Background: Resection is rarely indicated in giant hepatic hemangiomas (HHs) that are symptomatic. Enucleation (EN), compared with anatomical resection (AR), is considered the better technique to resect them as EN has been reported to have lower morbidity while conserving the normal liver tissue. But no study has yet clearly established the superiority of EN over AR. In addition, the independent predictors of postoperative morbidity have not been established. Methods: All consecutive patients operated for HH at two specialized hepatobiliary centers were reviewed. Patient demographics, operative variables, and postoperative outcomes were analyzed and compared between two techniques. Postoperative complications were graded as per Clavien-Dindo classification of surgical complications. The aims of this study were to compare two techniques of HH resection with respect to postoperative outcomes and to identify the risk factors for 90-day major postoperative morbidity and mortality. Results: A total of 64 patients, including 41 who underwent AR, 22 who underwent EN, and 1 who underwent liver transplantation, were operated for hemangiomas during the study period. Ten patients (9 who were operated for hemangiomas of size #4 cm and 1 who underwent transplantation) were excluded. Fifty-four patients, the majority being women (85%), with a median age of 48 years, were operated for giant HH. These patients were classified into two groups based on the technique of resection, namely, EN (22 patients) and AR (32 patients). Both groups were comparable in all aspects except that the number of liver segments resected was significantly more with AR. Postoperative outcomes were similar in both groups. Independent predictors of 90-day major complications including mortality were the use of total vascular exclusion (relative risk [RR]: 2.3, p = 0.028) and duration of surgery >4.5 h (RR: 2.3, p = 0.025). Conclusion: Both techniques yield similar results with respect to 90-day postoperative morbidity and mortality. The choice of technique should be based on the location of tumor and simplicity of liver resection.

Introducción: NutriNet-Salud México es un sistema de información en salud digital, instrumento de e-epidemiología, en línea, abierto y gratuito, para el registro y el análisis de los factores determinantes de los hábitos alimentarios y el estado nutricional de la población mexicana, para la prevención del sobrepeso, la obesidad y las enfermedades crónicas no transmisibles para el período 2018-2028.Objetivo: Describir el diseño, el desarrollo y la implementación de NutriNet-Salud México a partir del modelo francés NutriNet-Santé France 2008-2018.Método: La plataforma NutriNet-Salud México es la base digital para el desarrollo de un sistema de información en salud -para un estudio de cohorte prospectivo programado para 10 años (2018-2028)-con un sitio web dedicado cuyo desarrollo permite tener varias poblaciones de estudio que responden un conjunto inicial de cinco cuestionarios autoaplicables validados en población mexicana.Resultados: La información obtenida permitirá desarrollar investigación aplicada, conocer y vigilar los aportes alimentarios y el estado nutricional de la población, evaluar el impacto de acciones de salud pública sobre el comportamiento alimentario y el estado nutricional, y comparar poblaciones entre países (

Background:NutriNet-Salud Mexico is a digital health information system, e-epidemiology instrument, online, open and free, to recording and analysis the determinants of dietary habits and nutritional status of the Mexican population, for the prevention of overweight, obesity and noncommunicable diseases for the period 2018-2028.Objective:Describe the design, development and implementation of NutriNet-Salud Mexico from the French model NutriNet-Santé France 2008-2018.Method:NutriNet-Salud Mexico platform is the basis for the development of health information system for prospective cohort study, scheduled for a period of 10 years (2018-2028), with a dedicated website, and its development will enable to have multiple study populations within an initial set of five self-applicable questionnaires validated in Mexican population.Results:The information will enable to develop applied research, learn and monitor food contributions and nutritional status of the population, assess the impact of public health actions on feeding behavior and nutritional status, comparing populations between countries (Mexico, France, Belgium and Switzerland) and national institutes, universities and states.Conclusions:NutriNet-Salud Mexico will provide information for assist in research and public action, especially to guide public policies on nutrition Mexico. The scientific elements will make appropriate nutritional recommendations to different populations and access to a representative nominal population sample with low-cost, in real-time, and with dual approach to e-epidemiology: cohort study to identify causality and cross-sectional studies (descriptive research, monitoring and evaluation).

