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Resume Introduction Au cours de l’annee 2006, ont ete diffusees les recommandations pour la pratique clinique (RPC) sous l’egide de la Haute Autorite de Sante, sur la prise en charge du cancer du rectum. Les objectifs de cette etude etaient d’evaluer les consequences de l’application de ces RPC dans notre pratique multidisciplinaire en termes de choix des therapeutiques base sur le bilan d’extension, et des criteres de qualite de l’exerese chirurgicale. Secondairement, nous avons evalue l’impact de ces RPC sur les resultats operatoires et carcinologiques. Methodes Tous les patients operes consecutivement a visee curative d’un cancer du rectum sous peritoneal de 1995 a 2017 du centre hospitalier universitaire de Caen, ont ete inclus et divises, selon la date de diffusion des RPC en deux groupes : avant (Gr1) et apres 2006 (Gr2). Etaient colligees dans chaque groupe, les caracteristiques preoperatoires du patient et de la tumeur rectale ; les modalites therapeutiques incluant les donnees perioperatoires, les resultats postoperatoires et oncologiques. Resultats Six cent quatre patients ont ete inclus (Gr1 = 266 et Gr2 = 338). L’application des RPC influencait significativement la realisation : (i) d’un bilan d’extension exhaustif [ex., imagerie par resonnance magnetique pelvienne (p Conclusions L’adhesion aux RPC a permis d’ameliorer la qualite de la prise en charge multidisciplinaire des patients operes a visee curative d’un cancer du rectum sous peritoneal. Toutefois, des progres supplementaires sont encore necessaires pour ameliorer l’exhaustivite de l’adhesion aux RPC.

Summary Early postoperative infections due to Serratia marcescens have been reported by both clinicians and microbiologists in our teaching hospital. Here, we present an interlinked clinical, epidemiological, environmental and genomic investigation of this outbreak due to a T-shaped intraoperative probe contaminated by S. marcescens used during peroperative ultrasonography in laparoscopic liver resection.

This study was conducted in order to investigate the safety and accuracy of percutaneous transluminal forceps biopsy (PTFB) during percutaneous biliary drainage (PTBD) in patients with a suspicion of malignant biliary stricture. Fifty consecutive patients with obstructive jaundice underwent PTFB during PTBD. Biopsy specimens were obtained using 5.2-F flexible biopsy forceps and these specimens were independently analysed by two pathologists. Consensus was obtained in case of discrepancy. Biopsy was considered as a true positive when tumour cells were retrieved. In the absence of tumour cells, comparison with available surgical findings and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) and/or percutaneous liver biopsy and/or imaging or clinical follow-up was made to distinguish true and false negatives. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were calculated. Influence of tumour location and pre-operative imaging findings was evaluated. Adverse events were reported. Biliary drainage and tissue sampling were achieved in 100% of patients. Sensitivity and specificity were 70 and 100%, respectively, while overall accuracy was 72%. After excluding the first 25 patients, accuracy and sensitivity for tissue sampling reached 80 and 78%, respectively. Sensitivity was better (87%) if stenosis was located at the upper part of the biliary tree, compared to the lower part (55%). In case of cholangiocarcinoma or intraductal invasion suspected on imaging, biopsy was contributive in 84 and 81% of patients, respectively. Four complications occurred consisting of one bile leak, two haemobilia and one pneumoperitoneum. PTFB combined with PTBD is a safe and effective technique for both histopathological diagnosis and biliary decompression of biliary strictures. Implications for patient care: • Percutaneous transbiliary forceps biopsy is technically feasible (100% of tissue sampling in our study) and is a safe technique. • Radiological management combining PTFB plus PTBD may allow diagnosis and treatment of the biliary stricture at the same time. • Sensitivity and accuracy for PTFB reached 78 and 80%, respectively, with a 100% specificity.

Resume Introduction L’exerese trans-anale (ETA) est de plus en plus utilisee pour le traitement des petits cancers du rectum a cause de son faible taux de complications postoperatoires et de sequelles fonctionnelles par rapport a une exerese totale du mesorectum (ETM). Objectif Comparer dans une meta-analyse les resultats chirurgicaux et anatomopathologiques entre les patients ayant eu une ETA suivie d’une proctectomie avec ETM (groupe TAE) pour un petit cancer du rectum ayant necessite une ETM complementaire versus ceux ayant eu une proctectomie avec ETM d’emblee (groupe TME). Methodes Nous avons realise une revue de litterature dans les bases de donnees MedLine, Cochrane Trial Register qui comparaient les resultats a court terme entre les patients operes d’une ETA suivie d’une ETM complementaire contre les ETM primaires. Les etudes publiees jusqu’a decembre 2016 etaient incluses. La meta-analyse etait effectuee grâce au logiciel Review Manager version 5.0 (Cochrane Collaboration, Oxford, Royaume-Uni). Resultats La meta-analyse montrait que l’ETM complementaire apres ETA etait significativement associee a une augmentation du taux de reprise chirurgicale (OR = 4,28 ; 95 % IC, 1,10–16,76 ; p Conclusions Cette meta-analyse suggere que l’ETA altere significativement les resultats chirurgicaux et les resultats anatomopathologiques sur le caractere complet de l’ETM compare a l’ETM d’emblee. L’approche trans-anale premiere durant l’ETM complementaire devrait etre evaluee afin d’en diminuer les difficultes techniques.

