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1. Why and how to implement an electronic resident's surgical logbook to improve operating-room training? First 5-year feedback from a French center.

Author

Delhorme, J.-B., Romain, B., Manfredelli, S., Liu, D., Simeu Tamnou, B., Steinmetz, J.-P., Brigand, C., and Rohr, S.

Subjects
LOGBOOKS, OPERATING rooms, RESIDENTS, COLLEGE teachers, OPERATIVE surgery
Abstract

• The electronic logbook for general surgery residents is filled in only 55% of cases. • Supervising general surgery residents in the operating room has no impact on postoperative major morbidity. • Supervision of general surgery residents in the operating room is preferentially performed by a fellow or a practicing physician rather than an associate professor or a clinical professor. • The filling of a surgical logbook should be extended for all residents in French centers. The evaluation of general surgery residents' operating room (OR)-training and technical skills progression may be difficult in the absence of a standardized evaluation tool. The aim of this study was to evaluate the impact of the implementation of an electronic "surgical logbook" for general surgery residents. A prospective single center study was conducted between May 2015 and October 2020. An electronic logbook was filled by all residents immediately after each surgical procedure and data were prospectively collected and analyzed. Fifty-five students (34 men/21 women) reported their participation to 6917 surgical procedures, which corresponded to 55.5% of all procedures performed in our department. Residents performed the entire procedure as the operating surgeon in 28.5% of cases (n = 1963), parts of the procedure as operating surgeon in 32.5% of cases (n = 2230) and as operating-assistant in 38.5% (n = 2672). Residents were more likely an operating surgeon for the entire procedure when they were assisted by a fellow or a practicing physician than an associate professor or a clinical professor (P < 0.001). There was no significant difference in the major morbidity rate between different resident's contribution to the procedure (P = 0.14). We present here a simple, useful and cost efficient tool which offers easy data collection and reporting that could help improve OR-training, OR-supervision and certification at a local or national level. [ABSTRACT FROM AUTHOR]

Published
2022
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2. [Laparoscopic treatment of gastroesophageal reflux using fundoplication. Midterm results]

Author

Meyer, C, Rohr, S, de Manzini, Nicolo', Firtion, O, Thiry, L, Bourtoul, C., Meyer, C, Rohr, S, de Manzini, Nicolo', Firtion, O, Thiry, L, and Bourtoul, C.

Subjects
Adult, Lung Diseases, Male, Reoperation, Manometry, gastroesophageal reflux, Fundoplication, surgery, Recurrence, Pressure, Humans, Prospective Studies, Aged, Laparotomy, Hydrogen-Ion Concentration, Middle Aged, Treatment Outcome, Patient Satisfaction, Gastroesophageal Reflux, Female, Laparoscopy, Esophagoscopy, Gases, Deglutition Disorders, Follow-Up Studies
Abstract

The aim of this study was to see whether the results of surgical treatment of gastroesophageal reflux disease (GERD) by laparoscopic fundoplication were satisfactory and stable over time.From July 1992 to September 1996, 161 patients with medical treatment-dependent GERD were operated. 17 patients were excluded from the study (conversion or immediate laparotomy). The group of 144 patients included consisted of 92 men and 52 women with a mean age of 50 (25-77 years). The preoperative work-up included endoscopy, esophageal manometry and 24-hour pH monitoring. The surgical procedures were complete fundoplication without section of the short vessels (Nissen-Rossetti: 122 cases), with section of the shorts vessels (Nissen: 18 cases), or partial fundoplication of 270 degrees (Toupet: 4 cases). The patients were reviewed clinically 3 months after the operation, with repeat manometry and pH monitoring; yearly survey was performed.There was no postoperative mortality. The morbidity consisted of 2 respiratory complications (1.5%) with good recovery. With a follow-up of 3 and 21 months, the dysphagia rate was 24 vs 2% of patients (p0.05), the rate of gas bloat syndrome was 18% vs 21% (n.s.), and the GERD recurrence 6% vs 14% (p0.05). The mean time to recurrence was 8 months. 2 patients were reoperated: one for incisional hernia and one for slipped-Nissen.The results of laparoscopic treatment of GERD with fundoplication procedures at 2 years follow-up showed an 86% cure rate of GERD control and 94% satisfaction rate for the patients who were investigated.

Published
1998

3. [Pancreatico-jejunal anastomosis with invagination on isolated loop after cephalic pancreatoduodenectomy]

Author

Meyer C, Rohr S, Thiry CL, Firtion O., de Manzini, Nicolo', Meyer, C, Rohr, S, de Manzini, Nicolo', Thiry, Cl, and Firtion, O.

