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Levesque A, Bautrant E, Quistrebert V, Valancogne G, Riant T, Beer Gabel M, Leroi AM, Jottard K, Bruyninx L, Amarenco G, Quintas L, Picard P, Vancaillie T, Leveque C, Mohy F, Rioult B, Ploteau S, Labat JJ, Guinet-Lacoste A, Quinio B, Cosson M, Haddad R, Deffieux X, Perrouin-Verbe MA, Garreau C, Robert R. Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus. Eur J Pain 2021; 26:7-17. [PMID: 34643963 DOI: 10.1002/ejp.1861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE. METHODS The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. RESULTS The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication. CONCLUSION These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. SIGNIFICANCE Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.
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Affiliation(s)
- Amélie Levesque
- Urology Department, Nantes University Hospital, Nantes, France
| | - Eric Bautrant
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | | | | | - Thibault Riant
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Marc Beer Gabel
- Neurogastroenterology and Pelvic Floor Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Lara Quintas
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, Barcelona, Spain
| | - Pascale Picard
- Neurology Department, Clermont-Ferrand University Hospital, Inserm, Clermont-Ferrand, France
| | - Thierry Vancaillie
- School of Women and Children, University of New South Wales, Sydney, New South Wales, Australia
| | - Christine Leveque
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | - Frédérique Mohy
- Pain Management Center, University Hospital Felix Guyon, SAINT DENIS, La Reunion, France
| | - Bruno Rioult
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Stéphane Ploteau
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | | | - Amandine Guinet-Lacoste
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
| | - Bertrand Quinio
- Pain Center, Regional University Hospital la Cavale Blanche, Brest, France
| | - Michel Cosson
- Departement of Gynecology, University Hopsital Jeanne De Flandre, Lille, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart University Paris-Saclay, Clamart, France
| | | | | | - Roger Robert
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
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Bruyninx L, Meunier P. Assessment of Complex Perineal Fistulas. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098523] [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: 10/23/2022]
Affiliation(s)
- L. Bruyninx
- Department of Surgery, CHU Sart-Tilman, Liège
| | - P. Meunier
- Department of Radiology, C.H. Ardennes, Libramont-Ste Ode
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Affiliation(s)
- T. Brugman
- Dept. of Surgery, University Hospital Sart-Tilman, Liège, Belgium
| | - L. Bruyninx
- Dept. of Surgery, University Hospital Sart-Tilman, Liège, Belgium
| | - N. J. Jacquet
- Dept. of Surgery, University Hospital Sart-Tilman, Liège, Belgium
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Jottard K, Van den Broeck S, Komen N, Bruyninx L, De Wachter S. Treatment of Fecal Incontinence With a Rechargeable Sacral Neuromodulation System: Efficacy, Clinical Outcome, and Ease of Use-Six-Month Follow-Up. Neuromodulation 2020; 24:1284-1288. [PMID: 33107663 DOI: 10.1111/ner.13298] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/01/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Sacral neuromodulation is an effective treatment for fecal incontinence (FI) after conservative treatments have failed. A new rechargeable sacral neuromodulation system (r-SNM) includes a rechargeable implantable neurostimulator (INS). No data is available of the use of this technology in patients with fecal incontinence. MATERIALS AND METHODS Fifteen patients with FI were implanted with the Axonics rechargeable SNM system in a single-stage implant procedure and prospectively followed. Primary outcome was fecal incontinence episodes at four weeks and six months measured with stools diary. Success was defined as at least 50% improvement of fecal incontinence episodes. Additionally, quality of life and ease of use were evaluated. RESULTS At four weeks, 13 participants (87%) were test responders based on ≥50% reduction in FI episodes as documented on their bowel diary. Weekly FI episodes decreased from a median (25%-75% range) of 8 (5.8-20.3) at baseline to a median of 1.5 (0.4-4.5) at four weeks (p = 0.001), and 1.5 (0-2.6) at six months (p = 0.001), corresponding to 75% and 79% reduction in weekly FI episodes. Of the 13 subjects having ≥50% reduction in FI episodes at four weeks, 12 (PP = 92%) were therapy responders at six months. There were no unanticipated device or procedure-related adverse events. Mean time to recharge the system was 37 ± 3 min once or twice per week. All patients were moderately or very satisfied with the system and its effect. CONCLUSIONS The r-SNM system provides safe and effective therapy in patients with FI at six months.
