C-Reactive protein and procalcitonin for the early detection of postoperative complications after sleeve gastrectomy: preliminary study in 97 patients.

BACKGROUND: Fistula is the most fearsome complication after sleeve gastrectomy. The outcome depends on early and timely diagnosis. C-reactive protein (CRP) and procalcitonin (PCT) have not been extensively evaluated in this context. OBJECTIVE: This study aimed to evaluate the interest of C-reactive protein (CRP) and procalcitonin (PCT) assay for the early detection of gastric fistula after sleeve gastrectomy and to study the PCT as an adjunctive marker to the CRP. SETTING: Private Practice. PATIENTS AND METHODS: This is a retrospective analysis of data collected prospectively. This study was carried out in 97 patients who underwent sleeve gastrectomy between January 2011 and December 2012. The fistula is an abnormal connection between two organs. An abscess is a collection of pus. RESULTS: The rate of postoperative complications (fistulas and abscesses) was 7.2 %. The incidence of fistula was 2 % and the incidence of abscess was 5 %. Both CRP and PCT were significantly higher in patients with postoperative fistula or abscess. Mean CRP was 61.3 mg/l in patients without complications and 161.3 mg/l in case of complications (p = 0.02). Mean postoperative PCT was 0.062 ng/ml in uncomplicated patients versus 0.108 mg/l in those with complications (p = 0.0006). CRP and PCT measured during the postoperative period were correlated with the occurrence of postoperative complications. CONCLUSION: Early detection of fistula or abscess after sleeve gastrectomy simplifies the management of these complications. While the ideal biomarker of infection does not yet exist, this study shows that clinical observations in association with CRP and PCT measurements could be of help for the early detection of septic complications after sleeve gastrectomy.

[Princeps procedure of gastric bypass for morbid obesity]. / Court-circuit gastrique ("by pass" gastrique) avec anse en Y de Roux sous laparoscopie: variantes techniques.

Technical variants of gastric bypass for morbid obesity are briefly described in this article including the three main steps: Roux-en-Y intestinal loop, gastric pouch and gastrojejunal anstomosis.

[Princeps procedure of gastric bypass for morbid obesity]. / Court-circuit gastrique ("bypass" gastrique) avec anse en Y de Roux sous laparoscopie: technique princeps.

Princeps procedure of gastric bypass for morbid obesity is briefly described in this article including the three main steps: Roux-en-Y intestinal loop, gastric pouch and gastrojejunal anastomosis.

A correlation method for weight loss after gastroplasty.

BACKGROUND: Prevalence of morbid obesity is increasing in western countries. As a consequence, bariatric surgery has intensively developed in the last decades. Someone facing the need for comparison between gastric restrictive procedures could find it useful to have a general expression for weight loss after surgery. METHODS: A first approach of this issue can be made, taking into account two simple hypotheses: linear dependencies of weight variation versus sum of energy transfer, and of loss of energy versus weight. With the additional assumption of a constant energy income (the goal of surgery), one can obtain for the weight loss DeltaP=P(0)-P=(P(0)-B)(1-e(-betat)), where P and P(0) are the weight at time t and t(0), B and beta being adjustable constants. RESULTS: A preliminary study has shown us that most of our weight loss data could be fitted using such an expression. The model was successfully tested on gastric banding and calibrated vertical banded gastroplasty data, but with greater emphasis on laparoscopic vertical banded gastroplasty. CONCLUSION: We introduce a simple, exponential growth-like function that can be used for the fit of weight loss data of patients who underwent bariatric surgery in our surgical unit. Such a function could also be of practical interest for the survey of weight loss.

The LM Proring Band and left approach in laparoscopic vertical banded gastroplasty: preliminary results in 44 cases.

