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Duclos C, Durin T, Marchese U, Sauvanet A, Laurent C, Ayav A, Turrini O, Sulpice L, Addeo P, Souche FR, Perinel J, Birnbaum DJ, Facy O, Gagnière J, Gaujoux S, Schwarz L, Regenet N, Iannelli A, Regimbeau JM, Piessen G, Lenne X, El Amrani M, Heyd B, Doussot A. Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers. HPB (Oxford) 2024; 26:234-240. [PMID: 37951805 DOI: 10.1016/j.hpb.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Data on clinically relevant post-pancreatectomy hemorrhage (CR-PPH) are derived from series mostly focused on pancreatoduodenectomy, and data after distal pancreatectomy (DP) are scarce. METHODS All non-extended DP performed from 2014 to 2018 were included. CR-PPH encompassed grade B and C PPH. Risk factors, management, and outcomes of CR-PPH were evaluated. RESULTS Overall, 1188 patients were included, of which 561 (47.2 %) were operated on minimally invasively. Spleen-preserving DP was performed in 574 patients (48.4 %). Ninety-day mortality, severe morbidity and CR-POPF rates were 1.1 % (n = 13), 17.4 % (n = 196) and 15.5 % (n = 115), respectively. After a median interval of 8 days (range, 0-37), 65 patients (5.5 %) developed CR-PPH, including 28 grade B and 37 grade C. Reintervention was required in 57 patients (87.7 %). CR-PPH was associated with a significant increase of 90-day mortality, morbidity and hospital stay (p < 0.001). Upon multivariable analysis, prolonged operative time and co-existing POPF were independently associated with CR-PPH (p < 0.005) while a chronic use of antithrombotic agent trended towards an increase of CR-PPH (p = 0.081). As compared to CR-POPF, the failure-to-rescue rate in patients who developed CR-PPH was significantly higher (13.8 % vs. 1.3 %, p < 0.001). CONCLUSION CR-PPH after DP remains rare but significantly associated with an increased risk of 90-day mortality and failure-to-rescue.
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Affiliation(s)
- Côme Duclos
- Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France
| | - Thibault Durin
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP, Paris, France
| | - Alain Sauvanet
- Department of HPB Surgery, Hôpital Beaujon, University of Paris, Clichy, France
| | - Christophe Laurent
- Department of Digestive Surgery, Centre Magellan - CHU Bordeaux, Bordeaux, France
| | - Ahmet Ayav
- Department of HPB Surgery, Nancy University Hospital, Nancy, France
| | - Olivier Turrini
- Institut Paoli Calmettes, Marseille University, Department of Oncological Surgery, Marseille, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Julie Perinel
- Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
| | - David J Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Olivier Facy
- Department of Digestive and Surgical Oncology, University Hospital, Dijon, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery - Liver Transplantation, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, F-76100, Rouen, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Nantes Hospital, Nantes, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Jean M Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Claude Huriez University Hospital, F-59000, Lille, France
| | - Xavier Lenne
- Medical Information Department, Lille University Hospital, Lille, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Bruno Heyd
- Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France.
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Sabbagh C, Regimbeau JM. Ghost anastomosis: a new option for coloanal anastomosis. Tech Coloproctol 2024; 28:24. [PMID: 38200345 DOI: 10.1007/s10151-023-02902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, CHU d'Amiens Picardie, Amiens Cedex 01, France.
- Université de Picardie Jules Verne, Amiens, France.
| | - J M Regimbeau
- Department of Digestive Surgery, CHU d'Amiens Picardie, Amiens Cedex 01, France
- Université de Picardie Jules Verne, Amiens, France
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3
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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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Siembida N, Ralaihova H, Moulin S, Aubert F, Boulkedid R, Zourabichvili O, Regimbeau JM. P-133 PROSPECTIVE INTERVENTIONAL STUDY OF THE ANALGESIC EFFICACY OF A CYCLOMESH™ PARIETAL REINFORCEMENT IMPLANT SOAKED IN ROPIVACAINE HYDROCHLORIDE 10MG/ML IN THE TREATMENT FOR UNCOMPLICATED INGUINAL HERNIA. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
20–30% of patients operated for inguinal hernia will present early postoperative pain (EPP) which is, after the organizational causes, the first cause of conversion from ambulatory to traditional hospitalization. The objective of this study was to evaluate the interest of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine in the management of EPP.
Materials and Methods
This is a randomized, phase III, comparative superiority, double-blind, international multicentre study. From October 2019 to February 2022, 290 patients underwent surgery for inguinal hernia with placement of a ropivacaine or saline soaked parietal prosthesis. The primary endpoint was the H6 coughing pain assessment (EVA).
Results
The intention to treat population (ITTp) was composed of 150 patients in the ropivacaine group and 140 in the placebo group, for the per-protocol population (PPp) it was 125 and 115. The prosthesis type had no significant effect on H6 coughing pain, either for the ITTp (3.3 vs 3.2, p=0.12) or the PPp (3.3 vs 3.7, p=0.15). The ropivaciane soaked prosthesis resulted in a decrease in the overall pain at H2 (2.3 vs 3.2, p<0.0001), H4 (2.3 vs 3.1, p<0.0001) and H6 (2.3 vs 2.7, p=0.0039). Regarding painkillers consumption, postoperative complications and number of ambulatory conversions, there was no difference between the two groups.
Conclusion
The placement of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine did not reduce the H6 coughing pain but allowed a decrease in the overall pain over the first 6 hours after surgery and could simplify the management of patients.
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Affiliation(s)
- N Siembida
- Digestive and Oncological Surgery Department, Hospital of Amiens-Picardie , AMIENS , France
| | - H Ralaihova
- Statistical Department, QData- Quanta Medical Group , Antananarivo , Madagascar
| | - S Moulin
- Statistical and Data management Department , Quanta Medical, Rueil-Malmaison , France
| | - F Aubert
- Research & Development Department , Cousin Biotech, Wervicq-Sud , France
| | - R Boulkedid
- Clinical and Vigilance Operations Departement , Quanta Medical, Rueil-Malmaison , France
| | - O Zourabichvili
- Clinical and Vigilance Operations Departement , Quanta Medical, Rueil-Malmaison , France
| | - J M Regimbeau
- Department of Digestive Surgery, Hospital of Amiens-Picardie , AMIENS , France
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Brugel M, Letrillart L, Evrard C, Thierry A, Tougeron D, El Amrani M, Piessen G, Truant S, Turpin A, d'Engremont C, Roth G, Hautefeuille V, Regimbeau JM, Williet N, Schwarz L, Di Fiore F, Borg C, Doussot A, Lambert A, Moulin V, Trelohan H, Bolliet M, Topolscki A, Ayav A, Lopez A, Botsen D, Piardi T, Carlier C, Bouché O. Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID). Eur J Cancer 2022; 166:8-20. [PMID: 35259629 PMCID: PMC8828421 DOI: 10.1016/j.ejca.2022.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) - from diagnosis to treatment - of the reorganisation of the health care system during the first lockdown. METHODS This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1, 2019 and October 31, 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 to May 11, 2020) and after lockdown. RESULTS During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p = 0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p = 0.97). The number of borderline tumours increased (13.6%-21.7%), whereas the rate of metastatic diseases rate dropped (47.1%-40.3%) (p = 0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7%-32.6%) compared with upfront surgery (13%-7.8%) (p = 0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9%-69%; p = 0.044). After lockdown, the number of borderline tumours decreased (21.7%-9.6%) and advanced diseases increased (59.7%-69.8%) (p = 0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). CONCLUSION This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up. TRIAL REGISTRATION Clinicaltrials.gov NCT04406571.
