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  1. Article ; Online: Management of sigmoid diverticulitis: an update.

    Ambrosetti, Patrick / Gervaz, Pascal

    Updates in surgery

    2016  Volume 68, Issue 1, Page(s) 25–35

    Abstract: The role, indications and modalities of elective resection for sigmoid diverticulitis remain the cause of fierce debate. During the past two decades clinicians have increasingly recognized that: (1) young patients (<50) are no more at risk to develop ... ...

    Abstract The role, indications and modalities of elective resection for sigmoid diverticulitis remain the cause of fierce debate. During the past two decades clinicians have increasingly recognized that: (1) young patients (<50) are no more at risk to develop more aggressive course of the disease; and (2) patients who present initially with a first uncomplicated attack are no more at risk for developing subsequent complicated diverticulitis requiring emergency surgery. Hence, the previously well-recognized indications (based upon age of the patients or the number of attacks) are no longer valid. Yet, the number of sigmoid resections performed for diverticulitis in industrialized countries is increasing, which seems to indicate that in many cases, uncomplicated sigmoid diverticulitis progressively evolves towards a chronic symptomatic condition, which significantly impacts upon the patients' quality of life. The aims of this review are twofold: (1) to identify which disease presentation still represents good indications for elective laparoscopic sigmoid resection; and (2) to summarize the technical aspects of surgery for a benign condition, such as diverticular disease.
    MeSH term(s) Colectomy/methods ; Colon, Sigmoid/surgery ; Disease Management ; Diverticulitis/surgery ; Elective Surgical Procedures ; Humans ; Laparoscopy/methods
    Language English
    Publishing date 2016-03
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-016-0365-0
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  2. Article: Critical appraisal of laparoscopic lavage for Hinchey III diverticulitis.

    Gervaz, Pascal / Ambrosetti, Patrick

    World journal of gastrointestinal surgery

    2016  Volume 8, Issue 5, Page(s) 371–375

    Abstract: Laparoscopic lavage and drainage is a novel approach for managing patients with Hinchey III diverticulitis. However, this less invasive technique has important limitations, which are highlighted in this systematic review. We performed a PubMed search and ...

    Abstract Laparoscopic lavage and drainage is a novel approach for managing patients with Hinchey III diverticulitis. However, this less invasive technique has important limitations, which are highlighted in this systematic review. We performed a PubMed search and identified 6 individual series reporting the results of this procedure. An analysis was performed regarding treatment-related morbidity, success rates, and subsequent elective sigmoid resection. Data was available for 287 patients only, of which 213 (74%) were actually presenting with Hinchey III diverticulitis. Reported success rate in this group was 94%, with 3% mortality. Causes of failure were: (1) ongoing sepsis; (2) fecal fistula formation; and (3) perforated sigmoid cancer. Although few patients developed recurrent diverticulitis in follow-up, 106 patients (37%) eventually underwent elective sigmoid resection. Our data indicate that laparoscopic lavage and drainage may benefit a highly selected group of Hinchey III patients. It is unclear whether laparoscopic lavage and drainage should be considered a curative procedure or just a damage control operation. Failure to identify patients with either: (1) feculent peritonitis (Hinchey IV); (2) persistent perforation; or (3) perforated sigmoid cancer, are causes of concern, and will limit the application of this technique.
    Language English
    Publishing date 2016-03-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v8.i5.371
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  3. Article ; Online: Risk factors for survival after lung metastasectomy in colorectal cancer patients: systematic review and meta-analysis.

    Gonzalez, Michel / Gervaz, Pascal

    Future oncology (London, England)

    2015  Volume 11, Issue 2 Suppl, Page(s) 31–33

    Abstract: Despite the lack of randomized trials, lung metastasectomy is currently proposed for colorectal cancer patients under certain conditions. Many retrospective studies have reported different prognostic factors of poorer survival, but eligibility for ... ...

