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1.
Tech Coloproctol ; 25(5): 531-537, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33590438

RESUMEN

BACKGROUND: Fecal incontinence is a common complaint. In the presence of extensive sphincter deterioration, after anorectal trauma, or failure of non-invasive surgical procedures, a sphincter reconstruction with dynamic graciloplasty can be proposed. The aim of our study was to evaluate the long-term results of dynamic graciloplasty. METHODS: A retrospective study was conducted on all the patients who underwent dynamic graciloplasty between 1997 and 2019 in one French tertiary referral center for severe fecal incontinence after previous unsuccessful treatments. Only patients with available long-term results (≥ 1 year) were included. RESULTS: Among 40 patients who underwent dynamic graciloplasty, 31 patients [77% women, median age = 57 years (range 17-74 years)] were included with a mean long-term follow-up of 11 ± 6 years. The mean duration of fecal incontinence was 8 ± 7.9 years and the mean Wexner score was 16 ± 3. Fecal incontinence was adult-acquired in 88% of patients. 74% of patients underwent previously unsuccessful surgical procedures. A diverting colostomy was present in 7 patients (23%). Postoperative overall, surgical and major morbidity occurred in 20 (64%), 17 (55%) and 7 (23%) patients, respectively. At the end of follow-up, 18 patients still used their stimulation device (58%), and 4 patients required a permanent colostomy (12.5%). Long-term efficacy of dynamic graciloplasty was reported by 17 patients (55%). CONCLUSION: The efficacy of dynamic graciloplasty is conserved in 55% of patients after a mean follow-up of 11 years. This procedure needs to be kept in the surgical armamentarium for persistent and severe fecal incontinence after previous surgical interventions or in the presence of large perineal defects, before the ultimate step of permanent stoma.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Incontinencia Fecal , Adolescente , Adulto , Anciano , Canal Anal/cirugía , Incontinencia Fecal/etiología , Incontinencia Fecal/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
2.
Anaerobe ; 72: 102470, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34743984

RESUMEN

The aetiology of appendicular abscess is predominantly microbial with aerobic and anaerobic bacteria from gut flora. In this study, by using specific laboratory tools, we co-detected Methanobrevibacter oralis and Methanobrevibacter smithii among a mixture of enterobacteria including Escherichia coli, Enterococcus faecium and Enterococcus avium in four unrelated cases of postoperative appendiceal abscesses. These unprecedented observations raise a question on the role of methanogens in peri-appendicular abscesses, supporting antibiotics as an alternative therapeutic option for appendicitis, including antibiotics active against methanogens such as metronidazole or fusidic acid.


Asunto(s)
Absceso/diagnóstico , Absceso/microbiología , Apendicitis/complicaciones , Methanobrevibacter/clasificación , Absceso/tratamiento farmacológico , Adolescente , Adulto , Antibacterianos/uso terapéutico , Apendicitis/diagnóstico , Apendicitis/tratamiento farmacológico , Cultivo de Sangre , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Femenino , Humanos , Masculino , Methanobrevibacter/genética , Methanobrevibacter/aislamiento & purificación , Methanobrevibacter/ultraestructura , Persona de Mediana Edad , Tipificación Molecular , ARN Ribosómico 16S/genética , Tomografía Computarizada por Rayos X , Adulto Joven
3.
Colorectal Dis ; 21(7): 782-790, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30884089

RESUMEN

AIM: The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD: From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS: A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION: Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.


Asunto(s)
Colectomía/mortalidad , Neoplasias del Colon/cirugía , Tratamiento de Urgencia/mortalidad , Indicadores de Salud , Obstrucción Intestinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/complicaciones , Neoplasias del Colon/mortalidad , Femenino , Francia/epidemiología , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Curva ROC , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
4.
Colorectal Dis ; 21(9): 1058-1066, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30985984

