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Anal incontinence (AI) prevalence in general population is estimate to range from 1.4 to 19.5% (Wexner ≥ 1). Obesity could be an AI risk factor. However, AI prevalence in patients with obesity is not clearly established. The main objective of this study was to assess the prevalence of AI in patients with extreme obesity prior to bariatric surgery and to identify specific AI risk factors in this subset of patients.A cross-sectional study, in a tertiary referral center in obesity was performed during one year. Patients who presented criteria for bariatric surgery (BMI40 or BMI 35 with co-morbidities) were asked to fill in preoperative self-questionnaires. A Wexner score ≥ 3 was used to define AI to identified patients who had a clinic impact of AI, by frequency of symptoms or alteration of quality of life.Two hundred and fifty patients were included. Corresponded to, 196 women (78.4%) and 54 men (21.6%). Median BMI was 44.53kg/mAI is frequently observed in patients with extreme obesity scheduled for bariatric surgery and should be routinely evaluated. Modifiable risk factors as constipation should be manage before surgery as well as the specific management of AI, to prevent AI exacerbation after surgery. The choice of bariatric surgical procedure should be discussed and evaluated for the treatment of patients with obesity and AI.Moderate.

Background Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) predicts the risk of vocal cord palsy (VCP). IONM can be used to adapt the surgical strategy in order to prevent bilateral VCP and associated morbidity. Controversial results have been reported in the literature for the effect of IONM on rates of VCP, and large multicentre studies are required for elucidation. Methods Patients undergoing first‐time thyroidectomy for benign thyroid disease between May 2015 and January 2019, documented prospectively in the European registry EUROCRINE®, were included in a cohort study. The influence of IONM and other factors on the development of postoperative VCP was analysed using multivariable regression analysis. Results Of 4598 operations from 82 hospitals, 3542 (77·0 per cent) were performed in female patients. IONM was used in 4182 (91·0 per cent) of 4598 operations, independent of hospital volume. Postoperative VCP was diagnosed in 50 (1·1 per cent) of the 4598 patients. The use of IONM was associated with a lower risk of postoperative VCP in multivariable analysis (odds ratio (OR) 0·34, 95 per cent c.i. 0·16 to 0·73). Damage to the RLN noted during surgery (OR 24·77, 12·91 to 48·07) and thyroiditis (OR 2·03, 1·10 to 3·76) were associated with an increased risk of VCP. Higher hospital volume correlated with a lower rate of VCP (OR 0·05, 0·01 to 0·13). Conclusion Use of IONM was associated with a low rate of postoperative VCP., The influence of intraoperative nerve monitoring (IONM) and other factors on the development of postoperative vocal cord palsy (VCP) was assessed using multivariable regression analysis. In a cohort of 4598 patients from 82 hospitals, IONM was used in over 90 per cent of those treated by primary thyroidectomy for underlying benign thyroid disease. IONM reduced the rate of postoperative VCP. Intraoperative nerve monitoring associated with lower rates of vocal cord palsy

