X Barth

Claude Bernard University Lyon 1, Villeurbanne, Rhône-Alpes, France

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Publications (91)117.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: : Fecal incontinence is a socially devastating problem that can be cured by the artificial bowel sphincter in selected cases. : This study evaluates short- and long-term morbidity and functional results of the artificial bowel sphincter. : This study is a retrospective evaluation of consecutive patients. : This study was conducted at 2 academic colorectal units. : Between May 2003 and July 2010, all consecutive patients who underwent artificial bowel sphincter implantation for severe fecal incontinence were included in the study. : The artificial bowel sphincter was implanted through 2 incisions made in the perineum and suprapubic area. : Patients were reviewed at months 1, 6, and 12, and then annually. Mortality, morbidity (early infection within the first 30 days after implant, and late thereafter), and reoperations including explantations were analyzed. Anal continence was evaluated by means of the Cleveland Clinic Florida score. Mean follow-up was 38 months (range, 12-98). : Between May 2003 and July 2010, 21 consecutive patients with a mean age of 51 years (range, 23-71) underwent surgery. There was no mortality. All patients presented with at least 1 complication. Infection or cutaneous ulceration occurred in 76% of patients, perineal pain in 29%, and rectal evacuation disorders in 38%. The artificial bowel sphincter was definitely explanted from 17 patients (81%). The artificial sphincter was able to be activated in 17 patients (81%), and continence was satisfactory at 1 year in those who still had their sphincter in place (n = 12). : There is a very high rate of morbidity and explantation after implantation of an artificial bowel sphincter for fecal incontinence. Four of 21 patients who still had an artificial sphincter in place had satisfactory continence at a mean follow-up of 38 months.
    Diseases of the Colon & Rectum 04/2013; 56(4):505-10. DOI:10.1097/DCR.0b013e3182809490 · 3.20 Impact Factor
  • Henri Damon · Xavier Barth · Sabine Roman · François Mion
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    ABSTRACT: PURPOSE: Sacral nerve stimulation (SNS) is validated as an efficient treatment for fecal incontinence (FI). However, long-term results are scarce in the literature. The goal of this study was to assess the impact of SNS on FI symptoms and quality of life, based on a retrospective analysis of prospectively collected data. METHODS: From 2001 to 2009, 119 patients (six men, mean age 61 years) underwent SNS testing for FI after an extensive diagnostic workup. Permanent implantation was realized when FI symptoms improved during testing, and follow-up visits were performed every 12 months thereafter. This follow-up evaluated morbidity and efficacy, based on clinical data and self-administered questionnaires including Jorge and Wexner FI score, urinary incontinence score (urinary distress inventory-6, UDI-6), gastrointestinal quality of life index (GIQLI), and auto-evaluation scale. RESULTS: A permanent stimulator was implanted after a positive test in 102 patients (91 %). Ten patients were explanted during follow-up (pain in one case and absence of efficacy in nine), and 29 had the stimulator and/or the electrode changed. The mean follow-up was 48 months (range 12-84): there was a significant improvement of FI score (9 ± 1 vs 14 ± 3, p < 0.0001), UDI-6 score (8 ± 4 vs 11 ± 5, p < 0.05), and GIQLI index (p < 0.002). The improvement was present at 12 months follow-up and remained stable. Eighty percent of patients were satisfied with the treatment at the last point of follow-up. None of the pretreatment variables were predictive of SNS efficacy. CONCLUSIONS: SNS improved FI and quality of life, and this efficacy remained over time. Although a complete disappearance of FI was rare, most patients were satisfied.
