Publications by authors named "Elie Chouillard"

61 Publications

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting.

World J Emerg Surg 2021 May 11;16(1):23. Epub 2021 May 11.

Department of Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy.

Background: Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons.

Method: A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019.

Conclusions: Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.
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http://dx.doi.org/10.1186/s13017-021-00362-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111988PMC
May 2021

The use of Permacol® biological mesh for complex abdominal wall repair.

Minerva Surg 2021 Apr 23. Epub 2021 Apr 23.

Department of General & Digestive Surgery, Poissy/Saint-Germain Medical Center, Poissy, France -

Background: Complex abdominal wall repair (CAWR) remains challenging, especially in contaminated fields where the use of a synthetic mesh is associated with prohibitively complication rates. Consequently, biological mesh has been proposed as an alternative. The aim of our study was to evaluate the safety and efficacy of using Permacol® in patients who had CAWR.

Methods: We retrospectively reviewed the files of patients who had CAWR using the Permacol® mesh. Analysis included patients' preoperative characteristics, procedural parameters, and early and late post-operative complications including mainly recurrence. A multivariate regression model was performed to determine factors that influence 24-months recurrence rate.

Results: Between January 2009 and December 2018, 75 patients. The most common indication was hernia in a contaminated field (48.0%) and abdominal wall defect greater than 10 cm in diameter (36%). Overall, 44% of our patients were Centers for Disease Control (CDC) class II or III and 81.3% fall into category II or III according to the Ventral Hernia Working Group (VHWG) classification. Recurrence rate of our series was 9.3%. Complete fascial closure was achieved in 60 patients (80%). Upon univariate analysis complete fascial closure, posterior component separation, seroma drainage, BMI >30 kg/m2 and age >65 years, VHWD grade >2, DINDO CLAVIEN class > 2 affected the recurrence rate at 2 years follow up. When subcutaneous drains are placed prophylactically, recurrence rates drop from 38.7% (5/14) to 3.3% (2/61 patients) when drains are placed at the time of operation (p=0.02). Only fascial closure affected the 24-months recurrence rate on multivariate analysis (p<0.001).

Conclusions: Permacol® surgical implant use for CAWR is safe with a relatively low rate of hernia recurrence at 2 years. Prophylactic subcutaneous drain placement may reduce the risk of hernia recurrence. The presence of contaminated fields does not appear to influence hernia recurrence when Permacol® is used, in fact, the only factor that affects recurrence rate at 24-months on multivariate analysis is completeness of the fascial closure.
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http://dx.doi.org/10.23736/S2724-5691.21.08779-4DOI Listing
April 2021

COVID-19 pandemic: the second phase, are we ready now? An emergency surgeons' manifesto.

Minerva Surg 2021 06 14;76(3):289-290. Epub 2021 Apr 14.

Department of Trauma and Emergency Surgery, University Hospital of Parma, Parma, Italy.

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http://dx.doi.org/10.23736/S2724-5691.21.08699-5DOI Listing
June 2021

The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper.

World J Emerg Surg 2021 03 22;16(1):14. Epub 2021 Mar 22.

Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.

Method: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.

Results: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion.

Conclusions: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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http://dx.doi.org/10.1186/s13017-021-00349-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983964PMC
March 2021

The initiation, standardization and proficiency (ISP) phases of the learning curve for minimally invasive liver resection: comparison of a fellowship-trained surgeon with the pioneers and early adopters.

Surg Endosc 2020 Nov 10. Epub 2020 Nov 10.

Department of Surgery, Hôpital du Sacre Coeur, Montreal, QC, H4J 1C5, Canada.

Background: Using the Ideal Development Exploration Assessment and Long-term study (IDEAL) paradigm, Halls et al. created risk-adjusted cumulative sum (RA-CUSUM) curves concluding that Pioneers (P) and Early Adopters (EA) of minimally invasive (MI) liver resection obtained similar results after fewer cases. In this study, we applied this framework to a MI Hepatic-Pancreatic and Biliary fellowship-trained surgeon (FT) in order to assess where along the curves this generation fell.

