63 results on '"Suter M"'
Search Results
2. Chirurgie bariatrique : place de la gastrectomie en manchon (sleeve gastrectomy) en 2022 [Bariatric surgery: role of sleeve gastrectomy in 2022]
- Author
-
Gaspar-Figueiredo, S., Mantziari, S., Suter, M., and Thomopoulos, T.
- Subjects
Bariatric Surgery/methods ,Gastrectomy/methods ,Gastric Bypass/methods ,Gastroesophageal Reflux/complications ,Gastroesophageal Reflux/etiology ,Humans ,Obesity, Morbid/complications ,Obesity, Morbid/surgery - Abstract
Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications.
- Published
- 2022
3. Superobésité, une épidémie en croissance exponentielle : options thérapeutiques chirurgicales et attentes [Super obesity, an exponentially growing epidemic : surgical treatment options and expectations]
- Author
-
Rrupa, D., Piotet, L.M., Mantziari, S., Demartines, N., Suter, M., and Thomopoulos, T.
- Subjects
Bariatric Surgery ,Epidemics ,Humans ,Motivation ,Obesity/epidemiology ,Obesity/surgery ,Obesity, Morbid/epidemiology ,Obesity, Morbid/surgery ,Treatment Outcome - Abstract
Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.
- Published
- 2021
4. Les cannabinoïdes et leurs indications en antalgie chronique [Medical cannabinoids and their indications in chronic pain]
- Author
-
El Faleh-Kayal, Y., Suter, M., and Cachemaille, M.
- Subjects
Analgesics ,Cannabinoids ,Cannabis ,Chronic Pain/drug therapy ,Humans ,Multiple Sclerosis - Abstract
Democratization of the cannabis consumption and its derivatives incite patients to ask ever more for medical cannabinoid prescriptions, especially in the context of chronic pain. Its use is only validated in certain limited cases, in particular spasticity linked to multiple sclerosis and refractory epilepsies. All other prescriptions require a special request to the OFSP. Moreover, cannabinoid intake may produce several dose-dependent side effects that require a close monitoring with a slow and gradual initiation of its dosage. In the absence of clear medical evidence, many other mechanisms of action need to be investigated with ongoing and future studies to clarify their indication.
- Published
- 2020
5. Douleurs abdominals après chirurgie bariatrique : que faire ? [Abdominal pain after bariatric surgery : what to do ?]
- Author
-
Djafarrian, R., Blaser, B., Mantziari, S., Suter, M., and Fournier, P.
- Subjects
Abdominal Pain/etiology ,Abdominal Pain/therapy ,Bariatric Surgery ,Gastric Bypass ,Gastroplasty/adverse effects ,Humans ,Obesity, Morbid ,Retrospective Studies ,Weight Loss - Abstract
Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important.
- Published
- 2019
6. Complications fonctionnelles et chirurgicales après chirurgie bariatrique pour obésité sévère [Functional and surgical complications after bariatric surgery for severe obesity]
- Author
-
Mantziari, S., Duvoisin, C., Demartines, N., Favre, L., and Suter, M.
- Subjects
Bariatric Surgery/adverse effects ,Gastrectomy/adverse effects ,Gastric Bypass/adverse effects ,Gastroesophageal Reflux ,Humans ,Laparoscopy ,Obesity, Morbid/surgery ,Postoperative Complications - Abstract
Bariatric surgery, the most effective treatment for obesity, can lead to long-term complications. These may be of functional nature (dumping, hypoglycemia, reflux) or of surgical nature. Acute or chronic abdominal pain is not unusual after gastric bypass. Often unrelated to surgery, it can be caused by an acute surgical problem (internal hernia, obstruction, intussusception), which can lead to extensive bowel necrosis if not treated quickly. Other complications (candy cane, anastomotic ulcer, reflux) can also develop. An « obstructed sleeve » can develop early or late after sleeve gastrectomy. Rapid management of acute abdominal pain is essential and should, ideally, be done in a specialized setting where appropriate imaging and specific surgical skills are readily available.
- Published
- 2019
7. Recommandations de suivi des carences nutritionnelles après chirurgie bariatrique [Recommendations for monitoring nutritional deficiencies after bariatric surgery]
- Author
-
Favre, L., Ferrario, C., Mantziari, S., and Suter, M.
- Subjects
Bariatric Surgery/adverse effects ,Humans ,Malnutrition/diagnosis ,Malnutrition/etiology ,Obesity ,Obesity, Morbid/surgery ,Vitamins - Abstract
Bariatric surgery is the most effective long-term therapy for the management of patients with obesity but all bariatric surgical procedures have the potential to cause clinically significant micronutrient deficiencies due to reduced food intake, decreased gastric acid and intrinsic factor secretion, poor food choices and food intolerance. For clinicians, the acquisition of special knowledge is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present article, we summarize existing recommendations for monitoring and replacement of vitamins and minerals following bariatric surgery.
