Publications by authors named "Abdennaceur Dhahri"

48 Publications

Short-term Outcomes of Day-Case Stoma Closure: A Prospective, Observational Study.

Dis Colon Rectum 2021 Apr 26. Epub 2021 Apr 26.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France SSPC (Simplification of Surgical Patients Care) Clinical Research Unit, University of Picardie Jules Verne, Amiens, France Department of Anaesthesia, Amiens University Hospital, Amiens, France.

Background: Elective stoma closure is a common, standardized procedure in digestive surgery.

Objective: To evaluate the feasibility of day-case surgery for elective stoma closure.

Design: A prospective, single-center, non-randomized study of consecutive patients undergoing day-case elective stoma closure.

Setting: A French tertiary hospital between January 2016 and June 2018.

Patients: Elective stoma closure performed by local incision with an American Society of Anesthesiologists score of I, II or stabilized III.

Outcome Measures: The primary endpoint was the day case surgery success rate in the overall population (all patients having undergone elective stoma closure) and in the per protocol population (patients not fulfilling any of the preoperative or perioperative exclusion criteria). The secondary endpoints (in the per protocol population) were the overall morbidity rate (according to the Clavien-Dindo classification), the major morbidity rate (Clavien score ≥ 3), and day case surgery quality criteria (unplanned consultation, unplanned hospitalization, and unplanned reoperation).

Results: Between January 2016 and June 2018, 236 patients (the overall population; mean ± standard deviation age: 54 ± 17; 120 men (51%)) underwent elective stoma closure. Fifty of these patients (21%) met all the inclusion criteria and constituted the per protocol population. The day case surgery success rate was 17% (40 out of 236 patients) in the overall population and 80% (40 out of 50 patients) in the per protocol population. In the per protocol population, the overall morbidity rate was 30% and the major morbidity rate was 6%. Of the 40 patients with successful day case surgery, the unplanned consultation rate and the unplanned hospitalization rate were both 32.5%. There were no unplanned reoperations.

Limitations: This was a single-center study.

Conclusion: In selected patients, day case surgery for elective stoma closure is feasible and has acceptable complication and readmission rates. Day-case elective stoma closure can therefore be legitimately offered to selected patients. See Video Abstract at http://links.lww.com/DCR/B583.
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http://dx.doi.org/10.1097/DCR.0000000000001905DOI Listing
April 2021

Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management.

Surg Obes Relat Dis 2021 May 29;17(5):947-955. Epub 2021 Jan 29.

Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Simplification of Surgical Patient Care Clinical Research Unit, University of Picardie Jules Verne, Amiens, France. Electronic address:

Background: Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%.

Objectives: Assess the impact of factors that may lead to a poorer evolution of GL.

Setting: University Hospital, France, public practice.

Methods: This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL.

Results: Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healing was 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multivariate analysis identified body mass index (>47 kg/m), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL.

Conclusion: Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery.
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http://dx.doi.org/10.1016/j.soard.2021.01.023DOI Listing
May 2021

Correction to: Comparison of sleeve gastrectomy and Roux-en-Y gastric bypass after failure of gastric banding: a two-center study with a propensity score-matched analysis.

Surg Endosc 2021 Jul;35(7):3523

SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens, France.

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http://dx.doi.org/10.1007/s00464-020-08047-9DOI Listing
July 2021

Comparison of sleeve gastrectomy and Roux-en-Y gastric bypass after failure of gastric banding: a two-center study with a propensity score-matched analysis.

Surg Endosc 2021 Jul 26;35(7):3513-3522. Epub 2020 Aug 26.

SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens, France.

Background: Few studies on series comparing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) after failure of gastric banding (GB) are available. The objective of this study was to compare the short- and medium-term outcomes of SG and RYGB after GB.

Materials And Methods: Between January 2006 and December 2017, patients undergoing SG (n = 186) or RYGB (n = 107) for failure of primary GB were included in this two-center study. Propensity-score matching was performed based on preoperative factors with a 2:1 ratio. Primary endpoint was the weight loss at 2 years between the SG and RYGB groups. Secondary endpoints were overall mortality and morbidity, reoperation, correction of comorbidities and the rate of adverse events at 2 years follow-up.

Results: In our propensity score matching analysis, operative time was significantly less in the SG group (95 min vs. 179 min; p < 0.001). Post-operative complications were lower in the SG group (9.5% vs. 35.4%; p = 0.003). At 2 years follow-up, the mean EWL was similar as same as comorbidities. There was a significant difference in favor of SG concerning the rate of adverse events at 2 years follow-up (p < 0.001).

Conclusion: Revision of GB by SG or RYGB is feasible, with a higher rate of early post-operative complications for RYGB. Weight loss at 2 years follow-up is similar; however, RYGB appears to result in a higher rate of adverse events than SG.
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http://dx.doi.org/10.1007/s00464-020-07809-9DOI Listing
July 2021

Sleeve gastrectomy as a rescue of failed gastric banding: comparison of 1- and 2-step approaches.

Surg Obes Relat Dis 2020 Aug 10;16(8):1045-1051. Epub 2020 Apr 10.

Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université de Paris, Paris, France. Electronic address:

Background: Series comparing gastric banding (GB) removal and sleeve gastrectomy (SG) when procedures are performed as a 1- or a 2-step approach are contradictory in their outcomes. No series comparing these approaches with midterm weight loss is available.

Objectives: Compare the outcomes and weight loss of SG performed as 1- and 2-step approaches as a revisional procedure for GB failure.

Setting: University Hospital, France, public practice.

Methods: Between February 2006 and January 2017, all patients undergoing SG with a previous history of implementation of GB (n = 358) were included in this 2-center, retrospective, observational study. Revisional surgery was proposed in patients with insufficient excess weight loss (excess weight loss ≤50%) or weight regain after GB. A 1-step (1-step group, n = 270) or 2-step (2-step group, n = 88) approach was decided depending on patient's choice and/or surgeon's preference. The primary efficacy endpoint was the comparison of weight loss in the 1- and 2-step groups at the 2-year follow-up. The secondary efficacy endpoints were short-term outcomes (overall mortality and morbidity at postoperative day 30, specific morbidity, reoperation, length of hospital stay, and readmission).