RESUMEN

AIM: Faecal incontinence is frequent in the elderly. Little is currently known about the efficacy of sacral nerve modulation (SNM) in the elderly. The present study aimed to assess the impact of age on the outcome of SNM and on the surgical revision and explantation rates by comparing the results of a large data set of patients. METHOD: Prospectively collected data from patients who underwent an implant procedure between January 2010 and December 2015 in seven French centres were retrospectively evaluated. In total, 352 patients [321 women; median age (range): 63 (24-86) years] were included. Clinically favourable and unfavourable outcomes, and surgical revision and explantation rates, were compared according to the age of the patients. RESULTS: A similar outcome was observed when comparing patients < 70 years and ≥ 70 years (a favourable outcome in 79.2% and 76.2%, respectively, P = 0.89). The probability of a successful treatment as a function of time was similar for the two age groups (< 70 years and ≥ 70 years, P = 0.54). The explantation and revision rates were not influenced by age (explantation rate: 17% in patients < 70 years vs 14% in patients ≥ 70 years, P = 0.89; and revision rate: 42% in patients < 70 years vs 40% in patients ≥ 70 years, P = 0.89). The probability of explantation as a function of time was similar for the two age groups (P = 0.82). The limitations of this study were its retrospective status, the rate of loss at follow-up and different durations of patient follow-up. CONCLUSIONS: Our results suggest that patients ≥ 70 years suffering from faecal incontinence benefit from SNM with a similar risk as a younger population.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Plexo Lumbosacro , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Terapia por Estimulación Eléctrica/efectos adversos , Electrodos Implantados , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
5.
Colorectal Dis ; 19(8): 756-763, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28181378

RESUMEN

AIM: Poor functional results, such as faecal incontinence (FI), low anterior resection syndrome (LARS) or high stool frequency, can occur after colorectal resections, including proctocolectomy with ileal pouch-anal anastomosis (IPAA), rectal resection and left hemicolectomy. Management of such patients is problematic, and some case reports have demonstrated the effectiveness of sacral nerve stimulation (SNS) in these situations. Our aim was to analyse the effectiveness of SNS on poor functional results and on quality of life in patients after treatment with different types of colorectal resection. METHOD: At five university hospitals from 2006 to 2014, patients with poor functional results after rectal resection, IPAA or left hemicolectomy underwent a staged SNS implant procedure. Failure was defined by the absence or insufficient improvement (< 50%) of FI episodes. RESULTS: SNS for bowel dysfunction was performed in 16 patients after rectal resection with coloanal anastomosis, left hemicolectomy with colorectal anastomosis or IPAA. Two (13%) cases of primary failure were observed after the percutaneous stimulation test. Median frequency of stool, FI episodes and urgency were significantly improved in 14 patients. Wexner and LARS scores were also significantly improved for 14 patients. When we compared results according to the type of colorectal surgery (IPAA, rectal resection or left hemicolectomy), median frequencies of stool and urgency, Wexner and LARS scores were still significantly improved. Overall success rate was 75% (12/16 patients) in intention-to-treat analysis and 86% (12/14 patients with permanent electrode) in per-protocol analysis. CONCLUSION: SNS seems to improve bowel dysfunction following rectal resection, left hemicolectomy or IPAA.


Asunto(s)
Colectomía/efectos adversos , Enfermedades Funcionales del Colon/terapia , Plexo Lumbosacro , Complicaciones Posoperatorias , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Colon/cirugía , Enfermedades Funcionales del Colon/etiología , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Recto/cirugía , Resultado del Tratamiento , Adulto Joven
6.
Colorectal Dis ; 19(2): 194-199, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27338153

RESUMEN

AIM: The aim of this study was to assess the safety and efficacy of the emborrhoid technique (embolization of the superior haemorrhoidal arteries) in patients ineligible for surgery. METHODS: Between January 2014 and April 2015, 30 consecutive patients (average age 58 years) suffering from disabling chronic bleeding due to haemorrhoidal disease and with a contraindication for surgery (n = 23) or with a failure of instrumental or surgical treatment (n = 7) underwent embolization. All cases were discussed at multidisciplinary meetings including a proctology specialist or a surgeon and an interventional radiologist. We performed super selective micro coil embolization (pushable 2-3 mm fibre coils) of the distal branches of the superior rectal arteries with a microcatheter, via a right femoral approach, under local anaesthesia. We assessed clinical outcome by evaluating bleeding and specific clinical scores relating to bleeding and changes in quality of life. RESULTS: Immediate technical success, with no complication, was achieved in 93% of cases. A mean of 3.1 arteries per patient was embolized, with a mean of 7.6 coils per patient. Median follow-up was 5 months. Clinical score improvement was observed in 72%, in 17 patients after a single embolization session, and in four additional patients after a second embolization session. No improvement in bleeding was observed in eight patients (28%). CONCLUSION: Distal coil embolization of the superior rectal arteries for disabling chronic bleeding due to haemorrhoidal disease is safe and effective in patients untreatable by surgery.


