F Bretagnol

Publications (38)61.71 Total impact

• Article: Laparoscopic ventral rectopexy: a prospective long-term evaluation of functional results and quality of life.

  L Maggiori, F Bretagnol, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy. METHODS: Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI). RESULTS: Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3-7 days). After a mean follow-up of 42 ± 7 months (range 32-52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients' Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001). CONCLUSIONS: This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation.
  Techniques in Coloproctology 01/2013; · 1.29 Impact Factor
• Article: Intestinal transplantation: Indications and prospects.

  L Beyer-Berjot, F Joly, S Dokmak, F Bretagnol, O Corcos, Y Bouhnik, J Belghiti, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Intestinal transplantation (IT) can involve small bowel transplantation alone, or be associated with liver or multivisceral transplantation. Although IT is the radical treatment for intestinal failure, home parenteral nutrition (PN) remains the treatment of choice for this disease. Indications for IT are still debated. A recent study showed that early referral for IT is recommended for patients with life-threatening combined liver and intestinal failure or for patients with invasive intra-abdominal desmoid tumors. In the same study, no survival benefit was shown for patients undergoing IT for ultra-short bowel or major complications related to the PN catheter; indications still need to be fully assessed. While short-term outcomes for IT have improved dramatically (one-year survival for small bowel-alone IT is now 80% versus 0-28% in the 1980s), long-term outcomes have not improved much since the introduction of Tacrolimus in the 1990s: five-year survival still does not exceed 60%. Some prospective developments could improve these results: the use of multivisceral grafts, the use of Sirolimus and Thymoglobulins in the immunosuppressive treatment, or the use of new biochemical markers for early diagnosis of graft rejection.
  Journal of Visceral Surgery 11/2012; · 0.57 Impact Factor
• Article: Mener un examen clinique chez un patient ayant un cancer du rectum

  S. Gaujoux, F. Bretagnol, Y. Panis
  [show abstract] [hide abstract]
  ABSTRACT: L’examen clinique est un temps clé dans la prise en charge tant diagnostique que thérapeutique des patients ayant un cancer du rectum et vient compléter le bilan radiologique. Le toucher clinique doit permettre d’apprécier les caractéristiques de la tumeur, et en particulier sa distance par rapport au bord supérieur de l’appareil sphinctérien. La rectoscopie au tube rigide permet de compléter ces données. De l’ensemble de ces constatations dépendra en grande partie la décision de conserver ou non l’appareil sphinctérien. Clinical examination in patients with rectal cancer is a keystone in their management, in addition to imaging (MRI and endoluminal ultrasonography). Digital rectal examination gives important information regarding tumor’s characteristics, and should specially focus on the distance from the tumor to the upper edge of the anal sphincter. Rigid sigmoidoscopy completes accurately these information. Overall, decision to perform conservative surgery depends in part on the results of the clinical examination. Mots clésCancer du rectum-Examen clinique-Toucher rectal-Rectoscopie KeywordsRectal cancer-Clinical examination-Digital rectal examination-Rigid sigmoidoscopy
  Côlon & Rectum 04/2012; 4(2):122-123.
• Article: L’exérèse transanale selon Buess et al. par microchirurgie endoscopique (TEM) : l’âge de raison ?

  F. Bretagnol, Y. Panis
  Côlon & Rectum 04/2012; 2(4):229-230.
• Article: Proctectomie pour cancer du rectum : principes carcinologiques et séquelles fonctionnelles digestives

