G Fourtanier

University of Toulouse, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (128)206 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the present study was to assess the clinical fate of, and to gain new insights into, branch duct and mixed (predominantly main duct type) forms of intraductal papillary mucinous neoplasia of the pancreas (IPMN). During a 17-year period, 99 successive IPMN patients (52 men, 47 women; mean age, 64 years) were included and divided into two groups for further comparison: one group had branch duct IPMN, whereas the other had mixed IPMN. Patients from the mixed IPMN group (n = 52) displayed a greater rate of symptoms (83% vs 55%, P = 0.004), pancreatic resection (67% vs 38%, P = 0.007), malignancy (35% vs 13%, P = 0.017) and death (15% vs 4%, P = 0.09) than those from the branch duct IPMN group. A 38-month follow up of non-operated, symptom-free patients confirmed that more than 85% of branch duct IPMN patients were asymptomatic without evidence of malignancy. Borderline lesions and carcinoma are found in up to 50% of symptomatic resected branch duct IPMN cases. Patients with the mixed form of IPMN as well as with symptomatic branch duct IPMN should require pancreatic resection because of symptoms and the risk for malignancy. In silent branch duct IPMN without radiological signs of malignancy, a non-operative watch-and-wait strategy can be discussed.
    Journal of Gastroenterology and Hepatology 06/2009; 24(7):1211-7. DOI:10.1111/j.1440-1746.2009.05826.x · 3.50 Impact Factor
  • Fabrice Muscari · Jean-Louis Montastruc · Gilles Fourtanier
    Pédagogie médicale 05/2009;
  • F. Muscari · P. Trocard · J. P. Guinard · B. Foppa · R. Guimbaud · G. Fourtanier · B. Suc
    Gastroentérologie Clinique et Biologique 03/2009; 33(3). DOI:10.1016/S0399-8320(09)72916-1 · 1.14 Impact Factor
  • Gastroentérologie Clinique et Biologique 03/2009; 33(3). DOI:10.1016/S0399-8320(09)72755-1 · 1.14 Impact Factor
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    ABSTRACT: Posttransplant patient outcome and quality of life are affected by different factors, such as post-graft context, psychological state, and polymedication. Many surveys have been carried out to study immunosuppressant ADRs, and have mainly used a questionnaire completed by patients, but few have asked patients about their drug exposure. The aim of this study is to describe drug exposure and adverse drug events (ADEs) reported by liver-transplant patients (LTP). This observational, retrospective study assessed questionnaires from LTPs concerning demographic data, drug exposure, and ADEs. 118 LTPs exposed to 5.9 (+/- 2.8) drugs with immunosuppressive regimens, consisting mainly of tacrolimus (79.3%), cyclosporine (18.1%), or sirolimus (2.6%), were also exposed to antihypertensive drugs (43.2%), protonpump inhibitors (30.5%), statins (28.8%), drugs acting on bile composition (26.3%), and diuretics (19.5%). 1,389 ADEs were reported: 30.1% neurological, 13.4% cutaneous, 12.4% hematological, 11.1% digestive, 10.1% osteomuscular, 6.6% cardiovascular, and 16.3% others. Significantly more ADEs were reported by patients exposed to cyclosporine than those receiving tacrolimus (p < 0.05). Patients with a transplant for < 18 months had more tremors and those with a transplant for > 79 months reported more hirsutism, gingival hypertrophia, and arterial hypertension. This study shows the value of patient-reporting via structured interviews for both drug exposure and ADEs, and the importance of this approach to complement total data collection.
