[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.

RISSC: a novel database for ribosomal 16S-23S RNA genes spacer regions.

A novel database, under the acronym RISSC (Ribosomal Intergenic Spacer Sequence Collection), has been created. It compiles more than 1600 entries of edited DNA sequence data from the 16S-23S ribosomal spacers present in most prokaryotes and organelles (e.g. mitochondria and chloroplasts) and is accessible through the Internet (http://ulises.umh.es/RISSC), where systematic searches for specific words can be conducted, as well as BLAST-type sequence searches. Additionally, a characteristic feature of this region, the presence/absence and nature of tRNA genes within the spacer, is included in all the entries, even when not previously indicated in the original database. All these combined features could provide a useful documentation tool for studies on evolution, identification, typing and strain characterization, among others.

[Bilio-digestive fistula with an unusual etiology]. / Une fistule bilio-digestive d'étiologie inhabituelle.

On the basis of one case, the authors give the highlights on the various clinicopathological features of malignant gastric perforations. While medical imaging does not seem to contribute much in the positive diagnosis of such complications, it does remain essential to establish the local extension of the tumour process and thus to allow a better therapeutic management.

[Treatment of eventration after transverse laparotomy]. / Cure d'éventration après laparotomie transversale.

In the few cases of incisional hernia consecutive to transverse laparotomy the classical approximation of the rectus muscles cannot be performed due to the presence of transverse fibrotic scar tissue. An original technique using 4 aponeurotic quadrants cut out of the anterior surface of the rectus sheaths is described.

[Pericardio-peritoneal shunt with the automatic stapler EEA]. / Dérivation péricardo-péritonéale à la pince automatique EEA.

Transdiaphragmatic pericardio-peritoneal shunt is an effective answer to the problem of recurrent pericardial effusion. The EEA (end to end anastomosis) stapler is a perfect tool for this technique, being easy to handle and offering the possibility of a pathological examination of the pericardic fragment removed. Five patients underwent this type of surgery with satisfactory results on a 3 to 29 months' follow-up.

[Risk factors in gastric ulcer surgery after the age of 70 years. 34 cases]. / Facteurs de risque de la chirurgie de l'ulcére gastrque aprés 70 ans. 34 observations.

Post-operative morbidity and mortality factors were investigated in a retrospective study of 34 patients aged over 70 operated upon for gastric ulcer. In two-thirds of the patients the operation was motivated by a complication of the ulcer. Two-thirds presented with an concurrent disease at the time of surgery. Fourteen patients died in hospital during the post-operative period, this mortality being related to the concurrent disease. Bleeding of the ulcer and emergency surgery were aggravating factors. The absence of post-operative abdominal complications had more influence on the prognosis than the type of operation performed.

[Ulcers of the neck of hiatal hernias. 15 cases]. / Les ulcères du collet des hernies hiatales. 15 observations.

Of 450 patients treated for hiatus hernia, a review of case-reports showed ulcers of the neck in 15 patients (3,1%). Frequency of hemorrhage was high (13/15), and it was sometimes severe, one patient dying from massive bleeding preoperatively. Diagnosis was by radiology in 11 cases, by endoscopy in 3 and perioperatively in one case. Data on physiopathogenicity include both mechanical and chemical factors. Conservative treatment with repair of hiatus hernia combined or not with vagotomy was performed in 11 patients. Severity of hemorrhagic phenomena or absence of preoperative biopsy led to direct surgery on ulcer in 3 cases, while evidence of mediastinal inflammatory processes required major surgery in 1 patient and an upper pole esophagogastrectomy in another. Long-term follow up failed to show evidence of recurrence of ulcer or hemorrhage.

[Surgical treatment of pulsion diverticula of the esophagus]. / Le traitement chirurgical des diverticules de pulsion de l'oesophage.

A retrospective study of 53 patients, operated upon for esophageal pulsion diverticula, is used to compare results with those in the literature in an attempt to improve operative indications with the hope of reducing the number of only fair short and long term results. Findings showed that results were rated as good in 81% of the 35 patients with pharyngo-esophageal diverticula and 65% of the 18 with epiphrenic diverticula. Indications for operation for pharyngo-esophageal diverticula can be based on clinical and radiological signs. Cricopharyngeal manometry indicates that myotomy is a logical procedure but results show that it is not necessary for choice of indications for surgery. Our preference is for a diverticulectomy, with or without associated myotomy, of debatable value. In contrast, for epiphrenic diverticula, functional esophageal explorations provide greater precision of the type of dyskinesia and allow better adaptation of surgery to type of dyskinesia associated with diverticulum.

[Myoid tumors of the stomach. Diagnostic contribution of ultrasound and x-ray computed tomography. Apropos of a case]. / Les tumeurs myoïdes de l'estomac. Apport diagnostique de l'échographie et de la tomodensitométrie. A propos d'un cas.

The authors report a new case of myoid tumour of the stomach, a chance discovery in an asymptomatic patient. The diagnosis of a heterogeneous tumour of gastric origin was made possible by echography and tomodensitometry. The myoid nature of the tumour was confirmed histologically. With the recognition of this new case the literature on the subject was reviewed. The features special to these tumours are studied with emphasis on the usefulness of echography and tomodensitometry in diagnosis, also the therapeutic approach to be adopted with regard to these tumours.

[Surgical treatment of diverticula of the thoracic esophagus]. / Traitement chirurgical des diverticules de l'oesophage thoracique.

Pathogeny of thoracic esophageal diverticuli, divided into parabronchial and epiphrenic, appears to have been modified by development of functional esophageal motility measurement. We present 23 patients with epiphrenic diverticuli and 3 with parabronchial diverticuli (15 male and 11 female with a mean age of 61 years). Twenty-four underwent surgery: 4 isolated diverticulectomy, 7 diverticulectomy and associated myotomy, 5 myotomy alone, 3 antireflux procedure alone. Three patients required esophagectomy for carcinoma in a diverticulum, for a huge diverticulum adherent to the inferior pulmonary vein. One patient presenting with perforation of a carcinomatous diverticulum in the pleura was treated with pleurotomy and has died. No fistula has been notified. Long term results had been analysed with a mean follow up of 4 years. Special attention has been reported on development of gastro-esophageal-reflux. The finding of a thoracic diverticulum requires evaluation by barium swallow, fibroscopy and functional test which should indicate the operation required. Long term analysis should include functional manometric evaluation and a pHanalysis as long term results are reduced by the appearance of gastro-esophageal-reflux.