23 results on '"Castinel A"'
Search Results
2. French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease
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A. Laurain, D. Bouchard, J.-M. Rouillon, P. Petit, A. Liddo, B. Vinson Bonnet, A. Venara, J.-M. Didelot, G. Bonnaud, A. Senéjoux, T. Higuero, P. Delasalle, A.-L. Tarrerias, F. Devulder, A. Castinel, C. Thomas, H. Pillant Le Moult, C. Favreau-Weltzer, and L. Abramowitz more...
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Gastroenterology ,Surgery - Abstract
Purpose The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year’s follow-up. Method This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II–III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. Results A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p p p p Conclusion RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. Clinical trial registration and date Clinical trial NCT04229784 (18/01/2020). more...
- Published
- 2023
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3. Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence
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Pigot, F., Dao-Quang, M., Castinel, A., Juguet, F., Bouchard, D., Bockle, J., and Allaert, F. A.
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- 2006
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4. Recommandations pour la pratique clinique du traitement de la maladie hémorroïdaire – texte court
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P. Hemery, J.-M. Suduca, A. Castinel, T. Higuero, Laurent Siproudhis, C. Laclotte Duhoux, Laurent Abramowitz, A. Senéjoux, Ghislain Staumont, Nadia Fathallah, F. Pigot, B. Vinson-Bonnet, and H. Pillant-Le Moult more...
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery - Abstract
Coordonnateur : Thierry Higuero Auteurs : Laurent Abramowitz L, Helene Pillant-Le Moult; Philippe Hemery, Ghislain Staumont; Thierry Higuero, Francois Pigot, Agnes Senejoux, Jean-Luc Suduca, Cecile Laclotte Duhoux, Alain Castinel, Nadia Fathallah, Beatrice Vinson-Bonnet, Laurent Siproudhis. Groupe de lecture : Laurent Abramowitz, Paul Bendfredj, Dominique Bouchard, Carole Cordonnier, Hubert Dereux, Paul Dieterling, Jean-Luc Faucheron, Philippe Godeberge, Michel Gompel, Thierry Higuero, Pierre Moreau, Francois Mion, Francois Pigot, Elise Pommaret, Agnes Senejoux, Laurent Siproudhis, Denis Soudan, Marc Souffran, Ghislain Staumont, Jean Jacques Tassou, Christian, Thomas, Beatrice Vinson-Bonnet et autres membres anonymes de la SNFCP. more...
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- 2016
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5. Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty
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Laurent Abramowitz, Dominique Bouchard, Cregg: Club de Réflexion des cabinets et Groupe d’Hépato‐Gastroentérologie, Jean Michel Suduca, D. Soudan, Ghislain Staumont, M. Varastet, Franck Devulder, R. Ganansia, Alain Castinel, and Souffran M more...
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medicine.medical_specialty ,Anal fissure ,business.industry ,Urinary retention ,Gastroenterology ,medicine.disease ,Surgery ,law.invention ,medicine.anatomical_structure ,Quality of life ,Randomized controlled trial ,law ,medicine ,Sphincter ,Observational study ,Young adult ,medicine.symptom ,business ,Prospective cohort study - Abstract
Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. Results Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. Conclusion Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure. more...
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- 2013
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6. Guidelines for the treatment of hemorrhoids (short report)
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B. Vinson-Bonnet, T. Higuero, Ghislain Staumont, H. Pillant-Le Moult, F. Pigot, A. Senéjoux, P. Hemery, Nadia Fathallah, A. Castinel, J.-M. Suduca, Laurent Siproudhis, C. Laclotte Duhoux, and Laurent Abramowitz more...
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Hemorrhoidectomy ,medicine.medical_specialty ,Diet therapy ,MEDLINE ,Anti-Inflammatory Agents ,Hemorrhoids ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal Agents ,Medicine ,Combined Modality Therapy ,Humans ,Gastrointestinal agent ,Analgesics ,Pain, Postoperative ,business.industry ,General surgery ,General Medicine ,Ambulatory Surgical Procedure ,medicine.disease ,Surgery ,Ambulatory Surgical Procedures ,Elective Surgical Procedures ,Laxatives ,030220 oncology & carcinogenesis ,Ambulatory ,030211 gastroenterology & hepatology ,business ,Elective Surgical Procedure ,Diet Therapy - Abstract
Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Societe nationale francaise de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics. more...
