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Corbière L, Scanff A, Desfourneaux V, Merdrignac A, Ingels A, Thibault R, Bouguen G, Bergeat D. Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database. Br J Surg 2023; 110:251-259. [PMID: 36448229 DOI: 10.1093/bjs/znac398] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The outcomes of bariatric surgery (BS) in patients with chronic inflammatory bowel disease (IBD) remain rarely described. We aimed to evaluate the 90-day morbidity and mortality rates, and the risk of IBD complications 2 years after BS. METHOD Patients from the French Programme de Médicalisation des Systèmes d'Information (PMSI) database who underwent a primary BS between 2016 and 2018 were included. We identified patients with a previous diagnosis of IBD. Postoperative 90-day (POD90) morbidity and mortality rates were compared between the two groups. The evolution of IBD was followed 2 years after BS. RESULTS Between 2016 and 2018, 138 980 patients underwent primary BS, including 587 patients with IBD: 326 (55.5 per cent) with Crohn's disease (CD) and 261 (44.5 per cent) with ulcerative colitis (UC). The preferred surgical technique was sleeve gastrectomy, especially in the IBD group (81.1 per cent), followed by gastric bypass (14.6 per cent). Patients with IBD had more comorbidities (Charlson Comorbidity Index of 1 or more, hypertension, and diabetes; P < 0.001) than those without IBD. The POD90 mortality rate did not differ between the two groups (0.049 per cent in the IBD group versus 0 per cent in the non-IBD group), but more unscheduled rehospitalizations at POD90 were observed in patients with IBD (6.0 per cent versus 3.7 per cent; P = 0.004). Two years after BS, 86 patients (14.6 per cent) in the IBD group had at least one unplanned readmission for the management of their IBD; 15 patients stayed for 3 or more days. After multivariable analysis, patients with CD had an independent elevated risk of IBD-related unplanned readmissions 2 years after BS versus UC (adjusted odds ratio 1.90, 95 per cent c.i. 1.22 to 2.97; P = 0.005). CONCLUSION In a highly selected cohort of patients with well-controlled IBD, BS did not result in added mortality or morbidity. A point of vigilance must be underlined regarding BS in patients with CD.
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Affiliation(s)
- Lisa Corbière
- Department of Digestive Surgery, CHU Rennes, Rennes, France.,Rennes 1 University, Rennes, France
| | | | | | | | - Anne Ingels
- Service d'Information Médicale, CHU Rennes, Rennes, France
| | - Ronan Thibault
- Rennes 1 University, Rennes, France.,Nutrition Unit, CHU Rennes, Rennes, France.,INRAE, INSERM, University of Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
| | - Guillaume Bouguen
- Rennes 1 University, Rennes, France.,Service des Maladies de l'Appareil Digestif, CHU Rennes, Rennes, France
| | - Damien Bergeat
- Department of Digestive Surgery, CHU Rennes, Rennes, France.,Rennes 1 University, Rennes, France.,INRAE, INSERM, University of Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
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2
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Abdalla S, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corte H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Panis Y, Brouquet A. Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn's disease complicated by malnutrition: Results of a subgroup analysis of the nationwide cohort registry from the GETAID Chirurgie group. Colorectal Dis 2021; 23:1451-1462. [PMID: 33624371 DOI: 10.1111/codi.15600] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
AIM Postoperative morbidity is high in patients operated on for Crohn's disease (CD) complicated by malnutrition. This study aimed to evaluate the impact of preoperative enteral nutritional support (PENS) on postoperative outcome in patients with CD complicated by malnutrition included in a prospective nationwide cohort. METHOD Malnutrition was defined as body mass index <18 kg/m2 and/or albuminaemia <30 g/L and/or weight loss >10%. Failure of PENS was defined as the requirement for additional preoperative parenteral nutrition to PENS. Univariate analysis of the risk factors for PENS failure was performed. Propensity score matching (PSM) was used to compare the outcomes between 'upfront surgery' and 'PENS' groups. The primary endpoint was the rate of intra-abdominal septic morbidity and/or temporary defunctioning stoma. RESULTS Among 592 patients included, 149 were selected. In the intention-to-treat population including 20 (13.4%) patients with PENS failure after PSM, 78 'upfront surgery' and 71 'PENS'-matched patients were compared, with no significant difference in the primary endpoint. Perforating CD and preoperative intra-abdominal fistula were associated with PENS failure [37.5 vs 16.1% (P = 0.047) and 41.2% vs 16.2% (P = 0.020), respectively]. After exclusion of these 20 patients, PSM was used to compare 45 'upfront surgery' and 51 'PENS'-matched patients, with a significantly decreased rate of intra-abdominal septic complications and/or temporary defunctioning stoma in the PENS group (19.6 vs 42.2%, P = 0.016). CONCLUSION Preoperative enteral nutritional support is associated with a trend but no conclusive evidence of a reduction in intra-abdominal septic complications and/or requirement for defunctioning stoma. Patients with perforating CD complicated with malnutrition are at risk of PENS failure.