Methods: The term FT was used to designate surgeons without previous independent operative experience who went from surgical residency directly into fellowship. Three phases of the learning curve were defined using published data on EAs and Ps of MI Hepatectomy, including phase 1 (initiation) (i.e., the first 17 or 50), phase 2 (standardization) (i.e., cases 18-46 or 1-50) and phase 3 (proficiency) (i.e., cases after 46, 50 or 135). Data analysis was performed using the Social Science Statistics software ( www.socscistatistics.com ). Statistical significance was defined as p < .05.

Results: From November 2007 until April 2018, 95 MI hepatectomies were performed by a FT. During phase 1, the FT approached larger tumors than the EA group (p = 0.002), that were more often malignant (94.1%) when compared to the P group (52.5%) (p < 0.001). During phase 2, the FT operated on larger tumors and more malignancies (93.1%) when compared to the Ps (p = 0.004 and p = 0.017, respectively). However, there was no difference when compared to the EA. In the phase 3, the EAs tended to perform more major hepatectomies (58.7) when compared to either the FT (30.6%) (p = 0.002) or the P's cases 51-135 and after 135 (35.3% and 44.3%, respectively) (both p values < 0.001). When compared to the Ps cases from 51-135, the FT operated on more malignancies (p = 0.012), but this was no longer the case after 135 cases by the Ps (p = 0.164). There were no statistically significant differences when conversions; major complications or 30- and 90-day mortality were compared among these 3 groups.

Discussion: Using the IDEAL framework and RA-CUSUM curves, a FT surgeon was found to have curves similar to EAs despite having no previous independent experience operating on the liver. As in our study, FTs may tend to approach larger and more malignant tumors and do more concomitant procedures in patients with higher ASA classifications than either of their predecessors, without statistically significant increases in major morbidity or mortality.

Conclusion: It is possible that the ISP (i.e., initiation, standardization, proficiency) model could apply to other innovative surgical procedures, creating different learning curves depending on where along the IDEAL paradigm surgeons fall.
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http://dx.doi.org/10.1007/s00464-020-08122-1DOI Listing
November 2020

Is robotic pancreatic surgery finally ready for prime-time?

Hepatobiliary Surg Nutr 2020 Oct;9(5):650-653

Centre Hospitalier Intercommunal de Poissy/Saint-Germain-En-Laye, Poissy, France.

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http://dx.doi.org/10.21037/hbsn.2019.12.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603924PMC
October 2020

The experience of the minimally invasive (MI) fellowship-trained (FT) hepatic-pancreatic and biliary (HPB) surgeon: could the outcome of MI pancreatoduodenectomy for peri-ampullary tumors be better than open?

Surg Endosc 2020 Nov 4. Epub 2020 Nov 4.

Clinique Michel Ganger, Inc, 1 Carré Westmount Suite 801, Westmount, QC, H3Z 2P9, Canada.

Background: Although early series focused on benign disease, minimally invasive pancreatoduodenectomy (MIPD) might be particularly suited for malignancy. Unlike their predecessors, fellowship-trained (FT) Hepatic-Pancreatic and Biliary (HPB) surgeons usually have equal skills in approaching peri-ampullary tumors (PT) either openly or via minimally invasive (MI) techniques.

Method: We retrospectively reviewed a MI-HPB-FT surgeon's 10-year experience with PD. A sub-analysis of malignant PT was also done (MIPD-PT vs. OPD-PT). The primary endpoint was to assess postoperative mortality and morbidity. Secondary endpoints included operative parameters, length of hospital stay, and survival analysis. Moreover, we addressed practice pattern changes for a surgeon straight out of training with no previous experience of independent surgery.

