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Biomedical subjects

B Millat

Publications and source records attributed to B Millat.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic vertical banded gastroplasty. A multicenter prospective study of 200 procedures.

BACKGROUND: The commonest surgical procedure for management of morbid obesity in Europe is laparoscopic adjustable gastric banding (LAGB), even though laparoscopic vertical banded gastroplasty (LVBG) is still considered to be a gold standard restrictive option in bariatric surgery. A multicenter prospective study was designed to to assess the efficacy of LVBG in terms of weight loss and complication rates for obese patients who have indications for a restrictive procedure. PATIENTS AND METHODS: Two-hundred morbidly obese patients (84.5% female) with a mean age of 41 years and mean body mass index (BMI) of 43.2 kg/m(2) underwent LVBG as described by MacLean. Five trocars were placed in standard positions as per laparoscopic upper gastrointestinal surgery. A vertical gastric pouch (30 ml) was created with circular (21 or 25mm) and endolinear stapling techniques, enabling definitive separation of the two parts of the stomach. The gastric outlet was calibrated with either a polypropylene mesh (5.5 cm in length and 1cm in width) or a nonadjustable silicone band. The median follow-up period was 30 months (range, 1-72 months). RESULTS: One case had to be converted to open surgery (gastric perforation) and there was one death secondary to peritonitis of unknown etiology. The morbidity rate was 24%, comprising the following complications: gastric outlet stenosis (8%); staple line leak (2.5%); food trapping (1.5%); peritonitis (1%); thrombophlebitis (1.5%); pulmonary embolism (0.5%); and gastroesophageal reflux (9%). The excess weight loss achieved was 56.7% (1 year), 68.3% (2 years), and 65.1% (3 years). CONCLUSIONS: Laparoscopic vertical banded gastroplasty is an effective procedure for the surgical management of morbid obesity, especially for patients who present hyperphagia but are unable to manage the constraints of adjustable gastric banding. Laparoscopic vertical banded gastroplasty is safe, as demonstrated by an acceptable complication rate, of which gastric outlet stenosis, staple line leakage, and gastroesophageal reflux predominate.

Adult↗
PubMed2006

[Identification and management of HNPCC syndrome (hereditary non polyposis colon cancer), hereditary predisposition to colorectal and endometrial adenocarcinomas].

BACKGROUND: The HNPCC syndrome (hereditary nonpolyposis colon cancer) is an inherited condition defined by clinical and genealogical information, known as Amsterdam criteria. In about 70% of cases, HNPCC syndrome is caused by germline mutations in MMR genes, leading to microsatellite instability of tumor DNA (MSI phenotype). Patients affected by the disease are at high risk for colorectal and endometrial carcinomas, but also for small intestine, urothelial, ovary, stomach and biliary tract carcinomas. HNPCC syndrome is responsible for 5% of colorectal cancers. Identification and management of this disease are part of a multidisciplinary procedure. METHODS: Twelve experts have been mandated by the French Health Ministry to analyze and synthesize their consensus position, and the resulting document has been reviewed by an additional group of 4 independent experts. MAIN RECOMMENDATIONS: The lack of sensitivity of Amsterdam criteria in recognizing patients carrying a MMR germline mutation led to an enlargement of these criteria for the recruitment of possible HNPCC patients, and to a 2-steps strategy, asking first for a tumor characterization according to MSI phenotype, especially in case of early-onset sporadic cases. The identification of germline MMR mutations has no major consequence on the cancer treatments, but influences markedly the long-term follow-up and the management of at-risk relatives. Gene carriers will enter a follow-up program regarding their colorectal and endometrial cancer risks, but other organs being at low lifetime risk, no specific surveillance will be proposed.

Adenocarcinoma↗
PubMed2005

Migration of adjustable gastric banding from a cohort study of 4236 patients.

BACKGROUND: Experience was gained management of intra-gastric migration of adjustable gastric banding. METHODS: From July 1996 to January 2003, 4236 patients who underwent laparoscopic adjustable gastric banding were proposed for routine follow-up. Gastrograms were performed in case of band adjustment. Radiological controls and endoscopy were performed according to symptoms. RESULTS: A total of 45 cases of band migration (1.6%) were diagnosed during follow-up. All but one of the migrated bands were removed laparoscopically either by a dissection outside the stomach or through a short gastrotomy. Mortality was 0% and morbidity 8% (n = 4). CONCLUSION: The risk of an intragastric band migration remains low in the literature but could grow on account of the longer follow-up of patients. The retrieval of the band is the gold standard and must be planned promptly or delayed according to symptoms.