Subjects
Adult, Male, technics, pancreatic cancer, Middle Aged, Pancreaticoduodenectomy, surgery, Pancreaticojejunostomy, Humans, Female, Prospective Studies, Aged
Abstract

The most frequent and most dangerous complication of the duodenopancreatectomy is pancreatic fistula due to dehiscence of the pancreatic anastomosis. A technique that uses a separate Roux en Y loop for pancreatic anastomosis, to reduce the fatal risks of the pancreatic fistula, has been initially reported more than 50 years ago. With the development of the pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique is derived from those previously published, allowing a good intussuception of the pancreas in the intestinal loop. This method has been performed in 35 duodenopancreatectomy (malignant pancreatic disease: 32 patients, benign pancreatic disease: 3 patients). The mean age of the patients was 64 years (range 34-74). There were four operative deaths unrelated to the pancreaticojejunal anastomosis and two pancreatic fistulas with spontaneous healing. The pancreatico-jejunostomy using a separate Roux en Y loop represented in this short experience a safe procedure to prevent pancreatic fistula.

Published
1998

4. Results of fundoplication by laparoscopic approach in the treatment of gastroesophageal reflux. A propos of 224 cases

Author

Meyer C, Firtion O, Rohr S, Le JV, Thiry L.C., de Manzini, Nicolo', Meyer, C, Firtion, O, Rohr, S, de Manzini, Nicolo', Le, Jv, and Thiry, L. C.

Subjects
Adult, Male, gastroesophageal reflux, Fundoplication, Middle Aged, surgery, Postoperative Complications, Treatment Outcome, Humans, Female, Laparoscopy, Prospective Studies, Aged, Follow-Up Studies
Abstract

The aim of this paper is to evaluate prospectively immediate and 2-year results of laparoscopic fundoplicature (LF) for gastroesophageal reflux disease (GERD).Patients presenting GERD who had been previously submitted to a long-term medical treatment were included in this study. Preoperative workup included upper GI tract endoscopy, esophageal manometry and 24-hour pHmetry. Standard surgical procedure incorporated a Nissen-Rossetti 360 degrees fundoplicature. Short vessels division (Nissen operation) was performed in case of high strength of the wrap and a partial fundoplicature (Toupet 270 degrees) was performed when motility disorders of the esophagus were demonstrated by manometry. Postoperative morbidity and results were evaluated, with a clinical appreciation at 3 and 22 months, and by manometry and pHmetry at 3 months.Two hundred and thirty-five patients were observed, and 224 included in the study (143 men and 92 women). Nissen-Rossetti fundoplication was performed in 169 cases (80%), Nissen in 30 (14%) and Toupet in 13 (6%). In 12 cases (5%). LF was converted to an open Nissen-Rossetti procedure. There was no hospital mortality and complications were noted in three cases (1.5%): pneumonia (n = 2) and gastroplegia (n = 1). With a mean 22-month follow up, among the 103 patients who answered to a questionnaire, the rate of relapse of GERD was 14%, dysphagia was present in 2% and four patients had been reoperated on (one for a slipped Nissen, one for a stenosis of the esogastric junction and two incisional hernias).On the basis of this experience, LF for GERD is a safe and efficient operation, with 86% of good results at 2 years.

Published
1998

5. Outcome of surgical treatment of cancer of the stomach. Report of 330 cases

Author

Meyer C, Rohr S, Vix J, Bourtoul C, Thiry L.C., de Manzini, Nicolo', Meyer, C, Rohr, S, Vix, J, de Manzini, Nicolo', Bourtoul, C, and Thiry, L. C.

Subjects
Adult, Aged, 80 and over, Male, gastric cancer, surgery, Adenocarcinoma, Middle Aged, Survival Rate, Treatment Outcome, Stomach Neoplasms, Humans, Female, Aged, Follow-Up Studies
Abstract

The study concerned 330 cases of gastric adenocarcinoma operated from January 1969 to June 1996. Clinical, histological and therapeutic features were analyzed and compared during 3 periods (Group 1: 1969-79, Group 2: 1979-88, Group 3: 1989-96). The aim was to evaluate changes and results occurred in gastric carcinoma. The median age was 65 +/- 11 year (range 25-90), the sex ratio 2. The most common location was in the lower third of the stomach and the cancer was often far advanced (71 percent of stages III and IV). Subtotal gastrectomy was replaced by total gastrectomy and large lymph node dissection was systematically performed in group 3. Curative resection rate increased from 28 to 60 percent between group 1 and group 3. Despite the more radical surgery, post-operative mortality rates decreased respectively 22%, 9%, 8% for the groups 1, 2, 3 (p0.01) and global morbidity remained stable while the rate of intra-abdominal infection have changed in group 3 (4.8% vs 2.7% and 2.1% in respectively groups 1 and 2; p = ns). Two year survival rates were 20% for group 1.25% for group 2 and 35% for group 3 (p0.01). This results can be considered as encouraging but have to be confirmed at 5 year survival.

