The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed... more
The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.
Research Interests:
The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed... more
The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.
Research Interests:
Gardner's syndrome ie an autosomal dominant disease characterized by the association of a polyposis coli with one or more of specific extracolonic manifestations. A lebanese family is reported. Polyposis coli, desmoid tumors,... more
Gardner's syndrome ie an autosomal dominant disease characterized by the association of a polyposis coli with one or more of specific extracolonic manifestations. A lebanese family is reported. Polyposis coli, desmoid tumors, gastroduodenal polyps, procreation counselling etc. are difficult problems to manage in this syndrome.
Research Interests:
Research Interests:
Based on short-term outcome, gastric plication (LGP) could be considered as an alternative to sleeve gastrectomy (LSG) in patients with severe obesity. However, long-term follow-up of weight loss and comorbidity are yet to be available.... more
Based on short-term outcome, gastric plication (LGP) could be considered as an alternative to sleeve gastrectomy (LSG) in patients with severe obesity. However, long-term follow-up of weight loss and comorbidity are yet to be available. Theoretical advantages include reduced fistula rate, no implantable device, preservation of the alimentary pathway, and no gastric resection. We report a case-control study comparing short-term outcome in two groups of patients who had either LGP or LSG, respectively. From January 2012 to June 2013, 40 patients had LGP, matched with 40 patients who had LSG. No postoperative mortality was observed. Overall morbidity rate reached 22.5 % in the LGP Group and 10 % in the LSG Group (P = 0.04). The most common complication was nausea and vomiting occurring in 20 % of patients with LGP and 5 % of patients with LSG, respectively (P < 0.001). No clinical or radiological leak occurred. Mean operative time was 91.5 ±18.6 min in the LGP group and 81 min ±16.8 min in the LSG group, respectively (P = 0.104). Mean hospital stay was 3.4 ±1.1 days in the LGP Group and 3.2 ±1.2 days the LSG group, respectively (P = 0.614). Average total operating room (OR) cost was 1736 euros for LGP as compared to 2842 euros for LSG, respectively (P < 0.001). At 18-month follow-up, mean excess weight loss (EWL) was 56.5 % +9.8 in LGP patients and 71.3 % +10.4 in patients who had LSG (P = 0.041). LGP for patients with severe obesity is safe and feasible with low rates of serious complications. As compared to LSG, LGP is associated to higher postoperative rate of nausea, lower operative cost, and lower EWL at 18-month follow-up (P = 0.041).
Research Interests: Surgery, Treatment Outcome, Medicine, Humans, Weight Loss, and 14 moreFemale, Male, Length of Stay, Nausea, Obesity Surgery, Clinical Sciences, Adult, Public health systems and services research, Morbid Obesity, Laparoscopy, Vomiting, Case Control Studies, Postoperative Complications, and Gastrectomy
Research Interests:
Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and... more
Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and morbidity are much higher if the diagnosis is delayed more than 24 hours. These lesions should be strongly suspected after any blunt abdominal trauma, and repeated clinical assessment is mandatory in the conscious patient. Gastrografine upper GI study and CT Scan are interesting diagnosis procedures when the patient is unconscious or should be anesthesized. At laparotomy, the presence of a central retroperitoneal hematoma should guide the surgeon to explore the duodenum. Treatment depend on the time of diagnosis, the severity of the wound, and the associated pancreatic lesions.
Research Interests:
Early or late postoperative complications in 52 patients undergoing colic esophagoplasty for benign (27 cases) or malignant (25 cases) lesions of esophagus are discussed in relation to radiologic findings. Immediate postoperative... more
Early or late postoperative complications in 52 patients undergoing colic esophagoplasty for benign (27 cases) or malignant (25 cases) lesions of esophagus are discussed in relation to radiologic findings. Immediate postoperative complications due to infection were mainly bronchopneumopathies (14 cases), their incidence being increased by recurrent nerve palsy, and mediastinitis (3 cases). The frequency of upper anastomotic fistulae (16 cases) emphasizes the need for routine radiologic follow up on the 7th postoperative day by upper digestive tract follow-through examination with water-soluble contrast. Stenosis of upper part of graft may be of ischemic or fibrous origin. Ischemic stenosis develops 2 weeks to 4 months after surgery as a long filiform narrowing. Fibrous stenosis occurs in upper anastomosis at a later stage, after the 3rd month, as a short regular narrowing. Other complications are rare.
Research Interests:
Consumptive coagulopathy may complicate the early postoperative course of peritoneovenous shunting and be responsible for diffuse bleeding or even death. Since this complications has been related to procoagulant substances in ascitic... more
Consumptive coagulopathy may complicate the early postoperative course of peritoneovenous shunting and be responsible for diffuse bleeding or even death. Since this complications has been related to procoagulant substances in ascitic fluid getting access to the systemic circulation, it was demonstrated that the replacement of the ascitic fluid by normal saline solution during shunt insertion decreases the prevalence and severity of postoperative coagulopathy.