Summary Background Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME) Objective To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). Methods The Medline and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). Results Meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR = 4.28; 95% CI, 1.10–16.76; P ≤ 0.04) and incomplete mesorectal excision rate (OR = 5.74; 95% CI, 2.24–14.75; P ≤ 0.0003), as compared with primary TME. However there both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. Conclusions This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties.

Resume Objectif Evaluer la survie a long terme (5 et 10 ans) et le taux de recidive chez les patients en reponse anatomopathologique complete sur la piece d’œsophagectomie apres radiochimiotherapie neoadjuvante. Methode Entre 1993 et 2014, tous les dossiers de patients consecutifs pris en charge par therapie trimodale pour un cancer de l’œsophage localement avance non metastatique (adenocarcinome ou carcinome epidermoide) ont ete revus. En fonction de l’examen anatomopathologique de la piece operatoire, les patients ont ete classees en deux groupes : un groupe en reponse anatomopathologique complete (RPC) et un groupe avec persistance d’un residu tumoral sur la piece (PRT). L’objectif principal etait la survie globale. Les objectifs secondaires etaient la survie sans recidive, le taux de recidive et les facteurs predictifs de survie globale et de recidive. Resultats Cent trois patients ont ete inclus : 49 dans le groupe RPC et 54 dans le groupe PRT. La mediane de survie globale etait significativement plus longue dans le groupe RPC par rapport au groupe PRT (132 ± 22,3 vs 25,5 ± 4 mois) avec respectivement des taux de survie globale a 5 et 10 ans de 75,2 % vs 29,1 %, et 51,1 % vs 13,6 % (p Conclusions Les patients avec un cancer de l’œsophage localement avance en reponse anatomopathologique complete apres therapie trimodale ont un taux de survie globale a 10 ans de 51 %.

International audience; BACKGROUND:Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy.METHODS:The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well.RESULTS:Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001).CONCLUSIONS:Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence.

The aim of this study was to compare long-term survival after laproscopic completed and laparoscopic converted rectal resection for cancer.All consecutive patients who underwent curative laparoscopic rectal surgery for cancer at our institution between January 2001 and December 2016 were included in a single-center retrospective study. Patients were divided into two groups: the converted (CONV) group and the totally laparoscopic (LAP) group. The primary outcomes were long-term oncologic outcomes including overall survival (OS) and disease-free survival (DFS), as well as local and distant recurrence (LR, DR). The secondary outcomes included postoperative mortality and morbidity as defined as death or any complication occurring within 90 days postoperatively.Of 214 consecutive patients included, 57 were converted to open surgery (CONV group), leading to a 26.6% conversion rate. Mean length of follow-up was 68 ± 42 months in the LAP group and 70 ± 41 months in the CONV group. Five-year OS was significantly shorter in the CONV group compared to the LAP group (p = 0.0016). On multivariate analysis, rectal tumor location (middle and low) and conversion to open surgery were predictors of both OS and DFS.This study suggests that conversion to open surgery after laparoscopic rectal resection appears to significantly reduce OS without having a significant impact on DFS and recurrence rates.

Background The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). Methods Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. Results In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). Conclusion The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.

Background & Aims Herein, we aimed to establish benchmark values – based on a composite indicator of healthcare quality – for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers. Methods Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers. Results Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65–3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34–5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively. Conclusions This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. Lay summary In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.

The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study.This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection.Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010).Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.El objetivo de este estudio fue analizar el impacto de la cirrosis en los resultados a corto plazo después de la resección hepática laparoscópica (laparoscopic liver resection, LLR) en un estudio de cohortes multicéntrico nacional. MÉTODOS: Este estudio retrospectivo incluyó todos los pacientes sometidos a LLR en 27 centros entre 2000 y 2017. La cirrosis se definió como fibrosis F4 en el examen histopatológico. Los resultados a corto plazo de los pacientes con hígado cirrótico (cirrhotic liver CL) (pacientes CL) y los pacientes con hígado no cirrótico (non-cirrhotic liver, NCL) (pacientes NCL) se compararon después de realizar un emparejamiento por puntaje de propension del volumen del centro, las características demográficas y del tumor, y la extensión de la resección.Del total de 3.150 pacientes incluidos, se realizó LLR en 774 (24,6%) pacientes CL y en 2.376 (75,4%) pacientes NCL. Las tasas de complicaciones graves y mortalidad en el grupo de pacientes CL fueron del 10,6% y 2,6%, respectivamente. La insuficiencia hepática posterior a la hepatectomía (post-hepatectomy liver failure, PHLF) fue la principal causa de mortalidad (55% de los casos) y se produjo en el 3,6% de los casos en pacientes CL. Después del emparejamiento, los pacientes CL tendieron a tener tasas más altas de complicaciones graves (razón de oportunidades, odds ratio, OR 1,74; i.c. del 95% 0,92-0,41; P = 0,096) y de PHLF (OR 7,13; i.c. del 95% 0,91-323,10; P = 0,068) en comparación con los pacientes NCL. Los pacientes CL estuvieron expuestos a un mayor riesgo de mortalidad (OR 5,13; i.c. del 95% 1,08-48,6; P = 0,039) en comparación con los pacientes NCL. Los pacientes CL presentaron tasas similares de complicaciones cardiorrespiratorias graves (P = 0,338), de fuga biliar (P = 0,286) y de reintervenciones (P = 0,352) que los pacientes NCL. Los pacientes CL tuvieron una estancia hospitalaria más larga (11 versus 8 días; P = 0,018) que los pacientes NCL. La experiencia del centro fue un factor protector independiente de PHLF (OR 0,33; i.c. del 95% 0,14-0,76; P = 0,010) pacientes CL. CONCLUSIÓN: La presencia de cirrosis subyacente sigue siendo un factor de riesgo independiente de peores resultados en pacientes sometidos a resección hepática laparoscópica, incluso en centros con experiencia.

