Kortrijk, Belgium
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Deylgat B.,Groeninge Hospital | D'Hondt M.,Groeninge Hospital | Pottel H.,Interdisiciplinary Research Center | Vansteenkiste F.,Groeninge Hospital | And 2 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background: Roux-en-Y gastric bypass (RYGB) is considered the "gold standard" revision procedure. The purpose of this study was to compare the surgical outcome of primary laparoscopic RYGB (pLRYGB) to revisional open or laparoscopic Roux-en-Y gastric bypass surgery (rRYGB). Methods: A retrospective analysis of all patients who underwent pLRYGB or rRYGB from January 2003 to December 2009 has been performed. Demographics, indications for revision, and complications have been reviewed. The rRYGB and pLRYGB patients have been compared. Results: Seventy-two patients underwent rRYGB, and 652 patients underwent pLRYGB. Mean follow-up was 35 and 45 months, respectively. Fifty-six rRYGB procedures were performed laparoscopically. The primary operations had consisted of laparoscopic gastric banding (n = 28), laparoscopic vertical banded gastroplasty (n = 19), laparoscopic sleeve gastrectomy (n = 6), laparoscopic RYGB (n = 3), and biliopancreatic diversion with duodenal switch (n = 16). Indications included weight regain (n = 29), malabsorption (n = 16), gastrogastric fistula (n = 5), band-associated problems (n = 3), and refractory stomal ulceration (n = 1). There was no significant difference in early or late postoperative complications when comparing rRYGB to pLRYGBP patients (11.1% vs. 5.52%, P = 0.069 and 19.4% vs. 24.2%, P = 0.465 respectively). Five rRYGB patients (7.04%) required reintervention (3 internal hernias, 1 ventral hernia, 1 laparoscopic exploration) compared with 101 pLRYGB patients (15.71%; P = 0.051). None of the patients died. Mean hospital stay was not significantly longer in the rRYGB group (5.38 vs. 4.95 days, P = 0.058). Conclusions: In our series, hospital stay, morbidity, and mortality of rRYGB were not significantly higher compared with pLRYGB. Furthermore, we believe that this type of revisional bariatric surgery should be performed in high-volume bariatric centers. © Springer Science+Business Media, LLC 2012.


Hoste E.A.J.,Ghent University | Hoste E.A.J.,Research Foundation Flanders FWO | De Corte W.,Ghent University | De Corte W.,Groeninge Hospital
Contributions to Nephrology | Year: 2011

Acute kidney injury (AKI) can no longer be considered a surrogate marker for severity of illness. Recent epidemiologic data demonstrate the association of AKI and mortality. Even small decreases of kidney function are associated with increased mortality. Several clinical consequences of AKI may explain the association of AKI and mortality. Decreased free water clearance leading to volume overload contributes to morbidity and mortality, but also to deterioration of kidney function. Acid-base disorders and electrolyte abnormalities interfere with normal functioning of many processes in the body. Critically ill patients have an increased prevalence of infection. Infection and antimicrobial therapy can be the cause of AKI, but infection can also be a consequence of AKI. Finally, inadequate antimicrobial dosing probably plays an important role in the morbidity and mortality of AKI. These findings have led to a paradigm shift: patients die because of AKI rather than with AKI. Copyright © 2011 S. Karger AG, Basel.


D'Hondt M.,Groeninge Hospital | D'Hondt M.,University Hospitals Leuven | Devriendt D.,Groeninge Hospital | Van Rooy F.,Groeninge Hospital | And 4 more authors.
American Journal of Surgery | Year: 2011

Background: An open abdomen (OA) can result from surgical management of trauma, severe peritonitis, abdominal compartment syndrome, and other abdominal emergencies. Enteroatmospheric fistulae (EAF) occur in 25% of patients with an OA and are associated with high mortality. Methods: We report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later. Results: Three EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery. Conclusions: Although previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks. © 2011 Elsevier Inc. All rights reserved.


Dendale P.,Hasselt University | Dendale P.,Jessa Hospital | De Keulenaer G.,Middelheim Hospital | Troisfontaines P.,CHU Citadelle | And 8 more authors.
European Journal of Heart Failure | Year: 2012

Aims: Chronic heart failure (CHF) patients are frequently rehospitalized within 6 months after an episode of fluid retention. Rehospitalizations are preventable, but this requires an extensive organization of the healthcare system. In this study, we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners (GPs) and a heart failure clinic could reduce mortality and rehospitalization rate. Methods and results: One hunderd and sixty CHF patients [mean age 76 ± 10 years, 104 males, mean left ventricular ejection fraction (LVEF) 35 ± 15%] were block randomized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring (TM) or usual care (UC). The TM group measured body weight, blood pressure, and heart rate on a daily basis with electronic devices that transferred the data automatically to an online database. Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded. All-cause mortality was significantly lower in the TM group as compared with the UC group (5% vs. 17.5%, P = 0.01). The total number of follow-up days lost to hospitalization, dialysis, or death was significantly lower in the TM group as compared with the UC group (13 vs. 30 days, P = 0.02). The number of hospitalizations for heart failure per patient showed a trend (0.24 vs. 0.42 hospitalizations/patient, P = 0.06) in favour of TM. Conclusion: Telemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization, death, or dialysis in CHF patients. © The Author 2012.