Results: In the 1-step group, the mean preoperative body mass index before SG was 40.5 kg/m (27.0-69.0), while in the 2-step group, the mean preoperative body mass index was 43.5 kg/m (31.5-61.7). Mean operating time was 109 minutes (50-240) in the 1-step group and 78.7 minutes (40-175) in the 2-step group (P = .22). In the 1-step group, 6 conversions to laparotomy occurred, while in the 2-step group, 2 conversions to laparotomy occurred (P = .75). One death (.2%, in the 2-step group) and 39 complications (30 in the 1-step group [11.1%] and 9 in the 2-step group [10.2%]) also occurred. The mean length of hospital stay was 6.2 days in the 1-step group and 4.1 days in the 2-step group. At 2-year follow-up, mean body mass index was 32.4 kg/m in the 1-step group and 33.2 kg/m in the 2-step group (P = .15), representing excess weight losses of 61.9 and 50.1 (P = .05), respectively. The rates of revisional surgery were .7% and 2.2%, respectively.

Conclusions: SG after previous GB is efficient with similar outcomes depending on the 1- or 2-step approach. The 1-step approach seems to have increased weight loss compared with the 2-step approach.
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http://dx.doi.org/10.1016/j.soard.2020.03.015DOI Listing
August 2020

Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis.

Surg Endosc 2020 09 8;34(9):3978-3985. Epub 2019 Oct 8.

Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France.

Background: Sleeve gastrectomy (SG) has become a frequent bariatric procedure. Single-port sleeve gastrectomy (SPSG) could reduce parietal aggression however its development has been restrained due to fear of a complex procedure leading to increased morbidity and suboptimal sleeve construction. The aim of this study was to compare the short-term outcomes of SPSG versus conventional laparoscopic sleeve gastrectomy (CLSG) with regards to morbidity, weight loss, and co-morbidity resolution.

Methods: Between January 2015 and December 2016, data from all consecutive patients that underwent SPSG and CLSG in two institutions performing exclusively one or the other approach were retrospectively analyzed. Propensity score adjustment was performed on the factors known to influence the choice of approach.

Results: During the study period, 1122 patients underwent SG in both institutions (610 SPSG and 512 CLSG). From each group, 314 patients were successfully matched. A 15-min increase in operative time was observed during SPSG (P < 0.001). Postoperative morbidity was similar with a minor increase after SPSG (8.6 vs. 6.7%, P = 0.453). No differences in incisional hernia rates were observed (1.6 (SPSG) vs. 0.3% (CLSG), P = 0.216). Percentage of total weight loss was 31.1% and 28.2% in the CLSG and SPSG 12 months after surgery, respectively (P = 0.321). Co-morbidities resolution 12 months following the procedure was similar.

Conclusions: SPSG can be performed safely with similar intraoperative and postoperative morbidity compared to CLSG. Weight loss and co-morbidities resolution at 1 year are equivalent. A 15-min longer operative time was the only negative side of SPSG.
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http://dx.doi.org/10.1007/s00464-019-07175-1DOI Listing
September 2020

Comparison of Repeat Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Case of Weight Loss Failure After Sleeve Gastrectomy.

Obes Surg 2019 12;29(12):3919-3927

Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France.

Background: Few series are available on the results of repeat sleeve gastrectomy (re-SG) and Roux-en-Y gastric bypass (RYGB) performed to manage the failure of primary sleeve gastrectomy (SG). The objective of this study was to compare the short- and medium-term outcomes of re-SG and RYGB after SG.

Material & Methods: Between January 2010 and December 2017, patients undergoing re-SG (n = 61) and RYGB (n = 83) for failure of primary SG were included in this study. Revisional surgery was proposed for patients with insufficient excess weight loss (EWL ≤ 50%) or weight regain. The primary endpoint was the comparison of weight loss in the re-SG group and the RYGB group at the 1-year follow-up. The secondary endpoints were overall mortality and morbidity, specific morbidity, length of stay, weight loss, and correction of comorbidities.

Results: The mean interval between SG and re-SG was 41.5 vs. 43.2 months between SG and RYGB (p = 0.32). The mean operative time was 103 min (re-SG group) vs. 129.4 min (RYGB group). One death (1.7%; re-SG group) and 25 complications (17.4%; 9 in the re-SG group, 16 in the RYGB group) were observed. At the 1 year, mean body mass index was 31.6 in the re-SG group and 32.5 in the RYGB group (p = 0.61) and excess weight loss was 69.5 vs. 61.2, respectively (p = 0.05).

Conclusion: Re-SG and RYGB as revisional surgery for SG are feasible with acceptable outcomes and similar results on weight loss on the first postoperative year.
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http://dx.doi.org/10.1007/s11695-019-04123-9DOI Listing
December 2019

Impact of Routine 12 mm Epigastric Trocar Site Closure on Incisional Hernia After Sleeve Gastrectomy: a Prospective Before/After Study.

Obes Surg 2019 11;29(11):3500-3507

Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, F-80054, Amiens Cedex 01, France.

Background: Recent studies have reported trocar site hernia (TSH) rates after bariatric surgery ranging from 0 to 45.2% based on imaging assessment. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) comprising routine 12 mm epigastric trocar site closure (TSC).

Material: Prospective observational study with retrospective control cohort of a group of patients undergoing primary SG with routine 12 mm epigastric TSC. The "before" group (control group) was a previously published group of patients without 12 mm epigastric TSC and the "after" group (closure group) concerned patients with routine 12 mm epigastric TSC. Primary endpoint was the TSH rate after routine epigastric TSC. Secondary endpoints were comparison of the TSH rate, TSC feasibility and causes of failure, TSC-related morbidity, evaluation of TSC time and its course, and identification of risk factors for TSH.

Results: One hundred twenty-three patients were analyzed during the study period. Feasibility of epigastric TSC was 97.3% without related morbidity. Mean epigastric TSC time was 44.2 s (18-150). Epigastric TSC time was always less than 60 s after 10-15 procedures. At 1 year, 10 patients presented TSH (8.1%): epigastric in 6.5% (n = 8) cases and after open laparoscopy in 1.6% (n = 2) cases. Comparison of the two groups revealed a lower TSH rate in the closure group (8.1% vs. 17.0%; p = 0.02), due to a lower epigastric TSH rate (6.5% vs. 14.8%; p = 0.02). Routine epigastric TSC was a protective factor for TSH (p = 0.03; relative risk of 0.43).

