Esophageal dilation and motility disorders can happen years after laparascopic adjustable gastric band surgery. Achalasia-like is defined by persistent motility disorder after gastric band deflation. A 54-year-old woman, with medical history of morbid obesity and laparascopic adjustable gastric band performed in 2010 sought medical advice in September 2021 for mixt dysphagia, severe food intolerance, and undernutrition. The explorations highlighted a massive esophageal dilation and esophagal motility disorder. The management consisted in removal of the gastric band by coelioscopy and refeeding. This lead to partial reduction of the symptoms, weight regain, and reduction of the esophageal dilation. Nonetheless, solid dysphagia, grade II esophagitis, and gastro-esophageal reflux persisted 8 months after gastric band removal. Esophageal dilation and achalasia-like symptoms after gastric band surgery were adverse events leading to undernutrition, food intolerance, and gastro-esophagal reflux. Removal of the gastric band leads to partial regression of the symptoms. Esophageal dilatation after gastric band could lead to irreversible damages on esophageal peristaltism.

Introduction: Infectious complications of parietal mesh after prosthetic abdominal wall repair are rare. Their management is complex. Furthermore, the emergence of bacterial resistance, the presence of a foreign material, the need to continue an extended antibiotic therapy, and the choice of an appropriate treatment are crucial. The objective of this study is to access the microbiological epidemiology of infected parietal meshes in order to optimize the empirical antibiotic therapy.Methods: Between January 2016 and December 2021, a monocentric and retrospective study was performed in patients hospitalized for infected parietal meshes at Avicenne hospital, in Paris area. Clinical and microbiological data such as antibiotic susceptibility were collected. Results: Twenty-six patients with infected parietal meshes have been hospitalized during this period. Meshes were in preaponevrotic positions (n = 10; 38%), retromuscular (n = 6; 23%) and intraperitoneal (n = 10; 38%). Among the 22 (84.6%) documented cases of infections, 17 (77.3%) were polymicrobial. A total of 54 bacteria were isolated, 48 of which had an antibiogram available. The most frequently isolated bacteria were: Enterobacterales (n = 19), Enterococcus spp. (n = 11) and Staphylococcus aureus (n = 6), whereas anaerobes were poorly isolated (n = 3). Concerning these isolated bacteria, amoxicillin-clavulanic acid, metronidazole-associated cefo-taxime, piperacillin-tazobactam and meropenem were susceptible in 45.5%, 68.2%, 63.6%, 77.2%, of cases, respectively.Conclusion: This work highlights that infections of abdominal parietal meshes may be polymi-crobial and the association amoxicillin-clavulanic acid cannot be used as a probabilist antibiotic therapy because of the high resistance rate in isolated bacteria. The association piperacillin-tazobactam appears to be a more adapted empirical treatment to preserve carbapenems, a broad-spectrum antibiotic class.(c) 2023 Elsevier Masson SAS. All rights reserved.

Sleeve gastrectomy (VSG) leads to improvement in hepatic steatosis, associated with weight loss. The aims of this study were to investigate whether VSG leads to weight‐loss independent improvements in liver steatosis in mice with diet‐induced obesity (DIO); and to metabolically and transcriptomically profile hepatic changes in mice undergoing VSG.

