Service de Chirurgie Digestive

rue Saint Pierre, France

Service de Chirurgie Digestive

rue Saint Pierre, France
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Malgras B.,Service de chirurgie digestive | Guerin F.,Service de chirurgie pediatrique | Dokmak S.,Service de chirurgie hepatobiliaire et pancreatique
Journal of Visceral Surgery | Year: 2017

Congenital porto-caval shunt is a rare anomaly that can result in direct shunt-related complications (encephalopathy, pulmonary hypertension) or indirect complications such as the development of benign or malignant hepatic neoplasms. Treatment consists of management of the complications and occlusion of the porto-caval shunt in one or two stages by either a surgical or an interventional radiology approach. © 2017 Elsevier Masson SAS

Damon H.,Service dExploration Fonctionnelle Digestive | Barth X.,Service de Chirurgie Digestive | Barth X.,University Claude Bernard Lyon 1 | Roman S.,Service dExploration Fonctionnelle Digestive | And 3 more authors.
International Journal of Colorectal Disease | Year: 2013

Purpose: Sacral nerve stimulation (SNS) is validated as an efficient treatment for fecal incontinence (FI). However, long-term results are scarce in the literature. The goal of this study was to assess the impact of SNS on FI symptoms and quality of life, based on a retrospective analysis of prospectively collected data. Methods: From 2001 to 2009, 119 patients (six men, mean age 61 years) underwent SNS testing for FI after an extensive diagnostic workup. Permanent implantation was realized when FI symptoms improved during testing, and follow-up visits were performed every 12 months thereafter. This follow-up evaluated morbidity and efficacy, based on clinical data and self-administered questionnaires including Jorge and Wexner FI score, urinary incontinence score (urinary distress inventory-6, UDI-6), gastrointestinal quality of life index (GIQLI), and auto-evaluation scale. Results: A permanent stimulator was implanted after a positive test in 102 patients (91 %). Ten patients were explanted during follow-up (pain in one case and absence of efficacy in nine), and 29 had the stimulator and/or the electrode changed. The mean follow-up was 48 months (range 12-84): there was a significant improvement of FI score (9 ± 1 vs 14 ± 3, p < 0.0001), UDI-6 score (8 ± 4 vs 11 ± 5, p < 0.05), and GIQLI index (p < 0.002). The improvement was present at 12 months follow-up and remained stable. Eighty percent of patients were satisfied with the treatment at the last point of follow-up. None of the pretreatment variables were predictive of SNS efficacy. Conclusions: SNS improved FI and quality of life, and this efficacy remained over time. Although a complete disappearance of FI was rare, most patients were satisfied. © 2012 Springer-Verlag.

Chen Z.-W.,University of Évry Val d'Essonne | Joli P.,University of Évry Val d'Essonne | Feng Z.-Q.,University of Évry Val d'Essonne | Feng Z.-Q.,Southwest Jiaotong University | And 3 more authors.
Journal of Biomechanics | Year: 2015

Pelvic organ prolapse (POP) occurs only in women and becomes more common as women age. However, the surgical practices remain poorly evaluated. The realization of a simulator of the dynamic behavior of the pelvic organs is then identified as a need. It allows the surgeon to estimate the functional impact of his actions before his implementation. In this work, the simulation will be based on a patient-specific approach in which each geometrical model will be carried out starting from magnetic resonance image (MRI) acquisition of pelvic organs of one patient. To determine the strain and stress in the soft biological tissues, hyperelastic constitutive laws are used in the context of finite element analysis. The Yeoh model has been implemented into an in-house finite element code FER to model these organ tissues taking into account large deformations with multiple contacts. The 2D and 3D models are considered in this preliminary study and the results show that our method can help to improve the understanding of different forms of POP. © 2014 Elsevier Ltd.

Adam J.-P.,Haut Leveque Hospital | Jacquin A.,Haut Leveque Hospital | Laurent C.,Service de Chirurgie Digestive | Collet D.,Haut Leveque Hospital | And 4 more authors.
JAMA Surgery | Year: 2013

Objective: To compare preservation with the division of the splenic vessels in the surgical management of laparoscopic spleen-preserving distal pancreatectomy. Design: Bicentric retrospective study. Setting: Prospectively maintained databases. Patients: Between January 1997 and January 2011, 140 patients who underwent laparoscopic spleenpreserving distal pancreatectomy for benign or lowgrade malignant tumors in the body/tail of the pancreas were included. Patients treated with the attempted splenic vessel preservation were compared with patients treated with the attempted division of the splenic vessels (Warshaw technique). Main Outcome Measures: Operative outcomes and postoperative morbidity were evaluated. Results: The outcomes of 55 patients in the splenic vessel preservation group were compared with those of 85 patients in the Warshaw technique group. The clinical characteristics were similar in both groups, except for tumor size, which was significantly greater in the Warshaw technique group (33.6 vs 42.5 mm; P<.001). The mean operative time, mean blood loss, and rate of conversion to the open procedure did not differ between the 2 groups. The rate of successful spleen preservation was significantly improved following the splenic vessel preservation technique (96.4% vs 84.7%; P=.03). Complications related to the spleen only occurred in the Warshaw technique group (0% vs 10.5%; P=.03), requiring a splenectomy in 4 patients (4.7%). The mean length of stay was shorter in the splenic vessel preservation group (8.2 vs 10.5 days; P=.01). Conclusions: The short-term benefits associated with the preservation of the splenic vessels should lead to an increased preference for this technique in selected patients undergoing laparoscopic spleen-preserving distal pancreatectomy for benign or low-grade malignant tumors in the body/tail of the pancreas. © 2013 American Medical Association. All rights reserved.

