Anorectal Manometry in 3D NEW! - Swiss-knife.org

formed 5 months later, again with a completely uneventful follow-up.
Results: Colonic infarction in acute pancreatitis was first reported in 1945 by Moore et Castleman. The
incidence of colon involvement in patients with acute pancreatitis is 3.3-15% and has a mortality rate
of up to 54%. Direct spread of pancreatic enzymes and necrosis are the major cause for colonic pathology
in acute pancreatitis. Clinical presentation may be difficult due to the symptoms of acute pancreatitis
and especially abdominal sepsis due to colonic perforation may be diagnosed too late. In order to
reduce mortality early diagnosis and emergency surgery are mandatory. The treatment of choice is the
resection of the affected segment with construction of a (temporary) split (ileo-) colostomy.
Conclusion: Clinicians should be aware of possible colonic involvement and complications in acute
pancreatitis.
99.7
Les filets composites double-face sont-ils si anodins?
A. Donadini, S. Aellen, N. Demartines, H. Vuilleumier (Lausanne)
Objective: Les filets couverts respectivement par de la cellulose oxydée régénérée, du collagène porcin
ou des acides gras oméga-3 purifiés, peuvent être placés au contact direct des organes intra abdominaux
lors d’une réparation pariétale. Le revêtement anti adhérent n’est censé induire, en théorie, aucune
adhérence intra péritonéale, tout en gardant sa fonction mécanique de renforcement pariétal. Le but
de ce travail est de décrire les modifications in situ observée lors de ré-opérations au placement de filet
composite intra-péritonéaux.
Methods: Au total 10 patients consécutifs ont été réopérés entre 2008 et 2009, 5 pour des récidives
d’éventration, 1-2 ans après la mise en place de filets double-face intra péritonéaux par laparoscopie
et par laparotomie. Cinq autres on nécessité une opération pour abdomen aigu.
Results: Quatre récidives de hernie ont été traitées par mise en place de filets retro-musculaires selon la
technique de Rives-Stoppa et une en position pré-péritonéale. Une cholécystectomie a été effectuée par
laparoscopie. Cinq adhésiolyses extensives ont été effectuées pour iléus mécanique et dans un cas,
une résection grêle. D’importantes adhérences viscérales au niveau de l’implant ont été constatées
chez les 10 patients (100%). Nous avons observé la non-intégration du filet à la paroi, et également
des incrustations du filet dans la séreuse et l’ensemble de la paroi du grêle.
Conclusion: L’efficacité des filets composites double-face a été étudiée en majeure partie sur des
modèles expérimentaux. Les résultats montrent une efficacité limitée de ces filets avec tendance augmentée
aux récidives. La surface anti-adhérente démontre très peu d’adhérences intra péritonéales
à 7 jours, propriété totalement disparue à 30 jours. Suite à une phagocytose naturelle de la couche
anti-adhérente, une formation d’adhérences est induite qui pourrait être la cause de l’affaiblissement
de la paroi abdominale par non-incorporation du matériel prothétique, favorisant ainsi les récidives. Il
n’existe actuellement aucune étude prospective randomisé chez l’homme, ni même rétrospective car
peu de patient sont réopérés ou alors ce type de complications n’est pas rapporté. Les cas exposés
ci-dessus confirment que l’utilisation de prothèses composites double-face n’empêche pas la formation
d’adhérences intra péritonéales et qu’ils ne doivent être utilisés que parcimonieusement dans des
cas particulier.
99.8
Gastric banding versus Roux-en-Y gastric bypass in non-superobese patients. A matched-case control
study of 442 patients
S. Romy 1 , V. Giusti 1 , J.-M. Calmes 1 , N. Demartines 1 , M. Suter 2 ( 1 Lausanne, 2 Aigle- Monthey)
Objective: Roux-en-Y gastric bypass (RYGBP) and gastric banding (GB) are the two most popular
bariatric procedures. Only few studies have compared their results and follow-up duration is usually
limited to < 3 years. The aim of the present analysis is to assess and compare long-term outcome of
both GB and RYGBP in term of complications and weight reduction. Our Hypotesis is that despite a
lower immediate postoperative complication rate, GB in the long-term results in more complications
than RYGB, and less weight loss.