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Affiliation(s)
- Mathias Brugel
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France.
| | - Léa Letrillart
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France
| | - Camille Evrard
- Medical Oncology Department, CHU Poitiers, Poitiers, France
| | - Aurore Thierry
- Department of Research and Public Health, CHU Reims, Reims, France
| | - David Tougeron
- University of Poitiers, Hepatogastroenterology Department, CHU Poitiers, Poitiers, France
| | - Mehdi El Amrani
- Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Guillaume Piessen
- Digestive and Oncological Surgery Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Stéphanie Truant
- Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Anthony Turpin
- Medical Oncology Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Christelle d'Engremont
- Digestive Oncology and Hepatogastroenterology Department, CHU Grenoble-Alpes, Grenoble-Alpes University, Grenoble, France
| | - Gaël Roth
- Digestive Oncology and Hepatogastroenterology Department, CHU Grenoble-Alpes, Grenoble-Alpes University, Grenoble, France
| | - Vincent Hautefeuille
- Digestive Oncology and Gastroenterology Department, CHU Amiens-Picardie, Amiens, France
| | - Jean M Regimbeau
- Digestive Surgery Department, CHU Amiens-Picardie, SSPC (Simplification of Complex Patient Care) UR UPJV 7518, University of Picardie-Jules Verne, Amiens, France
| | - Nicolas Williet
- Hepatogastroenterology Department, CHU Saint Etienne, Saint-Priest-en-Jarez, France
| | - Lilian Schwarz
- Digestive Surgery Department, CHU Rouen, UNIROUEN, Inserm 1245, IRON Group, Normandie University, Rouen, France
| | - Frédéric Di Fiore
- Hepatogastroenterology Department, CHU Rouen, UNIROUEN, Inserm 1245, IRON Group, Normandie University, Rouen, France
| | - Christophe Borg
- Medical Oncology Department, CHU Besançon, INSERM, EFS BFC, UMR1098, RIGHT, University Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Doussot
- Digestive Surgical Oncology and Liver Transplantation Department, CHU Besançon, Besançon, France
| | - Aurélien Lambert
- Medical Oncology Department, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - Valérie Moulin
- Oncology Department, GH La Rochelle, La Rochelle, France
| | | | - Marion Bolliet
- Hepatogastroenterology Department, CH Colmar, Colmar, France
| | | | - Ahmet Ayav
- Hepatobiliary and Pancreatic Surgery Departement, CHRU Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Anthony Lopez
- Gastroenterology and Digestive Oncology, CHRU Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Damien Botsen
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - Tulio Piardi
- General, Digestive and Endocrine Surgery Department, CHU Reims, Research Unit EA 3797 (VieFra) University of Reims Champagne-Ardenne (URCA), Reims, France
| | - Claire Carlier
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - Olivier Bouché
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France
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6
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Loire M, Bridoux V, Mege D, Mathonnet M, Mauvais F, Massonnaud C, Regimbeau JM, Tuech JJ. Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI). Int J Colorectal Dis 2021; 36:2159-2164. [PMID: 34086087 DOI: 10.1007/s00384-021-03962-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical management of Hinchey III and IV diverticulitis involves Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. These procedures were evaluated in four randomized controlled trials. Early results from these trials demonstrated similar rates of complications but higher rates of colonic restoration after PRA than HP. Long-term follow-up has not been reported to date. The aim of this study was to analyze long-term outcomes and quality of life (QoL) in patients previously enrolled in a prospective randomized trial comparing HP and PRA for generalized peritonitis due to perforated diverticulitis (DIVERTI trial). STUDY DESIGN Follow-up data were available for 78 of 102 patients. Demographic data, incisional hernia rate, need for additional surgery related to the primary procedure, and QoL were recorded. RESULTS The overall survival rate was 76% and did not differ between the two groups. Incisional hernia was reported in 21 (52%) patients in the HP arm and in 11 (29%) patients in the PRA arm (p = 0.035). The HP arm demonstrated significantly lower SF-36 physical and mental component scores. The mean general QoL (EQ-VAS) and mean EQ-5D index scores were better after PRA than after HP, but this difference was not statistically significant. The results of GIQLI, which measures intestine-specific QOL, did not differ between the two groups. CONCLUSIONS This follow-up study with a median follow-up time of > 9 years among living patients indicates that PRA for perforated diverticulitis is associated with fewer long-term complications and better QoL than HP. PRA significantly reduced the incisional hernia rate and the need for reoperation. Long-term survival was not jeopardized by the PRA approach. Future studies are needed to address the utility of protective stoma.
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Affiliation(s)
- M Loire
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - D Mege
- Department of Digestive Surgery, Marseille University Hospital La Timone, Marseille, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais General Hospital, Beauvais, France
| | - C Massonnaud
- Department of Biostatistics, Rouen University Hospital, 76000, Rouen, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - J J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France.
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, Scatton O. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. Br J Surg 2021; 108:419-426. [PMID: 33793726 DOI: 10.1093/bjs/znaa110] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). METHODS Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. RESULTS In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). CONCLUSION The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.,Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - D Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Université Paris V, Paris, France
| | - L Barbier
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - J M Fabre
- Department of Digestive, Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - O Farges
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - F R Pruvot
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - P Pessaux
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Salamé
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris and Université Paris XI, Paris, France
| | - O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
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8
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Brac B, Sabbagh C, Regimbeau JM. Strategy and technique for colostomy reversal by laparoscopy after left colectomy with end colostomy (Hartmann procedure). J Visc Surg 2021; 158:506-512. [PMID: 34059482 DOI: 10.1016/j.jviscsurg.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B Brac
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France
| | - C Sabbagh
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France; Unité de Recherche UPJV 7518 SSPC "Simplification des Soins des Patients Complexes", Université de Picardie-Jules-Verne, Amiens, France
| | - J M Regimbeau
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France; Unité de Recherche UPJV 7518 SSPC "Simplification des Soins des Patients Complexes", Université de Picardie-Jules-Verne, Amiens, France.
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9
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Sabbagh C, Regimbeau JM. Re: "Cecal distension on non-tumoral left colonic obstacle: Management strategy in two cases". J Visc Surg 2020; 157:537-538. [PMID: 33289650 DOI: 10.1016/j.jviscsurg.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Sabbagh
- Department of visceral surgery, CHU Amiens-Picardie, Rond point du Pr Cabrol, 80054 Amiens cedex, France; UR UPJV 7518 SSPC (simplifying the care of complex surgical patients), Picardie Jules Verne University, 80054 Amiens cedex, France; Picardie Jules Verne University, 80054 Amiens cedex, France
| | - J M Regimbeau
- Department of visceral surgery, CHU Amiens-Picardie, Rond point du Pr Cabrol, 80054 Amiens cedex, France; UR UPJV 7518 SSPC (simplifying the care of complex surgical patients), Picardie Jules Verne University, 80054 Amiens cedex, France; Picardie Jules Verne University, 80054 Amiens cedex, France.
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10
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Sabbagh C, Siembida N, Dupont H, Diouf M, Schmit JL, Boddaert S, Regimbeau JM. The value of post-operative antibiotic therapy after laparoscopic appendectomy for complicated acute appendicitis: a prospective, randomized, double-blinded, placebo-controlled phase III study (ABAP study). Trials 2020; 21:451. [PMID: 32487213 PMCID: PMC7268648 DOI: 10.1186/s13063-020-04411-1] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately 30% of appendectomies are for complicated acute appendicitis (CAA). With laparoscopy, the main post-operative complication is deep abscesses (12% of cases of CAA, versus 4% for open surgery). A recent cohort study compared short and long courses of postoperative antibiotic therapy in patients with CAA. There was no significant intergroup difference in the post-operative complication rate (12% of organ/space surgical site infection (SSI)). Moreover, antibiotic therapy is increasingly less indicated for other situations (non-complicated appendicitis, post-operative course of cholecystitis, perianal abscess), calling into question whether post-operative antibiotic therapy is required after laparoscopic appendectomy for CAA. METHODS/DESIGN This study is a prospective, multicenter, parallel-group, randomized (1:1), double-blinded, placebo-controlled, phase III non-inferiority study with blind evaluation of the primary efficacy criterion. The primary objective is to evaluate the impact of the absence of post-operative antibiotic therapy on the organ/space surgical site infection (SSI) rate in patients presenting with CAA (other than in cases of generalized peritonitis). Patients in the experimental group will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, a placebo for ceftriaxone (2 g/24 h in one intravenous injection) and a placebo for metronidazole (1500 mg/24 h in three intravenous injections, for 3 days). In the control group, patients will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, antibiotic therapy (ceftriaxone 2 g/24 h and metronidazole 1500 mg/24 h for 3 days). In the event of allergy to ceftriaxone, it will be replaced by levofloxacin (500 mg/24 h in one intravenous injection, for 3 days). The expected organ space SSI rate is 12% in the population of patients with CAA operated on by laparoscopy. With a non-inferiority margin of 5%, a two-sided alpha risk of 5%, a beta risk of 20%, and a loss-to-follow-up rate of 10%, the calculated sample size is 1476 included patients, i.e., 738 per group. Due to three interim analyses at 10%, 25%, and 50% of the planned sample size, the total sample size increases to 1494 patients (747 per arm). TRIAL REGISTRATION Ethical authorization by the Comité de Protection des Personnes and the Agence Nationale de Sécurité du Médicament: ID-RCB 2017-00334-59. Registered on ClinicalTrials.gov (NCT03688295) on 28 September 2018.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France.,Jules Verne University of Picardie, Amiens, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France
| | - N Siembida
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France
| | - H Dupont
- Jules Verne University of Picardie, Amiens, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France.,Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - M Diouf
- Department of Methodology, Biostatistics, Direction of Clinical Research, Amiens University Medical Center, Amiens, France
| | - J L Schmit
- Jules Verne University of Picardie, Amiens, France.,Department of Infectious Diseases, Amiens University Medical Center, Amiens, France
| | - S Boddaert
- Department of Pharmacology, Amiens University Medical Center, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France. .,Jules Verne University of Picardie, Amiens, France. .,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France.