Conclusion: Routine epigastric TSC during SG is rapid and provides effective prevention of TSH.
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http://dx.doi.org/10.1007/s11695-019-03971-9DOI Listing
November 2019

Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study.

Surg Obes Relat Dis 2019 Apr 14;15(4):534-545. Epub 2019 Feb 14.

Department of Digestive Surgery, Amiens University Hospital, Amiens Cedex 01, France; SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, Amiens Cedex 01, France. Electronic address:

Background: Few series have demonstrated the feasibility of laparoscopic sleeve gastrectomy (SG) as day-case surgery (DCS).

Objective: Compare the outcomes and healthcare costs of SG performed as DCS or as an inpatient procedure.

Setting: University Hospital, France, public practice.

Methods: This was a prospective, nonrandomized study of 250 consecutive patients undergoing day-case SG from May 2011 to June 2017. Each patient in the DCS group (n = 250) was manually paired by sex, age, body mass index, preoperative co-morbidities, and year of surgery with 1 patient undergoing SG as an inpatient procedure (SG control group, n = 250). Patients in the SG control group were excluded from DCS on the basis of DCS criteria. The primary endpoint of this study was the clinical and economic impact of performing SG as DCS compared with inpatient management. The secondary endpoints were related to DCS, DCS satisfaction rate, comparison of outcomes and costs between DCS and inpatient procedures, and the changing modalities of SG as DCS in our institution (by comparing the first 100 patients to the last 150 patients).

Results: A total of 1573 patients underwent SG during the period, 250 patients underwent SG as DCS (15.9%) and 554 patients were excluded on the basis of DCS criteria. No postoperative deaths, 19 overnight admissions (7.6%), 16 unscheduled consultations (6.4%), and 12 unscheduled hospitalizations (4.8%) were observed in the DCS group. No significant differences were observed in postoperative complications. Readmission was higher in the DCS group (5.6% versus 4%; P < .001), while the length of rehospitalization was shorter in the DCS group (5.8 versus 10.8 d; P < .001). Overall cost and cost per patient were significantly lower in the DCS group (P < .001).

Conclusion: Day-case SG on selected patients was not associated with increased morbidity and mortality rates and was cost-effective due to the low cost of management of postoperative complications.
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http://dx.doi.org/10.1016/j.soard.2019.02.005DOI Listing
April 2019

Effectiveness of Fibrin Sealant Application on the Development of Staple Line Complications After Sleeve Gastrectomy: A Prospective Randomized Trial.

Ann Surg 2018 11;268(5):762-768

Department of Digestive Surgery, Amiens University Hospital, Amiens, France.

Objectives: Evaluate the effectiveness of the use of fibrin sealant (FS) for preventing the development of staple line complications (SLCs) after sleeve gastrectomy (SG).

Background: There is no consensus on the best means of preventing SLCs after SG.

Methods: This was a prospective, intention-to-treat, randomized, 2 center study of a group of 586 patients undergoing primary SG (ClinicalTrials.gov identifier: NCT01613664) between March 2014 and June 2017. The 1:1 randomization was stratified by center, age, sex, gender, and body mass index, giving 293 patients in the FS group and 293 in the control group (without FS). The primary endpoint (composite criteria) was the incidence of SLCs in each of the 2 groups. The secondary criteria were the mortality rate, morbidity rate, reoperation rate, length of hospital stay, readmission rate, and risk factors for SLC.

Results: There were no intergroup differences in demographic variables. In an intention-to-treat analysis, the incidence of SLCs was similar in the FS and control groups (1.3% vs 2%, respectively; P = 0.52). All secondary endpoints were similar: complication rate (5.4% vs 5.1%, respectively; P = 0.85), mortality rate (0.3% vs 0%, respectively; P = 0.99), GL rate (0.3% vs 1.3%, respectively; P = 0.18), postoperative hemorrhage/hematoma rate (1% vs 0.7%, respectively; P = 0.68), reoperation rate (1% vs 0.3%, respectively; P = 0.32). Length of stay was 1 day in both groups (P = 0.89), and the readmission rate was similar (5.1% vs 3.4%, respectively; P = 0.32). No risk factors for SLCs were found.

Conclusion: The incidence of postoperative SLCs did not appear to depend on the presence or absence of FS.
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http://dx.doi.org/10.1097/SLA.0000000000002892DOI Listing
November 2018

Repeat sleeve gastrectomy: optimization of outcomes by modifying the indications and technique.

Surg Obes Relat Dis 2018 04 4;14(4):490-497. Epub 2018 Jan 4.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Avenue René Laennec, Amiens, France. Electronic address:

Background: Few series are available concerning repeat sleeve gastrectomy (re-SG), and series have reported contradictory results concerning morbidity rates, with limited data concerning weight loss.

Objective: Evaluate the short- and medium-term outcomes of re-SG.

Setting: University hospital, France, public practice.

Methods: Between June 2007 and March 2016, all patients undergoing re-SG (n = 46 patients) were included. Re-SG was proposed for patients with insufficient excess weight loss (EWL) (≤50%) or renewed weight gain with excessively high residual gastric volume (>250 mL and/or large gastric pouch). The primary efficacy endpoint was the overall complication rate of re-SG. The secondary efficacy endpoints were operative data, evaluation of weight loss, and correction of co-morbidities, risk factors for gastric leak (GL), by comparing 2 periods (period 1, January 2004-December 2013: blue/green or purple staplers without reinforcement; period 2, after December 2013: black staplers with reinforcement) and comparison of weight loss according to the indication for re-SG.

Results: The re-SG group consisted of 46 patients (35 women, mean age: 47.5 yr). The mean body mass index (BMI) before SG was 47.2 kg/m² (35-63.6). The mean time interval between SG and re-SG was 73 months (11-106). The BMI before re-SG was 41.2 kg/m² (29-54.7). Indications for surgery were insufficient weight loss in 25 patients (54.3%) and weight regain in 21 patients (45.7%). A large gastric pouch was visible in 4 patients (8.6%). The mean operating time was 97.6 minutes (45-220). One death (2.1%) and 7 complications (15.2%) were observed. The mean length of hospital stay was 3.6 days (1-30). At last follow-up, mean BMI was 32.1 kg/m (20.3-41.3) and mean EWL was 62.3% (18-127.2). When analyzing risk factors for GL, residual gastric volume between 250 and 350 mL was associated with a higher GL rate compared with a volume ≥350 mL, and re-SG performed during period 1 was associated with a higher GL rate than re-SG performed during period 2 (17.4% versus 0%; P = .13). Re-SG performed for weight regain was associated with a significantly higher additional weight loss compared with re-SG performed for insufficient weight loss (mean additional EWL of 45.9%; P = .06).