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Affiliation(s)
- Solafah Abdalla
- Department of Digestive Surgery and Surgical Oncology, Hôpital Bicêtre, Université Paris Saclay, APHP, Le Kremlin Bicêtre, France.,UMR 1195, Institut National de la Santé et de la Recherche Médicale, Hôpital de Bicêtre, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Stéphane Benoist
- Department of Digestive Surgery and Surgical Oncology, Hôpital Bicêtre, Université Paris Saclay, APHP, Le Kremlin Bicêtre, France
| | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | | | - Jérémie H Lefevre
- Department of Digestive Surgery, Hôpital Saint Antoine, Université Paris Sorbonne, APHP, Paris, France
| | - Quentin Denost
- Department of Digestive Surgery, CHU Bordeaux, Bordeaux, France
| | | | - Eddy Cotte
- Department of Digestive Surgery, CHU Lyon-Sud, Pierre-Bénite, France
| | | | - Hélène Corte
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | | | - Amine Rahili
- Department of Digestive Surgery, CHU Nice, Nice, France
| | - Jean-Pierre Duffas
- Department of Digestive Surgery, CHU Toulouse-Rangueil, Toulouse, France
| | - Karine Pautrat
- Department of Digestive Surgery, Hôpital Lariboisière, Université Paris VII, APHP, Paris, France
| | - Christine Denet
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Jérôme Loriau
- Department of Digestive Surgery, Hôpital Saint Joseph, Paris, France
| | - Françoise Guillon
- Department of Digestive Surgery, CHU Montpellier, Montpellier, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, Université Paris VII, AP-HP, Paris, France
| | - Yves Panis
- Department of Colorectal Surgery, Hôpital Beaujon, Université Paris VII, APHP, Clichy, France
| | - Antoine Brouquet
- Department of Digestive Surgery and Surgical Oncology, Hôpital Bicêtre, Université Paris Saclay, APHP, Le Kremlin Bicêtre, France.,UMR 1195, Institut National de la Santé et de la Recherche Médicale, Hôpital de Bicêtre, Université Paris Saclay, Le Kremlin Bicêtre, France
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3
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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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4
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Rayar M, Beaurepaire JM, Bajeux E, Hamonic S, Renard T, Locher C, Desfourneaux V, Merdrignac A, Bergeat D, Lakehal M, Sulpice L, Houssel-Debry P, Jezequel C, Camus C, Bardou-Jacquet E, Meunier B. Hypothermic Oxygenated Perfusion Improves Extended Criteria Donor Liver Graft Function and Reduces Duration of Hospitalization Without Extra Cost: The PERPHO Study. Liver Transpl 2021; 27:349-362. [PMID: 33237618 DOI: 10.1002/lt.25955] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
Few studies have evaluated the efficacy or the cost of hypothermic oxygenated perfusion (HOPE) in the conservation of extended criteria donor (ECD) grafts from donation after brain death (DBD) donors during liver transplantation (LT). We performed a prospective, monocentric study (NCT03376074) designed to evaluate the interest of HOPE for ECD-DBD grafts. For comparison, a control group was selected after propensity score matching among patients who received transplants between 2010 and 2017. Between February and November 2018, the HOPE procedure was used in 25 LTs. Immediately after LT, the median aspartate aminotransferase (AST) level was significantly lower in the HOPE group (724UI versus 1284UI; P = 0.046) as were the alanine aminotransferase (ALT; 392UI versus 720UI; P = 0.01), lactate (2.2 versus 2.7; P = 0.01) There was a significant reduction in intensive care unit stay (3 versus 5 days; P = 0.01) and hospitalization (15 versus 20 days; P = 0.01). The incidence of early allograft dysfunction (EAD; 28% versus 42%; P = 0.22) was similar . A level of AST or ALT in perfusate >800UI was found to be highly predictive of EAD occurrence (areas under the curve, 0.92 and 0.91, respectively). The 12-month graft (88% versus 89.5%; P = 1.00) and patient survival rates (91% versus 91.3%; P = 1.00) were similar. The additional cost of HOPE was estimated at € 5298 per patient. The difference between costs and revenues, from the hospital's perspective, was not different between the HOPE and control groups (respectively, € 3023 versus € 4059]; IC, -€ 5470 and € 8652). HOPE may improve ECD graft function and reduce hospitalization stay without extra cost. These results must be confirmed in a randomized trial.
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Affiliation(s)
- Michel Rayar
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France.,INSERM, CIC 1414, Rennes, France
| | | | - Emma Bajeux
- Service d'Epidémiologie et de Santé Publique, CHU Rennes, Rennes, France
| | - Stéphanie Hamonic
- Service d'Epidémiologie et de Santé Publique, CHU Rennes, Rennes, France
| | - Thomas Renard
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France
| | - Clara Locher
- Faculté de Médecine, Université Rennes 1, Rennes, France.,Service de Pharmacologie Clinique, Centre Hospitalo- Universitaire Rennes, Rennes, France
| | | | - Aude Merdrignac
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Damien Bergeat
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France
| | - Mohamed Lakehal
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France
| | - Laurent Sulpice
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | | | - Caroline Jezequel
- Service des Maladies du Foie, Centre Hospitalo-Universitaire Rennes, Rennes, France
| | - Christophe Camus
- Service de Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Edouard Bardou-Jacquet
- Faculté de Médecine, Université Rennes 1, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Service des Maladies du Foie, Centre Hospitalo-Universitaire Rennes, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie Hépato-Biliaire et Digestive, CHU Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
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5
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Tuech JJ, Manceau G, Ouaissi M, Denet C, Chau A, Kartheuser A, Desfourneaux V, Duchalais E, Bertrand M, Badic B, Alves A, Ceribelli C, Venara A, Mege D, Mauvais F, Dumont F, Mabrut JY, Lakkis Z, Cotte E, Meillat H. Are colorectal cancer patients at risk for COVID-19 infection during the postoperative period? The Covid-GRECCAR study. Int J Colorectal Dis 2021; 36:611-615. [PMID: 33495872 PMCID: PMC7835106 DOI: 10.1007/s00384-021-03847-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, cancer patients have been regarded as having a high risk of severe events if they are infected with SARS-CoV-2, particularly those under medical or surgical treatment. The aim of this study was to assess the posttreatment risk of infection by SARS-CoV-2 in a population of patients operated on for colorectal cancer 3 months before the COVID-19 outbreak and who after hospitalization returned to an environment where the virus was circulating. MATERIALS AND METHODS This French, multicenter cohort study included consecutive patients undergoing elective surgery for colorectal cancer between January 1 and March 31, 2020, at 19 GRECCAR hospitals. The outcome was the rate of COVID-19 infection in this group of patients who were followed until June 15, 2020. RESULTS This study included 448 patients, 262 male (58.5%) and 186 female (41.5%), who underwent surgery for colon cancer (n = 290, 64.7%), rectal cancer (n = 155, 34.6%), or anal cancer (n = 3, 0.7%). The median age was 68 years (19-95). Comorbidities were present in nearly half of the patients, 52% were at least overweight, and the median BMI was 25 (12-42). At the end of the study, 448 were alive. Six patients (1.3%) developed COVID-19 infection; among them, 3 were hospitalized in the conventional ward, and none of them died. CONCLUSION The results are reassuring, with only a 1.3% infection rate and no deaths related to COVID-19. We believe that we can operate on colorectal cancer patients without additional mortality from COVID-19, applying all measures aimed at reducing the risk of infection.
