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Bariatric surgery may be associated with severe postoperative complications (SPC). Factors associated with the risk of SPC have not been fully investigated. This study aimed to identify preoperative risk factors of SPC within 90 days and to develop a risk prediction model based on these factors. We conducted a retrospective single-center cohort study based on a prospectively maintained database of obese patients undergoing laparoscopic bariatric surgery from October 2005 to May 2019. All SPC occurring up to the 90th postoperative day were recorded according to the Dindo-Clavien classification. Associations between potential risk factors and SPC were analyzed using a logistic regression model, and the risk prediction (“OS-SEV90 score”) was computed. Based on the OS-SEV90 score, the patients were grouped into 3 categories of risk: low, intermediate, and high. Among 1963 consecutive patients, no patient died and 82 (4.2%) experienced SPC within 90 days. History of gastric or esophageal surgery (adjusted odds ratio (aOR) 3.040, 95% confidence interval; CI 1.78–5.20, p< 0.0001), past of thromboembolic event aOR 2.26, 95%; CI 1.12–4.55, p = 0.0225), and surgery performed by a junior surgeon (aOR 1.99, 95%; CI 1.26–3.13, p = 0.003) were all independently associated with risk for SPC, adjusting for ASA physical status system (ASA) score ≥ 3, severe OSA, psychiatric disease, asthma, a history of abdominal surgery, alcohol, cardiac disease, and dyslipidemia. “the OS-SEV90 score” based on these factors was constructed to classify patients into 3 risk groups: low (≤2), intermediate (3–4), and high (≥5). According to “the OS-SEV90 score,” SPC increased significantly from 2.9% in the low-risk group, 7.7% in the intermediate-risk group, and 23.3% in the high-risk group. A predictive model of SPC within 90 days “the OS-SEV90 score” has been developed using 9 baseline risk factors. The use of the OS-SEV90 score may help the multidisciplinary team to identify the specific risk of each patient and inform them about and optimize the comorbidities before the surgery. Further studies are warranted to validate this score in a new independent cohort before using it in clinical practice.

Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of this systematic review is to inform and help the attending physician, the emergency physician and the non-bariatric surgeon who may be called upon to manage surgical complications that arise after adjustable gastric band (AGB), sleeve gastrectomy (SG), or gastric bypass (GBP). Data from evidence-based medicine were extracted from the literature by a review of the Medline database and also of the most recent recommendations of the learned societies implicated. The main complications were classified for each intervention, and a distinction was made between early and late complications. Early complications after AGB include prosthetic slippage or perforation; SG can be complicated early by staple line leak or fistula, and BPG by fistula, stenosis and postoperative hemorrhage. Delayed complications of AGB include intragastric migration of the prosthesis, late prosthetic slippage and infection, while SG can be complicated by gastro-esophageal reflux, and BPG by anastomotic ulcer and internal hernia. The analysis of available data allowed us to develop decisional algorithms for the management of each of these complications.

International audience; BACKGROUND:The aim of this study was to investigate whether the implementation of enhanced recovery after surgery (ERAS) guidelines according to Thorell and co. in our tertiary referral bariatric center might improve post-operative outcomes.METHODS:ERAS program was introduced in our center since January 1, 2017. Retrospective review of a prospectively collected database identified patients who underwent laparoscopic primary and revisional bariatric surgeries from October 2005 to January 2018. Patients exposed to ERAS program ("ERAS group") were matched in a 1:1 ratio with patients exposed to conventional care (control group) using a propensity score based on age, gender, preoperative body mass index (BMI), diabetes mellitus, and the type of procedures. The primary outcome was total hospital length of stay (LOS) and the secondary outcomes included the post-operative complications and readmission rates.RESULTS:During the study period, 464 patients were included, 232 in each group. Implementation of the ERAS protocol was significantly associated with a reduction of LOS (2.47 ± 1.7 vs 5.39 ± 1.9 days, p