Objective. ePlatform "NutriNet-Health, Mexico France 2017-2027", for the recording and analysis of health determinants, habits and nutritional status of large populations in Mexico. To generate scientific evidence for the prevention of overweight, obesity, diabetes mellitus (DBM), hypertension (HT), and chronic noncommunicable diseases (NCDs). Based on "NutriNet Health France". It allows: 1. To develop applied research. 2. To know and monitor the dietary intake and nutritional (and physical activity) status of the population. 3. TO evaluate the impact of public health actions on dietary behavior and nutritional status. 4. TO compare populations within Mexico and with different Francophone countries: France, Belgium, Switzerland and Quebec. Material and methods. "NutriNet-Health Mexico Francia" is a digital platform for the development of a "Health Information System", a prospective cohort study, for large and variated populations groups, scheduled for a period of 10 years (2017 -2027), with a dedicated website. It allows simultaneous monitoring of large populations: A. Health and education professionals, and their families; B. Students, patients and their families; C. Volunteer participants, adults and their families. Those who answered an initial set of self-validated international questionnaires, validated in the Mexican population, to evaluate: 1) physical activity, 2) anthropometry, 3) lifestyle, socioeconomic conditions, 4) health status, 5) Dietary assessment (food survey), 6) risk and healthy behavior, etc. Results. The "NutriNet-Health Mexico Francia" e-platform, is a digital health information system, an eepidemiology tool, online, open source and free, for registering the 24-hour nutritional reminder with photographs. Discussion. ePlatform, health information system, allows to generate evidence, from large databases, 5,000 to 500,000 users, to assist in research and public action. It offers a great opportunity to access a representative population sample, at a low cost and in real time, with a double approach to e-epidemiology: a cohort study that allows to identify causality (etiological research), and on the other, frequent cross-sectional studies (descriptive research, monitoring and evaluation). It provides a great opportunity to include other cohort studies, benefiting from the low cost, continuity, and complement to the study lines.

Une mutation profonde de la cardiologie et de la chirurgie cardiaque est en cours justifiant une réflexion sur la chirurgie cardiaque en 2025. La chirurgie coronarienne s'adressera à des patients avec plus de comorbidités. L'indication des TAVI va s'élargir vers des patients à risque intermédiaire entraînant une diminution de la chirurgie de la valve aortique. Les interventions percutanées devront être réalisées dans des centres médico-chirurgicaux au sein d'un « Heart team ». La prise en charge de l'insuffisance cardiaque sévère sera en grand développement avec l'assistance circulatoire mécanique. La chirurgie cardiaque courante de l'adulte devra se faire dans des centres de « proximité » et la chirurgie d'expertise dans des centres de « référence ». L'Académie nationale de médecine recommande d'effectuer des regroupements au sein de la chirurgie elle-même, de créer des réseaux de chirurgie cardiaque pour réaliser les interventions non courantes. A deep transformation is ongoing for cardiology and heart surgery; we have planned to do a prospective analysis of cardio-vascular surgery in 2025. More severe and older coronary patients will have to be treated in the future. The improving TAVI'results will probably allow to enlarge the indications to less severe and younger patients. We can think that in the next 10 years there will be a reduction of aortic valve surgery. The percutaneous procedures will need to be always performed in medico-surgical centers with a multi-disciplinary Heart team. The management of severe cardiac failure patients will probably increase a lot with the development of mechanical cardiac support. Classical adults cardiac surgery will need to be done in " local " centers, high level operations performed in " expertise " teams. National Medical Academy recommends: in concentrating several surgical teams, and also creating networks between local and expertise teams for the management of rare clinical cases. « Le seul moyen de prédire le futur, est de l'inventer. » Norman Shumway

Une mutation profonde de la cardiologie et de la chirurgie cardiaque est en cours justifiant une réflexion sur la chirurgie cardiaque en 2025. La chirurgie coronarienne s’adressera à des patients avec plus de comorbidités. L’indication des TAVI va s’élargir vers des patients à risque intermédiaire entraînant une diminution de la chirurgie de la valve aortique. Les interventions percutanées devront être réalisées dans des centres médico-chirurgicaux au sein d’un « Heart team ». La prise en charge de l’insuffisance cardiaque sévère sera en grand développement avec l’assistance circulatoire mécanique. La chirurgie cardiaque courante de l’adulte devra se faire dans des centres de « proximité » et la chirurgie d’expertise dans des centres de « référence ». L’Académie nationale de médecine recommande d’effectuer des regroupements au sein de la chirurgie elle-même, de créer des réseaux de chirurgie cardiaque pour réaliser les interventions non courantes.

Introduction Le traitement des shunts spleno-renaux (SSR) larges (>1 cm) en transplantation hepatique n’est pas codifie. La splenectomie (SP) supprime les SSR au prix d’une morbidite specifique et la ligature de la veine renale gauche (LVR) permet une deconnexion d’aval avec un retentissement renal peu etudie. Cette etude retrospective a compare ces 2 methodes en terme d’efficacite de revascularisation et de morbidite. Patients De 1994 a 2012, 22 SP et 7 LVR ont ete realisees pour cette indication. Resultats Il n’y avait pas de difference significative de duree operatoire et de taux de transfusion. Une revascularisation porte satisfaisante a ete obtenue dans 100% des cas. La morbidite postoperatoire, incluant les taux d’infection (SP+ 41 vs SP – 43%) et de thrombose porte partielle (32 vs 14%) n’etait pas significativement differente alors que la thrombopenie regressait plus rapidement apres SP (568 vs 148 G/L a J30) et que le groupe LVR presentait une degradation temporaire de la fonction renale. Apres un suivi median de 60 mois, 2 patients du groupe SP ont degrade secondairement le flux porte en raison d’un SSR distal non deconnecte et d’un shunt mesenterico- gonadique non traite. Conclusion La SP et la LVR sont 2 techniques efficaces pour assurer une perfusion porte satisfaisante en supprimant les SSR. La SP est efficace en cas de SSR proche du hile de la rate et permet une regression rapide de la thrombopenie. La LVR semble sans consequence durable sur la fonction renale. Declaration d’interet Les auteurs n’ont pas transmis de conflits d’interets.