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- 2016
7. Do we have to stop anticoagulant and platelet-inhibitor treatments during proctological surgery?
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Dominique Bouchard, Alain Castinel, F. Juguet, and François Pigot
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Transanal Excision ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Incidence (epidemiology) ,Anticoagulant ,Gastroenterology ,Heparin ,Clopidogrel ,Surgery ,Platelet inhibitor ,Anesthesia ,Relative risk ,medicine ,Risk factor ,business ,medicine.drug - Abstract
Aim This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments. Method The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology. Results A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) (P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin. Conclusion During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk. more...
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- 2012
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8. Prospective survey of secondary bleeding following anorectal surgery in a consecutive series of 1,269 patients
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F. Juguet, Dominique Bouchard, A. Castinel, F. Pigot, and J.-P. Vove
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Fistula ,Anal Canal ,Rectum ,Postoperative Hemorrhage ,Fistulotomy ,Severity of Illness Index ,Young Adult ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Young adult ,Child ,Prospective cohort study ,Digestive System Surgical Procedures ,Aged ,Aged, 80 and over ,Hepatology ,business.industry ,Data Collection ,Anticoagulant ,Gastroenterology ,Middle Aged ,Anal canal ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Anesthesia ,Female ,business - Abstract
Summary Introduction As little data is available about secondary bleeding after proctological surgery, we conducted a specific survey. Patients and methods Patients operated between November 2008 and April 2009 were prospectively included. Patients were followed until last visit (day 21–28). Severity of bleeding was low (at home stay), moderate (hospitalisation for observation), or severe (transfusion, and/or homeostasis in operating room). Results Included were 1269 patients: haemorrhoidectomy/pexy 527 (41%), fistula treatment 273 (21%), fissurectomy 197 (15%), perianal and pilonidal abscesses 124 (10%), others 148 (12%). Before surgery 78 patients were under long-term treatment with antiplatelet or anticoagulant therapy. Seventy-eight patients (6%) demonstrated 85 bleeding events. Severity rate was: low 22%, moderate 51%, and severe 27%. Ninety-five percent of events occurred before day 15. Univariate study showed increased risk after haemorrhoidopexy ( P −3 ) and anticoagulant treatment ( P = 0.002), decreased risk after fissurectomy and fistulotomy ( P −3 ), and no relation with age, sex or operator. After multivariate study only relationship with anticoagulant treatment remained significant. Conclusion Secondary bleeding occurred in 6% of patients after proctological surgery, requiring a readmission and/or an active treatment in about 75%. Treatment with anticoagulant exposed to increased bleeding frequency. more...
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- 2011
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9. Combined approach with infliximab, surgery, and methotrexate in severe fistulizing anoperineal Crohnʼs disease: Results from a prospective study
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Pauline Roumeguère, Delphine Gaye, Frank Zerbib, M. Capdepont, Dominique Bouchard, David Laharie, Frédéric Juguet, François Pigot, and Alain Castinel
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Adult ,Male ,medicine.medical_specialty ,Perineum ,Young Adult ,Crohn Disease ,Gastrointestinal Agents ,Maintenance therapy ,Intestinal Fistula ,medicine ,Humans ,Immunology and Allergy ,Prospective cohort study ,Aged ,Retrospective Studies ,Anus Diseases ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Antibodies, Monoclonal ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Infliximab ,Perineal fistula ,Surgery ,Regimen ,Methotrexate ,Treatment Outcome ,Female ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Background: Infliximab is the only medical therapy that has been proven to be effective in fistulizing Crohn's disease (CD), but the recurrence rate of fistulas is high despite maintenance therapy. The aim of this prospective study was to evaluate the short- and long-term efficacy of a combined schedule with infliximab, methotrexate, and sphincter-sparing surgery in patients with severe fistulizing anoperineal CD. Methods: From January 2006 to November 2007, all consecutive patients in three referral centers with severe fistulizing anoperineal CD were prospectively included after primary drainage. At inclusion, patients received three infliximab infusions at weeks 0, 2, and 6, and maintenance therapy with methotrexate. A second optimized surgical step consisting of at least removal of setons was performed between the second and the third infliximab infusions. Results: Thirty-four CD patients (26 women; median age 38.5 years) with complex anoperineal fistula were enrolled (including 9 with recto-vaginal fistulas, and 10 with anorectal stenosis). At week 14 the response rate was 85% with 74% complete responders. At 1 year, 50% were still responders; luminal CD worsening was the major cause of relapse. Median Perineal Disease Activity Index (PDAI) and magnetic resonance imaging (MRI) scores significantly decreased from baseline to week 50. Conclusions: A combined approach with infliximab induction, two surgical sphincter-sparing steps and methotrexate is effective in achieving short-term response in severe fistulizing anoperineal CD. The best maintenance regimen remains to be determined. (Inflamm Bowel Dis 2011;) more...
