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Monthly publications

#May 2009
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Laparoscopic indirect ventral rectopexy with sigmoidectomy for rectal prolapse in a young female patient
The aim of surgical treatment of rectal prolapse is to anatomically restore prolapse and functionally remedy fecal incontinence and disorder of rectal emptying. There is not yet sufficient evidence-based knowledge of the advantages and disadvantages of various surgical methods. In practice, trans-abdominal surgery is recommended for patients in good conditions and perineal surgery for elderly and frail patients suffering from associated diseases. The progress of laparoscopic surgery has, however, made the trans-abdominal operation possible also for those in increasingly poor condition. With this procedure a significant improvement of defecation disorder is achieved in over 80% of patients. This video demonstrates the laparoscopic management of a rectal prolapse associated with constipation and a posterior enterocele.
J Leroy, J Marescaux
Surgical intervention
9 years ago
3204 views
139 likes
0 comments
15:44
Laparoscopic indirect ventral rectopexy with sigmoidectomy for rectal prolapse in a young female patient
The aim of surgical treatment of rectal prolapse is to anatomically restore prolapse and functionally remedy fecal incontinence and disorder of rectal emptying. There is not yet sufficient evidence-based knowledge of the advantages and disadvantages of various surgical methods. In practice, trans-abdominal surgery is recommended for patients in good conditions and perineal surgery for elderly and frail patients suffering from associated diseases. The progress of laparoscopic surgery has, however, made the trans-abdominal operation possible also for those in increasingly poor condition. With this procedure a significant improvement of defecation disorder is achieved in over 80% of patients. This video demonstrates the laparoscopic management of a rectal prolapse associated with constipation and a posterior enterocele.
Staple line failure during NOTES sleeve gastrectomy
In current surgical practice, the majority of the anastomoses is performed using a stapling device. Despite correct usage, staple line failure might still occur.
Concerning surgical stapling devices, the United States Food and Drug Administration (FDA) received reports of 22,804 malfunctions, 2,180 injuries, and 112 deaths from 1992 to July 1, 2001. These numbers included all types of linear and circular stapling devices as well as clip appliers. The majority of operations reported were gastrointestinal. Failure of stapling devices to function resulted in suture line separation or leak as the most common problem. When interpreting these data, it should be borne in mind that besides the fact that staplers are used very frequently, surgeons have to know the appropriate surgical techniques to inspect and verify staple line defects, and the techniques to employ if issues occur especially when performing complex surgery such as in this case of NOTES sleeve gastrectomy.
Thanks to the high skills of the surgeon, the procedure was completed using only one further port.
M Vix, J Marescaux
Surgical intervention
9 years ago
1095 views
11 likes
0 comments
06:35
Staple line failure during NOTES sleeve gastrectomy
In current surgical practice, the majority of the anastomoses is performed using a stapling device. Despite correct usage, staple line failure might still occur.
Concerning surgical stapling devices, the United States Food and Drug Administration (FDA) received reports of 22,804 malfunctions, 2,180 injuries, and 112 deaths from 1992 to July 1, 2001. These numbers included all types of linear and circular stapling devices as well as clip appliers. The majority of operations reported were gastrointestinal. Failure of stapling devices to function resulted in suture line separation or leak as the most common problem. When interpreting these data, it should be borne in mind that besides the fact that staplers are used very frequently, surgeons have to know the appropriate surgical techniques to inspect and verify staple line defects, and the techniques to employ if issues occur especially when performing complex surgery such as in this case of NOTES sleeve gastrectomy.
Thanks to the high skills of the surgeon, the procedure was completed using only one further port.
Gastric bypass: surgical treatment of morbid obesity
Morbid obesity is a major health concern in so many countries. It is associated with severe life-threatening co-morbidities. Unfortunately, many studies have proven that non-surgical approaches to lose weight are doomed to fail. There is good evidence that bariatric surgery is the most enduring and efficacious means of tackling morbid obesity with regards to long-term weight loss.

Roux-en-Y gastric bypass is today one of the gold standard surgeries. It is based on several mechanisms: restriction, malabsorption, and changes in gut hormones secretions.
In this chapter, all aspects of this bariatric procedure such as anatomical details, indications, contraindications, surgical setting and technical details are carefully presented.
M Vix
Operative technique
9 years ago
7099 views
165 likes
0 comments
Gastric bypass: surgical treatment of morbid obesity
Morbid obesity is a major health concern in so many countries. It is associated with severe life-threatening co-morbidities. Unfortunately, many studies have proven that non-surgical approaches to lose weight are doomed to fail. There is good evidence that bariatric surgery is the most enduring and efficacious means of tackling morbid obesity with regards to long-term weight loss.

Roux-en-Y gastric bypass is today one of the gold standard surgeries. It is based on several mechanisms: restriction, malabsorption, and changes in gut hormones secretions.
In this chapter, all aspects of this bariatric procedure such as anatomical details, indications, contraindications, surgical setting and technical details are carefully presented.
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.
Gf Donatelli, M Gualtierotti, D Coumaros, J Marescaux
Surgical intervention
9 years ago
1529 views
29 likes
0 comments
04:57
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.
M Vix, B Dallemagne, D Coumaros, Gf Donatelli
Surgical intervention
9 years ago
425 views
9 likes
0 comments
15:54
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.
Laparoscopic right colectomy for cancer
Laparoscopic colorectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colorectal procedures has been demonstrated. Surgeons performing right hemicolectomy using the laparo-assisted technique consider it more difficult than open colectomy. It is possible to perform a completely laparoscopic right hemicolectomy in advanced laparoscopic centers with many benefits: less postoperative pain, short-term postoperative ileus, earlier return to daily activity. This chapter describes surgical anatomy, indications and techniques of laparoscopic right colon resection for cancer.
J Leroy, J Marescaux
Operative technique
9 years ago
85308 views
764 likes
5 comments
Laparoscopic right colectomy for cancer
Laparoscopic colorectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colorectal procedures has been demonstrated. Surgeons performing right hemicolectomy using the laparo-assisted technique consider it more difficult than open colectomy. It is possible to perform a completely laparoscopic right hemicolectomy in advanced laparoscopic centers with many benefits: less postoperative pain, short-term postoperative ileus, earlier return to daily activity. This chapter describes surgical anatomy, indications and techniques of laparoscopic right colon resection for cancer.