[Longitudinal sleeve gastrectomy as a stand-alone bariatric procedure: Results of a multicenter retrospective study]. / La gastrectomie longitudinale (sleeve gastrectomy) comme unique chirurgie bariatrique : résultats d'une étude rétrospective multicentrique de 446 patients.

INTRODUCTION: Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. MATERIALS: This is a retrospective study including 446 patients undergoing surgery in 14 teaching, private, and public hospitals. RESULTS: The immediate post-operative course were uneventful in 83.3% of patients. Minor complications occurred in 10.9% of patients and major complications in 5.3%. Suture line leaks occurred in 4.3% of the whole series. There was no mortality and the rate of reoperation was 2%. Overall mean weight loss after two years was 32 kg and the mean excess weight loss was 62%. Weight loss was significantly greater in non super-obese patients (p=0.0003). CONCLUSIONS: This study confirms the feasibility of sleeve gastrectomy in a multicenter setting; it is efficacious at two years as an isolated bariatric procedure for non super-obese patients. It is possible that an additional second-stage procedure may be necessary for super-obese patients.

[Megacolon in adults. Apropos of 76 cases]. / Le mégacôlon de l'adulte. A propos de 76 cas.

27 patients with Hirschsprung's disease and 49 patients with idiopathic megacolon were followed for a period ranging between 6 months and 15 years. The diagnosis is essentially based on the barium enema and functional ano-rectal investigations. Duhamel's operation was performed in 26 patients with Hirschsprung's disease and in 34 patients with idiopathic megacolon. There was no mortality, but 10 cases of pelvic suppuration required colostomy, 9 of which were temporary. 8 cases of anastomotic stenosis developed as a late complication, but they were easily dilated by a simple surgical procedure. One patient developed sexual dysfunction (retrograde ejaculation). A good result was obtained in all patients with Hirschsprung's disease, except for one case of adynamic colon. Two patients with idiopathic megacolon were lost to follow-up. All but two of the remaining patients obtained a good or excellent result. Other operations were performed for idiopathic megacolon: 6 sphincterotomies, with 3 successes and 3 failures; 15 sigmoidectomies, including 3 with sub-peritoneal anastomosis (State's operation). There were 5 good results, 6 mediocre results and 4 failures which subsequently required a Duhamel's operation. Other techniques were performed more rarely: Swenson's operation with a short-term technical failure, 3 side-to-side ileo-sigmoid anastomoses with 3 failures which required a sub-total colectomy with ileo-sigmoid anastomosis. The longterm result was mediocre. The trans-rectal, colo-anal descent of the colon therefore appears to be the treatment of choice in megacolon in adults of whatever cause.