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Affiliation(s)
- Jean-Jacques Tuech
- grid.41724.34Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, F-76031 Rouen cedex, France
| | - Gilles Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Mehdi Ouaissi
- grid.411167.40000 0004 1765 1600Department of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, CHRU Trouseau, Tours, France
| | - Christine Denet
- grid.418120.e0000 0001 0626 5681Service de Chirurgie Digestive, Institut Mutualiste Montsouris, Paris, France
| | - Amélie Chau
- Polyclinique d’Hénin-Beaumont, Route de Courrières, 62110 Hénin-Beaumont, France
| | - Alex Kartheuser
- grid.7942.80000 0001 2294 713XColorectal Surgery Unit, Department of Abdominal Surgery and Transplantation Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Véronique Desfourneaux
- grid.411154.40000 0001 2175 0984Department of Hepatobiliary and Digestive Surgery, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France
| | - Emilie Duchalais
- grid.277151.70000 0004 0472 0371Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l’Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093 Nantes, France
| | - Martin Bertrand
- grid.121334.60000 0001 2097 0141Digestive surgery & digestive cancerology, CHU Carémeau, université de Montpellier, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Bogdan Badic
- grid.411766.30000 0004 0472 3249CHRU de Brest, Brest, France
| | - Arnaud Alves
- grid.411149.80000 0004 0472 0160Service de chirurgie digestive CHU Caen, registre des tumeurs digestive du calvados, Inserm U1086 ANTICIPE, 14000 Caen, France
| | - Cecilia Ceribelli
- grid.29172.3f0000 0001 2194 6418Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519 Vandoeuvre-lès-Nancy, France
| | - Aurelien Venara
- grid.411147.60000 0004 0472 0283Department of Endocrinal and Visceral Surgery, Angers University Hospital, 49933 Angers, France
| | - Diane Mege
- grid.411266.60000 0001 0404 1115Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - François Mauvais
- Digestive Surgery Department, Beauvais Hospital, Beauvais, France
| | - Fréderic Dumont
- grid.418191.40000 0000 9437 3027Department of Surgical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | - Jean-Yves Mabrut
- grid.25697.3f0000 0001 2172 4233Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Zaher Lakkis
- grid.411158.80000 0004 0638 9213Department of Surgical Oncology, University Hospital Jean Minjoz, Besançon, France
| | - Eddy Cotte
- Department of Gastrointestinal Surgery, Hospices Civils de Lyon, Université de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - Helene Meillat
- grid.418443.e0000 0004 0598 4440Department of Digestive Surgical Oncology, Department of Mini Invasive Interventions (DIMI), Paoli Calmettes Institute, Marseille, France
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6
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Corbière L, Desfourneaux V, Merdrignac A. Ileal-J-Pouch Volvulus After Restorative Proctocolectomy. J Gastrointest Surg 2021; 25:325-326. [PMID: 32378094 DOI: 10.1007/s11605-020-04630-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa Corbière
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France
| | - Véronique Desfourneaux
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France
| | - Aude Merdrignac
- Department of Hepatobiliary and Digestive Surgery, Inserm, Institut NuMeCan (Nutrition, Metabolism and Cancer), University of Rennes, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France.
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7
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Bouguen G, Huguet A, Amiot A, Viennot S, Cholet F, Nachury M, Flamant M, Reimund JM, Desfourneaux V, Boureille A, Siproudhis L. Efficacy and Safety of Tumor Necrosis Factor Antagonists in Treatment of Internal Fistulizing Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:628-636. [PMID: 31128337 DOI: 10.1016/j.cgh.2019.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few data are available on the effects of tumor necrosis factor (TNF) antagonist therapy for patients with internal fistulizing Crohn's disease (CD) and there is debate regarding the risk of abscess. We aimed to assess the long-term efficacy and safety of anti-TNF therapy for patients with internal fistulas. METHODS We performed a retrospective study of data collected from the Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives trial, from January 1, 2000, through December 31, 2017. Our final analysis included 156 patients who began treatment with an anti-TNF agent for CD with internal fistula (83 men; median disease duration, 4.9 y). The primary end point was the onset of a major abdominal surgery. Secondary analysis included disappearance of the fistula tract during follow-up evaluation and safety. The Kaplan-Meier method was used for statistical analysis. RESULTS After a median follow-up period of 3.5 years, 68 patients (43.6%) underwent a major abdominal surgery. The cumulative probabilities for being surgery-free were 83%, 64%, and 51% at 1, 3, and 5 years, respectively. A concentration of C-reactive protein >18 mg/L, an albumin concentration <36 g/L, the presence of an abscess at the fistula diagnosis, and the presence of a stricture were associated independently with the need for surgery. The cumulative probabilities of fistula healing, based on imaging analyses, were 15.4%, 32.3%, and 43.9% at 1, 3, and 5 years, respectively. Thirty-two patients (20.5%) developed an intestinal abscess and 4 patients died from malignancies (3 intestinal adenocarcinomas). One patient died from septic shock 3 months after initiation of anti-TNF therapy. CONCLUSIONS In a retrospective analysis of data from a large clinical trial, we found that anti-TNF therapy delays or prevents surgery for almost half of patients with CD and luminal fistulas. However, anti-TNF therapy might increase the risk for sepsis-related death or gastrointestinal malignancies.
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Affiliation(s)
- Guillaume Bouguen
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France; INSERM, CIC1414, Institut Nutrition Metabolisms and Cancer, Rennes, France.