The job of surgeon has evolved in recent years. Imaging, biology, minimally invasive techniques and interventional entered in the operating room. It is likely that surgery tomorrow will be very different from today. Surgery is a trade with many constraints. Responsibility is often questioned. Availability must be constant. Work schedules are hardly compatible with the current evolution of the society; "Public" practice sector attracts young surgeons, because it appears less risky, facilitating teamwork and less exposed to financial risks. A number of highly specialized activities and research are dedicated to fool "public" hospital. The "private" sector occupies an important place in France: 65% of surgical procedures are performed in "private" practice. Professional practice is much lonelier, putting the personal responsibility of the surgeon involved. Salaries are below the informations published in the press. And upgrading of the acts did not follow the evolution of the cost of living.Career is short and the retirement age is between 65 and 68 Years. The amount of pension benefits is less than the executives.Despite all these considerations, Surgery remains an attractive profession, or you do not get bored and where there is no unemployment

A multivisceral abdominal transplantation could be required in case of intestinal insufficiency associated with another abdominal organ insufficiency, especially the liver. This procedure can improve the survival and the quality of life in selected patients. We report the case of an adult patient with a survival exceeding 5 years after multivisceral transplantation. We focused the discussion on the main technical points and the postoperative complications, especially intestinal acute rejection which represents a life-threatening complication.

Colorectal surgery is subject to a rate of major complications, especially after neo-adjuvant radiotherapy. Between October 1994 and August 2011, 46 patients have benefited from a "delayed" coloanal anastomosis (DCAA) to restore coloanal continuity. Pelvic radiotherapy was performed in 17 patients. The pathology was septic anastomotic complications in 33 patients, low Hartmann's reconstruction in four, rectal perforation in one, colic ischemia in two and selected pelvic local cancer recurrence (ovarian, rectal, appendiceal) in six.Mean follow-up was 65 months (range 6-192). There was no operative mortality. Overall morbidity was 33 %. There were no anastomotic leakage, three local infections, one colic ischemia and one ileovaginal fistula. The functional results were good or acceptable respectively in 73 % and 88 % of evaluable patients at one year and two years. At the end of follow-up, only three patients kept a stoma: two for poor functional outcome and one for ileovaginal fistula.After low colorectal anastomosis failure or low Hartmann's procedure or in some selected cases of pelvic cancer recurrence, DCAA is a safe procedure, with only 6 % of septic complications. DCAA is an alternative to Soave's procedure for sphincter preservation.

Abdominal approach is commonly used for resection of liver tumors. However, in rare cases, transthoracic approach may be a valuable option for management of lesions located in the hepatic dome or involving the cavo-hepatic junction for very selected patients. This approach can be an open procedure (thoracotomomy), a video-assisted minimally invasive technique (thoracoscopy), or a strictly percutaneously treatment (CT-guided radiofrequency ablation). This approach seems useful for high-risk patients, with previous major abdominal surgery, or awaiting for liver transplantation (bridge concept) with cranially located single lesions. A limited liver resection (tumorectomy or segmentectomy) can be performed, but this approach is also suitable for percutaneous ablation therapy (radiofrequency or cryotherapy), with an acceptable morbidity.

LIVER TRANSPLANTATION – A PARADIGM IN THE SURGICAL TREATMENT OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH NON-VIRAL LIVER CIRRHOSIS (Abstract): BACKGROUND: Worldwide the rate of hepatocellular carcinoma (HCC) is continuing increasing and the survival rate, without treatment, varies between 6 and 20 months. The actual surgical management comprises liver resections, focal ablation and liver transplantation. Apparently the liver transplantation is the best treatment both for liver cirrhosis and HCC. However, the literature data about liver transplantation for HCC associated with nonviral liver cirrhosis (NVLC) are limited. METHODS: We performed an observational study about the patients who underwent orthotopic liver transplantation for HCC arising in NVLC. Different clinical, operative, pathological and follow-up data were recorded into a MS Excel Database and statistically analyzed. RESULTS: We included 12 patients with a mean age of 59.3±2.8 years old (range: 56-64). All the patients were men. According to Child-Pugh score, 16.6% (N=2) were in stage A, 41.7% (N=5) in stage B and the other 41.7% (N=5) in stage C. The mean value for MELD score was 19.8±7.1. The mean operation time was 405±102 min and intraoperative mean blood loss was 1850±1560 mL. The tumors had a mean diameter of 27.5 (range: 10-60). Major postoperative complications were noted in 5 cases. We noted no postoperative deaths. The overall survival rate was 91.67%; one death was noted 8 months after the operation. The mean survival time was 34.9±26.5 months (median: 33). No loco-regional recurrence was noted. CONCLUSIONS: Liver transplantation represents a good choice for HCC associated with NVLC. The long term results are apparently superior to the others surgical procedures, with low rates of recurrence.