Published
1997

6. [Immediate resection-anastomosis after intra-operative colonic irrigation in cancer of the left colon with obstruction]

Author

Rohr, S, Meyer, C, Alvarez, G, Abram, F, Firtion, O, de Manzini, Nicolo', Rohr, S, Meyer, C, Alvarez, G, Abram, F, Firtion, O, and de Manzini, Nicolo'

Subjects
Aged, 80 and over, Male, Intraoperative Care, Anastomosis, Surgical, Middle Aged, colon cancer, obstruction, surgery, Survival Rate, Colonic Neoplasms, Colostomy, Humans, Female, Therapeutic Irrigation, Intestinal Obstruction, Aged
Abstract

In a consecutive series of 38 patients over 5 years, who required emergency surgery for obstructing left colonic carcinoma, 24 had primary bowel resection with immediate anastomosis, after intraoperative anterograde colonic irrigation. Complete colonic obstruction was present in all cases. There were 7 Dukes B tumors, 11 Dukes C tumors and 6 Dukes D tumors. The operative mortality was 8.3% (2 patients, with one from anastomotic leakage), anastomotic leakage rate was 4%. Superficial wound infection occurred in 4% of patients. The median postoperative hospital stay was 19.5 days. The Kaplan-Meier survival curve showed a 41% survival rate after 5 years. This technique was found to be safe and effective to perform a primary anastomosis, without requiring temporary colostomies, after emergency resection of selected left colonic carcinoma obstruction.

Published
1996

9. Outcomes of hypnosis combined with local anesthesia during inguinal repair: a pilot study.

Author

Romain, B., Rodriguez, M., Story, F., Delhorme, J.-B, Brigand, C., and Rohr, S.

Subjects
HYPNOTISM, HYPNOTHERAPY, ANESTHESIA, INGUINAL hernia, POSTOPERATIVE pain prevention, COMPARATIVE studies, HYPNOTISM in surgery, LOCAL anesthesia, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, POSTOPERATIVE pain, RESEARCH, PILOT projects, EVALUATION research, PAIN measurement, TREATMENT effectiveness, GENERAL anesthesia, SURGERY
Abstract

Purpose: To evaluate the usefulness and outcomes of hypnosis associated with local anesthesia during inguinal hernia repair procedure, notably on post-operative pain.Methods: A prospective study included patients operated on inguinal hernia repair according to Lichtenstein technique from January 2013 to September 2014. The cohort was divided into three groups (group 1: local anesthesia; group 2: hypnosis and local anesthesia; and group 3: general anesthesia). A questionnaire was filled by each participant before and after surgery. Pre-operative apprehension, pain at hospital discharge, surgeon comfort during procedure, immediate satisfaction after hospital discharge, and satisfaction at 1 month after surgery were evaluated.Results: A total of 103 patients were included in this study (group 1: n = 55; group 2: n = 35; and group 3: n = 13). Pre-operative apprehension and pain at hospital discharge's scores were significantly higher in the group 3 than in the groups 1 and 2 (p < 0.001). Pain at hospital discharge was significantly lower in the group 2 than in the group 1 (p = 0.03). Pre-operative apprehension, surgeon comfort during procedure, immediate satisfaction after hospital discharge, and satisfaction at 1 month after surgery were similar between groups 1 and 2.Conclusion: Hypnosis combined with local anesthesia is a feasible technique which allows extending inguinal hernia repair to a large population. There is no complication associated with its use. [ABSTRACT FROM AUTHOR]

Published
2017
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10. Pancreaticojejunal anastomosis by intussusception of an isolated loop in pancreaticoduodenectomy

Author

Meyer C, Rohr S, Thiry CL, Firtion O., de Manzini, Nicolo', Meyer, C, Rohr, S, Thiry, Cl, de Manzini, Nicolo', and Firtion, O.

Subjects
Adult, Male, pancreatic resection, surgery, Ampulla of Vater, Anastomosis, Surgical, Carcinoma, Middle Aged, Pancreaticoduodenectomy, Pancreatic Neoplasms, Jejunum, Postoperative Complications, Pancreatitis, Humans, Female, Prospective Studies, Pancreas, Aged
Abstract

The most frequent and severe complication of pancreaticoduodenectomy is pancreatic fistula due to dehiscence of the pancreas anastomosis. The technique that uses a separate Roux en Y loop for pancreas anastomosis, to reduce the fatal risks of pancreatic fistula, has been described for more than 50 years. With the development of pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique, derived from those previously described allows a good intussusception of the pancreatic stump into the intestinal loop. This method was performed in 22 pancreaticoduodenectomies. There were 2 operative deaths unrelated to the pancreaticojejunal anastomosis and one pancreatic fistula, which healed under medical treatment.

Published
1994

11. Laparoscopic treatment of gastroesophageal reflux. Cardiopexia with the round ligament versus Nissen's type fundoplication

Author

Meyer C, Rohr S, Thiry CL, Perraud V., de Manzini, Nicolo', Meyer, C, de Manzini, Nicolo', Rohr, S, Thiry, Cl, and Perraud, V.