    International Journal of Colorectal Disease 08/2012; 28(2). DOI:10.1007/s00384-012-1558-8 · 2.42 Impact Factor
  • V. Ky · X. Barth · F. Mion · S. Roman · H. Damon
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    ABSTRACT: ButLe but de cette étude était de préciser les caractéristiques cliniques, échographiques et manométriques de l’incontinence anale (IA) chez la patiente nullipare (NP). Patiente et méthodesDe mars 1997 à octobre 2010, 65 NP étaient adressées pour manométrie anorectale (MAR) et/ou échographie endoanale (EEA). La gravité clinique et le retentissement sur la qualité de vie (QDV) étaient évalués. Une MAR et/ou une EEA était respectivement réalisée dans 56 et 35 cas. RésultatsL’âge moyen était de 53 ± 18 ans. Vingt patientes présentaient un antécédent de chirurgie coloprotologique (CCP): résection colorectale (7 %), hémorroïdectomie (9 %), cure de fistule (9 %) et divers (5 %). Dix-sept patientes présentaient un prolapsus rectal dont 14 étaient extériorisés. Le score de Jorge Wexner (JW) moyen était de 11 ± 3. Le score de Gastro-Intestinal Quality-of-Life Index (GIQLI) moyen était de 86 ± 24. Treize patientes présentaient un défect sphinctérien. Les antécédents CCP n’étaient pas significativement plus fréquents dans le groupe avec défect. Cinq patientes présentaient un défect sans antécédent de CCP. La pression de repos diminuait significativement avec l’âge et la présence de défect sphinctérien. ConclusionNotre étude confirme la sévérité des symptômes et le retentissement important sur la QDV de l’IA. La présence d’un défect sphinctérien diminue la pression anale de repos. Elle confirme également le rôle délétère de la chirurgie et des maladies inflammatoires chroniques. Enfin, le nombre important de prolapsus rectal dans notre population doit faire rechercher un prolapsus rectal systématiquement même chez la patiente NP. PurposeThe aim of this study was to clarify the clinical, ultrasound and manometric characteristics of anal incontinence (AI) in nulliparous patients (NPs). Patient and methodsFrom March 1997 to October 2010, 65 NPs were referred for anorectal manometry (ARM) and/or endoanal ultrasound (EAS). Clinical severity and its impact on quality of life (QOL) were assessed. ARM and EAS were performed in 56 and 35 cases, respectively. ResultsThe mean age of the patients was 53 ± 18 years. Twenty patients had a past history of colorectal surgery (CRS): colorectal resection (7%), hemorrhoidectomy (9%), resection of anal fistula (9%) or other (5%). Seventeen patients had a rectal prolapse. 14 of these were external. The mean Jorge-Wexner (JW) score was 11 ± 3. The mean gastro-intestinal quality-of-life index (GIQLI) score was 86 ± 24. Thirteen patients had a sphincter defect. A past history of CRS was not significantly more frequent in the group with defect. Five patients had a defect without a history of CRS. Resting pressure decreased significantly with age and with the presence of sphincter defect. ConclusionOur study confirms the severity of AI and its significant impact on QOL. The presence of sphincter defect reduces resting anal pressure. We also confirm the deleterious role of surgery and chronic inflammatory disease. Finally, the high proportion of our population with rectal prolapse suggests that this should be looked for routinely in NPs. Mots clésIncontinence anale–Échographie endoanale–Manométrie anorectale–Nullipare KeywordsAnal incontinence–Endoanal ultrasound–Anorectal manometry–Nulliparous patients
    Pelvi-périnéologie 10/2011; 6(3):156-161. DOI:10.1007/s11608-011-0376-8 · 0.03 Impact Factor
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    ABSTRACT: Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed. This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments. Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio). The SNM significantly improved the continence status (P < 0.005) and quality of life (P < 0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was ∈8525 (95% confidence interval, ∈6686-∈10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was ∈6581 (95% confidence interval, ∈2077-∈11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was ∈94,204 and ∈185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively. The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.
    Annals of surgery 04/2011; 253(4):720-32. DOI:10.1097/SLA.0b013e318210f1f4 · 7.19 Impact Factor
  • ANZ Journal of Surgery 03/2011; 81(3):205-6. DOI:10.1111/j.1445-2197.2010.05664.x · 1.12 Impact Factor
  • O. Monneuse · X. Barth
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    ABSTRACT: La ragade anale è frequente; la sua fisiopatologia si basa su fattori meccanici, sfinterici e vascolari. Il suo trattamento è, in genere, chirurgico, e l’intervento di riferimento è la sfinterotomia laterale interna, benché essa esponga a un’ipocontinenza ai gas. La ragadectomia con anoplastica trova il suo posto nel trattamento delle ragadi sclerotiche e/o infette.
