Search

The COVID-19 pandemic commands a major reorganization of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare center, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the COVID-19 epidemic., (© 2020 Elsevier Masson SAS. All rights reserved.)

Obesity physioptahology is complex and involves several factors (genetic, behavioral, psychological…). In this still undefined context, bariatric surgery modifies gastrointestinal tract anatomy, reduces the caloric intake and modifies gastrointestinal hormonal secretions for some of them. Aim of this work was to describe bariatric surgical procedures (sleeve, gastric band, short-gastric gastric, biliopancreatic diversion), specifying their historical context and considering possible evolutions., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Bariatric surgery became consensual after the NIH consensus of 1991 and the appearance of laparoscopic approach. This type of operation has a functional role (improvement of quality of life, locomotion and digestive symptoms as gastro-esophageal reflux disease), a prevention role (increase in life expectancy, reduction of risk of cancer and cardiovascular disease) and a curative role (remission of diabetes mellitus, obstructive sleep apnea syndrome and arterial hypertension). The laparoscopic approach for bariatric surgery led to a major reduction of postoperative morbi-mortality. Types and rates of complications after bariatric surgery vary according to the procedure. The efficiency of each technique is closely related to its morbi-mortality rate. This concept explains the disparity concerning the choice of the adequate procedure for the patient according to the bariatric team. The risk/benefits balance evaluation must be analyzed case-by-case by each specialist of the multidisciplinary bariatric staff and explained to the patients before final decision. This preoperative period (6 to 12 months) is crucial to select good candidates for bariatric surgery and contributes to the reduction of postoperative complications. A multidisciplinary surveillance for life is mandatory to prevent and treat late complications of bariatric surgery., (Copyright © 2018. Published by Elsevier Masson SAS.)

Consequences and complications of bariatric surgery. Bariatric surgery has a functional role (improvement of quality of life), a prevention role (increase in life expectancy, reduction of risk of cancer and cardiovascular disease) and a curative role (remission of diabetes mellitus, obstructive sleep apnea syndrome and arterial hypertension). The laparoscopic approach for bariatric surgery led to a major reduction of postoperative morbi-mortality and promotes its expansion with 49 000 procedures in 2015 (French PMSI data). Types and rates of complications after bariatric surgery vary according to the procedure. The efficiency of each technique is closely related to its morbi-mortality rate. This concept explains the disparity concerning the choice of the adequate procedure for the patient according to the bariatric team. The risk/benefits balance evaluation must be analyzed case-by-case by each specialist of the multidisciplinary bariatric staff and explained to the patients before final decision. This preoperative period (6-12 months) is crucial to select good candidates for bariatric surgery and contributes to the reduction of postoperative complications. A multidisciplinary surveillance for life is mandatory to prevent and treat late complications of bariatric surgery related to undernutrition., Competing Interests: F.-R. Souche déclare n’avoir aucun lien d’intérêts. A. de Jong déclare avoir été pris en charge lors de congrès par Astellas. E. M. Skalli déclare des actions de formation pour Ethicon SAS et avoir été pris en charge lors de congrès par cette même entreprise. L. Brunaud déclare avoir été pris en charge lors de congrès par Ethicon. D. Nocca déclare des liens durables avec Ethicon, Gore, Olympus et MID ; des liens ponctuels avec Covidien et MSD ; et avoir été pris en charge lors d’un congrès par Ethicon.

