1
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Abstract
Sleeve gastrectomy (SG) is the most frequently performed operation for morbid obesity in the world. In spite of its demonstrated efficacy, the Achilles' Heel of this procedure seems to be either pre-existing or de novo gastro-esophageal reflux disease (GERD) with its potential complications such as peptic esophagitis, Barrett's esophagus and, in the long-term, esophageal adenocarcinoma. According to factual literature, it appears clear that Roux-en-Y gastric bypass is the preferred choice in case of pre-existing GERD or hiatal hernia discovered during preoperative workup for bariatric surgery. Nonetheless, certain authors propose performance of SG with an associated antireflux procedure such as Nissen fundoplication. Strict endoscopic surveillance is recommended after bariatric surgery. Revisional surgery (conversion of SG into Roux-en-Y gastric bypass (RYGB)) is the treatment of choice for patients who develop GERD after SG when conservative treatment (modified lifestyle and proton pump inhibitors) has failed. Lastly, with regard to the risk of esophageal adenocarcinoma after SG, large scale studies with adequate follow-up are necessary to come to factual conclusions. In all cases, the management of this conundrum remains a major technical challenge that has to be taken in consideration in future years, especially because of the current expansion of bariatric surgery.
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Affiliation(s)
- J Veziant
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France.
| | - S Benhalima
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - K Slim
- CHU of Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), France
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2
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Slim K, Gillion JF, Bonnet R. Could microbiological epidemiology guide the choice of antibiotic prophylaxis and implantation site for abdominal wall prostheses? J Visc Surg 2022; 160:81-84. [PMID: 36581515 DOI: 10.1016/j.jviscsurg.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- K Slim
- Digestive surgery Department, Hospital Center University of Clermont-Ferrand, 1, place Lucie Aubrac, 63003 Clermont-Ferrand cedex, France.
| | - J-F Gillion
- Digestive surgery Department Ramsay Santé, Antony private hospital, Clermont-Ferrand, France
| | - R Bonnet
- Bacteriology laboratory, Hospital Center University of Clermont-Ferrand, Clermont-Ferrand, France
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3
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Dziri C, Slim K. What the surgeons need to know about meta-analyses in 2023, beyond the simple Odds ratio. J Visc Surg 2022; 159:480-485. [PMID: 36333183 DOI: 10.1016/j.jviscsurg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- C Dziri
- Medical School of Tunis, Tunis El Manar University Tunisia, Honoris Medical Simulation Center Tunis, avenue Khaireddine Pacha, 1002 Tunis, Tunisia.
| | - K Slim
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France; Service de chirurgie digestive, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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4
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Affiliation(s)
- L Brunaud
- University of Lorraine, CHRU Nancy, Hospital Brabois Adultes, Department of Gastrointestinal, Visceral, and Metabolic Surgery (CVMC), INSERM U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - K Slim
- University Hospital, CHU Clermont-Ferrand, Department of Digestive Surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
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5
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Abstract
Researchers and practitioners are faced with an exponential increase in the number of systematic reviews (SRs) (with or without meta-analysis), a so-called `secondary' research method that synthesizes data from primary research. This growing number, sometimes with discordant results on the same subject or with non-conclusions, has led to the introduction of the concept of reviews to synthesize SR in order to combine scientific knowledge useful to practitioners. These so-called ``umbrella reviews'' (UR) constitute a new tertiary research tool. Surgical research is no exception to this development but umbrella surgical reviews remain relatively rare. Any UR must be transparent and meet rigorous methodological criteria. The UR could thus provide answers to practical questions in the field of surgery, but only on condition that the bias of the included SRs is limited. Let us not forget that the base requirement of clinical surgical research remains the good methodological quality of clinical studies (primary research). Only thus can SRs or URs (secondary or tertiary research) be more useful and decisive.