Chelala E.,Service de chirurgie digestive | Declercq S.,University of Antwerp
Hernia | Year: 2015

Perineal hernias are infrequent complications following abdominoperineal surgeries. These hernias require surgical repair when they become symptomatic by several conventional or reconstructive techniques. The benefits of a full laparoscopic approach and/or the combined approach of a perineal repair of the pelvic floor associated to the laparoscopic placement of a traditional synthetic mesh have been previously demonstrated. In this article, we present the case of a perineal incisional hernia, post-abdominoperineal resection of the rectum after radio chemotherapy, in the neoadjuvant treatment of a rectal adenocarcinoma tumor. An alternative approach, not previously described for the surgical repair of this type of hernia, is presented to assess the feasibility of the suturing repair, and efficacy of a biological acellular porcine collagen implant Permacol®. A full laparoscopic suturing for the closure of the perineal defect associated to biological mesh reinforcement was successfully undertaken, with good short-term outcomes. © 2013, Springer-Verlag France.

Schwarz L.,Service de chirurgie digestive
Journal of visceral surgery | Year: 2011

The incidence of complications after hepatectomy has been considerably reduced over the last 20 years. Better knowledge of liver anatomy and liver regeneration, and methods preventing bleeding during surgery have resulted in morbidity rates below 20% and mortality rates less than 5%. The treatment of the liver cross section remains controversial. Experimental studies have reported convincing biological effects of fibrin sealants or compresses when applied on the liver to decrease hemorrhagic or biliary complications. However, clinical studies are very heterogeneous, providing conflicting results compromising recommendations for routine use. Copyright © 2011. Published by Elsevier Masson SAS.

Khalil H.,Service de chirurgie digestive
Journal of visceral surgery | Year: 2010

Perforation of rectal cancer usually occurs intraperitoneally. Extraperitoneal perforation is rare and usually presents as perineal sepsis, leading to diagnosis and urgent surgical management plus antibiotic therapy. We report the case of a patient presenting with a perforated rectal carcinoma which presented as necrotizing fasciitis of the right thigh. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Studies showing the frequency of anal incontinence and its social and economic impact have driven progress in surgical treatment, from muscle repair by myorraphy (mainly posterior myorraphy) or sphincteroplasty by direct suture of the external anal sphincter some 20 years ago, to invasive surgery with implantation of an artificial anal sphincter in 1993, mini-invasive surgery based on sacral nerve stimulation in 1998, failure of mini-invasive procedures with injection of a bulking agent or radiofrequency in 2000-2010, and development in 2012 of cellular therapy based on injection of autologous myoblasts. Progress in functional gut exploration (anorectal manometry, electrophysiological tests, endoanal ultrasonography, MRI, colonic transit time) and better knowledge of colonic and ano-rectal physiology will lead to further surgical advances.

The Vacuum Assisted Closure therapy (VAC) is an efficient treatment in case of large wound defects with extensive loss of muscular and cutaneous tissues. The success of this therapy is based on strict rules of procedure and regular clinicobiological evaluation before and during treatment. The negative-pressure therapy can lead to a total healing of the defect but a secondary surgical closure or a skin graft can be necessary in some cases. © 2013 Elsevier Masson SAS. All rights reserved.

Bouillot J.L.,Service de chirurgie digestive
Journal of visceral surgery | Year: 2012

Incisional hernia is one of the classic complications after abdominal surgery. The chronic, gradual increase in size of some of these hernias is such that the hernia ring widens to a point where there is a loss of substance in the abdominal wall, herniated organs can become incarcerated or strangulated while poor abdominal motility can alter respiratory function. The surgical treatment of small (<5 cm) incisional hernias is safe and straightforward, by either laparotomy or laparoscopy. For large hernias, surgical repair is often difficult. After reintegration of herniated viscera into the abdominal cavity, the abdominal wall defect must be closed anatomically in order to restore the function to the abdominal wall. Prosthetic reinforcement of the abdominal wall is mandatory for long-term successful repair. There are multiple techniques for prosthetic hernia repair, but placement of Dacron mesh in the retromuscular plane is our preference. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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