Asunto(s)
Embolización Terapéutica/métodos , Hemorragia Gastrointestinal/terapia , Hemorroides/terapia , Arteria Mesentérica Inferior , Recto/irrigación sanguínea , Adulto , Anciano , Enfermedad Crónica , Procedimientos Endovasculares , Femenino , Hemorragia Gastrointestinal/etiología , Hemorroides/complicaciones , Humanos , Masculino , Persona de Mediana Edad
8.
Colorectal Dis ; 13(6): 684-8, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20184639

RESUMEN

AIM: Colorectal cancer (CRC) complicating inflammatory bowel disease (IBD) accounts for 10-15% of all IBD deaths. Survival of patients with IBD-related CRC was reviewed to analyse differences between ulcerative colitis (UC) and Crohn's disease (CD). METHOD: We analysed (24 men and 10 women) patients with CD (n = 14) or UC (n = 20) with CRC, who presented between 1990 and 2007, and were followed to October, 2009. RESULTS: The mean age of patients was 56 ± 12 years for patients with UC and 49 ± 17 years for patients with CD, and the mean duration of symptoms was 22 ± 11 and 16 ± 8 years, respectively. The median duration of follow up after the diagnosis of CRC was 49 (1-157) months. Recurrence occurred in five patients with UC and in nine with CD (P = 0.02). The overall and disease free five year survivals were significantly higher in patients with UC than CD [70%vs 43% (P = 0.01) and 63%vs 31% (P = 0.01), respectively]. CONCLUSION: The results showed a poorer prognosis of CRC in patients with CD than with UC.


Asunto(s)
Colitis Ulcerosa/complicaciones , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/mortalidad , Enfermedad de Crohn/complicaciones , Adulto , Anciano , Quimioterapia Adyuvante , Colitis Ulcerosa/mortalidad , Colitis Ulcerosa/patología , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Enfermedad de Crohn/mortalidad , Enfermedad de Crohn/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Tasa de Supervivencia
9.
Colorectal Dis ; 13(6): 689-96, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20236144

RESUMEN

AIM: Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. METHOD: Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. RESULTS: The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. CONCLUSION: Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.


Asunto(s)
Terapia por Estimulación Eléctrica , Incontinencia Fecal/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Electrodos Implantados/efectos adversos , Incontinencia Fecal/cirugía , Heces , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Calidad de Vida , Análisis de Regresión , Región Sacrococcígea/inervación , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto Joven
10.
World J Surg ; 35(4): 900-4, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21274532

RESUMEN

BACKGROUND: Sphincter-sparing procedures are increasingly advocated in the treatment of chronic anal fissures (CAF) resistant to conservative management. Herein, we report about our results with sphincter-sparing transanal mucosal advancement flap anoplasty (MAAP) to treat CAF. PATIENTS AND METHODS: The present study was a retrospective single-center analysis of patients in whom conservative management of CAF failed and who subsequently underwent MAAP between January 2003 and December 2008. RESULTS: A total of 26 patients with a median age of 46.5 years (range: 17-79 years) had undergone MAAP after suffering with CAF for a median period of 9 months (range: 4-36 months). Surgery was well tolerated in all patients. One patient developed a perianal abscess at the operative site 3 weeks after MAAP, which required excision. At 2, 12, and 24 months follow-up, all patients were free of pain with no fissure recurrence or any worsening of incontinence. CONCLUSIONS: Mucosal advancement flap anoplasty might be another sphincter-sparing treatment option in patients suffering from CAF. To draw final conclusions about the value of MAAP in the treatment of CAF, more solid data are required.


Asunto(s)
Fisura Anal/cirugía , Membrana Mucosa/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Cicatrización de Heridas/fisiología , Adolescente , Adulto , Anciano , Profilaxis Antibiótica , Enfermedad Crónica , Estudios de Cohortes , Femenino , Fisura Anal/diagnóstico , Fisura Anal/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto Joven
11.
J Visc Surg ; 158(2): 145-157, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33495108