Knol J.J.,Jessa Hospital | D'Hondt M.,Groeninge Hospital | Souverijns G.,Jessa Hospital | Heald B.,Colorectal Research Unit | Vangertruyden G.,Jessa Hospital
Techniques in Coloproctology | Year: 2015

Background: Laparoscopic total mesorectal excision (TME) for low rectal cancer can be technically challenging. This report describes our initial experience with a hybrid laparoscopic and transanal endoscopic technique for TME in low rectal cancer.Methods: Between December 2012 and October 2013, we identified patients with rectal cancer < 5 cm from the anorectal junction (ARJ) who underwent laparoscopic-assisted TME with a transanal minimally invasive surgery (TAMIS) technique. A standardized stepwise approach was used in all patients. Resection specimens were examined for completeness and measurement of margins. Preoperative magnetic resonance imaging (MRI) characteristics and short-term postoperative outcomes were examined. All values are mean ± standard deviation.Results: Ten patients (8 males; median age: 60.5 (range 36–70) years) were included. On initial MRI, all tumors were T2 or T3, mean tumor height from the ARJ was 28.9 ± 12.2 mm, mean circumferential resection margin was 5.3 ± 3.1 mm, and the mean angle between the anal canal and the levator ani was 83.9° ± 9.7°. All patients had had preoperative chemoradiotherapy, TME via TAMIS, and distal anastomosis. There were no intraoperative complications, anastomotic leaks, or 30-day mortality. The pathologic quality of all mesorectal specimens was excellent. The distal resection margin was 19.4 ± 10.4 mm, the mean circumferential resection margin was 13.8 ± 5.1 mm, and the median lymph node harvest was 10.5 (range 5–15) nodes.Conclusions: A combined laparoscopic and transanal approach can achieve a safe and oncologically complete TME dissection for low rectal tumors. This approach may improve clinical outcomes in these technically difficult cases, but larger prospective studies are needed. © 2015, Springer-Verlag Italia Srl.


PubMed | The Interdisciplinary Center, Jessa Hospital and Groeninge Hospital
Type: | Journal: Annals of surgical oncology | Year: 2017

Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function.A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65years; range 23-89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss.The median CVP before blood salvage was 8mmHg (range 4-30mmHg). The median volume of hypovolemic phlebotomy was 400ml (range 200-1000ml). After HP, CVP decreased to a median of 3mmHg (range -2 to 16mmHg), resulting in a median CVP drop of 5.5mmHg (range 2-14mmHg). The median EBL during liver resection was 165ml (range 0-800ml). The median preoperative serum creatinin (Scr) was 0.82g/dl (range 0.5-1.74g/dl), and the postoperative Scr on day 1was 0.74g/dl (range 0.44-1.68g/dl). The CVP drop was associated with EBL (P<0.001). There was no significant impact of CVP drop on postoperative Scr.A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.


Abasbassi M.,Groeninge Hospital | Pottel H.,Catholic University of Leuven | Deylgat B.,Groeninge Hospital | Vansteenkiste F.,Groeninge Hospital | And 3 more authors.
Obesity Surgery | Year: 2011

Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%. It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive patients undergoing primary AA-LRYGB from January 2003 to December 2009 in a single institution were retrospectively reviewed to determine the incidence, etiology, clinical symptoms, radiologic diagnostic accuracy and operative outcomes of SBO. Of the 652 patients, 63 (9.6%) developed SBO. The majority (6.9%, 45 patients) had a SBO due to IH. In 41 (91%) cases, the IH was at the jejunojejunostomy (JJ), four cases had an IH at Petersen's space. Adhesions and ventral hernia were found in 14 (2.1%) and four (0.6%) cases, respectively. Twenty-nine out of 63 cases had negative computed tomography (CT) findings and IH was diagnosed on CT in only 33% (14/45) of patients with IH. All patients underwent diagnostic laparoscopy. No bowel resections had to be performed. In contrast to previous reports, a high incidence of SBO with a high rate of IH at the JJ site was found in our series. Accuracy of CT is low and diagnostic laparoscopy is mandatory when SBO is suspected. Since 2010 we have started closing the JJ site, and data on SBO are collected prospectively. We believe that closing of the mesenteric defects is a mandatory step, even in an AA-LRYGB. © 2011 Springer Science + Business Media, LLC.


