Thion Medical (France)

A significant proportion of patients presenting a primary sclerosing cholangitis (PSC) will require liver transplantation (LT). The present study aimed to investigate graft loss and patient death in a large cohort of patients. We conducted a nationwide multicenter retrospective study including all adult patients transplanted for PSC in France From 1985 to 2019. Were included 571 patients; median follow-up after LT was 89.0 months (IQR, 43.0-151.0). Patient survival at 5, 10 and 20 years after LT was 88.2%, 81.2% and 62.6%. After exclusion of patients who died during the first month after LT, 37 patients (6.6%) died during the first 2 years and the main cause was malignancies (n = 15, 40.5%, including 12 cases of recurrent cholangiocellular carcinoma). After 2 years, 90 patients (17.2%) died; the two main causes were malignancies (n = 36, 40.0%, including 13 cases of colorectal cancer) and sepsis (n = 23, 25.6%, of which 7 were related to recurrent PSC). Graft survival at 5, 10 and 20 years was 89.5%,78.7% and 62.7%. Independent factors associated with late patient death (after 2 years) were an older age at LT, a bilio-digestive anastomosis and the use of preventive UDCA; independent factors associated with late graft loss were recurrent PSC, cellular rejection, a younger age at LT, and the use of tacrolimus (protective). Our results emphasise that the prognosis after LT for PSC could be improved by better detection of cholangiocellular carcinoma before LT, and colorectal cancer after LT.

CASE REPORTOur patient is a 14-year-old boy with severe scoliosis treated by spinal casting, scheduled for spinal arthrodesis.Six months before surgery, he was diagnosed with Crohn's disease requiring anti-TNF therapy, leading to postponement of the operation.Adalimumab induced deep remission with complete resolution of symptoms and normalization of fecal calprotectin (<30 g/g) within one year.At age 15, given the sustained remission, anti-TNF therapy was discontinued to perform arthrodesis under optimal safety conditions, as such treatment increases postoperative complications and should be stopped ideally 4 weeks before and after surgery.During the delay, the spinal curvature slightly progressed, necessitating an extended arthrodesis from T6 to L4.No cranial halo was required.His general condition improved, notably weight gain, and surgery was performed at a normal BMI of 19.2 kg/m (Fig. 1).Twenty-four hours postoperatively, the patient developed severe nausea and bilious vomiting.Despite fasting and gradual reintroduction of enteral feeding, each attempt triggered occlusive symptoms (bilious vomiting and abdominal pain).No signs of Crohn's flare or stenosis were found: no hypoalbuminemia, normal inflammatory markers, rapid postoperative CRP decrease, and normal ferritin (fecal calprotectin could not be measured due to absence of stool).Imaging showed no bowel inflammation.Intermittent macroscopic hematuria was also noted.An abdominal ultrasound on day 5 was normal.On day 11, an upper gastrointestinal contrast study revealed transient contrast stagnation in the second duodenal portion with delayed passage into the third.Contrast-enhanced CT demonstrated compression of the third duodenal segment between the superior mesenteric artery and aorta with a "thread-like" appearance and proximal left renal vein dilatation, consistent with nutcracker syndrome and superior mesenteric artery syndrome (SMAS) (Fig. 2).A multidisciplinary discussion (pediatric surgeons, orthopedic surgeons, gastroenterologists) favored conservative management, despite the patient's adequate preoperative nutritional status.Considering the recent complications, resumption of anti-TNF therapy was deferred.Exclusive enteral nutrition (EEN) using Modulen IBD , an isocaloric (1 kcal/mL) semi-elemental polymeric formula, commonly used in Crohn's disease, was initiated.Estimated nutritional requirements were ranged from 2800 and 3100 kcal/day for a 60 kg adolescent with low physical activity, recovering from scoliosis surgery.Enteral feeding was started at 20 mL/h and progressively increased by 10-20 mL/h every 12 h, up

The most prevalent conditions affecting the pelvic floor include fecal incontinence (FI) and urinary incontinence (UI), both of which are particularly common among women with obesity. Although the effect of metabolic bariatric surgery (MBS) on FI remains a topic of ongoing discussion, the present study seeks to assess the impact of effective bariatric surgery on UI and FI in women with obesity. An observational prospective study was conducted at the Tours University Hospital, involving 212 women who underwent MBS. Participants completed pre-operative and post-operative questionnaires to evaluate UI and FI one-year after surgery. Additionally, urinary symptom profile (USP) and Wexner score (WS) were utilized for the assessment of UI and FI, respectively. Of the 212 patients, 148 achieved a weight loss of more than 20% of their weight one-year after surgery, and of these 40 (27.0%) completed all questionnaires. The median pre-surgical BMI was found to be 41.8 kg/m², which reduced to 29.1 kg/m² one-year post-surgery. A significant improvement was observed in stress urinary incontinence (SUI), which decreased from 32.5% pre-operatively to 22.5% post-operatively (p < 0.0001). FI showed slight exacerbation, with an increase in moderate FI (from 5.0% to 10.0%), frequency of liquid stool per week (from 2.5% to 5.0%), and gas-related symptoms (from 0 to 2.5%). The findings of this study indicate that MBS significantly improves SUI in women with obesity, yet has minimal impact on FI one-year postoperatively. Further studies are required to more accurately assess the impact of metabolic bariatric surgery on postoperative FI.