- Published
- 2019
8. Processus psychologiques de gestion du stress et régulation neuroendocrinienne chez les adolescents délinquants en institution fermée : une étude pilote [Psychological processes of stress management and neuroendocrine regulation in incarcerated adolescent offenders: A pilot study]
- Author
-
Guillod, L., Habersaat, S., Suter, M., Jeanneret, T., and Bertoni, C.
- Subjects
Adolescent ,Aggression/psychology ,Antisocial Personality Disorder/psychology ,Child ,Humans ,Hydrocortisone/metabolism ,Juvenile Delinquency/psychology ,Male ,Neuropsychological Tests ,Neurosecretory Systems/metabolism ,Pilot Projects ,Prisoners/psychology ,Prisons ,Stress, Psychological/metabolism ,Stress, Psychological/psychology ,Substance-Related Disorders/complications ,Substance-Related Disorders/psychology ,Adolescents ,Constructive thinking ,Cortisol ,Délinquants ,Offenders ,Pensée constructive - Abstract
Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments. Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed). Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use. Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care.
- Published
- 2018
9. Résultats à long terme (≥ 10 ans) après chirurgie bariatrique :revue de la littérature [Long-term results (≥ 10 years) after bariatric surgery : review of the literature.]
- Author
-
Mantziari, S., Duvoisin, C., Demartines, N., Favre, L., and Suter, M.
- Subjects
Bariatric Surgery ,Comorbidity ,Humans ,Obesity ,Obesity, Morbid/surgery ,Treatment Outcome ,Weight Loss - Abstract
Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations.
- Published
- 2018
10. 24 - Analgésie
- Author
-
Buchser, E., Suter, M., Decosterd, I., and Albrecht, E.
- Published
- 2015
- Full Text
- View/download PDF
11. 7 - Opioïdes et antagonistes
- Author
-
Suter, M., Decosterd, I., Gilliard, N., and Albrecht, E.
- Published
- 2015
- Full Text
- View/download PDF
12. Chirurgie bariatrique en 2013: principes, avantages et inconvénients des interventions a disposition [Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures]
- Author
-
Suter, M. and Giusti, V.
- Subjects
Bariatric Surgery/methods ,Body Mass Index ,Gastric Bypass/methods ,Gastroplasty/methods ,Humans ,Obesity/surgery ,Weight Loss - Abstract
For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.
- Published
- 2013
13. Le dérapage de la chirurgie bariatrique: lorsque la quantité risque de dépasser la qualité [The skid of bariatric surgery: when the amount of risk exceeds the quality]
- Author
-
Suter, M. and Giusti, V.
- Subjects
Bariatric Surgery/methods ,Bariatric Surgery/standards ,Humans ,Obesity, Morbid/surgery ,Switzerland - Published
- 2012
14. Une décision essentielle en faveur des patients souffrant d'obésité
- Author
-
Naef, M, Bauknecht, F, Glätti, A, Huber, Olivier, Laederach, K, Peterli, R, and Suter, M
- Subjects
ddc:617 - Published
- 2011
15. Nouveautés en médecine 2008: Chirurgie
- Author
-
Cerantola, Y., Christoforidis, D., Halkic, N., Matter, M., Romy, S., Suter, M., Tempia-Caliera, A., Demartines, N., and Givel, J.C.
- Subjects
Digestive System Diseases ,Humans ,Melanoma ,Skin Neoplasms ,Surgical Procedures, Operative - Abstract
More than the number of real novelties, trends and preliminary results characterise the annual development in surgery. The wealth and diversity of topics to be covered require arbitrary choices, therefore not necessarily complete. The constant development of choledocolithiasis management, dominated by minimal invasive technology, treatments of unusual nature of two frequent proctological conditions, fistulae and haemorrhoids, the increasing importance of metabolic bariatric surgery, as well as the strict rules of effective melanoma treatment, represent as many directions in which the operating procedure, although unseen, continue to gain quality and security.