  F. Bretagnol, Y. Panis
  [show abstract] [hide abstract]
  ABSTRACT: La proctectomie pour cancer est associée à un excellent contrôle local à court et long termes. Malheureusement, la perte du réservoir rectal s’accompagne de séquelles fonctionnelles digestives non négligeables. En outre, la réalisation systématique de traitements néoadjuvants comme la radiochimiothérapie pour les tumeurs localement évoluées, la possibilité de conserver l’appareil sphinctérien, même pour des tumeurs du très bas rectum par la technique de dissection intersphinctérienne, sont autant de facteurs qui peuvent majorer ces séquelles. Rectal resection for cancer is associated with favourable short and long-term local control. However, unfortunately the loss of the rectal “reservoir” results in significant functional digestive after-effects. Moreover, systematic neoadjuvant treatments such as radio-chemotherapy for locally advanced tumours, and the potential to preserve the sphincteric system even for very low rectal tumours using the intersphincteric dissection technique, are factors which can worsen these afteraffects.
  Côlon & Rectum 04/2012; 2(4):191-197.
• Article: Place du « lavage laparoscopique » dans la péritonite diverticulaire

  F. Bretagnol, Y. Panis
  [show abstract] [hide abstract]
  ABSTRACT: Le « lavage-drainage » laparoscopique est une alternative séduisante à la sigmoïdectomie en urgence dans la prise en charge chirurgicale des péritonites diverticulaires. Cette procédure associe des résultats opératoires satisfaisants du fait de l’abord laparoscopique à d’excellents résultats en termes d’efficacité avec un taux d’échec très faible. Elle est indiquée en cas de péritonite purulente généralisée (Hinchey III) et en cas d’échec ou d’impossibilité de drainage radiologique d’un abcès pelvien (Hinchey II). Enfin, cette stratégie permet une résection sigmoïdienne prophylactique laparoscopique élective dans de bonnes conditions. The laparoscopic « lavage and drainage » may be a promising conservative alternative to urgent sigmoid resection in the management of perforated acute diverticulitis. This procedure is associated with good operative results because of the laparoscopic approach and with successful management. It is indicated in patients with generalized purulent peritonitis (Hinchey III) and those with failed pelvic abscess radiologic drainage (Hinchey II). Then, this strategy allows a delayed elective laparoscopic sigmoid resection.
  Côlon & Rectum 04/2012; 3(1):23-26.
• Article: Diverticulite sigmoïdienne: pour la sigmoöiectomie à froid chez le sujet jeune

  L. Maggiori, F. Bretagnol, Y. Panis
  [show abstract] [hide abstract]
  ABSTRACT: Si la chirurgie est recommandée après une poussée compliquée de diverticulite quel que soit l’âge, le bénéfice de la chirurgie à froid chez le sujet de moins de 50 ans après poussée non compliquée est discuté. Néanmoins, des études récentes suggèrent que cette chirurgie prophylactique est associée à une diminution du risque de récidive et du taux de mortalité par rapport à la simple surveillance, avec des résultats fonctionnels et de qualité de vie équivalents. De plus, l’essor de la laparoscopie a permis une diminution de la morbidité et de la durée de séjour par rapport à la chirurgie ouverte. Il est donc licite de proposer une sigmoïdectomie laparoscopique après une première poussée chez le patient de moins de 50 ans, même sans signe de gravité. Elective sigmoidectomy is usually recommended after an episode of complicated diverticulitis treated medically, but there is no clear evidence regarding elective surgery for patients under 50 after uncomplicated attack. However, recent studies suggest that prophylactic surgery is associated with lower recurrence and mortality rates than the non-operative policy, with equivalent functional outcomes and quality of life. Furthermore, laparoscopic sigmoidectomy results in a lower morbidity rate and shorter hospital stay. Thus, laparoscopic sigmoidectomy for patients under fifty can be recommended even after an uncomplicated episode of diverticulitis.
  Côlon & Rectum 04/2012; 3(1):30-33.
• Article: Traitement chirurgical des fistules rectovaginales hautes