BackgroundOsteoporosis is a common disease whose prognosis can be seriously impacted by the development of fractures that lead to functional limitations and may even have life-threatening sequelae (1). CT is useful for diagnosing vertebral fracture (VF) and measuring the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC- L1). Obesity might be a protective factor against bone loss and osteoporosis (2). Nonetheless, epidemiological studies have reported an association between obesity and an increased risk of fragility fractures (3) and suggested that obesity may be a risk factor for fracture and decreased bone density (4,5). For bariatric surgery, the results are less controversial. According to many studies, malabsorptive procedures lead to a decrease in bone mineral density and sometimes an increased risk of fragility fractures (2,6,7,8). However, the kinetics of bone loss and its physiopathology are unclear.ObjectivesThe primary objective was to evaluate bone fragility on computed tomography (CT) in obese patients before and 2 years after bariatric surgery. The secondary objectives were to identify risk factors for a decrease in the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1).MethodsThis descriptive study included obese patients who underwent bariatric surgery between January 2014 and December 2019 and CT before and two years (±6 months) after bariatric surgery. SBAC-L1 (in Hounsfield units (HU)) was measured on CT, and vertebral fracture (VF) was manually assessed. The SBAC-L1 fracture threshold was defined as below 145 HU.ResultsAmong the 78 included patients, 85.9% were women, with a mean age of 48.5 years (±11.4); the mean body mass index (BMI) was 46.2 kg/m2 (±7) before surgery and 29.8 kg/m2 (±6.7) 2 years after surgery. There was a significant change in SBAC-L1 two years after surgery (p=0.037). In multivariate analysis, the risk factors for having an SBAC-L1 ≤ 145 HU 2 years after bariatric surgery in those with an SBAC-L1 > 145 HU before surgery were age and sex, with men and older patients having a higher risk (OR = 32.6, CI95% = [1.86-568.77], and OR = 0.85, CI95% = [0.74-0.98], respectively).ConclusionSBAC-L1 was significantly lower two years after bariatric surgery than before surgery. When the SBAC-L1 was over 145 HU before bariatric surgery, men sex and older patients were the risk factors for having an SBAC-L1 below the fracture threshold 2 years after surgery.References[1]Toledano E, Candelas G, Rosales Z, Martínez Prada C, León L, Abásolo L, et al. A meta-analysis of mortality in rheumatic diseases. Reumatol Clin. 2012 Dec;8(6):334–41.[2]Lespessailles E, Paccou J, Javier R-M, Thomas T, Cortet B, GRIO Scientific Committee. Obesity, Bariatric Surgery, and Fractures. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4756–68.[3]Gonnelli S, Caffarelli C, Nuti R. Obesity and fracture risk. Clin Cases Miner Bone Metab. 2014 Jan;11(1):9–14.[4]Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, et al. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract. 2010 May;64(6):817–20.[5]Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res. 2014 Feb;29(2):487–93.[6]Ko B-J, Myung SK, Cho K-H, Park YG, Kim SG, Kim DH, et al. Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis. Obes Surg. 2016 Jul;26(7):1414–21.[7]Paccou J, Martignène N, Lespessailles E, Babykina E, Pattou F, Cortet B, et al. Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res. 2020 Aug;35(8):1415–23.[8]Lu C-, Chang Y-K, Chang H-H, Kuo C-S, Huang C-T, Hsu C-C, et al. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore). 2015 Dec;94(48):e2087.Disclosure of InterestsNone declared

Vickers indentation was used to evaluate the hardness and the apparent fracture toughness of unirradiated and irradiated UO2 fuels, with the objective to determine the effects of the irradiation on mechanical properties. Indentation tests were realized at room temperature on standard and doped UO2 fuels, irradiated in a pressurised water reactor up to a burnup of 81.6 GWd/tM. For the highest burnups, the fuels had restructured in a high burnup structure (HBS) on the periphery of the pellets. More than 100 valid impressions for the Vickers hardness determination were obtained on each fuel. The Vickers hardness of both UO2 increased with the local burnup, due to irradiation defects such as dislocations and fission products but decreased when the fuel restructured into the HBS. Valid crack patterns for the Vickers fracture toughness were only obtained for indentations inside the large grains of irradiated doped UO2 fuels or for both restructured fuels. The Vickers fracture toughness of the non-restructured doped UO2 was shown to increase quickly during the first irradiation cycle but was then constant with increasing local burnup. This increase of the apparent fracture toughness was mainly due to the decrease of the crack length from the corner of the indents, attributed to the interactions of the cracks with the defects such as bubbles or fission product precipitates and associated residual stresses. In the HBS, short cracks from the corner of the indents that followed grain boundaries of small grains led to high fracture toughness values. However, the use of the literature equations to calculate the apparent fracture toughness on porous samples such as HBS is questioned. All tests clearly illustrated the weakness of the grain boundaries in irradiated fuels.