Les infections de prothèse pariétale abdominale sont des complications rares. Leur prise en charge est complexe du fait de l’émergence des résistances bactériennes aux antibiotiques, de la présence de matériel étranger et de la nécessité d’une antibiothérapie prolongée. Le choix de l’antibiothérapie probabiliste dans ce contexte est un sujet de controverse. L’objectif de cette étude est de décrire l’épidémiologie microbienne des prothèses pariétales infectées afin de guider le choix d’antibiothérapie probabiliste. Une étude monocentrique, rétrospective, a été conduite entre janvier 2016 et décembre 2021 chez les patients hospitalisés pour une infection de prothèse pariétale au CHU Avicenne en région parisienne. Les données cliniques et microbiologiques comme la sensibilité aux antibiotiques ont été collectées. Vingt-six patients ayant une infection de prothèse pariétale ont été hospitalisés au cours de cette période. Les prothèses étaient situées en position pré-aponévrotique (n = 10, 38 %), rétromusculaire (n = 6 ; 23 %) et intrapéritonéale (n = 10 ; 38 %). Parmi les 22 (84 ; 6 %) infections documentées, 17 (77 ; 3 %) étaient polymicrobiennes. Au total, 54 bactéries ont été isolées avec 48 antibiogrammes disponibles. Les bactéries le plus souvent représentées étaient les entérobactéries (n = 19), Enterococcus sp (n = 11) et Staphylococcus aureus (n = 6). Les bactéries anaérobies ont été peu isolées (n = 3). La sensibilité aux associations amoxicilline–acide clavulanique, métronidazole–céfotaxime, pipéracilline–tazobactam et au méropénème étaient respectivement de 45,5 %, 68,2 %, 63,6 % et de 77,2 %. Dans cette série, les infections de prothèse pariétale étaient fréquemment polymicrobiennes. L’association amoxicilline-acide clavulanique ne devrait pas être utilisée en probabiliste en raison du fort taux de résistance. L’association pipéracilline–tazobactam semble être une option plus adaptée afin de préserver les carbapénèmes, une classe d’antibiotique à plus large spectre. Infectious complications of parietal meshes after prosthetic abdominal wall repair are rare. Their management is complex. Furthermore, the emergence of bacterial resistance, the presence of a foreign material, the need to continue an extended antibiotic therapy, and the choice of an appropriate treatment are crucial. The objective of this study is to access the microbiological epidemiology of infected parietal meshes in order to optimize the empirical antibiotic therapy. Between January 2016 and December 2021, a monocentric and retrospective study was performed in patients hospitalized for infected parietal meshes at Avicenne hospital, in Paris area. Clinical and microbiological data such as antibiotic susceptibility were collected. Twenty-six patients with infected parietal meshes have been hospitalized during this period. Meshes were in preaponevrotic positions (n = 10; 38 %), retromuscular (n = 6; 23 %) and intraperitoneal (n = 10; 38 %). Among the 22 (84.6 %) documented cases of infections, 17 (77.3 %) were polymicrobial. A total of 54 bacteria were isolated, 48 of which had an antibiogram available. The most frequently isolated bacteria were: Enterobacterales (n = 19), Enterococcus sp (n = 11) and Staphylococcus aureus (n = 6), whereas anaerobes were poorly isolated (n = 3). Concerning these isolated bacteria, amoxicillin–clavulanic acid, metronidazole-associated cefotaxime, piperacillin–tazobactam and meropenem were susceptible in 45.5 %, 68.2 %, 63.6 %, 77.2 %, of cases, respectively. This work highlights that infections of abdominal parietal meshes may be polymicrobial and the association amoxicillin–clavulanic acid cannot be used as a probabilist antibiotic therapy because of the high resistance rate in isolated bacteria. The association piperacillin–tazobactam appears to be a more adapted empirical treatment to preserve carbapenems, a broad-spectrum antibiotic class.

Background & Aims: Liver regeneration is a repair process in which metabolic reprogramming of parenchymal and inflammatory cells plays a major role. Monoacylglycerol lipase (MAGL) is an ubiquitous enzyme at the crossroad between lipid metabolism and inflammation. It converts monoacylglycerols into free fatty acids and metabolises 2-arachidonoylglycerol into arachidonic acid, being thus the major source of pro-inflammatory prostaglandins in the liver. In this study, we investigated the role of MAGL in liver regeneration. Methods: Hepatocyte proliferation was studied in vitro in hepatoma cell lines and ex vivo in precision-cut human liver slices. Liver regeneration was investigated in mice treated with a pharmacological MAGL inhibitor, MJN110, as well as in animals globally invalidated for MAGL (MAGL-/-) and specifically invalidated in hepatocytes (MAGLHep-/-) or myeloid cells (MAGLMye-/-). Two models of liver regeneration were used: acute toxic carbon tetrachloride injection and two-thirds partial hepatectomy. MAGLMye-/-liver macrophages profiling was analysed by RNA sequencing. A rescue experiment was performed by in vivo administration of interferon receptor antibody in MAGLMye-/-mice. Results: Precision-cut human liver slices from patients with chronic liver disease and human hepatocyte cell lines exposed to MJN110 showed reduced hepatocyte proliferation. Mice with global invalidation or mice treated with MJN110 showed blunted liver regeneration. Moreover, mice with specific deletion of MAGL in either hepatocytes or myeloid cells displayed delayed liver regeneration. Mechanistically, MAGLHep-/-mice showed reduced liver eicosanoid production, in particular prostaglandin E2 that negatively impacts on hepatocyte proliferation. MAGL inhibition in macrophages resulted in the induction of the type I interferon pathway. Importantly, neutralising the type I interferon pathway restored liver regeneration of MAGLMye-/-mice.Conclusions: Our data demonstrate that MAGL promotes liver regeneration by hepatocyte and macrophage reprogramming. Impact and Implications: By using human liver samples and mouse models of global or specific cell type invalidation, we show that the monoacylglycerol pathway plays an essential role in liver regeneration. We unveil the mechanisms by which MAGL expressed in both hepatocytes and macrophages impacts the liver regeneration process, via eicosanoid production by hepatocytes and the modulation of the macrophage interferon pathway profile that restrains hepatocyte proliferation.& COPY; 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients. All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage. Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups. The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.