| | - Audrey Huguet
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Université Paris-Est Créteil (UPEC) Val de Marne University, Creteil, France
| | - Stéphanie Viennot
- Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris de Caen, Caen, France
| | - Franck Cholet
- Centre Hospitalier Universitaire Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Maria Nachury
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Lille, University of Lille 2, Inserm Unit 995, Lille, France
| | - Mathurin Flamant
- Clinique Jules Verne, Institut des Maladies de l'Appareil Digestif, Hotel Dieu, Nantes, France
| | - Jean-Marie Reimund
- Hôpitaux Universitaires de Strasbourg (Hôpital de Hautepierre), INSERM U1113 Interface de Recherche Fondamentale et Appliquée en Cancérologie, Université de Strasbourg, Strasbourg, France
| | - Véronique Desfourneaux
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France
| | - Arnaud Boureille
- Inserm, U1235, University Nantes, Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris de Nantes, Institut des Maladies de l'Appareil Digestif, Hotel Dieu, Nantes, France
| | - Laurent Siproudhis
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France; INSERM, CIC1414, Institut Nutrition Metabolisms and Cancer, Rennes, France
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8
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Abdalla S, Brouquet A, Maggiori L, Zerbib P, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, Lefevre JH. Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn's Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie. J Crohns Colitis 2019; 13:1510-1517. [PMID: 31051502 DOI: 10.1093/ecco-jcc/jjz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn's disease [CD]. METHODS From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. RESULTS IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% in the PICR group [p = 0.024]. There was no significant difference between IICR and PICR regarding septic intra-abdominal complications, anastomotic leakage [8.8% vs 8.4%] or temporary stoma requirement. IICR patients were more likely to present with non-infectious complications and ileus [11.8% vs 3.7%, p < 0.001]. Uni- and multivariate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group. CONCLUSIONS Surgery for recurrent CD is associated with a slight increase of non-infectious morbidity [postoperative ileus] that mainly reflects the technical difficulties of these procedures. However, IICR remains a safe therapeutic option in patients with recurrent CD because severe morbidity including anastomotic complications is similar to patients undergoing primary resection. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Affiliation(s)
- Solafah Abdalla
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France; Saint-Antoine IBD Network
| | - Antoine Brouquet
- Service de Chirurgie Digestive, Hôpital Bicêtre, APHP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Léon Maggiori
- Service de Chirurgie Colorectale, Hôpital Beaujon, APHP, Université Paris VII, Clichy, France
| | | | - Quentin Denost
- Service de Chirurgie Digestive, CHRU Bordeaux, Bordeaux, France
| | | | - Eddy Cotte
- Service de Chirurgie Digestive, CHRU Lyon-Sud, Pierre-Bénite, France
| | | | - Nicolas Munoz-Bongrand
- Service de Chirurgie Digestive, Hôpital Saint-Louis, APHP, Université Paris VII, Paris, France
| | | | - Amine Rahili
- Service de Chirurgie Digestive, CHRU Nice, Nice, France
| | - Jean-Pierre Duffas
- Service de Chirurgie Digestive, CHRU Toulouse-Rangueil, Toulouse, France
| | - Karine Pautrat
- Service de Chirurgie Digestive, Hôpital Lariboisière, APHP, Université Paris VII, Paris, France
| | - Christine Denet
- Service de Chirurgie Digestive, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Jérome Loriau
- Service de Chirurgie Digestive, Hôpital Saint Joseph, Paris, France
| | - Françoise Guillon
- Service de Chirurgie Digestive, CHRU Montpellier, Montpellier, France
| | - Eric Vicaut
- Unité de recherche clinique, Hôpital Fernand Widal, APHP, Université Paris VII, Paris, France
| | - Stéphane Benoist
- Service de Chirurgie Digestive, Hôpital Bicêtre, APHP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Yves Panis
- Service de Chirurgie Colorectale, Hôpital Beaujon, APHP, Université Paris VII, Clichy, France
| | - Jérémie H Lefevre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France; Saint-Antoine IBD Network
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9
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Gouriou C, Chambaz M, Ropert A, Bouguen G, Desfourneaux V, Siproudhis L, Brochard C. A systematic literature review on solitary rectal ulcer syndrome: is there a therapeutic consensus in 2018? Int J Colorectal Dis 2018; 33:1647-1655. [PMID: 30206681 DOI: 10.1007/s00384-018-3162-z] [Citation(s) in RCA: 11] [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] [Accepted: 09/03/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To screen all treatments tested for solitary rectal ulcer syndrome (SRUS) without rectal prolapse and to assess their efficacy. METHOD A systematic review was performed according to the PRISMA guidelines, focusing on the treatment of SRUS without rectal prolapse. The types of treatment and their efficacy were collected and critically assessed. RESULTS A selection of 20 studies among the 470 publications focusing on SRUS provided suitable data for a total of 516 patients. Only 2 studies were randomised prospective trials that focused on argon plasma treatment. The mean follow-up was 21.8 months and ranged from 0.25 to 90 months. Most of the studies focused on surgery, including rectopexy, stapled transanal rectal resection, excision of the ulcer, the Delorme procedure, proctectomy, low anterior resection, and ostomy. Populations of the studies were heterogeneous and selected outcomes were specific (failure of medical or surgical treatment). Conservative treatment (high-fibre diet, laxatives, change of defecatory habits, and biofeedback treatment) induced a symptomatic improvement in 71/91 patients (63.6%) and healing of mucosal lesion in 17/51 patients (33.3%). Surgeries (all types) improved SRUS in 77% (54-100%) of patients. Argon plasma coagulation is a promising technique but longer follow-up is necessary. CONCLUSIONS The general quality of the studies focusing on the treatment of SRUS was poor due to the heterogeneity of the population, the sample size of the cohorts, and the heterogeneity of efficacy assessments. The therapeutic approach appears to be multimodal and multidisciplinary and validated in centres of expertise. Further studies evaluating multimodal strategies are needed.
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Affiliation(s)
- Claire Gouriou
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France
| | - Marion Chambaz
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France
| | - Alain Ropert
- Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Guillaume Bouguen
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,INSERM U1241, Université de Rennes 1, Rennes, France
| | - Véronique Desfourneaux
- Service de Chirurgie Viscérale, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Laurent Siproudhis
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France.,CIC 1414, INPHY, Université de Rennes 1, Rennes, France.,INSERM U1241, Université de Rennes 1, Rennes, France
| | - Charlène Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou, 35033, Rennes Cedex, France. .,Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France. .,CIC 1414, INPHY, Université de Rennes 1, Rennes, France. .,INSERM U1241, Université de Rennes 1, Rennes, France.