- Published
- 2009
16. [Visceral surgery]
- Author
-
Maurice MATTER, Paroz A, Jm, Calmes, Suter M, Brunisholz Y, Vuilleumier H, Aa, Tempia-Caliera, and Jc, Givel
- Subjects
Ovarian Neoplasms ,Pancreatic Neoplasms ,Endocrine Glands ,Surgical Procedures, Operative ,Rectocele ,Bariatric Surgery ,Humans ,Female - Abstract
Visceral surgery has benefited from several significant therapeutical improvements in 2005. They involve more specifically endocrine surgery, obesity, ovarian cancer, rectocele and cystic pancreatic neoplasia. Minimal invasive surgery is increasingly used, for example in endocrine conditions and obesity treatment. New techniques also emerge, such as electrical gastric stimulation for obesity or Stapled Trans Anal Rectal Resection (STARR) for anterior rectocele. Accurate diagnosis criteria allow better management of cystic pancreatic neoplasia, especially to choose the best treatment of this condition.
- Published
- 2006
17. 23 - Analgésie
- Author
-
Buchser, E., Suter, M., Decosterd, I., and Albrecht, E.
- Published
- 2009
- Full Text
- View/download PDF
18. 7 - Opioïdes et antagonistes
- Author
-
Suter, M., Decosterd, I., Gilliard, N., and Albrecht, E.
- Published
- 2009
- Full Text
- View/download PDF
19. Collaborateurs
- Author
-
Albrecht, E., Baeriswyl, M., Bernath, M.-A., Blanc, C., Buchser, E., Buclin, T., Calderari, B., Calvi, L., Cavin, F., Chassot, P.-G., Chollet-Rivier, M., Courbon, C., Coronado, M., Decosterd, I., Denys, A., Dolci, M., Fitting, J.-W., Freymond, D., Gardaz, J.-P., Gilliard, N., Haberer, J.-P., Heim, C., Jolles-Haeberli, B., Kern, C., Langenberger, T., Lyon, X., Martins-Favre, M., Moret, V., Mondragon, P., Mustaki, J.-P., Perruchoud, C., Portmann, L., Prior, J., Revelly, J.-P., Rutschmann, B., Samama, C.-M., Schoettker, P., Seemater, G., Suter, M., Teta, D., Thierrin, L., Villet, S., Wider, C., and Zanetti, G.
- Published
- 2015
- Full Text
- View/download PDF
20. P247 Étude des gènes codant les protéines des gouttelettes lipidiques chez les patients avec la stéatose hépatique
- Author
-
Minehira, K., Gual, P., Tran, A., Bonnaous, S., Bouzourene, H., Suter, M., and Giusti, V.
- Published
- 2010
- Full Text
- View/download PDF
21. Collaborateurs
- Author
-
Albrecht, E., Bernath, M.-A., Blanc, C., Buchser, E., Buclin, T., Calderari, B., Cavin, F., Chassot, P.-G., Chollet-Rivier, M., Coronado, M., Decosterd, I., Denys, A., Dolci, M., Fitting, J.-W., Freymond, D., Gardaz, J.-P., Gilliard, N., Haberer, J.-P., Jolles-Haeberli, B., Kern, Ch., Langenberger, T., Lyon, X., Martins-Favre, M., Moret, V., Mondragon, P., Mustaki, J.-P., Perruchoud, Ch., Portmann, L., Prior, J., Revelly, J.-P., Rutschmann, B., Samama, C.-M., Seemater, G., Schoettker, P., Suter, M., Teta, D., Thierrin, L., Villet, S., Wider, C., and Zanetti, G.
- Published
- 2009
- Full Text
- View/download PDF
22. [Bariatric surgery: role of sleeve gastrectomy in 2022].
- Author
-
Gaspar-Figueiredo S, Mantziari S, Suter M, and Thomopoulos T
- Subjects
- Gastrectomy methods, Humans, Bariatric Surgery methods, Gastric Bypass methods, Gastroesophageal Reflux complications, Gastroesophageal Reflux etiology, Obesity, Morbid complications, Obesity, Morbid surgery
- Abstract
Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2022
- Full Text
- View/download PDF
23. De l’activation des nocicepteurs à la douleur centrale : un changement de paradigme.
- Author
-
Allaz AF and Suter M
- Subjects
- Humans, Neuralgia, Nociceptors
- Published
- 2021
24. [Super obesity, an exponentially growing epidemic : surgical treatment options and expectations].
- Author
-
Rrupa D, Piotet LM, Mantziari S, Demartines N, Suter M, and Thomopoulos T
- Subjects
- Humans, Motivation, Obesity epidemiology, Obesity surgery, Treatment Outcome, Bariatric Surgery, Epidemics, Obesity, Morbid epidemiology, Obesity, Morbid surgery
- Abstract
Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2021
25. [Medical cannabinoids and their indications in chronic pain].
