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Lahfidi A, Imrani K, Youssef Y, Jerguigue H, Benkabbou A, Mohsine R, Latib R, Omor Y.
Radiol Case Rep. 2021 Apr 10;16(6):1388-1390.

The papillomatosis is a very rare benign pathology diagnosed histologically with a significant potential for malignant transformation. We report a case a 60-year-old female without comorbidity present the gallbladder papillomatosis without involvement of the intra or extra hepatic biliary tract. The interest in knowing the radiological aspect of this pathology and make the early diagnosis in order to oriented treatment.

EMPODaT Consortium. Transpl Int. 2021 Aug;34(8):1553-1565.

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.

de’Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de’Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, Ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, Sommacale D.

World J Emerg Surg. 2021 Jun 10;16(1):30.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Houssaini K, Majbar MA, Souadka A, Lahnaoui O, El Ahmadi B, Ghannam A, Houssain Belkhadir Z, Mohsine R, Benkabbou A.
J Visc Surg. 2021 Mar 17:S1878-7886(21)00028-X.

Aim of the study: To analyze the collective learning curve in the performance of safe liver resections, using the decrease of severe postoperative complications (SPC) as a proxy for overall safety competency.

Material and methods: This was a retrospective analysis of a prospective database in the setting of a liver surgery program implementation in a tertiary center in Morocco. The 100 first consecutive cases of elective liver resections starting from January 1st, 2018 were included in the analysis. SPC were defined as CD>IIIa during the first 90 postoperative days. We used a cumulative sum (CUSUM) technique to determine the number of cases required to achieve safety competency. We then compared case characteristics before and after the learning curve completion.

Results: SPC occurred in 15 cases (15%), including 5 deaths (5%). The CUSUM chart revealed a learning curve completion at the 49th case, marked by an inflection point towards the decrease in SPC (24.5% vs 5.9%; P=0.009). In period 2 (after), cases were associated with less diabetes, less synchronous digestive resection, more cirrhosis, and more prolonged preoperative chemotherapy. The rates of major resection (30.6% vs 29.9%; P=0.89) and biliary reconstruction were comparable, as were the operating time, and estimated blood loss.

Conclusion: Approximately 50 cases were required to complete the learning curve and improve the overall safety of liver resection. In our setting, the learning curve chronology was consistent with collective measures, including team stabilization and protocol development.


Benkabbou A, Souadka A, Hachim H, Awab A, Alilou M, Serji B, El Malki HO, Mohsine R, Ifrine L, Vibert E, Belkouchi A.

Background and study aims: In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department.

Patients and methods: From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications.

Results: The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR.

Conclusion: We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.

Houssaini K, Lahnaoui O, Souadka A, Majbar MA, Ghanam A, El Ahmadi B, Belkhadir Z, Amrani L, Mohsine R, Benkabbou A.

Background: The aggregate root cause analysis (AggRCA) was designed to improve the understanding of system vulnerabilities contributing to patient harm, including surgical complications. It remains poorly used due to methodological complexity and resource limitations. This study aimed to identify the main patterns contributing to severe complications after liver resection using an AggRCA.

Methods: This was a retrospective qualitative study aimed to identify the main patterns contributing to severe complications, defined as strictly higher than grade IIIa according to the Clavien-Dindo classification within the first 90 days after liver resection. All consecutive severe complications that occurred between January 1st, 2018 and December 31st, 2019 were identified from an electronic database and included in an AggRCA. This included a structured morbidity and mortality review (MMR) reporting tool based on 50 contributory factors adapted from 6 ALARM categories: « Patient », « Tasks », « Individual staff », « Team », « Work environment », and « Management and Institutional context ». Data resulting from individual-participant root cause analysis (RCA) of single-cases were validated collectively then aggregated. The main patterns were suggested from the contributory factors reported in more than half of the cases.

Results: In 105 consecutive liver resection cases, 15 patients (14.3%) developed severe postoperative complications, including 5 (4.8%) who died. AggRCA resulted in the identification of 36 contributory factors. Eight contributory factors were reported in more than half of the cases and were compiled in three entangled patterns: (1) Disrupted perioperative process, (2) Unplanned intraoperative change, (3) Ineffective communication.

