Pouya Iranmanesh - Academia.edu (original) (raw)
Papers by Pouya Iranmanesh
Revue médicale suisse, 2015
European Journal of Pediatric Surgery
Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The ai... more Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. Methods Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. Results Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative l...
British journal of surgery, May 1, 2024
World Journal of Gastrointestinal Oncology, Feb 15, 2022
Gastric cancer is generally diagnosed at an advanced stage, especially in countries without scree... more Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.
British Journal of Surgery, May 31, 2022
Objective: Elderly patients undergo bariatric surgery less frequently than younger patients. Shor... more Objective: Elderly patients undergo bariatric surgery less frequently than younger patients. Short-and medium-term outcomes after bariatric surgery in the elderly population remain largely unknown. The objective of the present retrospective, registry-based cohort study was to compare short-and medium-term outcomes between patients ,65 and ≥65 years undergoing bariatric surgery, hypothesizing similar outcomes between groups. Methods: In this retrospective, registry-based cohort study, the Ontario Bariatric Registry was used to compare data of patients ,65 and ≥65 years who underwent Roux-en-Y gastric bypass and sleeve gastrectomy between January 2010 and August 2019 in all accredited bariatric centers of excellence in Ontario, Canada. Primary outcomes were overall postoperative complications. Secondary outcomes included early (,30 days) complications, readmissions, reoperations, mortality, weight loss and comorbidities improvement at 1 and 3 year after surgery. Results: Data of 22,981 patients ,65 and 532 patients ≥65 years were analyzed. Overall postoperative complications were similar between patients ,65 and ≥65 years (3388/22,981 [14.7%] vs. 73/532 [13.7%], p = 0.537). Early (,30 days) postoperative complications, readmissions, reoperations, and mortality rates were also similar between groups. Both groups had significant weight loss and comorbidities improvement at 1-and 3-year follow-up. Patients ,65 years had superior weight loss (+3.5%, 95% CI: 1.6-5.4, p , 0.001) and higher rates of remission for diabetes mellitus (63.8% vs. 39.3%, p , 0.001), hypertension (37.9% vs. 14.5%, p , 0.001), dyslipidemia (28.2% vs. 9.5%, p , 0.001) and gastroesophageal reflux (65.1% vs. 24.0%, p , 0.001) compared to patients ≥65 years at 3 year. Conclusion: Patients ,65 and ≥65 years had similar perioperative morbidity and mortality after bariatric surgery. Even though patients ,65 years had overall better medium-term outcomes, bariatric surgery is safe and yields significant weight loss and comorbidities improvement in patients ≥65 years.
British Journal of Surgery, May 31, 2022
Objective: Single-anastomosis duodenal switch (SADS) has emerged in recent years as an alternativ... more Objective: Single-anastomosis duodenal switch (SADS) has emerged in recent years as an alternative to the standard double-anastomosis duodenal switch (DADS). The objective of this study was to compare short-and medium-term outcomes between SADS and DADS. Methods: Data collected in the Ontario Bariatric Registry between 2010 and 2019 were used for this retrospective study to determine outcomes of patients undergoing primary laparoscopic SADS versus DADS at a Canadian tertiary hospital and bariatric center of excellence. The primary outcome was weight loss at 1 and 2 years after surgery. Short-term secondary outcomes included operative times, intra-and early postoperative complications, hospital length of stay (LOS), and 30-day readmissions. Medium-term secondary outcomes included late postoperative complications as well as nutritional deficiencies and persistent diarrhea at 1 and 2 years after surgery. Subgroup analyses were performed to compare patients undergoing one-and two-stage procedures. Results: Data of 107 patients who underwent SADS (n = 25) or DADS (n = 82) were included in the study. Follow-up data were available for 59/107 (55.1%) patients at 1 year and 47/107 (43.9%) at 2 years after surgery. Patients in the SADS and DADS groups had similar %TBWL at 1 year (23.6 versus 26.2, P = 0.617) and 2 years (24.8 versus 30.2, P = 0.116) after surgery. Short-and medium-term outcomes were similar between groups. There was no difference between patients undergoing one-versus two-stage procedures. Conclusion: This study showed that patients undergoing SADS and DADS had similar weight loss at 1 and 2 years. Early and late postoperative morbidity, operative times, early readmissions, and LOS were also similar between groups. Further studies with longer follow-up are required to confirm these results.
