A, Bouras AF, Louvet A, Febvay C, Leteurtre E, Huet G, Zerbib P, Dharancy S, Hebbar M, Pruvot FR. Tumor size of hepatocellular carcinoma in noncirrhotic liver: a controversial predictive factor for outcome after resection. Eur J Surg Oncol 2012. [PMID: 22863304 DOI: 10.1016/j/ejso.2012.07.112] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients. METHODS From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥ 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome. RESULTS Five patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥ 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%). CONCLUSIONS Although patients with NC-HCC ≥ 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.
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Affiliation(s)
- S Truant
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue M. Polonovski, CHU, Univ Nord de France, F-59000 Lille, France.
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21
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Zerbib P, Koriche D, Truant S, Bouras AF, Vernier-Massouille G, Seguy D, Pruvot FR, Cortot A, Colombel JF. Pre-operative management is associated with low rate of post-operative morbidity in penetrating Crohn's disease. Aliment Pharmacol Ther 2010; 32:459-65. [PMID: 20497144 DOI: 10.1111/j.1365-2036.2010.04369.x] [Citation(s) in RCA: 56] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ileocaecal resection for penetrating Crohn's disease is still challenging with a high rate of post-operative morbidity and faecal diversion. AIM To report retrospectively the results of pre-operative management for penetrating Crohn's disease focusing on the rate of post-operative major morbidities and need for faecal diversion. METHODS Between 1997 and 2007, 78 patients with penetrating Crohn's disease underwent a first ileocaecal resection after a pre-operative management consisting in bowel rest, nutritional therapy, intravenous antibiotics, weaning off steroids and immunosuppressors, and drainage of abscesses when appropriate. RESULTS Resection was performed for terminal ileitis associated with (n = 41), abscesses (n = 37) or both (n = 5). A pre-operative nutritional therapy was performed in 50 patients (68%) for 23 days (range, 7-69 days) along with a weaning off steroids and immunosuppressors. A diverting stoma was performed for six patients (7.7%). There was no post-operative death. Post-operative complications were classified as minor in 10 patients (12.8%), and major in four patients (5%). Overall, the post-operative course was uneventful in 58 patients (74%). CONCLUSION Pre-operative management for penetrating Crohn's disease allowed ileocaecal resection with low rates of post-operative morbidity and faecal diversion.
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Affiliation(s)
- P Zerbib
- Department of Digestive Surgery and Transplantation, Univ Lille Nord de France, CHU Lille, France.
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Abstract
Hemato-oncologic imaging combines anatomical and functional imaging data for optimal staging and follow-up of patients. It is currently possible to achieve high spatial resolution and functional evaluation at whole body MR imaging. Functional imaging may be achieved with two techniques: dynamic imaging following intravenous contrast injection and diffusion-weighted imaging. The purpose of this article is to demonstrate how both functional imaging techniques can be combined with whole body MR imaging for the evaluation of multiple myeloma and lymphomas.
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Affiliation(s)
- A Luciani
- Service d'Imagerie Médicale AP-HP, Groupe Hospitalier Henri Mondor-Chenevier, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Paris XII 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France.
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Duriez A, Truant S, Desurmont P, Sergent G, Buob D, Leteurtre E, Zerbib P, Pruvot FR, Maunoury V. [Metachronous cancer of common bile duct after resection of an intrahepatic cholangiocarcinoma]. Gastroenterol Clin Biol 2010; 34:115-116. [PMID: 20071114 DOI: 10.1016/j.gcb.2009.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 11/04/2009] [Accepted: 12/03/2009] [Indexed: 05/28/2023]
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Zerbib P, Khoury-Helou A, Lebuffe G, Massouille D, Nunes B, Chambon JP. Surgical revascularization for chronic intestinal ischemia. MINERVA CHIR 2008; 63:191-198. [PMID: 18577905] [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: 05/26/2023]
Abstract
AIM The aim of this study was to assess outcome after surgical revascularization for chronic intestinal ischemia (CII). METHODS From 1980 until 2003, 34 patients underwent revascularization for CII. Records were reviewed for operative technique, perioperative mortality and long-term outcomes. CII was diagnosed on the basis of clinical, arteriographic and angio-magnetic resonance imaging (MRI) criteria. Revascularization patency was monitored by arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning or angio-MRI. RESULTS The celiac artery (CA) was severely diseased in 26 cases and the superior mesenteric artery (SMA) in 30 cases. Four patients presented single-vessel, 15 patients two-vessel, and 15 three-vessel involvement. Revascularization was performed by either simple (N=15) or double (N=19) bypass grafting. In 2 patients bypass grafting was combined with reimplantation. One patient underwent reimplantation alone. Median follow-up was 45 months. The 30-day mortality rate was 3%; there were 22 late death (64%). Primary revascularization patency was 94% at 1 month and 79.4% at 4 years. Clinical success rates were 85% and 70% respectively at 1 month and at 4 years. CONCLUSION To choose the most suitable intervention, the Authors distinguished isolated CII treatable by single SMA revascularization from the digestive arteritis affecting the supramesocolic level of the abdomen, which requires double CA and SMA revascularization.