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11
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Regimbeau JM, Dembinski J. An invited commentary on "Segment 4 occlusion in portal vein embolization increase future liver remnant hypertrophy - A scandinavian cohort study". Int J Surg 2020; 76:59. [PMID: 32084546 DOI: 10.1016/j.ijsu.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- J M Regimbeau
- Service de Chirurgie Digestive, CHU Amiens Picardie et Université de Picardie Jules Verne, Amiens, France; UR UPJV 7518 Researc Unit SSPC (Simplified Surgical Patients Care), Université de Picardie Jules Verne, Amiens, France.
| | - J Dembinski
- Service de Chirurgie Digestive, CHU Amiens Picardie et Université de Picardie Jules Verne, Amiens, France; UR UPJV 7518 Researc Unit SSPC (Simplified Surgical Patients Care), Université de Picardie Jules Verne, Amiens, France
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12
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Venara A, Meillat H, Cotte E, Ouaissi M, Duchalais E, Mor-Martinez C, Wolthuis A, Regimbeau JM, Ostermann S, Hamel JF, Joris J, Slim K. Correction to: Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis. World J Surg 2020; 44:1331. [PMID: 31993721 DOI: 10.1007/s00268-020-05386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.
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Affiliation(s)
- A Venara
- Faculty of Medicine of Angers, Angers, France. .,Department of Visceral and Endocrinal Surgery (Service de chirurgie viscérale et endocrinienne), CHU Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France. .,UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, Rue Gaston Veil, 44035, Nantes, France.
| | - H Meillat
- Institut Paoli-Calmette, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - E Cotte
- Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite Cedex, France.,Université de Lyon, Lyon, France
| | - M Ouaissi
- Department of Visceral Surgery, CHU Tours, 2 Boulevard Tonnelé, 37000, Tours, France
| | - E Duchalais
- UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, Rue Gaston Veil, 44035, Nantes, France.,Department of Visceral Surgery, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - C Mor-Martinez
- Department of Visceral Surgery, Clinique de l'Alliance, 1 Boulevard A Nobel, 37540, Saint Cyr Sur Loire, France
| | - A Wolthuis
- Department of Abdominal Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J M Regimbeau
- Department of Visceral Surgery, CHU Amiens, Avenue Laennec, 80054, Amiens, France
| | - S Ostermann
- Hirslanden Clinique La Colline, Geneva, Switzerland
| | - J F Hamel
- Department of Methodology and Biostatistics, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - J Joris
- Department of Anesthesiology, CHU Liège, Domaine de Sart Tilman, Université de Liège, 4000, Liege, Belgium
| | - K Slim
- Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France
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13
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Rebibo L, Dhahri A, Regimbeau JM. Technical tricks for "easy" sleeve gastrectomy. J Visc Surg 2019; 156:537-543. [PMID: 31501040 DOI: 10.1016/j.jviscsurg.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- L Rebibo
- Service de chirurgie digestive, centre hospitalo-universitaire d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; Simplification des soins des patients complexes (SSPC), centre de recherche clinique, université de Picardie Jules-Verne, 80054 Amiens cedex 01, France
| | - A Dhahri
- Service de chirurgie digestive, centre hospitalo-universitaire d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France
| | - J M Regimbeau
- Service de chirurgie digestive, centre hospitalo-universitaire d'Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; Simplification des soins des patients complexes (SSPC), centre de recherche clinique, université de Picardie Jules-Verne, 80054 Amiens cedex 01, France.
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14
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Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, De Angelis N, Ouaissi M, Sielezneff I, Karoui M, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Regimbeau JM, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer L, Bege T, Corte H, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Lefevre JH, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, De la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21:782-790. [PMID: 30884089 DOI: 10.1111/codi.14614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - D Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - V Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - A Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - T Voron
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint Antoine Hospital, Sorbonne Université, Paris, France
| | - N De Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - M Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
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15
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Sabbagh C, Siembida N, Yzet T, Robert B, Chivot C, Browet F, Mauvais F, Regimbeau JM. What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer? Colorectal Dis 2018; 20:688-695. [PMID: 29495118 DOI: 10.1111/codi.14056] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/05/2018] [Indexed: 02/08/2023]
Abstract
AIM In the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry. METHOD From January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case-control, two-centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end-point of the study was a determination of predictive factors for caecal perforation. RESULTS A total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P < 0.0001), caecal pneumatosis (P < 0.0001), mean maximum caecal diameter (P = 0.001), mean caecal diameter at the ileocaecal junction (P = 0.0001) and mean caecal volume (P = 0.001) were associated with caecal perforation. Receiver operating characteristic curve analysis revealed that a caecal volume greater than 400 cm3 (P < 0.0001), a maximum caecal diameter > 9 cm (P = 0.002) and a caecal diameter at the ileocaecal junction > 7.5 cm (P = 0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume > 400 cm3 (P = 0.001) was correlated with the risk of impending caecal perforation. CONCLUSION Caecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.,Jules Verne University of Picardie, Amiens, France
| | - N Siembida
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - T Yzet
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - B Robert
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - C Chivot
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - F Browet
- Department of Digestive Surgery, Department of Digestive Surgery, Amiens, France
| | - F Mauvais
- Department of Digestive Surgery, Department of Digestive Surgery, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.,Jules Verne University of Picardie, Amiens, France
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16
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Mariage M, Sabbagh C, Yzet T, Dupont H, NTouba A, Regimbeau JM. Distinguishing fecal appendicular peritonitis from purulent appendicular peritonitis. Am J Emerg Med 2018; 36:2232-2235. [PMID: 29779677 DOI: 10.1016/j.ajem.2018.04.014] [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: 12/10/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Fecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP). PATIENTS AND METHODS This single-center, retrospective study was conducted in consecutive patients to compare the FAP group and the PAP group. The primary endpoint was the 30-day postoperative morbidity and mortality according to the Clavien-Dindo classification. The secondary endpoints were description and comparison of intraoperative data (laparoscopy rate, conversion rate, type of procedure and the mean operating time), and short-term outcomes (types of complications, length of stay, readmission rate, and reoperation rate), comparison of intraoperative bacteriological samples of FAP and PAP as well as the rate of resistance to amoxicillin and clavulanic acid, used as routine postoperative antibiotic therapy. RESULTS Between January 2006 and January 2016, 2.2% of appendectomies were performed for FAP. Patients of the FAP group reported a longer history of pain than patients of the PAP group (mean: 58 h [range: 24-120] vs 24 h [range: 6-504], p = 0.0001) and hyperthermia was more frequent in the FAP group than in the PAP group (72% vs 26%, p = 0.0001). Mean preoperative CRP was also higher in the FAP group than in the PAP group (110 mg/L [range: 67-468] vs 37.5 mg/L [range: 3.1-560], p = 0.007). Significantly less patients were operated by laparoscopy in the FAP group (89.7% vs 96.6%, p < 0.0001). Mean length of stay was significantly longer in the FAP group than in the PAP group (10 days [range: 3-24] vs 5 days [range: 1-32], p = 0.001). The overall 30-day complication rate was significantly higher in the FAP group than in the PAP group (62.1% vs 24.7%, p = 0.0005). The readmission rate was not significantly different between the two groups (14% vs 11.2%, p = 0.2), but the reoperation rate was higher in the FAP group than in the PAP group (31% vs 11%, p = 0.01). No significant difference was observed between the FAP and PAP groups in terms of the positive culture rate (75.9% vs 65.6%, p = 0.3). No significant difference was observed between the two groups in terms of resistance to amoxicillin and clavulanic acid (18.2% vs 20.5%, p = 0.8). CONCLUSION FAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their patients.