Research Interests:
Research Interests:
Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common... more
Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713-723. doi: 10.1016/j.soard.2014.01.016 , 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954-1960 doi: 10.1007/s00464-014-3424-y , 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome. Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series. Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22-59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18-90). Mean body mass index (BMI) was 27.4 kg/m(2) (22-41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections. Despite the lack of long-term follow-up, RYFJ could be a safe and feasible salvage option for the treatment of patients with post-SG fistula, especially those who failed conservative management. Mid-term outcome analysis confirms that fistula control is durable. Weight loss panel is satisfactory.
Research Interests:
Research Interests:
The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large... more
The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large round or polygonal cells. Thin filaments are visible on electronic microscopy. Treatment of choice is the surgical resection.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Based on short-term outcome, gastric plication (LGP) could be considered as an alternative to sleeve gastrectomy (LSG) in patients with severe obesity. However, long-term follow-up of weight loss and comorbidity are yet to be available.... more
Based on short-term outcome, gastric plication (LGP) could be considered as an alternative to sleeve gastrectomy (LSG) in patients with severe obesity. However, long-term follow-up of weight loss and comorbidity are yet to be available. Theoretical advantages include reduced fistula rate, no implantable device, preservation of the alimentary pathway, and no gastric resection. We report a case-control study comparing short-term outcome in two groups of patients who had either LGP or LSG, respectively. From January 2012 to June 2013, 40 patients had LGP, matched with 40 patients who had LSG. No postoperative mortality was observed. Overall morbidity rate reached 22.5 % in the LGP Group and 10 % in the LSG Group (P = 0.04). The most common complication was nausea and vomiting occurring in 20 % of patients with LGP and 5 % of patients with LSG, respectively (P < 0.001). No clinical or radiological leak occurred. Mean operative time was 91.5 ±18.6 min in the LGP group and 81 min ±16.8 min in the LSG group, respectively (P = 0.104). Mean hospital stay was 3.4 ±1.1 days in the LGP Group and 3.2 ±1.2 days the LSG group, respectively (P = 0.614). Average total operating room (OR) cost was 1736 euros for LGP as compared to 2842 euros for LSG, respectively (P < 0.001). At 18-month follow-up, mean excess weight loss (EWL) was 56.5 % +9.8 in LGP patients and 71.3 % +10.4 in patients who had LSG (P = 0.041). LGP for patients with severe obesity is safe and feasible with low rates of serious complications. As compared to LSG, LGP is associated to higher postoperative rate of nausea, lower operative cost, and lower EWL at 18-month follow-up (P = 0.041).
Research Interests: Surgery, Treatment Outcome, Medicine, Humans, Weight Loss, and 14 moreFemale, Male, Length of Stay, Nausea, Obesity Surgery, Clinical Sciences, Adult, Public health systems and services research, Morbid Obesity, Laparoscopy, Vomiting, Case Control Studies, Postoperative Complications, and Gastrectomy
Early or late postoperative complications in 52 patients undergoing colic esophagoplasty for benign (27 cases) or malignant (25 cases) lesions of esophagus are discussed in relation to radiologic findings. Immediate postoperative... more
Early or late postoperative complications in 52 patients undergoing colic esophagoplasty for benign (27 cases) or malignant (25 cases) lesions of esophagus are discussed in relation to radiologic findings. Immediate postoperative complications due to infection were mainly bronchopneumopathies (14 cases), their incidence being increased by recurrent nerve palsy, and mediastinitis (3 cases). The frequency of upper anastomotic fistulae (16 cases) emphasizes the need for routine radiologic follow up on the 7th postoperative day by upper digestive tract follow-through examination with water-soluble contrast. Stenosis of upper part of graft may be of ischemic or fibrous origin. Ischemic stenosis develops 2 weeks to 4 months after surgery as a long filiform narrowing. Fibrous stenosis occurs in upper anastomosis at a later stage, after the 3rd month, as a short regular narrowing. Other complications are rare.
Research Interests:
During a period of 5 years, 314 patients with 427 inguinal hernias were operated. 80 males with bilateral inguinal hernia recurrent, or not, were operated with an insertion of a Crinoplaque by a pre-peritoneal approach. The operative time... more
During a period of 5 years, 314 patients with 427 inguinal hernias were operated. 80 males with bilateral inguinal hernia recurrent, or not, were operated with an insertion of a Crinoplaque by a pre-peritoneal approach. The operative time was 65 +/- 26 minutes. 10 patients (12.5%) had by the same incision a concomitant pelvic procedure (9 varicoceles, 1 benign prostatic hypertrophy). 4 patients (5%) developed minor parietal complications. After 1 to 4 years of follow-up, 1 patient (1,25%) showed one side recurrence, in the beginning of our experience. In conclusion, we consider the pre-peritoneal Crinoplaque insertion as a treatment of choice for bilateral recurrent, or not, inguinal hernia for its simplicity and its lower complication rate.