Résumé La pandémie de COVID-19 impose une réorganisation majeure de l’ensemble de notre système de soins. En France, des règles générales ont été diffusées au niveau national et sont déclinées par chaque établissement, public comme privé, sur l’ensemble du territoire. Ces recommandations, rédigées par un groupe d’experts sous l’égide de l’Association francophone de chirurgie endocrinienne (AFCE), ont pour objectif de proposer des principes spécifiques de prise en charge chirurgicale au cours et au décours de l’épidémie de COVID- 19, pour les pathologies chirurgicales de la thyroïde, des parathyroïdes, du pancréas endocrine, et des surrénales.

Les sujets obeses sont a risque de carence en fer, car l’absorption du fer est reduite. En preoperatoire, cette carence martiale doit etre corrigee par voie orale ou par voie intraveineuse, car l’anemie est associee a une augmentation du risque de morbimortalite en postoperatoire. Apres chirurgie bariatrique, l’absorption est fortement diminuee. La diminution des apports aggrave le risque de carence. La ferritine est le principal parametre a doser regulierement apres la chirurgie. Le coefficient de saturation de la transferrine est utile en cas d’inflammation ou lorsque la ferritine n’est pas contributive. Une supplementation systematique peut etre discutee, mais il parait preferable de ne supplementer qu’en cas de carence averee. Dans ce cas, la place du fer IV reste a definir, l’attitude pragmatique est de reserver la supplementation veineuse lorsque la voie orale est inefficace ou si le patient est intolerant au fer oral, ou si le patient a un taux d’hemoglobine inferieur a 10 g/dl.

Background The benefits of single‐use ultrasonic scissors in thyroid surgery are still debated. Although this device has been shown to reduce operating time compared with conventional haemostasis, its cost‐effectiveness has never been demonstrated. The aim of this study was to evaluate the efficacy, cost‐effectiveness and safety of ultrasonic scissors for total thyroidectomy. Methods This was a prospective, randomized, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with hypocalcaemia (serum calcium level below 2 mmol/l) on day 2. Secondary endpoints included postoperative complications and costs, with calculation of incremental cost differences and cost‐effectiveness ratios. Results In total, 1329 patients who underwent total thyroidectomy were included in the analysis: 670 were randomized to treatment with ultrasonic scissors and 659 to conventional haemostasis. There was no difference between groups in the rate of complications, including hypocalcaemia on day 2 (19.7 per cent in ultrasonic scissors group versus 20.3 per cent in conventional haemostasis group; P = 0·743). Median operating times were significantly shorter with ultrasonic scissors (90 versus 100 min with conventional haemostasis; P

Objective This study is to determine the impact of complications after total thyroidectomy on health-related quality of life (HR-QoL) and to identify significant predictive factors of HR-QoL changes. HR-QoL is usually impaired in patients with thyroid diseases compared to the general population. Thyroidectomy is largely performed in the case of benign thyroid benign and can be associated with long-term complications (vocal cord palsy, hypoparathyroidism). Design The prospective ThyrQoL multicenter trial (NCT02167529) included 800 patients who underwent total thyroidectomy for benign or malignant non-extensive disease in seven French referral hospitals between 2014 and 2016. Methods HR-QoL was assessed using the MOS 36-item short form health survey (SF-36) self-questionnaire with a 6-month follow-up. Results We observed a significant improvement of HR-QoL 6 months after surgery (P Conclusion We observed a significant improvement of HR-QoL 6 months after total thyroid surgery for benign thyroid disease.