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Affiliation(s)
| | - Sylvie Van den Broeck
- Department of Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Niels Komen
- Department of Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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Jottard K, Bruyninx L, Bonnet P, Mathieu N, De Wachter S. Pilot study: pudendal neuromodulation combined with pudendal nerve release in case of chronic perineal pain syndrome. The ENTRAMI technique: early results. Int Urogynecol J 2020; 32:2765-2770. [PMID: 33048179 DOI: 10.1007/s00192-020-04565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/20/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic perineal pain syndrome due to pudendal nerve impingement is difficult to diagnose and to treat. All the known treatment options leave room for improvement considering the outcome. Early neuromodulation of the pudendal nerve after its surgical release could improve outcomes. OBJECTIVES The aim of the study was to evaluate the potential beneficial effect of pudendal neuromodulation combined with release surgery using the ENTRAMI technique (endoscopic transgluteal minimally invasive technique). STUDY DESIGN This is a single-center prospective descriptive study. Between March 2019 and March 2020, 16 patients (2 males, 14 females) were included. Data were collected at baseline and 1 month after surgery. METHODS Patients eligible for inclusion had chronic perineal pain for at least 3 months in the area served by the pudendal nerve. We combined pudendal nerve release with neuromodulation. RESULTS At 1 month, the numeric pain rating scale (NPRS) dropped from 9.5 at baseline to 3.5 (p = 0.003). Seventy-six percent of patients showed a global impression of change (PGIC) of > 50% at 1 month, and optimal treatment response (PGIC ≥ 90%) was found in 41% of patients. LIMITATIONS The drawback of our study was that it was not randomized or blinded. The peripheral nerve evaluation lead (PNE) used could only be implanted for 1 month because of infection risk and is also prone to dislocations and technical failures. CONCLUSION Pudendal nerve liberation by the ENTRAMI technique combined with short-term pudendal neuromodulation seems feasible and promising in treating patients with chronic perineal pain. Clinical trial number: NCT03880786.
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Affiliation(s)
- Katleen Jottard
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium.
| | - Luc Bruyninx
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Nathalie Mathieu
- Department of Anesthesiology, Pain Clinic, Brugmann Hospital, Brussels, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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Jottard K, Bruyninx L, Bonnet P, De Wachter S. Endoscopic trans gluteal minimal-invasive approach for nerve liberation (ENTRAMI technique) in case of pudendal and/or cluneal neuralgia by entrapment: One-year follow-up. Neurourol Urodyn 2020; 39:2003-2007. [PMID: 32678485 DOI: 10.1002/nau.24462] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic neuropathic perineal pain syndrome is a collective term that encompasses several diagnoses. In patients where the neuropathic pain syndrome is caused by pudendal or cluneal nerve entrapment, surgical release can be proposed if other measures have failed. The aim of this study is to evaluate the clinical outcome of patients suffering from pudendal and/or cluneal nerve entrapment at 1 year after this minimal invasive surgery, which is based on the open trans gluteal approach who has proven its efficacy compared to medical treatment in a randomized control trial. METHODS Patients eligible for inclusion had chronic perineal neuropathic pain for at least 3 months in the area served by the pudendal and/or cluneal nerve, refractory to conservative measurements. Patients met all five of the Nantes criteria. RESULTS Fifteen patients underwent the ENTRAMI technique. At 1 year after surgery, overall reduction of the average maximal Numeric Pain rating Scale (NPRS-score) was from 9 (range, 7-10) at baseline to 5 (range, 0-10; P-value <.05). At 1 year 73% of patients declared to have a "good treatment response" (patient global impression of change [PGIC] >30%) and optimal treatment response (PGIC ≥90%) was found in 40% (P-value <.05). No complications were recorded. CONCLUSION This study clearly shows that the technique is feasible with promising long-term results in a difficult to manage patient group.