Methods: Prospective bariatric database since 1995. Non-superobese GB patients were matched for
sex, age and BMI to RYGBP patients. Follow-up considered up to five years.
Results: 442 patients could be matched in 221 pairs. Mean age (38,6) and mean BMI (43) were identical
between groups. Overall operative morbidity was significantly higher in the RYGBP group (17,2
versus 5,4%, p < 0,001), but major morbidity was similar (3,6 versus 2,2%, p = 0,39). Significantly
more patients developed long-term complications after GB (33% versus 20,3%, p = 0,002), and more
required reoperations (24,4% versus 13,6%, p = 0,003). Reoperations were mainly due to internal hernias
after RYGBP (87%), with no reversal, whereas 18,5% of the GB patients required band removal.
Even including only patients who retained their band, weight loss after RYGBP was significantly better
throughout the study period, and the 5-year EBMIL was 77,6% and 63,6% (p = 0,001) after RYGBP
and GB respectively.
Conclusion: GB is associated with a smaller overall operative morbidity and similar major morbidity,
but with more long-term complications, more reoperations, a significant number of reversal or conversion
procedures, and reduced weight loss when compared with RYGBP. Five-year results of RYGBP are
superior to GB and patients should be informed accordingly.
99.9
Liver transplantation for herpes simplex virus-induced hepatitis: a SRTR registry-based study
B. Moldovan, G. Mentha, P. Majno, T. Berney, I. Morard, E. Giostra, B. Wildhaber, Ph. Morel, C. Toso
(Geneva)
Objective: Herpes simplex virus (HSV)-induced hepatitis is a rare, but severe disease, sometimes requiring
emergency liver transplantation. The aim of this registry-based study was to analyze the epidemiology
and outcome of such transplantations.
Methods: This study was based on the SRTR registry, a large nation-wide US registry (including all
listed and/or transplanted patients in the US). All patients listed for liver transplantation for HSV hepatitis
from October 1987 to May 2009 were included. We first assessed all listed patients and then performed
a case-control study, matching each transplanted patients with 10 controls. Matching criteria
included: age ±5 years, transplantation date ±6 months, MELD score ±5 points, graft type: whole liver/
split and transplant status: emergency/elective.
Results: During the study period, 30 patients were listed for HSV hepatitis. Twelve were not transplanted,
including seven spontaneous recovery and 5 deaths. The chance of recovery was significant higher
in children (7/9) than in adults (0/3, p=0.017). Of the 18 transplanted patients, 10 were children and 8
adults. Most transplants (15/18) were performed on an emergency basis, with a mean MELD score of
28±13. The overall 5-year survival was 44%. In children, survival was similar between the HSV patients
and the 180 matched controls (5-year survival: 69 vs. 64%, log-rank p=0.89). Conversely, survival was
poor in adult HSV recipients, with 63% of them dying within the first 12 months (5-year survival: 13 vs.
59%, log-rank p=0.006). In addition, all three reported deaths in children were independent from HSV,
while 4/7 adults deaths were infection-related.
Conclusion: Children listed for HSV hepatitis have a significantly better survival than adults both prior
and after liver transplantation. While HSV fulminant hepatitis is an appropriate indication for liver transplantation
in children, it should only be performed in very selected adult patients.
99.10
Continuous peridural catheter analgesia improves intestinal motility but not early mobilisation after
open colon surgery
A. Ringger 1 , M. Worni 1 , A. Lechleiter 2 , M. Mastrocola 1 , U. Laffer 1 ( 1 Biel, 2 Berne)
Objective: Continuous peridural catheter analgesia (PDA) is increasingly used postoperatively in major
abdominal surgery, including colon resections. The aim is not only to reduce postoperative pain but
also to facilitate convalescence, especially to allow early mobilisation. We compared postoperative
outcome, in particular the number of footsteps, between patients with and without PDA.