Resume Le volvulus du colon represente la troisieme cause d’occlusion colique dans le monde, avec 2 localisations principales : le sigmoide et le caecum. Dans les pays occidentaux, le volvulus du sigmoide touche preferentiellement l’homme âge et le volvulus du caecum, la femme plus jeune. Certains facteurs de risque sont communs aux differentes localisations, notamment la constipation chronique, le regime riche en fibres, l’utilisation frequente de laxatifs, les antecedents de laparotomie et les predispositions anatomiques. Le tableau clinique est aspecifique, avec le plus souvent une association douleur abdominale, meteorisme et occlusion. L’examen complementaire de reference est actuellement le scanner abdominopelvien, qui permet de faire le diagnostic et de rechercher d’eventuelles complications. La prise en charge depend de la localisation du volvulus, du terrain, du malade et de la vitalite du colon, mais reste une urgence medico-chirurgicale dans tous les cas. La chirurgie en urgence est la regle en cas de criteres de gravite clinico-radiologiques, mais est associee a une morbi-mortalite elevee. En cas de volvulus du sigmoide et en l’absence de criteres de gravite, la strategie ideale est une detorsion endoscopique suivie, dans les 2 a 5 jours, d’un traitement chirurgical consistant en une resection-anastomose sigmoidienne. Les traitements endoscopiques exclusifs doivent etre reserves aux patients ayant un risque operatoire excessif. Dans la localisation caecale, l’endoscopie n’a pas de place et la chirurgie doit etre systematique.

In 2006 under the supervision of the French health authorities (HAS), recommendations for clinical practice (RCP) in the management of rectal cancers were first published. The primary objective of this study was to assess the impact of these guidelines on multidisciplinary management in terms of therapeutic strategies based on disease staging and quality indicators for surgical excision. Secondarily, we assessed the impact of the RCPs on postoperative and oncological outcomes.All consecutive patients having undergone curative surgical excision for middle and low (subperitoneal) rectal cancer from 1995 to 2017 in the university hospital of Caen were included in accordance with the relevant French guidelines. They were divided into two groups: before (Gr1) and after (Gr2) 2006. For each group, a chart review was conducted on demographic variables, preoperative rectal tumor features, disease severity variables and quality of surgery variables. Postoperative and oncological outcomes were likewise assessed and compared between the two groups.Six hundred and four patients were included (Gr1, n=266; Gr2, n=338). Compliance with French guidelines significantly improved (i) use of magnetic resonance imaging (P0.0001) and CT-scan (P0.0001)]; (ii) organization of multidisciplinary tumor boards (P0.0001) leading to suitable neo-adjuvant treatment plan classification (P0.0001). Consequently, compliance improved widespread total mesorectal excision (P0.0001), sphincter-sparing surgery (P=0,0005), and completeness of curative resection in the specimen (P0.0001). Although postoperative 90-day mortality was similar, overall postoperative morbidity significantly increased in Gr2 (P0.0001). Overall (P=0.0005) and disease-free survival (P=0.0016) of patients in Gr2 were significantly prolonged and correlated with a significant reduction in local and distant recurrences.Compliance with the relevant French guidelines improved the quality of multidisciplinary management of patients undergoing curative surgery for subperitoneal rectal cancer. However, further progress is still needed to render accession to the recommendations more comprehensive.

To evaluate long-term (5- and 10-year) survival and recurrence rates on the basis of the pathological complete response (pCR) in the specimens of patients with esophageal carcinoma, treated with trimodality therapy.Between 1993 and 2014, all consecutives patients with esophageal locally-advanced non-metastatic squamous cell carcinoma (SCC) or adenocarcinoma (ADC) who received trimodality therapy were reviewed. According to histopathological analysis, patients were divided in two groups with pCR and with pathological residual tumor (pRT). The primary endpoint was overall survival (OS). The secondary endpoints included the disease-free survival (DFS), the recurrence rate, and the predictive factors of overall survival and recurrence.One hundred and three patients were included: 49 patients with pCR and 54 patients with pRT. The median OS was significantly longer in pCR group than in pRT group (132±22.3 vs. 25.5±4 months), with both 5- and 10-years OS rates of 75.2% vs. 29.1%, and 51.1% vs. 13.6%, respectively (P0.001). Also, pRT, major postoperative complications (Dindo-Clavien gradeIIIb) and recurrence were the 3 independent predictive factors for worse OS.Patients with locally-advanced oesophageal carcinoma, who responded to trimodality therapy with a pCR, could be achieved a 10-year survival rate of 51%.