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Affiliation(s)
- P Zerbib
- Department of General and Vascular Surgery, University Hospital of Lille, Lille, France.
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Lin C, Luciani A, Haioun C, Pigneur F, Deux JF, Zerbib P, Vignaud A, Raymond R, Kobeiter H, Itti E, Rahmouni A. Imagerie par résonance magnétique (IRM) corps entier en cancérologie. ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Philippe D, Chakass D, Thuru X, Zerbib P, Tsicopoulos A, Geboes K, Bulois P, Breisse M, Vorng H, Gay J, Colombel JF, Desreumaux P, Chamaillard M. Mu opioid receptor expression is increased in inflammatory bowel diseases: implications for homeostatic intestinal inflammation. Gut 2006; 55:815-23. [PMID: 16299031 PMCID: PMC1856226 DOI: 10.1136/gut.2005.080887] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [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] [Revised: 10/06/2005] [Accepted: 10/11/2005] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Recent studies with mu opioid receptor (MOR) deficient mice support a physiological anti-inflammatory effect of MOR at the colon interface. To better understand the potential pharmacological effect of certain opiates in inflammatory bowel diseases (IBD), we (1) evaluated the regulation in vivo and in vitro of human MOR expression by inflammation; and (2) tested the potential anti-inflammatory function of a specific opiate (DALDA) in inflamed and resting human mucosa. PATIENTS AND METHODS Expression of MOR mRNA and protein was evaluated in healthy and inflamed small bowel and colonic tissues, isolated peripheral blood mononuclear cells and purified monocytes, and CD4+ and CD8+ T cells from healthy donors and IBD patients. The effect of cytokines and nuclear factor kappaB (NFkappaB) activation on MOR expression in lymphocyte T and monocytic human cell lines was assessed. Finally, DALDA induced anti-inflammatory effect was investigated in mucosal explants from controls and IBD patients. RESULTS MOR was expressed in ileal and colonic enteric neurones as well as in immunocytes such as myeloid cells and CD4+ and CD8+ T cells. Overexpressed in active IBD mucosa, MOR was significantly enhanced by cytokines and repressed by NFkappaB inhibitor in myeloid and lymphocytic cell lines. Furthermore, ex vivo DALDA treatment dampened tumour necrosis factor alpha mRNA expression in the colon of active IBD patients. CONCLUSIONS Given the increased expression of MOR and the ex vivo beneficial effect of DALDA in active IBD, natural and/or synthetic opioid agonists could help to prevent overt pathological intestinal inflammation.
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MESH Headings
- Adult
- Analgesics, Opioid/pharmacology
- CD4-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/metabolism
- Colon/drug effects
- Colon/metabolism
- Crohn Disease/immunology
- Crohn Disease/metabolism
- Cytokines/physiology
- Female
- Homeostasis
- Humans
- Ileum/metabolism
- Inflammatory Bowel Diseases/immunology
- Inflammatory Bowel Diseases/metabolism
- Intestinal Mucosa/drug effects
- Intestinal Mucosa/metabolism
- Irritable Bowel Syndrome/metabolism
- Male
- Middle Aged
- Oligopeptides/pharmacology
- RNA, Messenger/genetics
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/metabolism
- Signal Transduction
- Tumor Cells, Cultured
- Tumor Necrosis Factor-alpha/biosynthesis
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Legrand A, Bignon A, Borel M, Zerbib P, Langlois J, Chambon JP, Lebuffe G, Vallet B. [Perioperative management of asplenic patients]. ACTA ACUST UNITED AC 2005; 24:807-13. [PMID: 15967628 DOI: 10.1016/j.annfar.2005.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 05/17/2005] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis. STUDY DESIGN Update article. DATA SYNTHESIS For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections.
