Bilan préopératoire avant bypass gastrique chez le patient asymptomatique : l'endoscopie haute est-elle obligatoire?

Une oeso-gastro-duodénoscopie (OGD) est actuellement pratiquée systématiquement avant bypass gastrique. Notre objectif consiste à déterminer la prévalence des lésions découvertes lors de cet examen chez les patients asymptomatiques, ainsi que le taux d'infection à Helicobacter Pylori (HP), puis d'en évaluer l'impact clinique et financier, afin de déterminer le meilleur mode de bilan digestif préopératoire. Le taux élevé de lésions découvertes chez nos 319 patients confirme que l'absence de symptômes ne peut être considérée comme absence de lésion, et un bilan préopératoire systématique est donc obligatoire avant bypass gastrique. Toutefois, l'absence d'impact clinique des lésions découvertes et les investigations inutiles engendrées posent la question du rapport coût-bénéfice de l'OGD systématique avant bypass gastrique. Nous proposons donc d'investiguer les patients asymptomatiques par un dépistage non invasif de l'HP associé à une prophylaxie par inhibiteurs de la pompe à protons, permettant ainsi la détection et le traitement des lésions significatives sans l'invasivité et le coût d'une OGD

Twelve key nutritional issues in bariatric surgery

In morbidly obese patients, i.e. body mass index ≥35, bariatric surgery is considered the only effective durable weight-loss therapy. Laparoscopic Roux-en-Y gastric bypass (LRYGBP), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion with duodenal switch (BPD-DS) are associated with risks of nutritional deficiencies and malnutrition. Therefore, preoperative nutritional assessment and correction of vitamin and micronutrient deficiencies, as well as long-term postoperative nutritional follow-up, are advised. Dietetic counseling is mandatory during the first year, optional later. Planned and structured physical exercise should be systematically promoted to maintain muscle mass and bone health. In this review, twelve key perioperative nutritional issues are raised with focus on LRYGBP and LSG procedures, the most common current bariatric procedures

Innovation dans les technologies médicales:pourquoi et comment s'impliquer?

Medical technologies are an intrinsic part of our daily practice. More than a simple recipient of novel medical devices, clinicians have a unique role to play in medtech innovation. They are invaluable assets for testing devices and guiding manufacturers towards the most clinically relevant solutions. More importantly, they have a direct view on patient needs and can therefore identify unmet clinical needs. As these skills are not part of medical school curricula, new centers in medtech innovation education are arising across Europe following the success of US programs. These centers offer a full curriculum in medtech innovation so that doctors can more actively participate and foster innovation in their field. This new knowledge can allow us to initiate our own innovations and potentially influence the future of our own practice

Robotic distal pancreatectomy: a valid option?

Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach

Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory?

We aimed to determine before Roux-en-Y gastric bypass (RYGBP) in asymptomatic morbidly obese patients: 1) the prevalence of abnormal findings at upper gastrointestinal (UGI) endoscopy; 2) Helicobacter pylori (HP) status; 3) clinical consequences of these findings; and 4) associated costs

Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery

Revisional bariatric procedures (RBP) can be technically challenging. While robotics might provide help for complex procedures, the study aim was to report our experience with robotic RBP

Does perioperative nutrition and oral carbohydrate load sustainably preserve muscle mass after bariatric surgery? A randomized control trial

Perioperative nutrition and preoperative oral carbohydrate loading (CHL) have a beneficial impact on the outcomes of gastrointestinal oncological surgery. However no data exists on their effect on morbidly obese patients

Contemporary management of adult intussusception: who needs a resection?

Surgical resection is often recommended in adults with intestinal intussusception (AI) because of its potential association with malignancy. We provide a contemporary algorithm for managing AI by focusing on the probability of discovering a lead point