Discipline Clinique. Introduction et but de l’etude La chirurgie carcinologique sus-mesocolique est consideree comme a risque de syndrome de renutrition inappropriee (SRI). Bien que des supplementations ioniques soient prescrites de maniere systematique, ce risque n’est pas specifiquement identifie en pre-operatoire. Le but de cette etude etait d’evaluer la survenue du SRI dans notre population. Les objectifs secondaires etaient d’evaluer en pre-operatoire l’etat nutritionnel, le risque de SRI et leur impact sur la survenue de troubles ioniques post-operatoires. Materiel et methodes Etude observationnelle, retrospective, monocentrique, incluant consecutivement tous les patients ayant eu une chirurgie sus-mesocolique carcinologique programmee du 29/01/2018 au 29/06/2018 et ayant recu une nutrition artificielle post-operatoire. Les donnees recueillies etaient : denutrition (criteres HAS/SFNEP/SFAR ou perte de poids >10 % sans delai), ingesta, complements oraux, hydratation, nutrition artificielle en pre-operatoire et en post-operatoire, risque de SRI (criteres du National Institute for Health and Care Excellence, NICE), biologie (K, P, Mg) et la presence d’evenements intercurrents. Un SRI etait defini par un trouble ionique associe a une symptomatologie clinique compatible. Statistiques : test t de Student, Chi2 Yates ou test exact de Fisher, seuil de significativite fixe a p Resultats et analyse statistique Sur la periode, 22 patients ont beneficie d’une chirurgie majeure sus-mesocolique carcinologique (hors hepatectomie), 1 a ete exclu par manque de donnees. Âge median 67 ans [51–85] et 76 % d’hommes. Le geste etait : duodenopancreatectomie cephalique (57 %), œsophagectomie (24 %), gastrectomie totale (9,5 %) et gastrectomie partielle (9,5 %). L’evaluation pre-operatoire montrait 38 % de patients denutris. Les apports oraux pre-operatoires (complements nutritionnels inclus) etaient superieurs chez les patients non denutris par rapport aux patients denutris (2509 kcal vs 1734 kcal – p = 0,02). Le risque de SRI etait present chez 11 % des patients. De j0 a j10 post-operatoire, 45 % des patients ont presente une hypophosphoremie Conclusion Le SRI est rare mais grave. Dans ce travail, la denutrition etait un meilleur facteur predictif de SRI que les criteres du NICE. Il apparait important de mesurer les phosphoremies, magnesemies et kaliemies en periode post-operatoire, afin de mettre en place, le plus rapidement possible les supplementations adaptees, surtout chez les patients denutris.

Actual 5-year survival rates after resection of colorectal liver metastases (CLM) are 25-45%, whereas 10-year survival rates are extrapolated from survival curves. Few studies have reported long-term survivors with 10 years of actual follow-up. Therefore, no recurrences occurring after 10-plus years have been reported. The aim of our study was to analyze actual 10-year survival rates and prognostic factors.Clinical data of patients with CLM who had undergone first liver resection in our center between January 1990 and December 2000 were retrospectively analyzed.Eighty-nine patients of mean age 64 years were studied. Three patients were excluded from the study: one because of postoperative death, and two from being lost to follow-up. All other subjects had a potential 10-year follow-up. Only 33% patients received perioperative chemotherapy. The actual 10-year overall and disease-free survival rate were 22 and 19%, respectively. Poor prognostic factors were disease-free interval less than 1 year, wedge liver resection, clinical risk score2, segment 1 CLM location, and peritumoral lymphangitis. Good prognostic factors were tumors having mucinous components in primary tumor and CLM located in the right lobe.With actual long-term follow-up for 10 years, disease-free survival rate is 19% and mainly depends on surgical management. Recurrence continues to occur more than 5 years after liver resection for CLM; cure cannot be assumed at this time. Clinical risk score is a good predictor of cure and should be taken into account when choosing perioperative treatment.

Le but de notre etude etait d’evaluer l’impact du delai median de conversion (precoce 60 min) sur les resultats operatoires (morbi-mortalite) et carcinologiques (recidive locale, survie). De 2001 a 2016, 213 patients consecutifs ont eu une proctectomie carcinologique laparoscopique. Une conversion a ete necessaire chez 53 patients (25 %) dont 27 precoces et 26 tardives. Les groupes etaient comparables en termes de comorbidites, de hauteur tumorale, de traitement neo-adjuvant et de stomie de protection. Un patient est decede, converti precocement. La conversion tardive augmentait significativement la duree operatoire (197 ± 55 vs 258 ± 79 p = 0,001), le taux d’infection du site operatoire (1/27 contre 7/26, p = 0,048) et la duree d’hospitalisation (13 ± 5 vs 17 ± 9, p = 0,039). Selon la classification de Dindo–Clavien, la morbidite globale etait comparable. Il n’existait pas de difference en termes de marge circonferentielle ni distale. Avec un suivi median de 50 mois, le delai de conversion n’avait pas d’impact ni sur la survie globale ni sur le risque de recidive locale (1/27 vs 0/26 p = 0,9) et a distance (2/27 vs 4/26 p = 0,63). Notre etude plaide pour une conversion precoce afin de diminuer la duree operatoire et le risque d’infection du site operatoire.

Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed. Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0. Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32–4.91; p = 0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23–1.62; p = 0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29–1.77; p = 0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52–9.47; p = 0.29). This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.

Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations: the sigmoid colon and cecum. In Western countries, sigmoid volvulus preferentially affects elderly men whereas cecal volvulus affects younger women. Some risk factors, such as chronic constipation, high-fiber diet, frequent use of laxatives, personal past history of laparotomy and anatomic predispositions, are common to both locations. Clinical symptomatology is non-specific, including a combination of abdominal pain, gaseous distention, and bowel obstruction. Abdominopelvic computerized tomography is currently the gold standard examination, allowing positive diagnosis as well as detection of complications. Specific management depends on the location, patient comorbidities and colonic wall viability, but treatment is an emergency in every case. If clinical or radiological signs of gravity are present, emergency surgery is mandatory, but is associated with high morbidity and mortality rates. For sigmoid volvulus without criteria of gravity, the ideal strategy is an endoscopic detorsion procedure followed, within 2 to 5 days, by surgery that includes a sigmoid colectomy with primary anastomosis. Exclusively endoscopic therapy must be reserved for patients who are at excessive risk for surgical intervention. In cecal volvulus, endoscopy has no role and surgery is the rule.

