Guillaume Pourcher - Academia.edu (original) (raw)

Papers by Guillaume Pourcher

Surgery for Obesity and Related Diseases, Mar 1, 2016

Background: Laparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in su... more Background: Laparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in super-obese patients (SOPs), is associated with considerable weight loss. Traditionally, laparoscopic sleeve gastrectomy requires 4-7 skin incisions. Single-port laparoscopic surgery is now feasible for bariatric surgery. Objectives: To evaluate the feasibility and safety of single-port sleeve gastrectomy (SPSG) for SOPs.

Obesity Surgery, Feb 19, 2019

Background Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide, comm... more Background Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide, commonly performed using laparoscopic multiport. Feasibility and safety of single-port sleeve gastrectomy (SPSG) have been proved. We reported a standardized procedure describing the different steps as a reference for bariatric surgeons. Materials Two news concepts are necessary: Bsurgical corridor,^surgeon working in a small intraperitoneal area is less disturbed by excess abdominal fat and liver hypertrophy; Bparietal space^is the area in the abdominal wall through the instruments are introduced, it's important to preserve this. The patient was placed in a seated position and we utilized 2.5-3 cm skin incision in the umbilicus. Single trocar was placed; a flexible camera and double curve grasper are needed to decrease grasper conflict. Dissection of the stomach was obtained by 47 cm Thunderbeat (Olympus-Japan), the sleeve of the stomach was created over a 36F calibrator. A 60-mm roticulating XL staplers were used and beginning 4 cm proximal to the pylorus next to the gastro-pancreatic ligament and heading toward the left side of the gastro-esophageal junction. We utilized a linear staple line using 4 to 7 staples; hemostasis is controlled by bipolar coagulation. Results Specimen was removed easily through the single-site trocar. Parietal defect is easily repaired. Operating time is 41 min. The patient was discharged at day 1 without naso-gastric tube or drainage. No complication. Conclusion Umbilical SPSG is nowadays a standardized procedure based on the surgical corridor and the parietal space. This is a safe and reproductive procedure applicable in most patients with massive obesity but necessitate learning curve.

Journal of Acquired Immune Deficiency Syndromes, Jun 1, 2022

Objective: The aim of this study was to compare clinical characteristics and adipose/liver tissue... more Objective: The aim of this study was to compare clinical characteristics and adipose/liver tissue histology analysis in HIV-infected and HIV-uninfected subjects undergoing bariatric surgery. Design: This was a cross-sectional study of HIV-infected subjects undergoing single-port sleeve gastrectomy with prospective enrolment and frequency age (±5 years), sex, and body mass index (BMI, ± 5 kg/m2) matched on HIV-uninfected subjects. Methods: This study was conducted at a single clinical site at Pitié-Salpêtrière hospital-Paris-France comprising 19 HIV-uninfected and 21 HIV-infected subjects with plasma VL < 20 copies/mL, all with a BMI > 40 kg/m2 or >35 kg/m2 with comorbidities. Histology of subcutaneous and visceral abdominal adipose tissue (SCAT/VAT) and liver biopsies was collected during single-port sleeve gastrectomy. Outcomes included anthropometric characteristics, comorbidities, cardiovascular parameters, adipose tissue, and liver histology. Results: The age of HIV-infected participants was (median, interquartile range IQR) 48 y (42–51), with 76.2% females, a BMI of 41.4 kg/m2 (37.3–44.4), an antiretroviral duration of 16 y (8–21), current integrase strand transfer inhibitor (INSTI)-based regimen in 15 participants and non-INSTI regimen in 6 participants, and a CD4 count of 864/mm3 (560–1066). The age of controls was 43 y (37–51), with 78.9% females and a BMI of 39.2 kg/m2 (36.3–42.6). Anthropometric characteristics, comorbidities, and cardiovascular parameters did not differ according to HIV status and INSTI treatment. The number of macrophage crown-like structures in SCAT was lower in INSTI-treated participants than in HIV-uninfected participants (P = 0.02) and non–INSTI-treated HIV-infected subjects (P = 0.07). Hepatic steatosis and liver disease severity global score were lower in INSTI-treated participants than in non–INSTI-treated HIV-infected participants (P = 0.05 and P = 0.04, respectively). Conclusions: HIV-infected and HIV-uninfected subjects undergoing bariatric surgery presented a similar profile regarding anthropometric measures, cardiovascular parameters, and comorbidities. However, INSTI-treated participants presented milder SCAT and liver alterations than non–INSTI-treated participants.