Subjects
Adult, Male, gastroesophageal reflux disease, Fundoplication, Middle Aged, surgery, Gastroesophageal Reflux, Humans, Female, Laparoscopy, Round Ligament of Uterus, Aged
Abstract

Thirty nine patients with a symptomatic gastrooesophageal reflux (RGO), resistant to or relapsing after medical treatment, were prospectively studied and operated on with a laparoscopic approach: 8 which a ligamentum teres cardiopexy, 31 with a 360 degrees fundoplicature. Both groups were comparable concerning clinical, endoscopic, mano- and pHmetric features (Anova test at 95% for all comparison in the study). There was no operative mortality. Conversion and morbidity rate were significantly higher (p = 0.04) in the "cardiopexy" group, even if data suggest a responsibility of the learning curve only. During follow-up patients were interviewed at 1, 3 and 12 months and proposed for mano- and pHmetry at 3 and 12 months. Late results at 12 months showed a relapse of RGO in 5 out of 8 patients of the "cardiopexy" group, with no relapse in "fundoplicature" group (p = 0.01). Mano- and pHmetric records showed at 3 months a persistent hypotony of the lower oesophageal sphincter and a persistent acid reflux in the "cardiopexy" group, with a significant (p = 0.01 and = 0.03) difference with "fundoplicature" group, in which lower oesophageal sphincter was hypercorrected and no reflux appeared at pHmetry. Despite some rare evidence in literature, cardiopexy do not give good late results, and laparoscopic 360 degrees fundoplicature seems to be the better procedure for surgical treatment of symptomatic RGO.

Published
1994

12. Trans-suture mechanical colorectal anastomosis in the treatment of rectal cancer. A propos of 78 cases

Author

Meyer, C, Rohr, S, de Manzini, Nicolo', Dai, B, Bachellier Billot, C., Meyer, C, Rohr, S, de Manzini, Nicolo', Dai, B, and Bachellier Billot, C.

Subjects
Adult, Aged, 80 and over, Male, Postoperative Care, Time Factors, Colon, Rectal Neoplasms, Anastomosis, Surgical, Rectum, colorectal cancer, anastomosis, surgery, Radiotherapy Dosage, Middle Aged, anastomosi, Postoperative Complications, Surgical Staplers, Colostomy, Preoperative Care, Humans, Female, Neoplasm Metastasis, Aged, Follow-Up Studies
Published
1992

14. [Liver injuries]

Author

Vogt F, Rohr S, Dai B, Meyer C., de Manzini, Nicolo', Vogt, F, Rohr, S, de Manzini, Nicolo', Dai, B, and Meyer, C.

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Wounds, Penetrating, Abdominal Injuries, Middle Aged, Wounds, Nonpenetrating, Hemostasis, Surgical, surgery, liver trauma, Liver, Hepatectomy, Humans, Female, Tomography, X-Ray Computed, Aged
Published
1991

16. [Mechanical trans-sutural colorectal anastomosis in the treatment of cancers of the rectum. Apropos of 70 cases]

Author

Meyer C, Rohr S, Bachelier Billot C, Koscinsky T., de Manzini, Nicolo', Meyer, C, Rohr, S, de Manzini, Nicolo', Bachelier Billot, C, and Koscinsky, T.

Subjects
Adult, Aged, 80 and over, Male, Colon, Rectal Neoplasms, Anastomosis, Surgical, Suture Techniques, Rectum, Adenocarcinoma, Middle Aged, surgery, rectal cancer, Postoperative Complications, Surgical Staplers, Humans, Female, Neoplasm Metastasis, Neoplasm Recurrence, Local, Aged
Abstract

The reduction in the acceptable length of distal margin below the tumor makes low anterior resection more suitable for rectal cancers. The technical difficulties of low anastomosis are reduced by performing stapled colorectal anastomosis through the suture. Seventy patients were submitted to this procedure. There was no operative mortality, while the reported morbidity was 14%. Sixteen patients underwent preoperative radiotherapy of 30 Gy without any subsequent leakage. This technique is discussed in relation to the hand-sewn colo-anal anastomosis.

Published
1991

17. Interest of intestinal resection for treatment of advanced ovarian carcinoma.

Author

Hamid, D., Rohr, S., Baldauf, J.J., Ritter, J., Kurtz, E., Dufour, P., Meyer, P., Minetti, A., and Meyer, C.