D'Hondt M.,Groeninge Hospital | Vanneste S.,Groeninge Hospital | Pottel H.,Catholic University of Leuven | Devriendt D.,Groeninge Hospital | And 2 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: This retrospective study evaluated long-term weight loss, resolution of comorbidities, quality of life (QoL), and food tolerance after laparoscopic sleeve gastrectomy (LSG). Methods: Between January 2003 and July 2008, 102 patients underwent LSG as a sole bariatric operation. A retrospective review of a prospectively collected database was performed. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. Quality of life was measured using Medical Outcomes Survey Short Form 36 (SF-36) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were sent to all patients. The food tolerance score (FTS) was determined and compared with that of nonobese subjects. Results: A total of 83 patients (81.4%) were eligible for follow-up evaluation. Their mean initial body mass index (BMI) was 39.3 kg/m 2. No major complications occurred. At a median follow-up point of 49 months (range, 17-80 months), the mean %EWL was 72.3% ± 29.3%. For the 23 patients who reached the 6-year follow-up point, the mean %EWL was 55.9% ± 25.55%. The mean BAROS score was 6.5 ± 2.1, and a "good" to "excellent" score was observed for 75 patients (90.4%). In the comparison of patients with a %EWL greater than 50% and those with a %EWL of 50% or less, the SF-36 scores were statistically different only for "physical functioning" and "general health perception." The mean FTS was 23.8, and 95.2% of the patients described their food tolerance as acceptable to excellent. Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure, although a tendency for weight regain is noted after 5 years of follow-up evaluation. Resolution of comorbidity is comparable with that reported in the literature. The LSG procedure results in good to excellent health-related QoL. Food tolerance is lower for patients after LSG than for nonobese patients who had no surgery, but 95.2% described food tolerance as acceptable to excellent. © 2011 Springer Science+Business Media, LLC.


D'Hondt M.A.,Groeninge Hospital | Pottel H.,The Interdisciplinary Center | Devriendt D.,Groeninge Hospital | Van Rooy F.,Groeninge Hospital | Vansteenkiste F.,Groeninge Hospital
Obesity Surgery | Year: 2010

Background The purpose of this retrospective analysis was to determine if a short course of prophylactic proton pump inhibitor (PPI) therapy can prevent stomal ulceration after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods Four hundred forty-nine consecutive patients who underwent LRYGBP and had a minimum of 6 months follow-up were included. Patients were categorized in two groups: patients with Helicobacter pylori at preoperative endoscopy (HP group) and patients without H. pylori (nonHP group). All patients in the HP group were medically treated prior to surgery. In both groups, almost half of the patients received low-dose proton pump inhibitors (omeprazole 20 mg daily) for 1 month following LRYGBP. Results The incidence of stomal ulceration in the HP group was not statistically different from the incidence in the nonHP group (7/86, 81.4% vs. 41/363, 11.29%; p=0.559). When, comparing the patients who did receive PPI therapy with the patients who did not receive PPI therapy within the non-HP group, there was no significant reduction in development of stomal ulceration (1.8/1.69, 10.65% vs. 23/ 194, 11.86%; p=0.743). When comparing the patients who did receive PPI therapy with the patients who did not receive PPI therapy within the HP group, there is a significant reduction, in development of stomal ulceration (0/41, 0% vs. 7/45, 15.56%; p=0.0123). Conclusion Development of stomal ulceration in patients tested positive for pylori prior to LRYGBP can be prevented by prophylactic low-dose PPI therapy following surgery. © 2009 Springer Science+Business Media, LLC.


D'Hondt M.,Groeninge Hospital | Sergeant G.,Groeninge Hospital | Deylgat B.,Groeninge Hospital | Devriendt D.,Groeninge Hospital | And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2011

Background: The aim of this study was to determine the incidence of symptomatic gallstone disease requiring cholecystectomy (CCE) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and to identify the peri-operative risk factors associated with postoperative symptomatic gallstone disease. Methods: Between August 2003 and November 2009, 724 patients underwent LRYGBP at the Groeninge Hospital. Preoperative ultrasound was performed in 600 of 641 patients without history of CCE and 120 (20. 0%) were diagnosed with cholecystolithiasis. Result: Six hundred twenty-five patients were included, 43(6. 9%) developed delayed symptoms related to biliary disease. Of these 43 patients, 39 underwent post-LRYGBP CCE. Of these 39 patients, 9 (7. 5%) had a positive ultrasound prior to LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGB of more than 50% of excess weight [HR (95% CI), 2. 04 (1. 04-4. 28); p = 0. 037) as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Conclusions: Symptomatic gallstone disease occurred only in 6. 9% of patients post-LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGBP of more than 50% of excess weight as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Prophylactic CCE should not be recommended at the time of LRYGBP. © 2011 The Society for Surgery of the Alimentary Tract.

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