- Author
-
El Faleh-Kayal Y, Suter M, and Cachemaille M
- Subjects
- Analgesics, Humans, Cannabinoids, Cannabis, Chronic Pain drug therapy, Multiple Sclerosis
- Abstract
Democratization of the cannabis consumption and its derivatives incite patients to ask ever more for medical cannabinoid prescriptions, especially in the context of chronic pain. Its use is only validated in certain limited cases, in particular spasticity linked to multiple sclerosis and refractory epilepsies. All other prescriptions require a special request to the OFSP. Moreover, cannabinoid intake may produce several dose-dependent side effects that require a close monitoring with a slow and gradual initiation of its dosage. In the absence of clear medical evidence, many other mechanisms of action need to be investigated with ongoing and future studies to clarify their indication., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2020
26. [Long-term results after Roux-en-Y gastric bypass for severe obesity].
- Author
-
Suter M, Mantziari S, Duvoisin C, Dayer-Jankechova A, and Favre L
- Subjects
- Body Mass Index, Humans, Prospective Studies, Quality of Life, Treatment Outcome, Gastric Bypass methods, Obesity, Morbid surgery
- Abstract
Long-term results after Roux-en-Y gastric bypass for severe obesity Abstract. Roux-en-Y gastric bypass (RYGB) has been performed for almost 50 years, yet long-term results have only been scarcely reported. In this paper, we report results up to 15 years after gastric bypass and review the relevant literature on long-term results after this operation., Material and Methods: Our prospective database has been reviewed for this study. A literature search via Pubmed was done, and articles reporting on 10-year results after RYGB in at least 50 patients were retrieved and analyzed., Results: A total of 822 patients underwent primary RYGB in our institutions between 1999 and 2007. All are eligible for 10-year analysis, and 186 operated before 2003 for 15-year analysis. Follow-up rates after 10 and 15 years are 76 and 55 % respectively. Patients loose a mean of 12,9 BMI units after 10 years, a figure that remains unchanged after 15 years. 80 %, respectively 72 % of patients maintain a %total body weight loss of at least 20 % after 10 and 15 years. Comorbidities are markedly improved, as well as quality of life. These results compare well with those reported in the literature after this length of time. Studies from the literature also show a preventive effect of RYGB in the development of metabolic comorbidities in obese individuals submitted to RYGB., Conclusions: RYGB provides good to excellent long-term weight loss which persists up to 15 years after surgery. This is associated with markedly improved comorbidities and reduced cardiovascular risk, improved quality-of-life and reduced mortality. RYGB represents a good option for most patients who seek surgery for severe obesity.
- Published
- 2019
- Full Text
- View/download PDF
27. [Abdominal pain after bariatric surgery : what to do ?]
- Author
-
Djafarrian R, Blaser B, Mantziari S, Suter M, and Fournier P
- Subjects
- Humans, Retrospective Studies, Weight Loss, Abdominal Pain etiology, Abdominal Pain therapy, Bariatric Surgery, Gastric Bypass, Gastroplasty adverse effects, Obesity, Morbid
- Abstract
Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2019
28. [Functional and surgical complications after bariatric surgery for severe obesity].
- Author
-
Mantziari S, Duvoisin C, Demartines N, Favre L, and Suter M
- Subjects
- Gastrectomy adverse effects, Humans, Postoperative Complications, Bariatric Surgery adverse effects, Gastric Bypass adverse effects, Gastroesophageal Reflux, Laparoscopy, Obesity, Morbid surgery
- Abstract
Bariatric surgery, the most effective treatment for obesity, can lead to long-term complications. These may be of functional nature (dumping, hypoglycemia, reflux) or of surgical nature. Acute or chronic abdominal pain is not unusual after gastric bypass. Often unrelated to surgery, it can be caused by an acute surgical problem (internal hernia, obstruction, intussusception), which can lead to extensive bowel necrosis if not treated quickly. Other complications (candy cane, anastomotic ulcer, reflux) can also develop. An « obstructed sleeve » can develop early or late after sleeve gastrectomy. Rapid management of acute abdominal pain is essential and should, ideally, be done in a specialized setting where appropriate imaging and specific surgical skills are readily available., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2019
29. [Recommendations for monitoring nutritional deficiencies after bariatric surgery].
- Author
-
Favre L, Ferrario C, Mantziari S, and Suter M
- Subjects
- Humans, Obesity, Vitamins, Bariatric Surgery adverse effects, Malnutrition diagnosis, Malnutrition etiology, Obesity, Morbid surgery
- Abstract
Bariatric surgery is the most effective long-term therapy for the management of patients with obesity but all bariatric surgical procedures have the potential to cause clinically significant micronutrient deficiencies due to reduced food intake, decreased gastric acid and intrinsic factor secretion, poor food choices and food intolerance. For clinicians, the acquisition of special knowledge is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present article, we summarize existing recommendations for monitoring and replacement of vitamins and minerals following bariatric surgery., Competing Interests: Les auteurs n’ont aucun conflit d’intérêt à déclarer en relation avec cet article.