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Affiliation(s)
| | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
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Jottard K, Bonnet P, Bruyninx L, Ploteau S, De Wachter S. The ENTRAMI technique: Endoscopic transgluteal minimal invasive technique for implantation of a pudendal electrode under full visual control: A cadaver study. Neurourol Urodyn 2018; 38:130-134. [PMID: 30311696 DOI: 10.1002/nau.23850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/10/2018] [Indexed: 11/05/2022]
Abstract
AIM The aim of this article is to describe a minimal invasive trans gluteal endoscopic approach to implant a pudendal electrode for neuromodulation under full visual control. METHODS Eight trans gluteal approaches were performed on four cadavers. The sacral transforaminal percutaneous technique was performed to implant the electrode. The electrode was then picked up and placed under visual control next to the pudendal nerve. RESULTS The first trocar was placed in the upper lateral quadrant of the gluteal region. The 0° optical system was used to help with the pneumodissection to identify the sciatic nerve. At that point a second 3 mm trocar was placed to insert a dissecting grasping forceps. In some cases, a second 3 mm trocar was placed. A step by step dissection, based on anatomical findings, was necessary to be able to locate the pudendal nerve. The electrode, which was placed percutaneously and transforaminal through S3 or S4, was picked up and placed under full visual control next to the pudendal nerve, slightly entering the Alcock's canal. The electrode was placed in an ideal manner, meaning that all 4-contact points of the electrode are in parallel and in contact with the targeted nerve. The electrode was fixed in that ideal position at the level of the sacrospinous ligament. After placement of that electrode, an X-ray of the pelvic area was done. CONCLUSIONS The ENTRAMI technique allows optimal pudendal electrode placement under full visual control and should now be tested in a clinical setting.
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Affiliation(s)
| | - Pierre Bonnet
- Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Stéphane Ploteau
- Department of Gynecology and Obstetrics, Centre HospitalierUniversitaire, Nantes, France
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerp (UZA), Edegem, Belgium
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8
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Dobos S, Thill V, Deressa BK, Bruyninx L, Da Silva Costa CM, De Koster E, Toussaint E. Gastrostomy placement : when fluoroscopy helps the endoscopist. Acta Gastroenterol Belg 2018; 81:525-527. [PMID: 30645923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND STUDY AIMS Percutaneous endoscopic gastrostomy is the most common therapeutic procedure performed by the digestive endoscopists in the upper gastrointestinal tract. It aims to feed patients presenting denutrition and/or insufficient oral intake. Percutaneous endoscopic gastrostomy feasibility is about 95-100 % although in some cases it is impossible to achieve it, leading to ask for a surgical placement. Even though the feasibility of the surgical approach is excellent its complications are quite higher than percutaneous endoscopic placement, it requires general anesthesia and sometimes these patients could be non elligible for it due to their comorbidities (malnutrition, cardio-vascular diseases etc.). Another alternative technique is the percutaneous radiological gastrostomy but this procedure is rarely available in our country. PATIENTS AND METHODS We described four cases in patients with previous failure of PEG, in which we used an hybrid approach between radiological and endoscopic techniques, allowing the placement of gastrostomy tube, without general anesthesia. RESULTS This was successful in all patients and there was no complication related to the procedure. CONCLUSIONS This technique offers an additionnal opportunity to avoid general anesthesia and surgical complications in patients with unfavorable conditions.
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Affiliation(s)
- S Dobos
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
| | - V Thill
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
| | - B K Deressa
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
| | - L Bruyninx
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
| | | | - E De Koster
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
| | - E Toussaint
- CHU Brugmann, Hepato Gastroenterology, Brussels, Belgium
- CHU de Charleroi, Hôpital Marie Curie, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Charleroi, Belgium
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Ploteau S, Robert R, Bruyninx L, Rigaud J, Jottard K. A new endoscopic minimal invasive approach for pudendal nerve and inferior cluneal nerve neurolysis: An anatomical study. Neurourol Urodyn 2017; 37:971-977. [PMID: 29072775 DOI: 10.1002/nau.23435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/25/2017] [Indexed: 11/08/2022]
Abstract
AIM To describe a new minimal invasive approach of the gluteal region which will permit to perform neurolysis of the pudendal and cluneal nerves in case of perineal neuralgia due to an entrapment of these nerve trunks. METHOD Ten transgluteal approaches were performed on five cadavers. Relevant anatomic structures were dissected and further described. Neurolysis of the pudendal nerve or cluneal nerves were performed. Landmarks for secure intraoperative navigation were indicated. RESULTS The first operative trocar for the camera was inserted with regards to the iliac crest in the deep gluteal space. With the aid of pneumodissection, the infragluteal plane was dissected. The piriformis muscle was identified as well as the sciatic and the posterior femoral cutaneous nerve. Consequently, the sciatic tuberosity was visualized together with the cluneal nerves. Hereafter, the second trocar was introduced caudal to the first one and placed on an horizontal line passing at the level of the coccyx, allowing access to the ischial spine and the visualization of the pudendal nerve and vessels. A third 5 mm trocar was then inserted medial from the first one, permitting to dissect and transsect the sacrospinous ligament. The pudendal nerve was subsequently transposed and followed on its course in the pudendal channel. CONCLUSIONS A reliable exploration of the gluteal region including identification of the sciatic, pudendal, and posterior femoral cutaneous nerves is feasible using a minimal invasive transgluteal procedure. Consequently, the transposition of the pudendal nerve and the liberation of the cluneal nerves can be performed.