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- 2011
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10. Nouvelle classification des lésions cervicales pour l’aptitude au rugby professionnel
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J. Sénégas, B. Castinel, P. Bernard, B. Roger, M. Lafargue, V. Fière, J.-C. Peyrin, B. Dusfour, P. Cauhapé, and P. Adam
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Rehabilitation ,Orthopedics and Sports Medicine ,Surgery - Abstract
Resume Le rugby est un sport de contact parfois violent qui expose a un risque medullaire par traumatisme mais aussi par lesions degeneratives precoces. La prevalence de ces pathologies cervicales a augmente avec le professionnalisme. Elles surviennent souvent sur des canaux cervicaux etroits developpementaux, ce qui majore le risque de complication neurologique grave. Une premiere classification des criteres d’aptitude a la pratique du rugby professionnel avait ete adoptee par la Ligue Nationale de Rugby peu apres l’avenement du professionnalisme. Les bilans d’imagerie devenus obligatoires ont permis de depister de tres nombreux canaux cervicaux retrecis chez des joueurs asymptomatiques. L’indice de Torg, utilise initialement, s’avere imparfait. Ces elements ont rendu necessaire l’adaptation de cette classification. Le nouvel outil decisionnel permet une evaluation precise du risque medullaire a l’aide des donnees de l’examen clinique et de l’IRM, voire, si necessaire, des radiographies cervicales. La nouvelle classification est presentee avec ses quatre groupes de risque et d’aptitude (groupe 0 [G0] : aucune pathologie cervicale ; groupe 1 [G1] : pathologie n’entrainant pas de contre-indication a la pratique du rugby en competition ; groupe 2 [G2] : contre-indication relative [sur risque connu, a faire accepter par le joueur] ; groupe 3 [G3] : contre-indication absolue). Elle est discutee. Le risque structurel lie a la pratique du rugby persistant neanmoins, il reste indispensable de responsabiliser le joueur en l’impliquant dans le processus decisionnel. more...
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- 2009
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11. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study
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D. Soudan, Marina Varastet, R. Ganansia, Ghislain Staumont, Franck Devulder, Laurent Abramowitz, Alain Castinel, Jean Michel Suduca, Dominique Bouchard, François Pigot, and Marc Souffran
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Anal fistula ,Adult ,Male ,medicine.medical_specialty ,Anal Canal ,Fistulotomy ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Humans ,Rectal Fistula ,Postoperative Period ,Prospective Studies ,Stage (cooking) ,Transsphincteric anal fistula ,Digestive System Surgical Procedures ,Aged ,Aged, 80 and over ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Patient Satisfaction ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Transsphincteric fistula ,France ,business ,Large group ,Fecal Incontinence - Abstract
Aim The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. Method A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. Results Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0−11) and 2.0 (0−18) (P = 0.032) and the median Vaizey scores were 2.0 (0−14) and 3.0 (0−21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0−5: 88%, 86%; 6−10: 10.7%, 10.7%; 11−15: 1.0%, 2.6%; and 16−20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0−5: 86%, 66%; 6−10: 4.5%, 20%; 11−15: 9%, 11%; and 16−20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0−14) vs 4 (0−19) (P more...