British Journal of Surgery, May 1, 2021
Between 2015 and 2020 96 patients with HPT and negative/ equivocal conventional imaging were refe... more Between 2015 and 2020 96 patients with HPT and negative/ equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated. Results: All patients showed normalized serum calcium levels in the direct postoperative period. 50 of 60 patients (8 results are awaited) with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured as well while 1 patient deceased before 6 month follow up. Sensitivity per lesion for primary HPT was 88%, for secondary/tertiary HPT 75% and for familial HPT 75%, respectively. Sensitivity per patient was 92% for primary HPT, 100% for secondary/tertiary HPT and 50% for familial HPT, respectively. Positive predictive value was 98% in primary HPT and 100% in secondary/tertiary HPT and 100% in familial HPT as well. Conclusion: Diagnostic accuracy of 18F-Fluorcholine-PET/CT for patients with primary as well as secondary/tertiary and familial hyperparathyreoidism ist excellent. 18F-Fluorcholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
Surgical Endoscopy and Other Interventional Techniques, Dec 9, 2022
Background Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of baria... more Background Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of bariatric centers worldwide. Previous studies have identified a number of demographic and clinical variables as predictors of postoperative complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Some authors have suggested better early postoperative outcomes after RRYGB compared to LRYGB. The objective of the present study was to assess potential predictors of early postoperative complications after RRYGB. Methods A retrospective analysis of two prospective databases containing patients who underwent RRYGB between 2006 and 2019 at two high volumes, accredited bariatric centers was performed. Primary outcome was rate of 30 day postoperative complications. Relevant demographic, clinical and biological variables were entered in a multivariate, logistic regression analysis to identify potential predictors. Results Data of 1276 patients were analyzed, including 958 female and 318 male patients. Rates of overall and severe 30 day complications were 12.5% (160/1276) and 3.9% (50/1276), respectively. Rate of 30 day reoperations was 1.6% (21/1276). The overall gastrointestinal leak rate was 0.2% (3/1276). Among various demographic, clinical and biological variables, male sex and ASA score >2 were significantly correlated with an increased risk of 30 day complication rates on multivariate analysis (OR 1.68 and 1.67, p=0.005 and 0.005, respectively). Conclusion This study identified male sex and ASA score >2 as independent predictors of early postoperative complications after RRYGB. These data suggest a potentially different risk profile in terms of early postoperative complications after RRYGB compared to LYRGB. The robotic approach might have a benefit for patients traditionally considered to be at higher risk of complications after LRYGB, such as those with BMI >50. The present study was however not designed to assess this hypothesis and larger, prospective studies are necessary to confirm these results.
BMC Surgery, Apr 17, 2017
Background: Recent data have suggested that upfront cholecystectomy should be performed even in t... more Background: Recent data have suggested that upfront cholecystectomy should be performed even in the presence of moderately abnormal liver function tests (LFTs). As a consequence, more common bile duct (CBD) stones are discovered on intra-operative cholangiogram. We assessed the presentation and management of such patients to refine their management plan. Methods: Adult patients (>16 years) with an acute gallstone-related disease who had undergone same-stay cholecystectomy from January 2013 to January 2015 were retrospectively assessed. We excluded patients with pre-operative endoscopic CBD exploration. Results: Among the 612 patients with same-stay cholecystectomy, 399 patients were included in the study, and 213 were excluded because of a pre-operative CBD exploration. Fifty patients (12.5%) presented an image of CBD stone on the intra-operative cholangiogram. Such patients were younger (47 vs. 55 years, P = .01) and less likely to present with fever (1 vs. 11.7%, P = .04) or signs of cholecystitis on ultrasound (66 vs. 83.7%, P = .003). Admission LFTs were higher in patients with an image of a stone. Among the 50 patients with an image on cholangiogram, a stone was confirmed in 26 (52%). Most patients (n = 32) underwent post-operative assessment with endoscopic ultrasound (EUS). LFTs did not predict the presence of a confirmed stone. However, the absence of contrast passage into the duodenum was negatively associated with a confirmed stone (P = .08), and a filling defect was positively associated with one (P = .11). Most confirmed stones were successfully extracted by endoscopic retrograde cholangiopancreatogram (ERCP) (25/26, 96%), except in one patient who needed a per-cutaneous approach because of duodenal diverticuli. Conclusions: Same-stay cholecystectomy can (and should) be performed even in the presence of moderately abnormal liver function tests. The cholangiogram suspicion of a CBD stone is confirmed in only half of the patients (more often in the presence of a filling defect, and less often with the absence of contrast passage). All stones can be safely treated after surgery (most by ERCP).
