Service de Chirurgie Viscerale

Lausanne, Switzerland

Service de Chirurgie Viscerale

Lausanne, Switzerland
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Hanaire H.,Pole Cardio vasculaire et Metabolique | Dubet A.,French National Institute for Agricultural Research | Chauveau M.-E.,Pole Cardio vasculaire et Metabolique | Anduze Y.,Service de Chirurgie Viscerale | And 3 more authors.
Obesity Surgery | Year: 2010

Hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report shows that continuous glucose monitoring can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-h fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, continuous glucose monitoring is a very useful tool revealing the episodes in free living circumstances and can be used to monitor the treatment success. © 2009 Springer Science + Business Media, LLC.

Donatelli G.,Unite dEndoscopie Interventionnelle | Ferretti S.,Hopital University Antoine Beclere | Vergeau B.M.,Unite dEndoscopie Interventionnelle | Dhumane P.,Lilavati Hospital and Research Center | And 9 more authors.
Obesity Surgery | Year: 2014

Background: Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved. Methods: In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4-98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation. Results: Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26-45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25-42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26-∈180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20-276). Conclusions: EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required. © 2014 Springer Science+Business Media.

Hornez E.,Service de chirurgie viscerale
Journal of visceral surgery | Year: 2011

The hemodynamically unstable pelvic fracture are a diagnostic and therapeutic challenge. The current management is based on the control of pelvic bleeding by combining pelvic ring stabilization and embolization of pelvic arteries. The mortality of these patients, however, exceeds 30%. Recently the preperitoneal packing, based on the hemostatic tamponade of the pelvic cavity has been described. The objective of this study was to evaluate the interest of this new surgical procedure. The effectiveness of the standard algorithm is evaluated by analysis of pelvic injuries in 200 severe trauma treated at the Sainte-Anne Hospital. The results are then compared with literature data on the preperitoneal packing. The profile injury, management and morbidity and mortality was evaluated in 200 polytrauma. After an initial phase of resuscitation, unstable pelvic fractures were treated with a circumferential belt followed by the application of an external fixator. Arteriography was performed for all patients with persistent hemodynamic instability. The mean injury severity score (ISS) was 31 (4-75). The mean trauma-related injury severity score (TRISS) was 74% (3-99). The proportion of hemodynamically unstable patients was 47%. Fifteen patients (41%) had severe bleeding. The median number of blood transfusion was 10 (4-42); eight patients (22%) underwent embolization. For two patients, reducing the pelvic fracture with an external fixator resulted in permanent hemostasis. Two patients underwent a laparotomy first, for the control of a hemoperitoneum. The mortality rate of the group of patients with hemorrhage was 33% (5/15). This high mortality leads to reconsider the place of pelvic embolization as firstline treatment. Some major drawbacks are noted: its effectiveness in treating venous bleeding, availability and duration of the procedure. The preperitoneal packing is a fast and effective surgical alternative. It seems to improve hemodynamic status of patients and significantly reduce the use of embolization and massive transfusion. Embolization is still indicated for patients not responding to surgery. However survival is not significantly improved. Copyright © 2011. Published by Elsevier Masson SAS.

Gillion J.F.,Service de chirurgie viscerale
Journal of visceral surgery | Year: 2012

In clean surgery (Altemeier Class I), the incidence of infections is not increased by the placement of prosthetic material. Prosthetic mesh infections occur more frequently and are more serious in ventral incisional repair than in inguinal hernia repair. While removal of the mesh resolves the infectious problem, it creates other problems that are equally difficult. This underscores the need to: explore other conservative hernia treatment options; in the end, these are often feasible; respect and implement strict measures to prevent infection. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

The authors of the present article propose adjustments to the parentbaby psychotherapy framework in light of recent theoretical, clinical and technical findings in perinatal psychopathology. The points of view put forth here are based on a review of the literature of early therapies and their evolution in order to look more closely at the indications for this type of treatment as well as its epistemological, semiological, material, technical and therapeutic aspects. Because of this, the very clear position of the authors in their role as child-centered caregivers has brought them to think about the encounter with the baby and his parents, to formulate à framework, to organize the time, space and objects for each session and to accompany the therapeutic process as a function of their identification with the baby's situation. Finally, an account of psychotherapy illustrates the way in which the complexity of this type of clinical work imposes a permanent questioning as to how the therapists operate in terms of containment, third-party position, otherness, differentiation, metaphorisation and transformation of psychic processes.