Nous rapportons le cas d’une patiente âgee de 52 ans presentant un tableau suspect d’hypercorticisme ectopique revelant un pheochromytome bilateral. Madame N diabetique sous ADO et hypertendue est admise aux urgences pour une ischemie aigue du membre inferieure avec necessite d’une amputation sur echec de revascularisation. Mise en evidence d’un thrombus intracardiaque responsable du tableau d’ischemie et a l’angioscanner de 2 volumineuses surrenales de 48 et 85 mm. Constations morphologiques ayant fait realiser un bilan hormonal d’autant plus justifie du fait d’une hypokaliemie severe et resistance a la supplementation. Mise en evidence d’un hypercorticisme ACTH dependant, non freinable et d’allure ectopique. Par ailleurs, hypersecretion adrenergique avec derives methoxyles urinaires explosifs (plus de 20 fois la normale pour la normetadrenaline et 50 fois pour la metadrenaline) et ce au meme niveau que les catecholamines sanguines prelevees a l’occasion d’une symptomatologie evocatrice. Devant une IRM et un TEP FDG non contributifs, realisation d’un TEP DOPA en faveur d’un pheochromocytome bilateral associe a une fixation thyroidienne suspecte dans le contexte de tumeur medullaire. Pheochromocytome confirme sur le plan anatomopathologique apres surrenalectomie bilaterale avec depistage genetique NEM2 type FMTC positif. Correction de l’HTA et du diabete dans les suites. Thyroidectomie programmee dans un second temps. Le pheochromocytome, dont les manifestations cliniques peuvent etre diverses, est une tumeur neuroendocrine qui peut dans de rares cas etre responsable d’un hypercorticisme via une secretion ectopique d’ACTH. Du fait des pieges diagnostiques que cela peut engendrer, il nous parait important de connaitre le lien entre ces deux pathologies.

Introduction La sleeve, le bypass et l’anneau gastrique sont les trois principales chirurgies bariatriques realisees en France. Leurs complications postoperatoires etant principalement evaluees au cours du premier mois postoperatoire, notre objectif etait de comparer entre ces trois chirurgies, le risque de reprise chirurgicale et sa severite, dans les six mois postoperatoires. Methodes Nous avons selectionne dans la base PMSI nationale MCO, les patients operes entre 2013 et 2015 pour l’une de ces trois chirurgies. Au sein de chaque hopital, les patients operes d’une sleeve ont ete apparies aux patients operes d’un bypass (cohorte A) et d’un anneau (cohorte B), par des scores de propension considerant les caracteristiques des patients. Les reprises chirurgicales ont ete classees selon leur severite (faible, moderee, elevee), a l’aveugle, par trois chirurgiens sur la base des actes CCAM. Le risque de survenue d’une reprise chirurgicale et sa severite a ete compare dans les deux cohortes avec des modeles de survie tenant compte du risque competitif de deces, dans les six mois postoperatoires. Resultats La cohorte A etait constituee de 34252 patients operes dans 304 hopitaux. Le risque de reprise chirurgicale etait plus faible pour la sleeve que pour le bypass lors de la premiere semaine suivant l’intervention (HR 0,64 IC95 % [0,56–0,73]) ainsi qu’apres deux mois postoperatoires (0,64 [0,53–0,77]). La cohorte B etait constituee de 25206 patients operes dans 378 hopitaux. Le risque de reprise etait plus eleve pour la sleeve que pour l’anneau la premiere semaine suivant l’intervention (1,58 [1,29–1,94]) alors qu’il etait plus faible apres deux mois postoperatoires (0,08 [0,07–0,09]). Dans les deux cohortes, les resultats etaient similaires pour les reprises de severites moderees. Discussion/Conclusion Au-dela de deux mois postoperatoires, la sleeve est la procedure presentant le moins de risque de reprises chirurgicales y compris pour les severites moderees.

