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Postillon A, Buisset C, Parvanescu A, Bihain F, Quilliot D, Brunaud L. Anal incontinence incidence is high in patients with obesity prior to bariatric surgery: Prevalence, risks-factors. Prog Urol 2023; 33:207-216. [PMID: 36460604 DOI: 10.1016/j.purol.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Anal incontinence (AI) prevalence in general population is estimate to range from 1.4 to 19.5% (Wexner ≥ 1). Obesity could be an AI risk factor. However, AI prevalence in patients with obesity is not clearly established. The main objective of this study was to assess the prevalence of AI in patients with extreme obesity prior to bariatric surgery and to identify specific AI risk factors in this subset of patients. MATERIAL A cross-sectional study, in a tertiary referral center in obesity was performed during one year. Patients who presented criteria for bariatric surgery (BMI>40 or BMI > 35 with co-morbidities) were asked to fill in preoperative self-questionnaires. A Wexner score ≥ 3 was used to define AI to identified patients who had a clinic impact of AI, by frequency of symptoms or alteration of quality of life. RESULTS Two hundred and fifty patients were included. Corresponded to, 196 women (78.4%) and 54 men (21.6%). Median BMI was 44.53kg/m2. AI was diagnosed in 41 patients (prevalence 16.4%, 95CI 0.59). Constipation, urinary incontinence and the history of pregnancy (P = 0.03, OR 2.79; P = 0.01, OR 3.53 and P=0.02, OR 4.71, respectively) were significantly associated with AI. CONCLUSION AI is frequently observed in patients with extreme obesity scheduled for bariatric surgery and should be routinely evaluated. Modifiable risk factors as constipation should be manage before surgery as well as the specific management of AI, to prevent AI exacerbation after surgery. The choice of bariatric surgical procedure should be discussed and evaluated for the treatment of patients with obesity and AI. LEVEL OF EVIDENCE Moderate.
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Affiliation(s)
- A Postillon
- Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France.
| | - C Buisset
- Department of Digestive, Endocrine and Metabolic Surgery, UNEOS groupe hospitalier associatif, hôpital Robert-Schuman, rue du Champ Montoy, Metz, France
| | - A Parvanescu
- Department of Digestive Surgery, hôpital Saint-Joseph, rue Raymond-Losserand, Paris, France
| | - F Bihain
- Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France
| | - D Quilliot
- Department of Diabetology, Endocrinology and Nutrition, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France
| | - L Brunaud
- Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France
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Gaujoux S, Parvanescu A, Fusco G, Linglart A, Sauvanet A, Couvelard A, Levy P, Rebours V, Cros J. Familial Pancreatic Intraductal Papillary and Mucinous Neoplasms Do Not Carry Constitutional or Postzygotic GNAS Activating Mutations. Pancreas 2021; 50:e14-e15. [PMID: 33565803 DOI: 10.1097/mpa.0000000000001732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Gaujoux S, Parvanescu A, Cesaretti M, Silve C, Bieche I, Rebours V, Lévy P, Sauvanet A, Cros J. GNAS but Not Extended RAS Mutations Spectrum are Associated with a Better Prognosis in Intraductal Pancreatic Mucinous Neoplasms. Ann Surg Oncol 2019; 26:2640-2650. [DOI: 10.1245/s10434-019-07389-6] [Citation(s) in RCA: 8] [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] [Received: 01/02/2019] [Indexed: 12/28/2022]
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Abstract
Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1 ± 21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n = 13), small-bowel obstruction (35.1%, n = 13), and gastrointestinal bleeding (29.8%, n = 11) (anemia, n = 1; hematochezia, n = 10). Age distribution was significantly different (P = .02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P = .02) were statistically more frequently over 40 (P = .05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P = .05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.
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Affiliation(s)
- Alina Parvanescu
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Matthieu Bruzzi
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Thibault Voron
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Camille Tilly
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Franck Zinzindohoué
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Jean-Marc Chevallier
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Marco Gucci
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Philippe Wind
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Anne Berger
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Richard Douard
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
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Parvanescu A, Cros J, Ronot M, Hentic O, Grybek V, Couvelard A, Levy P, Chanson P, Ruszniewski P, Sauvanet A, Gaujoux S. Lessons from McCune-Albright syndrome-associated intraductal papillary mucinous neoplasms: : GNAS-activating mutations in pancreatic carcinogenesis. JAMA Surg 2014; 149:858-62. [PMID: 24898823 DOI: 10.1001/jamasurg.2014.535] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
GNAS-activating mutations are reported in intraductal papillary mucinous neoplasms (IPMNs) and in McCune-Albright syndrome, characterized by fibrous dysplasia, precocious puberty, and café au lait spots. Recently, IPMNs have been described as a McCune-Albright syndrome-associated tumor, present in about 15% of patients. The aim of the present work was to assess the prevalence of polyostotic fibrous dysplasia and McCune-Albright syndrome among patients operated on for presumptive sporadic IPMNs. All patients operated on for IPMNs between January 1, 2007, and December 31, 2012, with available imaging were retrospectively screened for polyostotic fibrous dysplasia based on their preoperative abdominal or thoracoabdominal spiral computed tomography images. Systematic screening of 272 patients operated on for IPMNs revealed 1 patient with axial and peripheral polyostotic fibrous dysplasia and café au lait spots on clinical examination suggestive of McCune-Albright syndrome. This patient had been operated on for an unusually large invasive colloid adenocarcinoma (pT3N0M0 R0) derived from an intestinal subtype GNAS-mutated IPMN. The patient underwent adjuvant chemotherapy with gemcitabine for 6 months and was alive without recurrence 6 years later. Besides providing additional evidence of a syndromic IPMN as a feature of McCune-Albright syndrome, this observation is further evidence of the functional oncogenic consequences of GNAS mutations in the pancreas.