Adolescent↗
PubMed2005

[HNPCC syndrome (hereditary non polyposis colon cancer): identification and management].

BACKGROUND: The hereditary non-polyposis colon cancer (HNPCC) syndrome is an inherited condition defined by clinical and genealogical information, known as Amsterdam criteria. In about 70% of cases, HNPCC syndrome is caused by germline mutations in MMR genes, leading to microsatellite instability of tumor DNA (MSI phenotype). Patients affected by the disease are at high risk for colorectal and endometrial carcinomas, but also for other organs tumors. HNPCC syndrome is responsible for 5% of colorectal cancers. MAJOR ASPECTS: The lack of sensitivity of Amsterdam criteria in recognizing patients carrying a MMR germline mutation led to an enlargement of these criteria for the recruitment of possible HNPCC patients, and to a two-steps strategy, asking first for a tumor characterization according to MSI phenotype, especially in case of early-onset sporadic cases. FURTHER DEVELOPMENTS: The identification of germline MMR mutations has no major consequence on the cancer treatments, but influences markedly the long-term follow-up and the management of at-risk relatives. Gene carriers will enter a follow-up program regarding their colorectal and endometrial cancer risks; other organs being at low lifetime risk, no specific surveillance will be proposed.

Adolescent↗
PubMed2005

Contraction induced by glicentin on smooth muscle cells from the human colon is abolished by exendin (9-39).

UNLABELLED: Glicentin and glucagon-like peptide-1 (7-36) amide (GLP-1) are gut hormones released during digestion. Glicentin and GLP-1 slow down gastric emptying and glicentin can switch off the duodenojejunal fed motor pattern. The effect of glicentin on the motor activity of colon has never been reported in humans. Our aim was to determine if circular smooth muscle cells (SMC) from the human colon are target cells for glicentin or GLP-1, and if their motility is dependent upon these digestive hormones. METHODS: Twenty-two resections were performed on patients operated for colon adenocarcinoma. The SMC were isolated from colonic circular muscle layer and cell contraction was assessed. RESULTS: Glicentin caused a dose-related contraction of SMC, when GLP-1 determined a contraction of weak amplitude. Exendin-(9-39), described as a GLP-1 receptor antagonist, inhibited contraction due to glicentin or GLP-1. In contrast, on antral SMC from rabbit, GLP-1 exerts neither relaxation nor contraction; however, exendin-(9-39) dose dependently reduced the contractile activity of glicentin [glicentin EC(50) = 5 pM, exendin-(9-39) pA(2) = -9.36]. CONCLUSIONS: The circular muscle from the human colon is a target tissue for glicentin and GLP-1. Whereas glicentin is a long-life digestive hormone which would contribute to segmental contraction, the biological activity of GLP-1 remains unknown on this tissue. On the digestive smooth muscle, exendin-(9-39) behaved as an antagonist for two members of the glucagon-receptor family, GLP-1 and glicentin.

Adult↗
PubMed2004

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery.

BACKGROUND: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research. METHODS: An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research. RESULTS: Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely. The following QoL instruments can be recommended: for benign esophageal and gallbladder disease, the GIQLI or the QOLRAD together with SF-36 or the PGWB; for obesity surgery, the IWQOL-Lite with the SF-36; for colorectal cancer, the FACT-C or the EORTC QLQ-C30/CR38; for inguinal and renal surgery, the VAS for pain with the SF-36 (or the EORTC QLQ-C30 in case of malignancy); and after hysterectomy, the SF-36 together with an evaluation of urinary and sexual function. CONCLUSIONS: Laparoscopic surgery provides better postoperative QoL in many clinical situations. Researchers would improve the quality of future studies by using validated QoL instruments such as those recommended here.

Cholecystectomy, Laparoscopic↗
PubMed2004

Appropriate gastric resection with lymph node dissection for early gastric cancer.