Introduction: Malignant tumours of the adrenal gland are adrenocortical carcinomas (ACC), malignant phaeochromocytomas (MPC) or metastatic tumours. The objective of this article is to propose guidelines for the management of these tumours., Material and Methods: A review of the literature was performed by selecting articles on malignant tumours of the adrenal gland published in PUBMED., Results: Abdominal computed tomography is the reference first-line examination. A diameter > 6 cm, a heterogeneous appearance, irregular margins, spontaneous high density (> 20 HU) and delayed wash-out are radiological signs of malignancy. MRI can be used to characterize the tumour with a sensitivity of 89% and a specificity of 99%. Hormone assays and an endocrinology consultation are recommended before any management. When ACC is suspected, (18)FDG-PET is the reference scintigraphic examination, while the isotope of choice for MPC is (18)F-DOPA, which is more sensitive than MIBG. These scintigraphic examinations have a sensitivity close to 100% and allow staging of distant metastases. Percutaneous biopsy has a limited place in the diagnostic work-up. It is only indicated in the case of suspected adrenal metastasis after having excluded phaeochromocytoma and must not be performed in the case of suspected adrenocortical carcinoma. Surgery is first-line treatment for localized and resectable tumours, but is rarely curative due to the high recurrence rate. For ACC, adjuvant therapy by mitotane or adjuvant radiotherapy can be proposed. Metabolic radiotherapy with (131)I-MIBG can be proposed for the treatment of MPC. First-line chemotherapy is indicated in the case of advanced disease or unresectable tumour. Surgical treatment of adrenal metastasis by adrenalectomy is recommended depending on the type and prognosis of the primary cancer., Conclusion: Preoperative laboratory, morphological and scintigraphic assessment is essential before any management. First-line treatment is surgical when the tumour is resectable, but must be completed by adjuvant therapy to limit the risk of recurrence., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Primary hyperparathyroidism is an unusual cause of acute pancreatitis. The aim of this study was to analyse data from multiple centers concerning patients with primary hyperparathyroidism and associated acute pancreatitis and to analyze potential predictive factors., Methods: In this retrospective multicentric study, 19 patients were identified (Group A) with the associated diagnoses of acute pancreatitis and primary hyperparathyroidism. Their clinical data was compared to that of a control group of 65 patients (group B) with primary hyperparathyroidism without acute pancreatitis., Results: Age, parathormone levels and pathology (uni/multiglandular disease) were similar between the two groups. The mean plasma calcium level was significantly higher in group A (12.64 mg/100ml) than in group B patients without pancreatitis (11.28 mg/100ml) (p<0.0001)., Conclusion: This study confirms the causal relationship between primary hyperparathyroidism and acute pancreatitis. The degree of hypercalcemia may play an important role in this association. Calcium levels should be measured in all patients with acute pancreatitis.

Thyroid cancers are the most common endocrine cancer. Cervical lymph node metastases are observed in 20 to 60% of patients with papillary thyroid cancer. In 2008, no prospective randomized study has defined whether prophylactic central neck dissection should be performed during initial surgery for papillary thyroid cancer. Prophylactic lymph node dissection remains controversial. Pros and cons for routine lymph node dissection of the central cervical compartment are discussed in this review of the literature which includes data from international and French consensus conferences.

L. Brunaud Thyroid cancers are the most common endocrine cancer. Cervical lymph node metastases are observed in 20 to 60% of patients with papillary thyroid cancer. In 2008, no prospective randomized study has defined whether prophylactic central neck dissection should be performed during initial surgery for papillary thyroid cancer. Prophylactic lymph node dissection remains controversial. Pros and cons for routine lymph node dissection of the central cervical compartment are discussed in this review of the literature which includes data from international and French consensus conferences., (Copyright © 2008 Elsevier Masson SAS. All rights reserved.)

Primary hyperparathyroidism is a relatively frequent disease whose incidence is often underestimated. It is caused by one or more hyperfunctioning parathyroid glands. Almost all pathologic glands (hyperplasia or adenoma) are located in the neck but 1-2% may be located in the mediastinum and may require a sternotomy or thoracotomy approach for resection. The thoracoscopic approach was proposed in 1994 and the DaVinci robotic system allows performance of this thoracoscopic procedure with the benefits of 3-dimensional vision, and improved surgical dexterity and ergonomics. We report a case of a patient with a parathyroid adenoma located in the aorto-pulmonary window which was resected using a left thoracoscopic approach aided by the Da Vinci robotic system.

Preoperative management of thyroid nodule is still controversial. Since 25 years ago, preoperative evaluation of thyroid nodule has been modified and improved. The aim of this study was to review, from a surgical point of view, the role of radionuclide imaging results in the management of patients with thyroid nodules.

Open minimally invasive parathyroidectomy or thyroidectomy (small-incision technique) are frequently performed. Benefits and disadvantages of this approach are discussed in this review. Preoperative patients selection is mandatory and is also discussed.

Surgical management of gastro-intestinal endocrine tumors has to be adapted to tumor localization and disease extension (local and general). The aim of this literature review was to define surgical management of these unfrequent tumors.

Study Aim: The goal of this study was to report the early results of unilateral transperitoneal adrenalectomy using robotic Da Vinci system, and to compare them to the results of the laparoscopic standard adrenalectomy., Methods: Prospective study included all patients operated on for unilateral laparoscopic or robotic adrenalectomy from November 2000 to November 2002., Results: Twenty-eight patients underwent unilateral adrenalectomy using either standard laparoscopy (14 patients) or robotic Da Vinci system (14 patients). Mean duration of robotic adrenalectomy seemed to be longer than standard laparoscopy (111 vs. 83 min; P = 0.057). This tendency decreased while surgeons' experience was increasing. Mean duration of operating room activity was similar for both types of surgery. Peroperative events without conversion, conversion rate (7%), drainage, morbidity (21%), duration of hospitalisation were similar for both types of surgery. Duration of standard laparoscopic adrenalectomy was positively correlated to patients body mass index. This correlation was absent in patients operated on by robotic Da Vinci system., Conclusion: This preliminary study found no objective data demonstrating that robotic Da Vinci system was superior to standard laparoscopic approach for unilateral adrenalectomy. However, we think that it is necessary to continue further evaluation of this system to demonstrate its possible superiority.