Radical cystectomy with urinary deviation is performed increasingly in France. Ileal conduit ureteral diversion (ICUD), described by Bricker and widely used after this type of radical resection, leads to substantial anatomic modifications that are potential danger zones during subsequent gastro-intestinal or urinary tract operations. Injury to the urinary diversion apparatus can lead to disastrous complications in these patients who are often elderly and frail. General surgeons are most often called upon to re-operate these patients, either for an ICUD-related gastro-intestinal complication, or for an unrelated abdominal emergency that arises later (bowel obstruction, infection, cancer). During such operations, certain anatomic structures are particularly exposed to injury that may be irreversible, particularly, the mesentery of the ileal conduit and the left ureter. Approaching the right lower quadrant, the dissection of the ileo-ileal anastomosis or of the left mesocolon are the procedures or maneuvers that pose the most risk. A number of simple but effective preventive measures are available and must be known, such as to operate the patient with an urologist or to insert ureteral stents before surgery. Preoperative contrast-enhanced computed tomography with late phase urinary imaging is essential to assess the anatomic modifications and anticipate the operative procedural steps. Finally, one should not hesitate to disinsert the stoma and proceed with retrograde dissection, thus facilitating the identification of the ileal conduit, the mesentery and the ureters.

One anastomosis gastric bypass (OAGB) is associated with similar metabolic improvements and weight loss as Roux-en-Y gastric bypass (RYGB). However, this bariatric procedure is still controversial as it is suspected to result in undernutrition. Reducing the size of the biliopancreatic limb of OAGB could be essential to maintain positive outcomes while preventing side effects. The objective of this study was to compare and contrast outcomes of OAGB with two different biliopancreatic limb lengths to RYGB and Sham surgery in obese and non-obese rats. Lean and diet-induced obese Wistar rats were operated on RYGB, OAGB with a short (15 cm OAGB-15) or a long (35 cm OAGB-35) biliopancreatic limb or Sham surgery. Body weight and food intake were monitored over 30 weeks, and rats underwent oral glucose and insulin tolerance tests with a pancreatic and gut hormone secretion assay. Macronutrient absorption was determined by fecal analyses. Statistical analyses used non-parametric one-way or two-way ANOVA tests. Compared to Sham rats, RYGB, OAGB-15 and OAGB-35 rats displayed a significant reduced weight. Weight loss was greater after OAGB-35 than after OAGB-15 or Sham surgery because of transient malabsorption. All OAGB- and RYGB-operated rats displayed an improved pancreatic and gut hormone secretion in response to a meal compared to Sham rats, these effects were independent of limb length, rat weight, and maintained overtime. In conclusion, glucose homeostasis was similarly improved in obese and non-obese OAGB-15 and OAGB-35 rats suggesting that shortening the biliopancreatic limb can improve the metabolic parameters without a major influence on weight.