- Published
- 2019
30. [Psychological processes of stress management and neuroendocrine regulation in incarcerated adolescent offenders: A pilot study].
- Author
-
Guillod L, Habersaat S, Suter M, Jeanneret T, Bertoni C, Stéphan P, and Urben S
- Subjects
- Adolescent, Aggression psychology, Antisocial Personality Disorder psychology, Child, Humans, Hydrocortisone metabolism, Male, Neuropsychological Tests, Pilot Projects, Substance-Related Disorders complications, Substance-Related Disorders psychology, Juvenile Delinquency psychology, Neurosecretory Systems metabolism, Prisoners psychology, Prisons, Stress, Psychological metabolism, Stress, Psychological psychology
- Abstract
Background: Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments., Method: Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed)., Results: Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use., Conclusions: Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care., (Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
31. [Long-term results (≥ 10 years) after bariatric surgery : review of the literature.]
- Author
-
Mantziari S, Duvoisin C, Demartines N, Favre L, and Suter M
- Subjects
- Comorbidity, Humans, Obesity, Treatment Outcome, Weight Loss, Bariatric Surgery, Obesity, Morbid surgery
- Abstract
Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2018
32. [Overweight and obesity in the canton of Vaud : projections for 2040].
- Author
-
Fournier P, Favre L, Montavon M, Audard-Mariller M, Suter M, Demartines N, and Pralong F
- Subjects
- Health Surveys, Humans, Prevalence, Switzerland epidemiology, Obesity epidemiology, Overweight epidemiology
- Abstract
The worldwide prevalence of obesity has more than doubled since 1980. This global figure needs to be addressed tackled at the local level to face our future challenges at the local level. We attempted to project the prevalence of obesity in the canton of Vaud in the next 25 years. Data from the Enquête suisse sur la santé, a survey conducted every five years since 1992 by the Swiss Federal Office of Public Health, were used. Using different mathematical assumptions, the rate of increase in the prevalence of obesity in Switzerland between 1992 and 2012 was calculated allowing a projection of future prevalences. Between 1992 and 2016, the prevalence of obesity was 9.64%. Effective growth rate of obesity from 2016 to 2040 should be between 16'500 cases and 69'500 cases depending on the uncertainty of the effective prevalence increase over this period., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2017
33. [Not Available].
- Author
-
Suter M and Allaz AF
- Subjects
- Geography, Humans, Observer Variation, Pain etiology, Randomized Controlled Trials as Topic statistics & numerical data, Pain Management methods, Placebo Effect
- Published
- 2016
34. [The Lausanne Obesity Cohort: why and how?].
- Author
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Vionnet N, Favre L, Fournier P, Demartine N, Suter M, and Pralong FP
- Subjects
- Cohort Studies, Humans, Switzerland, Bariatric Surgery, Obesity, Morbid surgery, Patient Selection
- Abstract
Bariatric surgery has become the treatment of choice for severe obesity. The significant weight loss induced by these procedures is accompanied by spectacular improvements in the metabolic comorbidities that participate in morbidity and mortality of obesity. However, several questions remain open regarding the identification of patients that will benefit the most from the intervention or the long-term outcomes in terms of weight and co-morbidities. The Cohort obesity of Lausanne was initiated in order to try and answer some of these questions, and more specifically to identify predictive factors of long-term response to gastric by-pass.
- Published
- 2016
35. [Pregnancy after bariatric surgery].
- Author
-
Favre L, Clarisse M, Pralong FP, Suter M, Fournier P, and Baud D
- Subjects
- Female, Fertility, Fetal Growth Retardation etiology, Humans, Bariatric Surgery, Nutritional Requirements, Pregnancy
- Abstract
Bariatric surgery interventions are rapidly growing and most are performed on female patients. Thus, pregnancies after bariatric surgery are increasingly common. Awareness of the consequences and risks of bariatric surgery on subsequent pregnancies is important. Literature data report a reduction of the usual pregnancy risks of pregnancies in obese patients, but also an increased risk of small-for-gestational-age infants, possibly related to nutritional deficiencies. A careful screening for micronutrient deficiencies is therefore already advised before conception. Nutritional follow-up and serious evaluation of any abdominal complaints are recommended as well during pregnancy.
- Published
- 2016
36. [Interventional analgesia].
