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1.
Eur J Cancer ; 206: 114128, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38805957

ABSTRACT

Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4-6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.


Subject(s)
Adenocarcinoma , Antibodies, Monoclonal, Humanized , Duodenal Neoplasms , Microsatellite Instability , Neoadjuvant Therapy , Humans , Adenocarcinoma/genetics , Adenocarcinoma/therapy , Adenocarcinoma/pathology , Duodenal Neoplasms/genetics , Duodenal Neoplasms/pathology , Duodenal Neoplasms/therapy , Neoadjuvant Therapy/methods , Male , Aged , Middle Aged , Female , Antibodies, Monoclonal, Humanized/therapeutic use , Immunotherapy/methods , Immune Checkpoint Inhibitors/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Treatment Outcome
2.
Acta Chir Belg ; 119(5): 309-315, 2019 Oct.
Article in English | MEDLINE | ID: mdl-30354853

ABSTRACT

Background: The optimal timing for cholecystectomy in patients with acute cholecystitis remains controversial. The aim of this study is to assess prospectively the impact of the duration of symptoms on outcomes in early laparoscopic cholecystectomy (ELC) for acute cholecystitis. Methods: The series consisted of 276 consecutive patients who underwent ELC for acute cholecystitis in 2016. The patients were divided into three groups according to the timing of surgery: within the first 3 days (group 1), between 4 and 7 days (group 2) and beyond 7 days (group 3) from the onset of symptoms. Results: The percentage of surgical procedure rated as difficult was respectively: 12% in G1, 18% in G2 and 38% in G3 (p < .001). Accordingly, we observed an increased mean operative time within groups but no significant difference in the conversion rate. We noted a different overall postoperative complication rate within groups, respectively: 9% in G1, 14% in G2 and 24% in G3 (p < .04). The median hospital stay was also different within groups, respectively: 3 in G1, 4 in G2 and 6 days in G3 (p < .001). On univariate analysis, age ≥60, male gender, ASA 3, WBC ≥13.000/µL, CRP ≥100 mg/l and delay between onset of symptoms and surgery were factors statistically associated with increased morbidity rate. On multivariate analysis, the delay was the only independent predictive factor of postoperative morbidity (OR: 1,08, 95% CI: 1.01-1.61, p < .031). Conclusion: Our study confirms that it is ideal to perform ELC within 3 days of symptoms onset and reasonable between 4 to 7 days. We do not recommend performing ELC beyond 7 days because of more difficult procedure and significantly increased risk of post-operative complications.


Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/surgery , Time-to-Treatment , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Time Factors , Treatment Outcome
3.
Acta Chir Belg ; 118(2): 94-98, 2018 Apr.
Article in English | MEDLINE | ID: mdl-28927340

ABSTRACT

OBJECTIVES: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS: Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.


Subject(s)
Gastroplasty/adverse effects , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Belgium/epidemiology , Female , Gastroplasty/methods , Humans , Male , Middle Aged , Morbidity/trends , Retrospective Studies , Risk Factors , Survival Rate/trends , Young Adult
4.
Acta Chir Belg ; : 1-7, 2016 01 12.
Article in English | MEDLINE | ID: mdl-27397034

ABSTRACT

In the case of Roux-en-Y gastric bypass with a long afferent limb, the need to carry out an ERCP still represents a technical challenge. In this article we describe the case of a 50-year-old male admitted to the ER for abdominal pain in the right upper quadrant, in the context of prior Roux-en-Y gastric bypass (4 years ago), with uncomplicated gallbladder stones discovered 3 months ago. The patient presented recurrent abdominal pain for 3 months but in the last few days the pain became continuous. The blood test revealed elevation of hepatic enzymes and bilirubin levels. The US findings were uncomplicated gallbladder lithiasis with no signs of lithiasic migration in the common bile duct, despite strong clinical suspicion and positive MRI 3 weeks before. We decided therefore to perform a laparoscopic cholecystectomy with perioperative cholangiography and a laparoscopy-assisted transjejunal ERCP through a jejunostomy 80 cm distal to the ligament of Treitz, allowed us to successfully carry out sphincterotomy and extraction of a 10mm lithiasis from the common bile duct.

5.
Acta Chir Belg ; 115: 81-2, 2015.
Article in English | MEDLINE | ID: mdl-26021797

ABSTRACT

The aim of this case report is to outline the challenge and the feasibility of laparoscopic gastric bypass in a patient with situs inversus totalis. Situs inversus totalis does not seem to be a contraindication for laparoscopic surgery.