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Affiliation(s)
- M Mariage
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
| | - T Yzet
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - H Dupont
- Intensive Care Unit, Amiens University Medical Center, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
| | - A NTouba
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France.
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Affiliation(s)
- K Slim
- Service de chirurgie digestive et unité de chirurgie ambulatoire, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - J M Regimbeau
- Service de chirurgie viscérale, CHU Amiens, chemin de Longpré 80080 Amiens, France
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Cosse C, Rebibo L, Brazier F, Hakim S, Delcenserie R, Regimbeau JM. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg 2018; 105:570-577. [DOI: 10.1002/bjs.10732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Gastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure.
Methods
Between April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of €30 000, and identification of the key drivers of ICER derived from a multivariable analysis.
Results
One hundred and twelve patients were enrolled. The overall mean costs of gastric leak were €22 470; the mean(s.d.) cost was €24 916(12 212) in the CS arm and €20 024(3352) in the DPS arm (P = 0·018). DPS was more cost-effective than CS (ICER €4743 per endoscopic procedure avoided), with an incremental net benefit of €25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure.
Conclusion
DPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible.
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Affiliation(s)
- C Cosse
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardie, Amiens, France
| | - L Rebibo
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - F Brazier
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - S Hakim
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - R Delcenserie
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- EA4294, Jules Verne University of Picardie, Amiens, France
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Cossé C, Sabbagh C, Fumery M, Zogheib E, Mauvais F, Browet F, Rebibo L, Regimbeau JM. Serum procalcitonin correlates with colonoscopy findings and can guide therapeutic decisions in postoperative ischemic colitis. Dig Liver Dis 2017; 49:286-290. [PMID: 28089622 DOI: 10.1016/j.dld.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postoperative ischaemic colitis (POIC) is a life-threatening vascular gastrointestinal condition. Serum procalcitonin (PCT) levels be of value in the detection of necrosis. AIMS To evaluate the correlation between serum PCT levels and the colonoscopic assessment of the severity of POIC. METHODS Between January 2007 and November 2014, 150 patients with POIC and PCT data were included in the study. The main outcome measure was the correlation between serum PCT and the colonoscopy-based assessment of the severity of POIC (according to Favier's classification: stage 1/2 without multi-organ failure vs. stage 2/3 with multi-organ failure). RESULTS Eighty-five percent of the stage 1 cases (n=22) had a serum PCT level ≤2μg/L; 63% (n=19) of the stage 2 cases with multi-organ failure had a PCT level between 4 and 8μg/L, and 70% (n=52) of the stage 3 cases had a PCT level ≥8μg/L. The PCT level was strongly correlated with the Favier stage (Spearman's rho: 0.701; p<0.0001). PCT levels were similar in stage 2 cases with multi-organ failure and in stage 3 cases (16.06μg/L vs. 7.79μg/L, respectively; p=0.35). CONCLUSION AND RELEVANCE Serum PCT is correlated with stage 2/3 POIC requiring surgery. If PCT ≥5μg/L, surgery should be considered.
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Affiliation(s)
- C Cossé
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France
| | - M Fumery
- Department of Gastroenterology, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - E Zogheib
- Department of Anaesthesiology and Cardiovascular Intensive Care, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - F Mauvais
- Department of Visceral Surgery, Beauvais General Hospital, Beauvais, France
| | - F Browet
- Department of Visceral Surgery, Beauvais General Hospital, Beauvais, France
| | - L Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - J M Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France.
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Doussot A, Lim C, Gómez-Gavara C, Fuks D, Farges O, Regimbeau JM, Azoulay D, Pascal G, Castaing D, Cherqui D, Baulieux J, Mabrut JY, Ducerf C, Belghiti J, Nuzzo G, Giuliante F, Le Treut YP, Hardwigsen J, Pessaux P, Bachellier P, Pruvot FR, Boleslawski E, Rivoire M, Chiche L. Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma. Br J Surg 2016; 103:1887-1894. [PMID: 27629502 DOI: 10.1002/bjs.10296] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/26/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of morbidity on long-term outcomes following liver resection for intrahepatic cholangiocarcinoma is currently unclear. METHODS This was a retrospective analysis of all consecutive patients who underwent liver resection for intrahepatic cholangiocarcinoma with curative intent in 24 university hospitals between 1989 and 2009. Severe morbidity was defined as any complication of Dindo-Clavien grade III or IV. Patients with severe morbidity were compared with those without in terms of demographics, pathology, management, morbidity, overall survival, disease-free survival and time to recurrence. Independent predictors of severe morbidity were identified by multivariable analysis. RESULTS A total of 522 patients were enrolled. Severe morbidity occurred in 113 patients (21·6 per cent) and was an independent predictor of overall survival (hazard ratio 1·64, 95 per cent c.i. 1·21 to 2·23), as were age at resection, multifocal disease, positive lymph node status and R0 resection margin. Severe morbidity did not emerge as an independent predictor of disease-free survival. Independent predictors of time to recurrence included severe morbidity, tumour size, multifocal disease, vascular invasion and R0 resection margin. Major hepatectomy and intraoperative transfusion were independent predictors of severe morbidity. CONCLUSION Severe morbidity adversely affects overall survival following liver resection for intrahepatic cholangiocarcinoma.
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Affiliation(s)
- A Doussot
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - C Lim
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - C Gómez-Gavara
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - D Fuks
- Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - O Farges
- Department of Hepatobiliary Surgery, Hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - J M Regimbeau
- Department of Surgery, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - D Azoulay
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | | | - G Pascal
- Hôpital Paul Brousse, Villejuif, France
| | | | - D Cherqui
- Hôpital Paul Brousse, Villejuif, France
| | - J Baulieux
- Hopital de la Croix Rousse, Lyon, France
| | - J Y Mabrut
- Hopital de la Croix Rousse, Lyon, France
| | - C Ducerf
- Hopital de la Croix Rousse, Lyon, France
| | | | - G Nuzzo
- University Catholic di Roma, Roma, Italy
| | | | | | | | - P Pessaux
- Hopital Hautepierre, Strasbourg, France
| | | | | | | | | | - L Chiche
- Centre Hospitalier Universitaire Bordeaux, France
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Affiliation(s)
- L Rebibo
- CHU Amiens, 80054 Amiens cedex, France.
| | - I Darmon
- CHU Amiens, 80054 Amiens cedex, France
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22
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Messager M, Sabbagh C, Denost Q, Regimbeau JM, Laurent C, Rullier E, Sa Cunha A, Mariette C. Is there still a need for prophylactic intra-abdominal drainage in elective major gastro-intestinal surgery? J Visc Surg 2015; 152:305-13. [PMID: 26481067 DOI: 10.1016/j.jviscsurg.2015.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prophylactic drainage of the abdominal cavity after gastro-intestinal surgery is widely used. The rationale is that intra-abdominal drainage enhances early detection of complications (gastro-intestinal leakage, hemorrhage, bile leak), prevents collection of fluid or pus, reduces morbidity and mortality, and decreases the duration of hospital stay. However, dogmatic attitudes favoring systematic drain placement should be questioned. The aim of this review was to evaluate the evidence supporting systematic use of prophylactic abdominal drainage following gastrectomy, pancreatectomy, liver resection, and rectal resection. Based on this review of the literature: (i) there was no evidence in favor of intra-peritoneal drainage following total or sub-total gastrectomy with respect to morbidity-mortality, nor was it helpful in the diagnosis or management of leakage, however the level of evidence is low, (ii) following pancreatic resection, data are conflicting but, overall, suggest that the absence of drainage is prejudicial, and support the notion that short-term drainage is better than long-term drainage, (iii) after liver resection without hepatico-intestinal anastomosis, high level evidence supports that there is no need for abdominal drainage, and (iv) following rectal resection, data are insufficient to establish recommendations. However, results from the French multicenter randomized controlled trial GRECCAR5 (NCT01269567) should provide new evidence this coming year. Accumulating data support that systematic drainage of the abdominal cavity in digestive surgery is a non-beneficial and obsolete practice, except following pancreatectomy where the consensus appears to indicate the usefulness of short-term drainage. While the level of evidence is high for liver resections, new randomized controlled trials are awaited regarding gastric, pancreatic and rectal surgery.