  F. Bretagnol, A. Alves, Y. Panis
  [show abstract] [hide abstract]
  ABSTRACT: La prise en charge chirurgicale des fistules rectovaginales hautes est complexe et répond à plusieurs principes. Le traitement est tout d’abord fonction de l’étiologie de la fistule, notamment la prise en charge d’une maladie de Crohn associée. L’arsenal thérapeutique est très varié et constitue une véritable «escalade», allant du simple drainage par séton en cas de sepsis local, le recours aux lambeaux d’avancement rectal et/ou musculaire jusqu’au traitement radical en cas d’échec ou de récidive que représente l’exérèse du rectum avec colostomie ou plus souvent iléostomie définitive. Par contre, lors d’un geste de réparation de la fistule, une stomie temporaire de dérivation des selles est souvent nécessaire afin de favoriser la cicatrisation locale. Les résultats dépendent de l’étiologie de la fistulemais restent globalement bons avec un espoir de guérison dans plus des deux tiers des cas. The surgical approach to complex rectovaginal fistulas varies and depends on a number of factors, including the aetiology of the fistula, its site and, most importantly, its association with Crohn’s disease. A variety of surgical options exists, such as local repair procedures (advancement flap and muscle transposition) and abdominal procedures (rectal excision with temporary or permanent stoma). Faecal diversion is a determinant factor for healing. After preoperative evaluation of the best treatment options, most fistulas can be successfully repaired in two-thirds of patients.
  Pelvi-périnéologie 04/2012; 2(3):275-279. · 0.07 Impact Factor
• Article: Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?

  A Laforest, F Bretagnol, A S Mouazan, L Maggiori, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Aim  A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. Methods  Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score). Results  From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P = 0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P = 0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P = 0.004) and mental functioning (P = 0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. Conclusion  This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.
  Colorectal Disease 01/2012; 14(10):1231-7. · 2.93 Impact Factor
• Article: Risk of recurrence after surgery for chronic radiation enteritis.

  J H Lefevre, A Amiot, F Joly, F Bretagnol, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Approximately one-third of patients with chronic radiation enteritis (CRE) require surgery, which is associated with a high morbidity rate and a high risk of reoperation. The aim of this study was to report outcome after surgery for CRE. Patients with CRE who underwent operation with extensive small bowel resection between 1980 and 2009 were included in the study. Postoperative morbidity and mortality, reoperation for recurrent enteritis and risk factors for reoperation were analysed. Of 107 patients (94 women; 87·8 per cent) with CRE included in the study, the main indication for surgery was symptomatic stricture (82 patients; 76·6 per cent). Forty-nine ileocaecal resections (45·8 per cent) were performed. Overall and surgical morbidity rates were 74·8 per cent (80 patients) and 28·0 per cent (30) respectively. Fourteen patients (13·1 per cent) underwent reoperation for complications. Reoperation rates for CRE at 1 and 3 years of follow-up were 37 and 54 per cent respectively. Risk factors for reoperation for recurrent enteritis were: emergency surgery (odds ratio (OR) 2·72, 95 per cent confidence interval 1·57 to 4·86), anastomotic leakage (OR 2·53, 1·54 to 4·42) and male sex (OR 3·57, 1·82 to 7·29). The only protective factor for reoperation was ileocaecal resection during the first surgical procedure (OR 4·48, 2·52 to 8·31). Ileocaecal resection was the only factor that protected against reoperation for recurrent CRE, demonstrating the importance of resecting all damaged tissue in these patients. These results suggest that there is little place for intestinal bypass surgery or adhesiolysis.
  British Journal of Surgery 09/2011; 98(12):1792-7. · 4.61 Impact Factor
• Article: Single-incision laparoscopic colonic surgery.

  S Gaujoux, F Bretagnol, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: SILS is an area of growing interest in colorectal surgery. We report our preliminary experience of 13 consecutively selected patients undergoing colonic surgery using SILS. From July 2009 to January 2010, 13 patients (five men) of median age 56 (23-82) years and a body mass index (BMI) of 23.5 (18-30) kg/m(2) underwent colonic surgery. Procedures included subtotal colectomy (1), ileocolic resection (2), right colectomy (4) and sigmoidectomy for benign disease (6). Three instruments (including camera) were introduced through a single 2.5-cm port (SILS™ Port Multiple Instrument Access Port; Covidien Inc., Norwalk, Connecticut, USA) inserted at the umbilicus. The median operating time was 150 (100-240) min, and the median size of the umbilical port incision was 32 (25-50) mm. There was no postoperative mortality and morbidity, and the median hospital stay was 6 (4-10) days. The cosmetic result was judged to be excellent in 12 of 13 patients who felt it to be better than expected. This preliminary experience shows that SILS is technically feasible and safe for colonic resection.
  Colorectal Disease 09/2011; 13(9):1066-71. · 2.93 Impact Factor
• Article: Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach.