Conclusion: Re-SG is feasible, but it requires adaptation of the surgical procedure to decrease complications. Results on weight loss are acceptable, but the best indications for re-SG were a gastric volume>350 mL and in the case of weight regain with the exception of technical failure of the primary SG.
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http://dx.doi.org/10.1016/j.soard.2017.12.025DOI Listing
April 2018

Compliance with a multidisciplinary team meeting's decision prior to bariatric surgery protects against major postoperative complications.

Surg Obes Relat Dis 2017 Sep 1;13(9):1537-1543. Epub 2017 Jun 1.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address:

Background: Good surgical practice guidelines in France state that patients eligible for bariatric surgery must always be discussed at a multidisciplinary team (MDT) meeting.

Objective: Describe MDT meetings and assess their possible impact on the postoperative course.

Setting: University Hospital, France, public practice.

Methods: From April 2009 to March 2013, we included all patients reviewed in a MDT meeting before bariatric surgery. The primary endpoint was the case validation rate. The secondary endpoints were the number of MDT meetings, the number of submissions discussed or refused, outcomes in patients who underwent surgery in another center after refusal, or deferral in our MDT meeting.

Results: Forty-nine MDT meetings were held representing 1099 case files (816 patients) that were discussed. Of the case files, 84.5% concerned first-line surgery, 14% concerned second-line surgery, and 1.4% concerned third-line surgery. Overall, 776 (70.6%) of these submissions were approved, accounting for 95% of the patients. Further investigation before a decision was required in 13.3%. Surgery was definitively refused in 1% (n = 11). For the 776 patients having undergone surgery, the complication rate was 10.1%, the major complication rate was 6%, and the reoperation rate was 3.2%. For the 11 patients for whom bariatric surgery was refused, 7 patients underwent surgery in another center (without MDT meetings). There were 4 postoperative complications (57.1%; 3 major and 1 minor).

Conclusion: The MDT meeting's decision is important for standardizing the management of obese patients before bariatric surgery. MDT meetings might help to reduce complication by optimizing patient selection and preoperative care.
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http://dx.doi.org/10.1016/j.soard.2017.05.026DOI Listing
September 2017

Identifying Patients Eligible for a Short Hospital Stay After Stoma Closure.

J Invest Surg 2018 Jun 31;31(3):168-172. Epub 2017 Mar 31.

a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France.

Introduction: The implementation of enhanced recovery programmes after elective colorectal surgery has dramatically reduced the length of stay. The objective of this study was to assess the selection of good candidates for short post-operative stay (GCSS) in the context of stoma closure.

Methods: Between January 2011 and December 2014, 222 patients were included in the present retrospective, single-center study. The primary endpoint was the proportion of GCSS. We also identified factors associated with GCSS status and built a predictive score.

Results: The study population was predominantly male (n = 122, 55%). 60% of the patients had undergone ileostomy and 85% had undergone hand-sewn anastomosis. The postoperative ileus rate was 5% and the readmission rate was 3.5%. 41% (n = 92) of the study population were considered to be GCSS. In a multivariate analysis, age under 50 (odds ratio (OR) [95% confidence interval (CI)] = 2.8 [1.2-5.6], p = 0.008), the absence of vascular comorbidities (OR [95%CI] = 3.2 [1.3-12.3]; p = 0.006) and stapled anastomosis (OR: 4.2, 95%CI: 1.1-17.3, p = 0.03) were associated with GCSS status. Predictive scores of 0, 1, 2, and 3 were associated with GCSS rates of 20%, 18%, 44%, and 62%, respectively (p < 0.001).

Conclusion: In the context of stoma closure, 41% of patients were GCSS.
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http://dx.doi.org/10.1080/08941939.2017.1299818DOI Listing
June 2018

Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy.

Surg Obes Relat Dis 2017 May 10;13(5):758-765. Epub 2017 Feb 10.

Department of Radiology, Amiens University Hospital, Amiens, France.

Background: Gastric leak (GL) is one of the main early-onset postoperative complications of sleeve gastrectomy (SG). Many institutions perform routine upper gastrointestinal (UGI) contrast studies within 24 hours of surgery, looking for GL or gastric stenosis and to determine the need for urgent re-exploration, but this examination delays oral feeding, can cause side effects and is responsible for systematic and probably unnecessary irradiation of the patient.

Objective: Determine the efficacy of routine UGI contrast studies to predict postoperative complications after SG in a large population.

Setting: University hospital, France, public practice.

Material And Methods: This study consisted of retrospective review of a prospective database of a cohort of patients who underwent primary SG between January 2007 and August 2013 (n = 1137). Routine UGI contrast studies, performed on postoperative day 1, were independently reviewed by 2 radiologists. The primary endpoint of the study was the effect of routine UGI contrast study on detecting postoperative complications. The secondary endpoints were comparison of the findings of routine UGI contrast study and abdominal computed tomography (CT) scan, sensitivity, and specificity of different imaging signs on abdominal CT scan in the presence of GL, evaluation of the SG learning curve based on the findings of routine UGI contrast studies.

Results: A total of 1137 patients underwent primary SG and 30 GL (2.6%) with a mean time to diagnosis of 23.4 days (1-245) and 15 cases of gastric stenosis (1.3%) were observed during the study period. Routine UGI study was performed in 1108 patients, whereas 29 patients were assessed by first-line CT scan. None of the 1108 UGI studies found a GL or gastric stenosis. In the 30 cases of GL, the most sensitive and specific sign was the presence of perigastric abscess without contrast material leak (sensitivity: 56.6%; specificity: 95%). The mean time interval between routine postoperative UGI contrast study and abdominal CT scan was 12.9 days (0-86). Uniform gastric shape was acquired after 30-32 SG procedures.