BACKGROUND: Morbid obesity is one of the most important social and medical issues in Western countries. Many authors have adopted a minimally invasive approach to reproduce current bariatric operations. The aim of this study is to present a personal technique for laparoscopic vertical banded gastroplasty (LVBG) and the preliminary results of 44 patients. METHODS: Patients fulfilled the indications for bariatric surgery and were followed prospectively. LVBG was performed in patients who refused laparoscopic banding because of port placement and adjustment, or in patients with hiatus hernia, with or without gastroesophageal reflux disease. The technique performed consisted of a laparoscopic Mason modified-MacLean gastroplasty using only 4 ports. The circular stapler was introduced in the left anterior axillary line subcostally using the same working port as the Endo-GIA stapler. A new device, a non-adjustable silicone ring, was placed as the collar around the lower end of the gastric pouch. RESULTS: The 44 patients underwent a satisfactory LVBG with no conversions to open surgery. Mean operative time was 80 minutes (range 45-180), hospital stay was 4 days, and all 44 operations had an uneventful postoperative course. There were 40 women and 4 men, with mean age 42.5 years (24-59). Preoperative mean weight was 118.7 kg (84.5-184), with mean BMI 44.5 (35.6-60.1). 27 of the 44 patients were selected for analysis of weight loss, selection criteria being a sufficient amount of data (> 2 weight losses separated by at least 2 months). For these 27 patients, mean age 41.9 (26-59), preoperative weight 119.3 kg (95-145) and mean BMI 44.6 (38.3-53.6), weight loss data were fitted with an exponential growth function, using a quasi-Newton fit algorithm. The fitted coefficient was used to calculate % excess weight loss and BMI. Mean weight loss at 1, 3, 6 and 12 months was 9.2 kg (4.4-17.2), 24.5 kg (11.0-35.9), 29 kg (12.6-53.6), and 36.5 kg (12.8-66.5) respectively. CONCLUSION: LVBG has given good results thus far and may be selected as a restrictive procedure. Weight loss and resolution of comorbidities occurred, and a considerable increase in self-confidence and quality of life were reported.

[Segmental absence of colonic muscularis propria. Report of a case in an adult]. / Absence segmentaire de musculeuse colique. A propos d'un cas chez l'adulte.

We report a case of segmental defect of colonic muscularis propria revealed by perendoscopic perforation in a 64-year-old woman. Segmental absence of intestinal musculature is well documented in new-borns and infants and is more frequent in small bowel. It is characterized by localised absence of muscularis propria without fibrous scar. The remaining layers of the bowel wall are intact. The pathogenesis of this lesion is discussed.

[Hepatic hamartoma in adults. Apropos of a case documented by MRI]. / Hamartome hépatique de l'adulte. A propos d'un cas documenté par IRM.

A mixed hamartoma of the liver in a 39 year old man is reported. Abdominal ultrasound revealed a 4 cm inhomogeneous echogenic mass with acoustic shadowing. MRI T1 weighted images showed a inhomogeneous low intensity mass with lower gadolinium enhancement than normal liver, a moderate low signal intensity on proton density weighted images, and heterogeneous isosignal intensity on T2 weighted images. Peripheric calcifications were found on pathologic examination.

Laparoscopic cholecystectomy: an original three-trocar technique.

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three-trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p < 0.01). Twenty-six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the "classic" four-trocar technique. Moreover, this technique is less expensive and allows one less scar.

Human breast and colon cancers exhibit alterations of DNA methylation patterns at several DNA segments on chromosomes 11p and 17p.

In breast and colon adenocarcinomas methylation patterns at CCGG sites of several loci located on the short arm of chromosome 11 were determined by Southern blot analysis. Results obtained indicate that all tumor samples (20/20) exhibit DNA methylation changes when compared to their normal counterparts. In colon tumors, gamma-globin gene is usually hypomethylated (9/10), whereas Ha-ras gene, which is located in the same region, retains an unmodified DNA methylation pattern. Hypomethylation of parathyroid hormone (5/10) and catalase genes (4/10) are also frequently detected in colon tumor specimens. For the catalase gene the region around exon 2 is the only one which is affected by these changes. In breast adenocarcinoma, modifications of the methylation patterns are less frequently observed. However, hypomethylation of the gamma-globin gene is a very common event in these tumors (8/10), and it is also detected (2/2) in lobular carcinoma in situ which is an early step in breast tumorigenesis. In addition, hypermethylation of a CpG island is also observed at the locus 17p13.3 in both colon (5/5) and breast (4/9) adenocarcinomas. In the tumoral tissues analyzed these hypermethylations are not associated with the hypermethylation of the 5' flanking sequences which contain a limited amount of CpG. Some of these alterations seem, therefore, to be tumor and sequence specific.

Adenocarcinoma of the duodenum: factors influencing survival. French Association for Surgical Research.