Conclusion: A pragmatic aggregated RCA process improved our understanding of system vulnerabilities based on the analysis of a limited number of events and a reasonable resource intensity. The identification of patterns contributing to severe complications lay the rationale of future contextualized safety interventions beyond the scope of liver resections.

Dig Surg. 2011;28(2):114-20. doi: 10.1159/000323819. Epub 2011 Apr 29.

Gaujoux S(1), Goéré D, Dumont F, Souadka A, Dromain C, Ducreux M, Elias D.

Department of Surgical Oncology, Institute Gustave Roussy, Villejuif, France.

Missing metastases, also called vanishing or disappearing liver metastases, concern about 5% of patients with colorectal liver metastasis undergoing chemotherapy, and this phenomenon is likely to become more frequent in the near future, with the widespread use of highly efficient chemotherapy. As their definition is highly dependent on the quality of initial imaging, a DLM on preoperative computed tomography scan should be systematically confirmed by a second imaging modality, ideally magnetic resonance imaging. It is important to note that a complete clinical response does not mean a complete pathologic response. Currently, there are no absolute criteria of a complete pathologic response. However, treatment with neoadjuvant and adjuvant hepatic arterial infusion in patients <60 years old with an initially low carcinoembryonic antigen level that normalizes under chemotherapy and who have no detectable lesion on both computed tomography and magnetic resonance imaging is probably more likely to yield a complete pathologic response. Whatever their treatment, patients with  DLM run a high risk of recurrence that could be decreased with the use of HAI. Despite a high recurrence rate, the overall 5-year survival rate of patients with DLM ranges from 40 to 80%. Having a DLM should no longer be a contraindication to hepatic surgery since long-term survival is expected in these highly chemosensitive patients. The use of adjuvant HAI in addition to efficient systemic chemotherapy could reduce the risk of hepatic relapse.

DOI: 10.1159/000323820

PMID: 21540596  [Indexed for MEDLINE]

Ann Surg. 2011 Jul;254(1):114-8. doi: 10.1097/SLA.0b013e31821ad704.

Goèré D(1), Gaujoux S, Deschamp F, Dumont F, Souadka A, Dromain C, Ducreux M, Elias D.

(1)Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, Cedex, France. 

BACKGROUND: After chemotherapy, complete clinical responses of colorectal liver metastases (CRLMs) increasingly occur, but these responses are rarely complete pathological responses. The management of patients with missing metastases, that  is, CRLMs that disappear under chemotherapy are undetectable intraoperatively and finally left in place, continues to be controversial. The aim of this study was to assess the long-term outcome of patients with « missing CRLMs. »

PATIENTS: Between 1999 and 2007, among 523 patients operated on for CRLMs, 96 missing CRLMs were observed and left in place in 27 originally unresectable patients. All of these patients received preoperative chemotherapy. Hepatic arterial infusion (HAI) of oxaliplatin combined with systemic 5-fluorouracil was  administered in 23 patients, including 12 before hepatectomy and 11 after. Hepatic surgery was performed after a minimal interval of 3 months during which CRLMs had disappeared on imaging.

RESULTS: After a median follow-up of 55 months (24-137) after hepatic surgery, an intrahepatic recurrence was diagnosed in 14 (52%) patients, but the recurrence rate was significantly lower in patients who had received adjuvant HAI compared with the others (27% vs 83%, P = 0.006). Recurrences arose at the site of the missing CRLMs in 9 (33%) patients, but was associated in all cases with another recurrence in the liver. The 5-year overall survival rate of these 27 highly chemosensitive patients was 80%, and the 5-year disease-free survival rate was 23%.

CONCLUSION: Highly chemosensitive patients, whose initially unresectable CRLMs become resectable because of missing CRLMs left in place, have a favorable long-term outcome. Missing CRLMs should not be longer, a contraindication to hepatic surgery. Use of postoperative HAI of oxaliplatin can help to reduce the risk of hepatic relapse.

DOI: 10.1097/SLA.0b013e31821ad704

PMID: 21516034  [Indexed for MEDLINE]

Rafi H(1), Kabbaj N, Salihoun M, Amrani L, Acharki M, Guedira M, Nya M, Amrani N.


Author information:

(1)EFD-Hepatogastroenterology Unit, Ibn Sina Hospital, UM5S, Rabat, Morocco.