Conclusion: Routine postoperative UGI on postoperative day 1 is of limited value after SG. Abdominal CT scan should be preferred in the presence of clinical suspicion of postoperative complications. Selective UGI contrast study remains indicated when gastric stenosis is suspected and at the beginning of the SG learning curve.
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http://dx.doi.org/10.1016/j.soard.2017.02.003DOI Listing
May 2017

Eliminating routine upper gastrointestinal contrast studies after sleeve gastrectomy decreases length of stay and hospitalization costs.

Surg Obes Relat Dis 2017 Apr 19;13(4):553-559. Epub 2016 Oct 19.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Virology Research Unit, EA 4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address:

Background: Recent series have shown the lack of value of routine upper gastrointestinal (UGI) contrast studies on postoperative day 1 or 2 for the detection of gastric leak (GL) after sleeve gastrectomy (SG). Despite this finding, many centers still perform routine early UGI contrast studies after SG. No series has evaluated the impact of eliminating this examination on the overall management of patients undergoing SG.

Objectives: To evaluate the impact of UGI contrast studies on SG management.

Setting: University hospital, France, public practice.

Methods: This study was an ambispective study of a cohort of patients who underwent primary SG between January 2014 and December 2014 (n = 267). Two consecutive groups were compared: patients with routine UGI contrast studies on postoperative day 1 (UGI+group, n = 154) and patients without routine UGI contrast studies (UGI-group, n = 113). The efficacy endpoint of the study was the overall impact of not performing routine UGI contrast studies (length of hospital stay, radiological data, rehospitalization data, and economic assessment).

Results: The overall complication rate was 9.3% and no deaths were observed. The GL rate was 1.5%. The mean hospital stay was 1.8 days (2.1 days versus 1.5 days; P = .57). Routine UGI contrast studies did not detect any cases of GL or gastric stenosis. After UGI contrast studies, 56 patients complained of events related to UGI contrast studies (36.4%). A total of 27 computed tomography scans were performed during the first 3 postoperative months (16 in the UGI+group (10.4%) versus 11 in the UGI-group (9.7%); P = .52). Twelve patients were rehospitalized (7 and 5; P = .6). The median length of rehospitalization was 7 days (7 and 5 days; P = .6). Overall cost per patient during SG hospitalization was $5,219 in the UGI+group and $3,678 in the UGI-group (P = .01).

Conclusion: Eliminating routine UGI contrast studies was associated with decreased length of hospital stay and cost of SG procedures. Larger series are required to show that not performing routine UGI contrast studies has no impact on the postoperative complication rate and the management of these complications.
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http://dx.doi.org/10.1016/j.soard.2016.10.011DOI Listing
April 2017

Gastropancreatic ligament: Description, incidence, and involvement during laparoscopic sleeve gastrectomy.

Clin Anat 2017 Apr 12;30(3):336-341. Epub 2017 Jan 12.

Department of Digestive Surgery, Amiens University Hospital, Amiens Cedex 01, F-80054, France.

During laparoscopic sleeve gastrectomy (LSG), adhesions between the stomach and the pancreas are sometimes found, forming a "gastropancreatic ligament" (GPL). However, the GPL has only been described once in the literature, in 1985. The objective of this study was to determine the incidence of the GPL during LSG, describe this structure and assess its effect on the surgical technique. All patients undergoing primary LSG in our institution (n = 240) and patients referred for gastric fistula (GF) after primary LSG (n = 18) between January 2015 and December 2015 were included. The primary endpoint was the incidence of a GPL during primary LSG. The secondary endpoints were the postoperative complication rate, the postoperative GF rate, and the presence of this ligament during reoperation for GF. Among the 240 patients, a GPL was visible in 49 cases (20.4%) and was described as thin in 34 of these (69.4%). Twelve postoperative complications (5%) were observed, including seven major (2.9%). The GF rate was 2% (n = 5), not requiring reoperation. The gastric stenosis rate was 0.4% (n = 1). The GPL had been previously sectioned in one of the five patients (20%) with postoperative GF. During the study period, 18 patients were referred for GF and 14 were reoperated. A non-sectioned GPL, not described in the operating report, was observed in four patients (28.5%). A GPL was identified in 20.4% of cases. Identification of a GPL could be important in the context of LSG, as section of the ligament allows tension-free stapling to be performed and can therefore possibly reduce the risk of postoperative complications, particularly GF. Clin. Anat. 30:336-341, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.22819DOI Listing
April 2017

Outpatient laparoscopic sleeve gastrectomy: first 100 cases.

J Clin Anesth 2016 Nov 3;34:85-90. Epub 2016 May 3.

Department of Anesthesiology and Critical Care, Amiens University Medical Center, Avenue René Laennec, F-80054, Amiens cedex 01, France.

Study Objective: The development of outpatient surgery was one of the major goals of public health policy in 2010. The purpose of this observational prospective study was to evaluate the feasibility of laparoscopic sleeve gastrectomy (SG) in an ambulatory setting.

Design: Study design was a prospective prospective observational, nonrandomized study, registered (ClinicalTrials.gov identifier: NCT01513005), with institutional review board approval and written informed consent.

Setting: Amiens University Medical Center.

Patients: Patients undergoing SG who were preselected by inclusion ambulatory criteria.

Interventions: All patients operated on for obesity by laparoscopic SG, from May 2011 through July 2013.

Measurements: We collected outcomes data on 100 patients including incidence of postoperative nausea and vomiting, maximum and average pain scores, and the overall satisfaction rate.

Main Results: Of the 100 obese patients, 93% were women. The mean age was 36 years (22-55 years). The mean preoperative body mass index was 42.4 kg/m(2). The mean operating time was 60 minutes (range, 30-95 minutes). The overall satisfaction rate was 93% (n = 93). When leaving the postoperative care unit, 94% of patients felt no or mild pain. Eighty-two percent had no postoperative postoperative nausea and vomiting, and 7 patients needed treatment using ondasetron.

Conclusions: Laparoscopic SG in an ambulatory setting is feasible with a dedicated anesthesiological approach and an expert surgical team. Appropriate patient selection is important for ensuring safety and quality of care within the outpatient program.
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http://dx.doi.org/10.1016/j.jclinane.2016.03.026DOI Listing
November 2016

New endoscopic technique for the treatment of large gastric fistula or gastric stenosis associated with gastric leaks after sleeve gastrectomy.