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Affiliation(s)
- M Messager
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France
| | - C Sabbagh
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - Q Denost
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - J M Regimbeau
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - C Laurent
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - E Rullier
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - A Sa Cunha
- Service de Chirurgie Digestive, Hôpital Paul-Brousse, Villejuif, France
| | - C Mariette
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France.
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Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F, Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey. Eur J Surg Oncol 2015; 41:1361-7. [PMID: 26263848 DOI: 10.1016/j.ejso.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.
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Affiliation(s)
- G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France.
| | - L Simon
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France; INSERM, U 965, Paris, France
| | - L Gladieff
- Department of Medical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - J M Bereder
- Department of General Surgery, Archet 2 University Hospital, Nice, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - F Bibeau
- Department of Pathology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - N Goasguen
- Department of General Surgery, Diaconesses Croix Saint Simon Group Hospital, Paris, France
| | - L Gouthi
- Department of Digestive Surgery, Purpan University Hospital, Toulouse, France
| | - B Heyd
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - R Kianmanesh
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - E Leblanc
- Department of Gynaecological Surgery, Oscar Lambret Cancer Center, Lille, France
| | - V Loi
- Department of Digestive Surgery, Tenon University Hospital, Paris, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Cancer Center, Angers, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - S Msika
- Department of Surgery, Louis Mourier University Hospital, Colombes, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J Paineau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - N Pirro
- Department of Digestive Surgery, Timône University Hospital, Marseille, France
| | - C Pomel
- Department of Surgical Oncology, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France
| | - J Porcheron
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - G Pourcher
- Department of General Surgery, Antoine-Béclère University Hospital, Clamart, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J M Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - E Thibaudeau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J J Torrent
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Tougeron
- Department of Hepato-Gastroenterology, University Hospital, Poitiers, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - F Zinzindohoue
- Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France
| | - P Lundberg
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - F Herin
- Department of Occupational Medicine, University Hospital, Toulouse, France
| | - L Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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Tartar L, Sabbagh C, Chivot C, Cosse C, Regimbeau JM. Does radiotherapy have an impact on the thickness of the puborectal muscle? Colorectal Dis 2015; 17:542-3. [PMID: 25827604 DOI: 10.1111/codi.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 02/08/2023]
Affiliation(s)
- L Tartar
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France.,Jules Verne University of Picardie, Amiens, France.,INSERM unit U1088, Jules Verne University of Picardie, Amiens, France
| | - C Chivot
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - C Cosse
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France.,Jules Verne University of Picardie, Amiens, France.,INSERM unit U1088, Jules Verne University of Picardie, Amiens, France.,Clinical Research Centre, Amiens University Hospital, Amiens, France
| | - J M Regimbeau
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France. .,Jules Verne University of Picardie, Amiens, France. .,Clinical Research Centre, Amiens University Hospital, Amiens, France. .,EA4294, Jules Verne University of Picardie, Amiens, France.
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Cosse C, Sabbagh C, Browet F, Mauvais F, Rebibo L, Zogheib E, Chatelain D, Kamel S, Regimbeau JM. Serum value of procalcitonin as a marker of intestinal damages: type, extension, and prognosis. Surg Endosc 2015; 29:3132-9. [PMID: 25701059 DOI: 10.1007/s00464-014-4038-0] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ischemic and necrotic damages are complications of digestive diseases and require emergency management. Nevertheless, the decision to surgically manage could be delayed because of no sufficiently preoperative accurate marker of ischemia diagnosis, extension, and prognosis. METHODS The aim of this study was to assess the predictive value of serum procalcitonin (PCT) levels for diagnosing intestinal necrotic damages, their extension, and their prognosis in patients with ischemic disease including ischemic colitis and mesenteric infarction by a gray zone approach. Between January 2007 to June 2014, 128 patients with ischemic colitis and mesenteric infarction (codes K55.0 and K51.9) were operated, for whom data on PCT were available. We perform a retrospective, multicenter review of their medical records. Patients were divided into subgroups: ischemia (ID group) versus necrosis (ND group); the extension [focal (FD) vs. extended (ED)] and the vital status [deceased (D) vs. alive (A)]. RESULTS PCT levels were higher in the ND (n = 94; p = 0.009); ED (n = 100; p = 0.02); and D (n = 70; p = 0.0003) groups. With a gray zone approach, the predictive thresholds were (i) for necrosis 2.473 ng/mL, (ii) for extension 3.884 ng/mL, and (iii) for mortality 7.87 ng/mL. CONCLUSION In our population, PCT could be used as a marker of necrosis; especially in case of extended damages and reflects the patient's prognosis.
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Affiliation(s)
- C Cosse
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.,INSERM U1088, Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - F Browet
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - L Rebibo
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - E Zogheib
- Department of Anesthesiology, Amiens South Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - D Chatelain
- Department of Pathology, Amiens North Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - S Kamel
- INSERM U1088, Jules Verne University of Picardie, Amiens, France.,Department of Biochemistry, Amiens South Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - J M Regimbeau
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France. .,EA4294, Jules Verne University of Picardie, Amiens, France. .,Department of Digestive and Oncological Surgery, CHU Nord Amiens and University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France. .,Clinical Research Center, Amiens University Hospital, Amiens, France.
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Cauchy F, Regimbeau JM, Fuks D, Balladur P, Tiret E, Paye F. Influence of bile duct obstruction on the results of Frey's procedure for chronic pancreatitis. Pancreatology 2013; 14:21-6. [PMID: 24555975 DOI: 10.1016/j.pan.2013.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the influence of a biliary obstruction (BO) requiring biliary bypass on both short and long-term outcomes of patients undergoing Frey's procedure for chronic pancreatitis (CP). METHODS From 1999 to 2010, 33 consecutive patients underwent Frey's procedure for CP in two centers. Seventeen (54%) patients underwent biliary bypass to treat an associated BO. Characteristics and outcomes of these patients were compared to those of 16 others without BO. RESULTS Patients with BO had more severe disease including lower BMI and larger pancreatic head (4 cm vs. 6 cm, p = 0.021). The operative mortality was nil. Patients with BO experienced more overall postoperative complications (71% vs. 31%, p = 0.024) but similar major complication rates (18% vs. 6%, p = 0.316) compared to those without BO. After a median follow-up of 51 (1-96) months, 91% of the patients experienced either partial or complete relief of their symptoms and 36% exhibited deterioration of their endocrine function. Multivariate analysis revealed preoperative BO to be associated with long-term impairment of endocrine function (OR: 43.249; 95% CI 2.221-84.277; p = 0.013). CONCLUSION In patients undergoing Frey's procedure for CP, associated BO can be safely managed using biliary bypass. However, the severity of CP in these patients is responsible for a higher risk of long-term endocrine insufficiency.
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Affiliation(s)
- F Cauchy
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - J M Regimbeau
- Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France
| | - D Fuks
- Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France
| | - P Balladur
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - E Tiret
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France
| | - F Paye
- Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France.
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Robert B, Chivot C, Fuks D, Gondry-Jouet C, Regimbeau JM, Yzet T. Percutaneous, computed tomography-guided drainage of deep pelvic abscesses via a transgluteal approach: a report on 30 cases and a review of the literature. ACTA ACUST UNITED AC 2013; 38:285-9. [PMID: 22684488 DOI: 10.1007/s00261-012-9917-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature. MATERIALS AND METHODS We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome. RESULTS From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage. CONCLUSION When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).
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Affiliation(s)
- Brice Robert
- Department of Digestive Radiology, Amiens North Hospital, University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
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Abstract
Since the initial studies published in the eighties, percutaneous radiologic drainage, is considered the first-line treatment of infected post-operative collections and is successful in over 80% of patients. Mortality due to undrained abscesses is estimated between 45 and 100%. Radiology-guided percutaneous drainage can be performed either with curative intent or to improve patient status prior to re-operation under better conditions. Cross-sectional imaging, using either ultrasound or computed tomography (CT), has changed the management of post-operative complications. Percutaneous drainage is most often performed by interventional radiologists and imaging is essential for road-mapping and guiding the puncture and drainage of intra-abdominal collections. Indeed, such imaging allows both identification of adjacent anatomical structures and determination of the best tract and the safest route. Cooperation between the surgeon and the interventional radiologist is essential to optimize the management and to avoid, if possible, surgery, which is so often difficult in this setting.