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Affiliation(s)
- Alina Parvanescu
- Assistance Publique-Hôpitaux de Paris, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France2Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris
| | - Jérôme Cros
- Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France3Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Beaujon, Clichy, France4Université Paris Diderot, Paris
| | - Maxime Ronot
- Université Paris Diderot, Paris, France5Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Beaujon, Clichy, France
| | - Olivia Hentic
- Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France
| | - Virginie Grybek
- Institut National de la Santé et de la Recherche Médicale, Unité 986, Groupe Hospitalier Paris-Sud, Le Kremlin-Bicêtre, France
| | - Anne Couvelard
- Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France4Université Paris Diderot, Paris, France8Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Bichat, Paris
| | - Philippe Levy
- Université Paris Diderot, Paris, France6Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France
| | - Philippe Chanson
- Université Paris-Sud 11, Unité Mixte de Recherche 693, Le Kremlin-Bicêtre, France10Assistance Publique-Hôpitaux de Paris, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Service d'Endocrinologie et des Maladies de la Reproduction
| | - Philippe Ruszniewski
- Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France4Université Paris Diderot, Paris, France6Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon
| | - Alain Sauvanet
- Assistance Publique-Hôpitaux de Paris, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France4Université Paris Diderot, Paris, France
| | - Sebastien Gaujoux
- Assistance Publique-Hôpitaux de Paris, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France2Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris
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Kianmanesh R, Piardi T, Tamby E, Parvanescu A, Bruno O, Palladino E, Bouché O, Msika S, Sommacale D. Liver angulometry: a simple method to estimate liver volume and ratios. HPB (Oxford) 2013; 15:976-84. [PMID: 23472855 PMCID: PMC3843616 DOI: 10.1111/hpb.12079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/21/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Volumetry is standard method for evaluating the volumes of the right liver (RL), left liver (LL), left lateral segments (LLS), total liver (TL) and future liver remnant (FLR). The aim of this study was to report a simple technique based on measurements of liver angles (angulometry) that can be used to predict liver ratios. METHODS Fifty computed tomography (CT) scans obtained in subjects with normal liver were studied. Four CT scan levels were preselected: level 1 passed by the upper part of the hepatic veins; level 2 passed by the left portal vein branch division; level 3 passed by the right portal vein branch division, and level 4 passed by the gallbladder bed. Left and right tangent lines passing the liver edges were drawn and joined to the centre of the vertebra defining the TL angle. Two lines through, respectively, the plane of the middle hepatic vein and the left portal branches determined the angles of the RL, LL and LLS. Volumetric and angulometric data obtained on levels 2 and 3 in 50 different subjects were compared. RESULTS Level 2 CT scans represented the most accurate way of obtaining angulometric measurements. The mean ± standard deviation (SD) angles of the TL and LL were 134 ± 12 ° and 55 ± 12 °, respectively. The mean ± SD percentages of the TL represented by the LL in angulometry and volumetry were 38 ± 7% and 36 ± 6%, respectively (non-significant difference). The mean ± SD percentages of the TL represented by the LLS in angulometry and volumetry were 25 ± 4% and 20 ± 3%, respectively (P < 0.05). The mean ± SD overestimation of the percentage of the TL represented by the LLS in angulometry was 2.7 ± 7.0%. CONCLUSIONS Angulometry is a simple and accurate technique that can be used to estimate the ratio of the FLR to TL volume on one or two CT (or magnetic resonance imaging) slices. It can be helpful for clinicians, especially before right or extended right hepatectomy and after right portal vein occlusion techniques.
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Affiliation(s)
- Reza Kianmanesh
- Department of Digestive Surgery, University of ReimsReims, France,Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Tullio Piardi
- Department of Digestive Surgery, University of ReimsReims, France
| | - Esther Tamby
- Department of Digestive Surgery, University of ReimsReims, France
| | - Alina Parvanescu
- Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Onorina Bruno
- Department of Liver Surgery, University of Paris 7Paris, France,Department of Radiology, Beaujon University Hospital Centre, University of Paris 7Paris, France
| | - Elisa Palladino
- Department of Digestive Surgery, University of ReimsReims, France
| | - Olivier Bouché
- Department of Digestive Oncology, Robert Debré University Hospital Centre, University of ReimsReims, France
| | - Simon Msika
- Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Daniele Sommacale
- Department of Digestive Surgery, University of ReimsReims, France,Department of Liver Surgery, University of Paris 7Paris, France
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