BACKGROUND AND STUDY AIMS: Hepatic steatosis seems to be frequently found histopathologically in chronic hepatitis C virus (HCV)-infected patients. The aim of this study is to determine the influence of steatosis on HCV disease severity  (fibrosis) and to evaluate its impact on sustained virological response (SVR) to  antiviral therapy.

PATIENTS AND METHODS: From April 2008 to April 2010, 148 consecutive adults (87 females (59%) and 61 males (41%); mean age: 55.2 years) with HCV admitted for liver biopsy were included in this retrospective study. At least one element of metabolic syndrome was identified in all cases: Obesity (n=44), hyperlipidaemia (n=40), hypertension (n=29) and diabetes (n=21). Liver fibrosis was classified according to the Metavir score and hepatic steatosis described as following: S0:  absent; S1: minimal (<30%); S2: moderate (30-60%); and S3: severe (>60%). Patients were divided into two groups: S0S1 group (absent or minimal steatosis) and S2S3 group (moderate to severe steatosis). Of the 148 patients, 53 were treated with pegylated interferon and ribavirin combination therapy.

RESULTS: Steatosis was found in 40 patients (27%): S1 in 72.5%, S2 in 17.5% and S3 in 10% of cases. The distribution of patients according to the degree of fibrosis was as follows: in the S0S1 group, F1=12.4%, F2=36.5%, F3=21.1% and F4=21.1% and in the S2S3 group, F1=9%, F2=45.5%, F3=18.2% and F4=27.3%. There was no difference between the two groups regarding the degree of fibrosis (p≥0.80). The rate of SVR was 64%: 63% in the S0S1 group and 75% in the S2S3 group. The difference was not statistically significant (p=1).

CONCLUSION: Steatosis was found in 25% of cases. Liver steatosis in chronic hepatitis C is not a negative prognostic factor of response to combined antiviral therapy. These results must be confirmed by a large series of patients.

Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd.

All rights reserved.


DOI: 10.1016/j.ajg.2011.07.003

PMID: 22055591  [Indexed for MEDLINE]


Arab J Gastroenterol. 2011 Sep;12(3):136-8. doi: 10.1016/j.ajg.2011.07.003. Epub  2011 Sep 15.

Benkabbou A(1), Castaing D, Salloum C, Adam R, Azoulay D, Vibert E.

Author information:

(1)AH-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.

BACKGROUND: Roux-en-Y hepaticojejunostomy (RYHJ) is the most well-accepted treatment for most post-cholecystectomy bile duct injuries (BDI). RYHJ failure is a complex situation that requires expert planning and the possibility of using a  combination of operative, radiologic, and endoscopic techniques. The aim of this  study was to report our experience with a multidisciplinary approach to failed RYHJ after post-cholecystectomy BDI.

METHODS: Between January 1996 and March 2008, 44 consecutive patients were managed for RYHJ failure in our department. They presented with recurrent cholangitis in 40 patients (91%) and/or jaundice in 9 (20%). First-line treatment consisted of primary revisionary surgery in 26 cases (59%; repeat RYHJ in 22 and  hepatectomy in 4) and a percutaneous approach in 18 cases (41%; biliary interventions in 16 and portal vein embolization in 2).

RESULTS: Postoperative mortality was nil. Postoperative morbidity was 11% after repeat RYHJ without hepatectomy, 80% (bile leaks) after hepatectomy, and 10% (mild cholangitis and hemobilia) after a percutaneous approach. Delayed revisionary surgery with the intent to wait for bile duct dilation failed in all  5 patients. With a mean follow-up of 49 ± 40 months, second- or third-line treatment was attempted in 7 patients (16%). One patient (2%) died because of suicide. Overall clinical success defined by the absence of incapacitating biliary symptoms after treatment was achieved in 39 patients (89%).

CONCLUSION: An immediate, multidisciplinary approach including repeat biliary surgery and/or a percutaneous approach in a tertiary hepatobiliary center is required to obtain good, long-term results when treating the failure of RYHJ post-cholecystectomy BDI.

Copyright © 2013 Mosby, Inc. All rights reserved.

DOI: 10.1016/j.surg.2012.06.028

PMID: 23044267  [Indexed for MEDLINE]

Surgery. 2013 Jan;153(1):95-102. doi: 10.1016/j.surg.2012.06.028. Epub 2012 Oct 6.

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