Surgical Endoscopy and Other Interventional Techniques, Nov 2, 2017

patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achie... more patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. Conclusions The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

Obesity Surgery, Jan 26, 2021

Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. However, with... more Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. However, without a standardised surgical technique, heterogeneous outcomes and complications such as gastro-oesophageal reflux disease (GERD) have been reported. The aim of this study was to identify reproducible anatomical criteria for SG to obtain safe and effective results. A prospective photographic study that captured every phase of each procedure was completed. The photographic documentation was carefully examined in order to identify anatomical criteria that would help make our technique reproducible. Postsurgical results were reported in terms of complications and mortality, while functional and morphological results were evaluated using 3-month upper gastrointestinal (UGI) series and 12-month computed tomography (CT) scan, respectively. BMI, percentage excess weight loss (%EWL), comorbidities, and GERD symptoms at 12 months were analysed. One hundred thirty-four consecutive laparoscopic SG were photographed, and four reproducible anatomical criteria were identified: (1) to preserve the gastric antral posterior ligament (GAPL); (2) to dissect the gastro-pancreatic ligament (GPL); (3) to expose the right edge of the left diaphragmatic crus; and (4) to ensure staple-line linearity. No leaks occurred, and only one patient needed relaparoscopy for staple-line hematoma. Mortality and 30-day readmission rates were null. Gastric tube morphologies on the 12-month CT scans were homogeneous. At 12 months, median BMI was 30.8 kg/m2 [IQR 20–47.2] and mean %EWL was 69.0 ± 24.5%; comorbidities resolved in 65.8–88.1% of patients, and GERD symptoms resolved in 44.4%. The four anatomical criteria for SG that we propose are safe, effective, and reproducible and have acceptable postsurgical outcomes.

Endoscopy, Feb 13, 2017

▶ Fig. 1 Endoscopic view showing a recurrent leiomyoma in the mid-esophagus. ▶ Fig. 2 Endoscopic ... more ▶ Fig. 1 Endoscopic view showing a recurrent leiomyoma in the mid-esophagus. ▶ Fig. 2 Endoscopic ultrasound (EUS) showing a huge para-aortic leiomyoma developing from the muscularis propria layer.

International Journal of Surgery Case Reports, 2014

INTRODUCTION: Liver surgery was one of the last fields to be conquered by laparoscopy, which has ... more INTRODUCTION: Liver surgery was one of the last fields to be conquered by laparoscopy, which has become safe and effective, especially for left lateral sectionectomy (LLS) and limited peripheral resections. However, major hepatectomies remain challenging. Laparoendoscopic single-site (LESS) surgery is being employed for an increasing variety of surgical sites and indications. PRESENTATION OF CASE: Three patients underwent LESS hepatectomy. A 36-year-old woman had LLS for a 38-mm adenoma, an 85-year-old woman an atypical resection of segment VI for a 12-mm hepatocellular carcinoma and a 41-year-old woman an atypical right anterior resection for a 9 cm symptomatic FNH. Procedures were performed transperitoneally with a single-port device, via a 20-mm or 30-mm incision. Operative times were 110 min for LLS, 100 min for the atypical segment VI resection and 120 min for the atypical right anterior liver resection. Blood loss was less than 50 ml in the first two patients and 150 ml in the third. Postoperative courses were uneventful. The first two patients were discharged on postoperative day 3 and the third on postoperative day 1. DISCUSSION: To date, some case reports and series of LESS liver surgery have been published. We performed the reported hepatectomies after a considerable experience in laparoscopic hepatic surgery and after applying the LESS approach to other procedures. Our hepatectomy technique was not modified by the use of the single-port and results were very encouraging. CONCLUSION: We believe that in selected patients, both peripheral resections and LLS are feasible by LESS surgery, with good intra-operative and post-operative results.