Research Interests:
The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large... more
The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large round or polygonal cells. Thin filaments are visible on electronic microscopy. Treatment of choice is the surgical resection.
Research Interests:
Consumptive coagulopathy may complicate the early postoperative course of peritoneovenous shunting and be responsible for diffuse bleeding or even death. Since this complications has been related to procoagulant substances in ascitic... more
Consumptive coagulopathy may complicate the early postoperative course of peritoneovenous shunting and be responsible for diffuse bleeding or even death. Since this complications has been related to procoagulant substances in ascitic fluid getting access to the systemic circulation, it was demonstrated that the replacement of the ascitic fluid by normal saline solution during shunt insertion decreases the prevalence and severity of postoperative coagulopathy.
Research Interests:
Four-hundred esophageal anastomoses were performed with a stapler in the Department of Digestive Surgery, Hospital Beaujon in Paris, in a six year period. The experience of the 14 different surgeons in esophageal surgery was very uneven... more
Four-hundred esophageal anastomoses were performed with a stapler in the Department of Digestive Surgery, Hospital Beaujon in Paris, in a six year period. The experience of the 14 different surgeons in esophageal surgery was very uneven (zero to 25 years). Two-hundred and sixty-eight esophagogastrostomies (220 in the chest and 48 in the neck), 83 esophagojejunostomies and 49 esophagocolostomies were done. The overall mortality rate was 9.2%, three per cent owing to leaks. The average incidence of leakage was 7% falling to 5.5% if cervical anastomoses were excluded. The incidence of stenoses was 8%. Several points which might account for problems are discussed. Stapled anastomoses seem to reduce the mortality and the morbidity rates of esophageal anastomoses, especially for surgeons with no experience in esophageal surgery.
Research Interests:
Since the introduction of routine abdominal echography, silent gallstone has become a major medical concern. The management of a patient with silent gallstone, is very controversed, and routine cholecystectomy is not always beneficial.... more
Since the introduction of routine abdominal echography, silent gallstone has become a major medical concern. The management of a patient with silent gallstone, is very controversed, and routine cholecystectomy is not always beneficial. Aged and high operative risk patients, should be treated conservatively. Literature review can identify subgroups of patients in whom cholecystectomy is justified: patients with micro or macro-lithiasis, patients in whom oral cholecystography reveals multiple floating stones, dyskinectic, not opacified or calcified gallbladder, and patients receiving general anesthesia for other reasons than gallbladder disease.
Research Interests:
Jejunogastric intussusception is a rare complication after gastric surgery. The authors report a case of acute jejunogastric intussusception diagnosed in a 57-year-old woman, 22 years after vagotomy and gastroenterostomy for duodenal... more
Jejunogastric intussusception is a rare complication after gastric surgery. The authors report a case of acute jejunogastric intussusception diagnosed in a 57-year-old woman, 22 years after vagotomy and gastroenterostomy for duodenal ulcer. There are three types of jejunogastric intussusception: 1) the acute type, presenting as a surgical emergency, and characterized by a sudden onset of cramp-like epigastric pain, followed by nausea and vomiting, with a palpable epigastric mass. 2) the chronic recurrent type, which may progress to the acute type of may result in severe disability, and may require corrective surgery depending on the severity of the symptoms. 3) the acute post-operative type, presenting on the 4th or 5th post-operative day, and usually improving with conservative treatment.
Research Interests:
Research Interests:
Research Interests: Surgery, Bariatric Surgery, Adolescent, Medicine, Complication, and 15 moreHumans, Female, Male, Gastric banding, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Morbid Obesity, Laparoscopy, Postoperative care, Excess Weight, and Intraoperative complications
Research Interests: Bariatric Surgery, Treatment Outcome, Adolescent, Medicine, Humans, and 14 moreWeight Loss, Female, Male, Gastric banding, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Morbid Obesity, Laparoscopy, Postoperative care, and Intraoperative complications
Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and... more
Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and morbidity are much higher if the diagnosis is delayed more than 24 hours. These lesions should be strongly suspected after any blunt abdominal trauma, and repeated clinical assessment is mandatory in the conscious patient. Gastrografine upper GI study and CT Scan are interesting diagnosis procedures when the patient is unconscious or should be anesthesized. At laparotomy, the presence of a central retroperitoneal hematoma should guide the surgeon to explore the duodenum. Treatment depend on the time of diagnosis, the severity of the wound, and the associated pancreatic lesions.
Research Interests:
Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years... more
Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years earlier. A review of the literature revealed 15 cases already reported. All patients had an asymptomatic thoracic lesion discovered on a plain chest film 9 to 32 years (mean 16) after the initial accident. In 13 cases an operation was necessary to establish the diagnosis. In two cases technetium 99m and indium 111 scans established the diagnosis.