- Published
- 2015
12. Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence
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F. Pigot, François-André Allaert, F. Juguet, J. Bockle, A. Castinel, M. Dao-Quang, and D. Bouchard
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Patient characteristics ,Hemorrhoids ,Severity of Illness Index ,New onset ,Surgical Stapling ,medicine ,Humans ,Prospective Studies ,Aged ,Aged, 80 and over ,Univariate analysis ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Treatment Outcome ,Stapled hemorrhoidopexy ,Staple line ,Female ,business ,Fecal Incontinence ,Follow-Up Studies ,Abdominal surgery - Abstract
The ability of stapled hemorrhoidopexy (SH) to cure hemorrhoidal symptoms appears to depend on patient characteristics and operative technique. We assessed the association between outcome of SH and patients’ characteristics and procedure parameters (associated procedure, suture line height, doughnut size, presence of malpighian tissue or smooth muscle in specimen). A total of 68 consecutive patients (56 males) were prospectively operated by 3 different surgeons. Hemorrhoids were grade II (6%), grade III (76%) or grade IV (18%). At a mean 32-week follow-up (range, 9–77), symptoms had resolved in 77% of patients, independently of any operative or clinical parameter. New onset anal incontinence occurred in 11 men (17%): all had urgency, with flatus and liquid stool incontinence in two, and flatus incontinence and mucus soiling in one. Univariate analysis revealed that persistent incontinence was associated with a staple line more...
- Published
- 2006
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13. Vécu de la douleur postopératoire et résultats à long terme après chirurgie hémorroïdaire par anopexie
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M. Dao Quang, A. Castinel, J. Bockle, François-André Allaert, D. Bouchard, F. Juguet, and F. Pigot
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,business - Abstract
Resume Buts de l'etude. – L'anopexie permet de traiter chirurgicalement la maladie hemorroidaire, avec des suites moins douloureuses que l'hemorroidectomie. Cette information importante a communiquer au patient, peut etre source d'insatisfaction si la douleur vecue depasse la douleur attendue. Evaluer la douleur et l'incapacite physique ressenties apres anopexie par rapport a celles attendues. Evaluer les resultats fonctionnels en fonction des donnees pre- et peroperatoires. Resultats. – Soixante-huit malades consecutifs (56 hommes), d'âge moyen 51 ans (25–83) ont ete inclus prospectivement. Les hemorroides etaient quatre fois de grade 2 (6 %), 52 de grade 3 (76 %) et 12 de grade 4 (18 %). La douleur postoperatoire etait egale ou moindre a celle attendue pour 85 %, avec une meilleure tolerance superieure a 45 ans (p Conclusion. – Une information pragmatique bien qu'imprecise sur la moindre douleur a attendre apres anopexie n'expose pas a la deception des malades. Les resultats fonctionnels ne sont pas influences par la technique operatoire. A l'inverse les troubles de la continence sont peu severes, mais frequents si la ligne d'agrafage est a moins de 6,5 mm de la ligne pectinee. more...