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Affiliation(s)
- Stéphane Ploteau
- Department of Gynecology and Obstetrics, Center Hospitalier Universitaire, Nantes, France
| | - Roger Robert
- Pain Unit, Le Confluent, Catherine de Sienne Center, Nantes, France
| | - Luc Bruyninx
- Department of Surgical, Hospital Brugmann, Université libre de Bruxelles, Brussels, Belgium
| | - Jérome Rigaud
- Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Katleen Jottard
- Department of Surgical, Hospital Brugmann, Université libre de Bruxelles, Brussels, Belgium
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10
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Laouni J, Scaillon M, Steyaert H, Segers V, Bruyninx L. [Diagnosis and management of a particular caseof intractable constipation]. Rev Med Brux 2017; 38:501-505. [PMID: 29318807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Constipation is a very common pattern in childhood. There are multiple reasons for constipation including one very rare : chronic intestinal pseudo-obstruction syndrome. We report the case of a young patient monitored for multiple incidents of intestinal pseudo- obstruction with intractable constipation. The patient underwent several surgical interventions to relieve his symptoms because the non operative treatments, based on liquid diet and laxatives, didn't show great effectiveness. We will review the differential diagnosis of chronic constipation and we will discuss the particular diagnostic entity of this patient. We will also discuss the different treatments that allowed to provide tolerance to oral feeding.
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Affiliation(s)
- J Laouni
- Service de Chirurgie digestive, C.H.U. Brugmann, ULB
| | - M Scaillon
- Service de Gastroentérologie, H.U.D.E.R.F., ULB
| | - H Steyaert
- Service de Gastroentérologie, H.U.D.E.R.F., ULB
| | - V Segers
- Service de Chirurgie digestive, C.H.U. Brugmann, ULB
| | - L Bruyninx
- Service de Chirurgie digestive, C.H.U. Brugmann, ULB
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Deressa BK, Bruyninx L, Ngassa M, Thill V, Toussaint E. Uncommon cause of retrosternal pain. Acta Gastroenterol Belg 2016; 79:251-253. [PMID: 27382947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present the case of a 54-year old male patient who was admitted with severe acute epigastric pain, vomiting, and inability to eat since three days before admission. After having excluded cardiac and pulmonary emergencies, an oesogastroduodenoscopy was planned and showed a gastric volvulus. The patient was treated surgically allowing gastric decompression, gastropexy and Nissen intervention. We discuss the case and describe the classification, the diagnosis, the etiologies and therapeutic options in acute and chronic gastric volvulus.
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12
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Waxweiler C, Dobos S, Thill V, Bruyninx L. Selection criteria for surgical treatment of pudendal neuralgia. Neurourol Urodyn 2016; 36:663-666. [DOI: 10.1002/nau.22988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Sebastian Dobos
- Department of Digestive Surgery; CHU Brugmann; Bruxelles Belgium
| | - Viviane Thill
- Department of Digestive Surgery; CHU Brugmann; Bruxelles Belgium
| | - Luc Bruyninx
- Department of Digestive Surgery; CHU Brugmann; Bruxelles Belgium
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Wolthuis AM, Leonard D, Kartheuser A, Bruyninx L, Van De Stadt J, Van Cutsem E, D'Hoore A. Different surgical strategies in the treatment of familial adenomatous polyposis: what's the role of the ileorectal anastomosis? Acta Gastroenterol Belg 2011; 74:435-437. [PMID: 22103050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Prophylactic (procto-) colectomy is the treatment of choice to reduce the risk of colorectal cancer in FAP patients with multiple adenomas. Because patients present at young age, rectum-sparing surgery is sometimes advocated, so that there is no pelvic dissection with impact on quality of life, preserved pelvic innervation and sexual function and fertility. The main disadvantage of a total colectomy with an ileorectal anastomosis (IRA) is a rectal cancer risk of 50% at the age of 50 years and a cumulative risk of 25.8% after 25 years of follow-up. Therefore, this procedure should be reserved for patients with an unaffected rectum. There should be no discussion to perform a primary IPAA in patients with multiple rectal adenomas (> 20) or those with a severe dysplastic or large (> 3 cm) rectal adenoma or a cancer elsewhere in the colon. A patient with an IRA should undergo yearly follow-up by rectoscopy.