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10
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Rayar M, Tron C, Locher C, Chebaro A, Beaurepaire JM, Blondeau M, Cusumano C, Bardou-Jacquet E, Houssel-Debry P, Camus C, Petitcollin A, Verdier MC, Lakéhal M, Desfourneaux V, Sulpice L, Meunier B, Bellissant E, Boudjema K, Lemaitre F. Tacrolimus Concentrations Measured in Excreted Bile in Liver Transplant Recipients: The STABILE Study. Clin Ther 2018; 40:2088-2098. [PMID: 30467013 DOI: 10.1016/j.clinthera.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Tacrolimus (TAC) is the main immunosuppressive drug in liver transplantation. Despite intensive therapeutic drug monitoring (TDM) that relies on whole blood trough concentration (TACblood), patients still present with acute cellular rejection or TAC-related toxic effects with concentrations within the therapeutic range. TAC concentration in peripheral blood mononuclear cells (TACPBMC) is considered as an efficient surrogate marker of TAC efficacy. However, it is still not applicable in daily practice. New TDM methods are therefore needed, especially during the early postoperative period. TAC is metabolized in the liver and eliminated through biliary excretion. We therefore hypothesised that TAC concentration measured in excreted bile (TACbileC) could be a relevant surrogate marker of its efficacy. METHODS The Therapeutic Drug Monitoring of Tacrolimus Biliary Concentrations for Liver-Transplanted Patients (STABILE) study is a prospective monocentric trial. During the 7 first days after TAC therapy initiation, TACbileC was measured. The correlation between TACbileC and TACPBMC as well as between TACblood and TACPBMC was assessed. The correlations between TACbileC and liver graft function parameter or with occurrence of neurologic toxic effects were also evaluated. FINDINGS Between May 2016 and April 2017, 41 patients were analyzed. TACbileC was significantly correlated with TACPBMC (r = 0.25, P = 0.007). However, a better correlation was found between TACPBMC and TACblood (r = 0.53, P < 0.001) and was confirmed in multivariate analysis. However, only TACbileC was significantly correlated with liver graft function, such as factor V (r = 0.40, P = 0.009) or bilirubin level (r = 0.21, P = 0.01), and significantly lower in patients presenting with neurologic toxic effects (P < 0.001). Receiver operating characteristic curve analysis found that a TACbileC level lower than 0.20 ng/mL on day 2 after TAC therapy initiation was a good predictive marker of occurrence of neurotoxic effects (AUC = 0.81). IMPLICATIONS TACbileC is not a better surrogate maker of TAC activity than TACblood. However, TACbileC could help predict the occurrence of TAC toxic effects when a T-tube is inserted. ClinicalTrials.gov identifier: NCT02820259.
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Affiliation(s)
- Michel Rayar
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France.
| | - Camille Tron
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Clara Locher
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Alexandre Chebaro
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | | | - Marc Blondeau
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | - Caterina Cusumano
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | - Edouard Bardou-Jacquet
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Service des Maladies du Foie, CHU Rennes, Rennes, France
| | - Pauline Houssel-Debry
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Service des Maladies du Foie, CHU Rennes, Rennes, France
| | - Christophe Camus
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Service de Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Antoine Petitcollin
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Marie Clémence Verdier
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Mohamed Lakéhal
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | | | - Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Eric Bellissant
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Florian Lemaitre
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
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11
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Rayar M, Levi Sandri GB, Blondeau M, Lakehal M, Desfourneaux V, Sulpice L, Meunier B, Boudjema K. Lateral cavo-caval shunt: an alternative veno-venous bypass in liver surgery. Transl Gastroenterol Hepatol 2018; 3:23. [PMID: 29971254 DOI: 10.21037/tgh.2018.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 12/15/2022] Open
Abstract
When inferior vena cava (IVC) resection is mandatory during liver surgery, use of a veno-venous bypass (VVB) is usually required despite its specific related adverse events. We describe a safe and alternative technique which allows both derivation of the portal and the caval blood flow by performing a lateral cavo-caval shunt using a prosthetic graft.
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Affiliation(s)
- Michel Rayar
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Université Rennes1, Faculté de médecine, Rennes, France
| | | | - Marc Blondeau
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | - Mohamed Lakehal
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | | | - Laurent Sulpice
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Université Rennes1, Faculté de médecine, Rennes, France
| | - Bernard Meunier
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Université Rennes1, Faculté de médecine, Rennes, France
| | - Karim Boudjema
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Université Rennes1, Faculté de médecine, Rennes, France
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12
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Cauchois A, Desfourneaux V, Kammerer-Jacquet SF, Bouguen G, Rioux-Leclercq N, Henno S. [A case of idiopathic myointimal hyperplasia of mesenteric veins]. Ann Pathol 2016; 36:415-419. [PMID: 27838074 DOI: 10.1016/j.annpat.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 08/02/2016] [Accepted: 09/16/2016] [Indexed: 12/17/2022]
Abstract
The idiopathic myointimal hyperplasia of mesenteric veins is a rare pathology, affecting recto-sigmoid and mimicking clinically an inflammatory chronic disease of the bowel. Only about fifteen cases have been reported in the literature. This lesion is characterized by a myointimal thickening of the mesenteric veins, without inflammatory infiltrate of the vascular wall, differentiating it from vasculitis. We present here the case of a 48-year-old man, in whom the diagnosis of ulcerative colitis then digestive vasculitis had first been raised.
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Affiliation(s)
- Aurélie Cauchois
- Service d'anatomie pathologique, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Véronique Desfourneaux
- Service de chirurgie digestive, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | | | - Guillaume Bouguen
- Service des maladies de l'appareil digestif, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Nathalie Rioux-Leclercq
- Service d'anatomie pathologique, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Sébastien Henno
- Service d'anatomie pathologique, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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13
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Zerbib F, Siproudhis L, Lehur PA, Germain C, Mion F, Leroi AM, Coffin B, Le Sidaner A, Vitton V, Bouyssou-Cellier C, Chene G, Zerbib F, Simon M, Denost Q, Lepicard P, Lehur PA, Meurette G, Wyart V, Kubis C, Mion F, Roman S, Damon H, Barth X, Leroi AM, Bridoux V, Gourcerol G, Coffin B, Castel B, Gorbatchef C, Le Sidaner A, Mathonnet M, Vitton V, Lesavre N, Orsoni P, Siproudhis L, Brochard C, Desfourneaux V. Randomized clinical trial of sacral nerve stimulation for refractory constipation. Br J Surg 2016; 104:205-213. [DOI: 10.1002/bjs.10326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT.