Hasbi S.,Service de chirurgie viscerale | Kaoui H.,Service de chirurgie viscerale
Journal Africain d'Hepato-Gastroenterologie | Year: 2016

This is a retrospective study of a series of 44 cases of appendicular syndrome treated at the service over a two years period. The aim of our study is to clarify the possibility and the conditions for non-operative attitude to uncomplicated acute appendicitis. Fifteen patients were treated with antibiotics (34%) of which 3 were operated thereafter in the absence of improvement and two have a recurrence of symptoms after two months (13.3%). © 2016 Springer-Verlag France

Elhjouji A.,Service de chirurgie viscerale
Journal of visceral surgery | Year: 2011

Juvenile polyposis is a rare disorder. We report an unusual case of juvenile polyposis in a 22-yr-old woman with ulcerative colitis, apparently one of the first cases reported in the literature. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Hernigou J.,Service de chirurgie viscerale
Journal of visceral surgery | Year: 2013

We report the case of a patient with appendicitis due to actinomycosis, complicated by multiple liver abscesses. Definitive diagnosis was based on histopathologic examination of the resected appendix. Accurate identification of the pathogen led to curative antibiotic therapy of the liver abscesses. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Nguyen V.,Service de chirurgie viscerale
Journal of visceral surgery | Year: 2012

The goal of this study was to prospectively evaluate the surgical management of hemorrhoids by Doppler-guided hemorrhoidal artery ligation (Doppler HAL™). This study was conducted between April 2008 and September 2009. The Doppler HAL™ technique was performed in patients with grades II to IV, irrespective of whether they had previously undergone medical or instrumental management or not. The other demographics of the studied population, the operative and post-operative results as well as the functional outcome at one month and at one year were recorded prospectively and analyzed retrospectively. Sixty-one consecutive patients (mean age 45 [range 28-85]) underwent Doppler HAL™. The mean duration of operation was 26minutes [range 18-45]. The average number of ligations per patient was seven. Three patients left the hospital the same day, 51 patients were discharged on day 1 and five patients on day 2. Post-operative mortality was nil. The post-operative morbidity rate was 4.9%. Functional results evaluated at one month and one year showed that initial symptoms had disappeared in more than 78% of patients. The recurrence rate for hemorrhoidal related disease was 10.5% during the first year. Surgical treatment of hemorrhoids by the Doppler-guided hemorrhoidal artery ligation technique is mini-invasive, with low morbidity, and satisfactory short and medium term functional results. This technique represents a reliable surgical alternative to classical hemorrhoidectomy and hemorrhoidopexy in the therapeutic strategy of hemorrhoidal disease. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Jarry J.,Service de chirurgie viscerale
Médecine tropicale : revue du Corps de santé colonial | Year: 2011

Retrospective analysis of the medical records of patients who underwent acute appendectomy in the Gastrointestinal Surgery Department of the Desgenettes Military Hospital in Lyon, France from the 1st of November 2009 to the 21th of February 2011, turned up two cases of appendicular parasitosis for a prevalence of 3.3%. Both patients presented acute appendicular oxyuriasis caused by Enterobius vermicularis that was discovered inadvertently after appendectomy. This unexpected diagnosis raises questions about the exact role of parasites in the physiopathology of appendicitis. Though appendicitis is the most common surgical emergency in France, appendix vermicularis is rare. In comparison, developing countries and particularly endemic areas such as sub-Saharan Africa show considerably higher appendicular parasitosis prevalence rates and greater variety in the parasites involved. The purpose of this article is to describe the different parasites with potential to affect the appendix, to discuss the different pathophysiological mechanisms underlying acute appendicitis, and to recall the need for medical treatment after appendectomy.

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