X Barth

Università degli studi di Cagliari, Cagliari, Sardinia, Italy

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Publications (89)102.1 Total impact

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    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. · 3.34 Impact Factor
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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; · 2.24 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. · 7.90 Impact Factor
  • ANZ Journal of Surgery 03/2011; 81(3):205-6. · 1.50 Impact Factor
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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 01/2011; 6(3):156-161. · 0.04 Impact Factor
  • G Fantola, X Barth, O Monneuse
    Journal of Gastroenterology and Hepatology 07/2010; 25(7):1333. · 3.33 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. · 2.08 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. · 2.23 Impact Factor
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    ABSTRACT: Primary group A streptococcal peritonitis (PSAP) is a rare, fulminant and often fatal infection. The clinical manifestations include diffuse peritoneal signs with toxic shock syndrome and sometimes fasciitis. Patients with PSAP diagnosed between December 2002 and December 2006 were studied retrospectively, focusing on the initial presentation, diagnosis, treatment and outcome. Six patients were identified (five women and one man). The clinical presentation was heterogeneous. All six patients had diffuse peritonitis, four had toxic shock syndrome on hospital admission and two patients also had fasciitis. All patients were treated surgically, and the final diagnosis was confirmed after operation. There were no deaths, but two patients had aesthetic sequelae owing to necrotizing fasciitis. PSAP is a rare condition, often requiring aggressive surgical treatment. Group A streptococcal peritonitis should be suspected in patients with no radiological evidence of a peritoneal portal of entry and no history of ascites.
    British Journal of Surgery 01/2010; 97(1):104-8. · 4.84 Impact Factor
  • Gastroenterology 01/2010; 138(5). · 12.82 Impact Factor
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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. · 2.23 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. · 2.08 Impact Factor
  • Diseases of the Colon & Rectum 05/2009; 52(4):752-3; author reply 753-4. · 3.34 Impact Factor
  • Contact Dermatitis 12/2008; 59(5):319-20. · 2.93 Impact Factor
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    ABSTRACT: To search for clinical risk factors and symptoms of elytrocele in female patients without hysterectomy. Of 1060 women who underwent defecography, radiographic evidence of elytrocele was observed in 303. History-taking was standardized, and included obstetric, surgical and medical history as well as clinical symptoms and their duration. Group A comprised 192 women with hysterectomy while group B included 111 women with no history of hysterectomy; these two groups were compared. Group B was also compared with patients who had neither elytrocele nor hysterectomy (group C; n=516). Women in group B (no hysterectomy) were younger than those in group A (with hysterectomy) (57.9 years versus 62.8 years; p<0.05). Patients in group B had fewer obstetric (87.4% versus 97.9%; p=0.01) and abdominal (64.9 versus 82.3%; p=0.01) surgical events than those in group A, but more urinary tract surgery (18.9% versus 10.9%) and higher infant birth weights than patients in control group C. Six women (2%) had no surgical or obstetric history: mean age 42.7 years (20.6-74 years). Group B used protection against urinary soiling less often (17.3% versus 29.07%; p=0.017), but had more fecal soiling (23.4% versus 13.6%; p=0.033). Defecography showed that women in group B had more external rectal prolapse (17.7% versus 4.9%; p=0.003) and cystocele (48.6% versus 34.9%; p=0.019) than those in group A. This study was unable to identify risk factors of elytrocele in patients without hysterectomy except for a history of urinary tract surgery and higher infant birth weights. In some women, the elytrocele may be the result of significant rectal prolapse as part of a major pelvic floor disorder, predominantly in the posterior pelvis. Constitutional or congenital causes could also be involved as several young women free of any surgical or obstetric history nevertheless presented with an elytrocele.
    Gastroentérologie Clinique et Biologique 10/2008; 32(11):953-9. · 1.14 Impact Factor
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    ABSTRACT: The mechanisms of action of sacral nerve stimulation (SNS) to treat faecal incontinence remain poorly understood. The aims of our study were: (i) to measure the effect of SNS on rectal function and (ii) to evaluate rectal function as a predictive factor of clinical response to SNS. Rectal function was studied before and 3 months after permanent SNS in 18 patients (17 women, mean age 58.5 years) with faecal incontinence, using an electronic barostat. Rectal sensitivity and volume variations were recorded during isobaric distensions. Three months after SNS, 14 patients had a significant improvement of faecal incontience symptoms and four had not. Baseline 'maximal tolerated volume' was significantly lower in the positive response group (210 +/- 56 vs 286 +/- 30 mL, P = 0.02). Baseline rectal compliance was lower in patients with a positive response than those without, although this difference did not reach significance (6.2 +/- 3.2 vs 9.2 +/- 2.9 mL mmHg(-1),P = 0.10). Rectal compliance was not significantly modified by SNS. Our results suggest that an increased rectal capacity as measured by the maximal tolerated volume may be a predictive factor of poor response to SNS in faecal incontinence. SNS does not significantly modify rectal function.