- Author
-
Suter M
- Subjects
- Contraindications, Early Medical Intervention methods, Humans, Injections, Intralesional, Low Back Pain therapy, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative methods, Analgesia methods, Chronic Pain therapy, Pain Management methods
- Published
- 2014
37. [Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures].
- Author
-
Suter M and Giusti V
- Subjects
- Body Mass Index, Gastroplasty methods, Humans, Weight Loss, Bariatric Surgery methods, Gastric Bypass methods, Obesity surgery
- Abstract
For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.
- Published
- 2013
38. [The skid of bariatric surgery: when the amount of risk exceeds the quality].
- Author
-
Suter M and Giusti V
- Subjects
- Bariatric Surgery standards, Humans, Switzerland, Bariatric Surgery methods, Obesity, Morbid surgery
- Published
- 2012
39. [New guidelines for bariatric surgery care: practical implications].
- Author
-
Giusti V and Suter M
- Subjects
- Humans, Quality Assurance, Health Care, Bariatric Surgery standards, Obesity, Morbid surgery
- Abstract
From the 1st of January 2011, new conditions have been validated in which surgery for weight loss is borne by the basic insurance. These are very significant changes compared to the old criteria. Indeed, on one hand, patients with BMI > or = 35 kg/m2 may, without age limit and in the absence of comorbidities benefit from surgery without prior request to the medical council health insurance company concerned. On the other hand, the notion of a minimum casuistry is for the first time introduced in centers performing this type of intervention. In addition, certified centers are required to follow standard procedures for the patients' teaching and follow up.
- Published
- 2011
40. [Trends in surgery].
- Author
-
Cerantola Y, Christoforidis D, Halkic N, Matter M, Romy S, Suter M, Tempia-Caliera A, Demartines N, and Givel JC
- Subjects
- Digestive System Diseases surgery, Humans, Melanoma surgery, Skin Neoplasms surgery, Surgical Procedures, Operative trends
- Abstract
More than the number of real novelties, trends and preliminary results characterise the annual development in surgery. The wealth and diversity of topics to be covered require arbitrary choices, therefore not necessarily complete. The constant development of choledocolithiasis management, dominated by minimal invasive technology, treatments of unusual nature of two frequent proctological conditions, fistulae and haemorrhoids, the increasing importance of metabolic bariatric surgery, as well as the strict rules of effective melanoma treatment, represent as many directions in which the operating procedure, although unseen, continue to gain quality and security.
- Published
- 2009
41. [Visceral surgery].
- Author
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Matter M, Paroz A, Calmes JM, Suter M, Brunisholz Y, Vuilleumier H, Tempia-Caliera AA, and Givel JC
- Subjects
- Bariatric Surgery, Endocrine Glands surgery, Female, Humans, Ovarian Neoplasms surgery, Pancreatic Neoplasms surgery, Rectocele surgery, Surgical Procedures, Operative
- Abstract
Visceral surgery has benefited from several significant therapeutical improvements in 2005. They involve more specifically endocrine surgery, obesity, ovarian cancer, rectocele and cystic pancreatic neoplasia. Minimal invasive surgery is increasingly used, for example in endocrine conditions and obesity treatment. New techniques also emerge, such as electrical gastric stimulation for obesity or Stapled Trans Anal Rectal Resection (STARR) for anterior rectocele. Accurate diagnosis criteria allow better management of cystic pancreatic neoplasia, especially to choose the best treatment of this condition.
- Published
- 2006
42. [Surgical options for obesity: results and complications].
- Author
-
Suter M and Giusti V
- Subjects
- Biliopancreatic Diversion adverse effects, Biliopancreatic Diversion methods, Duodenum surgery, Gastric Bypass adverse effects, Gastric Bypass methods, Gastroplasty adverse effects, Gastroplasty methods, Humans, Weight Loss, Obesity surgery
- Abstract
Conservative therapy results almost always in failure in the morbidly obese patient. Bariatric surgery is currently the only treatment associated with sufficient and sustained weight loss. The role of obesity surgery has markedly increased since the development of laparoscopic techniques. Proximal gastric bypass is currently the procedure of choice. It is followed by an excess weight loss of approximately 60-70%, and is effective in over 80% of the patients. In Switzerland, access to surgery is limited to patients with a BMI >40 kg/m2. Preoperative evaluation is of paramount importance, and so is patient instruction and teaching before surgery. After bariatric surgery, life-long follow-up by a specialized team is essential.
- Published
- 2005
43. [Impact of bariatric surgery on health and quality life of obese patients].