    International journal of clinical pharmacology and therapeutics 03/2009; 47(3):159-64. DOI:10.5414/CPP47159 · 1.22 Impact Factor
  • Fabrice Muscari · Jean-Louis Montastruc · Gilles Fourtanier
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    ABSTRACT: Aim of study: To evaluate a new assessment grid of written summary in order to obtain a reduction of the variation of scores between different correctors. Material and Method: The assessment grid allowed to elaborate a score based on a “global” evaluation and a score obtained from “key words”, which made it original. Fifty copies were collected for this work. Five different correctors collected each copy. the criteria of judgement were the following: 1) dispersion of the five scores obtained for each copy by calculating the average; 2) percentage of variation of the scores according to correctors; and 3) dispertion of the value of each score for each corrector compared to the average calculated from all copies. Résultats : This modified assessment grid with the addition of key the words does not lead to a reduction of scores variation according to the corrector. The key word scoring leads even to a greater variation of scores between corrector: 50% of copies had a variation of scores inter-corrector of more than 40%. Also, this new assessment grid conducts to a great dispersion of scores according to the corrector experience. Conclusion: This new assessment grid of written scientific article critical reading summaries weakly diminishes the variation of scores between correctors for the same copy. It is thus necessary to test of other assessment grids to ensure equity of correction for students. But : Tester une nouvelle grille de correction des résumés afin d'obtenir une réduction de la variation inter-correcteurs des scores. Matériel et Méthodes : La grille de correction permettait d'élaborer un score sur la base d'une évaluation "globale" et d'une évaluation de "mots clés", ce qui en faisait l'originalité. Cinquante copies ont été recueillies pour ce travail. Chaque copie a fait l'objet d'une correction par cinq correcteurs différents. Les critères de jugement étaient : la dispersion des cinq scores obtenus par chaque copie en calculant la moyenne ; le pourcentage de variation des notes en fonction des correcteurs; la dispersion des notes de chacun des scores pour chaque correcteur par rapport à la moyenne calculée sur l'ensemble des copies. Résultats : Cette grille de correction modifiée avec l'adjonction de mots clés n'entraîne pas de diminution des variations des notes en fonction du correcteur. La notation de la partie mots clés entraine même une grande variation des notes d'un correcteur à l'autre : 50 % des copies avaient une variation de note inter-correcteur de plus de 40 %. De même, cette nouvelle grille de correction entraîne une grande dispersion des notes en fonction de l'expérience du correcteur. Conclusion : Cette nouvelle grille de correction du résumé diminue peu les variations de scores inter-correcteurs pour une même copie. Il faut donc tester d'autres grilles de correction du résumé de la lecture critique pour assurer une équité de correction pour les étudiants.
    Pédagogie médicale 02/2009; DOI:10.1051/pmed/20080334
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    ABSTRACT: Multivariable analysis best identifies independent risk factors. We conducted a prospective evaluation of 2,605 patients through univariate analysis followed by nonconditional multiple logistic regression analysis on 39 pre-, intra-, and postoperative factors, analyzed according to preoperative factors alone, preoperative and intraoperative factors together, and all 3 combined. The purpose was to identify surgeon-dependent independent risk factors for mortality after elective colorectal surgery, with immediate anastomosis for cancer and nonacute diverticular disease. Overall mortality was 3.5%. Through multivariable analysis, five risk factors were found when preoperative data were analyzed alone. Four remained (age between 60 and 75 years, age greater than 75 years, male gender, and heart failure) and 4 new factors (palliative resection, total colectomy, respiratory failure, and surgeon-dependent fecal soiling [the only surgeon-dependent factor]) appeared when pre- and intraoperative factors were analyzed together. Of the latter, two remained stable when all three categories of risk factors were combined and analyzed (palliative resection and total colectomy), and the two others disappeared. Of the eight pre-, intra-, and postoperative factors combined, two new factors appeared: extrasurgical site (ESS) and surgeon-dependent, organ space surgical site (O/SSS) morbidity. Every effort must be made to collect specific, surgeon-dependent (technical and clinical) data, along with administrative data, for multivariable analysis of risk factors. Classification into three periods (pre-, pre- and intraoperative together, and pre-, intra-, and postoperative combined) enables determination of relevant, surgeon-dependent risk factors (fecal soiling and postoperative morbidity) for which there are direct preventive actions.