RESUMEN

Rectocele is defined as a hernia of the rectum with protrusion of the anterior rectal wall through the posterior wall of the vagina. This condition occurs commonly, with an estimated prevalence of 30-50% of women over age 50. The symptomatology that leads to consultation is variable but consists predominantly of anorectal and/or gynecological complaints such as dyschezia, requiring digital disimpaction maneuvers, pelvic heaviness, anal incontinence, or dyspareunia. Rectocele may be isolated or associated with other disorders of pelvic stasis involving cystocele and uterine prolapse. Complementary exams (dynamic imaging and anorectal manometry) are essential before deciding on the surgical management of this condition. The indications for surgical management of rectocele are based on the intensity of symptoms and the resulting deterioration in quality of life, and surgery should be discussed after failure of medical treatment. Different approaches are possible, although there is currently no real consensus in the literature. The initial approach depends on the type of rectocele: if it involves the low or mid rectum or is isolated, an approach from below (transanal, transperineal, or transvaginal approach) can be proposed, while, in the presence of a high rectocele and/or associated with various disorders of pelvic stasis, transabdominal rectopexy is more suitable.


Asunto(s)
Calidad de Vida , Rectocele , Estreñimiento , Femenino , Humanos , Persona de Mediana Edad , Rectocele/cirugía , Recto , Vagina
12.
BJS Open ; 5(3)2021 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-34097005

RESUMEN

BACKGROUND: Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. METHOD: This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. RESULTS: There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3-5, P < 0.001). CONCLUSION: The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.


Asunto(s)
Neoplasias del Recto , Quimioradioterapia/efectos adversos , Humanos , Morbilidad , Estadificación de Neoplasias , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Resultado del Tratamiento
13.
Morphologie ; 94(305): 9-12, 2010 May.
Artículo en Francés | MEDLINE | ID: mdl-20149707

RESUMEN

AIM OF THE STUDY: Lymph node involvement is one of the most significant prognostic factors of patients with rectal cancer. Despite major advances in our understanding of the propagation of the rectal cancer, the lymphatic drainage of the rectum remains unclear. This study was designed to assess the number of lymph nodes located around the superior rectal artery and to assess the frequency of Mondor's lymph nodes. PATIENTS AND METHODS: Twenty-five anatomic subjects were studied. All resections were performed using total mesorectal excision. Lymph nodes were sought in the tissue surrounding the superior rectal artery up to 2 cm under the ending of the superior rectal artery by manual dissection and were submitted for histological examination. The correlation between the number of lymph nodes, and the volume and weight of the tissue surrounding the superior rectal artery was evaluated by non-parametric Spearman test. RESULTS: The mean number of lymph nodes per specimen was 2.7 +/- 1.4. The size of the lymph nodes varied between 1 and 7 mm. The lymph nodes were mostly smaller than 3 mm (56%). The number of lymph nodes in the superior rectal mesentery was independent of its volume and its weight. Seven subjects had a Mondor's lymph node. The mean size of Mondor's lymph node was 3.4 +/- 2.1 cm. CONCLUSIONS: The number of NL located around the superior rectal artery is small, varying between 1 and 5. The Mondor's lymph node is an inconstant rectal NL. Its only characteristic is its location in the bifurcation or trifurcation of the superior rectal artery.


Asunto(s)
Ganglios Linfáticos/patología , Neoplasias del Recto/patología , Disección/métodos , Femenino , Humanos , Ganglios Linfáticos/anatomía & histología , Masculino , Arteria Mesentérica Inferior/anatomía & histología , Arteria Mesentérica Inferior/patología , Arteria Mesentérica Superior/anatomía & histología , Arteria Mesentérica Superior/patología , Estadificación de Neoplasias , Neoplasias del Recto/irrigación sanguínea
14.
Colorectal Dis ; 11(6): 572-83, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19508514

RESUMEN

OBJECTIVE: Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. METHOD: Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. RESULTS: We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. CONCLUSION: We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.


Asunto(s)
Canal Anal/inervación , Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Guías de Práctica Clínica como Asunto , Electrodos Implantados , Medicina Basada en la Evidencia , Humanos , Región Sacrococcígea/inervación
15.
Gastroenterol Clin Biol ; 33(2): 138-46, 2009 Feb.
Artículo en Francés | MEDLINE | ID: mdl-19195806

RESUMEN

Lymph node (LN) involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of rectal LN is not well known. The rectal LN are mainly located around the rectal arteries. In the mesorectum, the LN are mainly located posteriorly. The number of LN by patient varies considerably. Many reasons can explain this variability. Acquired factors such as infection, inflammation or metastatic involvement facilitate the detection of LN. In contrast, preoperative radiotherapy reduces the number and size of lymph nodes. The procedure of resection affects the number of LN harvested. Extensive lymphadenectomies increase the number of LN harvested. The technique used by pathologist has equally a major influence. The fat clearing method allows detection of a greater number of LN than manual dissection particularly for small LN. Toxicity of these solutions and a time-consuming process explain that fat clearing method is rarely used in clinical practice. Detection of rectal lymph nodes is difficult and tedious but is necessary for an accurate staging of patients with rectal cancer.


