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4 results on '"Division of Endocrine and Minimally Invasive Surgery"'

1. Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients

Author

Rasa Zarnegar, Phi-Linh Nguyen-Thi, G. Fantola, Laurent Brunaud, M.-A. Sirveaux, N. Reibel, Laurent Bresler, Adeline Germain, Ahmet Ayav, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ESPRI-Biobase [CHRU Nancy] (Unité fonctionnelle de la plateforme d’aide à la recherche clinique), Unité médico-chirurgical de chirurgie de l’obésité [CHRU Nancy], Division of Endocrine and Minimally Invasive Surgery, Departments of Surgery and Public Health, Weill Medical College of Cornell University [New York]-Weill Medical College of Cornell University [New York], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Multivariate analysis, Adolescent, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Gastric Bypass, Hematocrit, Young Adult, Postoperative Complications, Risk Factors, medicine, Humans, Postoperative Period, Young adult, Aged, Retrospective Studies, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Mortality rate, Postoperative complication, Retrospective cohort study, Robotics, Odds ratio, Middle Aged, Obesity, Morbid, 3. Good health, Surgery, Treatment Outcome, Concomitant, Female, Laparoscopy, business
Abstract

International audience; BACKGROUND:Totally robotic gastric bypass (robotic Roux-en-Y gastric bypass, R-RYGBP) has been adopted in some centers on the basis of large retrospective studies. In view of some data showing higher morbidity and higher costs, some authors have considered that robotic gastric bypass may no longer be justified with the existing system. Although low postoperative complication rates after R-RYGBP have been reported, risk factors for postoperative morbidity have never been evaluated. The goal of this study was to identify risk factors for postoperative morbidity after R-RYGBP.METHODS:A retrospective analysis of a prospectively maintained database was performed and included 302 consecutive patients after R-RYGBP performed between 2007 and 2013. This subset of patients represented 34 % of all gastric bypass procedures performed during this study period. Univariate and multivariate analyses were performed in order to identify risk factors for postoperative overall morbidity (Clavien scores 1-4 versus 0) and major morbidity (Clavien score ≥3 versus 0-1-2).RESULTS:Postoperative morbidity and mortality rates were 24.4 and 0.6 %, respectively. In multivariate analysis, independent risk factors for overall morbidity were American Society of Anesthesiologists (ASA) score ≥3 (odds ratio (OR) 2.0) and previous bariatric surgery (revisional gastric bypass) (OR 2.0). Independent risk factors for major morbidity (Clavien ≥3) were previous bariatric surgery (revisional gastric bypass) (OR 3.7), low preoperative hematocrit level (OR 0.9), and revisional gastric bypass procedure with concomitant gastric banding removal (OR 5.7).CONCLUSIONS:R-RYGBP is prone to increased complications in the setting of a high preoperative ASA score and revisional surgery. This should be taken into consideration by clinicians when evaluating R-RYGBP.

Published
2015

2. Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study

Author

Jean-Benoit Hardouin, Catherine Ansquer, Damien Masson, Antoine Hamy, Jean-François Henry, Delphine Drui, Claire Blanchard, Elise van Nuvel, Muriel Mathonnet, Frederic Sebag, Caroline Kubis, C. Caillard, Françoise Kraeber-Bodéré, Eric Mirallié, Rasa Zarnegar, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Service de chirurgie générale et endocrinienne, Hôpital de la Timone [CHU - APHM] (TIMONE), Clinique de chirurgie digestive et endocrinienne, IMAD, Département d'endocrinologie, Centre hospitalier universitaire de Nantes (CHU Nantes), Département de Biochimie [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Nord Laennec [CHU Nantes], Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Médecine Nucléaire [Nantes], Hôpital Laennec, Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, PRES Université Nantes Angers Le Mans (UNAM), Division of Endocrine and Minimally Invasive Surgery, Departments of Surgery and Public Health, Weill Medical College of Cornell University [New York]-Weill Medical College of Cornell University [New York], Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Laboratoire d'Informatique Gaspard-Monge (LIGM), and Université Paris-Est Marne-la-Vallée (UPEM)-École des Ponts ParisTech (ENPC)-ESIEE Paris-Fédération de Recherche Bézout-Centre National de la Recherche Scientifique (CNRS)