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Affiliation(s)
- B Robert
- Service d'imagerie médicale, département de radiologie digestive, CHU Amiens Nord, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Schwarz L, Huet E, Yzet T, Fuks D, Regimbeau JM, Scotte M. An extremely uncommon variant of left hepatic artery arising from the superior mesenteric artery. Surg Radiol Anat 2013; 36:91-4. [PMID: 23652481 DOI: 10.1007/s00276-013-1131-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
We report a new variation of the left hepatic artery arising from the superior mesenteric artery. The variant was discovered during radiological examinations in a patient presenting with ruptured hepatocellular carcinoma of the left liver lobe. Anatomical description was based on CT-scan and angiographic analysis. When present the left hepatic artery originates from the left gastric artery, with an incidence of 12-34 %. Knowledge of left hepatic artery anatomy is mandatory to optimize surgical and radiological management in complex clinical situations.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Rouen University Hospital-Hôpital Charles Nicolle, 76031, Rouen Cedex, France
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30
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Farges O, Regimbeau JM, Fuks D, Le Treut YP, Cherqui D, Bachellier P, Mabrut JY, Adham M, Pruvot FR, Gigot JF. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg 2012; 100:274-83. [PMID: 23124720 DOI: 10.1002/bjs.8950] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indications for preoperative biliary drainage (PBD) in the context of hepatectomy for hilar malignancies are still debated. The aim of this study was to investigate current European practice regarding biliary drainage before hepatectomy for Klatskin tumours. METHODS This was a retrospective analysis of all patients who underwent formal or extended right or left hepatectomy for hilar cholangiocarcinoma between 1997 and 2008 at 11 European teaching hospitals, and for whom details of serum bilirubin levels at admission and at the time of surgery were available. PBD was performed at the physicians' discretion. The primary outcome was 90-day mortality. Secondary outcomes were morbidity and cause of death. The association of PBD and of preoperative serum bilirubin levels with postoperative mortality was assessed by logistic regression, in the entire population as well as separately in the right- and left-sided hepatectomy groups, and was adjusted for confounding factors. RESULTS A total of 366 patients were enrolled; PBD was performed in 180 patients. The overall mortality rate was 10·7 per cent and was higher after right- than left-sided hepatectomy (14·7 versus 6·6 per cent; adjusted odds ratio (OR) 3·16, 95 per cent confidence interval 1·50 to 6·65; P = 0·001). PBD did not affect overall postoperative mortality, but was associated with a decreased mortality rate after right hepatectomy (adjusted OR 0·29, 0·11 to 0·77; P = 0·013) and an increased mortality rate after left hepatectomy (adjusted OR 4·06, 1·01 to 16·30; P = 0·035). A preoperative serum bilirubin level greater than 50 µmol/l was also associated with increased mortality, but only after right hepatectomy (adjusted OR 7·02, 1·73 to 28·52; P = 0·002). CONCLUSION PBD does not affect overall mortality in jaundiced patients with hilar cholangiocarcinoma, but there may be a difference between patients undergoing right-sided versus left-sided hepatectomy.
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Affiliation(s)
- O Farges
- Department of Hepatobiliary Surgery, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Université Paris 7, Clichy, France.
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Regimbeau JM, Fuks D, Bachellier P, Le Treut YP, Pruvot FR, Navarro F, Chiche L, Farges O. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. Eur J Surg Oncol 2011; 37:505-12. [PMID: 21514090 DOI: 10.1016/j.ejso.2011.03.135] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 02/23/2011] [Accepted: 03/28/2011] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Jaundice is frequent in patients with gallbladder cancer (GBC) and indicates advanced disease and, according to some teams, precludes routine operative exploration. The present study was designed to re-assess the prognostic value of jaundice in patients with GBC. METHODS Patients with GBC operated from 1998 to 2008 were included in a retrospective multicenter study (AFC). The main outcome measured was the prognostic value of jaundice in patients with GBC focusing on morbidity, mortality and survival. RESULTS A total of 110 of 429 patients with GBC presented with jaundice, with a median age of 66 years (range: 31-88). The resectability rate was 45% (n=50) and the postoperative mortality and morbidity rates were 16% and 62%, respectively; 71% had R0 resection and 46% had lymph node involvement. Overall 1- and 3-year survivals of the 110 jaundiced patients were 41% and 15%, respectively. For the 50 resected patients, 1- and 3-year survivals were 48% and 19%, respectively (real 5-year survivors n=4) which were significantly higher than that of the 60 non-resected patients (31%, 0%, p=0.001). Among the resected jaundiced patients, T-stage, N and M status were found to have a significant impact on survival. R0 resection did not increase the overall survival in all resected patients, but R0 increased median survival in the subgroup of N0 patients (20 months versus 6 months, p=0.01). CONCLUSION This series confirms that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (N0).
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Affiliation(s)
- J M Regimbeau
- Department of Digestive Surgery, Amiens North Hospital, University of Picardy Medical Centre, Place Victor Pauchet, Amiens Cedex 01, France.
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Brasseur A, Demuynck F, Sabbagh C, Chatelain D, Monet P, Robert B, Yzet T, Regimbeau JM, Remond A. [Cystic pneumatosis of the sigmoid complicated by perforation]. J Radiol 2009; 90:1751-1753. [PMID: 19953065 DOI: 10.1016/s0221-0363(09)73276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A Brasseur
- Service de Radiologie, Hôpital Ambroise Paré, Boulogne Billancourt, France.
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33
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Fuks D, Jabot G, Demuynck F, Dumont F, Sabbagh C, Robert B, Yzet T, Verhaeghe P, Regimbeau JM. [Acute appendicitis in an incarcerated crural hernia: a case report]. J Radiol 2009; 90:1079-1081. [PMID: 19752812 DOI: 10.1016/s0221-0363(09)73248-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Slim K, Blay JY, Brouquet A, Chatelain D, Comy M, Delpero JR, Denet C, Elias D, Fléjou JF, Fourquier P, Fuks D, Glehen O, Karoui M, Kohneh-Shahri N, Lesurtel M, Mariette C, Mauvais F, Nicolet J, Perniceni T, Piessen G, Regimbeau JM, Rouanet P, sauvanet A, Schmitt G, Vons C, Lasser P, Belghiti J, Berdah S, Champault G, Chiche L, Chipponi J, Chollet P, De Baère T, Déchelotte P, Garcier JM, Gayet B, Gouillat C, Kianmanesh R, Laurent C, Meyer C, Millat B, Msika S, Nordlinger B, Paraf F, Partensky C, Peschaud F, Pocard M, Sastre B, Scoazec JY, Scotté M, Triboulet JP, Trillaud H, Valleur P. [Digestive oncology: surgical practices]. ACTA ACUST UNITED AC 2009; 146 Suppl 2:S11-80. [PMID: 19435621 DOI: 10.1016/s0021-7697(09)72398-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Slim
- Chirurgien Clermont-Ferrand.
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Brehant O, Fuks D, Bartoli E, Yzet T, Verhaeghe P, Regimbeau JM. Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Colorectal Dis 2009; 11:178-83. [PMID: 18477021 DOI: 10.1111/j.1463-1318.2008.01578.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [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: 01/03/2023]
Abstract
INTRODUCTION Acute malignant colorectal obstruction (CRO) can be satisfactorily dealt by the placement of a self-expanding metallic stent (SEMS). The aim of this prospective study was to evaluate the rate of elective (planned) colectomy (EPC) in patients with CRO after SEMS placement as a bridge to surgery on an intention-to-treat (ITT) basis. METHOD From 2002 to 2007, 30 SEMS were placed as a bridge to surgery in 30 CRO patients (median age 73 +/- 12 years). The obstructing lesions were located in the right (n = 1), transverse (n = 1) or left colon (n = 24) or the upper third of the rectum (n = 4). RESULTS The SEMS was placed successfully in 25 (83%) patients. Five patients underwent Hartmann's procedure (n = 2) or a diverting colostomy (n = 3). The SEMS was functionally operational in 23 (92%) of the 25 patients. A diverting colostomy was avoided in 23 (77%) of the 30 patients (placement failure n = 5, clinical failure n = 2). There were no complications in 17 (80%) patients. On an ITT basis, 70% of the patients (21 out of 30) underwent an EPC. CONCLUSION On an ITT basis, SEMS placement in CRO patients enabled EPC in 70% of patients.