Surg Obes Relat Dis 2016 Sep - Oct;12(8):1577-1584. Epub 2016 Apr 28.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Covered stent (CS) is required when gastric leak (GL) after sleeve gastrectomy is combined with gastric stenosis (GS) or when a large (>2 cm in diameter) gastric fistula is present (increasing the likelihood of double pigtail stent [DPS] migration).

Objective: To compare the results of our previous endoscopic management of large GL or GS associated with GL (using CS only) with those of our new endoscopic treatment (using combined CS and DPS).

Setting: University hospital, France, public practice.

Material And Methods: Between January 2009 and June 2015, all patients treated for large GL or GS associated with GL after sleeve gastrectomy (n = 20 patients) were included. Our previous endoscopic management required CS placement (CS group), whereas our new endoscopic treatment required combined CS and DPS placement (CS+DPS group). The primary efficacy endpoint was the treatment duration after CS placement until closure of the GL. The secondary efficacy endpoints were the number of endoscopic procedures, the stent migration rate, and the failure rate.

Results: Nine patients were treated by CS only (CS group), whereas 11 patients were treated by both CS and DPS (CS+DPS group). The median time to GL closure after CS placement was 84 days (33-130) in the CS group and 32 days (26-89) in the CS+DPS group (P≤.05). The median number of endoscopic procedures at the time of CS placement was 2 (1-3) in the CS group and 1 (1-2) in the CS+DPS group (P≤.05). The stent migration rate after CS placement was 33.3% in the CS group and 0% in the CS+DPS group (P = .21), and the failure rate was 11% and 0% (P = .36).

Conclusion: The combination of CS and DPS constitutes an effective treatment for large GL or GS associated with GL, allowing significantly fewer endoscopic procedures and a shorter treatment duration.
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http://dx.doi.org/10.1016/j.soard.2016.04.026DOI Listing
October 2017

Does sleeve gastrectomy improve the gait parameters of obese patients?

Surg Obes Relat Dis 2016 Sep - Oct;12(8):1474-1481. Epub 2016 Mar 25.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Few studies have evaluated the effect of bariatric surgery on gait parameters, which constitute an important aspect of quality of life.

Objective: Evaluate the effects of sleeve gastrectomy (SG) on kinematic gait parameters 6 months after surgery.

Setting: University Hospital, France, public practice.

Methods: This prospective, nonrandomized study was conducted in patients undergoing SG between January 2013 and December 2013. The primary endpoint was the difference in functional parameters of the patient's 6-minute walk test (6 MWT) before and 6 months after SG. Secondary outcomes were surgical data, weight loss, and quality of life score.

Results: Fifty-six patients were included. Mean preoperative body mass index was 46.3±7.1 kg/m (35.2-71.0). On the preoperative 6 MWT, the mean distance traveled was 467 m (267-606) at an average speed of 4.6 km/hr (2.67-6.06). Three patients were unable to complete the 6 MWT. At 6 months postoperatively, mean body mass index was 34.4±6.0 kg/m (24.8-53.8). On the 6-month postoperative 6 MWT, the mean distance traveled was 515 m (280-652) at an average speed of 5 km/hr (2.82-6.50; P<.01). All patients completed the test. A decrease in muscle and joint pain and an increased range of motion of the joints were observed (P<.01). All domains of the Short Form 36 questionnaire were significantly improved (P< .01).

Conclusion: SG significantly improves walking as well as range of motion of the joints. It also allows reduction of pain, facilitating the mobilization of obese patients that may be responsible for more marked weight loss after bariatric surgery. Quality of life improves and weight loss occurs after the SG.
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http://dx.doi.org/10.1016/j.soard.2016.03.023DOI Listing
October 2017

Gastric leaks after sleeve gastrectomy: no impact on weight loss, co-morbidities, and satisfaction rates.

Surg Obes Relat Dis 2016 Mar-Apr;12(3):502-510. Epub 2015 Jul 26.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Department of Gastro-Enterology, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address:

Background: No data are available concerning the results on weight loss, correction of co-morbidities, and satisfaction rates in patients with healed gastric leak (GL) after sleeve gastrectomy (SG).

Objective: Evaluate weight loss, correction of co-morbidities, and satisfaction rate of patients with healed GL after SG.

Setting: University hospital, France, public practice.

Methods: Between March 2004 and October 2012, all patients managed for GL after SG with a minimum of 1 year follow-up were included. These patients (GL group) were matched in terms of preoperative data and type of surgical procedure (first- or second-line SG) on a 1:2 basis with 74 patients without GL (control group) selected from a population of 899 SGs. Primary endpoint was the weight change over a 1-year period after performing SG. Secondary endpoints were GL data, co-morbidities data, and satisfaction rates 1 year after SG.

Results: The GL group consisted of 37 patients (27 first-line SG [73%]). The mean EWL in the GL group was 52.2% and 68.8% at 6 and 12 months, whereas the mean EWL in the control group was 58.9% and 72.2%, respectively (P = .12; P = .46). No significant difference was observed between the 2 groups in terms of correction of co-morbidities. At 12 months follow-up, mean BAROS score was 6.02 in the GL group and 7.14 in the control group (P = .08). No significant difference was observed between the 2 groups in terms of the SF-36 questionnaire.

Conclusion: Despite the morbidity associated with GL, the results on weight loss, correction of co-morbidities, and satisfaction rates were similar in patients with healed GL and in patients without GL.
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http://dx.doi.org/10.1016/j.soard.2015.07.016DOI Listing
October 2017

Repeat sleeve gastrectomy for the treatment of incomplete sleeve gastrectomy.

Surg Obes Relat Dis 2016 Feb 26;12(2):436-8. Epub 2015 Jul 26.

Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Medical Center, Amiens, France. Electronic address:

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http://dx.doi.org/10.1016/j.soard.2015.07.015DOI Listing
February 2016

Gastric Stenosis After Laparoscopic Sleeve Gastrectomy: Diagnosis and Management.

Obes Surg 2016 May;26(5):995-1001

Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, F-80054, Amiens Cedex 01, France.

Purpose: The use of laparoscopic sleeve gastrectomy (LSG) is increasing worldwide. Although post-LSG gastric stenosis (GS) is less frequent, it has not been well defined and lacks standardized management procedures. The objective of the present study was to describe a series of patients with GS symptoms after LSG and to develop a standardized management procedure for this complication.