Asunto(s)
Sistema Linfático , Recto/inmunología , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Sistema Linfático/patología , Cuidados Preoperatorios , Pronóstico , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Recto/irrigación sanguínea , Recto/patología
16.
J Visc Surg ; 156(3): 197-208, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30948208

RESUMEN

PURPOSE: Surgical management of obstructive left colon cancer (OLCC) is controversial. The objective is to report on postoperative and oncological outcomes of the different surgical options in patients operated on for OLCC. METHODS: From 2000-2015, 1500 patients were treated for OLCC in centers members of the French Surgical Association. Colonic stent (n=271), supportive care (n=5), palliative derivation (n=4) were excluded. Among 1220 remaining patients, 456 had primary diverting colostomy (PDC), 329 a segmental colectomy (SC), 246 a Hartmann's procedure (HP) and 189 a subtotal colectomy (STC) as first-stage surgery. Perioperative data and oncological outcomes were compared retrospectively. RESULTS: There was no difference between the 4 groups regarding gender, age, BMI and comorbidities. Postoperative mortality and morbidity were 4-27% (PDC), 6-47% (SC), 9-55% (HP), 13-60% (STC), respectively (P=0.005). Among the 431 living patients after PDC, 321 (70%) patients had their primary tumour removed. Cumulative mortality and morbidity favoured PDC (7-39%) and SC (6-40%) compared to HP (1-47%) and STC (13-50%) (P=0.04). At the end of follow-up definitive stoma rates were 39% (HP), 24% (PDC), 10% (SC), and 8% (STC) (P<0.0001). Five-year overall and disease-free survival was: SC (67-55%), PDC (54-48%), HP (54-37%) and STC (48-49%). After multivariate analysis, SC and PDC were associated with better prognosis compared to HP and STC. CONCLUSION: In OLCC, SC and PDC are the two preferred options in patients with good medical conditions. For patients with severe comorbidities PDC should be recommended, reserving HP and STC for patients with colonic ischaemia or perforation complicating malignant obstruction.


Asunto(s)
Colectomía/métodos , Colon/cirugía , Neoplasias del Colon/cirugía , Obstrucción Intestinal/cirugía , Sociedades Médicas , Adulto , Anciano , Anciano de 80 o más Años , Colon/diagnóstico por imagen , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Francia , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
17.
J Chir (Paris) ; 145(1): 27-31, 2008.
Artículo en Francés | MEDLINE | ID: mdl-18438279

RESUMEN

BACKGROUND: Stapled transanal rectal resection is a new alternative for the treatment of outlet obstruction syndrome. The aim of this study was to assess its feasibility and safety in a multicenter context. MATERIALS AND METHOD: The study had a retrospective design and included 102 patients who were operated in 5 centers. All patients complained of symptomatic outlet obstruction. Surgical technique involved a double hemi-circumferential rectal stapling according to the technique described by Longo. Mean follow-up was 17.2 months. RESULTS: The STARR procedure was done in 100 patients (2 patients had a non relaxing sphincter preventing anal dilatation). Immediate postoperative morbidity included bleeding in 4 cases (4%) and rectal stenosis in 3 cases (3%). The main postoperative medium-term complaints were urge to defecate (34%) which was regressive in most patients and de novo incontinence to flatus (9%). Nevertheless, results were considered favorable in 85% of patients. CONCLUSION: This multicenter study, reporting the results of the largest published series, suggests that the STARR technique is feasible and safe in the medium term for the treatment of rectocele. Occurrence of adverse events such as incontinence to flatus should be better evaluated by future studies with longer follow up in order to assess the actual place of STARR in the treatment of rectocele or outlet obstruction.