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Affiliation(s)
- Albert M Wolthuis
- Belgian Polyposis Project, Familial Adenomatous Polyposis Association (FAPA), Brussels.
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Leonard D, Wolthuis A, D'Hoore A, Bruyninx L, Van De Stadt J, Van Cutsem E, Kartheuser A. Different surgical strategies in the treatment of familial adenomatous polyposis: what's the role of the ileal pouch-anal anastomosis? Acta Gastroenterol Belg 2011; 74:427-434. [PMID: 22103049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND STUDY AIMS Restorative coloproctectomy (RCP) with ileal pouch-anal anastomosis (IPAA), is one of the surgical responses to the crucial question of prophylactic treatment in familial adenomatous polyposis (FAP). No consensus has been reached, until now, to choose between IPAA and ileo-rectal anastomosis (IRA), the rectal sparing prophylactic colectomy. This paper aims to review the latest issues related to IPAA and highlights its specificities compared to IRA. METHODS PubMed database was searched using the following search items: familial adenomatous polyposis, surgery, ileal pouch-anal anastomosis, ileo-rectal anastomosis. Papers published between 1978 and 2010 were selected. RESULTS Absence of mortality, acceptable morbidity and good functional results combined to high quality of life have promoted the IPAA technique. New technical issues such as the double stapled technique, mesenteric lengthening, omission of temporary protective stoma can be addressed almost systematically for these patients. A laparoscopic approach, lessening the body image impact, has proven to be as effective and safe as the open approach to perform IPAA. Further advantages of laparoscopic IPAA rely on the lower adhesion formation resulting in less small bowel occlusion. Sexuality, fertility and childbirth are important functional issues often cited as threatened by the pelvic manoeuvres of the IPAA technique which can be prevented by close rectal wall dissection and a laparoscopic approach. CONCLUSION IPAA offers the best available prophylaxis in FAP patients. Technical enhancements in IPAA will most probably decrease the functional risks. Thus IPAA remains the alternative to IRA for the prophylactic treatment of FAP.Nevertheless, based on the latest evidence, the choice between both procedures is still matter of debate.
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Affiliation(s)
- D Leonard
- Belgian Polyposis Project, Familial Adenomatous Polyposis Association (FAPA), Brussels
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15
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Nzimbala M, Bruyninx L, Pans A, Martin P, Herman F. Chronic anal fissure: common aetiopathogenesis, with special attention to sexual abuse. Acta Chir Belg 2009; 109:720-6. [PMID: 20184055 DOI: 10.1080/00015458.2009.11680523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chronic anal fissures represent 15% of proctologic consultations, although their aetiopathogenesis is unclear and multifactorial. This study aims to identify the aetiopathogenesis, risk factor of recurrence after lateral subcutaneous internal anal sphincterotomy and existing correlation with sexual abuse, as sexual abuse accounts for over 21% of anal fissures. PATIENTS AND METHODS We retrospectively studied 80 cases of surgical (n = 54) and medical (n = 26) patients known with chronic anal fissure over eight months. We built an original questionnaire referring to the NorVold Abuse Questionnaire. Sixty cases were interviewed with only twenty filling the questionnaire themselves. RESULTS Among the aetiological factors observed, as reported by these patients, we underlined chronic constipation 51 (64%), postoperative haemorrhoidectomy 15 (19%), sexual abuse 15 (19%), vaginal delivery and hysterectomy 10 (13%), traumatic anal sex 10 (13%), digital anal examination 4 (5%), anti-inflammatory non-steroid suppository 3 (4%), asthma with chronic cough 3 (4%). The recurrence rate reached 39% (31 cases, 13/26 (50%) in the medical group, against 18/54 (33%) in the surgical group. The 4/15 (27%) of sexual abuse happened in adulthood and 6/15 (40%) never disclosed this information. CONCLUSION Sexual abuse is a significant aetiological factor of chronic anal fissures and it is to be suspected in cases of recurrence after anal sphincterotomy. For such cases, a multidisciplinary treatment is crucial to improve the prognosis of the disease. We recognise that the causality is difficult to prove and we cannot confirm that every sexually abused person could inevitably develop chronic anal fissure.