Results: From December 2007-February 2018, one MI-HPB-FT performed a total of 100 PDs, including 57 MIPDs and 43 open PDs (OPDs). In both groups, over 70% of PDs were undertaken for malignancy. Eight patients with borderline resectable pancreatic ductal cancer (PDC) were in the OPD-PT group (as compared to only 2 in the MIPD-PT group) (p = 0.07). Estimated mean blood loss and length of stay were less in the MIPD-PT group (345 mL and 12 days) as compared to the OPD-PT group (971 mL and 16 days), p < 0.001 and p = 0.007, respectively. However, the mean operative time was longer for the MIPD-PT (456 min) as compared to the OPD-PT (371 min), p < 0.001. Thirty and 90-day mortality was 2.6%/5.1% after MIPD-PT compared to 0%/3.2% after OPD-PT, respectively, p = 1. Overall 30-/90-day morbidity rates were similar at 41.0%/43.6% after MIPD-PT and 35.5%/41.9% after OPD-PT, respectively, p = 0.8 and 1. Complete resection (R0) rates were not statistically different, 97.4% after MIPD-PT compared to 87.0% after OPD-PT (p = 0.2). After MIPD and OPD for malignant PT, overall 1, 3 and 5-year survival rates, and median survival were 82.5%, 59.6% and 46.3% and 38 months as compared to 52.5%, 15.7% and 10.5% and 13 months, respectively (p = 0.01). In the MIDP-PT group, recurrence free survival (RFS) at 1, 3 and 5 years and median RFS were 69.1%, 41.9% and 33.5% and 26 months as compared to 50.4%, 6.3% and 6.3% and 13 months, in the OPD-PT group, respectively (p = 0.03).

Conclusion: FT HPB Surgeons who begin their practice with the ability to do both MI and OPD may preferentially approach resectable peri-ampullary tumors minimally invasively. This may result in decreased blood loss decreased length of hospital stays. Despite longer operative time, the improved visualization of MI techniques may enable superior R0 rates when compared to historical open controls. Moreover, combined with quicker initiation of adjuvant chemotherapeutic treatments, this may eventually result in improved survival.
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http://dx.doi.org/10.1007/s00464-020-08118-xDOI Listing
November 2020

Current management of acute left colon diverticulitis: What have Italian surgeons learned after the IPOD study?

Updates Surg 2021 Feb 3;73(1):139-148. Epub 2020 Oct 3.

Emergency and Trauma Surgery Department, University Hospital of Parma, Parma, Italy.

The acute left diverticulitis is a common problem encountered by surgeons in the acute setting. Some years ago, the Italian Prospective Observational Diverticulitis (IPOD) study showed several disputes in managing acute left colon diverticulitis in Italian surgical department. The aim of this study is to check the compliance of Italian surgeons with clinical evidence-based guidelines in non-university hospitals. A 21 multiple-choice questions survey was sent to the Italian Society of Hospital Surgeons (ACOI) mailing list members, from the 1st April 2019 to 6th June 2019. One hundred and seventy-four Italian general surgeons (the ACOI collaborative diverticulitis group) joined the project and answered to the survey. The response rate was 7% (174/2500 ACOI members). Despite current international guidelines about the management of acute diverticulitis, several controversies have emerged from the analysis of this survey in the clinical practice of Italian surgeons, resulting from their low compliance with evidence-based recommendations.
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http://dx.doi.org/10.1007/s13304-020-00891-7DOI Listing
February 2021

Correction to: Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases.

Obes Surg 2020 Oct;30(10):3988

Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France.

In the original article the name of author Luigi Prisco was incorrect. It is correct here.
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http://dx.doi.org/10.1007/s11695-020-04810-yDOI Listing
October 2020

Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases.

Obes Surg 2020 Oct 17;30(10):3982-3987. Epub 2020 Jun 17.

Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France.

Purpose: In France, laparoscopic gastric plication (GP) has rarely been utilized as a weight loss procedure. Although relatively safe and efficient, its long-term results are still controversial. The goal of this study is to assess the indications and outcomes of revisional surgery post-GP.

Materials And Methods: Between February 2010 and September 2017, patient characteristics undergoing GP were prospectively collected from our database. Failure of conservative treatment or presence of anatomical anomaly explaining weight loss insufficiency was an indication for revisional surgery (RS).

Results: A total of 300 patients were included, 41 patients were lost to follow-up (13.7%), 124 patients (41.3%) had total weight loss (TWL) > 30%, and 116 patients (38.7%) underwent RS. Revisional procedures were laparoscopic Roux-en-Y gastric bypass (RYGB) in 72 patients (62.1%) and sleeve gastrectomy (SG) in 44 patients (37.9%). The median interval to RS was 29 months. The mean operative time was 60 min for the SG and 125 min for the RYGB (p < 0.0001). Mortality was nil. Significant morbidity occurred in eight patients (6.9%) including 4 non-abdominal complications, 1 gastric leak, 1 case of hemorrhage, 1 case of hematoma, and 1 intra-abdominal abscess. The mean length of hospital stay (LOS) was 2.9 days (range, 1-11) for the SG group vs 3.2 days (range, 2-8) for the RYGB group (p = 0.608).