Introduction Le syndrome d’apnees hypopnees obstructives du sommeil (SAHOS) est un probleme majeur de sante publique. Son facteur de risque principal est l’obesite. L’objectif de notre etude etait d’evaluer l’evolution (clinique/polygraphique) et les facteurs predictifs d’amelioration du SAHOS modere a severe, apres court-circuit gastrique de patients obeses grade 2 et 3. Methodes Parmi les 277 patients incidents candidats a une chirurgie bariatrique dans notre institut, entre juin 2012 et aout 2014, 129 presentaient un SAHOS necessitant un traitement par PPC. Un enregistrement du sommeil post-chirurgie a ete realise pour 44 patients (la majorite des patients refusant de realiser ce deuxieme examen), apres une perte ponderale d’au moins 10 %. Les resultats sont exprimes en moyenne ± ecart type. Resultats La plupart des patients presentaient un SAHOS severe avec un IAH moyen de 52,8/h ± 23,8 et un index de desaturation de 57,7/h ± 43,9. L’IMC moyen etait de 46,1 kg/m2 ± 5,1. Ils etaient tous traites par PPC (autopilotee entre 4 et 16 cmH2O pour la plupart). Le delai moyen entre le diagnostic de SAHOS et la chirurgie bariatrique etait de 7,9 mois ± 5,4. Entre les deux enregistrements du sommeil, la perte ponderale etait de 27,8 % ± 7,3. Trente et un patients (70,5 %) ont gueri (IAH Conclusion Apres court-circuit gastrique, 70,5 % des 44 patients guerissent ou ameliorent leur SAHOS permettant l’arret de la PPC. Au diagnostic : un plus jeune âge et un index de desaturation par heure plus faible, sont des criteres predictifs d’amelioration du SAHOS. Un suivi specifique des patients ne presentant pas ces criteres de bon pronostic, reste a definir.

Background The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease. Methods Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics. Results Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017). Conclusion NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

Ces trois dernieres annees ont ete riches pour la thyroide puisque sont parues trois grandes publications internationales autour de la prise en charge des cancers thyroidiens, du diagnostic au traitement. Chacune de ces trois publications impactent a leur niveau l’etendue de la chirurgie thyroidienne : –la nouvelle classification des cytologies de nodule thyroidien, Bethesda 2017, (Cibas & Ali, Thyroid, 2017) integre les NIFT-P (Non ivasive follicular thyroid neoplasm with papillary-like nuclear features) pour le calcul de la probabilite de cancer, et integre la biologie moleculaire avant decision de chirurgie ; –la nouvelle classification de l’OMS des Tumeurs Endocrines (4th Edition of the WHO Classification of Tumors of Endocrine Organs) officialise entre autres le re-classement des NIFT-P en tumeur et non plus en cancer. Le nouveau TNM classe les microcancers papillaires y compris avec extension thyroidienne en cancer de bon pronostic ; –enfin, concernant les traitements des cancers thyroidiens (Haugen et al., Thyroid, 2015), on assiste a une tendance a la decroissance, qu’il s’agisse de l’activite delivree, ou de l’etendue de la chirurgie et en particulier du curage ganglionnaire. L’objectif de cet atelier est de faire une synthese de ces nouveautes, et de proposer un algorithme decisionnel a la lumiere de ces nouvelles recommandations et tendances. L’apport de l’echographie et de la nouvelle classification EU-TIRADS 2017 seront egalement discutes.

Resume Le nombre de femmes enceintes en France est actuellement estime a 950 000 par an. Cette incidence implique qu’une femme enceinte est donc susceptible de presenter une ou plusieurs pathologies abdominales au cours de la grossesse avec parfois la necessite d’un traitement chirurgical eventuellement urgent. Le but de cette mise au point etait de decrire les circonstances de prise en charge d’une femme enceinte par un chirurgien visceral a travers quatre thematiques differentes : les cancers colorectaux, les urgences digestives, la place de la laparoscopie et la chirurgie bariatrique.

There is currently no consensus as to what is considered a failure following bariatric surgery. Weight loss then weight stabilisation must be taken into consideration, but so also must any effects on comorbidity and quality of life. The reference goal is no longer achieving an ideal weight but one that corresponds with a BMI of 25 kg/m2. Weight loss objectives are seen differently by doctors, surgeons and patients. Those undergoing surgery dream of losing 50% of their preoperative weight, whereas preliminary results suggest that the average weight loss is 32%. More studies are needed to assess how effective therapeutic education is with respect to how results are viewed over time. The SOS Study demonstrated that while some of the surgery’s effects on psychological parameters and quality of life depend on weight change, others do not. Delta weight and its development are thus key biopsychosocial indicators that must be analysed several years after surgery.