    Neurogastroenterology and Motility 10/2008; 20(10):1127-31. · 2.94 Impact Factor
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    ABSTRACT: AimThe aim of this study was to study a cohort of patients with faecal incontinence (FI) to gain a better insight into the clinical and epidemiological characteristics of this pathology and its repercussions on quality of life (QL). Materials and methodsConsecutive patients with FI seen at tertiary centres filled in a self-questionnaire. The severity of FI, constipation and urinary incontinence (UI) was evaluated, respectively, by the Jorge and Wexner score, the Knowles–Eccersley–Scott Symptom score and the Urological Distress Inventory score. ROME II criteria were used to assess the existence of an associated irritable bowel syndrome. The repercussion on QL was evaluated by the Gastrointestinal Quality of Life index score and the Ditrovie score. The psychological status was assessed by the Hospital Anxiety and Depression scale. ResultsSix hundred twenty-one patients (114 men), mean age 58 ± 15years (range: 20–92), with FI, filled in the questionnaire. The mean Jorge and Wexner score was 11 ± 4. Twenty-seven presented with an irritable bowel syndrome. Thirty-eight percent had an associated constipation. A UI was associated in 48% women and 25% men. QL was significantly altered, and anxiety and depression were frequent. ConclusionsFI symptoms are frequently severe, QL very altered and anxiety and depression common. FI is frequently associated with other digestive and perineal symptoms, which argue in favour of a multi-disciplinary management of FI.
    International Journal of Colorectal Disease 09/2008; 23(9):845-851. · 2.24 Impact Factor
  • F Mion, S Roman, X Barth, H Damon
    Gastroentérologie Clinique et Biologique 06/2008; 32(5 Pt 2):S240-5. · 1.14 Impact Factor
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    ABSTRACT: Anal incontinence (AI) is a frequent symptom with considerable impact on quality of life. The aim of this study was to describe the clinical, sonographic and manometric characteristics of a male population with AI. Endoanal ultrasonography (EAU) was performed in 92 men referred for exploration of AI. Anal incontinence severity was evaluated by the Jorge and Wexner score (JW). The gastrointestinal quality-of-life index (GIQLI) was determined in 57% of patients. Anorectal manometry was performed in 62.6% of patients. The average JW score was 11+/-1. Anal incontinence had considerable impact on quality of life: average GIQLI=81+/-4. Seventeen patients presented an anal sphincter defect on EAU, 16 of whom had a history of coloproctological surgery. Prior surgery was significantly more common among patients who had a defect on ultrasonography; manometry showed significantly lower resting anal pressure. Our study confirms the severity of AI in a male population and its impact on quality of life. It also highlights the high prevalence of anal sphincter defects in patients with a history of anal surgery.
    Gastroentérologie Clinique et Biologique 04/2008; 32(3):328-36. · 1.14 Impact Factor
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    ABSTRACT: Depuis la première publication de Matzel et al., en 1995, rapportant l’efficacité de la stimulation des racines sacrées chez des patients incontinents anaux, les indications, la technique de stimulation ainsi que le suivi des patients implantés ont évolué [1]. Cet article a pour objectif, à partir d’une revue critique de la littérature et au vu des expériences de chacun des experts participants, de proposer une attitude consensuelle pour la prise en charge des patients incontinents anaux par stimulation sacrée. Seront discutées: 1) les indications; 2) la technique du test temporaire; 3) la technique de l’implantation; 4) les modalités de suivi des patients; 5) la conduite à tenir en cas d’échappement thérapeutique. Nous espérons ainsi offrir aux praticiens intéressés par la stimulation sacrée un guide pour la prise en charge des patients mais également harmoniser nos pratiques, orienter et faciliter les travaux de recherche futurs. Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation in patients with fecal incontinence, the indications, contraindications and stimulation technique used, along with the follow-up of implanted patients, have all changed [1]. The aim of this article is to suggest a consensus of opinion on the management of patients with fecal incontinence by sacral nerve stimulation, based on a critical review of the literature and the experience of each of the participating experts. We will discuss: 1) indications and contraindications; 2) temporary test technique; 3) implantation technique; 4) patient follow-up; 5) approach in case of treatment failure. We hope to provide a guide to patient management for clinical practitioners interested in sacral nerve stimulation, and also to harmonise our practice and orient future research.
    Pelvi-périnéologie 01/2008; 3(4):265-278. · 0.04 Impact Factor

Publication Stats

493 Citations
102.10 Total Impact Points


  • 2010
    • Università degli studi di Cagliari
      Cagliari, Sardinia, Italy
  • 2008–2010
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 1990–2010
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      • Service de Chirurgie
      Lyons, Rhône-Alpes, France
  • 2002–2008
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France
  • 2004
    • CHU de Lyon - Hôpital Gériatrique des Charpennes
      Lyons, Rhône-Alpes, France