Subjects
*OVARIAN cancer, *SURGERY, *MORTALITY
Abstract

Aim of the study: Digestive surgery is often necessary for surgical management of advanced ovarian carcinoma.Patients and methods: In a series of 62 patients with stage III ovarian carcinoma, postoperative morbidity and mortality, overall survival after 5 years and disease-free survival after 2 years were studied and corelated with several patients criteria (age, stage of the disease, residual disease, type of surgery, CA125 normalisation delay, postoperative complications and hospital stay). Patients were divided into two groups according to the surgical treatment. The first group (n=17) included patients treated by gynecologic and digestive surgery, the second group (n=45) included patients treated by gynecologic surgery only. All patients were proposed for chemotherapy included platyn salt. Mean age was 60 years (range: 20–83). The stage of the cancer was stage IIIa in 7 cases, stage IIIb in ten and stage IIIc in 45.Results: Postoperative mortality was 3.5% (2/62). Postoperative morbidity was 26% (13/62). No statistical differences were noted for hospital stay, general morbidity, surgical morbidity when a gastric resection or a colon resections or a splenectomy were performed. Overall survival at 5 years was 56%. Residual disease less than 2 cm3 is the only prognostic factor for overall survival (56% vs 23% ⟦P=0.03〉) and disease-free survival (86% vs 46% ⟦P=0.02〉).Conclusion: This study including 62 patients confirmed the prognostic significance of extensive cytoreductive surgery for treatment in advanced ovarian epithelial cancer without increasing the postoperative morbidy and mortality. [Copyright &y& Elsevier]

Published
2002

18. Injuries of the spleen: conservative treatment or exeresis?

Author

Bahnini J, Meyer C, Rohr S, Hollender L.F., de Manzini, Nicolo', Bahnini, J, Meyer, C, de Manzini, Nicolo', Rohr, S, and Hollender, L. F.

Subjects
surgery, Postoperative Complications, spleen injury, Splenectomy, Humans, Tissue Adhesives, Splenic Rupture, Spleen, Aged
Abstract

The authors report their experience with splenic preservation in a series of 36 patients. 77 patients with splenic injury were seen during the period from 1982 to 1987. In 41 cases splenectomy had to be carried out. This was for splenic contusions secondary to road traffic accidents in 36 cases and iatrogenic per-operative lesions in 5 cases. Intra-omental splenic autotransplantation was performed in 4 cases. In 36 other patients, the spleen was able to be preserved. Hemostasis was fairly obtained using infra-red photocoagulation (24 cases), splenorrhaphy (8 cases), surrounding the spleen with a resorbable mesh (3 cases) or by partial splenectomy (1 case). Only 1 case of transient and moderate secondary hemorrhage was seen and did not require further surgery. The authors define the legitimacy of splenic preservation and its indications and also stress its limitations. They insist on the following contraindications: preexisting splenic disease, subject on anticoagulants, labile blood pressure, multiple intra-abdominal lesions, presence of intra-peritoneal infection, severe cranio-encephalic lesions, age over 70 years. Study of this series shows that conservative treatment is most often justified for splenic trauma. Nevertheless, in view of the real but rare risk of OPSI, it is better to have a correct splenectomy than an incorrectly preserved spleen.

Published
1989

19. Chirurgie digestive et varices

Author

Steib, A., Laporte, S., Vailly, B., Rohr, S., Daudenthun, I., Geffroy, A., Mazoyer, E., and Wind, P.

Subjects
*CANCER treatment, *SURGERY, *VEIN diseases, *BLOOD vessels
Abstract

Abstract: The thromboembolic risk related to surgery may be considered as low for varicose vein surgery and non major digestive surgery. It could be defined as moderate in case of large dissection, long duration of procedures and emergency cases. The risk may be considered as high for major abdominal surgery involving cancer surgery or not and bariatric surgery. The absence of prophylaxis can be proposed for low risk surgery (grade B). However, elastic compression stocking are effective for all cases of digestive surgery and suggested to be used (grade A). There are no data concerning the moderate risk situation. Therefore, experts recommend the use of elastic compression stockings or low doses of LMWH (grade D). High-risk surgery requires the use of high doses of LMWH recommended for reasons of efficacy, tolerance, and easiness to use (grade A). Associated elastic stockings is efficious (grade B). The duration of prophylaxis lasts generally 7-10 days. Extension to 1 month is recommended for major abdominal cancer surgery (grade A). [Copyright &y& Elsevier]

Published
2005
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20. Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer