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Affiliation(s)
- K Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, place Lucie Aubrac, 63003 Clermont-Ferrand, France.
| | - T Marquillier
- University of Lille, CHU Lille, Pediatric dentistry, 59000 Lille, France; Sorbonne Paris Nord University, Health Education and Practices Laboratory, LEPS UR 3412, 93017 Bobigny, France
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6
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Affiliation(s)
- K Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Selvy
- Surgery Department, Centre Hospitalier de Béziers, Bézier, France
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7
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Slim K, Joris J. Comment on: Safety and efficacy of low pressure pneumoperitoneum in laparoscopic colorectal surgery. Br J Surg 2021; 108:e277. [PMID: 34113982 DOI: 10.1093/bjs/znab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022]
Abstract
Feasibility of low-pressure pneumoperitoneum is feasible in expert hand. Its efficacy within enhanced recovery programmes and its safety need to be demonstrated in future studies
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France.,Francophone Group for Enahnced Recovery After Surgery (GRACE)
| | - J Joris
- Francophone Group for Enahnced Recovery After Surgery (GRACE).,Department of Anaesthesia, University Hospital Liege, Belgium
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8
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Reskot F, Vacheron C, Friggeri A, Piriou V, Slim K, Chambrier C. L’immunonutrition préopératoire ne réduit pas la morbidité postopératoire dans la chirurgie pour cancer colorectal dans le cadre d’un programme de réhabilitation améliorée. Une étude prospective. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Abstract
The aim of this article is to present the concept of "4P medicine" i.e., medicine that is Personalized, Preventive, Predictive, and Participatory. We will discuss the evolution from cure-focused traditional medicine toward personalized medicine based on genome analysis. This new approach is illustrated by several clinical examples such as prevention of cardiovascular diseases (primary and secondary), prophylactic cancer surgery, targeted therapies, targeted peri-operative care and patient participation in their care. Finally, it will discuss the impact of this development on the health system of the future and the ethical questions raised by this new approach.
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Affiliation(s)
- K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France.
| | - M Selvy
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - J Veziant
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France
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10
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Affiliation(s)
- J Veziant
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France.
| | - O Antomarchi
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - K Slim
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
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11
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Abstract
Pancreatic fistula is the most common and dreaded complication after pancreatic resection, responsible for high morbidity and mortality (2 to 30%). Prophylactic drainage of the operative site is usually put in place to decrease and/or detect postoperative pancreatic fistula (POPF) early. However, this policy is currently debated and the data from the literature are unclear. The goal of this update is to analyze the most recent evidence-based data with regard to prophylactic abdominal drainage after pancreatic resection (pancreatoduodenectomy [PD] or distal pancreatectomy [PD]). This systematic review of the literature between 1990 and 2020 sought to answer the following questions: should drainage of the operative site after pancreatectomy be routine or adapted to the risk of POPF? If a drainage is used, how long should it remain in the abdomen, what criteria should be used to decide to remove it, and what type of drainage should be preferred? Has the introduction of laparoscopy changed our practice? The literature seems to indicate that it is not possible to recommend the omission of routine drainage after pancreatic resection. By contrast, an approach based on the risk of POPF using the fistula risk score seems beneficial. When a drain is placed, early removal (within 5 days) seems feasible based on clinical, laboratory (C-reactive protein, leukocyte count, neutrophile/lymphocyte ratio, dosage and dynamic of amylase in the drains on D1, D3±D5) and radiological findings. This is in line with the development of enhanced recovery programs after pancreatic surgery. Finally, this literature review did not find any specific data relative to mini-invasive pancreatic surgery.