Unlabelled: The aim of this study was to retrospectively assess the safety and efficacy of dynamic graciloplasty performed in 5 French surgical centers involved in the treatment of fecal incontinence., Patients and Methods: Between March 1994 and March 2000, a total of 24 patients were treated with dynamic graciloplasty for fecal incontinence excluding case of anal reconstruction for cancer. Intramuscular leads and neurostimulators were implanted to stimulate the transposed gracilis. Continence and safety were evaluated using patients' records during hospitalisation and during the out-patient visit or further hospitalisation., Results: No death occurred. A successful functional outcome was reported for 19 patients (79%) during the follow up period. Twenty-two complications occurred including wound. Wound infection in 6 patients and tendon detachment in 4. One patient presented with an infected anal erosion leading to material explantation., Conclusion: Dynamic graciloplasty is an effective procedure for patients with refractory fecal incontinence. However, the procedure has significant morbidity which seems to be correlated with the surgeons' experience. Moreover, this procedure should now be compared to the artificial anal sphincter.

Aim of the Study: Total thyroidectomy has been advocated for the treatment of multinodular nontoxic and benign goiter. The aim of this study, based on our experience, was to define the surgical factors which permit to decrease morbidity related to total thyroidectomy for multinodular euthyroid benign goiter., Methods and Materials: In a retrospective study performed between January 1996 and September 2000, all records of total thyroidectomy for initial treatment of multinodular euthyroid benign goiter were reviewed. This study allowed to specify recurrent and parathyroid morbidity after surgery., Results: There were 51 women and 13 men with a mean age of 47 years. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another (1.6%). Transient hypocalcemia was found in 8 patients (12.5%). One patient had permanent hypocalcemia (1.6%)., Conclusion: The results of our serie are comparable to previous reports. Systematic identification of the recurrent laryngeal nerve, and preservation of the parathyroid blood supply permit to decrease the surgical morbidity.

Background: The tumor size is considered as a limitation for laparoscopic adrenalectomy. The aim of this study was to assess diagnostic characteristics, hemodynamic modifications, and outcome of intraperitoneal laparoscopic adrenalectomy according to the size of pheochromocytoma., Methods: Retrospective study from January 1997 to December 2000. Results were evaluated according to the size of pathologic study (< or > or = 5 cm)., Results: Forty two patients underwent laparoscopic adrenalectomy during this period. Among them, 11 (26%) were operated on for adrenal pheochromocytoma (6 patients < 5 cm and 5 patients > or = 5 cm). Preoperative systolic hypertension was 138 mmHg and 178 mmHg respectively (p = 0.01). Urinary metanephrine/normetanephrine rate was 1.259 and 0.268 respectively (p = 0.08). Capsular tumor effraction rate was 27%. Tumor size was 37% larger than that estimated by CT scan (24% versus 52%). Mean hospital stay was 10 days and 8 days respectively. Morbidity and mortality were 18% and 0%. All these criteria were not statistically significant among the two groups of patients., Conclusions: Pheochromocytoma size > or = 5 cm do not modify outcome of patients but is responsible for preferential noradrenaline secretion and stronger hemodynamic modifications. Tumor fragmentation rate and CT scan size underestimation seem important in this group of patients. These characteristics have to be integrated to improve laparoscopic adrenalectomy outcome of patients with pheochromocytoma > or = 5 cm.

Intraoperative MIBG radionuclear scanning has been used to improve pathological foci localization and surgical accuracy in patients with neural crest derived tumors. This intraoperative detection has been reported in less than 10 patients during reoperation for pheochromocytoma. We report a case of 123I-MIBG intraoperative detection allowing to improve surgical resection quality during reoperation for pheochromocytoma. The use of intraoperative MIBG radionuclear scanning is helpful when reoperation for pheochromocytoma is performed.

Objective: To study the interest of partial fundoplication under laparoscopy, not only in terms of efficacy but also in the low rate of complications., Methods: The study included all patients having undergone coelioscopic surgery for gastroesophageal reflux from January 1995 to February. A ventral semi-valve was created in all patients. Complications during surgery and post-surgical follow-up immediately after, six weeks later and then at distance were analyzed., Results: The mean duration of surgery was 81 minutes (40-170 min.) and mean hospital stay 6.2 days (2-12 days). Twelve conversions were observed (9.6%) and post-surgical morbidity was of 9.7% after coelioscopy. At 6 weeks, 72 patients (63.7%) were satisfied with the operation, 13 patients (11.5%) complained of dysphagia and 5 (4.4%) of bloating. At distance, after a mean of 3.2 years (0.5-5.5 years), 72 patients (73%) were totally satisfied; 4 presented recurrent reflux (4.1%) and 3 patients (3.1%) complained of dysphagia., Conclusion: The results of laparoscopic surgery for gastroesophageal reflux with creation of a ventral semi-valve are encouraging. Pre-existing symptomatology is eradicated and post-surgical complications are clearly decreased.