Conclusion: GP is associated with a relatively high rate of weight regain or insufficient weight loss. When compared to SG, RYGB seems to be the safer revisional procedure with fewer surgical complications.
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http://dx.doi.org/10.1007/s11695-020-04767-yDOI Listing
October 2020

Roux-en-Y Gastro-jejunostomy for Complex Leak After the "Nissen" Variant of Sleeve Gastrectomy.

Obes Surg 2020 Sep;30(9):3642-3644

Department of Bariatric Surgery, CHU Felix-Guyon, St-Denis, la Réunion, France.

Background: Recently, improvised variants of sleeve gastrectomy SG were reported as alternative bariatric options in patients suffering from both morbid obesity and GERD, including mainly additional anterior or posterior fundoplication over a partially sleeved stomach.

Methods: We present the case of a 29-year-old male patient with a body mass index (BMI) of 46.2 kg/m2 underwent laparoscopic SG with concomitant posterior fundoplication: Nissen-SG (N-SG). At postoperative day (POD) 4, he presented with epigastric pain, nausea, and 40 °C fever. The abdomen was tender with signs of peritonitis. Explorative laparotomy displayed a massive gastric leak with generalized peritonitis. Peritoneal lavage was performed. the patient was transferred to our department for the management of persistent SGL.

Results: Initial management comprised total parenteral nutrition and wide-spectrum intravenous antibiotics. Three weeks later, the patient underwent laparoscopic exploration. As shown in the video, at least two leaks were individualized, including one, anterior, catheterized by the pigtails, and the other one, posterior, impossible to reach endoscopically (Fig. 1). A residual abscess, located between the left crus, the pancreas, and the upper edge of the spleen, was evacuated. Eventually, Roux-en-Y gastro-jejunostomy was performed CONCLUSION: The adjunction of a posterior fundoplication may have contributed to the multiple and complex occurrence of SGL. Having an ill-vascularized redundant fundus may have increased ischemia of the GE junction. Moreover, it is more difficult to perform endoscopic treatment in a plicated and sleeved stomach as well.
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http://dx.doi.org/10.1007/s11695-020-04731-wDOI Listing
September 2020

König's Syndrome After Roux-en-Y Gastric Bypass: Candy Cane Twist.

Obes Surg 2020 Aug;30(8):3251-3252

Department of General and Digestive Surgery, Bariatric Surgery Unit, Poissy Saint Germain-en-laye, Saint Germain-en-laye, France.

Background: A König's syndrome is referred to abdominal pain in relation to meals with constipation alternated with diarrhea, meteorism, and abdominal distension. A postoperative long-term complication after Roux-en-Y gastric bypass could be the appearance of chronic abdominal pain associated with vomiting, dysphagia, and nausea.

Case Report: A 43-year-old female patient was submitted for a Roux-en-Y gastric bypass for morbid obesity with an initial body mass index (BMI) of 36 kg/m (weight 100 kg, height 168 cm). At the 5-year follow-up, the patient's BMI was 22.3 kg/m with a weight loss of 40 kg. In the last month, the patient has undergone a further weight loss of 8 kg (BMI 18.4 kg/m) with the presence of chronic abdominal pain, dyspepsia, and dysphagia and abdominal distension. Any vasomotor problems (hot flushing, sweating, palpitations, and diarrhea) were described. The computer tomography (CT) with oral contrast shows the presence of a blind afferent Roux limb at the gastrojejunostomy, explaining a possible König's syndrome.

Results: The patient was submitted for a diagnostic laparoscopy, which revealed the presence of a twisted candy cane that was identified and resected. The postoperative stages were uneventful and the patient was discharged on the second postoperative day.