Methods: We performed a retrospective analysis of a prospective database of patients presenting with GS after LSG procedures performed between January 2008 and March 2014. The primary efficacy criterion was the frequency of post-LSG GS. GS was classified as functional (i.e. a gastric twist) or organic. The secondary efficacy criteria included the time interval between LSG and diagnosis of GS, the type of stenosis, the type of management, and the follow-up data.

Results: During the study period, 1210 patients underwent primary or secondary LSG. Seventeen patients had post-operative symptoms of GS (1.4%); one patient had achalasia that had not been diagnosed preoperatively and thus was excluded from our analysis. The median time interval between LSG and diagnosis of GS was 47.2 days (1-114). Eleven patients had organic GS and six had functional GS. Seven patients required nutritional support. Endoscopic treatment was successful in 15 patients (88.2%) after balloon dilatation (n = 13) or insertion of a covered stent (n = 2). Two of the 15 patients required conversion to Roux-en-Y gastric bypass (11.8%).

Conclusion: GS after LSG is a rare complication but requires standardized management. Most cases can be treated successfully with endoscopic balloon dilatation.
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http://dx.doi.org/10.1007/s11695-015-1883-4DOI Listing
May 2016

Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video).

Surg Endosc 2016 Mar 15;30(3):1235-41. Epub 2015 Aug 15.

Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.

Introduction: Pancreatic pseudocysts and walled-off necrosis are well-known complications, described in 10% of cases of acute pancreatitis. Open cystogastrostomy is usually proposed after failure of minimally invasive drainage or in the presence of septic shock. The objective of this study was to evaluate the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy for treatment of symptomatic pancreatic pseudocyst with pancreatic necrosis.

Materials And Methods: Between January 2011 and October 2014, all patients with pseudocyst and pancreatic necrosis undergoing open cystogastrostomy were included. Surgical procedure was standardized. The primary efficacy endpoint was the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy as treatment of symptomatic pancreatic pseudocyst. Secondary endpoints included demographic data, preoperative management, operative data, postoperative data and follow-up.

Results: Laparoscopy-assisted open cystogastrostomy was performed in 11 patients [six men (54%)], with a median age of 61 years (45-84). Nine patients received preoperative radiological or endoscopic management. First-line open cystogastrostomy was performed in two cases. Median operating time was 190 min (110-240). There was one intraoperative complication related to injury of a branch of the superior mesenteric vein. There were no postoperative deaths and two postoperative complications (18%) including one major complication (postoperative bleeding). The median length of hospital stay after surgery was 16 days (7-35). The median follow-up was 10 months (2-45). One patient experienced recurrence during follow-up.

Conclusion: Open cystogastrostomy for necrotizing pancreatitis promotes adequate internal drainage with few postoperative complications and a short length of hospital stay. However, this technique must be performed very cautiously due to the risk of vascular injury which can be difficult to repair in the context of severe local inflammation related to pancreatic necrosis.
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http://dx.doi.org/10.1007/s00464-015-4331-6DOI Listing
March 2016

Laparoscopic management of gastric leak secondary to distal staple line disunion after sleeve gastrectomy.

Surg Obes Relat Dis 2015 Jul-Aug;11(4):940-1. Epub 2015 Apr 2.

Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens cedex 01, France; EA4294, Jules Verne University of Picardie, F-80054 Amiens, France; Clinical Research Center, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens cedex 01, France. Electronic address:

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http://dx.doi.org/10.1016/j.soard.2015.03.022DOI Listing
May 2016

Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation.

Surg Obes Relat Dis 2016 Jan 24;12(1):84-93. Epub 2015 Apr 24.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address:

Background: Gastric leak (GL) represents one of the main early-onset postoperative complication of sleeve gastrectomy (SG). Most studies of GL featured short series and no data on the time to reoperation for persistent GL.

Objectives: Characterize the time between discovery of persistent post-SG GL and the implementation of reoperation.

Setting: University hospital, France, public practice.

Methods: All patients treated for post-SG GL between November 2004 and December 2013 were included. The primary efficacy criterion was the time interval between discovery of a persistent GL and reoperation. The secondary efficacy criteria were demographic, surgical, and endoscopic data; mortality rate; time to GL healing; treatment success rate; and risk factors for failure treatment.

Results: Eighty-six patients were treated for post-SG GL. Forty patients (46.5%) had early-onset GL (postoperative day ≤ 7). Two patients (2.3%) presented primary gastrobronchial fistula. Fifty-six patients (70%) underwent immediate reoperation. Endoscopic treatment was required to treat the GL in 92.7% of the cases (n = 77). The mortality rate was 1.2% (n = 1). The treatment success rate was 89.1%. The median time to healing GL was 84 days (14-423 d). Eighty percent of the GLs had healed 120 days after discovery. After 120 days, the incidence of complications related to GL increased and few additional GLs healed. The only identified risk factor for treatment failure was large retained gastric fundus (P ≤ .05).

Conclusions: Most cases of GL can be adequately treated by incorporating endoscopic stenting. Surgery for persistent GL should be performed within 120 days of discovery; after this cut-off, the incidence of GL-related complications increases. Large retained gastric fundus is a risk factor for treatment failure and may prompt the surgeon to consider earlier reoperation.
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http://dx.doi.org/10.1016/j.soard.2015.04.012DOI Listing
January 2016

Combined stents for the treatment of large gastric fistulas or stenosis after sleeve gastrectomy.

Endoscopy 2015 17;47 Suppl 1 UCTN:E59-60. Epub 2015 Feb 17.

Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.

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http://dx.doi.org/10.1055/s-0034-1390711DOI Listing
January 2016

Trocar site hernia after laparoscopic sleeve gastrectomy using a specific open laparoscopy technique.

Surg Obes Relat Dis 2015 Jul-Aug;11(4):791-6. Epub 2014 Dec 5.

Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Obesity is recognized as a risk factor for trocar site hernia (TSH) after laparoscopic surgery. Some recent studies have reported a TSH rate after bariatric surgery ranging from 0% to 1.6% using clinical evaluation and may underestimate the TSH rate. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) by abdominal computed tomography (CT) scan.

Methods: A retrospective review of all patients who underwent first-line SG and abdominal CT scan between March 2004 and February 2014 was performed. The primary endpoint was the incidence of TSH. Secondary endpoints were the site of TSH, the TSH rate with open laparoscopy using the authors' technique, and risk factors for TSH after SG.