  S Gaujoux, F Bretagnol, J Au, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Minimally invasive surgery is advancing with single port access (SPA). We describe a technique for a SPA transabdominal combined with transanal approach to perform laparoscopic proctectomy with total mesorectal excision (TME) and intersphincteric resection of low rectal adenocarcinoma. Transanal intersphincteric resection was followed by laparoscopic abdominal proctectomy with TME. An SPA device was placed at the site of the future stoma through a 2.5-cm incision. A hand-sewn side-to-end coloanal anastomosis was performed and a terminal loop ileostomy was created at the site of the SPA device. The procedure was performed on two healthy nonobese women who had not had previous abdominal surgery. The operating times were 195 and 210 min, and blood loss < 250 ml. The postoperative course was uneventful, with discharge on postoperative days 5 and 6. Pathological examination revealed adequate surgical margins and lymph node retrieval with an intact mesorectum. Four weeks after stoma closure, the scar in the right lower quadrant was 35 mm in one patient and 45 mm in the other, and the scar from the 5-mm port was barely visible. This preliminary experience shows that proctectomy with TME and intersphincteric resection can be safely performed using only two ports.
  Colorectal Disease 05/2011; 13(9):e305-7. · 2.93 Impact Factor
• Article: T4 colorectal cancer: is laparoscopic resection contraindicated?

  F Bretagnol, A Dedieu, M Zappa, N Guedj, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: T4 colorectal cancer remains a contraindication for laparoscopy. It is argued that the risk of incomplete resection could be higher than in open surgery. Furthermore, difficulty in dissection could lead to a very high rate of conversion. There is little information on this. The study aimed at assessing feasibility and operative and oncologic results of laparoscopic resection for T4 colorectal cancer. Between 2006 and 2009, 39 patients with colorectal cancer with suspected involvement of another organ (T4) on computed tomography scanning and/or magnetic resonance imaging were included. The cancers were in the right colon (n = 18), left colon (n =9) and rectum (n = 12). The distribution of possible organ involvement was abdominal or pelvic side-wall (n = 21), urinary bladder (n = 4), small bowel or colon (n = 6), vagina and ovary (n = 3), prostate or seminal vesicles (n = 3) and duodenum (n = 2). The overall conversion rate was 18%. Postoperative mortality and morbidity were 2.5 and 33%, respectively. Clinical anastomotic leakage rate was 15% (n = 6). Abdominal reoperation was required in three (7%) patients. Pathological invasion to other organs (pT4) was confirmed in 30 (77%) patients. The R1 resection rate was 13% (4 of 30). After a median follow up of 19 months (range 1.5-45 months), the overall survival and disease-free survival rates were 97 and 89%, respectively. This study suggests that laparoscopic surgery is feasible for colorectal T4 cancer resection. Laparoscopy cannot therefore be considered an absolute contraindication for T4 colorectal cancer.
  Colorectal Disease 02/2011; 13(2):138-43. · 2.93 Impact Factor
• Article: Transanal endoscopic microsurgery (TEM) for rectal tumor: the first French single-center experience.