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Affiliation(s)
- O Brehant
- Federation of Digestive Diseases, Amiens North Hospital, University of Picardy Jules Verne, Amiens Cedex 01, France
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Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M, Yzet T, Regimbeau JM. Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia 2008; 13:183-7. [PMID: 18949443 DOI: 10.1007/s10029-008-0436-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
Abstract
The aim of this prospective observational study was to determine the effects of progressive preoperative pneumoperitoneum (PPP) on the size of large incisional hernia (IH) and abdominal muscles by abdominal computed tomography (CT) scan. PPP was performed in 18 patients. All IH were large. A mean volume of 12.8 l was insufflated over a mean period of 14.8 days. Respectively, before and after PPP, the mean IH height and width was 117 and 130 mm (P < 0.05) and 101 and 115 mm (P < 0.05), the mean width of the right and left rectus abdominis was 99 and 109 mm (P < 0.05) and 100 and 113 mm (P < 0.05), and the length of the right and left anterolateral muscles was 198 and 233 mm (P < 0.05) and 185 and 210 mm (P < 0.01). In conclusion, PPP increases the abdominal wall muscle length and has the same impact on the IH orifice. PPP would facilitate the fascial repair of otherwise untreatable large IH.
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Affiliation(s)
- F Dumont
- The Surgical Department, Amiens North Hospital, University of Picardy, 8 Place Victor Pauchet, 80054 Amiens Cedex 01, France
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Brehant O, Duval H, Dumont F, Fuks D, Deshpande S, Verhaeghe P, Yzet T, Bartoli E, Brazier F, Mauvais F, Lobjoie E, Dupas JL, Regimbeau JM. Surgical conservative treatment of recurrent bleeding duodenal ulcer. Hepatogastroenterology 2008; 55:1327-1331. [PMID: 18795682] [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: 05/26/2023]
Abstract
BACKGROUND/AIMS Endoscopic hemostasis and proton pump inhibitors (PPI) have decreased the incidence of rebleeding and reduced the need for surgery for bleeding duodenal ulcer (BDU). The gold standard surgical treatment of BDU remains vagotomy-antrectomy. Currently, no recommendation is made on the best procedure when emergency surgery is necessary. The aim of this study was to assess the results of a systematic conservative treatment (CT): under-running bleeding gastroduodenal artery (GDA) and ulcer suture through a duodenotomy with (CT+L group) or without (CT group) GDA double ligation along with continuous intravenous PPI. METHODOLOGY From 1995 to 2006, 22 consecutive patients (11 per group) underwent emergency surgery for BDU. Mean age was 63 +/- 18 years, ASA score 2.64 +/- 0.7. Ten patients (45%) presented collapse. Mean transfusion number was 11 +/- 9, number of therapeutic endoscopies 1.7 +/- 1, and Rockall score 6 +/- 2. RESULTS Overall, 2 patients (9%) had rebleeding and 5 patients (22%) died. No death was reported secondary to rebleeding. In the CT+L group, 9 patients (82%) had intravenous PPI, no patient had rebleeding and 2 patients died (22%). CONCLUSIONS Surgical CT of BDU with continuous PPI is effective, with a low rate of rebleeding. The standard use of vagotomy-antrectomy is questionable.
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Affiliation(s)
- O Brehant
- Departments of Digestive Surgery, University Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens 01, France
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Brehant O, Fuks D, Sabbagh C, Wouters A, Mention C, Dumont F, Regimbeau JM. [Surgical management of duodenal ulcer with hemorrhage from the gastroduodenal artery: antrectomy versus conservative surgery?]. J Chir (Paris) 2008; 145:234-237. [PMID: 18772730] [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: 05/26/2023]
Abstract
When surgery is indicated for bleeding duodenal ulcer, the traditional standard of care has been "radical surgical treatment is preferable to conservative therapy since the risk of rebleeding is reduced without an augmentation in morbidity and mortality". This principle is based on two prospective studies published before 1995. Radical surgery at that time consisted of antrectomy, while conservative therapy included oversewing of the bleeding vessel in the ulcer bed and ligation of the gastroduodenal artery (Weinberg procedure). This strategy must be re-evaluated in 2008 in view of our better understanding of the role of Helicopacter pylori in the causation of duodenal ulceration and the decreased risk of post-operative re-bleeding with the use of proton pump inhibitors. The role of surgery has changed. Its aim is no longer to cure the ulcer diathesis but rather to urgently control bleeding in anticipation of ulcer cure with medical therapy.
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Affiliation(s)
- O Brehant
- Service de chirurgie digestive, CHU Amiens Nord, Amiens
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39
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Fuks D, Istamboli S, Yzet T, Dumont F, Bartoli E, Chatelain D, Delcenserie R, Regimbeau JM. [Adenocarcinoma of the pancreatic head complicating chronic calcified pancreatitis: image of the "empty center"]. ACTA ACUST UNITED AC 2008; 89:251-4. [PMID: 18354356 DOI: 10.1016/s0221-0363(08)70401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Fuks
- Service de Chirurgie Viscérale et Digestive, Hôpital Nord, Amiens, Université de Picadie, Amiens
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Traulle S, Gignon M, Regimbeau JM, Chaine FX, Braillon A. [Evaluation of Best Practices in the improvement and quality of care: seven notions for better understanding]. J Chir (Paris) 2007; 144:203-208. [PMID: 17925712 DOI: 10.1016/s0021-7697(07)89515-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of Professional Practices Evaluation (PPE) is continuous improvement in the quality and safety of patient care. Over a five year period, each physician in France is required to complete a PPE according to guidelines validated by the Haute Autorité de Santé. This PPE will be overseen by a Committee of the Conseil Régional de l'Ordre des Médecins. The PPE guidelines are suggestions developed to assist healthcare professionals to provide and patients to seek the most appropriate care. Clinical audit is a self-assessment method which allows the practitioner to compare his own health care practices with accepted norms and to improve them.
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Affiliation(s)
- S Traulle
- Service d'évaluation médicale, CHU Nord, Amiens Cedex 1
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Fuks D, Bréhant O, Dumont F, Viart L, Manaouil D, Bartoli E, Yzet T, Mauvais F, Regimbeau JM. [Tissue adhesive treatment of persistent recto-cutaneous fistula following Hartmann procedure]. ACTA ACUST UNITED AC 2007; 144:35-8. [PMID: 17369760 DOI: 10.1016/s0021-7697(07)89454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cutaneous fistulas from the rectal stump after Hartmann procedure are not rare. Rarely do they require operative intervention, but they may result in prolonged skin care during hospitalization. PURPOSE of study: To describe the use of fibrin glue in the treatment of rectocutaneous fistulas occurring after Hartmann procedure. STUDY DESIGN Ten patients underwent irrigation of the fistulous tract followed by fibrin glue injection. The glue was reconstituted using the usual two syringe admixture technique; the tract was catheterized as far as the rectal stump, and the glue was injected as the catheter was withdrawn to skin level. RESULTS No complications were noted and the discharge from seven out of ten fistulas dried up completely. CONCLUSION Biologic glue occlusion of rectocutaneous fistulas simplified local care and decreased hospital stay.
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Affiliation(s)
- D Fuks
- Services de Chirurgie Viscérale et Digestive, Hôpital Nord - Amiens
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42
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Manaouil C, Gignon M, Manaouil D, Regimbeau JM, Jardé O. Mise en cause du chirurgien : quelles sont les procédures ? Comment gérer une expertise ? ACTA ACUST UNITED AC 2007; 144:111-7. [PMID: 17607225 DOI: 10.1016/s0021-7697(07)89482-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgeons are particularly exposed to lawsuits. Most will be threatened or confronted with litigation several times during their career. The surgeon can be held directly and personally liable during a penal procedure. Civil jurisdictions oversee expert evaluation in cases involving self-employed and salaried surgeons in private practice. An administrative structure for expert evaluation is set up for surgeons working in the public sector. The law of March 4, 2002 has set up a new structure with commissions for reconciliation and compensation of medical accidents (CRCI); these apply to all surgeons. It is essential that the practitioner prepare himself fully, studying both the patient dossier and the pertinent medical literature in order to participate in an expert evaluation under the best circumstances and to justify the diagnostic and therapeutic measures taken. The surgeon may be accompanied by legal counsel and an expert medical witness, but he should not abdicate all responsibility for testimony to them; he, as the treating physician, has the fullest knowledge of the medical case and can best respond to the expert's interrogation. This behavior also demonstrates both responsibility and respect to the patient and his family.