    Abstract Despite the lack of randomized trials, lung metastasectomy is currently proposed for colorectal cancer patients under certain conditions. Many retrospective studies have reported different prognostic factors of poorer survival, but eligibility for pulmonary metastasectomy remains determined by the complete resection of all pulmonary metastases. The aim of this review is to clarify which pre-operative risk factors reported in systematic reviews or meta-analysis are determinant for survival in colorectal metastatic patients. Different criteria have been now identified to select which patient will really benefit from lung metastasectomy.
    MeSH term(s) Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Humans ; Lung Neoplasms/mortality ; Lung Neoplasms/secondary ; Lung Neoplasms/surgery ; Metastasectomy/mortality ; Risk Factors ; Survival Rate
    Language English
    Publishing date 2015
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 2184533-5
    ISSN 1744-8301 ; 1479-6694
    ISSN (online) 1744-8301
    ISSN 1479-6694
    DOI 10.2217/fon.14.259
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  4. Article ; Online: A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study.

    Wassmer, Charles-Henri / Revol, Rebecca / Uhe, Isabelle / Chevallay, Mickaël / Toso, Christian / Gervaz, Pascal / Morel, Philippe / Poletti, Pierre-Alexandre / Platon, Alexandra / Ris, Frederic / Schwenter, Frank / Perneger, Thomas / Meier, Raphael P H

    International journal of surgery (London, England)

    2023  Volume 109, Issue 6, Page(s) 1620–1628

    Abstract: Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors ... ...

    Abstract Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management.
    Patients and methods: All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors.
    Results: Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80-0.89).
    Conclusion: The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.
    MeSH term(s) Humans ; Aged ; Cohort Studies ; Prospective Studies ; Retrospective Studies ; Intestinal Obstruction/diagnosis ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Abdominal Injuries ; Ischemia/etiology
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1097/JS9.0000000000000171
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  5. Article ; Online: Time for a (re) definition of (recurrent) sigmoid diverticulitis?

    Gervaz, Pascal / Ambrosetti, Patrick

    Annals of surgery

    2011  Volume 254, Issue 6, Page(s) 1076–1077

    MeSH term(s) C-Reactive Protein/metabolism ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/diagnosis ; Diverticulitis, Colonic/surgery ; Humans ; Intestinal Perforation/diagnosis ; Intestinal Perforation/surgery ; Leukocyte Count ; Recurrence ; Sigmoid Diseases/complications ; Sigmoid Diseases/diagnosis ; Sigmoid Diseases/surgery ; Tomography, X-Ray Computed
    Chemical Substances C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2011-12
    Publishing country United States
    Document type Letter
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0b013e31823acc5c
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  6. Article: T0 N1 adenocarcinoma of the colon following oxaliplatin-based neoadjuvant chemotherapy.

    Gervaz, Pascal / Morel, Philippe

    Journal of surgical oncology

    2008  Volume 97, Issue 1, Page(s) 94–95

    MeSH term(s) Adenocarcinoma/pathology ; Aged ; Chemotherapy, Adjuvant ; Colectomy ; Colonic Neoplasms/drug therapy ; Colonic Neoplasms/pathology ; Colonic Neoplasms/surgery ; Female ; Humans ; Liver Neoplasms/secondary ; Organoplatinum Compounds/therapeutic use
    Chemical Substances Organoplatinum Compounds ; oxaliplatin (04ZR38536J)
    Language English
    Publishing date 2008-01-01
    Publishing country United States
    Document type Case Reports ; Comment ; Letter
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.20888
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  7. Article: Should preoperative mechanical bowel preparation be abandoned?

    Bucher, Pascal / Gervaz, Pascal / Morel, Philippe

    Annals of surgery

    2007  Volume 245, Issue 4, Page(s) 662

    MeSH term(s) Colon/surgery ; Digestive System Surgical Procedures ; Enema/utilization ; Humans ; Preoperative Care
    Language English
    Publishing date 2007-04
    Publishing country United States
    Document type Letter ; Meta-Analysis
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/01.sla.0000259047.43665.04
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  8. Article: Natural history of uncomplicated sigmoid diverticulitis.

    Buchs, Nicolas C / Mortensen, Neil J / Ris, Frederic / Morel, Philippe / Gervaz, Pascal

    World journal of gastrointestinal surgery

    2015  Volume 7, Issue 11, Page(s) 313–318

    Abstract: While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to population-based or retrospective studies. This ...