Author

Jean-Michel Fabre, Delphine Lignier, Claude Bertrand, Xaviéra Coueffé, Brice Gayet, Marie Seman, Peggy Jourdan Enfer, Gainant A, Christophe Trésallet, Magalie Cabau, Jacques Jougon, Magalie Lefrançois, Gil Lebreton, Emmanuel Tiret, Nicolas Contival, Styliani Mantziari, Bernard Meunier, Nicolas Demartines, Flora Hec, Alexandre Filipello, Denis Lantuas, Federica Pipitone, Chiara Da Re, Renaud Flamein, François Paye, Denis Collet, Patrick Pessaux, Karine Pautrat, Jean-Marc Bigourdan, Simon Msika, Michel Prudhomme, Johan Gagnière, Jérémie Thereaux, Mehdi Karoui, Patrice Valleur, Diane Goéré, Yann Parc, Mael Chalret du Rieu, Jean-Pierre Bail, Jacques Baulieux, Denis Pezet, Stéphanie Lisunfui, Williams Tessier, Laurent Brunaud, Ion Donici, Marguerite Vanderbeken, Fabien Fredon, N. Chafai, Gilles Poncet, Charlotte Cohen, Jérémie H. Lefevre, Guillaume Luc, Letizia Laface, Serge Rohr, Frédéric Dumont, Jean-Marc Regimbeau, Oussama Baraket, R Frisoni, Serge Cappeliez, Issam El Nakadi, Eric Pappalardo, Marius Nedelcu, Thibault Coste, Marc Pocard, Cécile Brigand, N. Briez, Patrick Lozach, Amandine Klipfel, Gaelle Godiris Petit, Olivier Tiffet, Daniel Pop, Arnaud Alves, Jack Porcheron, Christophe Mariette, Delphine Vaudoyer, Arnaud Pasquer, Frédéric Marchal, Bogdan Stan-Iuga, Thierry Perniceni, Nicolas Carrere, Laurent Villeneuve, Jean-Christophe Vaillant, Caroline Gronnier, Olivier Glehen, B. Malgras, Muriel Mathonnet, Nicolas Venissac, Pierre Balladur, Markus Schäfer, Noémie Kamlet, Olivier Aze, Laurent Bresler, C. Ducerf, Jérôme Mouroux, Dominique Elias, Cyril Cosse, Bogdan Badic, Salim Mezoughi, Jean-Yves Mabrut, Emanuele Felli, Abdennahceur Dhahri, Fabrice Menegaux, Laurent Hannoun, Kathleen Turner, Ahmet Ayav, Mustapha Adam, Rodrigue Chemaly, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service de Chirurgie Générale et Viscérale (CGV - BREST), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Médecine Interne, PRES Université Lille Nord de France-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CIC-IT Bordeaux, Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO), Peuplements végétaux et bioagresseurs en milieu tropical (UMR PVBMT), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Institut National de la Recherche Agronomique (INRA)-Université de La Réunion (UR), Département de chirurgie digestive, CHU Clermont-Ferrand, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Sorbonne Paris Cité (USPC), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Montreal Heart Institute, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Interactions, Corpus, Apprentissages, Représentations (ICAR), École normale supérieure de Lyon (ENS de Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines (ENS LSH)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Thoracique (NICE - Chirurgie Thoracique), Centre Hospitalier Universitaire de Nice (CHU Nice), Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU), Babes-Bolyai University [Cluj-Napoca] (UBB), Service de Chirurgie thoracique, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Lab-STICC_UBS_CID_DECIDE, Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (UMR 3192) (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Mathématiques Informatique et Applications (LAMIA), Université des Antilles et de la Guyane (UAG), Université des Antilles (Pôle Guadeloupe), Université des Antilles (UA), Service de Chirurgie Digestive, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Association Pro Pictura Antiqua (APPA-CEPMR), Ville de Soissons, CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Hubert Curien (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Mutualiste de Montsouris (IMM), Departement medico-chirurgical de pathologie digestive, Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Strasbourg, Laboratoire brestois de mécanique et des systèmes (LBMS), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne), Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), Chercheur indépendant, Hospices Civils de Lyon (HCL), Centre de recherche Jean-Pierre Aubert-Neurosciences et Cancer, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Universitaire Estaing, Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), UMR Peuplement Végétaux et Bioagresseurs en Milieu Tropical (UMR PVBMT - INRA), Institut National de la Recherche Agronomique (INRA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Hopital Louis Mourier - AP-HP [Colombes], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), equipe 4, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre de Recherche en Cancérologie de Lyon (CRCL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines-Centre National de la Recherche Scientifique (CNRS), Normandie Université (NU)-Institut National des Sciences Appliquées (INSA), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), Service de gastroentérologie et cancérologie digestive [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service de chirurgie générale viscérale et endocrinienne [CHU Pitié-Sapêtrière], Service de chirurgie digestive et hépato-bilio-pancréatique [CHU Pitié-Salpétrière], Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Service de chirurgie générale et digestive [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Laboratoire Hubert Curien [Saint Etienne] (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Saint-Etienne, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Edouard Herriot [CHU - HCL], École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines (ENS LSH)-Centre National de la Recherche Scientifique (CNRS), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Chirurgie Générale, Viscérale et Endocrinienne [CHU Pitié-Sapêtrière], Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Service de Chirurgie Hépatobiliaire et Digestive [Rennes], FREGAT Working Group-FRENCH-AFC, Dhahri, A., Lignier, D., Cossé, C., Regimbeau, J.M., Luc, G., Collet, D., Cabau, M., Jougon, J., Badic, B., Lozach, P., Bail, J.P., Cappeliez, S., El Nakadi, I., Lebreton, G., Alves, A., Flamein, R., Pezet, D., Pipitone, F., Stan-Iuga, B., Coueffé, X., Contival, N., Pappalardo, E., Msika, S., Hec, F., Vanderbeken, M., Tessier, W., Briez, N., Fredon, F., Gainant, A., Mathonnet, M., Bigourdan, J.M., Mezoughi, S., Ducerf, C., Baulieux, J., Mabrut, J.Y., Pasquer, A., Baraket, O., Poncet, G., Adam, M., Vaudoyer, D., Enfer, P.J., Villeneuve, L., Glehen, O., Coste, T., Fabre, J.M., Marchal, F., Frisoni, R., Ayav, A., Brunaud, L., Bresler, L., Cohen, C., Aze, O., Venissac, N., Pop, D., Mouroux, J., Donici, I., Prudhomme, M., Felli, E., Lisunfui, S., Seman, M., Petit, G.G., Karoui, M., Tresallet, C., Ménégaux, F., Vaillant, J.C., Hannoun, L., Malgras, B., Lantuas, D., Pautrat, K., Pocard, M., Valleur, P., Lefevre, J., Chafai, N., Balladur, P., Lefranéois, M., Parc, Y., Paye, F., Tiret, E., Nedelcu, M., Laface, L., Perniceni, T., Gayet, B., Turner, K., Meunier, B., Filipello, A., Porcheron, J., Tiffet, O., Kamlet, N., Chemaly, R., Klipfel, A., Pessaux, P., Brigand, C., Rohr, S., Chalret du Rieu, M., Carrére, N., Da Re, C., Dumont, F., Goéré, D., Elias, D., and Bertrand, C.