La cystectomie radicale avec dérivation des urines est une intervention de plus en plus fréquente en France. L’urétérostomie cutanée trans-iléale (UCTI) de type Bricker réalisée couramment après ce type de résection, engendre des modifications anatomiques importantes, susceptibles de favoriser des lésions digestives ou urinaires lors de réinterventions digestives ou urologiques, responsables de complications dramatiques chez des patients souvent âgés et fragiles. Les chirurgiens viscéraux sont les plus susceptibles de réopérer ces patients, pour une complication digestive liée à l’intervention initiale ou dans le cadre d’une chirurgie abdominale en urgence (occlusion, infection, cancer). Lors de ces interventions, certaines structures anatomiques sont particulièrement exposées à des lésions potentiellement irréversibles, en particulier le méso du greffon iléal et l’uretère gauche. C’est l’abord direct de la fosse iliaque droite, de l’anastomose iléo-iléale, ou un geste malencontreux lors du décollement du méso colon gauche qui semblent être les manœuvres les plus à risque. Afin de réduire les accidents per opératoires, certaines mesures de prévention simples mais efficaces doivent être discutées telles que d’opérer en double équipe avec un urologue ou mettre en place des sondes urétérales de repérage. L’intérêt d’un scanner injecté en préopératoire avec temps tardif urinaire est également essentiel pour apprécier les modifications des rapports anatomiques et anticiper les gestes opératoires. Enfin, il ne faut pas hésiter à désinsérer la stomie pour permettre une dissection rétrograde et ainsi faciliter l’identification du greffon iléal, de son méso et des uretères.

Les complications infectieuses de prothèses pariétales abdominales post-cure d'éventration sont rares. Elles impliquent une prise en charge médicochirurgicale complexe. Avec l'émergence des résistances bactériennes, la présence d'un matériel étranger et la nécessité de poursuivre un traitement antibiotique (ATB) prolongé, le choix d'une antibiothérapie probabiliste adaptée est crucial. L'objectif de ce travail est d'étudier l'épidémiologie microbienne des infections de prothèses. Étude rétrospective entre 2016 et 2021 sur les cas de patients hospitalisés pour infection de prothèse pariétale à l'hôpital Avicenne. Des données cliniques et microbiologiques telle que la sensibilité à différents ATB ont été collectées. Vingt-six cas de patients ayant présenté une infection de prothèse pariétale ont été analysés durant cette période. Les prothèses étaient en position pré-aponévrotique (n = 10, 38 %), rétromusculaire (n = 6, 23 %) et intrapéritonéale (n = 10 ; 38 %). Parmi les 22 (84,6 %) cas d' infections documentées, 17 (77,3 %) étaient polymicrobiennes. Au total 54 germes ont été isolés dont 48 avec un antibiogramme disponible. Les germes les plus fréquemment isolés étaient : entérobactéries (n = 19), Enterococcus sp (n = 11) et Staphylococcus aureus (n = 6). Parmi les 22 patients ayant eu une infection documentée, l'association amoxicilline–acide clavulanique, le céfotaxime associé au métronidazole, l'association pipéracilline–tazobactam et le méropénem étaient sensibles dans 45,5 %, 68,2 %, 63,6 %, 77,2 %, des cas, respectivement. Ce travail montre que les infections de prothèse sont polymicrobiennes et l'association amoxicilline-acide clavulanique ne peut être utilisée en raison du taux de résistance élevé. L'association pipéracilline–tazobactam apparaît être une antibiothérapie probabiliste appropriée tout en préservant les carbapénèmes.