Subject(s)
Gastric Bypass , Laparoscopy , Obesity, Morbid/complications , Obesity, Morbid/surgery , Situs Inversus/complications , Female , Humans , Middle Aged , Radiography , Situs Inversus/diagnostic imaging , Situs Inversus/surgery
6.
Acta Chir Belg ; 115(1): 81-2, 2015 Jan.
Article in English | MEDLINE | ID: mdl-27384902

ABSTRACT

The aim of this case report is to outline the challenge and the feasibility of laparoscopic gastric bypass in a patient with situs inversus totalis. Situs inversus totalis does not seem to be a contraindication for laparoscopic surgery.


Subject(s)
Gastric Bypass/methods , Obesity, Morbid/complications , Obesity, Morbid/surgery , Situs Inversus/complications , Body Mass Index , Female , Follow-Up Studies , Humans , Laparoscopy/methods , Middle Aged , Obesity, Morbid/diagnosis , Risk Assessment , Situs Inversus/diagnosis , Treatment Outcome , Weight Loss
7.
Acta Chir Belg ; 113(4): 254-7, 2013.
Article in English | MEDLINE | ID: mdl-24224433

ABSTRACT

OBJECTIVES: Sleeve gastrectomy (SG) has been used as the first step of a staged malabsorptive procedure for high-risk patients. More recently SG was proposed as an stand alone procedure in the treatment of morbidly obese patients. The aim of this study is to analyze perioperative outcome of morbid obese patients after SG. METHODS: 301 patients, 201 women and 100 men, undergoing SG were retrospectively analyzed. SG was performed by 17 surgeons all member of the Club Coelio. The mean BMI was 44.7kg/m2 (27.4-70.3 kg/m2). 34 patients (11.3%) of our series had SG as revisional surgery. These revisional procedures consisted of 32 conversions from gastric banding, 1 conversion from vertical gastroplasty (VBG) and 1 from transoral endoscopic gastroplasty. Among the 32 patients that had revisional SG after a gastric banding, 13 bands were removed at least 3 months before the revisional SG and 19 bands were removed during the SG procedure. Endpoints were perioperative morbidity and mortality and potential risk factors for complications, mainly per or postoperative bleeding or leakage. RESULTS: Overall mortality was 0% and morbidity was 10.3%. Perioperative bleeding occurred in 10 patients (3.3%), leakage in 12 patients (4%) patients and stenosis in 3 patients (1%). The risk of leakage was significantly higher after revisional bariatric surgery and in case of gastric perforation during surgery (p = 0.0001). Previous gastric banding is also associated with a higher risk of postoperative bleeding (p = 0.0006). CONCLUSIONS: SG can be safely performed but patients and surgeons must be aware of a higher risk of postoperative complications when SG is proposed as a revisional surgery.


Subject(s)
Gastroplasty/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Risk Assessment/methods , Adult , Aged , Belgium/epidemiology , Body Mass Index , Female , Follow-Up Studies , Gastroplasty/methods , Gastroscopy , Humans , Male , Middle Aged , Morbidity/trends , Postoperative Complications/etiology , Retrospective Studies , Time Factors , Treatment Failure , Treatment Outcome , Young Adult
8.
Ann Oncol ; 23(9): 2327-2335, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22377565

ABSTRACT

BACKGROUND: Prognosis of patients with pancreatic adenocarcinoma is poor. Many prognostic biomarkers have been tested, but most studies included heterogeneous patients. We aimed to investigate the prognostic and/or predictive values of four relevant biomarkers in a multicentric cohort of patients. PATIENTS AND METHODS: A total of 471 patients who had resected pancreatic adenocarcinoma were included. Using tissue microarray, we assessed the relationship of biomarker expressions with the overall survival: Smad4, type II TGF-ß receptor, CXCR4, and LKB1. RESULTS: High CXCR4 expression was found to be the only independent negative prognostic biomarker [hazard ratio (HR) = 1.74; P < 0.0001]. In addition, it was significantly associated with a distant relapse pattern (HR = 2.19; P < 0.0001) and was the strongest prognostic factor compared with clinicopathological factors. In patients who did not received adjuvant treatment, there was a trend toward decrease in the overall survival for negative Smad4 expression. Loss of Smad4 expression was not correlated with recurrence pattern but was shown to be predictive for adjuvant chemotherapy (CT) benefit (HR = 0.59; P = 0.002). CONCLUSIONS: CXCR4 is a strong independent prognostic biomarker associated with distant metastatic recurrence and appears as an attractive target to be evaluated in pancreatic adenocarcinoma. Negative SMAD4 expression should be considered as a potential predictor of adjuvant CT benefit.


