Faisabilité de la gastrectomie longitudinale en ambulatoire

Introduction La chirurgie ambulatoire est en plein essor ces dernières années au même titre que la gastrectomie longitudinale tubulisée (GL) dans le traitement de l'obésité morbide. La mise en place d un anneau gastrique en chirurgie ambulatoire est effectuée régulièrement dans de nombreux centres de chirurgie bariatrique. Le but de cette étude prospective était de montrer la faisabilité de la GL en ambulatoire. Matériel et méthodes Il s'agissait d'une étude prospective non randomisée de 30 patients ayant une GL en ambulatoire de mai 2011 à Avril 2012. Tous les patients répondaient aux critères de la chirurgie ambulatoire et de la chirurgie bariatrique. Les procédures chirurgicales, anesthésiques et analgésiques ont été standardisées. Le critère principal de l étude était le taux d'admissions non programmées. Les critères secondaires étaient les critères de la chirurgie en ambulatoire, les complications et les critères de la chirurgie bariatrique. Résultats Parmi les 136 patients ayant eu une GL, 30 (22%) ont été inclus. Il n'y avait aucunes admissions non programmées. Nous avons enregistrer 6 consultations non programmées (20%), 4 hospitalisations non programmées (13,3%) et 2 complications majeures (6,6%) dont une chirurgie non programmée pour fistule gastrique (3,3%). La perte moyenne d excès de poids à 3 et 6 mois étaient respectivement de 48,5% et 78,9%. Le score BAROS moyen était à 3 et 6 mois respectivement 4,46 points et 6,04 points. Lors du suivi, 93,3% des patients étaient satisfaits de la réalisation de la GL en ambulatoire. Conclusion La GL en ambulatoire est faisable avec des résultats acceptables concernant les taux de complications, de bons résultats en termes de taux d hospitalisation non programmée et des résultats similaires à une GL en hospitalisation conventionnelle en ce qui concerne la perte de poids. La GL peut raisonnablement être proposée chez des patients sélectionnés.Introduction Day-case surgery (DCS) is booming in recent years as the longitudinal sleeve gastrectomy in the treatment of morbid obesity. The implementation of gastric banding in day case surgery is performed regularly in many bariatric surgery centers. The purpose of this prospective study was to show the feasibility of LSG in DCS. Material and methods This was a prospective non randomized study of 30 patients undergoing LSG in DCS (i.e without overnight hospitalization) from May 2011 to April 2012. All patients responding to DCS criteria and obesity criteria. Standard surgical, anesthetic and analgesic protocols were used. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were DCS criteria, complications and obesity criteria (weight loss and quality of life scores during a period of 6 months). Results Among 136 patients screened, 30 (22%) were included. There was no unplanned overnight admission. We register six unexpected consultation (20%), four hospital readmission (13.3%) and two major complications (6.6%) with one unexpected surgery for gastric fistula (3.3%). The EWL at 3 and 6 months were respectively 48.5% and 78.9%. The Baros score was at 3 and 6 months respectively 4.46 points and 6.04 points. At follow-up, 93.3% of patients were satisfied of performing LSG in DCS. Conclusion Laparoscopic sleeve gastrectomy in DCS is feasible in selected patients with acceptable results concerning complication rates, good results concerning readmission rates and similar results than LSG with overnight hospitalization concerning weight loss. LSG in DCS could reasonably be proposed for selected patients.AMIENS-BU Santé (800212102) / SudocSudocFranceF

What are the Particularities of Pancreatic Surgery in the Cirrhotic Patient?

International audienceThe objective of this work was to review the entire literature on pancreatic surgery in order to best define the surgical indications and the specifics of their management. The bibliographic research was done on Pubmed over the period from January 1995 to June 2015, using French and English as the languages of publication. The two main indications discussed here are the management of cancer and chronic pancreatitis. Surgery in the cirrhotic patient exposes the patient to a higher risk of complications than in the non-cirrhotic patient. Child-Pugh and MELD scores should be used to assess risk and guide operative decision. Child-Pugh classes B and a MELD score value greater than 15 are associated with higher morbidity and mortality. However, if suitable selection is made of cirrhotic patients who are candidates for pancreatic surgery, long-term survival seems to be equivalent to the non-cirrhotic group. No risk factors for long-term survival have been reported. In conclusion, cirrhotic patients, candidates for pancreatic surgery must be correctly selected, cirrhosis exposes to a higher risk of postoperative morbidity and mortality

The Distance between the Pylorus and Left Vagus Nerve during Sleeve Gastrectomy

International audienceThe sleeve gastrectomy (SG) can be performed with or without antral preservation (distance from the pylorus <50 mm). The objective of this study was to evaluate the distance between the pylorus and the end of the left vagus nerve in order to determine whether it could be used as a constant anatomical landmark to start gastric transection. This was a prospective, nonrandomized study of 120 patients undergoing SG from January to October 2018. The distance measurement between pylorus and vagus nerve was performed at the beginning of the SG. The primary endpoint was the distance between the beginning of the pylorus and the end of the second branch of the vagus nerve on the upper edge of the antrum. The secondary endpoints was the correlation factors between the preoperative data and the position of the end of the vagus nerve. A total of 120 patients, with a mean body mass index of 42.2 kg/m(2), underwent primary SG. The mean distance between pylorus and the end of the vagus nerve was 50.4 mm (35-64) on the upper part of the antrum. When considering the inferior part of the antrum, the minimum distance was 50 mm. No correlations were found between preoperative data and distance measurements. The vagus nerve can be considered as a constant and reliable anatomical landmark for performing SG with antral preservation. However, no correlation was found between the preoperative data and the location of the end of the vagus nerve. Clin. Anat., 2019. (c) 2019 Wiley Periodicals, Inc

Portal vein variants associated with right hepatectomy: An analysis of abdominal CT angiography with 3D reconstruction

International audienceGlissonian approach has been described as a selective vascular clamping procedure during hepatectomy based on external anatomical landmarks. Anatomical variations of the right Glissonian pedicle have been identified with an increased risk of clamping failure during Glissonian approach. The objective of this study was to characterize the anatomical variations of the right Glissonian pedicle at risk of clamping failure during right hepatectomy. This was a retrospective analysis of abdominal multiphasic CT and routine 3D reconstruction (n = 346). Anatomical variations at risk of clamping failure were Types 1 to 3 (Madoff's classification) and an angle of less than 50 degrees between the portal vein and the left portal vein. Primary objective was the risk of right Glissonian pedicle clamping failure. Secondary objectives were the rate of normal anatomy, the rate of variations, and the rate of incomplete or extended clamping. Normal anatomy was found in 245 patients (71%). Anatomical variations were as follows: Type 1: 11%, Type 2: 17%, Type 3: 0.8%, Type 4: 0%. Angle variation less than 50 degrees was observed in 4.5%. The risk of selective clamping failure was 34%. Extension of clamping was observed in 16%, while incomplete clamping was observed in 17.8%. Failure of right Glissonian pedicle clamping was predictable in 34% of cases while 71% of patients presented normal portal vein anatomy. Clin. Anat. 32:328-336, 2019. (c) 2018 Wiley Periodicals, Inc

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

International audienceBackground: 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. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved

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

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Effectiveness of Fibrin Sealant Application on the Development of Staple Line Complications After Sleeve Gastrectomy

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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 (August, 10.1007/s00464-020-07809-9, 2020)

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