Richard Douard

Clinique Bizet · Digestive Surgery

Preoperative transfusion (PT) reduces acute postoperative vaso-occlusive events (VOE) in sickle cell disease (SCD), but exposes patients to alloimmunization, encouraging a recent trend towards transfusion sparing. The aim of this study was to investigate the benefit–risk ratio of PT before cholecystectomy on the occurrence of postoperative VOE. Adu...

Introduction La transfusion (TF) préopératoire est souvent réalisée afin de diminuer les complications aiguës postopératoires chez les patients drépanocytaires, mais expose à une allo-immunisation, parfois grave, justifiant une tendance récente à l’économie transfusionnelle. Les conditions pour surseoir à la TF pour une chirurgie simple et fréquent...

In the world, among all type of cancers, colorectal cancer (CRC) is the third most commonly diagnosed in males and the second in females. In most of cases, (RP1) patients’ prognosis limitation with malignant tumors can be attributed to delayed diagnosis of the disease. Identification of patients with early-stage disease leads to more effective ther...

People suffering from extreme obesity may be exposed to delayed diagnosis and treatment of cancer. A 37-year-old woman (weight = 245 kg, body mass index (BMI) = 79 kg/m²), presented a sepsis associated with nonspecific abdominal pain for 4 months. After several unsuccessful attempts due to her weight and a large waist circumference, abdominal CT sc...

Introduction Postoperative ileus(POI) and anastomotic leakage(AL) are highly associated but the direction of this link is unknown. Indeed, it has traditionally been stated that AL leads to POI(secondary POI). The objective was to statistically determine the best model of link between POI and AL by comparing different Structural Equation Models(SEM)...

Background In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. Methods This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites betwee...

Background The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare.CaseWe describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ve...

The most dreadful complication after sleeve gastrectomy (SG) is staple line leak. Its rate varies between 1 and 2%. With the development of interventional endoscopy, its treatment is currently fairly standardized and allows healing in the majority of cases without revisional surgery. However, if endoscopic treatment fails, surgical treatment become...

Objective To assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. Study design For pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specim...

Background One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic biliary reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term...

In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus can pose an additional technical challenge. A 58-year-old patient with total situs inversus underwent Roux-en-Y gastric bypass (RYGB) surgery in our department. The main diff...

Purpose During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels...

Objectifs L’efficacité de la chirurgie aortique endovasculaire réside dans la précision de l’imagerie peropératoire. À partir d’un angioscanner, la fusion d’images permet un repérage peropératoire de la morphologie aortique sous fluoroscopie sans nécessiter l’injection de produit de contraste. Cependant, la morphologie de l’aorte abdominale est mod...

Introduction La fistule œsogastro-bronchique et/ou pleurale (OGBP) après sleeve gastrectomie (SG ou gastrectomie en manchon) est une complication grave et méconnue. Nous avons décidé d’étudier les bases anatomiques de ce type de fistule complexe. Méthode Notre travail a consisté en l’analyse clinique, endoscopique et radiologique des fistules OGBP...

Introduction La prise en charge moderne de l’ischémie mésentérique d’origine athéro-thrombotique (IMA) s’inscrit dans une stratégie de sauvetage intestinal et repose essentiellement sur la revascularisation endovasculaire par stent de l’artère mésentérique supérieure (AMS). Cette pathologie rare impose au chirurgien vasculaire la maîtrise de l’anat...

One anastomosis gastric bypass (OAGB) is a popular bariatric procedure, but controversies remain regarding biliary reflux and the potential risk of cancer. Esophagojejunostomy (EJ) in rats is a validated and reproducible model for the development of metaplasia [Barett’s esophagus (BE)] and esophageal adenocarcinoma (EA) with a minimal exposure of 1...

Purpose Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. Methods Our work consisted of an analy...

Introduction One anastomosis gastric bypass (OAGB) was suggested as an option in the management of weight loss failure after sleeve gastrectomy (SG). In parallel, the length of the biliopancreatic limb (BPL) is currently debated. Objectives To evaluate morbidity and efficiency of the conversion of SG to OAGB using two lengths of BPL (150 cm versus...

Background Recurrence patterns in stage III colon cancer (CC) patients according to molecular markers remain unclear. The objective of the study was to assess recurrence patterns according to microsatellite instability (MSI), RAS and BRAFV600E status in stage III CC patients. Methods All stage III CC patients from the PETACC-8 randomized trial tes...

But Analyser le site de récidive des patients traités pour un cancer du côlon (CdC) stade III en fonction du statut moléculaire. Méthodes les patients traités pour un CdC de stade III issus de l’étude PETACC-8 et testés pour les statuts microsatellite (MSS ou MSI), RAS et BRAFont été inclus. Les sites de récidive et la survie après récidive (SAR)...