Pancreatic adenocarcinoma tissue contains estrogen receptors and some pilot studies have suggested that tamoxifen could increase the survival of patients with unresectable pancreatic cancer. However data of comparative studies are conflicting. We report the case of a woman who presented with unresectable pancreatic head carcinoma with hepatic metastasis. The patient refused chemotherapy and was treated with tamoxifen 30 mg/day. A complete clinical remission of 50 months was observed. A further large-scale study may be required to assess the usefulness of tamoxifen in the second-line treatment of advanced pancreatic carcinoma.

Aim of the Study: To evaluate the prevalence of pancreatic pseudocyst after persistent fistula closure with somatostatin or octreotide. To compare the patient characteristics according to the subsequent presence or absence of pseudocyst., Patients and Methods: This retrospective study from January 1994 to August 1999 included 15 patients with an external pancreatic fistula. Fistula closure was observed for all patients with somatostatin or octreotide. CT scan was performed 66 +/- 34 days after the end of this treatment., Results: CT scan was normal in 9 patients (favorable group) and showed pancreatic pseudocyst (failure group) in 6 patients. Pancreatic fistula etiologies were different between the two groups. The 5 patients presenting pancreatic fistula after duodenopancreatectomy belonged to the favorable group. Six of the 10 patients presenting pancreatic fistula after pseudocyst drainage belonged to the failure group. There were no other differences between the two groups., Conclusion: Persistent pancreatic fistula can be cured with somatostatin or octreotide. However, fistulas occurring after duodenopancreatectomy are more easily cured with somatostatin or octreotide than fistulas occurring after external pseudocyst drainage. Somatostatin or octreotide cannot be considered to be an effective treatment for pancreatic fistula occurring after pseudocyst drainage, despite the fact that 40% of them were permanently cured.

Aims: The cancer of the rectum touches 10,000 patients per year in France. Its treatment is mainly surgical. 50% of the treated patients will die of their cancer, either by loco-regional recurrence, or by metastatic disease. The rates of local recurrence vary from 10 to 40%. Heald is first who brought back recurrence rates lower than 4%, results obtained by the only surgical treatment. This treatment included the total exeresis of cellulo-fatty tissue surrounding the rectum, tissue which was baptized mesorectum. The aims of this work is to define and describe this space, and to discuss its Christian name., Material and Methods: The anatomical study carries on the dissection of 2 frozen pelvis of fresh man, one cut transversely on the level of L4, the other half-compartment sagittaly, then defrosted for the dissection., Results: The mesorectum is defined and its various structures, fascia, vessels and nerves, are detailed., Conclusion: The mesorectum is an anatomical and surgical structure individualisable. Its recognition and its importance were born from the understanding of the fascia and the rectal anatomy. Its exeresis decreases the rate of the local recurrence (18). The technique of exeresis of the mesorectum must be validated, standardized, in order to be reproducible in the treatment of the cancer of the rectum.

The posterior extra-peritoneal route is usually preferred for exeresis of benign tumors of the adrenal glands measuring less than 5 cm. We examined the hospital reports for patients in which Young access was used since 1985. From December 1985 to December 1994, 12 patients underwent surgery for benign tumor of the adrenal gland. There were 9 women and 3 men (mean age 49.4 years, range 29-67). In all patients, the tumor was localized pre-operatively on a CT-scan. There was a unique tumor in each case. There were 11 adrenal adenomas including 10 Conn tumors and 1 secreting tumor (Cushing's syndrome). The last case was a cortical cyst. One patient died in the post-operative period, probably due to massive pulmonary embolism although necroscopic evidence was not obtained. Parietal infection occurred in one case and a spontaneously regressive hematoma in another. Mean duration of hospitalization was 7.0 days. At follow-up, 1 patient suffered deinnervation of the oblique muscles of the abdomen which did not require reoperation. Two months after surgery, clinical signs and hormone disorders related to the Conn adenomas had regressed in 7 of the 9 patients. In summary, the posterior route is perfectly adapted to the treatment of benign tumors of the adrenal glands when the exact localization can be identified on pre-operative imaging. This access should be considered as the reference route of evaluating laparoscopic procedures.