Surgery for Obesity and Related Diseases
Canadian Journal of Surgery, Dec 1, 2022
Demographics and presentation comparing intermediate risk patients with or without a common bile ... more Demographics and presentation comparing intermediate risk patients with or without a common bile duct stone image on cholangiogram. Assessment of demographic and clinical criteria considering only the patients at intermediate risk of CBD stone. The results were similar to those using the entire cohort. (PDF 15Â kb)
Revue Médicale Suisse, 2018
Surgical Endoscopy, 2019
BackgroundPatients with obesity have a higher risk of trocar site hernia. The objective of the pr... more BackgroundPatients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery.MethodsThis is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia.ResultsThe use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group.ConclusionsUse of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up.
PloS one, 2018
The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the ... more The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease. Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed. Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%). ...
Journal of Hepatology, 2017
Gastrointestinal endoscopy, Jan 24, 2016
Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (includ... more Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed decreased length of stay (LOS) and fewer common bile duct investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines. Initial cholecystectomy has become the standard management strategy at Geneva University Hospital since July 2013 for patients at intermediate-risk of CBD stone admitted with acute gallstone-related conditions. Between July 2013 and December 2014, LOS, number of CBD investigations and adverse events were collected for these patients and compared with the data of the randomized controlled trial patients. Data of 161 consecutive newly assessed patients at intermediate-risk ...
Journal of Pediatric Surgery, 2004
Background: Evidence for diagnostic accuracy and clinical efficacy of intraoperative cholangiogra... more Background: Evidence for diagnostic accuracy and clinical efficacy of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones in children is sparse and unclear. Methods: Retrospective analysis of 202 children who underwent laparoscopic cholecystectomy (LC) between 1996 and 2002 was performed. Forty-eight children had suspected CBD stones on clinical, biochemical, and radiologic grounds. Two clinical pathways, LC followed by ERCP (L3 E) versus ERCP followed by LC (E3 L) were compared. Results: From the cohort of 202 patients, 154 did not have suspected CBD stones. Of the 48 patients that did have suspected stones, 2 management pathways were followed: (1) ERCP first: 14 of 48 patients (including 1 failed examination). Three yielded positive findings on ERCP. Ten had negative findings on ERCP, 3 of which went on to have a subsequent IOC. All 3 had negative IOC examination findings. (2) LC Ϯ IOC first: 34 of 48 patients. Twenty-eight had negative findings on IOC and had no further investigations. Three patients had positive IOC examination findings and went on to have postoperative ERCP. Two of these 3 patients
Journal of Hepatology, 2014
Revue médicale suisse, 2015
European Journal of Pediatric Surgery
Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The ai... more Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. Methods Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. Results Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative l...
British journal of surgery, May 1, 2024
World Journal of Gastrointestinal Oncology, Feb 15, 2022
Gastric cancer is generally diagnosed at an advanced stage, especially in countries without scree... more Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.
British Journal of Surgery, May 31, 2022
Objective: Elderly patients undergo bariatric surgery less frequently than younger patients. Shor... more Objective: Elderly patients undergo bariatric surgery less frequently than younger patients. Short-and medium-term outcomes after bariatric surgery in the elderly population remain largely unknown. The objective of the present retrospective, registry-based cohort study was to compare short-and medium-term outcomes between patients ,65 and ≥65 years undergoing bariatric surgery, hypothesizing similar outcomes between groups. Methods: In this retrospective, registry-based cohort study, the Ontario Bariatric Registry was used to compare data of patients ,65 and ≥65 years who underwent Roux-en-Y gastric bypass and sleeve gastrectomy between January 2010 and August 2019 in all accredited bariatric centers of excellence in Ontario, Canada. Primary outcomes were overall postoperative complications. Secondary outcomes included early (,30 days) complications, readmissions, reoperations, mortality, weight loss and comorbidities improvement at 1 and 3 year after surgery. Results: Data of 22,981 patients ,65 and 532 patients ≥65 years were analyzed. Overall postoperative complications were similar between patients ,65 and ≥65 years (3388/22,981 [14.7%] vs. 73/532 [13.7%], p = 0.537). Early (,30 days) postoperative complications, readmissions, reoperations, and mortality rates were also similar between groups. Both groups had significant weight loss and comorbidities improvement at 1-and 3-year follow-up. Patients ,65 years had superior weight loss (+3.5%, 95% CI: 1.6-5.4, p , 0.001) and higher rates of remission for diabetes mellitus (63.8% vs. 39.3%, p , 0.001), hypertension (37.9% vs. 14.5%, p , 0.001), dyslipidemia (28.2% vs. 9.5%, p , 0.001) and gastroesophageal reflux (65.1% vs. 24.0%, p , 0.001) compared to patients ≥65 years at 3 year. Conclusion: Patients ,65 and ≥65 years had similar perioperative morbidity and mortality after bariatric surgery. Even though patients ,65 years had overall better medium-term outcomes, bariatric surgery is safe and yields significant weight loss and comorbidities improvement in patients ≥65 years.