Laparostomy is a damage control strategy used in abdominal compartment syndrome (ACS) to prevent early death. However, once the acute episode is controlled, the closure of the open abdomen can be difficult or even impossible [1]. Opening of the abdominal cavity has deleterious effect, it increases the protein loss and the hypercatabolism. On the long term, lack of parietal closure can lead to consequences such as giant incisionnal hernia or eviscerations. Extended length of the laparostomia, muscular retraction, digestive stomias and cutaneo-muquous oedema are obstacles to a complete parietal closure. Use of vacuum-assisted wound therapy (VAC therapy) could increase the rate of parietal closure. Biologic meshes have the advantage prevent septic complications for that reason they can be use in a septic context [2]. This video aim is to suggest a protocol of laparostomy's closure combining fluid depletion by hemodialysis, sequential parietal closure, VAC therapy and use of biologic mesh in an intraperitoneal position. This video describes the management of a 68-year-old woman who has presented an ACS associated with intestinal ischemia after a septic shock on a perforated duodena ulcer. The initial medico-surgical management of the ACS led to a decrease of the intra-abdominal pressure (IAP) at the expense of a xipho-pubic laparotomy treated with a VAC therapy and two double barreled ileostomy and colostomy. A Day 7, the patient was clinically stabilized. Yet, there were multiple bad prognosis factors of complete abdominal closure: a ten centimeters abdominal defect, two complex stomas with very thin skin bridges, a massive edema and a laparostomy open for more than 7 days. We describe in this video a medico-surgical strategy aiming to obtain a complete abdominal and skin closure after an open abdomen. The first step was dialysis in the intensive care unit to increase the elasticity of the tissues. Then, the abdominal cavity and the skin were closed sequentially 3 times at the operating theater between day 7 and day 13 (figure 1). The vacuum- assisted wound closure therapy was pursued all along. During the last surgery at day 13, an intraperitoneal biologic mesh was placed using a bridging repair to obtain a complete abdominal closure. 6 months later after closure of the ileostomy, patient has no sequala despite an asymptomatic incisional hernia, which is an expected sequella after bridging repair with an intraperitoneal biologic mesh [3]. In conclusion, this strategy allows a complete abdominal closure and avoids a skin-only closure.

Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.

Le syndrome du compartiment abdominal (SCA), défini par la présence d’au moins une défaillance d’organe associée à une hyperpression intra-abdominale supérieure à 20mmHg, est une complication fréquente et redoutée survenant à la phase précoce des pancréatites aiguës (PA) sévères. Cette complication peut entraîner le décès du patient à très court terme. L’objectif de cette revue est de fournir des éléments objectifs au chirurgien et au réanimateur pour les aider dans leur prise de décision. Le monitoring de la pression intra-vésicale (PiV) est indispensable à la phase précoce d’une PA sévère pour diagnostiquer précocement une hyperpression intra-abdominale ou un SCA. Le traitement du SCA est médicochirurgical et impose une collaboration étroite entre les équipes de chirurgie et de réanimation. Le traitement médical peut associer un plafonnement du remplissage vasculaire, des prokinétiques, une curarisation efficace et un drainage percutané d’une ascite volumineuse. En cas de défaillance respiratoire ou cardiaque non contrôlée ou en cas d’échec du traitement médical maximal, la plupart des équipes privilégient la réalisation en urgence d’une laparotomie xyphopubienne de décompression avec mise en laparostomie. Cette procédure suit les principes de la laparotomie écourtée décrits pour les traumatismes abdominaux.

Although bariatric surgery is proven to sustain weight loss in morbidly obese patients, long-term adverse effects have yet to be fully characterized. This study compared the long-term consequences of two common forms of bariatric surgery: one-anastomosis gastric bypass (OAGB) and Roux-en-Y Gastric Bypass (RYGB) in a preclinical rat model. We evaluated the influence of biliopancreatic limb (BPL) length, malabsorption, and bile acid (BA) reflux on esogastric mucosa. After 30 weeks of follow-up, Wistar rats operated on RYGB, OAGB with a short BPL (15cm, OAGB-15), or a long BPL (35cm, OAGB-35), and unoperated rats exhibit no cases of esogastric cancer, metaplasia, dysplasia, or Barrett's esophagus. Compared to RYGB, OAGB-35 rats presented higher rate of esophagitis, fundic gastritis and perianastomotic foveolar hyperplasia. OAGB-35 rats also revealed the greatest weight loss and malabsorption. On the contrary, BA concentrations were the highest in the residual gastric pouch of OAGB-15 rats. Yet, no association could be established between the esogastric lesions and malabsorption, weight loss, or gastric bile acid concentrations. In conclusion, RYGB results in a better long-term outcome than OAGB, as chronic signs of biliary reflux or reactional gastritis were reported post-OAGB even after reducing the BPL length in a preclinical rat model.