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Affiliation(s)
- A Legrand
- Clinique d'anesthésie réanimation, CHRU Claude-Huriez, rue Michel-Polonovski, 59037 Lille cedex, France
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Charlanne H, Hatron PY, Zerbib P, Lambert M, Launay D, Queyrel V, Hachulla E, Devulder B. Un vrai micmac! Rev Med Interne 2004; 25 Suppl 2:S244-6. [PMID: 15460464 DOI: 10.1016/s0248-8663(04)80017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Charlanne
- Service de médecine interne, hôpital Huriez, CHRU de Lille, 59037 Lille cedex, France
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Abstract
Cancer of the gastric stump is a classical late complication of gastrectomy for benign lesion. This tumor is defined by various criteria, including a minimal delay of 5 years since the initial gastrectomy and the benignity of the initial lesion. Early diagnosis is difficult since suggestive clinical signs are usually associated with advanced tumors. Prognosis is globally bad and theoretically justifies routine endoscopic screening. For tumors which can be radically resected, completion gastrectomy with lymphadenectomy is indicated and allows a 40% 5-year survival. In other cases, palliative treatment remains a major concern.
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Affiliation(s)
- P Zerbib
- Service de chirurgie adulte ouest, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France.
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Chambon JP, Vallet B, Caiazzo R, Zerbib P. [Management of splenectomized patients]. Presse Med 2003; 32:S20-3. [PMID: 14631642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
PARTIAL SPLENECTOMY: Partial resection is possible in certain indications for splenectomy. Partial splenectomy is the best way to prevent postsplenectomy infections, even though vaccination and antibiotic prophylaxis must be prescribed. This association is also necessary when the patient undergoes an autograft to reimplant splenic tissue or develops splenosis, i.e. fortuitous autotransplantation of splenic parenchyma. GUIDELINES FOR PLANNED SPLENECTOMY: Prophylactic vaccination should be performed 15 days, or 6 weeks, before surgery. Antibiotic prophylaxis includes a preoperative injection of cefazolin followed by intravenous amoxicillin, then Oracilline (Penicilline V) with resumption of oral intake. SURGICAL ASPECTS: Indications for laparoscopic surgery have broadened, laparotomy being reserved for the most difficult cases. Special care is recommended concerning complications, particularly respiratory disorders (pleural effusion, atelectasia) and acute pancreatitis.
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Abstract
The metastasis of testicular choriocarcinoma are often hemorrhagic, primarily of cerebral or pulmonary seat. The secondary digestive localizations are rare and of bad forecast when they bleed. The surgical operation by laparotomy allows the topographic diagnosis and the treatment, but was made responsible for hemorrhagic decompensation of other metastatic localizations engaging the vital forecast.
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Affiliation(s)
- P Zerbib
- Service de chirurgie adultes Ouest, hôpital Claude-Huriez, CHRU, 59037 Lille, France.
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Abstract
STUDY AIM The aim of this retrospective study was to report on seven blunt fractures of the pancreas and to emphasize the difficulties of their diagnosis and treatment as well as their severity. PATIENTS AND METHOD From October 1995 to March 2000, seven cases of blunt fracture of the pancreas were observed. The diagnosis was immediate in two cases, due to an emergency abdominal CT scan, and for the five other patients it was postponed by 4 to 12 days because of the frequency and severity of the associated lesions present in five cases out of seven. A left splenopancreatectomy was performed in four patients; a late necrosectomy with external drainage in two patients; and one patient was not operated on. RESULTS There was one postoperative death due to associated cerebral lesions. After left splenopancreatectomy a pancreatic fistula dried up in less than a week in two patients. After necrosectomy and drainage, the operation was complicated in the two cases because of repetitive abscesses and a large and long-lasting pancreatic fistula. CONCLUSION Blunt fractures of the pancreas are rare and serious lesions. The diagnosis is often made during an emergency laparotomy for hemoperitoneum or peritonitis. The existence of a canal rupture confirmed by transpapillary wirsungography, or better by wirsungo-MRI, is a strong arguing point for a left splenopancreatectomy when the patient's state allows it. Simple external drainage is only justified when the left splenopancreatectomy isn't possible.
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Affiliation(s)
- P Zerbib
- Service de chirurgie adultes ouest, hôpital Claude-Huriez, CHRU, 59037 Lille, France
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Zerbib P, Chambon JP, Bertheloot D, Quandalle P. [Acute primary intestinal intussusception in an adult diagnosed by ultrasonography]. Ann Chir 2000; 125:291-2. [PMID: 10829512 DOI: 10.1016/s0001-4001(00)00140-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zerbib P. [Place of specific desensitization in the treatment of asthma and allergic diseases]. Maroc Med 1969; 49:168-75. [PMID: 5405189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sorel R, Zerbib P, Degoy A. [Statistical correlations between eczema in infants and allergic respiratory manifestations; apropos of 500 cases]. Pediatrie 1966; 21:155-60. [PMID: 5907081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Zerbib P. [Asthma: a disease or syndrome?]. J Med (Oporto) 1965; 58:839-41. [PMID: 5215231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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