Subject(s)
Adenocarcinoma/metabolism , Biomarkers, Tumor/metabolism , Pancreatic Neoplasms/metabolism , Receptors, CXCR4/metabolism , Smad4 Protein/metabolism , Adenocarcinoma/mortality , Adenocarcinoma/secondary , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Disease Progression , Female , Humans , Kaplan-Meier Estimate , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/therapy , Proportional Hazards Models , Prospective Studies , Treatment Outcome
10.
Rev Med Brux ; 31(5): 459-62, 2010.
Article in French | MEDLINE | ID: mdl-21174648

ABSTRACT

OBJECTIVES: Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG). METHODS: A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed. RESULTS: After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free. CONCLUSION: The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.


Subject(s)
Adenocarcinoma/etiology , Gastroplasty/adverse effects , Stomach Neoplasms/etiology , Female , Humans , Middle Aged
11.
Br J Cancer ; 100(9): 1444-51, 2009 May 05.
Article in English | MEDLINE | ID: mdl-19352387

ABSTRACT

Chemokines and their receptors are involved in tumourigenicity and clinicopathological significance of chemokines receptor expression in pancreatic adenocarcinoma (PA) is not fully understood. This study was conducted to determine patients' outcome according to the expressions of CXCR4, CXCR7 and HIF-1alpha after resection of PA. Immunohistochemistry for CXCR4, CXCR7 and HIF-1alpha expressions as well as cell proliferative index (Ki-67) was conducted in 71 resected (R0) PA and their 48 related lymph nodes (LN) using tissue microarray. CXCR4 and CXCR7 expressions were positively correlated to HIF-1alpha suggesting a potential role of HIF-1alpha in CXCR4 and CXCR7 transcription activation. Patients with CXCR4(high) tumour expression had shorter OS than those with low expression (median survival: 9.7 vs 43.2 months, P=0.0006), a higher risk of LN metastases and liver recurrence. In multivariate analysis, high CXCR4 expression, LN metastases and poorly differentiated tumour are independent negative prognosis factors. In a combining analysis, patients with a CXCR7(high)/CXCR4(high) [corrected] tumour had a significantly shorter DFS and OS than patients with a CXCR4(low)/CXCR7(low) [corrected] tumour. CXCR4 in resected PA may represent a valuable prognostic factor as well as an attractive target for therapeutic purpose.


Subject(s)
Adenocarcinoma/genetics , Adenocarcinoma/surgery , Gene Expression Regulation, Neoplastic , Pancreatectomy/statistics & numerical data , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms/surgery , Receptors, CXCR4/genetics , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Staging , Oligonucleotide Array Sequence Analysis , Pancreatectomy/mortality , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Prognosis , Receptors, CXCR/genetics , Retrospective Studies , Survival Analysis , Survivors
12.
Endoscopy ; 40(5): 406-13, 2008 May.
Article in English | MEDLINE | ID: mdl-18459077

ABSTRACT

BACKGROUND AND STUDY AIMS: Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS: Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS: Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS: This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.


Subject(s)
Endoscopy, Digestive System , Gastroplasty/methods , Obesity, Morbid/surgery , Surgical Stapling/methods , Weight Loss , Adult , Anti-Inflammatory Agents/administration & dosage , Feasibility Studies , Female , Follow-Up Studies , Gastroplasty/instrumentation , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome
13.
Surg Endosc ; 22(3): 589-98, 2008 Mar.
Article in English | MEDLINE | ID: mdl-17973163