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, ARDS, medicine.medical_specialty, Esophageal Neoplasms, medicine.drug_class, medicine.medical_treatment, Low molecular weight heparin, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, Aged, Aged, 80 and over, Esophageal Neoplasms/surgery, Esophagectomy/adverse effects, Female, Hospital Mortality, Humans, Incidence, Length of Stay, Middle Aged, Postoperative Complications/etiology, Risk Factors, Venous Thromboembolism/epidemiology, Venous Thromboembolism/etiology, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Internal medicine, Medicine, cardiovascular diseases, ComputingMilieux_MISCELLANEOUS, business.industry, Incidence (epidemiology), Cancer, Venous Thromboembolism, Esophageal cancer, equipment and supplies, medicine.disease, 3. Good health, Pulmonary embolism, Surgery, Esophagectomy, Venous thrombosis, 030220 oncology & carcinogenesis, Cardiology and Cardiovascular Medicine, business
Abstract

Background Major oncologic surgery is associated with a high incidence of venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the incidence and risk factors for symptomatic VTE during curative treatment for patients with esophageal cancer are poorly documented. Methods Data were collected from 30 European centers from 2000 to 2010. The incidence of in-hospital VTE was assessed in 2,944 patients with esophageal cancer having surgery with curative intent, and 50 clinically relevant parameters were assessed as potential risk factors for VTE. Patients received low molecular weight heparin prophylaxis during hospital stay and for 4 weeks after surgery. Results Eighty-four patients (2.9%) developed a symptomatic VTE; all of them had a DVT and 44 were also diagnosed with a PE. In the VTE group there were 19 postoperative deaths recorded, 5 of which (26.3%) were directly caused by PE at postoperative days 7, 10, 21, 45, and 48 despite VTE prophylaxis. In-hospital postoperative mortality was significantly higher in VTE patients (23% versus 7%, p 0.001) and mean hospital stay was also longer in this group (33 ± 24 versus 25 ± 21 days, p 0.001). Multivariable analysis showed that high American Society of Anesthesiologists (ASA) class ( p = 0.008), pneumopathy ( p = 0.002), or an acute respiratory distress syndrome (ARDS) ( p = 0.015) were significantly associated with VTE. Conclusions Patients with ASA class III or IV and those who present a postoperative pneumopathy or ARDS seem to be at higher risk for VTE. Thus, current VTE screening and thromboprophylaxis for these patients might be inadequate and needs further investigation.

Published
2016

21. Complicated colonic diverticulosis. Changes in treatment and results over 22 years

Author

S, Rohr, C L, Thiry, H, Sadok, N, de Manzini, L F, Hollender, C, Meyer, Rohr, S, Thiry, Cl, Sadok, H, de Manzini, Nicolo', Hollender, Lf, and Meyer, C.

Subjects
Adult, Aged, 80 and over, Male, Sigmoid Diseases, Anastomosis, Surgical, diverticular disease, Middle Aged, Peritonitis, Diverticulum, Colon, Abscess, Diverticulitis, Colonic, surgery, Intestinal Perforation, Colostomy, Humans, Female, Gastrointestinal Hemorrhage, Aged, Retrospective Studies
Abstract

The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease.We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females).Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p0.02). Morbidity in emergency surgery fell from 21 to 4% (P0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%).The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.