The records of 66 patients with histologically proven adenocarcinoma of the duodenum were reviewed retrospectively to determine factors influencing survival. The parameters studied were age, sex, weight loss, jaundice, anaemia, duodenal stenosis, type of surgical procedure, tumour size and location, depth of parietal invasion, presence and location of lymph node metastases, and pancreatic invasion. These factors were assessed in a group of 46 patients who underwent curative resection of the tumour; 20 patients who received palliative procedures were excluded from statistical analysis. Survival curves were established by the Kaplan-Meier method and compared by the Mantel-Haentszel test. The actuarial 3- and 5-year survival rates of patients undergoing curative resection were 59 and 45 per cent respectively. None of the prognostic factors studied influenced survival. These results indicate that resection of adenocarcinoma of the duodenum should be performed whenever possible, even in the presence of lymph node metastasis and pancreatic spread.

Laparoscopic-assisted perineal rectosigmoidectomy with pullthrough.

We report for the first time the treatment of an early rectal cancer by laparoscopically assisted rectosigmoidectomy with pullthrough. The low colorectal anastomosis was constructed using a double-stapling technique. We believe that this procedure might offer a promising new option for the treatment of midrectal cancer with sphincter saving. Further investigation is recommended.

Laparoscopically assisted subtotal colectomy.

A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.

A technique of laparoscopic gastrectomy and Billroth II gastrojejunostomy.

This report describes a technique of total intraabdominal laparoscopic gastrectomy using laparoscopic stapling and suturing. The reestablishment of continuity of the upper gastrointestinal tract was performed by gastrojejunostomy (Billroth II) using the Endo GIA stapler. This procedure merits inclusion in the armamentarium of approaches toward surgical treatment of recurrent gastric ulcer.

Thoracoscopic dissection of the esophagus in human cadavers.

A technique for thoracoscopic dissection of the esophagus is described which gives a large and magnified view of the pleural cavity, the mediastinum, and the esophagus. This technique was developed on human cadavers which gives excellent technical resources for learning and practicing endoscopic surgical anatomy of the esophagus. It avoids the need to change the position of the patient to perform a total thoracoabdominal esophagectomy via a triple surgical approach.

[Subtotal colectomy under celioscopy]. / Colectomie subtotale sous coelioscopie.

Indications for laparoscopic surgery of digestive disease are increasing in scope and now include colorectal affections. A technique for subtotal colectomy with ileorectal anastomosis under laparoscopic control is described.

Characterization of the DiFi rectal carcinoma cell line derived from a familial adenomatous polyposis patient.

The DiFi human colorectal cancer cell line was recently established from a familial adenomatous polyposis patient with extracolonic features characteristic of the Gardner syndrome. These cells have now been propagated for 150 passages in standard culture media and vessels without feeder layers or collagen coatings. They retain features of colonic epithelial cells such as surface microvilli, secretory vesicles, and desmosomes. Cytosol of DiFi cells contains a high level (502 U/mg protein) of the mucin CA 19-9. In addition, DiFi cells produce carcinoembryonic antigen, and induce tumors in athymic mice. Cytoskeleton analysis of DiFi cells by fluorescence microscopy showed a pronounced disorganization of actin cable structure. The isozyme genetic signature of DiFi cells is unique (0.01 probability of finding the same genetic signature in a different cell line), differs from that of HeLa cells, and has expressional features seen in other colorectal cell lines. The DiFi cell karyotype is tetraploid, contains many marker chromosomes, and shows numerous episomal particles. Two copies of chromosome 18 were absent, and only a single normal chromosome 17 was found. This parallels detection of allelic losses from DiFi cell DNA at loci on chromosomes 17p and 18 using molecular (cDNA) probes. DiFi cells clearly express transcripts for the c-myc proto-oncogene, the c-myb proto-oncogene, and the p53 tumor suppressor gene. Transforming growth factor beta inhibits DiFi cell growth in soft agar and suppresses c-myc expression in these cells. The value of this cell line in the study of genetic alterations in colorectal cancer is discussed.

[Computerized tomography and preoperative evaluation of cancers of the esophagus. Apropos of 54 anatomo-radiological comparisons]. / Tomodensitométrie et bilan préchirurgical des cancers de l'oesophage. A propos de 54 confrontations anatomo-radiologiques.

The authors report their experience in the study of esophageal carcinoma before surgery by CT. Computed tomography is essential to establish the local extension of the tumor process and thus to allow a better therapeutic management.