ABSTRACT

OBJECTIVE: To evaluate the safety and feasibility in human subjects of a new transoral restrictive procedure for the treatment of obesity. METHODS: The protocol was approved by the institutional review boards (IRBs) of both centers involved, and all patients gave informed consent. Patients met established inclusion criteria for bariatric surgery. The TOGa system (Satiety Inc., Palo Alto, CA), a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curve of the stomach. Patients were hospitalized overnight for observation and underwent barium upper gastrointestinal (UGI) the next morning. Post procedure, all patients were placed on a liquid diet for 1 month and asked to begin an exercise program. Follow-up was carried out at 1 week and 1, 3, 4, 5, and 6 months. RESULTS: Twenty one patients were enrolled [17 female, age 43.7 (22-57) years, BMI 43.3 (35-53) kg/m(2)]. Device introduction was completed safely in all patients. There were no serious adverse events (AEs). The most commonly reported procedure or device related adverse events were vomiting, pain, nausea, and transient dysphagia. At 6 month endoscopy, all patients had persistent full or partial stapled sleeves. Gaps in the staple line were evident in 13 patients. Patients lost an average 17.6 pounds at 1 month, 24.5 pounds at three months, and 26.5 pounds at 6 months post-treatment [excess weight loss (EWL) of 16.2%, 22.6%, and 24.4%, respectively]. CONCLUSIONS: There is great interest in new procedures for morbid obesity that could offer lower morbidity than current options. Early experience with the TOGa procedure indicates that this transoral approach may be safe and feasible. Further experience with the device and technique should improve anatomic and functional outcomes in the future. Additional studies are underway.


Subject(s)
Gastroplasty/methods , Gastroscopy/methods , Obesity, Morbid/surgery , Quality of Life , Adult , Body Mass Index , Endoscopy/adverse effects , Endoscopy/methods , Feasibility Studies , Female , Follow-Up Studies , Gastroscopy/adverse effects , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Obesity, Morbid/diagnosis , Postoperative Complications/physiopathology , Prospective Studies , Risk Assessment , Safety Management , Single-Blind Method , Treatment Outcome , Weight Loss
14.
Rev Med Brux ; 28(4): 254-6, 2007 Sep.
Article in French | MEDLINE | ID: mdl-17958017

ABSTRACT

Bariatric surgery remains the only durable option for weight loss in the morbidly obese patient. The aim of this article is to present the different types of surgical procedures. This multidisciplinary approach try to define which type of surgery would be the more indicated for which patient.


Subject(s)
Bariatric Surgery/methods , Obesity, Morbid/surgery , Patient Selection , Gastroplasty/methods , Humans
15.
Transplant Proc ; 39(8): 2668-71, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17954203

ABSTRACT

BACKGROUND: Due to the organ shortage, marginal donors are increasingly used in liver transplantation (OLT). These grafts may be safely used in less critical recipients but, the real influence of extended donor criteria (EDC) remains uncertain when graft-recipient matching is not applied. Our study analyzed the impact of EDC on initial graft function within the Eurotransplant patient-driven allocation system. PATIENTS AND METHODS: We reviewed 70 OLT performed between 2004 and 2006. The impact of the following EDC were analyzed: age > 60; intensive care unit (ICU) stay > 4 days; peak serum Na(+) > 160 mEq/L; body mass index (BMI) > 30; cardiac arrest with cardiopulmonary resuscitation, and high doses of vasopressors. Early graft function, as defined according to peak transaminase level and spontaneous prothrombin time within the first 5 posttransplant days, was compared between the donors with none or one criterion (group A = 39) and those with >1 criterion (group B = 31). RESULTS: The most frequent EDC were high vasopressor use, ICU stay > 4 days and BMI > 30, were present in respectively 44%, 27%, and 16% of the donors. No EDC were present in 13 donors, one in 26, three in eight, and four in three. Demographics and origin and severity of the liver disease were similar in both groups. We failed to observe significant differences in initial graft function. CONCLUSION: The presence of EDC did not significantly affect early graft function in a population where donor and recipient were not matched. While this observation must be confirmed in a multicenter analysis, it tends to support the use of marginal liver grafts, even in patient-driven allocation systems.


Subject(s)
Liver Transplantation/statistics & numerical data , Tissue Donors/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Body Mass Index , Cardiopulmonary Resuscitation/statistics & numerical data , Female , Heart Arrest/epidemiology , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Patient Selection , Retrospective Studies , Tissue Donors/supply & distribution
16.
Surg Endosc ; 21(11): 1985-90, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17704884

ABSTRACT

BACKGROUND: Laparoscopic Toupet fundoplication (TF) is reported to be as effective as Nissen (NF), but to be associated with fewer unfavorable postoperative side-effects. This study evaluates the one- and three-year clinical outcome of 140 randomized patients after a laparoscopic NF or TF. PATIENTS AND METHODS: Inclusion criteria included patients over 16 years old with complications of gastro-oesophageal reflux disease (GORD) and persistence or recurrence of symptoms after three months of treatment. Subjects with a previous history of gastric surgery or repeated fundoplication, brachy-oesophagus or severe abnormal manometry results were excluded. Seventy-seven NF and 63 TF were performed. The severity of symptoms was assessed before and after the procedure. RESULTS: One hundred and twenty-one of the 140 patients after one year, and 118 after three years, were evaluated and no statistically significant clinical difference was observed. The level of satisfaction concerning the outcome of the operation remained high after one or three years regardless of the type of fundoplication performed. CONCLUSIONS: Functional complications after NF are not avoided with TF.