    Journal of the American College of Surgeons 01/2009; 207(6):888-95. DOI:10.1016/j.jamcollsurg.2008.07.012 · 5.12 Impact Factor
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    ABSTRACT: To assess the results and complications of an endoscopic transgastric/transduodenal approach as a possible alternative to conventional surgery. Infected organized pancreatic necrosis carries a high mortality despite antibiotic therapy and numerous conventional and laparoscopic surgical techniques of debridement. The advent of natural orifice transluminal endoscopic surgery (NOTES) provides a possible alternative approach. Between 2004 and 2007, patients with infected organized pancreatic necrosis were referred for endoscopic necrosectomy as their initial treatment of choice. Accessibility was confirmed by CT and endoscopic ultrasound. Access to the cavities was transgastric or transduodenal, after passing the endoscope inside the retroperitoneal cavity all necrotic and purulent material was evacuated under direct endoscopic vision. Thirteen patients (12 men, mean age: 55 years, range: 38-66 years) underwent endoscopic necrosectomy. Two patients had complementary percutaneous drainage for endoscopically inaccessible cavities. Resolution infection was the rule in all cases. Infection recurred in 4 patients and a necrotic cavity persisted in 1 patient; all were managed by further endoscopic necrosectomies (total = 23 necrosectomy sessions; mean, 1.8 per patient; range, 1-3). Mean duration of each session was 3.5 hours (range, 2.5-4 hours). Endoscopic treatment was eventually successful in all patients with gradual diminution of the necrotic cavities on CT images. Average duration of follow-up was 19.5 months (range, 2-56 months) with no recurrence of the infectious process and no surgery was required for any patient. Complications included bleeding (n = 3) and transient aggravation of sepsis (n = 3). No mortality occurred. This technique is highly effective and safe in the treatment of infected organized pancreatic necrosis. Results are achievable and sustainable with a limited number of sessions.
    Annals of surgery 01/2009; 248(6):1074-80. DOI:10.1097/SLA.0b013e31818b728b · 8.33 Impact Factor
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    ABSTRACT: To assess the consequences of graft steatosis on postoperative liver function as compared with normal liver grafts. From January 2005 to December 2007, liver transplant patients were prospectively included, excluding those who experienced arterial or biliary complications or presented acute rejection. All patients had a surgical biopsy after reperfusion. Patients were compared according to the rate of macrovacuolar steatosis: namely above or below 20%. Fifty-three patients were included: 10 in the steatosis group and 43 in the control group. No significant difference was observed in terms of morbidity, mortality, and primary non- or poor function. Nevertheless, biological changes after the procedure were significantly different during the first postoperative week. Prothrombin time, serum bilirubin, and transaminases were significantly increased among the steatosis group compared with the control group (P < .05). This case-controlled study including a small number of patients, described postoperative biological changes among liver transplantations with steatosis in the graft.
    Transplantation Proceedings 12/2008; 40(10):3562-5. DOI:10.1016/j.transproceed.2008.06.087 · 0.98 Impact Factor
  • Endoscopy 03/2008; 40(03). DOI:10.1055/s-2008-1066979 · 5.05 Impact Factor
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    ABSTRACT: No agent has been consistently effective in preventing formation of peritoneal adhesions and postoperative bowel obstruction after abdominal surgery. The aim of this prospective multicenter study was to assess clinical safety and efficiency of a new adhesion-reduction barrier Between September 2000 and April 2001, Prevadh was used in 78 patients. Operative procedures included 25 hepatic resections, 7 cholecystectomies, 32 colonic resections, 7 protectomies, 3 colostomy or recovery of continuity, 1 gynaecologic surgery and 3 others. Eleven patients were operated on by laparoscopy and 67 by laparotomy. The overall incidence of abscesses and wound complications was 2.4% and 9% respectively. After a mean follow-up of 36 months (range: 4-51 months), no patients experienced adverse events related to the adhesion barrier. Surgical reoperative procedures were performed in 10 patients for unrelated causes and no bowel obstruction occurred within the protected area. This study confirmed the safety of Prevadh adhesion barrier and suggested that this resorbable barrier might provide prevention from adhesion formation on peritoneal injured surfaces. However, a large randomized controlled trial remains necessary to prove the real effectiveness of adhesion barriers on clinical long-term outcome.
    Hepato-gastroenterology 03/2008; 55(82-83):517-21. · 0.93 Impact Factor
  • Annales de Chirurgie 07/2006; 131(6):415-420. DOI:10.1016/j.anchir.2006.04.004 · 0.52 Impact Factor
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    ABSTRACT: Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data. Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were analyzed. In univariate analysis, mortality was increased with age 70 years or more, extended resection(s), and volume and center effects. IACs occurred more often with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, extended resection(s), and the center effect. Pancreatic fistula was more frequent with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, and the center effect. In multivariate analysis, independent risk factor(s) for mortality were age greater than 70 years (odds ratio [OR], 3; 95% confidence interval [CI], 1.3-8) and extended resection (OR, 5; 95% CI, 1.2-22), risk factors for IACs were extended resection (OR, 5; 95% CI, 1.2-22) and main pancreatic duct diameter of 3 mm or less (OR, 2; 95% CI, 1.1-3), and the risk factor for pancreatic fistula was main pancreatic duct diameter of 3 mm or less (OR, 2.5; 95% CI, 1.2-4.6). Age more than 70 years, extended resections, and main pancreatic duct diameter less than 3 mm are independent risk factors that should be considered in indications for and techniques of pancreatoduodenectomy.