Published
1994

22. Cancer of the rectum: clinical and therapeutic aspects. What changes occurred during the last 2 decades?

Author

C, Meyer, S, Rohr, S, Neagu, N, de Manzini, C, Thiry, L F, Hollender, Meyer, C, Rohr, S, Neagu, S, de Manzini, Nicolo', Thiry, C, and Hollender, L. F.

Subjects
Adult, Aged, 80 and over, Male, Time Factors, Rectal Neoplasms, Middle Aged, Combined Modality Therapy, surgery, rectal cancer, Humans, Female, Aged, Neoplasm Staging, Retrospective Studies
Abstract

This retrospective study of 440 cases of cancer of rectum was done over a period of 2 decades (1970-1993) which was divided in 3 periods (1970-79, 1980-89, 1990-93) and a comparative analysis was done with respect to clinical features, histo-pathology, treatment and results. At least one predisposing lesion (polyp, villous tumour) was noted in 26.7%, 41.5% and 41.5% respectively. The topographic distribution was unchanged in all three periods. The Dukes staging showed increase in stage A with 1.9%, 9.8% and 10% respectively and decrease in stage D with 26.1%, 20.2% and 16% respectively. The operability rate was 92.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3% and 95.9% and curative resection rate was 83.3%, 86% and 88.2% respectively. Amongst the operations done, abdomino-perineal resection was done in 55.8%, 39.5% and 7.2%; anterior resection was done in 5.5%, 36.6% and 81.4%; thus these two curves crossed in 1985. Hartmann's procedure was done in 11%, 8.7% and 4.1%. The radiotherapy was given in 6.9%, 23.9% and 75.8% respectively. Overall hospital mortality rate was 5.8% which showed progressive decrease in the 3 groups with 13.8%, 1.24% and 2% respectively. The principal factors influencing the mortality rate were the emergency presentation the type and the palliative type of operation. Overall early complication rate was 42% which showed progressive decrease in the 3 groups with 64.8%, 37% and 21% respectively. Rate of local recurrence was 17.2% which was related to the topography of the tumour, Dukes staging, type of operation, margin of resection and preoperative radiotherapy. 5 year survival rate was 43% which in relation to the curative or palliative nature of the operation and the Dukes staging. The expected progress in terms of survival depended on surgery in early stages of disease and use of radiotherapy and chemotherapy.

Published
1994

23. Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer

Author

Nicolò de Manzini, Serge Rohr, Bernadette Dai, Christian Meyer, Meyer, C, Rohr, S, de Manzini, Nicolo', and Dai, B.

Subjects
Adult, Male, medicine.medical_specialty, surgery, Postoperative Complications, Surgical Staplers, medicine, duodenal ulcer, hemorrhage, Humans, Aged, Aged, 80 and over, business.industry, Suture Techniques, Vascular surgery, Middle Aged, Cardiac surgery, Surgery, Survival Rate, medicine.anatomical_structure, Peptic Ulcer Hemorrhage, Cardiothoracic surgery, Hemostasis, Duodenal Ulcer, Duodenal Fistula, Duodenum, Female, Complication, business, Abdominal surgery
Abstract

Bleeding posterior duodenal ulcers is a critical problem especially in patients of advanced age. Surgical treatment should obtain efficient and stable hemostasis and avoid digestive fistulas due to leakage of the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodenum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).

Published
1994

24. Severe acute intestinal hemorrhage. Value of investigation tests

Author

C, Meyer, S, Rohr, H, Sadock, N, de Manzini, L F, Hollender, Meyer, C, Rohr, S, Sadock, H, de Manzini, Nicolo', and Hollender, L. F.

Subjects
Adult, Aged, 80 and over, Male, Laparotomy, acute bleeding, Adolescent, diagnosis, Decision Trees, Enema, Colonoscopy, Middle Aged, gastrointestinal, surgery, Acute Disease, Humans, Female, Barium Sulfate, Emergencies, Gastrointestinal Hemorrhage, Aged
Abstract

Episodes of intestinal bleeding likely to endanger vital functions require detailed etiological and topographical examination before surgical intervention. Forty-two cases of serious haemorrhage of the lower digestive system in adults were studied retrospectively. The origin of the bleeding was localized preoperatively in 37 cases (88%). Four exploratory laparotomies were carried out after etiological examination including at least digestive arteriography. Hence it was always possible to localize the source of bleeding. We found it convenient to establish the order of the complementary pretherapeutic tests by taking into account two symptoms, acute active bleeding (AAB) and haemorrhage with acute anemia (HAA).

Published
1990

25. Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease

Author

Serge Rohr, Ch. Meyer, N. De Manzini, Meyer, C, de Manzini, Nicolo', and Rohr, S.

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, gastroesophageal reflux disease, Reflux, Disease, Nissen fundoplication, laparoscopic surgery, Surgery, Surgical therapy, Gastro, medicine, business, Laparoscopy, Prospective cohort study

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