Resume Objectif Evaluer la presence des corpuscules de Gamna-Gandy (CGG) en IRM chez les patients atteints de cirrhose. Patients et methodes Cent dix-sept patients consecutifs suivis en IRM pour cirrhose ont ete etudies retrospectivement. Deux groupes ont ete definis : le premier comprenait des patients presentant des CGG en IRM (n = 15), le second, des patients sans CGG (n = 102). Les deux groupes ont ete analyses a la lumiere des caracteristiques cliniques et biologiques habituels de la cirrhose, a savoir le sexe et l’âge des patients, l’etiologie de la cirrhose, le score de Child-Pugh, l’existence de varices œsophagiennes, d’une splenomegalie, d’une ascite, la reouverture des veines para-ombilicales, l’apparition d’une encephalopathie hepatique. Un Fisher's exact test et un t-test ont ete utilises pour la comparaison statistique entre les deux groupes. Resultats Les CGG etaient plus frequemment retrouves en cas de splenomegalie (p = 0,035). L’hemochromatose etait la seule etiologie de la cirrhose statistiquement liee a la presence de CGG (p = 0,006) dans notre serie. Aucun lien statistique n’etait en revanche etabli entre la presence de CGG en IRM et les autres caracteristiques de la cirrhose. Conclusion D’identification aisee sur toutes les sequences en IRM, les CGG n’apparaissent pas correles a la gravite de la cirrhose. En revanche, ils sont fortement lies a la presence d’une splenomegalie et doivent etre consideres comme le reflet d’une hypertension segmentaire splenique. Ils semblent par ailleurs tres frequents en cas d’hemochromatose.

Purpose To determine the value of multidetector-row CT (MDCT) in the management of sigmoid volvulus. Materials and methods Twenty-three MDCT examinations showing sigmoid volvulus were retrospectively evaluated and analyzed based on the type of volvulus (mesentericoaxial versus organoaxial), degree of rotation (180 degrees or 360 degrees ), maximum diameter of the volvulized sigmoid loop and presence or absence of the northern exposure sign, signs of bowel wall ischemia, and ascitis. A statistical analysis was performed to determine the correlation between patients characteristics, CT findings, type of management, and histological findings when available. Results In our study, organoaxial volvulus occurred in older patients (p=0.047), had a higher risk of recurrence (p=0.015) and more frequently required urgent surgical management than mesentericoaxial volvulus. A higher degree of rotation was associated with a more distended volvulized sigmoid colon (p=0.033) and more frequently required surgery. Conclusion In addition to detection of volvulus and signs of bowel wall ischemic, MDCT can characterize the type of volvulus and degree of rotation, findings that may assist in determining the severity of the process and direct towards optimal management, endoscopic or surgical.

OBJECTIVE. The objective of our study was to evaluate the accuracy of CT for differentiating small-bowel bezoar from small-bowel feces in cases of small-bowel obstruction (SBO).CONCLUSION. In cases of SBO, although some CT features of bezoars and small-bowel feces overlap, a well-defined mass mottled with gas bubbles associated with an encapsulating wall, the newly described “floating fat-density debris” sign, and a lesion in the stomach that appears similar to the obstructing mass is typical of a small-bowel bezoar; an isolated amorphous mass mottled with gas bubbles is typical of small-bowel feces.

Il trattamento chirurgico del reflusso gastroesofageo ha visto evolvere le proprie indicazioni grazie alla crescente efficacia dei trattamenti medici: ad oggi, si riservano alla chirurgia le forme recidivanti all’arresto della terapia o quelle a essa resistenti. Una miglior conoscenza dell’anatomia funzionale del reflusso e delle diverse condizioni cliniche ha permesso di adattare l’atto chirurgico a ogni situazione. Il trattamento laparoscopico del reflusso gastroesofageo, eseguito per la prima volta nel 1991, e diventato il trattamento chirurgico di riferimento. I diversi studi realizzati dopo chirurgia convenzionale hanno permesso di analizzare meglio i risultati delle diverse procedure e di privilegiare essenzialmente i procedimenti valvolari. In questo capitolo, dopo un richiamo delle indicazioni chirurgiche – che non devono essere modificate per l’accesso laparoscopico – verranno descritte le principali tecniche realizzabili in laparoscopia. I risultati di queste procedure verranno analizzate in rapporto alle opzioni tecniche. Se le diverse modalita di fundoplicatio sono equivalenti sul controllo dei sintomi da reflusso, sembra che le fundoplicatio parziali comportino meno reinterventi per insuccesso. Mancano ancora dati a lungo termine per valutare i risultati di questi interventi in termini di disfagia e della qualita della vita.