    Surgery 06/2006; 139(5):591-8. DOI:10.1016/j.surg.2005.08.012 · 3.38 Impact Factor
  • Journal de Chirurgie 06/2006; 143(3):160-164. DOI:10.1016/S0021-7697(06)73644-4 · 0.50 Impact Factor
  • G Fourtanier · F Muscari · J-P Duffas · B Suc
    Annales de Chirurgie 05/2006; 131(4):233-5. DOI:10.1016/j.anchir.2006.01.015 · 0.52 Impact Factor
  • I Sobocki · G Fourtanier · P Otal · J Estany
    2nd Congress of the IFSO European Chapter/3rd Combined Meeting of; 04/2006
  • Jacek Sobocki · Gilles Fourtanier · Joan Estany · Phillipe Otal
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    ABSTRACT: It has been shown that vagal nerve stimulation (VNS) can affect body mass. The aim of this study was to evaluate effect of VNS on body mass, body composition, metabolic rate, and plasma leptin and IGF-I levels. Eight female pigs were included in the study. Under general anesthesia, a bipolar electrode was implanted on the anterior vagal nerve by laparoscopy. Group A was treated by VNS, and group B was the control. After 4 weeks, stimulation was discontinued in group A and started in group B. The following parameters were evaluated: body mass, body composition, metabolic rate, plasma leptin and IGF-1 levels and intramuscular fat content (IMF). VNS attenuated body weight gain (2.28 +/- 3.47 kg vs 14.04 +/- 6.75 kg; P = .0112, for stimulation and nonstimulation periods, respectively), backfat gain (0.04 +/- 0.26 mm vs 2.31 +/- 1.12 mm) and IMF gain (-3.76 +/- 6.06 mg/g MS vs 7.24 +/- 12.90 mg/g MS; P = .0281). VNS resulted in lower backfat depth/loin muscle area ratio (0.33 +/- 0.017 vs 0.38 +/- 0.35; P = .0476). Lower plasma IGF-I concentration was found after VNS (-3.67 +/- -11.55 ng/mL vs 9.86 +/- 10.74 ng/mL; P = .0312). No significant changes in other parameters were observed. VNS affects body weight mainly at the expense of body fat resources; however, metabolic rate is not affected.
    Surgery 03/2006; 139(2):209-16. DOI:10.1016/j.surg.2005.06.025 · 3.38 Impact Factor
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    ABSTRACT: Impact of intraoperative blood salvage autotransfusion (IBSA) on neoplastic recurrence. during liver transplantations for hepatocellular carcinoma (LT-HCC). Between January 1989 and February 2003, 16 patients received a LT-HCC without IBSA. This group was compared with 31 patients who received the same surgical procedure during the same period, but with IBSA. Data were prospectively collected. All patients had at least a 1-year postoperative follow up. Pairing was made according to the size of the largest nodule. The percentage of recurrence observed in the two groups was similar: 6.4% in the IBSA group vs. 6.3% in the group without IBSA. The median amount of transfused salvage blood was 1558 ml. The differences observed between the two groups concerned the Child score which was A in 58% patients of the IBSA group vs. 80% in the other group; the percentage of severe portal hypertension was 55% in the IBSA group vs. 31%; the median number of packed red blood cell units transfused intraoperatively was 7 in the IBSA group vs. 0, and the median number of frozen fresh plasma units transfused intraoperatively was 11 in the IBSA group vs. 4.5. It appears that IBSA, essentially used during the most haemorrhagic transplantations, could be used in the case of HCC because it does not modify the risk of neoplastic recurrence.