Conclusion: Candy cane syndrome is a rare and challenging complication reported in bariatric patients following Roux-en-Y gastric bypass and is best investigated with a barium swallow or oesophago-gastro-duodenoscopy (OGD). This means that this kind of pathology could be avoided by not leaving such a long blind loop during the primary gastric bypass operation. An explorative laparoscopy could be performed in the event of abdominal pain, nausea, and vomiting at a long-term follow-up after gastric bypass. Even if there are little data regarding the efficacy of surgical treatment, if present, "candy cane" surgical revision seems to be the best treatment for the majority of the patients with long-term symptomatic relief.
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http://dx.doi.org/10.1007/s11695-020-04563-8DOI Listing
August 2020

Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!

World J Emerg Surg 2020 04 19;15(1):28. Epub 2020 Apr 19.

Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy.

Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).
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http://dx.doi.org/10.1186/s13017-020-00308-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168830PMC
April 2020

Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial.

BMC Cancer 2019 Dec 4;19(1):1185. Epub 2019 Dec 4.

Department of Surgery, Paris-Sud University, Assistance Publique Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicetre, France.

Background: Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population.

Methods: The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total.

Discussion: To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years.

Trial Registration: ClinicalTrials.gov NCT03033719 (January 27, 2017).
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http://dx.doi.org/10.1186/s12885-019-6376-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894257PMC
December 2019

Timing of laparoscopic elective surgery for acute left colonic diverticulitis. Retrospective analysis of 332 patients.

Am J Surg 2020 07 19;220(1):182-186. Epub 2019 Oct 19.

Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France.

Purpose: The optimal time to perform elective surgery remains to be determined. We analyzed the impact of time interval to surgery on short-terme outcome parameters in patients undergoing elective laparoscopic left colonic resection for diverticulitis.

Materials And Methods: Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of diverticulitis: group A (within 90 days) and group B (beyond 90 days).

Results: 332 patients had left colonic resection for diverticulitis. 117 patients were included in group A vs 114 patients in group B. Overall abdominal morbidity in Group A was 21% vs 5% in group B (p = 0.02). Mean hospital stay was 7.7 days in group A vs 5 days in group B (p = 0.08). Residual inflammation was significantly increased in group A (31%) as compared to group B (11%) (p = 0.01).

Conclusions: Laparoscopic left colonic resection for acute diverticulitis is best performed beyond the third month after the last acute episode.
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http://dx.doi.org/10.1016/j.amjsurg.2019.10.039DOI Listing
July 2020

Complete resolution of obstructive colonic amebic pseudotumor with conservative treatment: A case report and literature review.

Int J Surg Case Rep 2019 7;59:1-3. Epub 2019 May 7.

Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, Poissy, France.

Introduction: Entamoeba histolytica is a well-known cause of infectious colitis, it has a worldwide distribution. Presentation ranges from mild diarrhea to occasionally frank dysentery and may spread to involve extra intestinal sites such as the liver, lung, and other organs, in the form of amebic abscesses.

Case Presentation: Herein, we report a case of amebic pseudotumor wherein the diagnosis was revealed after 2 months of diarrhea.

Discussion: Colonic amebiasis, may rarely form a segmental mass called amebic pseudotumor in patient untreated or inadequately treated during the course of proven amebic colitis. Due to the rarity of colonic amoebic pseudo tumor it is usually discovered incidentally during surgical interventions. However if discovered earlier it responds well to medical treatment and usually resolves within few weeks.

Conclusion: So surgical intervention is reserved for complications of this entity manifested by fulminant colitis or colonic perforation.
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http://dx.doi.org/10.1016/j.ijscr.2019.04.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517529PMC
May 2019

Esophageal Stricture Due to a Self-Expandable Metal Stent (SEMS) Placement for Post Sleeve Gastrectomy Leak: a Case Report.

Obes Surg 2019 06;29(6):1943-1945

Department of General and Digestive Surgery, Bariatric Surgery Unit, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, Poissy, 78300, France.

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http://dx.doi.org/10.1007/s11695-019-03835-2DOI Listing
June 2019

Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial.

Lancet 2019 Mar 6;393(10178):1299-1309. Epub 2019 Mar 6.

CarMeN Laboratory, Université Claude Bernard Lyon 1, INSERM 1060, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Specialized Center for Obesity Management, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite, France.

Background: One anastomosis gastric bypass (OAGB) is increasingly used in the treatment of morbid obesity. However, the efficacy and safety outcomes of this procedure remain debated. We report the results of a randomised trial (YOMEGA) comparing the outcomes of OAGB versus standard Roux-en-Y gastric bypass (RYGB).