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Affiliation(s)
- C Manaouil
- Expert auprès de la cour d'appel d'Amiens, membre titulaire de la CRCI de Picardie, CHU d'Amiens, Amiens, France.
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Affiliation(s)
- J M Regimbeau
- Service de Chirurgie Viscérale et Digestive, CHU, - Amiens.
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44
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Mauvais F, Fuks D, Cook MC, Morjane A, Dumont F, Verhaeghe P, Regimbeau JM. Apport du ligament veineux (ligament d'Arantius) lors du contrôle de la veine hépatique gauche et du tronc veineux hépatique. ACTA ACUST UNITED AC 2005; 130:640-3. [PMID: 16289089 DOI: 10.1016/j.anchir.2005.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 10/12/2005] [Indexed: 11/19/2022]
Abstract
Control of the left hepatic vein or of the common trunk left hepatic vein-middle hepatic vein during a hepatic resection is presumed difficult. This control is facilitated by the knowledge of the Arantius' ligament anatomy. The combined manoeuvre which associates lowering the top of segment I and section-traction of the Arantius' ligament allows exposure of the inferior aspect of the left or middle hepatic veins and allows safe dissection of these veins.
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Affiliation(s)
- F Mauvais
- Service de chirurgie digestive, CHU d'Amiens Nord, université de Picardie, place Victor-Pauchet, 80054 Amiens cedex, France
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Affiliation(s)
- C Sabbagh
- Service de Chirurgie Digestive, Centre Hospitalier et Universitaire Amiens Nord, Amiens
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46
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Affiliation(s)
- J M Regimbeau
- Service de chirurgie digestive, centre hospitalier et universitaire, université de Picardie Amiens Nord, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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47
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Dumont F, Yzet T, Vibert E, Poirier J, Bartoli E, Delcenserie R, Manaouil D, Dupas JL, Bounicaud D, Regimbeau JM. [Pancreas divisum and the dominant dorsal duct syndrome]. ACTA ACUST UNITED AC 2005; 130:5-14. [PMID: 15664370 DOI: 10.1016/j.anchir.2004.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pancreas divisum, the most frequent congenital malformation of the pancreas, results from the absence of embryologic fusion of the dorsal and ventral pancreatic ducts which keep an autonomy of drainage. The dorsal pancreatic duct is dominant and drains the major part of the pancreatic fluid through a non adapted accessory papilla. The high prevalence of pancreas divisum in patients presenting recurrent acute pancreatitis, the presence of obstructive pancreatitis electively located on the dorsal pancreatic duct and the results of the treatments targeted on the accessory papilla are the arguments pleading for the pathogenic character of the pancreas divisum. Currently, the diagnosis of pancreas divisum is based on magnetic resonance imaging. For symptomatic patients (after exclusion of patients with intestinal functional disorders), results of endoscopic sphincterotomy or surgical sphincteroplasty are favourable in 75% of patients with recurrent acute pancreatitis. They are worse in patients with chronic pain. Surgical sphincteroplasty must be discussed in the same manner as the endoscopic treatment for sometimes avoiding multiplication of the procedures.
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Affiliation(s)
- F Dumont
- Fédération médicochirurgicale d'hépatogastroentérologie, CHU d'Amiens Nord, 80054 Amiens, France
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48
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Vibert E, Mauvais F, Chatelain D, Yzet T, Delcenserie R, Brazier F, Dupas JL, Regimbeau JM. Traitement de la sténose biliaire par prothèse métallique. ACTA ACUST UNITED AC 2004; 141:355-9. [PMID: 15738843 DOI: 10.1016/s0021-7697(04)95359-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A patient presented with a cholangiocarcinoma of the common bile duct; it was initially considered unresectable leading to the placement of the metallic stent whose upper end extended beyond the convergence of the hepatic ducts. The metallic biliary stent became obstructed and so encrusted as to be unremovable; the patient required a left hepatectomy with resection of the stent and the biliary convergence in addition to a pancreatoduodenectomy in order to resect his primary lesion This difficult situation emphasizes that, whenever there is doubt as to the resectability of a biliary lesion, the decision to place a metallic stent should be the fruit of a thorough medico-surgical discussion; where there is any doubt, a plastic stent which is more easily removable should be placed.
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Affiliation(s)
- E Vibert
- Fédération Médico-Chirurgicale d'Hépato-Gastroentérologie, CHU Amiens Nord-Amiens, F-80054 Amiens Cedex 01, France
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49
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Rousseau A, Regimbeau JM, Vibert E, Vullierme MP, Sauvanet A, Belghiti J. Hémobilie après traumatisme hépatique ferme : une complication parfois tardive. ACTA ACUST UNITED AC 2004; 129:41-5. [PMID: 15019855 DOI: 10.1016/j.anchir.2003.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Accepted: 11/05/2003] [Indexed: 11/16/2022]
Abstract
Haemobilia is a rare but serious complication of hepatic blunt trauma. Its diagnosis can be difficult because the delay between initial trauma and haemobilia ranges from few days to several months. Once the diagnosis is considered, a diagnostic and therapeutic arteriography must be performed as soon as possible. We reported the case of a patient who developed hemobilia 2 months after hepatic blunt trauma, due to pseudoaneurism of the anterior branch of the right hepatic artery; haemostasis was successfully obtained by arteriographic embolisation.
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Affiliation(s)
- A Rousseau
- Service de chirurgie digestive, hôpital Beaujon, AP-HP, université Paris-VII, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France
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Regimbeau JM, Colombat M, Mognol P, Durand F, Abdalla E, Degott C, Degos F, Farges O, Belghiti J. Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl 2004; 10:S69-73. [PMID: 14762843 DOI: 10.1002/lt.20033] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Ten percent of patients who undergo resection for hepatocellular carcinoma (HCC) associated with chronic liver disease have no detectable cause for this underlying liver disease. Recent studies have shown that patients with cryptogenic chronic liver disease frequently have risk factors for nonalcoholic fatty liver disease (NAFLD). This study examines the incidence of risk factors for NAFLD in patients with chronic liver disease who underwent resection for HCC. Among 210 patients with chronic liver disease who underwent resection for HCC, 18 (8.6%) had no identifiable cause for the underlying liver disease. These patients were assessed for obesity, diabetes mellitus, and histological features of the tumor and the adjacent liver parenchyma. Comparisons were made with matched patients with alcohol- and chronic-viral-hepatitis-related HCC. The prevalence of obesity (50% vs. 17% vs. 14%), diabetes (56% vs. 17% vs. 11%), aspartate aminotransferase/alanine aminotransferase ratio<1 (50% vs. 19% vs. 17%), and steatosis>20% (61% vs. 17% vs. 19%) was significantly higher in patients with cryptogenic liver disease than in patients with alcohol abuse and chronic viral hepatitis (P<0.0001 for each). Well-differentiated tumors were significantly more common in patients with cryptogenic liver disease (89% vs. 64% in patients with alcohol-related HCC vs. 55% in patients with chronic viral hepatitis-related HCC, P<0.0001). In conclusion, the hypothesis that obesity and diabetes mellitus may be important risk factors for cryptogenic chronic liver disease in patients with HCC is supported by the analysis of surgically treated patients. Whether HCC is primarily related to obesity and diabetes mellitus or secondarily to a NAFLD-like parenchymal lesions remains to be clarified.
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Affiliation(s)
- Jean M Regimbeau
- Fédération Médico-Chirurgicale d'Hépato-Gastro-Entérologie, Department of Surgery, Hospital Beaujon, Assistance Publique-Hôpitaux de Paris and Faculty of Medicine Xavier Bichat, University Paris VII, Paris, France
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