ASSISTANCE HEPATIQUE PAR XENOPERFUSION EXTRACORPORELLE DE FOIE DE PORC (MODELES D'ETUDES EXPERIMENTALES ET PRE-CLINIQUES)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

TRAITEMENT COELIOSCOPIQUE DU REFLUX GASTRO-OESOPHAGIEN PAR FUNDOPLICATURE A 270 DEGRES (ETUDE DE 96 PATIENTS)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Réinterventions pour complications et séquelles d'oesophagoplastie colique

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les Perforations de l'oesophage (traitement et facteurs pronostiques : Service de Chirurgie Viscérale, Digestive et de Transplantation Hépatique (Pr. J. Baulieux) ; Service de Chirurgie Viscérale, Digestive, Endocrinologique et Thoracique (Pr. JL. Peix))

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anastomose coloanale "différée" modifiée Baulieux (indications, particularités, techniques et résultats)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Evaluation de la morbidité et de la mortalité périopératoires des résections hépatiques anatomiques (à propos d'une série de 337 hépatectomies)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

ETUDE DE LA QUALITE DE VIE APRES CHIRURGIE CONSERVATRICE POUR CANCER DU BAS RECTUM TRAITE PAR RADIOTHERAPIE PRE-OPERATOIRE SUIVIE D'ANASTOMOSE COLO-ANALE DIFFEREE

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Chirurgie itérative après intervention anti-reflux (analyse des causes d'échecs et suivi d'une série de soixante quatorze patients)

Buts de l'etude : comprendre les causes d ' echec des montages anti-reflux, proposer des moyens de prevention des echecs, evaluer la morbidite, la mortalite et les resultats fonctionnels des reinterventions. Materiel et methodes : 74 patients ont ete reoperes a moyen ou long terme apres echec d'une ou plusieurs chirurgies anti-reflux dans deux services de centres hospitaliers universitaires. Les re interventions pour complications post-operatoires precoces etaient exclues. Une etude retrospective a ete conduite. Les facteurs etudies etaient : antecedents medicaux, geste et voie d'abord de l'intervention initiale, symptome principal et diagnostic preoperatoire, delai de re intervention, voie d'abord et geste de la re intervention, constat peroperatoire, morbidite, mortalite, re intervention dans les trois semaines, duree de sejour, et resultat fonctionnel selon la classification de Visick. Resultats : le diagnostic avant re intervention etait statistiquement lie a la voie d'abord (p<0.001) et au geste initial (p=0.008). Deux sclerodermies meconnues etaient decouvertes. Les gestes realises etaient : 39 transformations, repositionnements ou refections de montage, dont 16 en coelioscopie, 19 diversions duodenales totales, 5 interventions de Collis, 3 coloplasties, 5 pyloroplasties, une myotomie de Heller, 2 autres. Il n'etait observe aucun deces post operatoire precoce. Le taux de morbidite etait de 28 %. Un resultat fonctionnel correct ou bon etait obtenu dans 71 % des cas. Conclusion : des mesures preventives des echecs peuvent etre mises en place. Un bilan preoperatoire bien conduit des l'intervention initiale est indispensable. Les complications et les mauvais resultats fonctionnels sont plus frequents apres les reinterventions qu'apres une premiere chirurgie.ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Split/Reduced Liver Transplantation “IMSS”: The First Two Cases and Literature Overview

Introduction: The term Split/Liver Transplantation involved the ex vivo division of an adult cadaver liver into a pediatric allograft and a remnant adult allograft. The efforts were an attempt to satisfy an increasing demand for pediatric cadaver allografts that had resulted in prolonged waiting periods and a wait-list mortality of approximately 50% at major pediatric referral centers. The main of this work is given to know our experience in two different cases and encouraged at the adult surgeons to confide and accept the right allograft of this technique for an adult patient.Cases: We performed two reduced procedures by the split liver technique. The first case was a&nbsp; procurement of a male donor of 33 years’ old with diagnosis of cerebral death due to aneurysm rupture, and the recipient was a five years’ old girl with the diagnosis of biliary atresia. For the second case, we had a male donor of 8 years’ old with diagnosis of cerebral death secondary to arteriovenous malformation and the recipient was a 2.9 year´s old girl, with biliary atresia.Conclusion: There are no differences in complications between split in cadaveric donor to living liver donor. However for a good outcome, it is important to have a good donor like it is for a good recipient. In our&nbsp;center, the split liver transplantation is uncommon and there is a clear need for better training of surgeons and for improved sharing of information about this needed procedure.</p

Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer: evidence from randomized trials.

International audiencePURPOSE: The main treatment for resectable rectal cancer T2-T4 N0-N2 M0 is surgery. The benefit of preoperative or postoperative radiation therapy can be analyzed in terms of improvement of local control, sphincter preservation, and survival weighted against increased toxicity. METHODS: Only randomized trials can provide strong evidence of a positive cost-benefit ratio of such combined approach. The most recent trials were reviewed. RESULTS: Three randomized trials, including the latest German CAO-ARO trial, have demonstrated the superiority of preoperative radiotherapy with or without chemotherapy (vs. postoperative) in terms of local control and toxicity. The Ducth TME trial showed that even with modern standard surgery, preoperative radiotherapy improved local control. Preoperative irradiation using a high dose in a small volume and a long interval before surgery may improve sphincter preservation (Lyon trials). Concurrent chemoradiation (FFCD 9203, EORTC 22921, did not significantly improve sphincter preservation or survival but significantly reduced the local recurrence rate. CONCLUSIONS: In 2005 examination of randomized trials provides evidence for the benefit of preoperative chemoradiation in improving local control and probably sphincter preservation in rectal cancer. Randomized trials should be designed to further demonstrate improved sphincter preservation and to increase survival using adjuvant medical treatments