Purpose There is confusion regarding the names, the number, and the exact location of the colonic arterial arches which provide connections between the superior and inferior (IMA) mesenteric arteries at the level of the left colic angle. The aim of this review was to delineate the “true” colic arches arising in the meso of the left colic angle and...

Background: Ampullary adenocarcinoma (AA) originates from either intestinal (INT) or pancreaticobiliary (PB) epithelium. Different prognostic factors of recurrence have been identified in previous studies. Methods: In 91 AA patients of the AGEO retrospective multicentre cohort, we evaluated the centrally reviewed morphological classification, pa...

Background and study aims: Post-laparoscopic sleeve gastrectomy (LSG) fistula is a major complication, responsible for high morbidity. Endoscopic treatment represents an alternative to surgical management, with variable approaches and success rates. In this study, we aimed to evaluate the efficacy of endoscopic treatment in a tertiary care center....

Background/aims: This study aims to describe the autonomic nervous network of the female pelvis with a 3D model and to provide a safe plane of dissection during radical hysterectomy for cervical cancer. Methods: Pelvises of 3 human female fetuses were studied by using the computer-assisted anatomic dissection. Results: The superior hypogastric...

The aim of this study was to determine the threshold values of pelvimetry by scanning and to evaluate the ability of the pelvimetry alone to diagnose a fetal-pelvic disproportion. It was an observational retrospective study on 410 pregnant women who had a scanner pelvimetry for any reasons. Based on the fetal presentations, two subgroups (breech an...

But L’utilisation des prothèses biologiques de renfort pariétal est croissante sans données de haut niveau de preuve sur leur bénéfice. Notre but était d’analyser les résultats de ces traitements innovants sur une large cohorte de patients. Matériel et méthodes Étude rétrospective sur 3 marques de prothèses biologiques implantées pour éventrations...

Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical c...

Introduction/Objectifs Réaliser une modélisation tridimensionnelle du foie chez le fœtus à partir de coupes IRM fœtales et d’un logiciel de reconstruction en 3D pour analyser la morphogenèse hépatique et celle du tronc porte. Matériels/patients et méthodes Les foies de 2 fœtus de 26 et 39 SA, indemnes de malformations, ont été modélisés à partir d...

Introduction/Objectifs Le but de cette étude était de décrire la topographie et la fréquence des différentes lésions d’endométriose pelvienne profonde. Matériels et méthodes Revue de littérature de 2003 à 2017 en utilisant les mots clés suivants : « anatomical distribution », « deeply infiltrating endometriosis », « deep endometriosis », « surgery...

Introduction/Objectifs Étudier la morphologie du cerveau et du tronc cérébral à l’aide d’un modèle 3D réalisé à partir de coupes d’IRM 3 Tesla de 3 fœtus indemnes de malformations encéphaliques et d’un logiciel de reconstruction 3D. Matériels/patients et méthodes Les cerveaux de 3 fœtus de 29 à 39 SA ont été reconstitués, à partir de coupes d’IRM...

Background: Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anasto...

After concomitant chemo-radiation therapy, 20 to 30% of advanced cervical cancers recur in irradiated territory. Pelvic exenteration remains a therapeutic option for selected patients. However, this procedure remains complex because of tissue fragility after radiotherapy and their associated co-morbidities. Minimally invasive surgery such as roboti...

Background: Enhanced recovery programs (ERP) improve post-operative outcomes in proportion to how fully they are implemented. Maintaining an optimal level of application of all the ER components is thus essential. Our aim was to assess the sustainability of ER surgical components 2 years after their first implementation. Method: Patients undergo...

Reconstruction of the extensor tendons remains a therapeutic challenge. Tendon transfers and grafts are a potential source of morbidity at the donor site, and the graft stock is limited. In the index finger, the tendon of the extensor indicis proprius can be anastomosed to the tendon of the extensor digitorum, and then the extensor digitorum tendon...

Objectif Analyser le développement cérébral fœtal et de sa gyration à partir d’une modélisation vectorielle en 3D par dissection assistée par ordinateur à partir de coupes IRM du cerveau fœtal et d’un logiciel de reconstruction en 3D. Matériel et méthodes Les cerveaux normaux de 5 fœtus de 19 à 37 SA ont été reconstruits en 3D à partir de coupes I...

Introduction Il existe une confusion dans la dénomination, le nombre et la localisation des arcades coliques permettant la connexion entre l’artère mésentérique supérieure (AMS) et l’artère mésentérique inférieure (AMI) au niveau du côlon transverse gauche et de l’angle colique gauche. Méthodes Une revue systématique de la littérature scientifique...

Purpose of review: Morbid obesity and type-2 diabetes mellitus (T2DM) are both major public health problems. Bariatric surgery is a proven and effective treatment for these conditions; laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the gold-standard treatment. One-anastomosis gastric bypass (OAGB) is described as a simpler, safer, and n...