Methods: Between august 2007 and march 2008 data of patients undergoing open colonic resection
in a single center were collected prospectively. Data (postoperative complications, hospital stay, stool
passage, vomiting) were extracted from hospital charts. All patients got a portable watch that counted
all footsteps that a patient was performing over a 24 hour time period. Every 24 hours, the watch was
read off and the footsteps were recorded. We separated all patients into two groups, one with (group
1; n=23, 64%) and one without PDA (group 2; 13, 36%). We included 15 women and 21 men, with a
median age of 69.5 years (range 31-88). Performed operations were: left hemicolectomy (n=11, 31%),
right hemicolectomy (8, 22%), subtotal colectomy (5, 14%) and rectosigmoid resections (12, 33%).
Results: Demographic data of group 1 and 2 are comparable. Vomiting following colonic operation
occurred in 26.1% in group 1 and in 69.2% of patients in group 2 (p = 0.0168, Fisher’s Exact test). There
was a trend to earlier first stool passage in group 1 than in group 2, 2.3 days and 2.9 days, respectively,
but it didn’t reach significance (p = 0.2; t-test). For every single day there was no significant difference
between mean footsteps performed in the first five days after colonic surgery, they were 410 (SE 139;
day 1), 771 (SE 330; d2), 1794 (SE 981; d3), 1465 (SE 553; d4) and 2651 (SE 933; d5) in group 1
and 594 (SE 240; d1), 830 (SE 281; d2), 1559 (SE 379; d3), 2095 (SE 599; d4) and 2841 (SE 701;
d5) in group. No significant differences were found for postoperative complications and for length of
hospitalization.
Conclusion: This preliminary data shows that continuous peridural catheter analgesia may be associated
with earlier returning of bowel function but not with premature mobilization. Because the patient
collective is small and PDA is not randomly used, it has to be proven in a prospective randomized trial.
99.11
Single port access mesh repair of primary and incisional ventral hernia: a step toward less parietal
trauma
P. Bucher, F. Pugin, Ph. Morel (Geneva)
Objective: Single port access (SPA) laparoscopic surgery has rapidly entered clinical practice. SPA
approach may be of interest in patients prone to trocar port incisional hernia. This reason may be one
of the fundamentals for testing this approach for ventral hernia repair. We here report a new technique
of SPA ventral, either primary or incisional, hernias mesh repair using working channel laparoscope
and standard laparoscopic instruments.
Methods: Prospective experience with SPA laparoscopic prosthetic repair of primary and incisional
ventral hernia in 45 patients. Patient’s median age was 46 years, 26-85, and BMI 30, 20-38 kg/m 2 .
Mean fascial defect was 9.4 cm 2 for primary hernia (n=16) and18.4 cm 2 for incisional hernia (n=18;
one patient had combined primary and incisional hernias). Intraperitoneal composite mesh hernia
repair were achieved through a 12mm flank port using conventional laparoscopic port. To complete
surgeries working channel laparoscope were used with standard strait laparoscopic instruments.
Meshes were fixed using resorbable tackers and trans-fascial stitches.
Results: SPA laparoscopic repair of primary and incisional ventral hernia was completed in all cases
without conversion to standard laparoscopy. Median operative time was 58, 42-95 minutes. No intraoperative
or post-operative complications were recorded. Median hospital stay was 1 (1-5) days. No
recurrence or trocar port site incisional hernia have been recorded during follow-up (median follow-up:
12 ,19-1, months).
Conclusion: SPA prosthetic repair of primary and incisional ventral hernia is easily feasible and seems
safe. It may offer cosmetic and recovery advantages compare to multiport laparoscopic repair. Main
interestingly, SPA ventral hernia repair decrease parietal trauma and scarring in patients at risk of trocar
port site incisional hernia and may be associated with a decrease in their rate compare to multiport
laparoscopy. SPA ventral hernia repair has to be compared through randomized trial to standard
laparoscopic approach.
swiss knife 2010; 7: special edition 65