Jean-Michel Guys

Chronic renal failure and portal hypertension--is portosystemic shunt indicated?

Abstract We report two girls with histories of recessive polycystic kidney disease. Both were on maintenance hemodialysis. They had undergone surgical distal portocaval shunt because of portal hypertension. Later, bilateral nephrectomy was performed, and they presented with hepatic encephalopathy (HE) and evolution towards irreversible hepatic coma and death. Portosystemic shunt is the treatment of choice of portal hypertension. The kidney plays a pivotal role in ammonia disposal during portosystemic shunt. Thus, we stress the risk of HE after portosystemic shunt followed by bilateral nephrectomy in patients with end-stage renal failure and suggest that combined liver-kidney transplantation should be considered.

Management of Pediatric Laryngotracheal Stenosis

In the past 6 years, 40 children underwent surgery for laryngotracheal stenosis; 32 by the external approach and 8 by endoscopic CO2 laser. Twenty-seven children (67%) were less than 5 years old at the time of treatment and 80% of the stenoses (n = 32) corresponded to an etiology that is secondary to endotracheal intubation and/or tracheotomy. By grading the stenoses according to the amount of narrowing of the lumen, the authors emphasize the interest of conservative treatment (endoscopic for grade I [less than 70%, n = 8], and treatment by external surgical methods for grade II [70% to 90%, n = 13], grade III [90% to 99%, n = 14], and grade IV [total obstruction, n = 5]). At this time, the most commonly used technique is laryngotracheoplasty with costal cartilage interposition. In this series, 88% of the patients were successfully decannulated. As for the treatment of stenosis in infants, the authors describe their recent experience of laryngotracheofissure in 7 patients as an alternative to either tracheotomy in cases of difficult extubation or laryngotracheoplasty when the child is underweight.

Prof. Pascal de Lagausie (1960–2016)

Prof. Pascal de Lagausie has been an outstanding pediatric surgeon whom we will always remember for personal and professional reasons. He was part of a generation of pediatric surgeons who developed and promoted endoscopic surgery in children. Pascal de Lagausiewas a true innovator in hisfield and made significant and lasting contributions to pediatric surgery. He completed his medical school in Aix-Marseille University, and thenmoved to Paris for his residency. Later he served as a consultant at the Robert Debre Hospital and finally went back to Marseille, where he was appointed as a Consultant Surgeon and a University Professor at the Timone Hospital in the year 2004. Pascal de Lagausie published more than 170 scientific articles and textbook chapters. He delivered more than 300 lectures and oral communications. His whole life had been dedicated to child care, opera, and rugby! The members of both hospitals, Robert Debre and Timone Children, recall his dedication, passion, and influence. He traveled extensively lecturing and acting as an ambassador of the French Pediatric Surgery. Registrars who trained with him and visitors who came fromall over Europe recall him as an enthusiastic and effective teacher andmentor. Pascal de Lagausie was member of numerous pediatric surgical societies. He had begun facing health problems 7 years ago, but he continued teaching pediatric surgery at his department and abroad, he was operated every week, and assumed his responsibilities at our congresses and meetings. During the last years, his courage, determination, and mental strength were exceptional and recognized by all people he met. He continued to exhibit optimism day after day. Pascal de Lagausie passed away quietly, at the age of 55 years, in his home in Marseille with his life partner Claudine, family, and friends by his side. A good and useful life had ended too early. We will remember Pascal de Lagausie for his dedication, his open mindedness, and his enthusiasm. Prof. Pascal de Lagausie (1960–2016)

A Retrospective Analysis of Fifty Years of Open Surgery in the Treatment of Gastroesophageal Reflux

Every evaluation of surgery for gastroesophageal reflux (GER) should address three basic questions. First, is surgery effective in stopping reflux? Second, is surgery able to stop all symptoms and, if symptoms persist, may they be due to coexisting causes? Finally, are morbidity and mortality of surgical treatment lower than those of a medical treatment?