- Published
- 2006
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14. Local Excision of Large Rectal Villous Adenomas
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François Pigot, Alain Castinel, Majid Mortaji, Frédéric Juguet, Jean-Claude Chaume, Jacques Faivre, and Dominique Bouchard
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Adult ,Male ,Villous adenoma ,medicine.medical_specialty ,Adenoma ,medicine.medical_treatment ,Rectum ,Postoperative Complications ,Adenoma, Villous ,medicine ,Humans ,Radical surgery ,Aged ,Retrospective Studies ,Aged, 80 and over ,Transanal Excision ,Rectal Neoplasms ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Radiation therapy ,Dissection ,Treatment Outcome ,medicine.anatomical_structure ,Female ,business - Abstract
Transanal excision of rectal villous adenomas is a widely used surgical technique, because it is a one-step procedure, requiring no sophisticated instrumentation, and allowing complete histologic analysis of the excised tumor. Therefore, it ranks alongside radical surgery and palliative destructive procedures, but its results are highly variable in the published series. This discrepancy may be explained by the variable completeness of tumor excision because of potential dissection difficulties. Because intraoperative exposure may be a major limiting factor, one of us (JF) has developed a tractable cutaneomucous flap procedure to lower the rectal tumor to the anal verge, where control of the dissection line is easier. This retrospective review of consecutive patients operated on during ten-year period reports long-term results after transanal excision for large rectal villous adenomas with the tractable flap technique.From 1978 to 1988, 207 consecutive patients (100 males), mean age 68 (range, 24-90) years, were operated on for an apparently benign villous rectal adenoma. Twenty-one patients (10 percent) were referred after failure of previous treatments: 11 endoscopic, 8 surgical, 1 laser, 1 radiotherapy. Mean distance of lower tumor edge from anal margin was 5.6 (range, 0-13) cm and was10 cm in 82 percent.Three patients (1.5 percent), including one with a Tis carcinoma, underwent a secondary treatment for immediate gross failure of resection: one further local excision and two palliative laser destructions. Immediate postoperative course was uneventful for 96 percent; there was one death from perineal gangrenous infection, four cases of hemorrhage, and three urinary retentions. Subsequently one case of transient fecal incontinence and 11 medically managed stenoses were noted. Mean size of resected tumor was 5.4 (range, 1-17) cm. Deep excision margins concerned the rectal muscular layers in 199 patients (96 percent) and perirectal fat in 8 (4 percent). Specimen margins were negative for cancer in 175 (85 percent) and positive or unknown in 32 cases. Histologic evaluation demonstrated in situ cancer in 28 (14 percent) and invasive carcinoma in 9 (4 percent). In three patients (1 percent), two abdominoperineal resections were immediately performed (one T2 with a mucinous contingent, one T3) and one adjuvant radiotherapy (one undifferentiated T2). Four patients (2 percent) did not return for postoperative evaluation. For the remaining 198 patients, mean follow-up was 74 +/- 34 (median, 75; range, 1-168) months. Forty-four died from unrelated causes. Recurrence occurred in seven (3.6 percent) and was malignant in two, who subsequently died. Specific recurrence-free probability was 99.5 percent at one year, 96 percent at five years, and 95 percent at ten years. A lesion size6 cm (10 vs. 1 percent for smaller tumors) and the presence of an invasive carcinoma (20 vs. 3 percent without invasive carcinoma) were significantly associated with an increased probability of recurrence at five years.Providing that adequate intraoperative exposure is obtained and advanced malignant tumors receive immediate secondary treatment, transanal resection of clinically benign, large rectal villous adenomas is safe and effective. It is an alternative to rectal resection, which exposes the patient to potentially adverse effects, and also to destructive procedures, which preclude any histologic evaluation of the tumor. more...
- Published
- 2003
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15. Exérèse locale avec radiothérapie préopératoire dans les cancers T2 ou T3 du bas rectum. Résultats à long terme
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J. Faivre, F. Pigot, A. Castinel, F. Juguet, M Dernaoui, and J.C. Chaume
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Gynecology ,medicine.medical_specialty ,Combined treatment ,business.industry ,Medicine ,Surgery ,business ,Rectal disease - Abstract
Resume Objectif : Evaluer, de facon prospective, le risque de recidive locale des cancers du bas rectum stade T2 ou T3 traites par exerese transanale et radiotherapie preoperatoire. Patients et methodes : De 1992 a 1999, 34 patients ont ete traites apres radiotherapie par exerese locale d’un adenocarcinome envahissant (stade T2) ou depassant la musculeuse (stade T3), sans adenopathie perirectale en echographie endorectale ou a l’examen sous anesthesie. Quatre patients traites de facon palliative ou perdus de vue ont ete exclus de l’etude. L’analyse a porte sur les 30 patients restants (huit uT2, huit uT3 et 14 de stade pretherapeutique indetermine). Resultats : Apres un suivi moyen de 74 mois (mediane : 46), le taux de recidive locale a cinq ans etait de 33 %. Le benefice de la radiotherapie n’apparait dans aucun des sous groupes de patients avec ou sans facteur de risque significatif de recidive : taille > 40 mm, marge saine Conclusion : L’exerese locale des cancers du bas rectum de stade T2 ou T3, quelles que soient leurs caracteristiques, expose a un risque important de recidive locale. Ce resultat est constate meme en y associant une radiotherapie preoperatoire. Ce traitement ne peut etre propose qu’a un patient informe et ayant formellement refuse une exerese radicale. more...