Methods: This prospective, multicentre, randomised non-inferiority trial, was held in nine obesity centres in France. Patients were eligible for inclusion if their body-mass index (BMI) was 40 kg/m or higher, or 35 kg/m or higher with the presence of at least one comorbidity (type 2 diabetes, high blood pressure, obstructive sleep apnoea, dyslipidaemia, or arthritis), and were aged 18-65 years. Key exclusion criteria were a history of oesophagitis, Barrett's oesophagus, severe gastro-oesophageal reflux disease resistant to proton-pump inhibitors, and previous bariatric surgery. Participants were randomly assigned (1:1) to OAGB or RYGB, stratified by centre with blocks of variable size; the study was open-label, with no masking required. RYGB consisted of a 150 cm alimentary limb and a 50 cm biliary limb and OAGB of a single gastrojejunal anastomosis with a 200 cm biliopancreatic limb. The primary endpoint was percentage excess BMI loss at 2 years. The primary endpoint was assessed in the per-protocol population and safety was assessed in all randomised participants. This study is registered with ClinicalTrials.gov, number NCT02139813, and is now completed.

Findings: From May 13, 2014, to March 2, 2016, of 261 patients screened for eligibility, 253 (97%) were randomly assigned to OAGB (n=129) or RYGB (n=124). Five patients did not undergo their assigned surgery, and after undergoing their surgery 14 were excluded from the per-protocol analysis (seven due to pregnancy, two deaths, one withdrawal, and four revisions from OAGB to RYGB) In the per-protocol population (n=117 OAGB, n=117 RYGB), mean age was 43·5 years (SD 10·8), mean BMI was 43·9 kg/m (SD 5·6), 176 (75%) of 234 participants were female, and 58 (27%) of 211 with available data had type 2 diabetes. After 2 years, mean percentage excess BMI loss was -87·9% (SD 23·6) in the OAGB group and -85·8% (SD 23·1) in the RYGB group, confirming non-inferiority of OAGB (mean difference -3·3%, 95% CI -9·1 to 2·6). 66 serious adverse events associated with surgery were reported (24 in the RYGB group vs 42 in the OAGB group; p=0·042), of which nine (21·4%) in the OAGB group were nutritional complications versus none in the RYGB group (p=0·0034).

Interpretation: OAGB is not inferior to RYGB regarding weight loss and metabolic improvement at 2 years. Higher incidences of diarrhoea, steatorrhoea, and nutritional adverse events were observed with a 200 cm biliopancreatic limb OAGB, suggesting a malabsorptive effect.

Funding: French Ministry of Health.
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http://dx.doi.org/10.1016/S0140-6736(19)30475-1DOI Listing
March 2019

Correction to: Massive Gastrointestinal Bleeding Due to Splenic Artery Erosion by a PigTail Drain in a Post Sleeve Gastrectomy Leak: a Case Report.

Obes Surg 2019 May;29(5):1657

Department of General Surgery and Minimally Invasive Surgery, Poissy Saint-Germain Medical Complex, Poissy, France.

The name of author Frédérick Moryoussef was incorrect in the original article - it is correct here.
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http://dx.doi.org/10.1007/s11695-019-03787-7DOI Listing
May 2019

Resectional One Anastomosis Gastric Bypass/Mini Gastric Bypass as a Novel Option for Revision of Restrictive Procedures: Preliminary Results.

J Obes 2018 18;2018:4049136. Epub 2018 Sep 18.

Department of Imaging, Clinique du Levant, University Saint Joseph Medical School, Beirut 50226, Lebanon.

Background: Revisional surgery is becoming a common and challenging practice in bariatric centers. The aim of this study was to evaluate resectional one anastomosis gastric bypass/mini gastric bypass (R-OAGB/MGB) as a revisional procedure.

Methods: From January 2016 to February 2017, data on 21 consecutive patients undergoing R-OAGB/MGB for weight loss failure after primary restrictive procedures were prospectively collected and analysed.