Subjects
Parathyroidectomy, Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Subgroup analysis, Quality of life, Surgical oncology, Surveys and Questionnaires, medicine, Humans, Postoperative Period, Prospective Studies, Prospective cohort study, Aged, Neoplasm Staging, Aged, 80 and over, Hyperparathyroidism, business.industry, Middle Aged, medicine.disease, Hyperparathyroidism, Primary, Prognosis, humanities, Surgery, Oncology, Multicenter study, Quality of Life, Female, business, Primary hyperparathyroidism, Follow-Up Studies
Abstract

International audience; BACKGROUND: The objectives of this study were to evaluate, in mild primary hyperparathyroidism (pHPT) patients, the quality of life (QoL) using the SF-36 questionnaire before and after parathyroidectomy and to detect preoperatively patients who benefit the most from surgery. Most pHPT patients present a mild pHPT defined by calcemia ≤11.4mg/dL. For these patients, there is debate about whether they should be managed with surveillance, medical therapy, or surgery.METHODS: A prospective multicenter study investigated QoL (SF-36) in patients with mild pHPT before and after parathyroidectomy in four university hospitals. Laboratory results and SF-36 scores were obtained preoperatively and postoperatively (3, 6, and 12months).RESULTS: One hundred sixteen patients were included. After surgery, the biochemical cure rate was 98%. Preoperatively, the mental component summary and the physical component summary (PCS) were 38.69 of 100 and 39.53 of 100, respectively. At 1year, the MCS and the PCS were 41.29 of 100 and 42.03 of 100. The subgroup analysis showed a more significant improvement in patientsCONCLUSIONS: This study showed, in patients with mild pHPT, an improvement of QoL 1year after parathyroidectomy. Patients

Published
2013

3. Multifactorial Analysis of the Learning Curve for Totally Robotic Roux-en-Y Gastric Bypass for Morbid Obesity

Author

Didier Quilliot, Adeline Germain, Laurent Bresler, N. Reibel, Ahmet Ayav, Myriam Renaud, Rasa Zarnegar, Laurent Brunaud, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Unité Multidisciplinaire de Chirurgie de l'Obésité [CHRU Nancy], Division of Endocrine and Minimally Invasive Surgery, Departments of Surgery and Public Health, Weill Medical College of Cornell University [New York]-Weill Medical College of Cornell University [New York], Service de Diabétologie, Nutrition et Maladies métaboliques [CHRU Nancy], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and UL, NGERE

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Gastric bypass, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Operative Time, 030230 surgery, Risk Assessment, Management of obesity, 03 medical and health sciences, Postoperative complications, 0302 clinical medicine, Weight Loss, Humans, Medicine, Prospective Studies, Obesity, Laparoscopy, Prospective cohort study, Learning curve, Bariatric surgery, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Mortality rate, Robotics, Length of Stay, Roux-en-Y anastomosis, Obesity, Morbid, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Treatment Outcome, Female, 030211 gastroenterology & hepatology, Clinical Competence, Morbidity, business, Complication
Abstract