Resume La sleeve gastrectomie (SG) est une technique restrictive en plein essor avec 5302 actes realises en 2009, 13 557 en 2011 et 24 190 en 2013. Parmi les complications precoces, la stenose gastrique est bien decrite avec une prevalence comprise entre 0,7 et 4,0 % (Dhahri et al., 2010). Nous rapportons ici un cas d’une stenose fonctionnelle sans stenose anatomique. Cette complication rare est la consequence d’un agrafage spiroide, correspondant a une malfacon initiale (Iannelli et al., 2014). La torsion du tube de sleeve gastrectomie par agrafage spiroide expose au risque de dysphagie recurrente avec une stenose au transit œso-gastro-duodenal (TOGD) non retrouvee a la fibroscopie œso-gastro-duodenale (FOGD). La conversion en by-pass gastrique en Y (RYGBP) est une solution. La patiente est actuellement a 6 mois de sa conversion et n’a plus aucun symptome avec une excellente qualite de vie et un score de +9 au questionnaire BAROS.

Sleeve gastrectomy (SG) is an increasingly popular restrictive bariatric procedure as attested by the 5,302 procedures performed in 2009, increasing worldwide to 13,557 in 2011 and to 24,190 in 2013. Among the early complications, gastric stricture is well described with a prevalence between 0.7 and 4.0% (Dhahri et al., 2010). The patient reported here had functional stenosis without any underlying anatomic stricture. This complication is rare and is the consequence of spiral stapling resulting in a gastric tube that is twisted from the start (Iannelli et al., 2014). Twisted sleeve gastrectomy resulting from spiral stapling exposes the patient to the risk of recurrent dysphagia, which has the appearance of stenosis on upper GI series but not on fibroscopy. Conversion to RY-GBP is one solution. At six months follow-up after conversion, our patient is symptom-free, with quality of life was rated excellent (a score greater than 9 on the BAROS questionnaire).

Esophagopericardial fistula (EPF) is an uncommon but life-threatening complication of upper gastrointestinal tract surgery or endoscopy, which is related to anastomotic breakdown, chronic infection or esophageal traumatism. We first describe the first case of an EPF secondary to double pigtail drain migration: an endoscopic internal approach for the treatment of leak following revisional sleeve gastrectomy.

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.

Resume Introduction L’infection profonde apres cure de hernie inguinale est rare, alors que l’utilisation de prothese s’est generalisee ; il existe meme un debat sur l’opportunite de la necessite d’une eventuelle antibioprophylaxie. But du travail Evaluer l’incidence de ce type de complication et preciser les modalites diagnostiques et l’attitude therapeutique optimale par la mise en commun de l’experience de 32 chirurgiens. Methode Un questionnaire a ete adresse a 50 chirurgiens sur leur experience de l’utilisation de prothese pour la cure de hernie de l’aine. Pour chaque cas d’infection profonde, les elements diagnostiques et therapeutiques etaient detailles. Resultats Quarante-cinq cas ont ete rapportes chez 38 patients, quelle que soit la voie d’abord. Le diagnostic est aise apres un delai variable: 51 % dans le premier mois postoperatoire, mais superieur a un an dans 26 % des cas. La guerison a ete obtenue chez 33 patients par l’ablation de la prothese, d’emblee dans 14 cas, mais apres diverses tentatives therapeutiques dans 19 cas, pendant un delai moyen de 12,5 mois. Conclusions Cette collection retrospective, la plus importante rapportee dans la litterature, confirme la rarete et la gravite de ce type de complication et suggere que seule l’ablation de la prothese permet la guerison.