    01/2011; 17(3):1–5. DOI:10.1016/S1283-0798(11)70640-4
  • O. Monneuse · X. Barth
    01/2011; 6(2):1-5. DOI:10.1016/S0246-0424(11)51083-0
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    G Fantola · X Barth · O Monneuse
    Journal of Gastroenterology and Hepatology 07/2010; 25(7):1333. DOI:10.1111/j.1440-1746.2010.06394.x · 3.63 Impact Factor
  • Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)62513-9 · 13.93 Impact Factor
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    ABSTRACT: Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
    Colorectal Disease 03/2010; 13(6):689-96. DOI:10.1111/j.1463-1318.2010.02260.x · 2.02 Impact Factor
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    ABSTRACT: The clinical diagnosis of acute appendicitis in adults remains tricky, but radiological examinations are very helpful to determine the diagnosis even when the adult patient presents atypically. This study was designed to quantify the proportion of patients with a preoperative diagnosis of acute appendicitis that had isolated right lower quadrant pain without biological inflammatory signs and then to determine which imaging examination led to the determination of the diagnosis. In this monocentric study based on retrospectively collected data, we analyzed a series of 326 patients with a preoperative diagnosis of acute appendicitis and isolated those who were afebrile and had isolated right lower quadrant pain and normal white blood cell counts and C-reactive protein levels. We determined whether the systematic ultrasonography examination was informative enough or a complementary intravenous contrast media computed tomography scan was necessary to determine the diagnosis, and whether the final pathological diagnosis fit the preoperative one. A total of 15.6% of the patients with a preoperative diagnosis of acute appendicitis had isolated rebound tenderness in the right lower quadrant, i.e., they were afebrile and their white blood cell counts and C-reactive protein levels were normal. In 96.1% of the cases, the ultrasonography examination, sometimes complemented by an intravenous contrasted computed tomography scan if the ultrasonography result was equivocal, fit the histopathological diagnosis of acute appendicitis. The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs. In our study, ultrasonography and computed tomography were very helpful when making the final diagnosis.
    World Journal of Surgery 02/2010; 34(2):210-5. DOI:10.1007/s00268-009-0349-z · 2.35 Impact Factor
  • X. Barth · E. Tissot · O. Monneuse
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    ABSTRACT: La malattia pilonidale è una patologia frequente, che compare essenzialmente nell’adolescente e nel giovane adulto. Corrisponde a una cavità pseudocistica contenente peli, a sede solitamente in regione sacrococcigea e causa di infezione acuta o cronica, causa di dolori e di alterazione della qualità della vita con ripercussioni sulla vita socio-professionale. Il suo trattamento, esclusivamente chirurgico, è controverso, tenuto conto dei lunghi tempi di guarigione di alcune tecniche e del rischio di insuccesso e di recidiva successiva. Nel corso dell’ascessualizzazione la semplice messa a piatto di prima intenzione è spesso la giusta soluzione. Nella fase di suppurazione cronica si può prendere in esame sia un metodo conservativo scarsamente invasivo (ma con frequenti recidive), sia un’exeresi radicale della totalità delle lesioni, seguita, a seconda dei casi, da una fase di guarigione diretta per seconda intenzione oppure dalla chiusura cutanea primaria o da un intervento di chirurgia plastica.