- Author
-
Suter M and Giusti V
- Subjects
- Humans, Obesity mortality, Obesity psychology, Gastric Bypass economics, Obesity surgery, Quality of Life
- Abstract
The important weight loss due to bariatric surgery allows to improve and even correct, a great part of the comorbidities induced by obesity, as well as quality of life, and to reduce the coming out of cardiovascular and metabolic diseases in operated patients. The impact of surgical treatment on the patient's health and quality of life also allows to reduce direct and indirect costs of morbid obesity. However, its effects on mortality have not yet been clearly proved. The preoperative evaluation and the long term follow-up by a skilled team are essential to reduce potential complications, especially on the nutritional field and the risks of recovered weight linked to binge eating disorders.
- Published
- 2005
44. [Preparation and follow up of candidates for surgical treatment of obesity: pre- and postoperative courses].
- Author
-
Giusti V, Di Vetta V, Suter M, Héraïef E, Gaillard RC, and Burckhardt P
- Subjects
- Follow-Up Studies, Humans, Postoperative Care, Preoperative Care, Obesity, Morbid surgery, Patient Education as Topic
- Published
- 2002
45. [Validation of laparoscopic surgical techniques].
- Author
-
Bettschart V, Suter M, and Mosimann F
- Subjects
- Evidence-Based Medicine, Feasibility Studies, Humans, Laparoscopy methods, Laparoscopy trends, Reproducibility of Results, Treatment Outcome, Laparoscopy standards
- Abstract
The use of laparoscopic surgery has increased rapidly. However, a technically feasible procedure is not automatically recommendable. Thus, if cholecystectomy and fundoplication are currently fully validated techniques, this does not hold true for gastroplasty and kidney harvesting for transplantation: these operations are feasible indeed but their efficacy remains to be proved. Laparoscopic oncology has been shown to be feasible too, but its efficacy has not been documented yet.
- Published
- 2001
46. [Indications for gastroplasty in the treatment of obesity].
- Author
-
Giusti V, Navarro C, Suter M, Jayet A, Zysset E, and Héraïef E
- Subjects
- Body Mass Index, Contraindications, Humans, Obesity, Morbid classification, Obesity, Morbid psychology, Patient Care Team, Preoperative Care, Treatment Outcome, Gastroplasty adverse effects, Gastroplasty classification, Gastroplasty methods, Obesity, Morbid diagnosis, Obesity, Morbid surgery, Patient Selection
- Published
- 1999
47. [Has laparoscopy changed the surgical approach in gastroesophageal reflux? Apropos of an experience with 63 cases of gastroesophageal reflux treated by laparoscopy].
- Author
-
Suter M and Bettschart V
- Subjects
- Adult, Female, Follow-Up Studies, Gastroesophageal Reflux diagnosis, Humans, Male, Outcome Assessment, Health Care, Postoperative Complications etiology, Postoperative Complications surgery, Prospective Studies, Recurrence, Reoperation, Retrospective Studies, Fundoplication, Gastroesophageal Reflux surgery, Laparoscopy
- Abstract
Introduction: Indications for surgery in gastrooesophageal reflux disease (GERD) have decreased significantly since the introduction of proton pump inhibitors. At the same time there has been renewed surgical interest in this disease triggered by the development of laparoscopy. We present our results with laparoscopic treatment of GERD and the change in our surgical approach to the condition during the past few years., Methods: All patients admitted to the surgical department underwent prior evaluation by a gastroenterologist. Indications for surgery were resistance to medical therapy in 30 cases, recurrence of GERD after cessation of treatment in 25 cases and personal preference of the patient when maintenance therapy was necessary in 6 cases. The data were reviewed and the patients contacted during the first trimester of 1998 to evaluate long-term results., Results: 63 patients were operated on between 1991 and July 1997. Rossetti-Nissen fundoplication was performed routinely until March 1995. Thereafter, the type of antireflux surgery has been chosen according to the preoperative evaluation of the patients, including endoscopy, oesophageal manometry and gastric emptying studies. There was no mortality and, except for one case, only minor morbidity. Four patients required reoperation, two for severe gas bloat syndrome and two for recurrence of GERD. Overall, the long-term follow-up shows that 93 patients are satisfied or very satisfied with their outcome (Visick 1 or 2). 5% of the patients need daily medication for heartburn, 5% complain of occasionally disturbing dysphagia, and 12% of sometimes distressing gas bloat. More patients have gas bloat after the Rossetti-Nissen procedure than after the Nissen or Toupet fundoplications., Conclusions: The enthusiasm of surgeons for the laparoscopic approach to GERD has prompted renewed interest in the pathophysiology of the disease. Consequently, indications for surgery are better defined, surgical technique is chosen according to the individual patient based on objective preoperative studies and follow-up has improved. In this setting, laparoscopic fundoplication represents an effective treatment for GERD. It is associated with lower postoperative morbidity than open surgery and represents the first choice when surgery is indicated.