British Journal of Surgery, May 31, 2022
Objective: Single-anastomosis duodenal switch (SADS) has emerged in recent years as an alternativ... more Objective: Single-anastomosis duodenal switch (SADS) has emerged in recent years as an alternative to the standard double-anastomosis duodenal switch (DADS). The objective of this study was to compare short-and medium-term outcomes between SADS and DADS. Methods: Data collected in the Ontario Bariatric Registry between 2010 and 2019 were used for this retrospective study to determine outcomes of patients undergoing primary laparoscopic SADS versus DADS at a Canadian tertiary hospital and bariatric center of excellence. The primary outcome was weight loss at 1 and 2 years after surgery. Short-term secondary outcomes included operative times, intra-and early postoperative complications, hospital length of stay (LOS), and 30-day readmissions. Medium-term secondary outcomes included late postoperative complications as well as nutritional deficiencies and persistent diarrhea at 1 and 2 years after surgery. Subgroup analyses were performed to compare patients undergoing one-and two-stage procedures. Results: Data of 107 patients who underwent SADS (n = 25) or DADS (n = 82) were included in the study. Follow-up data were available for 59/107 (55.1%) patients at 1 year and 47/107 (43.9%) at 2 years after surgery. Patients in the SADS and DADS groups had similar %TBWL at 1 year (23.6 versus 26.2, P = 0.617) and 2 years (24.8 versus 30.2, P = 0.116) after surgery. Short-and medium-term outcomes were similar between groups. There was no difference between patients undergoing one-versus two-stage procedures. Conclusion: This study showed that patients undergoing SADS and DADS had similar weight loss at 1 and 2 years. Early and late postoperative morbidity, operative times, early readmissions, and LOS were also similar between groups. Further studies with longer follow-up are required to confirm these results.
British Journal of Surgery, May 1, 2021
Between 2015 and 2020 96 patients with HPT and negative/ equivocal conventional imaging were refe... more Between 2015 and 2020 96 patients with HPT and negative/ equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated. Results: All patients showed normalized serum calcium levels in the direct postoperative period. 50 of 60 patients (8 results are awaited) with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured as well while 1 patient deceased before 6 month follow up. Sensitivity per lesion for primary HPT was 88%, for secondary/tertiary HPT 75% and for familial HPT 75%, respectively. Sensitivity per patient was 92% for primary HPT, 100% for secondary/tertiary HPT and 50% for familial HPT, respectively. Positive predictive value was 98% in primary HPT and 100% in secondary/tertiary HPT and 100% in familial HPT as well. Conclusion: Diagnostic accuracy of 18F-Fluorcholine-PET/CT for patients with primary as well as secondary/tertiary and familial hyperparathyreoidism ist excellent. 18F-Fluorcholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
Surgical Endoscopy and Other Interventional Techniques, Dec 9, 2022
Background Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of baria... more Background Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of bariatric centers worldwide. Previous studies have identified a number of demographic and clinical variables as predictors of postoperative complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Some authors have suggested better early postoperative outcomes after RRYGB compared to LRYGB. The objective of the present study was to assess potential predictors of early postoperative complications after RRYGB. Methods A retrospective analysis of two prospective databases containing patients who underwent RRYGB between 2006 and 2019 at two high volumes, accredited bariatric centers was performed. Primary outcome was rate of 30 day postoperative complications. Relevant demographic, clinical and biological variables were entered in a multivariate, logistic regression analysis to identify potential predictors. Results Data of 1276 patients were analyzed, including 958 female and 318 male patients. Rates of overall and severe 30 day complications were 12.5% (160/1276) and 3.9% (50/1276), respectively. Rate of 30 day reoperations was 1.6% (21/1276). The overall gastrointestinal leak rate was 0.2% (3/1276). Among various demographic, clinical and biological variables, male sex and ASA score >2 were significantly correlated with an increased risk of 30 day complication rates on multivariate analysis (OR 1.68 and 1.67, p=0.005 and 0.005, respectively). Conclusion This study identified male sex and ASA score >2 as independent predictors of early postoperative complications after RRYGB. These data suggest a potentially different risk profile in terms of early postoperative complications after RRYGB compared to LYRGB. The robotic approach might have a benefit for patients traditionally considered to be at higher risk of complications after LRYGB, such as those with BMI >50. The present study was however not designed to assess this hypothesis and larger, prospective studies are necessary to confirm these results.