L’idee de faire maigrir les patients avant une chirurgie bariatrique n’est pas nouvelle et avait ete proposee, des 1986, pour diminuer le volume hepatique et ameliorer la steatose hepatique. Le but de ce travail a ete d’evaluer les donnees objectives disponibles concernant l’amaigrissement preoperatoire avant chirurgie bariatrique. Si pour le chirurgien les benefices de l’amaigrissement semblent intuitivement interessants, les donnees actuelles ne permettent aucune conclusion definitive (principalement en ce qui concerne la morbidite, la duree operatoire et la duree d’hospitalisation). Il semble neanmoins qu’un amaigrissement preoperatoire soit souhaitable pour les patients superobeses (IMC > 50 kg/m2), mais cette option doit alors etre mise en balance avec la strategie chirurgicale en deux temps (par exemple: sleeve gastectomy puis courtcircuit gastrique).

La chirurgie bariatrique entraine des risques de complications metaboliques et nutritionnelles. Les carences observees sont liees le plus souvent a la malabsorption creee par le montage chirurgical, mais la diminution des apports et le desequilibre alimentaire genere par la restriction est egalement en cause. La prevalence elevee de la carence en fer (environ un tiers des patients apres gastroplastie et plus de 50 % apres court-circuit gastrique [CCG]) justifie une surveillance biologique reguliere. Une supplementation en cas de carence averee est conseillee apres chirurgie restrictive, et chez l’homme apres CCG. Une supplementation systematique doit etre discutee chez les femmes en âge de procreer ayant subi un CCG (200 mg de fer element par jour). La carence en vitamine B12 est classique apres CCG, mais n’est pas rare apres chirurgie restrictive (4–10 %). Une supplementation est indispensable apres CCG. La voie orale est possible (1 000 μg/semaine a 500 μg/j). Le deficit en acide folique concerne environ 40 % des sujets apres CCG. Une dose de 400 μg a 1 mg/j est necessaire pour corriger cette carence. Elle doit etre prevenue systematiquement en cas de desir de grossesse. Une elevation de la parathormone, traduisant la carence en vitamine D et la diminution de l’absorption du calcium avec ses consequences osseuses, est frequente apres CCG. Une supplementation calcique et en vitamine D doit etre proposee dans ce cas (1 000–1 500 mg/j de calcium [citrate] associee a 400–1 000 UI de cholecalciferol). La carence en thiamine (Vit B1), responsable d’une encephalopathie de Gayet-Wernicke, est generalement provoquee par la perfusion de glucose chez un patient carence (vomissements). La carence en zinc et en selenium touche 25 a 30 % des patients. La supplementation en fer, vitamine B12, folate, calcium et vitamine D et un suivi rigoureux du statut nutritionnel est necessaire apres chirurgie bariatrique, et notamment apres CCG. Le patient devra etre informe de cette necessite. L’evaluation de la compliance du patient est un des elements a prendre en compte dans l’analyse de l’indication.