Methods
Patients with at least two of the following criteria were included: fewer than three bowel movements per week; straining to evacuate on more than 25 per cent of attempts; or sensation of incomplete evacuation on more than 25 per cent of occasions. Response to therapy was defined as at least three bowel movements per week and/or more than 50 per cent improvement in symptoms. Responders to an initial 3-week peripheral nerve evaluation were offered permanent implantation of a pulse generator and were assigned randomly in a crossover design to two 8-week intervals of active or sham stimulation. At the end of the two trial periods, the patients received active stimulation until the final evaluation at 1 year.
Results
Thirty-six patients (34 women; mean(s.d.) age 45(14) years) underwent peripheral nerve evaluation. Twenty responded and received a permanent stimulator. A positive response was observed in 12 of 20 and 11 of 20 patients after active and sham stimulation periods respectively (P = 0·746). Pain related to the device occurred in five patients and wound infection or haematoma in three, leading to definitive removal of the pulse generator in two patients. At 1 year, 11 of the 20 patients with an implanted device continued to respond. Stimulation had no significant effect on colonic transit time.
Conclusion
These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - L Siproudhis
- Department of Gastroenterology, Rennes University Hospital, and Université de Rennes, Rennes, France
| | - P-A Lehur
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - C Germain
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
| | - F Mion
- Department of Digestive Physiology, Lyon University Hospital, and Université Claude Bernard, Lyon, France
| | - A-M Leroi
- Department of Digestive and Urinary Physiology, Rouen University Hospital, and Université de Rouen, Rouen, France
| | - B Coffin
- Department of Gastroenterology, Louis Mourier University Hospital, Assistance Publique – Hôpitaux de Paris, Colombes, and Université Denis Diderot Paris 7, Paris, France
| | - A Le Sidaner
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - V Vitton
- Department of Gastroenterology, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, and Plateforme d'Interface Clinique, CRN2M, Unité Mixte de Recherche 7286, and Aix Marseille Université, Marseille, France
| | - C Bouyssou-Cellier
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - G Chene
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
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14
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Rayar M, Levi Sandri GB, Cusumano C, Houssel-Debry P, Camus C, Desfourneaux V, Lakehal M, Meunier B, Sulpice L, Boudjema K. Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors. Liver Transpl 2016; 22:1301-2. [PMID: 27197713 DOI: 10.1002/lt.24482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/24/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Michel Rayar
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM CIC 1414, Rennes, France.,Université Rennes, Faculté de Médecine, Rennes, France
| | | | - Caterina Cusumano
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | | | - Christophe Camus
- CHU Rennes, Réanimation médicale, Rennes, France.,INSERM CIC 1414, Rennes, France
| | | | - Mohamed Lakehal
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | - Bernard Meunier
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Université Rennes, Faculté de Médecine, Rennes, France
| | - Laurent Sulpice
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM CIC 1414, Rennes, France.,Université Rennes, Faculté de Médecine, Rennes, France
| | - Karim Boudjema
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,INSERM CIC 1414, Rennes, France.,Université Rennes, Faculté de Médecine, Rennes, France
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15
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Harnoy Y, Desfourneaux V, Bouguen G, Rayar M, Meunier B, Siproudhis L, Boudjema K, Sulpice L. Sexuality and fertility outcomes after hand sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis. J Surg Res 2016. [DOI: 10.1016/j.jss.2015.06.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Wallenhorst T, Bouguen G, Brochard C, Cunin D, Desfourneaux V, Ropert A, Bretagne JF, Siproudhis L. Long-term impact of full-thickness rectal prolapse treatment on fecal incontinence. Surgery 2015; 158:104-11. [PMID: 25869649 DOI: 10.1016/j.surg.2015.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fecal incontinence is frequently associated with rectal prolapse, but little is known about recovery after treatment of the prolapse. OBJECTIVE We therefore aimed to investigate the long-term outcome of fecal incontinence in a cohort of patients suffering from full-thickness rectal prolapse. DESIGN A database of 145 patients diagnosed with full-thickness rectal prolapse was compiled prospectively over a 7-year period (2003-2010). MAIN OUTCOME MEASURES Patients were referred to a single institution and assessed by standardized questionnaires, anorectal manometry, endosonography, and evacuation proctography. Fecal incontinence was evaluated according to the Cleveland Clinic Score; continence improvement was defined by ≥50% improvement of the Cleveland Clinic Score. RESULTS Among the population studied (134 women, 11 men; median follow-up, 38.9 months [range, 21.2-67.2]), 103 patients (71%) underwent operation for their prolapse and 42 (29%) did not. According to the Cleveland Clinic Score, 139 patients (96%) suffered from fecal incontinence before treatment and 64 (46%) reported improvement at the end of the follow-up. Pretreatment history of incontinence symptoms for >2 years (hazard ratio [HR], 1.99; 95% CI, 1.14-3.46; P = .015) and ventral rectopexy (HR, 1.86; 95% CI, 1.026-3.326; P = .04) were associated with continence improvement. Patients who underwent an operative procedure other than ventral rectopexy had similar outcome as compared with nonoperated patients. Conversely, chronic pelvic pain precluded fecal incontinence improvement (HR, 0.32; 95% CI, 0.135-0.668; P = .0017). LIMITATIONS Follow-up, returned questionnaires, and the heterogeneous reasons put forth for declining surgery may introduce some methodologic bias. CONCLUSION Fecal incontinence in patients suffering from rectal prolapse is improved when ventral rectopexy is performed compared with other operative or medical therapies.
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Affiliation(s)
- Timothée Wallenhorst
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Guillaume Bouguen
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France
| | - Charlène Brochard
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Diane Cunin
- Department of Hepatobiliary and Digestive Surgery, University Hospital of Rennes, Pontchaillou, France
| | - Véronique Desfourneaux
- Department of Hepatobiliary and Digestive Surgery, University Hospital of Rennes, Pontchaillou, France
| | - Alain Ropert
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Jean-François Bretagne
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Laurent Siproudhis
- Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, France; INSERM U991, University of Rennes 1, Rennes, France.