Asunto(s)
Canal Anal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Obstrucción Intestinal/cirugía , Rectocele/cirugía , Recto/cirugía , Grapado Quirúrgico , Anciano , Defecografía , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Francia , Humanos , Obstrucción Intestinal/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias , Rectocele/complicaciones , Estudios Retrospectivos , Grapado Quirúrgico/efectos adversos , Grapado Quirúrgico/instrumentación , Grapado Quirúrgico/métodos , Resultado del Tratamiento
18.
J Visc Surg ; 155(4): 337-338, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30173710

RESUMEN

Mesenteric hernia is a frequent cause of intestinal obstruction in childhood but is exceptional in the adult. We describe a case in a young adult without any remarkable history who presented with an acute abdomen and intestinal obstruction.


Asunto(s)
Abdomen Agudo/etiología , Hernia Abdominal/diagnóstico , Enfermedades del Íleon/etiología , Obstrucción Intestinal/etiología , Mesenterio , Enfermedades Peritoneales/diagnóstico , Adulto , Hernia Abdominal/complicaciones , Humanos , Masculino , Enfermedades Peritoneales/complicaciones
19.
J Visc Surg ; 155(3): 173-181, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29396112

RESUMEN

Management of functional consequences after pancreatic resection has become a new therapeutic challenge. The goal of our study is to evaluate the risk factors for exocrine (ExoPI) and endocrine (EndoPI) pancreatic insufficiency after pancreatic surgery and to establish a predictive model for their onset. PATIENTS AND METHODS: Between January 1, 2014 and June 19, 2015, 91 consecutive patients undergoing pancreatoduodenectomy (PD) or left pancreatectomy (LP) (72% and 28%, respectively) were followed prospectively. ExoPI was defined as fecal elastase content<200µg per gram of feces while EndoPI was defined as fasting glucose>126mg/dL or aggravation of preexisting diabetes. The volume of residual pancreas was measured according to the same principles as liver volumetry. RESULTS: The ExoPI and EndoPI rates at 6 months were 75.9% and 30.8%, respectively. The rate of ExoPI after PD was statistically significantly higher than after LP (98% vs. 21%; P<0.001), while the rate of EndoPI was lower after PD vs. LP, but this difference did not reach statistical significance (28% vs. 38.5%; P=0.412). There was no statistically significant difference in ExoPI found between pancreatico-gastrostomy (PG) and pancreatico-jejunostomy (PJ) (100% vs. 98%; P=1.000). Remnant pancreatic volume less than 39.5% was predictive of ExoPI. CONCLUSION: ExoPI occurs quasi-systematically after PD irrespective of the reconstruction scheme. The rate of EndoPI did not differ between PD and LP.


Asunto(s)
Enfermedades del Sistema Endocrino/etiología , Insuficiencia Pancreática Exocrina/etiología , Pancreatectomía , Pancreaticoduodenectomía , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Sistema Endocrino/diagnóstico , Enfermedades del Sistema Endocrino/epidemiología , Insuficiencia Pancreática Exocrina/diagnóstico , Insuficiencia Pancreática Exocrina/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
20.
J Chir (Paris) ; 144(3): 197-202, 2007.
Artículo en Francés | MEDLINE | ID: mdl-17925711

RESUMEN

Fecal incontinence is one of the most feared complications of vaginal delivery. It may be the consequence of sphincter tears, of pudendal neuropathy, or of a combination of the two. Fecal incontinence occurs immediately following 13-54% of vaginal deliveries but its persistence in the mid and long term is poorly known. The incidence of perineal tear with anal sphincteric defect varies from 1-9% and the incidence of unrecognized sphincter injury may be as high as 18-35%. Half the women who undergo primary anal sphincter repair have short or long term continence problems. Pudendal neuropathy is caused by nerve stretch during pushing in the second stage of labor and descent of the fetal head; it may occur even with the first delivery. Risk factors for sphincter injury and pudendal neuropathy include forceps delivery, large neonatal size, and prolonged second stage of labor. The risk of fecal incontinence must be considered even during the first pregnancy. Routine episiotomy does not prevent sphincter injury and may even predispose to it. Pudendal neuropathy following delivery may lead to delayed fecal incontinence abetted by postmenopausal hormonal deficiency and tissue senescence. The possible benefit of early episiotomy for women at high risk of sphincter injury must be evaluated by prospective studies.


Asunto(s)
Parto Obstétrico/efectos adversos , Incontinencia Fecal/etiología , Canal Anal/lesiones , Canal Anal/inervación , Incontinencia Fecal/prevención & control , Femenino , Humanos , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/etiología , Embarazo , Factores de Riesgo
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