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Affiliation(s)
- J Veziant
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Selvy
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Buc
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - K Slim
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), Beaumont, France
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12
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Reskot F, Vacheron C, Slim K, Friggeri A, Piriou V, Chambrier C. In real-life, preoperative immunonutrition did not reduce postoperative morbidity in elective oncological colo-rectal surgery with an enhanced recovery protocol. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Slim K, Joris J. Failure of enhanced recovery after surgery: what is it? Colorectal Dis 2020; 22:1830-1831. [PMID: 32810372 DOI: 10.1111/codi.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023]
Affiliation(s)
- K Slim
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Francophone Group for Enhanced Recovery After Surgery, Beaumont, France
| | - J Joris
- Francophone Group for Enhanced Recovery After Surgery, Beaumont, France.,Department of Anaesthesia, University Hospital Liège, Liège, Belgium
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14
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Paracchini S, Bustos B, Aviles R, Bourdel N, Canis M, Rabischong B, Slim K, Botchorishvili R. Equipment failures in laparoscopic surgery: Causes and consequences. J Visc Surg 2020; 158:476-480. [PMID: 33223479 DOI: 10.1016/j.jviscsurg.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess incidence, causes and consequences of equipment failures in a high volume, advanced endoscopic surgery department. METHODS This is a prospectical observational single centre study between April and July of 2019 in the Gynecological surgery department of the Estaing University Hospital of Clermont-Ferrand, France. During the study period, 171 laparoscopies were observed. Data were collected real time by three supernumerary observers. RESULTS In total, 66 (38.6%) laparoscopies were complicated by equipment failures. The bipolar cable and forceps accounted for 31% of the total amount of malfunctions in laparoscopy. Causes of malfunctions were in 45% due to the instrument per se and in 43% due to the incorrect combination of elements. Less commonly, the equipment was not available or a mismatched was reported. The total length of the surgery increased by 1.35% due to the malfunctions. Human error was identified in 50% of cases. No morbility, neither mortality was reported in this series; however we observed 34 malfunctions that could have led to serious consequences for the patients and 3 incidents induced a real consequence on the operation workflow. CONCLUSIONS Equipment failure is a common event in endoscopy. On the opposite, time wasted for the malfunctions is low in laparoscopy, as it only accounts for 1.35% of the overall surgical time. Human decisions contributed to malfunctions in almost half of cases. This alarming finding may advise for intensification in training on instruments of the whole surgical team.
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Affiliation(s)
- S Paracchini
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Department of Surgical Sciences, AOU Città della Scienza e della Salute di Torino, Torino, Italy.
| | - B Bustos
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Hospital Parroquial de San Bernardo, Region Metropolitana, Chile
| | - R Aviles
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, Hospital Dr. Luis-Valentìn-Ferrada, Universidad Finis-Terrae, El-Carmen, Maipù, Chile
| | - N Bourdel
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - M Canis
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - B Rabischong
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Estaing, Clermont-Ferrand, France
| | - R Botchorishvili
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
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15
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Veziant J, Poirot K, Mulliez A, Pereira B, Slim K. Is an enhanced recovery program (ERP) after rectal surgery as feasible as after colonic surgery? A multicentre Francophone study of 870 rectal resections. Langenbecks Arch Surg 2020; 405:1155-1162. [PMID: 33057822 DOI: 10.1007/s00423-020-02001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enhanced recovery program (ERP) is well-established in colorectal surgery. Rectal surgery (RS) is known to be associated with high morbidity and prolonged hospital stay, which might explain why ERPs are less applied in this specific group of patients. The aim of this large-scale study was to assess the feasibility of an ERP in RS compared with colonic surgery. METHODS This study was a retrospective analysis of a prospective database including 3740 patients eligible for colorectal resection from February 2014 to January 2017 in 75 European Francophone centres. Patients were divided into two groups (colon group C vs. rectum group R). The main endpoint was compliance with ERP components. A subgroup analysis was performed in patients for whom a defunctioning stoma (DS) was required after RS. RESULTS A total of 3740 patients were included. There were 2870 patients in group C and 870 patients in group R. The overall compliance rate for ERPs was 81.71% in group C and 79.09% in group R. Patients were significantly less mobilized within 24 h in group R. Specific recommendations for RS concerning bowel preparation and abdominal drainage were significantly less implemented. Overall morbidity was significantly higher in group R. Mean length of stay (LOS) was significantly shorter in group C. In the sub-group analysis, a DS was significantly associated with fewer compliance with early mobilization and early feeding, leading to significantly longer LOS (group R). CONCLUSION ERP is safe and effective in RS, despite the well-known higher morbidity and LOS compared with colonic surgery. DS could be a limiting factor in ERP implementation after RS.