Results: Mean age was 39 ± 12 years (18-65), and 11 (52.3%) were women. The mean operative time was 96.4 ± 20.9 min (range, 122-80), and the mean postoperative stay was 47.8 ± 7.4 hours (range, 36-73). There were no deaths and no procedure-related complications. The mean body mass index (BMI) decreased from 42.9 ± 6.5 at the time of R-OAGB/MGB to 28.5 ± 4 at the 12-month follow-up. At that time point, the mean percentage of BMI loss (%EBL) and the mean percentage of total body weight loss (%TWL) reached 81.6 ± 0.17% and 35 ± 0.01%, respectively.

Conclusion: R-OAGB/MGB was technically straightforward, effective, and safe in this at-surgical risk population. R-OAGB/MGB should be added to the armamentarium of revisional bariatric procedures considering its technical aspects and the potential advantage on weight loss.
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http://dx.doi.org/10.1155/2018/4049136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167600PMC
September 2019

Changing the quality of life in old age bariatric patients. Cross-sectional study for 79 old age patients.

Int J Surg 2018 Jun 3;54(Pt A):236-241. Epub 2018 May 3.

Department of Digestve Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. Electronic address:

Purpose: Bariatric surgery is being safely performed in elderly patients. However, current recommendations lack precise indications for bariatric surgery and fail to define an upper age limit for surgical procedure, leaving the field wide open to case by case assessment according to patient's physiological age and benefit-to-risk balance.

Objectives: The aim of this study is to evaluate the quality of life of obese patients older than 60 years one year after bariatric surgery, and to compare the variation of their nutritional parameters to those of matched younger patients.

Methods: and methods. Data were prospectively collected for all patients who underwent bariatric surgery at our institution starting 1998. Seventy-nine patients older than 60 years (Group1) were matched 1:2 with 158 patients younger than 50 years (Group 2) for comparison of nutritional parameters. A modified Impact of Weight on Quality Of Life (IWQOL) questionnaire was filled by all included patients, at the one-year check-up.

Results: The modified IWQOL questionnaire was filled by 69 patients (87.3%). Of a total of 1860 answers, 11 (0.6%) were marked worsening, 64 (3.4%) were mild worsening, 181 (9.7%) were mild improvement, and 1422 (76.5%) were marked improvement. There were more positive answers than negative ones consistently within the five sections. In both groups, mean serum albumin were lower at the third postoperative month than the preoperative values (39.75 versus 41.72; p < 0.001 and 39.78 versus 41.99; p < 0.001 in Groups 1 and 2, respectively). At 6 and 12 months, in both groups, these values were similar to those of the preoperative period. The serum prealbumin levels reached back the preoperative values at 12 and 6 months, respectively, in Groups 1 and 2. Values were significantly lower in Group1 compared to Group 2 at three and six months (0.18 versus 0.19; p = 0.04 and 0.20 versus 0.21; p = 0.03, respectively) but not at one year.

Conclusions: Bariatric surgery improves quality of life in elderly obese patients with no compromise on their nutritional status (protein deficiencies). In the lack of precise recommendations, this represents a major argument that may serve to the preoperative assessment of such patients. More complex evaluations in a prospective controlled studies with long-term follow-up are mandatory to validate these findings and precise the estimated advantage in terms of risks of fall and fracture.
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http://dx.doi.org/10.1016/j.ijsu.2018.04.050DOI Listing
June 2018

Metabolic Surgery and Diabesity: a Systematic Review.

Obes Surg 2018 07;28(7):2069-2077

Departement of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France.

Bariatric surgery is used to induce weight loss (baros = weight). Evidence has shown that bariatric surgery improves the comorbid conditions associated with obesity such as hypertension, hyperlipidemia, and type 2 diabetes mellitus T2DM. Hence, shifting towards using metabolic surgery instead of bariatric surgery is currently more appropriate in certain subset of patients. Endocrine changes resulting from operative manipulation of the gastrointestinal tract after metabolic surgery translate into metabolic benefits with respect to the comorbid conditions. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect. The aim of this systematic review is to examine clinical trials regarding long-term effects of bariatric and metabolic surgery on patients with T2DM and to evaluate the potential mechanisms leading to the improvement in the glycaemic control.
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http://dx.doi.org/10.1007/s11695-018-3252-6DOI Listing
July 2018

Detecting Bile Reflux-the Enigma of Bariatric Surgery.