Background Leakage after one-anastomosis gastric bypass (OAGB) is fortunately rare (<1%), it but remains the most severe complication. Few published data exist on this specific issue. Objectives To analyze the results from patients who presented with acute intra-abdominal sepsis (AIAS) caused by leakage after OAGB. Setting A university public hos...

Intraoperative enteroscopy (IOE) to explore obscure gastrointestinal bleeding is now rarely indicated. IOE allows complete small bowel exploration in 57% to 100% of cases, finds a bleeding source in 80% of cases, allows the recurrence-free management of gastrointestinal bleeding in 76% of cases, but carries a high morbidity and mortality. IOE only...

Since the MOSAIC study, oxaliplatin-based adjuvant chemotherapy has been the standard treatment for stage III colon cancer. Combination therapy with fluoropyrimidines and oxaliplatin has improved overall survival (OS) and reduced the risk of recurrence in patients with resected stage III colon cancer. However, only 20% of patients really benefit fr...

Objectives: To precise key-points of surgical neuroanatomy of the female pelvis to improve nerve-sparing radical hysterectomy (RH). Material and Methods: Review of the literature, computer-assisted anatomical dissection, and classic dissection of a female cadaver. Results: The superior hypogastric plexus (SHP) divides into two hypogastric nerves (H...

Sigmoid volvulus is the third leading cause of large bowel obstruction in adults. The main predisposing factor is a long redundant sigmoid colon with an elongated mesocolon. Sigmoid volvulus presents as an abdominal emergency but its management is controversial. Clinical exam is usually poor and must search gravity signs (septic shock and peritonit...

Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic spl...

Background: On November 13th, 2015, terrorist bomb explosions and gunshots occurred in Paris, France, with 129 people immediately killed, and more than 300 being injured. This article describes the staff organization, surgical management, and patterns of injuries in casualties who were referred to the Teaching European Hospital Georges Pompidou....

Purpose: Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas. Methods: A vascular recon...

More than half the patients with rectal cancer present with locally advanced rectal disease at diagnosis with a high risk of recurrence. Preoperative chemoradiotherapy and standardized radical surgery with total mesorectal excision have been established as the 'gold standard' for treating these patients. Pathological staging using the ypTNM classif...

Background: Surgery appears to be the best treatment option for a chronic fistula after laparoscopic sleeve gastrectomy (LSG). Conservative procedures (conversion into a Roux-en-Y gastric bypass, Roux-limb placement) have proven their feasibility and efficacy, but an open total gastrectomy (TG) is sometimes required in challenging situations. Obj...

Objectives: To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design: Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting: 11 university hospital ambulatory surgery units in Paris, France. Participants: Patients...

Objectives: To achieve a 3D vectorial model of a female pelvis by Computer-Assisted Anatomical Dissection and to assess educationnal and surgical applications. Materials and method: From the database of "visible female" of Visible Human Project(®) (VHP) of the "national library of medicine" NLM (United States), we used 739 transverse anatomical...

Supplementary data. (PDF)

Supplementary data. (PDF)

Supplementary data. (PDF)

CONSORT Checklist. (PDF)

Original study protocol. (PDF)

Supplementary data. (PDF)

Supplementary data. (PDF)

Supplementary data. (PDF)

Supplementary data. (PDF)

Background & aim: Kupffer cells (KC) play a key role in the onset of inflammation in non-alcoholic steatohepatitis (NASH). The glucocorticoid receptor (GR) induces glucocorticoid-induced leucine zipper (GILZ) expression in monocytes/macrophages and is involved in several inflammatory processes. We hypothesized that the GR-GILZ axis in KC may contr...

Introduction La fistule anastomotique (FA) est une complication grave en chirurgie colorectale, observée dans 3 à 6,4% des cas, qui nécessite fréquemment une réintervention et est associée à une importante morbi-mortalité. Parmi les facteurs potentiels favorisant la survenue d’une FA, le site de l’anastomose est rarement pris en compte. L’objectif...

Introduction Les perforations du grêle au cours des traumatismes fermés de l’abdomen sont de diagnostic souvent retardé avec une morbimortalité élevée. Le but est de préciser les signes cliniques et radiologiques permettant un diagnostic précoce de ces lésions. Méthode Entre 2001 et 2014, 28 patients (22 h, 6 f, âge moyen 28 ans) opérés d’une lési...

Objectif Le traitement endovasculaire des pathologies aortiques est une technique récente qui nécessite une navigation intra-aortique en trois dimensions avant la mise en place des endoprothèses. Afin de mieux comprendre cette nouvelle vision de l’anatomie aortique nous avons effectué une revue de la littérature pour appréhender les déformations li...

Background: Long-term outcomes of revisional laparoscopic single anastomosis-gastric bypass for a failed restrictive procedure (rSAGB) have not been analyzed. Objectives: To assess 5-year outcomes of rSAGB compared with 5-year outcomes of primary SAGB (pSAGB). Setting: University public hospital, France. Methods: One hundred twenty-six patie...