BMC Surgery, Apr 17, 2017
Background: Recent data have suggested that upfront cholecystectomy should be performed even in t... more Background: Recent data have suggested that upfront cholecystectomy should be performed even in the presence of moderately abnormal liver function tests (LFTs). As a consequence, more common bile duct (CBD) stones are discovered on intra-operative cholangiogram. We assessed the presentation and management of such patients to refine their management plan. Methods: Adult patients (>16 years) with an acute gallstone-related disease who had undergone same-stay cholecystectomy from January 2013 to January 2015 were retrospectively assessed. We excluded patients with pre-operative endoscopic CBD exploration. Results: Among the 612 patients with same-stay cholecystectomy, 399 patients were included in the study, and 213 were excluded because of a pre-operative CBD exploration. Fifty patients (12.5%) presented an image of CBD stone on the intra-operative cholangiogram. Such patients were younger (47 vs. 55 years, P = .01) and less likely to present with fever (1 vs. 11.7%, P = .04) or signs of cholecystitis on ultrasound (66 vs. 83.7%, P = .003). Admission LFTs were higher in patients with an image of a stone. Among the 50 patients with an image on cholangiogram, a stone was confirmed in 26 (52%). Most patients (n = 32) underwent post-operative assessment with endoscopic ultrasound (EUS). LFTs did not predict the presence of a confirmed stone. However, the absence of contrast passage into the duodenum was negatively associated with a confirmed stone (P = .08), and a filling defect was positively associated with one (P = .11). Most confirmed stones were successfully extracted by endoscopic retrograde cholangiopancreatogram (ERCP) (25/26, 96%), except in one patient who needed a per-cutaneous approach because of duodenal diverticuli. Conclusions: Same-stay cholecystectomy can (and should) be performed even in the presence of moderately abnormal liver function tests. The cholangiogram suspicion of a CBD stone is confirmed in only half of the patients (more often in the presence of a filling defect, and less often with the absence of contrast passage). All stones can be safely treated after surgery (most by ERCP).
Surgery for Obesity and Related Diseases
Canadian Journal of Surgery, Dec 1, 2022
Demographics and presentation comparing intermediate risk patients with or without a common bile ... more Demographics and presentation comparing intermediate risk patients with or without a common bile duct stone image on cholangiogram. Assessment of demographic and clinical criteria considering only the patients at intermediate risk of CBD stone. The results were similar to those using the entire cohort. (PDF 15Â kb)
Revue Médicale Suisse, 2018
Surgical Endoscopy, 2019
BackgroundPatients with obesity have a higher risk of trocar site hernia. The objective of the pr... more BackgroundPatients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery.MethodsThis is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia.ResultsThe use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group.ConclusionsUse of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up.
PloS one, 2018
The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the ... more The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease. Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed. Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%). ...
Journal of Hepatology, 2017
Gastrointestinal endoscopy, Jan 24, 2016
Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (includ... more Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed decreased length of stay (LOS) and fewer common bile duct investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines. Initial cholecystectomy has become the standard management strategy at Geneva University Hospital since July 2013 for patients at intermediate-risk of CBD stone admitted with acute gallstone-related conditions. Between July 2013 and December 2014, LOS, number of CBD investigations and adverse events were collected for these patients and compared with the data of the randomized controlled trial patients. Data of 161 consecutive newly assessed patients at intermediate-risk ...
Journal of Pediatric Surgery, 2004
Background: Evidence for diagnostic accuracy and clinical efficacy of intraoperative cholangiogra... more Background: Evidence for diagnostic accuracy and clinical efficacy of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones in children is sparse and unclear. Methods: Retrospective analysis of 202 children who underwent laparoscopic cholecystectomy (LC) between 1996 and 2002 was performed. Forty-eight children had suspected CBD stones on clinical, biochemical, and radiologic grounds. Two clinical pathways, LC followed by ERCP (L3 E) versus ERCP followed by LC (E3 L) were compared. Results: From the cohort of 202 patients, 154 did not have suspected CBD stones. Of the 48 patients that did have suspected stones, 2 management pathways were followed: (1) ERCP first: 14 of 48 patients (including 1 failed examination). Three yielded positive findings on ERCP. Ten had negative findings on ERCP, 3 of which went on to have a subsequent IOC. All 3 had negative IOC examination findings. (2) LC Ϯ IOC first: 34 of 48 patients. Twenty-eight had negative findings on IOC and had no further investigations. Three patients had positive IOC examination findings and went on to have postoperative ERCP. Two of these 3 patients
Journal of Hepatology, 2014