  M Seman, F Bretagnol, N Guedj, L Maggiori, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Transanal endoscopic microsurgery (TEM) allows complete local excision of rectal tumor, especially in the middle and upper part of the rectum, and provides an alternative to conventional surgery. This is a report of the first French single-center experience to assess the feasibility and postoperative results for rectal tumor excised by TEM. From October 2007 to December 2008, 27 patients underwent TEM for excision of either rectal adenoma (n=19) or carcinoma (n=8). The median distance from the anal verge was 60mm (range: 10-140). TEM excision was performed in 26/27 patients. Intraoperative technical difficulties were recorded in two patients (peritoneal perforation and gas leakage, respectively). The morbidity rate was 22% (n=6), including two patients (7%) with major complications (delayed rectal bleeding) requiring readmission to hospital for both, and surgical hemostasis for one. R0 resection rates for adenoma and carcinoma were 84% and 75%, respectively. Immediate salvage surgery was performed in one patient because of a T2R1 carcinoma. At the time of the median follow-up at nine months (range: 2.5-17.5), no patient had experienced a recurrence. TEM is a safe and effective procedure with low morbidity for local rectal tumor resection. It allows local excision of benign tumors, especially those that are inaccessible to conventional local surgery resection, thereby avoiding radical surgery. In cases of carcinoma, its role in local surgery remains controversial and is yet to be defined.
  Gastroentérologie Clinique et Biologique 09/2010; 34(8-9):488-93. · 0.80 Impact Factor
• Article: Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer.

  L Maggiori, F Bretagnol, J H Lefèvre, M Ferron, E Vicaut, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Anastomotic leakage (AL) after sphincter-saving resection (SSR) for rectal cancer can result in a definitive stoma (DS). The aim of the study was to assess risk factors for DS after AL-complicating SSR. Between 1997 and 2007, 200 patients underwent SSR for rectal cancer. AL occurred in 20.5% (41/200) [symptomatic 13.5% (n = 27), asymptomatic 7% (n = 14)]. Possible risk factors for DS after AL were analysed. Management of AL consisted in no treatment (n = 14), medical treatment (n = 6), local drainage (n = 10) and abdominal reoperation (n = 11). After a median follow-up of 38 months, the overall rate of DS was 3% (n = 6): 0% for asymptomatic vs 22% after symptomatic AL (P = 0.061). After reoperation, the risk of DS was 13% when the anastomosis was preserved vs 100% after Hartmann's procedure (P = 0.007). Risk factors of DS after AL included obesity, age over 65, American Society of Anesthesiologists (ASA) score > 2 and abdominal reoperation for AL. The risk of DS after SSR for cancer is low (3%) but rises to 22% after symptomatic AL. This risk depends on the surgical treatment for AL and is up to 100% if a Hartmann's procedure is performed.
  Colorectal Disease 03/2010; 13(6):632-7. · 2.93 Impact Factor
• Article: Laparoscopic colorectal anastomosis using the novel Chex(®) circular stapler: a case-control study.

  L Maggiori, F Bretagnol, M Ferron, Y Chevalier, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this study was to assess the safety and effectiveness of a new cost-effective circular stapler for colorectal anastomosis, the Chex(®) CS. From 2007 to 2009, a case-control study was conducted of 54 patients who underwent left colectomy with stapled anastomosis using the Chex stapler. The patients were matched to 64 patients in whom the anastomoses were performed using the CDH(®) stapler or the EEA(®) stapler. The following criteria were matched: sex, age, body mass index, American Society of Anesthesiology grade, diagnosis, formation of a temporary stoma and surgical approach. Primary end-points were postoperative mortality and morbidity. The surgeon was asked to fill out a questionnaire to assess the ergonomics of the device using an analogue visual scale. A cost analysis was performed to compare the cost of the different devices. There were no postoperative deaths. Morbidity, including anastomotic leakage (9%vs 8%, P = 1.000), was similar in the two groups. The surgeon's overall appreciation was scored at 8.1/10 (3-9.5), including the best score for stapler removal (9.5). No major device failure was observed during the study. Mean surgical costs were significantly lower in the Chex group: € 903 ± 73 (885-1192) vs the control group € 971 ± 61 (956-1263) (P < 0.0001). This study suggests that colorectal anastomosis using the Chex circular stapler is safe and does not increase overall morbidity. In particular, this device did not have a higher rate of anastomotic leakage in our patients than more expensive models currently used in our hospital.
  Colorectal Disease 02/2010; 13(6):711-5. · 2.93 Impact Factor
• Article: Colorectal breast carcinoma metastasis diagnosed as an obstructive colonic primary tumor. A case report and review of the literature.