Obes Surg 2018 07;28(7):2050-2051

Department of Pediatric Surgery, CHU Félix Guyon, Saint-Denis, Réunion, France.

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http://dx.doi.org/10.1007/s11695-018-3267-zDOI Listing
July 2018

Retrospective Comparison of Single-Port Sleeve Gastrectomy Versus Three-Port Laparoscopic Sleeve Gastrectomy: a Propensity Score Adjustment Analysis.

Obes Surg 2018 07;28(7):2105-2112

Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France.

Purpose: Evaluate the efficacy of single-port sleeve gastrectomy (SPSG) and then compare it to a less-invasive sleeve approach (three-port) (3PSG) according to a propensity score (PS) matching analysis.

Materials And Methods: We analyzed all patients who underwent SG through a three-port or a single-port laparoscopic approach.

Results: After 2 years, the follow-up was completed in 84% patients treated with 3PSG and 95% patients of the SPSG group. Excess weight loss (EWL) was comparable for the first year of follow-up within the two groups except for the controls at 3 months in which the SPSG group showed a higher EWL (p = 0.0243).

Conclusion: We demonstrated the efficacy of SPSG in bariatric surgery even compared to another, less invasive, laparoscopic SG approach (three-port).
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http://dx.doi.org/10.1007/s11695-018-3244-6DOI Listing
July 2018

How to manage bile duct injury in patients with duodenal switch.

Surg Obes Relat Dis 2018 03 28;14(3):428-430. Epub 2017 Nov 28.

Department of Digestive and Minimally Invasive Surgery, Poissy, France.

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http://dx.doi.org/10.1016/j.soard.2017.11.025DOI Listing
March 2018

Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience.

Obes Surg 2018 04;28(4):939-944

Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France.

Background: Gastrogastric fistula (GGF) occurs in 1-6% of patients who undergo Roux-en-Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer.

Objectives: The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication.

Setting: The setting of this study is University Hospital, France.

Materials And Methods: We conducted a retrospective review of all patients' records with a diagnosis of GGF after RYGB between January 2004 and November 2014.

Results: During the study period, 1273 patients had RYGB for morbid obesity. Fifteen patients presented with a symptomatic GGF (1.18%). The average interval from surgery to presentation was 28 months (22-62). A history of marginal ulcer or anastomotic leak was present in nine patients (60%). The most common presentation was weight regain (80%), followed by pain (73.3%). Two types of fistulas were identified, an exclusively GGF (high) and a gastro-jejuno-gastric fistula (low). High GGF, frequently associated with dilatation of the gastric pouch, was treated by a sleeve of the pouch and sleeve resection of the remnant stomach (nine patients). Low GGF was treated with gastric resection coupled with a revision of the gastrojejunal anastomosis (six patients). All patients were treated laparoscopically with no conversion to laparotomy. The average length of postoperative hospital stay was 5.2 days (range 3-10).

Conclusion: GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.
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http://dx.doi.org/10.1007/s11695-017-2949-2DOI Listing
April 2018

Recurrent gastric metal bezoar: a rare cause of gastric outlet obstruction.

BMJ Case Rep 2017 Sep 27;2017. Epub 2017 Sep 27.

Digestive and Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France.

A 52-year-old male patient with psychiatric medical history who presented to the emergency department five times during a period of 5 years due to gastric outlet obstruction manifested mainly by abdominal pain, vomiting and haematemesis after intentionally ingesting metals and which necessitate several surgical interventions. Lately, he presented with generalised peritonitis due to gastric perforation from metal bezoars. Chronic abdominal symptoms in patient having a psychiatric disorder can be due to foreign body ingestion. Treatment is often surgical and the whole digestive tract should be explored to avoid retained bezoars.
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http://dx.doi.org/10.1136/bcr-2017-221928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747782PMC
September 2017

More than a Case Report? Should Wernicke Encephalopathy After Sleeve Gastrectomy be a Concern?

Obes Surg 2017 10;27(10):2684-2687

Department of Digestive and Minimally Invasive Surgery, CHI Poissy, 10 Rue du champ Gaillard, 78300, Poissy, France.

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http://dx.doi.org/10.1007/s11695-017-2823-2DOI Listing
October 2017