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical model, longitudinal studies can be carried out to provide an improved understanding of the mechanisms underlying the outcomes seen after bariatric surgery in humans. For this purpose, rats are operated on through a laparotomy under general anesthesia with isoflurane. First, the surgeon creates a long and tubular gastric pouch: after greater curve and hiatal dissection, the nonglandular stomach is stapled and removed. Then, the remaining stomach is also stapled in order to create a gastric tube and exclude the antrum of the stomach. After that, the surgeon performs a single end-to-side gastrojejunostomy 35 cm from the duodenojejunal angle. This limb length has been chosen in order to reproduce the same ratio between the biliopancreatic limb (BPL) and common limb (CL) length as in human bariatric surgery. The operation ends by aponeurotic and cutaneous closure. The early postoperative management consists of subcutaneous hydration, an intramuscular prophylactic antibiotic injection, a parietal injection of xylocaine, the administration of painkillers, and a progressive reintroduction of diet.

Objective Sustained inflammation originating from macrophages is a driving force of fibrosis progression and resolution. Monoacylglycerol lipase (MAGL) is the rate-limiting enzyme in the degradation of monoacylglycerols. It is a proinflammatory enzyme that metabolises 2-arachidonoylglycerol, an endocannabinoid receptor ligand, into arachidonic acid. Here, we investigated the impact of MAGL on inflammation and fibrosis during chronic liver injury. Design C57BL/6J mice and mice with global invalidation of MAGL (MAGL -/- ), or myeloid-specific deletion of either MAGL (MAGLMye-/-), ATG5 (ATGMye-/-) or CB2 (CB2Mye-/-), were used. Fibrosis was induced by repeated carbon tetrachloride (CCl4) injections or bile duct ligation (BDL). Studies were performed on peritoneal or bone marrow-derived macrophages and Kupffer cells. Results MAGL -/- or MAGLMye-/- mice exposed to CCl4 or subjected to BDL were more resistant to inflammation and fibrosis than wild-type counterparts. Therapeutic intervention with MJN110, an MAGL inhibitor, reduced hepatic macrophage number and inflammatory gene expression and slowed down fibrosis progression. MAGL inhibitors also accelerated fibrosis regression and increased Ly-6Clow macrophage number. Antifibrogenic effects exclusively relied on MAGL inhibition in macrophages, since MJN110 treatment of MAGLMye-/- BDL mice did not further decrease liver fibrosis. Cultured macrophages exposed to MJN110 or from MAGLMye-/- mice displayed reduced cytokine secretion. These effects were independent of the cannabinoid receptor 2, as they were preserved in CB2Mye-/- mice. They relied on macrophage autophagy, since anti-inflammatory and antifibrogenic effects of MJN110 were lost in ATG5Mye-/- BDL mice, and were associated with increased autophagic flux and autophagosome biosynthesis in macrophages when MAGL was pharmacologically or genetically inhibited. Conclusion MAGL is an immunometabolic target in the liver. MAGL inhibitors may show promising antifibrogenic effects during chronic liver injury.

Background For radiologists, the venous drainage of adrenal glands is a key to the technique of selective adrenal venous sampling. For endocrine surgeons, it is key to adrenalectomy for carcinoma and pheochromocytoma. This study aims to demonstrate direct anastomosis between the left adrenal vein, the diaphragmatic circulation and the azygos system. Anatomical textbooks only offer very little information concerning the left adrenal vein (LAV) and its potential anastomosis with the reno-lumbo-azygo trunk (RLAT) and the diaphragmatic circulation. Methods Between November 2014 and October 2015 in the LADAF (French Alps Anatomy Laboratory), we dissected 44 formalin-fixed adult cadavers. Results We found no direct anastomosis between the left adrenal vein and the reno-azygo-lumbar trunk and two anastomoses (4.5%) between the adrenal capsular vein and azygos system. A lumbo-azygo trunk has been found 38 times (86.3%), drained 35 times (79.5%) into the left renal vein and 3 times (6.8%) into the left genital vein. An inferior phrenic vein ending into an adrenal vein was highlighted in all cases, 6 times (13.7%) in a double adrenal vein and 38 times (86.3%) in a single one. Conclusions No connections have been found between left adrenal vein and the RLAT, and frequency of the IPV is discordant with the literature. However, our findings concerning the capsular vessels’ anastomosis with the azygos system, inferior diaphragmatic flow and double adrenal vein could have two clinical applications: Firstly, the ligation of the adrenal vein solely is not enough to entirely interrupt the adrenal vein drainage, and secondly, sampling of hormones in the LAV could be underestimated because of the risk of dilution.