- Published
- 2001
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16. One-year outcome of haemorrhoidectomy: a prospective multicentre French study
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D. Soudan, Jean Michel Suduca, Franck Devulder, Laurent Abramowitz, Dominique Bouchard, R. Ganansia, Ghislain Staumont, Alain Castinel, M. Varastet, and François Pigot
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Anal fistula ,Adult ,Hemorrhoidectomy ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Visual analogue scale ,Anal Canal ,Hemorrhoids ,Cohort Studies ,Young Adult ,Postoperative Complications ,Anal stenosis ,Recurrence ,medicine ,Humans ,Rectal Fistula ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Aged ,Aged, 80 and over ,Anal fissure ,Urinary retention ,business.industry ,Gastroenterology ,Anal canal ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Patient Satisfaction ,Female ,Fissure in Ano ,medicine.symptom ,business - Abstract
An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]).A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life (SF-36).Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n = 345, 54.5%), anal fissure (n = 56, 8.9%) or low anal fistula (n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention (n = 3), bleeding (n = 11), local infection (n = 7) and faecal impaction (n = 9). At 1 year, the main complications included skin tags (n = 2) and anal stenosis (n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p0.001), anal discomfort from 5.5/10 to 0.1/10 (P0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied.Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms. more...
- Published
- 2012
17. 963 Results from a Prospective Study Combining Infliximab, Surgery, and Methotrexate in Severe Fistulising Ano-Perineal Crohn's Disease
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David Laharie, E. Chanteloup, Frédéric Juguet, Frank Zerbib, Alain Castinel, Dominique Bouchard, Delphine Gaye, Pauline Roumeguère, M. Capdepont, and François Pigot
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Crohn's disease ,medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,Methotrexate ,medicine.disease ,business ,Prospective cohort study ,Infliximab ,medicine.drug ,Surgery - Published
- 2009
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18. Erratum
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M.K. Baig, J.A. Larach, S. Chang, C. Long, E.G. Weiss, J.J. Nogueras, S.D. Wexner, M. Bouchoucha, G. Devroede, E. Dorval, A. Faye, P. Arhan, M. Arsac, A.P. Zbar, R.O. Oyetunji, R. Gill, A. D’Annibale, E. Morpurgo, V. Fiscon, B. Termini, A. Serventi, G. Sovernigo, C. Orsini, P. Fa-Si-Oen, P. van de Gender, H. Putter, N. Ectors, A. D’Hoore, B. Topal, F. Penninckx, C.F.S. Marques, S.C. Nahas, C.S.R. Nahas, C.W. Sobrado, A. Habr-Gama, D.R. Kiss, E.G.G. Verdaasdonk, J.M. Bueno de Mesquita, L.P.S. Stassen, M. Nano, M. Prunotto, M. Ferronato, M. Solej, M. Galloni, F. Pigot, M. Dao-Quang, A. Castinel, F. Juguet, D. Bouchard, J. Bockle, F.A. Allaert, F. de la Portilla, R. Rada, J. Vega, N. Cisneros, V.H. Maldonado, A. Utrera, E. Espinosa, A. Trecca, F. Gaj, G.P. Di Lorenzo, M.R. Ricciardi, M. Silano, A. Bella, M. Sperone, G.I. Vorobiev, P.V. Tsarkov, and E.V. Sorokin more...