Las indicaciones del tratamiento quirurgico del reflujo gastroesofagico han evolucionado debido a la creciente eficacia de los tratamientos medicos; la cirugia se reserva para las recidivas una vez interrumpido el tratamiento o para los pacientes refractarios al mismo. El mejor conocimiento de la anatomia funcional del reflujo y de las diferentes formas clinicas permite adaptar la conducta quirurgica a cada situacion. El tratamiento laparoscopico del reflujo gastroesofagico, realizado por primera vez en 1991, es la opcion quirurgica de referencia. Los diferentes estudios realizados tras la cirugia tradicional han permitido analizar mejor los resultados de los distintos procedimientos y dar prioridad a las tecnicas valvulares. En este articulo se recordaran las indicaciones quirurgicas, que no cambian para el acceso laparoscopico, y se detallaran las principales tecnicas que se realizan por laparoscopia. Los resultados de estos procedimientos se analizan en funcion de las opciones tecnicas. Aunque las distintas fundoplicaturas son equivalentes en cuanto al control de la sintomatologia del reflujo, parece que las fundoplicaturas parciales tienen menos riesgo de reintervencion por fracaso de la tecnica. Faltan estudios a largo plazo para poder evaluar los resultados de estas intervenciones respecto a la disfagia y la calidad de vida.

Il trattamento chirurgico del reflusso gastroesofageo ha visto le sue indicazioni evolvere grazie alla crescente efficacia del trattamento medico, che lascia alla chirurgia solo le forme recidivanti alla sospensione della terapia o i casi resistenti a quest’ultima. Una miglior conoscenza dell’anatomia funzionale del reflusso e delle diverse situazioni cliniche ha permesso di adattare l’atto chirurgico a tutte le situazioni. In questo articolo, dopo un ricordo dell’anatomia del giunto gastroesofageo e delle indagini preoperatorie, verranno descritte le principali tecniche eseguibili con accesso laparotomico in caso di reflusso gastroesofageo semplice o complicato. Nel reflusso gastroesofageo semplice l’analisi dei risultati pubblicati di queste diverse procedure permette di limitare la scelta alle fundoplicatio totali o parziali. Se le fundoplicatio complete garantiscono un’azione efficace e importante sul reflusso, le alterazioni funzionali postoperatorie sono piu frequenti che dopo fundoplicatio parziali. L’impiego dell’una o dell’altra dipende da scelte di scuola. Nelle forme piu complicate il ruolo della chirurgia e la tecnica realizzata dipendono dal tipo di complicazioni e devono essere discusse rispetto a ogni singola condizione clinica.

Las indicaciones del tratamiento quirurgico del reflujo gastroesofagico han evolucionado gracias a la eficacia creciente de los tratamientos medicos, que han limitado la cirugia a los casos que recidivan tras la interrupcion del tratamiento y a los que no responden a el. El mejor conocimiento de la anatomia funcional del reflujo y de las distintas situaciones clinicas ha permitido adaptar la intervencion quirurgica a cada situacion. En este articulo se recuerda la anatomia de la union gastroesofagica y de las exploraciones preoperatorias, para describir despues las tecnicas principales que se realizan por laparotomia en el reflujo gastroesofagico simple o complicado. En el reflujo simple, el analisis de los resultados publicados de los distintos tipos de intervenciones permite limitar la eleccion a las fundoplicaturas totales o parciales. Aunque las fundoplicaturas totales garantizan una gran eficacia en el tratamiento del reflujo, los trastornos funcionales postoperatorios son mas frecuentes que en las parciales. La utilizacion de uno u otro tipo de fundoplicatura depende de las preferencias de cada grupo. En las formas complicadas, la indicacion quirurgica y la tecnica que se realice dependen del tipo de complicacion y han de individualizarse para cada situacion clinica.

Aberrant pancreas of the duodenal wall (APD) and duodenal diaphragm (DD) are two rare entities, which developed during duodenal embryogenesis. Occurrence, diagnosis and therapeutic approach of these lesions are different. Herein, we report the first case of this exceptional association in a man who had no symptoms. A surgical resection of both lesions was performed and the outcome was uneventful. Embryogenesis, morphological characteristics and treatment are discussed.

CERVOXY ACL CLIN; International audience

Ventriculoperitoneal shunt is used as a treatment of hydrocephalus. Although this procedure is usually safe, several abdominal complications have been reported in the literature. However, to our knowledge, a catheter-induced splenic trauma has not been previously described. We report here the case of a patient who presented with a spontaneous splenic trauma, 10 years after ventriculoperitoneal shunt insertion. A conservative treatment with careful monitoring was successful and the patient recovered without surgery.

To determine the presence of Gamna-Gandy bodies (GGB) on MRI in patients with liver cirrhosis.A total of 117 consecutive patients with cirrhosis followed-up by MRI were retrospectively reviewed. Two groups were defined: the first group included patients with GGB on MRI (n=15), the other group included patients without GGB (n=102). Both characteristics of groups were reviewed using standard cirrhosis criteria evaluation: sex, age, etiology of cirrhosis, Child-Pugh score, presence of esophageal varices, splenomegaly, ascitis, recanalization of the periumbilical veins, and presence of hepatic encephalopathy. Fisher's exact test and student t-test were used to compare both groups.GGB were more frequently observed in patients with splenomegaly (P=0.035). Hemochromatosis was the only etiology for cirrhosis statistically correlated to the presence of GGB (P=0.006) in our series. No other statistically significant association was noted between GGB and other characteristics of our cirrhotic patients.Easily identified on all MRI pulse sequences, GGB do not correlate with the severity of cirrhosis. However, they are strongly correlated with the presence of splenomegaly and may be the result of segmental splenic hypertension. They are frequent in patients with hemochromatosis.