- Published
- 1998
48. [Interlocking nailing of the tibia].
- Author
-
Suter M, Blanc CH, and Chevalley F
- Subjects
- Bone Nails, Compartment Syndromes etiology, Humans, Postoperative Complications etiology, Prospective Studies, Pseudarthrosis etiology, Pulmonary Embolism etiology, Radiography, Tibial Fractures diagnostic imaging, Fracture Fixation, Intramedullary instrumentation, Tibial Fractures surgery
- Abstract
Centromedullary nailing is a well-established method of treatment for diaphyseal long bone fractures. The indications have been broadened greatly since the introduction in 1974 of interlocking centromedullary nailing. The purpose of this paper is to review our first results with locked intramedullary nailing of the tibia. We report our experience with the first 19 cases of interlocking tibia nails (15 fractures, 1 delayed union, 2 pseudarthrosis, 1 osteotomy). On the extension table, the insertion of the nail and the placement of the interlocking screws did not cause any problem. In 3 cases, a proximal screw had to be removed within two weeks because of spontaneous displacement. Complications have been noticed in three patients (15.8%) (pulmonary embolism on day 1, and compartment syndrome two days later in one case, sciatic nerve neuroapraxia in the other two). The other patients have been mobilized 24 to 48 hours after surgery. 94% of the fractures were consolidated 4 months post-operatively, with no major deformation. Interlocking tibia nailing seems to be an attractive method in the treatment of certain fractures of the tibia. Early mobilisation and weight-bearing are provided. The indications, the technical aspects as well as the dangers of the method must be carefully respected in order to avoid complications and poor results.
- Published
- 1995
49. [Therapeutic approach to para-esophageal hernia].
- Author
-
Achtari C, Worreth M, and Suter M
- Subjects
- Aged, Female, Gastroesophageal Reflux surgery, Humans, Male, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Treatment Outcome, Hernia, Hiatal surgery
- Abstract
The charts of all the patients operated upon for paraesophageal hernia (HPO) were reviewed. 24 patients could be found between 1976 and 1992. The mean age was 64 years, with 15 men and 9 women. 15 patients had a pure HPO, whereas 9 had a mixed hernia (HPO and laxial hiatal hernia). 3 patients presented with acute symptoms, and 2 of them were operated on emergently. The remaining patients had elective surgery, consisting of reduction of the stomach (all cases), excision of the hernia sac (12), closure of the diaphragm (17) and gastropexy (8). There was no mortality. Due to the fact that acute complications occur in as much as 30-40% of the cases, elective surgery should be proposed to any patient with a known paraesophageal hernia if the operative risks are not prohibitive. A careful preoperative assessment including endoscopy and pH-manometry of the esophagus will provide arguments to add a antireflux procedure to the standard operation, which should include reduction of the stomach, resection of the sac, closure of the hiatal defect and gastropexy.
- Published
- 1994
50. [Volvulus of the small intestine as a cause of primary acute abdomen].
- Author
-
Tevaearai H, Achtari C, and Suter M
- Subjects
- Abdomen, Acute pathology, Abdomen, Acute surgery, Adult, Aged, Aged, 80 and over, Female, Gangrene, Humans, Intestinal Obstruction pathology, Intestinal Obstruction surgery, Male, Middle Aged, Recurrence, Reoperation, Abdomen, Acute etiology, Intestinal Obstruction complications, Intestine, Small pathology, Intestine, Small surgery
- Abstract
As a cause of small intestine occlusion, volvulus is often a consequence of a band or adhesions. Except in infants, it is rarely the primary cause of symptomatology. Between January 1976 and December 1992, 13 patients (7 women and 6 men, mean age of 56.8 years) were admitted in our department for an acute abdomen due to a spontaneous primary volvulus of the small bowel. Clinical examination and laboratory tests did not help in preoperative diagnosis. All patients underwent an explorative laparotomy. Six patients had had prior abdominal surgery but none of them presented adhesion or band. In 8 patients (62%), detorsion was sufficient. Resection of a segment of small bowel was necessary in 4 patients. Gangrenous of the entire bowel was observed in one patient who rapidly died. Two patients presented minor complications. One patient with Down syndrome died of bronchoaspiration. One patient has been reoperated on one year later for recurrence of the volvulus, and underwent a Noble procedure. We conclude that volvulus of the small bowel is a rare cause of acute abdomen that must be remembered. Early surgery is mandatory to reduce the risk of gangrene, which is known to double the mortality. Laparoscopy will be helpful in early diagnosis and therapy.
- Published
- 1994
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