    Abstract While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to population-based or retrospective studies. This comprehensive review aimed to evaluate the NH of simple sigmoid diverticulitis. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low, ranging from 13% to 47%, depending on the definition used by the authors. Among different risk factors for recurrence, patients with C-reactive protein > 240 mg/L are three times more likely to recur. Other risk factors include: Young age, a history of several episodes of acute diverticulitis, medical vs surgical management, male patients, radiological signs of complicated first episode, higher comorbidity index, family history of diverticulitis, and length of involved colon > 5 cm. The risk of developing a complicated second episode (and its corollary to require an emergency operation) is less than 2%-5%. In fact, the old rationale for elective surgery as a preventive treatment, based mainly on concerns that recurrence would result in a progressively increased risk of sepsis or the need for a colostomy, is not upheld by the current evidence.
    Language English
    Publishing date 2015-12-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v7.i11.313
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  9. Article ; Online: Management of obstructive and perforated colorectal cancer.

    Schwenter, Frank / Morel, Philippe / Gervaz, Pascal

    Expert review of anticancer therapy

    2010  Volume 10, Issue 10, Page(s) 1613–1619

    Abstract: Colorectal cancer frequently presents with obstruction or perforation at the time of diagnosis, and requires urgent surgery. Various surgical and endoscopic approaches are available that minimize the risk of complications related to emergency colorectal ... ...

    Abstract Colorectal cancer frequently presents with obstruction or perforation at the time of diagnosis, and requires urgent surgery. Various surgical and endoscopic approaches are available that minimize the risk of complications related to emergency colorectal operations and optimize the oncological outcome for the patients. The surgeon has to make clinically and oncologically adequate decisions, ranging from diverting colostomy to partial or total colectomy in a one-stage procedure or multistage interventions. The endoscopic insertion of a self-expanding metallic stent is an option either as a definitive procedure in palliative conditions or as a bridge to safer elective surgery. In this article, we discuss the current surgical and endoscopic treatments of complicated colorectal cancer and propose an algorithm for the management of patients with obstructive tumors.
    MeSH term(s) Colectomy ; Colon ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/drug therapy ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/therapy ; Colostomy ; Humans ; Intestinal Obstruction/complications ; Intestinal Obstruction/surgery ; Intestinal Obstruction/therapy ; Intestinal Perforation/complications ; Intestinal Perforation/surgery ; Intestinal Perforation/therapy ; Stents ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2010-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2112544-2
    ISSN 1744-8328 ; 1473-7140
    ISSN (online) 1744-8328
    ISSN 1473-7140
    DOI 10.1586/era.10.147
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    Zs.A 5907: Show issues Location:
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  10. Article ; Online: Colorectal cancer and thoracic surgeons: close encounters of the third kind.

    Gonzalez, Michel / Ris, Hans Beat / Krueger, Thorsten / Gervaz, Pascal

    Expert review of anticancer therapy

    2012  Volume 12, Issue 4, Page(s) 495–503

    Abstract: Resection of lung metastases from colorectal cancer (CRC) is increasingly performed with a curative intent. This strategy was made possible in the 1990s by the development of new chemotherapeutic approaches, improved surgical techniques and better ... ...

    Abstract Resection of lung metastases from colorectal cancer (CRC) is increasingly performed with a curative intent. This strategy was made possible in the 1990s by the development of new chemotherapeutic approaches, improved surgical techniques and better imaging modalities. However, evidence-based data showing clinical benefits of lung metastasectomy in this setting are nonexistent, and there are no prospective randomized trials to support the routine performance of these procedures for stage IV CRC. Current evidence suggests that resection of pulmonary metastases in combination with new cytotoxic agents, such as oxaliplatin, irinotecan and bevacizumab, may result in prolonged survival for many, and cure for a small minority of CRC patients who experienced tumor spread beyond the limits of the abdomen. This review focuses on the results of surgical management of CRC patients with lung metastases: we report the outcome of published series according to the presence or the absence of liver metastasis (and hepatic resection) prior to lung resection.
    MeSH term(s) Age Factors ; Aged ; Antineoplastic Agents/therapeutic use ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Female ; Humans ; Lung Neoplasms/drug therapy ; Lung Neoplasms/secondary ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Thoracic Surgery/manpower
    Chemical Substances Antineoplastic Agents
    Language English
    Publishing date 2012-04
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2112544-2
    ISSN 1744-8328 ; 1473-7140
    ISSN (online) 1744-8328
    ISSN 1473-7140
    DOI 10.1586/era.12.21
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