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17
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Cunin D, Siproudhis L, Desfourneaux V, Berkelmans I, Meunier B, Bretagne JF, Bouguen G. No surgery for full-thickness rectal prolapse: what happens with continence? World J Surg 2014; 37:1297-302. [PMID: 23440486 DOI: 10.1007/s00268-013-1967-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgery is the only validated means of treating overt rectal prolapses, but both patients and physicians may decline or postpone the surgical approach. However, little is known on the functional outcome of nonoperated rectal prolapse. The aim of the present study was to highlight the natural history of overt rectal prolapse in patients for whom surgery was avoided or delayed. PATIENTS AND METHODS A total of 206 patients complaining of full-thickness rectal prolapse were referred to a single institution that provided anorectal physiology for functional anorectal disorders. Standardized questionnaires, anorectal manometry, endosonography, and evacuation proctography constituted a prospective database. Fecal incontinence was evaluated with the Cleveland Clinic score (CCIS), and constipation was evaluated with the Knowles Eccersley Scott Symptom score (KESS). RESULTS Forty-two nonoperated patients (mean age: 61 ± 16 years) were compared to those of operated patients paired according to age and gender: the mean follow-up was 44 ± 26 months. The two groups had a similar past-history, follow-up, stool frequency, and main complaints, but lower quantified symptomatic scores and a better quality of life were reported in the nonsurgical group. At the end of follow-up, the nonsurgical group did not show any variation in CCI and KESS scores. By contrast, these two scores significantly improved in the rectopexy group. Sixteen nonoperated patients experienced a degradation of their continence status with an average increase of 5 ± 4.3 points of the CCIS. The patients with a CCIS <7 at referral were likely to deteriorate as compared to those having a higher score. Patients with a symptom history longer than 4 years never improved and in two-thirds continence deteriorated throughout the follow-up. CONCLUSION In the absence of the surgical option, patients with a 4-year duration of rectal prolapse and those with mild incontinence had no chance of improvement. These findings may be taken into account when surgery of rectal prolapse is not chosen.
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Affiliation(s)
- Diane Cunin
- CHU Rennes Service de Chirurgie Hépatobiliaire et Digestive, 35033, Rennes, France.
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18
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Sulpice L, Desfourneaux V, Rayar M, Meunier B, Lakehal M, Bentabak K, Graba A, Boudjema K. Techniques de transplantation hépatique chez l’adulte. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s0246-0424(12)57364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Cunin D, Siproudhis L, Desfourneaux V, Bouteloup PY, Meunier B, Ropert A, Berkelmans I, Bretagne JF, Boudjema K, Bouguen G. Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy. Colorectal Dis 2013; 15:470-6. [PMID: 22966956 DOI: 10.1111/codi.12027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to quantify incontinence before and after laparoscopic rectopexy in patients suffering from rectal prolapse. METHOD Eighty-five patients underwent laparoscopic rectopexy to treat rectal prolapse between 2003 and 2009. Symptomatic and functional data were collected prospectively before and after surgery by self-administered questionnaires including the Cleveland Clinic Fecal Incontinence Score (CCIS) and constipation, gastrointestinal quality of life and urinary incontinence questionnaires. Incontinence was considered to be present when the CCIS remained at ≥ 5 after surgery. RESULTS After a mean follow-up period of 36 months after surgery, 83% of the patients reported good to excellent results. Continence was improved in 58 (68%), with a significant decrease in the continence score (-3.4 ± 5.8, P = 0.001). However, 50 (58.9%) patients remained incontinent: 47 (55%) reported urge incontinence and 27 (32%) had passive leakage. Incontinence for liquid stool, incontinence for solid stool and the need for protection was seen in 43 (51%), 35 (41%) and 43 (51%) patients. Manometry, defaecography and ultrasonography were not associated with any improvement. In contrast, the patients' average age (60.2 ± 15.8 vs 46.9 ± 15.5 years; P = 0.003), symptom duration before surgery (58.1 ± 70.1 vs 29.5 ± 33.3 months; P = 0.011), preoperative urinary incontinence score (10.7 ± 10.8 vs 4.2 ± 5.7; P = 0.0131) and faecal incontinence score (12.9 ± 4.9 vs 7.1 ± 6; P < 0.0001) were significantly higher in patients suffering from postoperative incontinence. CONCLUSION Despite some continence improvement in two-thirds of patients who underwent surgery for rectal prolapse, the level of improvement remained low in more than half of the patients.
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Affiliation(s)
- D Cunin
- CHU Rennes Service de Chirurgie hépatobiliaire et digestive, Rennes, France
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20
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Gallas S, Michot F, Faucheron JL, Meurette G, Lehur PA, Barth X, Damon H, Mion F, Rullier E, Zerbib F, Sielezneff I, Ouaïssi M, Orsoni P, Desfourneaux V, Siproudhis L, Mathonnet M, Menard JF, Leroi AM. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients. Colorectal Dis 2011; 13:689-96. [PMID: 20236144 DOI: 10.1111/j.1463-1318.2010.02260.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [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: 12/19/2022]
Abstract
AIM Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. METHOD Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. RESULTS The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. CONCLUSION Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
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Affiliation(s)
- S Gallas
- ADEN EA 3234 ⁄ IFR MP 23, Rouen University Hospital, Grenoble, France
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22
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Leroi AM, Damon H, Faucheron JL, Lehur PA, Siproudhis L, Slim K, Barbieux JP, Barth X, Borie F, Bresler L, Desfourneaux V, Goudet P, Huten N, Lebreton G, Mathieu P, Meurette G, Mathonnet M, Mion F, Orsoni P, Parc Y, Portier G, Rullier E, Sielezneff I, Zerbib F, Michot F. Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience. Colorectal Dis 2009; 11:572-83. [PMID: 19508514 DOI: 10.1111/j.1463-1318.2009.01914.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [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: 02/08/2023]
Abstract
OBJECTIVE Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. METHOD Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. RESULTS We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. CONCLUSION We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
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Affiliation(s)
- A M Leroi
- ADEN EA 3234/IFRMP 23, Faculté de Médecine de Rouen, France.