  J Théraux, F Bretagnol, N Guedj, D Cazals-Hatem, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Common sites of colorectal breast carcinoma metastasis are bones, lungs, the central nervous system and the liver. Metastases in the gastrointestinal (GI) tract are rare and especially involve the stomach rather than the colon. Clinical or radiological features usually cannot differentiate them from a primary colorectal tumor, resulting in inappropriate treatment. In some cases, this lesion suggests multifocal spread of breast cancer with peritoneal carcinomatosis. Colorectal breast cancer metastasis is a rare finding and there is no consensus on the management of these lesions. The present case report describes a 69-year-old female with metastatic breast cancer presenting as an obstructive tumor of the transverse colon.
  Gastroentérologie Clinique et Biologique 11/2009; 33(12):1114-7. · 0.80 Impact Factor
• Article: [Ultrasound and CT imaging in the diagnosis of acute appendicitis].

  F Bretagnol, M Zappa, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: The diagnosis of acute appendicitis is still made on the basis of clinical findings in the majority of cases. When the clinical picture is unclear, ultrasound examination is a simple and effective tool to confirm the diagnosis. When ultrasound is unsatisfactory due to patient habitus or otherwise fails to clarify clinical uncertainty, abdominopelvic CT scan yields excellent results in terms of both sensitivity and specificity. While recognizing these evidence-based results, the surgeon must remain pragmatic and realize that the quality of each exam depends on the quality of the examination and the experience of the radiologist.
  Journal de Chirurgie 10/2009; 146 Spec No 1:8-11. · 0.50 Impact Factor
• Article: [Management of large villous tumors of the lower part of the rectum].

  F Bretagnol, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: Radical surgery (i.e. rectal resection) remains the gold standard for surgical management of large villous tumours but such a strategy is associated with potential postoperative complications with high risk of functional disorders and genito-urinary dysfunction. Transanal local surgery is an alternative treatment with low morbidity. A new procedure as transanal endoscopic microsurgery can be proposed to achieve local complete excision of rectal tumours especially in the middle and upper parts of the rectum lesions unresectable by conventional local surgery. For malignant tumours, accurate pathological evaluation to define histopathological criteria must be done to propose or not additional radical surgery.
  Gastroentérologie Clinique et Biologique 09/2009; 33(10-11 Suppl):F101-5. · 0.80 Impact Factor
• Article: Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula.

  J H Lefèvre, F Bretagnol, L Maggiori, A Alves, M Ferron, Y Panis
  [show abstract] [hide abstract]
  ABSTRACT: The aim of this study was to assess the efficacy of gracilis muscle transposition for recurrent rectovaginal fistula. Gracilis muscle transposition for recurrent rectovaginal fistula was performed in eight patients. Causes of fistulas included Crohn's disease (n = 5), perineal surgery (n = 2), and obstetrical injury (n = 1). All patients underwent a mean of three (range, 1-6) previous repairs. Fecal diversion was performed in all cases. Six of eight patients (75%) healed after gracilis muscle transposition alone. The other two patients required a second gracilis. These two patients failed with another recurrence and one of them underwent laparotomy with successful omental interposition. Thus, after a median follow-up of 28 (range, 4-55) months, the per-gracilis muscle transposition healing rate was 60% (6/10) and the overall healing success rate after gracilis muscle transposition and other procedures was 88% (7/8). For patients with Crohn's disease, four of five (80%) presented no recurrent rectovaginal fistula. Seven of eight patients underwent ileostomy closure after gracilis, but two required subsequent stomas, one for a late recurrence. Overall, five of eight patients are stoma-free. Despite healing, postoperative quality of life and sexual activity remained significantly altered. Gracilis muscle transposition can be proposed in cases of recurrent rectovaginal fistula. The procedure has a good success rate, especially in Crohn's disease patients.
  Diseases of the Colon & Rectum 08/2009; 52(7):1290-5. · 3.13 Impact Factor