International audience; BackgroundLaparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric operation worldwide for the surgical management of obesity. Totally robotic Roux-en-Y gastric bypass (TR-RYGBP) has been considered to be a better approach by some groups especially early in a surgeon's experience. However, the learning curve associated with TR-RYGBP has been poorly evaluated yet. The aim of this study was to evaluate the learning curve of patients who underwent TR-RYGBP.MethodsThis is a prospective study of 154 first consecutive patients undergoing TR-RYGBP to analyze the influence of surgeon experience, bedside first assistant, and patient factors on operative time and postoperative complications. To give a comprehensive view of success related to the learning process, a single hybrid variable was generated. Multivariate analysis predicted the risk factors for complications and operative time. A risk-adjusted cumulative sum analysis estimated the learning curve.ResultsThe learning curve for TR-RYGBP was 84 cases. Case rank and first assistant level were independent predictors of total operative time. Overall 30-day postoperative morbidity rate was 33.1 % and decreased over time. Surgeon experience (OR 2.6; CI 95 [1.290 to 5.479]; p = 0.0081) and first assistant level (OR 2.42; CI 95 [1.197 to 4.895]; p = 0.0139) remained independent predictors of composite event (operative time and complications).ConclusionsThis study identifed criteria that should be assessed in future studies about TR-RYGBP. Both surgeon experience and bedside first assistant level affected operative duration, but surgeon experience was the most significant factor in reducing complication rates.

Published
2013

4. Surgery for 'asymptomatic' mild primary hyperparathyroidism improves some clinical symptoms postoperatively

Author

Antoine Hamy, Claire Blanchard, Delphine Drui, Patrice Rodien, Christelle Volteau, Muriel Mathonnet, F. Archambeaud, Jean-François Henry, Marie-Françoise Heymann, Jean-Benoit Hardouin, Malanie Roy, Eric Mirallié, Vincent Wyart, Frederic Sebag, Rasa Zarnegar, Bertrand Cariou, C. Caillard, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Service de chirurgie générale et endocrinienne, Hôpital de la Timone [CHU - APHM] (TIMONE), Clinique de chirurgie digestive et endocrinienne, IMAD, Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Plateforme de Biométrie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d’Anatomopathologie [CHU Nantes], Département d'endocrinologie, Différenciation et communication neuronale et neuroendocrine (DC2N), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Normandie Université (NU), Service de Médecine interne B, Endocrinologie, Diabète, Maladies métaboliques [CHU Limoges], Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Division of Endocrine and Minimally Invasive Surgery, Departments of Surgery and Public Health, Weill Medical College of Cornell University [New York]-Weill Medical College of Cornell University [New York], Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, and PRES Université Nantes Angers Le Mans (UNAM)

Subjects
Parathyroidectomy, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030209 endocrinology & metabolism, 030230 surgery, Logistic regression, Asymptomatic, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, medicine, 80 and over, Humans, Postoperative Period, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, Creatinine, Hyperparathyroidism, business.industry, Hydroxycholecalciferols, Age Factors, General Medicine, Middle Aged, Hyperparathyroidism, Primary, medicine.disease, 3. Good health, Surgery, Clinical trial, Treatment Outcome, chemistry, Calcium, Female, medicine.symptom, business, Primary hyperparathyroidism, Primary, Follow-Up Studies
Abstract

Objective and backgroundMost primary hyperparathyroidism (pHPT) patients do not conform to the guidelines for parathyroidectomy established by an international panel of specialists and have a mild pHPT. This group is typically defined as ‘asymptomatic’. The primary aim of this study was to determine symptom improvement in this ‘asymptomatic’ group after parathyroidectomy. Secondly, we aimed to create a preoperative clinical score predicting postoperative symptom resolution.DesignA prospective nonrandomized study included patients with mild pHPT.MethodsA questionnaire (22 items) was given to ‘asymptomatic’ patients preoperatively and at 3, 6, and 12 postoperative months. A logistic regression was performed to create a preoperative clinical score.ResultsOne hundred and sixteen patients were included. Postoperatively, HPT was resolved in 98% of patients. Twelve of 22 nonspecific symptoms were improved at 1 year. Subgroups analysis showed a greater improvement in patients ConclusionPatients with asymptomatic pHPT have clinical improvement of their symptoms postoperatively even after 1 year. Younger patients and those with higher preoperative calcium levels show the best improvement.

Published
2013

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