Objective The objective of the study was to evaluate computed tomography (CT) in the differential diagnosis of patients with toxic megacolon (TM) complicating severe acute colitis (SAC) and patients with SAC but no TM. Materials and methods We identified 16 patients who presented clinically complicated SAC and CT examination before surgery. The CT scans of these patients were retrospectively evaluated in consensus by two abdominal radiologists blinded to the clinical and pathological results for CT findings of SAC, i.e., diffuse colonic wall thickening, submucosal edema, pericolonic fat stranding and ascites, and CT findings of TM reported in the literature, i.e., segmental colonic wall thinning, air-filled colonic distension over 6 cm with abnormal haustral pattern, nodular pseudopolyps and associated small bowel distension. Fisher's Exact Test was used for all statistical analyses. Results Segmental colonic wall thinning with abnormal haustral pattern was noted in TM only ( P =.001). As compared to patients with SAC but no TM as a complication, patients with TM showed statistically more frequent air-filled colonic distension over 6 cm ( P =.001) and nodular pseudopolyps ( P =.001). Diffuse colonic wall thickening ( P =.036) and submucosal edema ( P =.036) were more present in cases of uncomplicated SAC. Pericolonic fat stranding ( P =.12), ascites ( P =.6), and small bowel and gastric distension ( P =1) were not distinctive criteria. Conclusion Computed tomography is useful in distinguishing patients with TM from patients with SAC but no TM as a complication. The association of air-filled colonic distension >6 cm, abnormal haustral pattern and segmental colonic parietal thinning seems pathognomonic of TM and should lead to rapid surgery.

To determine the value of multidetector-row CT (MDCT) in the management of sigmoid volvulus.Twenty-three MDCT examinations showing sigmoid volvulus were retrospectively evaluated and analyzed based on the type of volvulus (mesentericoaxial versus organoaxial), degree of rotation (180 degrees or 360 degrees ), maximum diameter of the volvulized sigmoid loop and presence or absence of the northern exposure sign, signs of bowel wall ischemia, and ascitis. A statistical analysis was performed to determine the correlation between patients characteristics, CT findings, type of management, and histological findings when available.In our study, organoaxial volvulus occurred in older patients (p=0.047), had a higher risk of recurrence (p=0.015) and more frequently required urgent surgical management than mesentericoaxial volvulus. A higher degree of rotation was associated with a more distended volvulized sigmoid colon (p=0.033) and more frequently required surgery.In addition to detection of volvulus and signs of bowel wall ischemic, MDCT can characterize the type of volvulus and degree of rotation, findings that may assist in determining the severity of the process and direct towards optimal management, endoscopic or surgical.

Aim To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). Materials and methods Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher’s exact test and the t -test. Results Although demonstrated in symptomatic patients ( p = 0.041), the occurrence of AC was not correlated with the severity of the symptoms ( p = 0.16). Among the CT signs, the presence of loculated fluids ( p = 0.011), a small bowel faeces sign ( p = 0.002); and small bowel obstruction ( p = 0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity = 67%, specifity = 100%, positive predictive value = 100%, negative predictive value = 96%). Conclusion CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.

The purpose of this study was to evaluate the CT findings that can help to differentiate small-bowel obstruction (SBO) due to adhesive bands from SBO caused by matted adhesions.CT scans of 67 consecutive patients with adhesive SBO caused by either surgically confirmed adhesive bands or matted adhesions were analyzed. CT findings were compared between the two groups with regard to simple obstruction patterns (single abrupt transition zone, beak sign, "fat notch" sign), patterns of closed-loop obstruction (two adjacent beaks, C-shaped bowel, radial distribution of mesenteric vessels), the location of the obstruction in the abdominal cavity, and the presence of a whirl sign and a "small-bowel feces" sign. Statistical analyses were performed using the Fisher's exact test.Closed-loop patterns and a whirl sign were seen only in cases of SBO from adhesive bands. Compared with SBO cases from matted adhesions, significantly more SBO cases that were due to adhesive bands showed a beak sign (p = 0.0001) and fat notch sign (p = 0.0001). The small-bowel feces sign was more frequently seen in cases of SBO from matted adhesions (p = 0.014). Bowel ischemia and bowel necrosis were more frequent findings with adhesive bands than with matted adhesions (p = 0.011 and p = 0.049, respectively). The location in the pelvis of the adhesive structure (p = 0.039) and a higher rate of accidental bowel perforation (p = 0.031) were associated with matted adhesions.CT is useful for differentiating SBO caused by adhesive bands from SBO due to matted adhesions.

Median arcuate ligament (MAL) syndrome results from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers or by fibrous bands of the celiac nervous plexus. In 10% to 50% of cases it is responsible for significant angiographic celiac trunk compression. In orthotopic liver transplantation (OLT), the presence of celiac compression by MAL is considered to be a risk factor for hepatic arterial thrombosis (HAT); it may lead to graft loss. Various surgical procedures have been proposed to overcome the impact of MAL in OLT, but their impact is still ill defined. The aim of our study was to compare standard hepatic artery reconstruction and graft reconstruction (aortohepatic bypass) in terms of HAT among patients with MAL undergoing OLT. We retrospectively reviewed 168 adult recipients of OLT performed from January 1991 to December 1998. Ten cases (5.6%) of celiac compression by MAL were identified after celiomesenteric arteriography. There was no significant difference in terms of HAT incidence when aortohepatic bypass was performed compared to a standard anastomosis; moreover, this was greater in the graft reconstruction group (25% vs 17%; P = .67). In our opinion, the presence of an arcuate ligament should not contraindicate a routine hepatic artery reconstruction.