Subject(s)
Fundoplication/methods , Gastroesophageal Reflux/surgery , Deglutition Disorders/etiology , Eructation , Female , Flatulence/etiology , Follow-Up Studies , Fundoplication/adverse effects , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Patient Satisfaction , Pneumothorax/etiology , Postoperative Hemorrhage/etiology , Treatment Outcome
17.
Obes Surg ; 14(9): 1233-6, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15527640

ABSTRACT

BACKGROUND: Among the different techniques of surgical treatment for morbid obesity, silastic ring vertical gastroplasty (SRVG) is an alternative, effective and easily reproducible technique. The aim of this study is to evaluate a cohort of patients >6 years after SRVG for morbid obesity. METHODS: From 1991 to 1996, 273 consecutive patients were eligible for SRVG. The evaluation criteria included weight loss, evolution of co-morbidities, long-term morbidities, satisfaction of patients and quality of life. RESULTS: Among these 273 patients, 1 patient died in the postoperative period (0.4%). Postoperative morbidities occured in 27 patients (10%). The long-term follow-up involved 213 patients (78%). Late postoperative complications consisted of outlet stoma stenosis (14%), staple-line dehiscence (5.6%) and incisional hernia (8.5%). 23 patients (10%) needed a re-do operation. Co-morbidities drastically improved. BMI fell from 45.3 to 30.7. Failure of SRVG was statistically associated with male gender and super-obese patients. 69% of the patients were satisfied, and 73% would recommend this operation. CONCLUSION: SRVG is very effective in a selected group of morbidly obese patients.


Subject(s)
Gastroplasty , Adolescent , Adult , Comorbidity , Female , Follow-Up Studies , Gastroplasty/adverse effects , Humans , Male , Middle Aged , Quality of Life , Treatment Failure , Weight Loss
18.
Surg Endosc ; 18(5): 818-20, 2004 May.
Article in English | MEDLINE | ID: mdl-15216865

ABSTRACT

BACKGROUND: We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD). METHODS: Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis. RESULTS: All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent. CONCLUSION: LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.


Subject(s)
Esophagogastric Junction , Fundoplication/methods , Gastroesophageal Reflux/therapy , Laparoscopy , Polyvinyls/administration & dosage , Adult , Aged , Esophagogastric Junction/pathology , Female , Humans , Injections, Intralesional , Male , Middle Aged
19.
Surg Endosc ; 18(3): 554-6, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15115027

ABSTRACT

Laparoscopic cholecystectomy (LC) seems to be associated with an increased risk of biliary or vascular injuries. Hepatic artery pseudoaneurysms (HAP) are rare complications of LC. HAP can occur in the early or late postoperative period. Patients with HAP present with abdominal pain, hemobilia, and liver function test (LFT) alterations. We report the case of a patient who was affected with a cystic duct stump leak associated with a right HAP and was treated by endoscopic biliary drainage and angiographic coil embolization.


Subject(s)
Aneurysm, False/etiology , Cholecystectomy, Laparoscopic , Cystic Duct/injuries , Hepatic Artery/injuries , Postoperative Complications/etiology , Sphincterotomy, Endoscopic , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Aneurysm, False/therapy , Angiography, Digital Subtraction , Cholangiopancreatography, Endoscopic Retrograde , Cholecystitis/complications , Cholecystitis/surgery , Cholelithiasis/complications , Cholelithiasis/surgery , Combined Modality Therapy , Cystic Duct/surgery , Drainage , Embolization, Therapeutic , Female , Hepatic Artery/diagnostic imaging , Hepatic Artery/surgery , Humans , Middle Aged , Postoperative Complications/surgery , Postoperative Complications/therapy , Postoperative Hemorrhage/etiology , Postoperative Period , Risk
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