Contexte Peu d’etudes ont evalue le role de la TEP/TDM au 18F-Fluorodeoxyglucose dans le diagnostic de tumeurs surrenaliennes chez les patients non oncologiques. Objectif Evaluer la contribution de la TEP/TDM au 18F-FDG dans cette indication dans le cadre d’une etude prospective. Materiel et methodes La population d’etude a consiste en 87 masses surrenales (87 patients) : 56 avec diametre > 40 mm et 31 avec diametre ≤ 40 mm mais de nature indeterminee sur le scanner surrenalien (avec calcul des lavages). Quatorze patients avaient un hypercortisolisme. Les masses surrenaliennes ont ete caracterisees par TEP/TDM au 18F-FDG. L’histologie a ete consideree comme l’etalon pour le diagnostic de lesion benigne ou maligne. Dans d’autres cas, la nature benigne de la lesion a ete basee sur le suivi par TDM a 12 mois (modification de la taille Resultats Quinze ont ete classees comme malignes (incluant 11 CSM) et 72 benignes (49 histologiquement prouvees et 23 stables). Comparees aux lesions benignes, les lesions malignes avaient une plus grande taille ( p = 0,003), une densite spontanee plus elevee ( p = 0,002), un lavage relatif plus bas ( p = 0,007) et une captation de 18F-FDG plus elevee sur l’analyse qualitative et quantitative ( p 1,5 avec des sensibilite, specificite, VPP, VPN et exactitude de 86,7 % (l’intervalle de confiance de 95 % : 62,1 %–96,3 %), 86,1 (76,3–92,3), 56,5 (36,8–74,4), 96,9 (89,3–99,1) et 86,2 (77,4–91,9), respectivement. Bien que statistiquement non significative, comparee aux parametres quantitatifs, l’analyse visuelle avait une sensibilite de 100 % (contre 90,9 % pour le ratio) dans la distinction entre l’adenome vs CSM. Un modele predictif pour le diagnostic de CSM tenant compte de la taille et du ratio a ete construit. Conclusions Nos resultats montrent que la TEP/TDM au 18F-FDG permet d’ameliorer la caracterisation des masses surrenaliennes volumineuses et/ou atypiques a la TDM et devrait etre recommandee dans cette indication.

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

Primary hyperparathyroidism is an unusual cause of acute pancreatitis. The aim of this study was to analyse data from multiple centers concerning patients with primary hyperparathyroidism and associated acute pancreatitis and to analyze potential predictive factors.In this retrospective multicentric study, 19 patients were identified (Group A) with the associated diagnoses of acute pancreatitis and primary hyperparathyroidism. Their clinical data was compared to that of a control group of 65 patients (group B) with primary hyperparathyroidism without acute pancreatitis.Age, parathormone levels and pathology (uni/multiglandular disease) were similar between the two groups. The mean plasma calcium level was significantly higher in group A (12.64 mg/100ml) than in group B patients without pancreatitis (11.28 mg/100ml) (p0.0001).This study confirms the causal relationship between primary hyperparathyroidism and acute pancreatitis. The degree of hypercalcemia may play an important role in this association. Calcium levels should be measured in all patients with acute pancreatitis.

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

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

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

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

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

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

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

The tumor size is considered as a limitation for laparoscopic adrenalectomy. The aim of this study was to assess diagnostic characteristics, hemodynamic modifications, and outcome of intraperitoneal laparoscopic adrenalectomy according to the size of pheochromocytoma.Retrospective study from January 1997 to December 2000. Results were evaluated according to the size of pathologic study (oror = 5 cm).Forty two patients underwent laparoscopic adrenalectomy during this period. Among them, 11 (26%) were operated on for adrenal pheochromocytoma (6 patients5 cm and 5 patientsor = 5 cm). Preoperative systolic hypertension was 138 mmHg and 178 mmHg respectively (p = 0.01). Urinary metanephrine/normetanephrine rate was 1.259 and 0.268 respectively (p = 0.08). Capsular tumor effraction rate was 27%. Tumor size was 37% larger than that estimated by CT scan (24% versus 52%). Mean hospital stay was 10 days and 8 days respectively. Morbidity and mortality were 18% and 0%. All these criteria were not statistically significant among the two groups of patients.Pheochromocytoma sizeor = 5 cm do not modify outcome of patients but is responsible for preferential noradrenaline secretion and stronger hemodynamic modifications. Tumor fragmentation rate and CT scan size underestimation seem important in this group of patients. These characteristics have to be integrated to improve laparoscopic adrenalectomy outcome of patients with pheochromocytomaor = 5 cm.

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