Jean-Luc Bouillot

Validity of Leg-to-Leg Bioelectrical Impedance Analysis to Estimate Body Fat in Obesity

BackgroundBioelectrical impedance analysis (BIA) is a safe and easy method of assessing body composition. Its accuracy to predict fat mass (FM) in obesity and the change in FM following weight loss is questioned. Our objective was to compare leg-to-leg BIA to dual-energy X-ray absorptiometry (DXA) in the assessment of FM in a large population, the changes in FM after Roux-en-Y gastric bypass (RYGB) and to estimate between-method differences (bias) and limits of agreement. MethodsBIA (Tanita BC-420MA) and DXA (Hologic Discovery W) were used in 5,740 consecutive patients (mean BMI, 37.7u2009±u20098.2xa0kg/m2) examined in a clinical nutrition department and in 72 women undergoing RYGB (BMI, 47.2u2009±u20097.2xa0kg/m2). Analyses included correlations between methods and Bland Altman analysis.ResultsIn the entire population, BIA significantly overestimated FM in comparison with DXA (1.1u2009±u20096.1xa0kg, 0.8u2009±u20095.6%). FM estimates by each method were significantly correlated in absolute value (kg; r2u2009=u20090.9 in the whole population), and in percentage (r2u2009=u20090.6). However, wide limits of agreement were observed. In surgery patients, BIA significantly overestimated FM both before and 12xa0months after bypass. BIA significantly overestimated changes in FM after RYGB at 3xa0months (2.9u2009±u20095.0xa0kg) and at 12xa0months (1.9u2009±u20093.9xa0kg) but not at 6xa0months (0.9u2009±u20095.0xa0kg; pu2009=u20090.08). Estimates of changes in FM by each method were significantly correlated (r2u2009=u20090.4, 0.6, and 0.9, respectively).ConclusionAccording to the wide limits of agreement, BIA seems more interesting for epidemiological rather than individual use to evaluate body FM and FM changes in obese women undergoing RYGB.

Elective laparoscopic-assisted colectomy for diverticular disease : A prospective study in 50 patients

AbstractBackground: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question, we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid colon for diverticular disease.n Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn anastomosis.n Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280 min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.n Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.

Complications vésiculaires après chirurgie bariatrique

Resume Devant l’incidence croissante de l’obesite dans les societes occidentales et l’echec relatif des traitements medicaux, on assiste a un developpement rapide de la chirurgie bariatrique, notamment depuis sa realisation par cœliochirurgie. La gastroplastie par anneau ajustable est l’intervention la plus repandue en France, mais le bypass gastrique tend a devenir l’intervention gold standard. La perte de poids engendree par ces interventions expose a des complications biliaires d’origine lithiasique specifiques a ce type de chirurgie. A travers une recente revue de la litterature, nous exposerons les mecanismes physiopathologiques a l’origine de cette maladie lithiasique post-chirurgie bariatrique, ainsi que les moyens diagnostiques et preventifs permettant d’eviter ces complications.

Stented hepaticojejunostomies after resection for cholangiocarcinoma allow access for subsequent diagnosis and therapy

A method is described for stenting hepaticojejunostomies after resection for hilar carcinomas. The small size of the catheters allows the intubation of all biliary anastomoses, in order to decrease the morbidity rate and allow postoperative internal radiotherapy.

Parietal mesh abscess as an original presentation of cancer of the caecum.

We report a case of cancer of the caecum in a 71-year-old male who presented with parietal mesh abscess. Two years before, he was treated for a right inguinal hernia by insertion of a Dacron mesh. CT scan then colonoscopy determined the existence of a voluminous caecal tumor perforated in the abdominal wall with an important abscess around the mesh. Right colectomy and parietal muscles excision were performed completed with postoperative radiochemotherapy. At 2 years, there is no evidence of recurrence. Atypical features with a hernia mesh repair associated with a sudden change in the patient’s condition should alert the clinician to the possibility of a further subjacent pathological process.

Traitement chirurgical de l'obésité : gastroplastie ou « bypass » gastrique ?

En pediatrie, les catheters centraux sont devenus un element indispensable pour les traitements intraveineux de longue duree. L’obstruction totale ou partielle, sous-estimee, est la complication la plus frequente, le remplacement, source de risques physiques, psychologiques et financiers. La prevention de l’obstruction est primordiale. La pharmacopee offre differents produits chimiques et biochimiques pour desobstruer ces dispositifs centraux. Souvent, le diagnostic, les prescriptions, les protocoles sont empiriques ou relevent d’habitudes. La composition, l’importance, la longueur du bouchon sont toujours meconnus. Les thrombolytiques, au premier rang desquels l’urokinase extractive, sont actuellement le traitement de choix pour la majorite des obstructions. Cependant, le mecanisme, les doses utiles, et la duree necessaire restent encore imprecis.Auteur(s) : Mazda Daneshvar, Vittorio Alberti, Claude Laurian Service de chirurgie vasculaire, Hopital St Joseph, 185 rue Raymond Losserand, 75014 Paris Observation Mr V., 35xa0ans, presentait depuis 15xa0ans des douleurs peri-ungueales du 5e doigt droit. Une tache bleue etait apparue depuis 15xa0ans a la base de l’ongle, associee a des douleurs regulieres et vives lors de tout contact ou lors de l’exposition au froid. Un premier bilan avait ete realise il y a 10xa0ans, l’arteriographie [...]

Chirurgie de l’obésité chez un adolescent : de la demande personnelle à la décision collégiale

Resume La chirurgie bariatrique chez les jeunes âges de moins de 20 ans souleve des questions cliniques, organisationnelles, ethiques. Cet article porte sur le parcours clinique initial, c’est-a-dire de la demande de chirurgie a la prise de decision. Il s’agit de clarifier les enjeux pour le jeune, sa famille, et son pediatre ou son medecin traitant. La prise en charge multifocale dans des centres hyperspecialises doit - d’emblee - s’inscrire dans la duree.

Urgences : étape critique du parcours de soins après chirurgie bariatrique

Resume Le parcours de soins apres chirurgie bariatrique est emaille de situations urgentes, precoces ou tardives. Des symptomes souvent atypiques, des difficultes d’examen posent des problemes de diagnostic. Deux regles imperatives : – tachycardie (> 120 batt./min), gene respiratoire, sepsis, agitation, avec ou sans douleur abdominale, ou vomissement, doivent faire evoquer une complication chirurgicale et imposent un avis du chirurgien qui decidera d’une eventuelle exploration chirurgicale en urgence ; – des signes evocateurs de carences vitaminiques, notamment neurologiques, justifient l’administration immediate de vitamine B1.