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23
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Piche T, Dapoigny M, Bouteloup C, Chassagne P, Coffin B, Desfourneaux V, Fabiani P, Fatton B, Flammenbaum M, Jacquet A, Luneau F, Mion F, Moore F, Riou D, Senejoux A. [Recommendations for the clinical management and treatment of chronic constipation in adults]. ACTA ACUST UNITED AC 2007; 31:125-35. [PMID: 17347618 DOI: 10.1016/s0399-8320(07)89342-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Thierry Piche
- Service d'Hépato-Gastroentérologie et Nutrition Clinique, Nice
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24
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Piche T, Dapoigny M, Bouteloup C, Chassagne P, Coffin B, Desfourneaux V, Fabiani P, Fatton B, Flammenbaum M, Jacquet A, Luneau F, Mion F, Moore F, Riou D, Senejoux A. [Recommendations for the clinical management and treatment of chronic constipation in adults]. Gastroenterol Clin Biol 2007; 31:125-35. [PMID: 17347618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Thierry Piche
- Service d'Hépato-Gastroentérologie et Nutrition Clinique, Nice
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Abstract
PURPOSE Solitary ulcer syndrome is a rare condition characterized by inflammation and chronic ulcer of the rectal wall in patients suffering from outlet constipation. Despite similar surgical options (rectopexy, anterior resection), solitary ulcer syndrome may differ from overt rectal prolapse with regard to symptoms and pathogenesis. The present work analyzed differences between these conditions in a case-control physiology study. METHODS From 1997 to 2002, 931 consecutive subjects were investigated in a single physiology unit for anorectal functional disorders. Standardized questionnaires, anorectal physiology, and evacuation proctography were included in a prospective database. Diagnosis of solitary ulcer syndrome was based on both symptoms and anatomic features in 25 subjects with no overt rectal prolapse (21 females and 4 males; mean age, 37.2 +/- 15.7 years) and no past history of anorectal surgery. They were compared with age-matched and gender-matched subjects: 25 with outlet constipation (also matched on degree of internal procidentia), 25 with overt rectal prolapse without any mucosal change, and 14 with overt rectal prolapse and mucosal changes. RESULTS Subjects with solitary ulcer syndrome reported symptomatic levels (digitations, pain, incontinence) similar to those of patients with outlet constipation, but they had significantly more constipation and less incontinence than patients with overt rectal prolapse. Compared with each of the three control groups (dyschezia, rectal prolapse without mucosal change, and rectal prolapse with mucosal change), subjects with solitary ulcer syndrome more frequently had an increasing anal pressure at strain (15 vs. 5, 3, and 1, respectively ; P < 0.01) and a paradoxical puborectalis contraction (15 vs. 9, 1, and 1, respectively; P < 0.05). With respect to evacuating proctography, complete rectal emptying was achieved less frequently in this group (5 vs. 12, 23, and 10, respectively; P < 0.05). Compared with patients with overt rectal prolapse, mean resting and squeezing anal pressures were significantly higher in both groups of subjects with solitary ulcer syndrome and with outlet constipation. Prevalence and levels of anatomic disorders (perineal descent, rectocele) did not differ among the four groups except for rectal prolapse grade and prevalence of enterocele (higher in overt rectal prolapse group). Interestingly, and despite matched controls for degree of intussusception, individuals with solitary ulcer syndrome had circular internal procidentia more often compared with those suffering from outlet constipation without mucosal lesions (15 vs. 8, P < 0.05). CONCLUSION This case-controlled study quantifies functional anal disorders in patients suffering from solitary ulcer syndrome. Despite no proven etiologic factor, sphincter-obstructed defecation and circular internal procidentia both may play an important part in the pathogenesis and an exclusive surgical approach may not be appropriate in this context.
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Affiliation(s)
- Olivia Morio
- Physiology Unit, Rennes University Hospital, Rennes, France
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26
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Vauleon E, Egreteau J, Boucher E, Desfourneaux V, Bretagne JF, Raoul JL. [Glucagonoma: a recent series of 7 cases]. Bull Cancer 2004; 91:637-40. [PMID: 15381454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report a series of 7 glucagonoma patients seen between 1994 and 2001, 5 males and 2 females, aged 32-69 years, with: necrolytic migratory erythema (NME) (n = 2), liver metastases (n = 3), jaundice (n = 1) and 1 case of familial history of multiple endocrine neoplasia. The diagnosis combined histology and hyperglucagonemia; 6 patients developed metastasis (5 initially); during the follow-up 3 developed a necrolytic erythema migraticum (NEM) worsening the general status. Somatostatin receptor scanning was highly positive in all. Four patients were operated, 5 received chemotherapy (2 OR and 2 SD), 3 had chemoembolization (1 transient improvement). Somatostatin was efficient on general status or skin lesions in all patients. Two died and 5 are alive with a follow up ranging from 12 to 60 months. We want to emphasize on the higher frequency than expected of this disease, the frequency of NEM, the efficacy of SMS on NEM and general status and on the fairly good prognosis. The high uptake of SMS by tumors on scanning could rise hopes about radioconjugate therapy.
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Affiliation(s)
- Elodie Vauleon
- Département d'oncologie médicale, Centre Eugène Marquis, 35042 Rennes, FRANCE
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27
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Masson B, Desfourneaux V, Raymond JM, Beyssac R, Belleannee G. [Somatostatinoma. Apropos of a case]. J Chir (Paris) 1997; 134:22-6. [PMID: 9295993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Somatostatinoma are uncommon pancreatic endocrine tumors. We review the epidemiological, pathological, clinical and biological characteristics. The diagnosis of a somatostatinoma may be suggested clinically but is confirmed by histology of the resected tumor and specific immunohistochemistry marking. Malignancy is diagnosed on the presence metastases. Surgery is required with excision of the tumor, lymph nodes and metastases.
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Affiliation(s)
- B Masson
- Service de Chirurgie Digestive en Endocrinologique, Hôpital du Haut Lévêque, Pessac
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28
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Masson B, Hostyn B, Desfourneaux V, Potaux L. [Cysto-ileal diversion by Y loop of a compressive pseudocyst after segmental pancreatic transplantation]. J Chir (Paris) 1996; 133:342-5. [PMID: 9084737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a young female patient who underwent dual segmentary pancreatic and renal transplantation in May 1990. The immediate post-operative course was marked by the peri pancreatic collections normally noted with this technique. However, a peculiarity was a long-lasting pseudocyst of the grafted tissue which could not be drained externally despite several attempts. This was compressing the splenic vein of the tissue, thereby causing a reflux. Fear of losing tissue functionality led us four and a half years later to perform an internal cysto-ileal derivation on a bowel loop. In this way, normal endocrine function of the pancreatic graft tissue has now been maintained for over a year.
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Affiliation(s)
- B Masson
- Service de Chirurgie Viscérale et Endocrinienne, Hôpital du Haut Lévêque, Pessac
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