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Gastroenterology ,Surgery - Published
- 2009
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19. P089 - Results from a prospective study combining infliximab, surgery, and methotrexate in severe fistulising ano-perineal Crohn's disease
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P. Roumeguère, Alain Castinel, M. Capdepont, D. Bouchard, E. Chanteloup, D. Laharie, F. Pigot, Frank Zerbib, D. Gaye, and Frédéric Juguet
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medicine.medical_specialty ,Crohn's disease ,business.industry ,Gastroenterology ,General Medicine ,medicine.disease ,Inflammatory bowel disease ,Infliximab ,Surgery ,Discontinuation ,Exact test ,Delayed hypersensitivity ,medicine ,Methotrexate ,Prospective cohort study ,business ,medicine.drug - Abstract
Background: Treatment with infliximab (IFX) can result in immunogenicity through the formation of human anti-chimeric antibodies (HACAs). These antibodies are associated with a decreased duration of response, whereas therapeutic levels of IFX are associated with durable clinical response. We evaluated the clinical utility of measuring serum IFX and HACA levels. Methods: We retrospectively reviewed charts of patients with inflammatory bowel disease who had IFX drug and HACA levels measured over a three-year period from 2005-2008. The clinical utility of these tests was assessed by determining whether the result affected clinical management. The management and subsequent clinical response to therapeutic changes based on test results was evaluated. Fisher's exact test and log-rank test for discontinuation were used for statistical analysis. Results: One hundred and fifty-five patients underwent IFX level and HACA status testing. The median time to initial testing after IFX initiation was 50 weeks (IQR: 22.7-120). The main indications for testing were: loss of response to IFX (50.3%), partial response after initiation of IFX (22.6%) and possible autoimmune/delayed hypersensitivity reaction (14.8%). HACAs were identified in 35 patients (22.6%) and therapeutic IFX levels were found in 51 (32.9%). Of 177 total tests assessed, the results impacted treatment decisions in 73.4% (95% CI: 66-80%). In those with positive HACAs, change to another anti-TNF was associated with a complete or partial response in 91.6% of patients whereas increasing the dose had a response of 16.7% (p more...
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- 2009
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20. Mécanismes des traumatismes cervicaux dans le jeu de rugby
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B. Castinel, Ph. Turblin, Ch. Baudot, P. Milburn, and K. Quarrie
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Rehabilitation ,Orthopedics and Sports Medicine ,Surgery - Published
- 2005
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21. Do we have to stop anticoagulant and platelet-inhibitor treatments during proctological surgery?
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Pigot, F., Juguet, F., Bouchard, D., and Castinel, A.
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ANTICOAGULANTS ,BLOOD coagulation ,PLATELET aggregation inhibitors ,ANORECTAL function tests ,ASPIRIN ,CLOPIDOGREL ,HEMORRHOIDS - Abstract
Aim This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments. Method The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology. Results A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) ( P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin. Conclusion During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk. [ABSTRACT FROM AUTHOR] more...
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- 2012
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22. Local Excision of Large Rectal Villous Adenomas: Long-Term Results.