Stem Cells, Aug 27, 2017

Increasing evidence supports that modifications in the mitochondrial content, oxidative phosphory... more Increasing evidence supports that modifications in the mitochondrial content, oxidative phosphorylation (OXPHOS) activity, and cell metabolism influence the fate of stem cells. However, the regulators involved in the crosstalk between mitochondria and stem cell fate remains poorly characterized. Here, we identified a transcriptional regulatory axis, composed of transcription factor 7-like 2 (TCF7L2) (a downstream effector of the Wnt/b-catenin pathway, repressed during differentiation) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1a) (the master regulator of mitochondrial biogenesis, induced during differentiation), coupling the loss of pluripotency and early commitment to differentiation, to the initiation of mitochondrial biogenesis and metabolic shift toward OXPHOS. PGC-1a induction during differentiation is required for both mitochondrial biogenesis and commitment to the hepatocytic lineage, and TCF7L2 repression is sufficient to increase PGC-1a expression, mitochondrial biogenesis and OXPHOS activity. We further demonstrate that OXPHOS activity is required for the differentiation toward the hepatocytic lineage, thus providing evidence that bi-directional interactions control stem cell differentiation and mitochondrial abundance and activity. STEM CELLS 2017;35:2184-2197 SIGNIFICANCE STATEMENT Mitochondria, which represent the major source of energy and power for the cells, are increasingly recognized as major regulators of stem cells. In this study, we show that increasing the content and activity of mitochondria is essential for stem cell differentiation into hepatocytes. We identified a regulatory axis that couples the loss of pluripotency and commitment to differentiation to the increase of mitochondria abundance and activity. In turn, mitochondrial activity further supports the differentiation process. By better deciphering the interplay between mitochondria and stem cell differentiation, these findings could benefit the development of stemcell based therapeutics and regenerative medicine.

Journal of Visceral Surgery, Feb 1, 2015

Increasing rate of obesity was reported in HIV-infected patients in USA. In France, no data are a... more Increasing rate of obesity was reported in HIV-infected patients in USA. In France, no data are available to date. Bariatric surgery is the best option for morbid obesity in general population but few data exist in HIV-infected patients. We describe the prevalence of obesity in France in HIV-infected patients. The prevalence of obesity is 15.1% in women and 5.3% in men. Moreover, we described our experience and point of view in the management of HIV infected patients with morbid obesity. Prospective studies are needed for an optimal management of HIV-infected patients with morbid obesity.

Obesity Surgery, Jan 28, 2019

Background Novice surgeons experience high levels of physical and mental workload during the earl... more Background Novice surgeons experience high levels of physical and mental workload during the early stages of their curriculum and clinical practice. Laparoscopic sleeve gastrectomy is the first bariatric procedure worldwide. Feasibility and safety of singleport sleeve gastrectomy (SPSG) has been demonstrated. An immersive virtual reality (VR) simulation was developed to provide a repetitive exercise to learn this novel technique. The primary objective of this study was to evaluate the impact of the VR training tool on mental and physical workload in novice surgeons. The secondary objective included an evaluation of the VR simulator. Methods A monocentric-controlled trial was conducted. Ten participants were divided into two groups, the VR group and the control group (without VR training). Surgery residents participated in a first real case of SPSG and a second case 1 month later. The VR group underwent a VR training between the two surgeries. Mental and physical loads were assessed with self-assessment questionnaires: NASA-TLX, Borg scale, and manikin discomfort test. The VR simulator was evaluated through presence, cybersickness, and usability questionnaires. Results This study showed a decrease of the mental demand and effort dimensions of NASA-TLX between the first and the second surgery in the VR group (P < .05). During the second surgery, a marginally significant difference was shown concerning the mental demand between the two groups. Postural discomfort of the VR group decreased with practice (P < .01), mainly between the first and the second surgery (P < .05). Furthermore, participants characterized the VR simulator as realistic, usable, and very useful to learned surgery. Conclusion This exploratory study showed an improvement in mental and physical workload when novice surgeons trained with VR (repetitive practice, gesture improvement, reduction of stress, etc.). Virtual reality appears to be a promising perspective for surgical training.

American Journal of Surgery, 2013

BACKGROUND: Selective control of vascular inflow can reduce blood loss and transfusion rates and ... more BACKGROUND: Selective control of vascular inflow can reduce blood loss and transfusion rates and may be particularly efficient in laparoscopic liver resection (LLR). The aim of this study was to evaluate the efficacy of selective prior vascular control (PVC) in patients undergoing laparoscopic or open liver resections (OLR). METHODS: Between 1999 and 2008, 52 patients underwent LLR with PVC with prospective data collection and were compared with patients undergoing OLR with PVC. RESULTS: There was no difference in the operative time between the 2 groups. Blood loss and transfusion rates were lower in patients who underwent LLR (367 vs 589 mL, P 5 .001; 3.8% vs 17.3%, P 5 .05, respectively). Morbidity did not differ significantly between the 2 groups. Hospital stay was longer in the OLR group (11.0 vs 7.4 days, P 5 .001). CONCLUSIONS: PVC during LLR was feasible and improved intraoperative and postoperative results. Selective PVC should be obtained in LLR whenever possible.