    01/2010; 16(4):1–7. DOI:10.1016/S1283-0798(10)70438-1
  • O. Monneuse · E. Tissot · X. Barth
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    ABSTRACT: La enfermedad de Verneuil o hidrosadenitis supurativa es una afección poco frecuente, que se convierte en supurada de forma secundaria y que afecta a los territorios cutáneos de las glándulas sudoríparas apocrinas (periné, fosas inguinales y huecos axilares, esencialmente). Durante mucho tiempo se ha relacionado con una obstrucción primaria de estas glándulas, pero en la actualidad parece que esta afección es secundaria y que la causa inicial es una hiperqueratinización del folículo piloso. El diagnóstico clínico no suele plantear muchos problemas, sobre todo en las formas evolucionadas. La asociación de lesiones cicatrizadas queloides y de lesiones inflamatorias en las zonas predilectas permite establecer el diagnóstico en la inmensa mayoría de los casos. Puede producirse una malignización en las formas evolucionadas y cronificadas, con la aparición de un carcinoma epidermoide. Se han planteado distintos tratamientos médicos, pero no han demostrado ser eficaces. Sólo la cirugía de exéresis amplia y mutilante permite esperar una curación sin recidivas, sobre todo en las formas perianales de mejor pronóstico. La cicatrización dirigida secundaria parece en la actualidad la actitud más difundida, a pesar del carácter prolongado de este tratamiento (6-10 semanas).
    01/2010; 26(3):1–6. DOI:10.1016/S1282-9129(10)70117-3
  • X. Barth · E. Tissot · O. Monneuse
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    ABSTRACT: La enfermedad pilonidal es una afección frecuente, que afecta sobre todo a adolescentes y adultos jóvenes. Corresponde a una cavidad seudoquística que contiene pelos y que se localiza en la mayoría de las ocasiones en la región sacrococcígea. Es una fuente de infección aguda o crónica, que ocasiona dolor y una alteración de la calidad de vida, con repercusión sociolaboral. Su tratamiento es exclusivamente quirúrgico y es motivo de controversia, debido al período de cicatrización de algunas técnicas y al riesgo de fracaso o de recidiva posterior. En el período de abscedación, lo más corriente es realizar un desbridamiento simple en primer lugar. En la fase de supuración crónica, se puede plantear un método conservador poco invasivo (pero con recidivas frecuentes) o una extirpación radical de todas las lesiones, seguida según los casos de una cicatrización dirigida, de un cierre cutáneo primario o de una intervención de cirugía plástica.
    01/2010; 26(3):1–7. DOI:10.1016/S1282-9129(10)70118-5
  • O. Monneuse · E. Tissot · X. Barth
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    ABSTRACT: La malattia di Verneuil, o idrosadenite suppurativa, è una malattia poco frequente, a suppurazione secondaria, che colpisce le zone cutanee a presenza di ghiandole sudoripare apocrine (essenzialmente: perineo, pieghe inguinali e ascellari). È stata a lungo ricondotta a un’ostruzione primitiva di queste ghiandole, ma pare ora che questa lesione sia secondaria e che il primum movens sia da individuarsi in una ipercheratosi del follicolo pilifero. La diagnosi clinica pone di solito pochi problemi, soprattutto nei riguardi dei casi evoluti. L’associazione di lesioni cicatriziali cheloidi e di lesioni infiammatorie nella zone elettive permette di porre la diagnosi nella stragrande maggioranza dei casi. Una degenerazione neoplastica è possibile nelle forme evolute e cronicizzate con comparsa di carcinomi spinocellulari. Sono state proposte diverse terapie mediche, ma non hanno dato prova della loro efficacia. Solo la chirurgia exeretica, ampia e aggressiva permette di mirare a una guarigione senza recidive, in particolare nelle forme perianali, a miglior prognosi. La guarigione diretta per seconda intenzione appare al momento attuale il comportamento più diffuso, e ciò nonostante il carattere prolungato di questo trattamento (6–10 settimane).
    01/2010; 16(3):1–6. DOI:10.1016/S1283-0798(10)70443-5
  • X. Barth · E. Tissot · O. Monneuse
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    ABSTRACT: Organo terminale del tubo digerente, l’ano svolge un doppio ruolo: di continenza e di defecazione, in sinergia con il retto, organo cui fa seguito. La conoscenza della sua morfologia, della sua vascolarizzazione e della sua innervazione, del suo apparato sfinteriale e degli spazi celluloadiposi che lo circondano è essenziale per la comprensione delle molteplici patologie che interessano la regione anorettale e del loro trattamento chirurgico.