Summary Introduction Infection after repair of groin hernia is rare, even since the advent of mesh repair. The debate remains open about antibiotic prophylaxis. Aim of the study Assess incidence of this kind of complication, determine criteria of diagnosis and strategy of therapy by examining the collective experience of 32 surgeons. Method Fifty surgeons were asked to report their experience with mesh repair of inguinal hernias and specifically mesh infection. Diagnosis and therapy for each mesh infection were detailed. Results Forty-five cases were reported in 38 patients who had undergone open or laparoscopic mesh repair. Diagnosis was straightforward and established at a variable delay after mesh insertion: 51% during the first postoperative month; 26% more than one year after the procedure. Infection cured in 33 patients after mesh removal, in one step in 14 cases, but after many attempts for conservative therapy in 19 cases; the mean delay to cure was 12.5 months. Visceral resections had to be associated with mesh removal in 13% of cases. Conclusions This is the largest series of mesh infections after inguinal hernia repair reported in the literature. According to the evidence provided here, mesh removal appears to be the most appropriate treatment of this rare and serious complication.

Sleeve gastrectomy (SG) is currently considered as a primary bariatric surgery. This is because of its relative simplicity and satisfactory results. As observed with other bariatric procedures, surgeons are confronted with insufficient weight loss or weight regain, insufficient resolution of metabolic disorders, and intractable severe reflux. A retrospective analysis of conversion from SG to Roux-en-Y gastric bypass (RYGBP) was performed to assess weight loss, diabetes resolution, and relief of reflux symptoms. The mean interval between the two procedures was almost 24 months. Eighteen patients underwent conversion from SG to RYGBP for insufficient weight loss (n = 9), severe reflux (n = 6), and persistence of type 2 diabetes mellitus (T2DM) (n = 3). The median follow-up was 15.5 months. Weight loss was significantly improved with a mean percentage of excess of body mass index loss at 64.6 % after conversion versus 47.1 % before conversion. All reflux symptoms were immediately relieved without any medication at the end of the follow-up. The three patients who had an operation for persistence of T2DM are now free of medication. Only one postoperative complication was observed as a small bowel injury, which was treated surgically. Conversion from SG to RYGBP is safe. Severe reflux is definitely treated and is an incontestable indication with this procedure. Additionally, weight loss and diabetes are clinically improved. Our results appear to be similar to those with a primary RYGBP.

But Le muscle transverse profond du perinee est une structure musculaire qui est mal connue tant sur le plan morphologique que sur le plan fonctionnel. Le but de cette etude est de rechercher dans la litterature si le muscle transverse profond est vu de facon identique par tous les auteurs. Materiel et methode Revue bibliographique anatomique, y compris en anatomie comparee, embryologique, histologique, clinique, ancienne que recente. Resultats si pour la plupart des auteurs, le muscle transverse profond du perinee existe avec des variations de forme d’importance, associe ou non a la membrane perineale certains le nient l’assimilant a la membrane perineale. Son role fonctionnel est discute tant chez les animaux quadrupedes que chez l’homme. Conclusion Le muscle transverse profond du perinee existe sur le plan morphologique, mais avec un role sur la statique pelvienne et sur la continence urinaire et anale qui reste encore a preciser.

But Le role du muscle transverse profond du perinee dans la continence urinaire n’est actuellement pas precise. Le but de cette etude est de rechercher si le muscle transverse profond s’insere sur l’uretre de la femme. Materiel et methode 3 sujets non embaumes de sexe feminin, ayant fait don de leur corps a la science âge moyen 83 ans. Dans un premier temps une dissection par voie perineale a permis de reconnaitre ce muscle est de determiner ses relations avec le perinee moyen et l’uretre en etudiant ses insertions et ses dispositions. Dans un deuxieme temps, ces structures etaient prelevees pour un examen microscopique avec coloration HE et trichrome de Masson. Resultats Il existait une structure musculaire visible dans les cas observes. Triangulaire elle fermait l’espace entre les branches ischio-pubiennes et les elements visceraux medians : uretre et vagin chez la femme. Sa terminaison posterieure se faisait sur le centre tendineux du perinee mais egalement sur la paroi laterale du vagin, mais aussi sur l’uretre. Conclusion Le muscle transverse profond du perinee se termine sur l’uretre. Avec ses insertions sur le vagin et le centre tendineux du perinee il joue un role de soutien des structures uretrales et donc indirectement agit sur la continence.