BACKGROUND: The extent of lymphadenectomy (limited vs. extended) and that of gastric resection (partial vs. total) remain controversial issues in the management of early gastric cancer (EGC). A multicentric study was performed to elucidate the appropriate gastric resection with lymph node dissection for early gastric cancer. METHODS: From 1979 to 1988, 332 patients with EGC underwent surgery in 23 French centers. Clinicopathological data, the extent of resection, and the number of lymph nodes retrieved were reviewed retrospectively and screened for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months. RESULTS: Postoperative mortality was correlated to age (odds ratio [OR], 1.1) and extent of gastric resection (OR,10.3). Examination of survival data (excluding postoperative deaths) with univariate analysis and the Cox proportional hazards model showed that the independent factors for excellent prognosis included no lymphatic involvement (P =.005), 10 or more lymph nodes retrieved (P =.003), site of the tumor in the lower third of the stomach (P =.01), and mucosal lesions (P =.04). The extent of resection did not influence long-term survival. CONCLUSIONS: Our results suggest that because of the associated good prognosis, the appropriate surgical treatment for EGC is partial gastrectomy with lymphadenectomy retrieving 10 or more lymph nodes.

Aged↗
PubMed2003

Acute biliary pancreatitis, endoscopy, and laparoscopy.

Current practices for diagnosis and treatment of common bile duct stones are not evidence-based. Acute biliary pancreatitis (ABP) is a specific situation in which endoscopic procedures are either overused or misused. Pancreatitis is a poor marker for choledocholithiasis. Prognostic systems are accurate to discern those patients with ABP who do not need aggressive procedures. Patients with a benign ABP do not need an endoscopic approach. Laparoscopic common bile duct exploration is an underrated treatment for patients with choledocholithiasis. Laparoscopic approach to infected necrotic collections and pseudocysts warrant further investigations.

Acute Disease↗
PubMed2003

[Laparoscopic treatment of common bile duct stones].

Whether for a diagnostic evaluation or for the treatment of common bile duct lithiasis, the laparoscopic approach is the most efficient method compared with the other alternatives. The authors describe in the present article the method to treat laparoscopically common bile duct lithiasis.

Gallstones↗
PubMed2003

Treatment and prognosis of early multiple gastric cancer.

AIM: Early gastric cancer (EGC) may have a 5-year survival rate of over 90% following surgery. Early multifocal gastric cancer (EMGC) accounts for between 8.3 and 17% of all EGCs. A multicenter retrospective study is reported of prevalence, characteristics, prognosis and type of resection for EMGC patients. METHOD: 333 patients with EGC were operated on, between January 1979 and December 1988, and followed to June 1996. RESULTS: 33 EGC patients had EMGC. There was no significant difference in clinico-pathological features between EGC and EMGC. 21 cases of EMGC underwent a subtotal gastrectomy and 12 underwent a total gastrectomy. Recurrences after subtotal gastrectomy were, respectively, 10 and 18% for EGC and EMGC patients (p=0.2). The cumulative 5 years specific survival rate for 298 EGC and 34 EMGC were 94 and 90%, respectively (p=0.9). Five-year survival rates after subtotal gastrectomy were 92 and 90% for EGC and EMGC patients, respectively (p=0.8). CONCLUSION: EGC and EMGC had the same clinico-pathological features and prognosis. A careful follow up of the stomach remnant is essential.

Adult↗
PubMed2003

[Intraoperative cholangiography by laparoscopy. Why and how to do it?].

Intraoperative cholangiography under fluoroscopic control is a fundamental step in laparoscopic cholecystectomy. Its two principal objectives are delineation of the anatomy of the biliary tree, and detection of stones within the main bile duct. Cannulation of the cystic duct is possible in 90% cases. The ability to detect common duct stones is excellent and offers the benefit of treatment of choledocholithiasis with a single operative procedure. We encourage the systematic performance of intraoperative cholangiography because it permits a diminution of both the incidence and severity of injuries to the biliary ductal system.

Biliary Tract↗
PubMed2002

One hundred laparoscopic choledochotomies with primary closure of the common bile duct.

BACKGROUND: Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. METHODS: Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). RESULTS: The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1-26). No patient required additional CBD procedures during follow-up. CONCLUSIONS: In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.

Adult↗