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Hammam Sousse, Tunisia

Chalret du Rieu M.,Service de chirurgie generale
Journal of visceral surgery | Year: 2011

Chylothorax is a rare but severe complication of thoracic and esophageal surgery. The anatomical relations of the thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At an early stage, chylothorax can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. Optimal management of chylothorax can decrease mortality. It is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated at diagnosis and results in resolution of the chylothorax is achieved in 50 to 70% of cases. In case of either high flow rate chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery. Copyright © 2011 Elsevier Masson SAS. All rights reserved. Source


Chirica M.,Service de chirurgie generale
Journal of visceral surgery | Year: 2010

The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy. Copyright © 2010. Published by Elsevier Masson SAS. Source


Bozio G.,Service de chirurgie generale
Journal of visceral surgery | Year: 2011

The goal of this review is to evaluate, through a review of the surgical literature, the role of esophagectomy in the management of Barrett's esophagus as it evolves histologically from intestinal metaplasia through increasing grades of dysplasia to adenocarcinoma. We precisely define the indications and therapeutic modalities of esophagectomy for high-grade dysplasia, superficial adenocarcinoma, and invasive adenocarcinoma. Copyright © 2011 Elsevier Masson SAS. All rights reserved. Source


Arapis K.,Service de chirurgie generale
Journal of visceral surgery | Year: 2012

There are conflicting results concerning the bariatric effectiveness of adjustable gastric banding in super-obese patients with a Body Mass Index (BMI) more or equal to 50 kg/m(2). A cohort of 186 patients with a BMI greater or equal to 50 kg/m(2) who underwent adjustable gastric banding (AGB) at the Bichat-Claude-Bernard University Hospital (Paris, France) were prospectively entered into a database. The following data were recorded: BMI, percentage of BMI loss, percentage of excess weight lost (%EWL), complications, and surgical re-interventions. Loss of greater than 50% of excess weight was considered a success (primary endpoint). A %EWL of less than 25% after one year, or the removal of the gastric band was considered a failure. Thirty-five men (18.8%) and 151 women (81.2%), with a mean age of 38.9 years (range: 16-65) underwent AGB between September 1995 and December 2007. The mean BMI was 55.06 kg/m(2) (range: 50-74.4). Mean follow-up was 112.5 months with a minimum of 28 months and a maximum of 172 months. The follow-up rate was maintained at 89% at ten years. The technique of AGB was by "peri-gastric dissection" in the first 115 patients (61.82%) and by "pars flaccida dissection" in 71 patients (38.17%). The gastric band was removed in 87 of 186 patients (46.8%); band ablation was due to a complication of the gastric band in 62 of these cases (33.3%), to failure of weight loss in 23 cases (12.4%), and to patient request in two cases (1%). The major complications requiring re-operation were: chronic dilatation of the proximal gastric pouch (27 patients - 14.5%), acute dilatation (21 patients - 11.3%), intragastric migration of the prosthesis (six patients - 3.2%), reflux esophagitis (six patients - 3.2%), infection of the gastric band (one patient - 0.5%), and Barrett's esophagus (one patient - 0.5%). No statistically significant difference was found between the two operative techniques with regard to the possibility of preserving the gastric band for ten years. For patients who underwent band removal, no further follow-up analysis of patient data after band ablation was performed. The results were best at two years after AGB with a median BMI of 42.72 kg/m(2), a band removal rate of 8.6% (16 of 186 patients), and a failure rate of 16.4% (28 of 170 patients) of those patients who still had their band in place. However, at 10 years, the picture was completely reversed with a band removal rate of 52.2% (47 of 90 patients), a failure rate of 22% (seven of 33 patients) of those who still had their band in place, and a median BMI of 43.43 kg/m(2). Laparoscopic gastroplasty using the adjustable gastric band appeared to be a promising intervention for super-obese patients when the results at two years were analyzed - fairly simple to perform, with perioperative morbidity and mortality near zero. However, these results do not persist in the long-term for super-obese patients. At ten years, only 11% of patients (nine of 80) have successful bariatric results (%EWL>50%) and we were forced to remove the gastric band in 52.2% of patients (47 of 90) because of complications, regardless of the initial operative technique used. Given these results, AGB gastroplasty is not a recommended method for super-obese patients and we believe that a BMI greater or equal to 50 kg/m(2) is a contra-indication for this procedure. Copyright © 2012. Published by Elsevier Masson SAS. Source


Miloudi N.,Service de chirurgie generale
Journal of visceral surgery | Year: 2012

Lipomas of the colon are relatively rare benign tumors. Colo-colonic intussusception is an unusual complication of colonic lipoma. We report the case of a 79-year-old man who presented with spasmodic, self-limiting abdominal pain associated with rectal bleeding. Colonoscopy revealed a submucosal mass suggestive of a benign tumor but that was too large for endoscopic resection. CT scan demonstrated an endoluminal fatty mass in the transverse colon, typical of lipoma, and suggested colo-colonic intussusception due to the mass. The mass was removed laparoscopically. Recovery was uneventful. Copyright © 2012. Published by Elsevier Masson SAS. Source

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