Stem Cells International, 2011

We previously described the large-scale production of RBCs from hematopoietic stem cells (HSCs) o... more We previously described the large-scale production of RBCs from hematopoietic stem cells (HSCs) of diverse sources. Our present efforts are focused to produce RBCs thanks to an unlimited source of stem cells. Human embryonic stem (ES) cells or induced pluripotent stem cell (iPS) are the natural candidates. Even if the proof of RBCs production from these sources has been done, their amplification ability is to date not sufficient for a transfusion application. In this work, our protocol of RBC production was applied to HSC isolated from fetal liver (FL) as an intermediate source between embryonic and adult stem cells. We studied the erythroid potential of FL-derived CD34 + cells. In this in vitro model, maturation that is enucleation reaches a lower level compared to adult sources as observed for embryonic or iP, but, interestingly, they (i) displayed a dramatic in vitro expansion (100-fold more when compared to CB CD34 +) and (ii) 100% cloning efficiency in hematopoietic progenitor assays after 3 days of erythroid induction, as compared to 10-15% cloning efficiency for adult CD34 + cells. This work supports the idea that FL remains a model of study and is not a candidate for ex vivo RBCS production for blood transfusion as a direct source of stem cells but could be helpful to understand and enhance proliferation abilities for primitive cells such as ES cells or iPS.

Revue de Chirurgie Orthopédique et Traumatologique, May 1, 2018

Les complications immédiates causées par l'implantation erronée de matériel lors des arthrodèses ... more Les complications immédiates causées par l'implantation erronée de matériel lors des arthrodèses sont possibles. Aucune complication immédiate lors du retrait de matériel implanté n'a été rapportée au niveau du rachis. Nous rapportons le cas de la migration intrapéritonéale d'une vis pédiculaire lors de sa tentative de retrait. Celle-ci a traversé le muscle psoas avant de perforer une anse intestinale grêle, déclenchant un choc hémorragique et une péritonite par perforation. Nous analysons les causes et mécanismes qui ont conduit à cette migration exceptionnelle en vue de faire partager les mesures préventives. Le placement extra pédiculaire initial et la pression à exercer sur la vis pour effectuer son retrait sont responsables de cet incident grave.

Journal de Chirurgie Viscérale, Jun 1, 2012

Journal de Chirurgie Viscérale, Oct 1, 2015

Introduction La sleeve gastrectomie (SG) est realisee en routine par trocart unique dans notre de... more Introduction La sleeve gastrectomie (SG) est realisee en routine par trocart unique dans notre departement comme alternative a l’approche laparoscopique conventionnelle. L’objectif de cette etude est de rapporter nos resultats postoperatoires precoces et au cours d’un suivi de 3 ans apres SG par trocart unique (SGTU). Methodes Les donnees de tous les patients consecutifs operes d’une SGTU dans notre institution entre aout 2010 et s eptembre 2014 sont compilees dans une base de donnees prospective et ont ete revues retrospectivement. Pour l’analyse de l’evolution de la perte de poids et des comorbidites, seuls les patients presentant plus d’une annee de suivi ont ete inclus. Resultats Au total 717 patients ont ete operes d’une SGTU pendant la periode de l’etude. L’indice de masse corporelle median etait 42,6 kg/m2. La duree operatoire mediane etait 112 min et diminuait au cours de la periode d’etude. L’introduction d’un trocart supplementaire etait necessaire dans 56 cas (7,8 %). Une reprise chirurgicale par laparoscopie et/ou un traitement endoscopique etaient necessaires pour traiter une hemorragie dans 21 cas (2,9 %) et une fistule gastrique dans 28 cas (3,9 %). La perte d’exces de poids moyenne etait de 69 % a 1 an et 6 2,2 % a 2 ans. Une eventration sur le site du trocart unique est survenue dans 13 cas (3,8 %). Discussion La SG peut etre realisee en routine par laparoscopie au travers d’une incision unique, avec des resultats equivalents a la laparoscopie conventionnelle. Declaration d’interet Les auteurs n’ont pas transmis de conflits d’interets.

Archives De Pediatrie, Jul 1, 2015

Surgical Innovation, Nov 1, 2017

American Journal of Obstetrics and Gynecology

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2022