Results: During the period study, 1108 patients underwent first-line SG, including 10 cases of conversion to laparotomy (excluded from the present analysis). Of the remaining patients, 228 had abdominal CT scan (20.7%), with a mean age of 45.1 years (18-68 yr) and a mean BMI of 47.6 kg/m(2) (33-75.4 kg/m(2)). The median time interval between SG and CT scan was 27 months (3-92 mo). CT scan revealed 44 TSH in 43 patients (18.8%). The site of the TSH was epigastric (16.6%), open laparoscopy (1.7%), right subcostal margin (0.8%), with no TSH in the left subcostal margin. In patients with>1 year of follow-up, the TSH rate was 19.7%.

Conclusion: The TSH rate after bariatric surgery is underestimated. The authors' open laparoscopy technique is a reliable technique with a low TSH rate. In the light of these results, the epigastric trocar site is systematically closed at the end of SG.
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http://dx.doi.org/10.1016/j.soard.2014.11.028DOI Listing
May 2016

Is sleeve gastrectomy still contraindicated for patients aged≥60 years? A case-matched study with 24 months of follow-up.

Surg Obes Relat Dis 2015 Sep-Oct;11(5):1008-13. Epub 2014 Nov 28.

Departments of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Current guidelines consider that bariatric surgery is relatively contraindicated in elderly adults (aged≥60 years). The objective of this study was to evaluate obesity-related morbidity after sleeve gastrectomy (SG) according to whether patients were aged≥60 years or<60 years.

Methods: Forty-two patients aged≥60 years (the elderly group) were matched 1:2 with 84 patients aged<60 (the control group). The primary objective was to compare weight change and the remission rate of co-morbidities in the 2 groups after 24 months of follow-up. The secondary endpoints were short-term and midterm postoperative outcomes (operating time, the frequency of conversion to laparotomy, the length of hospital stay, postoperative complications, mortality, and the SG failure rate).

Results: No significant differences were observed between the elderly and control groups in terms of the mean operating time (83 minutes in both groups; P = .90), length of stay (3.2 versus 3.4 days, respectively; P = .51), morbidity rate (4.7% versus 9.5%, P = .35), or mortality rate (0% in both groups). The mean excess weight loss was significantly lower in the elderly group than in the control group at 12 months (56.2% versus 71.4%, respectively; P<.01) and 24 months (51.8% versus 73.5%, P<.01). Similar statistically significant differences were observed between the elderly group and control group for remission of metabolic syndrome (95% versus 90%, respectively; P = .55), type 2 diabetes mellitus (87% versus 71%, respectively; P = .13), hypertension (81% versus 77%, respectively; P = .71), and dyslipidemia (94% versus 74%, respectively; P = .09) at 24 months after SG.

Conclusion: Results support the safety and efficacy of SG for morbid obesity in patients aged≥60 years. In contrast to weight loss, the long-term morbidity rate and remission of obesity-related co-morbidities were similar in the participants aged≥60 years and those aged<60 years.
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http://dx.doi.org/10.1016/j.soard.2014.11.015DOI Listing
September 2016

The Safety of Laparoscopic Sleeve Gastrectomy in Patients Receiving Chronic Anticoagulation Therapy: A Case-Matched Study.

Obes Surg 2015 Sep;25(9):1686-92

Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.

Background: Obesity is linked to cardiac disorders with a relative risk of atrial fibrillation of 1.5 (requiring the use of chronic anticoagulation therapy, CAT). However, CAT is a known risk factor for postoperative bleeding after elective surgery. The primary objective of the present study was to evaluate the short- and long-term complications of laparoscopic sleeve gastrectomy (LSG) in patients receiving CAT.

Methods: This is a retrospective analysis of a prospective database of CAT patients undergoing LSG between March 2004 and December 2012. This LSG-CAT group was matched 1:2 on preoperative data with patients not receiving CAT (LSG-control group). Primary efficacy criterion was the frequency of CAT-related complications. Secondary efficacy criteria were the major postoperative complications, frequency of revisional surgery, long-term CAT-related complications, and a change in the dose level of oral anticoagulants.

Results: The LSG-CAT group consisted of 15 patients with a median age of 54 years (32-65). The LSG-control group consisted of 30 patients. Median operating time was 75 min in both groups (p = 0.33). Major complication rates in the LSG-CAT and LSG-control groups were 13.3 and 3.3 %, respectively (p = 0.20), with one case of postoperative bleeding in each group (6.7 and 3.3 %, p = 0.6); incidence of revisional surgery was 13.3 and 3.3 % (p = 0.2). There were no postoperative mortalities. After a median follow-up of 14 months (9-43), no changes in the dose level of oral anticoagulants were reported.

Conclusions: LSG in patients receiving CAT is not associated with CAT-specific complications. This surgical procedure enables good weight loss and does not require change in the dose level of oral anticoagulants.
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http://dx.doi.org/10.1007/s11695-015-1590-1DOI Listing
September 2015

Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization).

Surg Obes Relat Dis 2015 Mar-Apr;11(2):335-42. Epub 2014 Sep 16.

Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Day-case surgery (DCS) has boomed over recent years, as has laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity. The objective of this study was to evaluate the safety and feasibility of day-case SG.

Methods: This was a prospective, nonrandomized study of 100 patients undergoing day-case SG from May 2011 to July 2013. All patients met the criteria for DCS and for the treatment of morbid obesity. Standard surgical, anesthetic, and analgesic protocols were used. The primary study endpoint was the unplanned overnight admission rate. Secondary endpoints were standard DCS criteria, frequency and type of complications, and satisfaction rate of performing day-case SG. The short-term postoperative course of patients undergoing day-case and conventional SG also were compared.

Results: A total of 416 patients were screened and 100 (24%) were included. There were 8 unplanned overnight admissions. Seven unexpected consultations, 7 hospital readmissions, and 5 major complications were recorded, including 3 cases of unexpected surgery for gastric leak. At follow-up, 96% of the patients were satisfied with day-case SG. The short-term postoperative course was similar among patients undergoing DCS and conventional management.

Conclusion: In selected patients, day-case SG is feasible with acceptable complication and readmission rates. The postoperative course was similar to that observed for standard SG.
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http://dx.doi.org/10.1016/j.soard.2014.08.017DOI Listing
January 2016