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Pigot, François, Bouchard, Dominique, Mortaji, Majid, Castinel, Alain, Juguet, Frédéric, Chaume, Jean-Claude, and Faivre, Jacques
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SURGERY ,SURGICAL excision ,LARGE intestine ,RECTUM ,RECTAL medication ,LUMPECTOMY - Abstract
PURPOSE: Transanal excision of rectal villous adenomas is a widely used surgical technique, because it is a one-step procedure, requiring no sophisticated instrumentation, and allowing complete histologic analysis of the excised tumor. Therefore, it ranks alongside radical surgery and palliative destructive procedures, but its results are highly variable in the published series. This discrepancy may be explained by the variable completeness of tumor excision because of potential dissection difficulties. Because intraoperative exposure may be a major limiting factor, one of us (JF) has developed a tractable cutaneomucous flap procedure to lower the rectal tumor to the anal verge, where control of the dissection line is easier. This retrospective review of consecutive patients operated on during ten-year period reports long-term results after transanal excision for large rectal villous adenomas with the tractable flap technique. PATIENTS: From 1978 to 1988, 207 consecutive patients (100 males), mean age 68 (range, 24–90) years, were operated on for an apparently benign villous rectal adenoma. Twenty-one patients (10 percent) were referred after failure of previous treatments: 11 endoscopic, 8 surgical, 1 laser, 1 radiotherapy. Mean distance of lower tumor edge from anal margin was 5.6 (range, 0–13) cm and was <10 cm in 82 percent. RESULTS: Three patients (1.5 percent), including one with a Tis carcinoma, underwent a secondary treatment for immediate gross failure of resection: one further local excision and two palliative laser destructions. Immediate postoperative course was uneventful for 96 percent; there was one death from perineal gangrenous infection, four cases of hemorrhage, and three urinary retentions. Subsequently one case of transient fecal incontinence and 11 medically managed stenoses were noted. Mean size of resected tumor was 5.4 (range, 1–17) cm. Deep excision margins concerned the rectal muscular layers in 199 patients (96 percent) and perirectal fat in 8 (4 percent). Specimen margins were negative for cancer in 175 (85 percent) and positive or unknown in 32 cases. Histologic evaluation demonstrated in situ cancer in 28 (14 percent) and invasive carcinoma in 9 (4 percent). In three patients (1 percent), two abdominoperineal resections were immediately performed (one T2 with a mucinous contingent, one T3) and one adjuvant radiotherapy (one undifferentiated T2). Four patients (2 percent) did not return for postoperative evaluation. For the remaining 198 patients, mean follow-up was 74 ± 34 (median, 75; range, 1–168) months. Forty-four died from unrelated causes. Recurrence occurred in seven (3.6 percent) and was malignant in two, who subsequently died. Specific recurrence-free probability was 99.5 percent at one year, 96 percent at five years, and 95 percent at ten years. A lesion size >6 cm (10 vs. 1 percent for smaller tumors) and the presence of an invasive carcinoma (20 vs. 3 percent without invasive carcinoma) were significantly associated with an increased probability of recurrence at five years. CONCLUSION: Providing that adequate intraoperative exposure is obtained and advanced malignant tumors receive immediate secondary treatment, transanal resection of clinically benign, large rectal villous adenomas is safe and effective. It is an alternative to rectal resection, which exposes the patient to potentially adverse effects, and also to destructive procedures, which preclude any histologic evaluation of the tumor. [ABSTRACT FROM AUTHOR] more...
- Published
- 2003
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23. Vécu de la douleur postopératoire et résultats à long terme après chirurgie hémorroïdaire par anopexie
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Pigot, F., Dao Quang, M., Castinel, A., Juguet, F., Bouchard, D., Allaert, F.-A., and Bockle, J.
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HEMORRHOIDS , *POSTOPERATIVE pain , *SURGICAL complications , *SURGEONS , *PATIENTS - Abstract
Abstract: Aims. – Anopexy allows treatment of hemorrhoidal symptoms with a less painful postoperative course. This information is important for the patient, but may lead to dissatisfaction if pain level is higher than expected. To evaluate perceived pain and physical limitation levels in relation to patient''s expectation. Evaluate long-term functional results. Results. – Sixty-eight consecutive patients (56 males) were prospectively included. Distribution of haemorrhoid grades were 4 grade 2 (6%), 52 grade 3 (76%) and 12 grade 4 (18%). Postoperative pain level was less or equal than expected for 85% of patients, with a better acceptance superior to 45 years. Physical limitation was equally or less important than expected for 89%. At the 32 weeks follow-up hemorrhoidal symptoms were present in 23%, uninfluenced by any patient''s or operative characteristics. Incontinence with urgency was reported by 17%. Presence of an alliterated continence was linked to stapled line inferior to 6,5 mm from pectineate line, doughnut height inferior to 22 mm, external hemorrhoids and related to surgeon. Conclusion. – Pragmatic information, although vague, about postoperative pain does not expose to patient''s dissatisfaction. Functional results are not influenced by technical variation. Continence alterations are not severe, but frequent when stapled line is too close from pectineate line. [Copyright &y& Elsevier] more...
- Published
- 2006
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