    Transplant International 12/2005; 18(11):1236-9. DOI:10.1111/j.1432-2277.2005.00207.x · 2.60 Impact Factor
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    ABSTRACT: Only 2 large (more than 100 patients) prospective trials comparing pancreatogastrostomy (PG) with pancreatojejunostomy (PJ) after pancreatoduodenectomy (PD) have been reported until now. One nonrandomized study showed that there were less pancreatic and digestive tract fistula with PG, whereas the other, a randomized trial from a single high-volume center, found no significant differences between the two techniques. Single blind, controlled randomized, multicenter trial. The main endpoint was intra-abdominal complications (IACs). Of 149 randomized patients, 81 underwent PG and 68 PJ. No significant difference was found between the two groups concerning pre- or intraoperative patient characteristics. The rate of patients with one or more IACs was 34% in each group. Twenty-seven patients sustained a pancreatoenteric fistula (18%), 13 in PG (16%; 95% confidence interval [CI] 8-24%) and 14 in PJ (20%; 95% CI 10.5-29.5%). No statistically significant difference was found between the 2 groups concerning the mortality rate (11% overall), the rate of reoperations and/or postoperative interventional radiology drainages (23%), or the length of hospital stay (median 20.5 days). Univariate analysis found the following risk factors: (1) age > or =70 years old, (2) extrapancreatic disease, (3) normal consistency of pancreas, (4) diameter of main pancreatic duct <3 mm, (5) duration of operation >6 hours, and (6) a center effect. Significantly more IAC, pancreatoenteric fistula, and deaths occurred in one center (that included the most patients) (P = .05), but there were significantly more high-risk patients in this center (normal pancreas consistency, extrapancreatic pathology, small pancreatic duct, higher transfusion requirements, and duration of operation >6 hours) compared with the other centers. In multivariate analysis, the center effect disappeared. Independent risk factors included duration of operation >6 hours for IAC and for pancreatoenteric fistula (P = .01), extrapancreatic disease for pancreatoenteric fistulas (P < .04), and age > or =70 years for mortality (P < .02). The type of pancreatoenteric anastomosis (PJ or PG) after PD does not significantly influence the rate of patients with one or more IAC and/or pancreatic fistula or the severity of complications.
    The American Journal of Surgery 07/2005; 189(6):720-9. DOI:10.1016/j.amjsurg.2005.03.015 · 2.29 Impact Factor
  • F Muscari · B Suc · J Aguirre · G.L. Di Mauro · E Bloom · J.P. Duffas · P Blanc · G Fourtanier
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    ABSTRACT: We evaluated the peri- and postoperative effects of the lack of a temporary portocaval anastomosis (TPCA) during orthotopic liver transplantation (OLT) in 84 patients with cirrhosis. From December 1996 to December 2002, 156 liver transplant recipients included (54%; 60 men and 24 women) of mean age 52 +/- 9 years with portal hypertension. In whom peri- and postoperative data were analyzed. The median fall in mean arterial pressure upon vascular clamping and unclampings was 20 mm Hg (range 15 to 75), while the median duration of portal vein clamping was 77 minutes. The median amount of blood autotransfusion was 1100 mL (range 0 to 5400). The median number of red blood cell and fresh-frozen plasma units transfused were 5 and 6.5, respectively. The median intraoperative urinary output was 72 mL/h (range 11 to 221). Three patients (3.5%) presented a perioperative complication, but no perioperative death was observed. Six patients experienced an early postoperative complication (<10 days): five hemodynamic complications and one transient renal failure, which did not require hemodialysis. One patient (1%) died at 12 hours after OLT from acute pulmonary edema. This study shows that systematic TPCA during OLT with preservation of the native retrohepatic vena cava in cirrhotic patients does not appear to be justified. In contrast, peri- and postoperative hemodynamic parameters as well as blood component requirements were comparable to those of the literature reporting OLT with straightforward TPCA.
    Transplantation Proceedings 07/2005; 37(5):2159-62. DOI:10.1016/j.transproceed.2005.03.005 · 0.98 Impact Factor

Publication Stats

1k Citations
206.00 Total Impact Points


  • 2009
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2006
    • Paul Sabatier University - Toulouse III
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2002
    • University Hospital Magdeburg
      Magdeburg, Saxony-Anhalt, Germany
  • 1987–2001
    • Centre Hospitalier Universitaire de Toulouse
      • • Service de Chirurgie Générale et Digestive
      • • Service de Radiologie
      Toulouse, Midi-Pyrenees, France
  • 1994
    • French National Centre for Scientific Research
      • Centre de Recherche de Biochimie Macromoléculaire
      Lutetia Parisorum, Île-de-France, France
  • 1992
    • Institut Claudius Regaud
      Tolosa de Llenguadoc, Midi-Pyrénées, France