    12/2009; 15(4):1–7. DOI:10.1016/S1283-0798(09)70450-4
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    ABSTRACT: The development of mesenteric venous thrombosis (MVT) does not necessarily require surgical intervention. The aim of this study was to assess the efficacy of avoiding early operative intervention, which can lead to significant sacrifice of the small bowel. Patients with MVT were identified using the inpatient registry for the years between 2003 and 2007. Each patient's past medical history, history of prior deep venous thrombosis or hypercoagulable state, clinical and biologic presentation, and computed tomography (CT) results were analyzed. The proportion of ischemic bowel observed on the CT scans was compared with the length of the bowel resected. Nine patients were admitted for extensive MVT during the time period evaluated (six men, three women). All CT scans demonstrated signs of severe bowel ischemia, with a mean ischemic bowel proportion of 21% (range 5-45%). Four patients received medical management alone. Five patients underwent surgery. The mean admission time for these patients prior to the operation was 14.8 days (6-36 days). Surgery was required only in cases of intestinal perforation. The mean length of the bowel resections was 33 cm (20-45 cm). At 6 months after admission, none of the patients required parenteral nutrition. The mean follow-up evaluation period was 27 months (15-38 months). One patient died secondary to amyotrophic lateral sclerosis during the follow-up. Initial nonsurgical management comprised of inpatient observation on a surgical ward along with systemic anticoagulation must be considered an alternative treatment strategy for MVT. This strategy delays surgery and therefore avoids short bowel syndrome.
    World Journal of Surgery 09/2009; 33(10):2203-8. DOI:10.1007/s00268-009-0168-2 · 2.35 Impact Factor
  • V Vitton · S Roman · H Damon · X Barth · F Mion
    Diseases of the Colon & Rectum 05/2009; 52(4):752-3; author reply 753-4. DOI:10.1007/DCR.0b013e3181a1a8f5 · 3.20 Impact Factor
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    ABSTRACT: Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
    Colorectal Disease 05/2009; 11(6):572-83. DOI:10.1111/j.1463-1318.2009.01914.x · 2.02 Impact Factor
  • X. Barth · E. Tissot · O. Monneuse
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    ABSTRACT: Las supuraciones de la región anal constituyen un grupo heterogéneo de infecciones de periné. Aunque el tratamiento del quiste pilonidal o de la hidrosadenitis supurada está bien codificado, el de las supuraciones anales de origen críptico, que representan más del 75% de los casos, es más difícil, pues debe permitir a la vez eliminar de forma definitiva la supuración y conservar el aparato esfinteriano, así como la continencia del paciente. El conocimiento de la anatomía de la región anal es indispensable para comprender las supuraciones anoperineales y su tratamiento. Las fístulas únicas, con un trayecto único y situado en una posición baja, se curan con una simple fistulotomía baja. Las fístulas transesfinterianas altas, supra o extraesfinterianas, así como las fístulas complejas de trayectos múltiples requieren en la mayoría de las ocasiones un estudio radiológico preoperatorio (ecografía endoanal, resonancia magnética) y técnicas quirúrgicas más complejas (fistulectomía, drenaje en sedal, colgajo rectal de avance, obturación con cola biológica de la fístula) y tienen un riesgo de recidiva o de incontinencia elevado. Las supuraciones anales que aparecen en el contexto de una enfermedad de Crohn requieren un tratamiento quirúrgico lo más conservador posible en el aparato esfinteriano, asociado al tratamiento médico específico de esta enfermedad.
    01/2009; 25(4):1–11. DOI:10.1016/S1282-9129(09)70128-X

Publication Stats

731 Citations
117.41 Total Impact Points

Institutions

  • 2008–2012
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France
  • 2008–2011
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 1990–2011
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      • Service de Chirurgie
      Lyons, Rhône-Alpes, France