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Abstract
The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF This case history was discovered while carrying out administrated interviews during authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as: 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess; 4x Bartholin's gland; 4x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and 1x sphincterotomy; 2x haemorrhoid; and 1x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF: although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%.
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Affiliation(s)
- M. J. Nzimbala
- Independent fully registered medical practitioner, “Universite Libre de Bruxelles”, Brussels, Belgium
| | - L. Bruyninx
- Departments of Abdominal Surgery and Gastro-enterology, Andre-Renard Clinic, Herstal, Liège University, Faculty of Medicine, Belgium
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Bruyninx L, Meunier P. Assessment of complex perineal fistulas. Acta Chir Belg 2000; 100:115-7. [PMID: 11280174] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- L Bruyninx
- Department of Surgery, CHU Sart-Tilman, Liège
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18
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Brugman T, Bruyninx L, Jacquet NJ. Fissure-in-ano, to divide or not to divide? Acta Chir Belg 1999; 99:215-20. [PMID: 10582070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options.
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Affiliation(s)
- T Brugman
- Dept. of Surgery, University Hospital Sart-Tilman, Liège, Belgium
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Defraigne JO, Honoré P, Boverie J, Pirenne J, Bruyninx L, Meurisse M, Jacquet N. [Boerhaave's syndrome. Apropos of 2 cases diagnosed at a late stage and treated by a combined surgical and radiologic approach]. J Chir (Paris) 1989; 126:659-62. [PMID: 2695532] [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: 01/02/2023]
Abstract
Two cases of Boerhaave syndrome are presented which were diagnosed at a late stage. After failure of the primary suture of the perforation, the first case was treated by selective intubation of the oesophagus and percutaneous drainage of the abscess under radiological control. In the second case fistulization was produced first surgically, and secondly with drains of decreasing calibre being inserted percutaneously. The diagnosis of Boerhaave syndrome is often made at a late stage. In cases of important mediastinitis and after failure of primary suture, oesophageal exclusion and oesophagectomy are sometimes recommended. However, these procedures require repeated interventions with a significant morbidity. From this viewpoint a combination of controlled fistulization and percutaneous oesophageal intubation under radiological control is a valuable alternative.
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Affiliation(s)
- J O Defraigne
- Service de Chirurgie Digestive, C.H.U. Liège, Belgique
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Defraigne JO, Honoré P, Boverie J, Pirenne J, Bruyninx L, Meurisse M, Jacquet N. [Boerhaave syndrome: pathogenesis, diagnosis, treatment]. Rev Med Liege 1989; 44:321-6. [PMID: 2662318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Defraigne JO, Closon MT, Bruyninx L, Dewandre JM, Hourlay P, Meurisse M, Honore P, Bury J, Beguin Y. Experience with a totally implantable catheter in adult patients: a single institution retrospective study of 114 cases. Eur J Surg Oncol 1989; 15:61-4. [PMID: 2917667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
One hundred and fourteen consecutive totally implantable catheters were inserted in 114 patients between April 1984 and April 1987. Catheters were inserted under neuroleptanalgesia, through the jugular vein in 101 cases or the internal saphenous vein in 13 cases. No problem was encountered during the insertion procedure. Infection occurred in 5.2% of the patients but removal of the device was required in only 2.6%. Occlusion of the catheter occurred in 6.1% of the patients but never during the first 2 months. This complication rate is lower than the one observed with external tunnelled catheters. The comfort of the patient is substantially improved and nursing care is greatly facilitated.
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Defraigne JO, Markiewicz S, Bruyninx L, Meurisse M, Dubois J, Honoré P. [Meckel's diverticulum: pathology and therapeutic measures]. Rev Med Liege 1987; 42:888-92. [PMID: 3423527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Bruyninx L, Grenade T, Limet R. [Evaluation of 10 years of aortocoronary bypass]. Rev Med Liege 1987; 42:96-100. [PMID: 3494289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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