Aims: To evaluate if oxaliplatin is likely to vaporize under HIPEC conditions and to see if it could be a source of pulmonary contamination for surgeons. Methods: Three oxaliplatin concentrations (230, 460 and 920 mg oxaliplatin/l), 3 heating temperatures (41, 43 and 45 � C) and 3 bubbling durations (30, 60 and 90 min) were tested. Drug vaporization was evaluated by using inductively coupled plasma mass spectrometry (ICPMS) to analyze platinum concentrations in the trap solutions. Results: At all concentrations of oxaliplatin solutions, heating temperatures and bubbling trap periods, the quantities of vaporized platinum were always insignificantly lower than 1 mg/l. Conclusions: The experimental risk of pulmonary contamination of hospital staff during HIPEC procedure appears to be negligible. However a monitoring study with an analysis of samples of the operating theatre and urine from surgical personnel should be carried out to confirm these conclusions. 2007 Published by Elsevier Ltd.

Aberrant pancreas of the duodenal wall (APD) and duodenal diaphragm (DD) are two rare entities, which developed during duodenal embryogenesis. Occurrence, diagnosis and therapeutic approach of these lesions are different. Herein, we report the first case of this exceptional association in a man who had no symptoms. A surgical resection of both lesions was performed and the outcome was uneventful. Embryogenesis, morphological characteristics and treatment are discussed.

Introduction Les lesions du foie et du diaphragme droit sont frequemment associees dans les traumatismes abdominaux fermes (39 % des cas). Ces lesions posent la question de la voie d’abord, en raison du risque d’aggravation des lesions traumatiques du foie lors de sa mobilisation pendant la laparotomie. Le but de notre etude etait de valider la faisabilite et la securite d’une approche par thoracoscopie droite. Methodes Entre juin 1998 et 2008, six patients ont ete pris en charge dans notre service pour des traumatismes fermes responsables de lesions associees du foie et diaphragmatique droite. Les criteres d’inclusion etaient l’absence de lesions abdominales necessitant une laparotomie en urgence en particulier une perforation d’organe creux, l’instabilite hemodynamique, l’existence d’une lesion cerebrale, l’existence d’une extravasation de produit de constrate hepatique au scanner et un etat respiratoire contre-indiquant une intubation selective. Les donnees telles que l’âge, l’ISS (Injury severity Score), la nature et la localisation des lesions hepatiques, la presence d’une lesion thoracique associee, le delai de prise en charge, les donnees peroperatoires, les durees operatoire, de drainage thoracique et d’hospitalisation ont ete analysees. L’intervention etait pratiquee sous anesthesie generale en decubitus lateral gauche et le bras droit laisse pendant. Une sonde d’intubation double lumiere etait systematiquement utilisee. La colonne de coelioscopie a gauche du patient et un optique de 0° C ou 30° C choisit suivant les preferences de l’operateur. Entre 3 et 4 thoracoports etaient utilises. Resultats La mediane de l’âge des patients etait de 35 ans (20-58) et l’ISS de 27,5 (12-43). Le score moyen de Mirvis etait de 2,66 (2-4). Tous les patients presentaient des lesions hepatiques, dont trois hematomes avec rupture capsulaire du dome. Il existait chez tous les patients des contusions pulmonaires avec hemothorax associe. Les ruptures diaphragmatiques furent traitees par un surjet de fil non resorbable avec utilisation d’une prothese chez deux patients. La duree operatoire moyenne fut de 165 minutes (150-240). La duree moyenne de drainage thoracique fut de 5 jours (4-7), la duree moyenne d’hospitalisation dans notre unite fut de 8 jours (6-12) et la mediane de la duree d’hospitalisation totale de 13 jours (6-29). Conclusion Un mois apres la sortie de l’hopital, 4 patients etaient totalement asymptomatiques et 2 necessitaient des antalgiques de palier 1 de maniere occasionnelle. Un controle scanographique ne montrait pas de recidive. Les resultats de cette etude pilote montrent que l’approche thoracoscopique dans les lesions associees hepatique et diaphragmatique droite, est faisable et sure chez des patients selectionnes.

Objectifs Analyser la valeur du scanner pour le diagnostic differentiel d’un bezoard et d’un small bowel feces (SBF) sign dans le cadre des occlusions du grele. Materiels et methodes Vingt sept examens TDM realises pour occlusion du grele (8 patients avec un bezoard confirme chirurgicalement et 19 patients avec un SBF sign et pas de bezoard a la chirurgie) ont ete analyses retrospectivement par 2 radiologues specialises. Les criteres TDM etudies etaient la forme (bien definie ou amorphe), la longueur (courte, 10 cm) et le site de la lesion, la presence d’une coque lesionnelle et une image similaire dans l’estomac. Un fat-density floating fibers (FFF) sign, correspondant a la visualisation de fibres de densite graisseuse au sein de la lumiere intestinale etait notee. Un Fischer's exact test a ete utilise pour la comparaison statistique. Resultats Les 8 bezoards et les 19 SBF sign ont tous ete identifies comme une image lesionnelle intraluminale, contenant du gaz, situee immediatement en amont du site de l’occlusion. Les bezoards ont montre une plus forte incidence de coque lesionnelle (p = 0,002), d’image similaire dans l’estomac (p = 0,011) et de FFF sign (p Conclusion Bien que certains criteres se recoupent, la decouverte TDM au cours d’une occlusion du grele d’une masse intraluminale de contours bien definis contenant du gaz, presentant une coque lesionnelle, une image similaire dans l’estomac et un FFF sign est typique d’un bezoard ; une masse intraluminale amorphe et isolee contenant du gaz est typique d’un SBF.