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Affiliation(s)
- J Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France.
| | - K Poirot
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
| | - A Mulliez
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - B Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - K Slim
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
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16
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Affiliation(s)
- K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand France.
| | - J Joris
- Department of anaesthesia and critical care, CHU de Liège, 4030 Liège Belgium
| | - L Beyer-Berjot
- Department of digestive surgery, hôpital Nord, AP-HM, 13000 Marseille, France
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17
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Abstract
Factors associating environmental degradation with human health have shown that air pollution is a source of morbi-mortality throughout the world. Unfortunately, hospitals are themselves "silent polluters". As healthcare professionals, we are the guarantors not only of quality of patient care, but also of proper hospital conduct. The aim of this attempt at clarification is to outline what can be done in the operating theater to reduce the environmental impact of the treatments we administer. Our recommendations will go above and beyond regulatory frameworks and draw upon daily practice concerning waste management, energy consumption, utilization of anesthetic agents and multiple forms of waste. A number of French and international pilot experimentations have been carried out and could strongly contribute to the modification of clinical practices with a societal impact, at a time when ecology has become one of the main preoccupations of our fellow citizens.
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Affiliation(s)
- M Selvy
- Digestive surgery department, University hospital center of Clermont-Ferrand, 63003 Clermont-Ferrand, France.
| | - M Bellin
- Anesthesia department, Hospital center of Douai, 50507 Douai, France
| | - K Slim
- Digestive surgery department, University hospital center of Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - J Muret
- Anesthesia department, Institut Curie, 75005 Paris, France
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18
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic. J Visc Surg 2020; 157:S7-S12. [PMID: 32249098 PMCID: PMC7269902 DOI: 10.1016/j.jviscsurg.2020.03.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.
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Affiliation(s)
- J-J Tuech
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.
| | - A Gangloff
- Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Di Fiore
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - P Michel
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France; Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - L Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France
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19
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Abstract
The Covid-19 pandemic has markedly changed our practices. This article analyses the risks of contamination among healthcare professionals (HCPs) during laparoscopic surgery on patients with Covid-19. Harmful effects of aerosols from a pneumoperitoneum, with the virus present, have not yet been quantified. Measures for the protection of HCPs are an extrapolation of those taken during other epidemics. They must still be mandatory to minimise the risk of viral contamination. Protection measures include personal protection equipment for HCPs, adaptation of surgical technique (method for obtaining pneumoperitoneum, filters, preferred intracorporeal anastomosis, precautions during the exsufflation of the pneumoperitoneum), and organisation of the operating room.
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Affiliation(s)
- J Veziant
- Digestive surgery department, University Hospital of Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - N Bourdel
- Gynaecology Department, University Hospital of Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - K Slim
- Digestive surgery department, University Hospital of Clermont-Ferrand, 63003 Clermont-Ferrand, France.
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20
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Slim K, Veziant J. [Urgent digestive surgery, a collateral victim of the Covid-19 crisis?]. ACTA ACUST UNITED AC 2020; 157:S4-S5. [PMID: 32292533 PMCID: PMC7144856 DOI: 10.1016/j.jchirv.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K Slim
- Service de chirurgie digestive, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.,Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), allée du Riboulet, 63110 Beaumont France
| | - J Veziant
- Service de chirurgie digestive, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
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21
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, Clermont-Ferrand Teaching Hospital, Clermont-Ferrand, France.
| | - J Veziant
- Department of Digestive Surgery, Clermont-Ferrand Teaching Hospital, Clermont-Ferrand, France
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22
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, CHU, Clermont-Ferrand, France
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23
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. [Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 157:S6-S12. [PMID: 32834885 PMCID: PMC7271206 DOI: 10.1016/j.jchirv.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La pandémie due au COVID-19 modifie l’organisation des soins et change la réalisation de la chirurgie digestive. Les priorités sanitaires et les circuits de soins sont modifiés. La chirurgie d’urgence reste prioritaire. Les interventions pour chirurgie fonctionnelles sont à reporter. La chirurgie par laparoscopie doit suivre des règles strictes pour ne pas exposer les professionnels à un surrisque. Le questionnement principal concerne la chirurgie oncologique, opérer ou reporter ? Il existe probablement un sur risque opératoire induit par la pandémie qui doit être mis en balance avec le retard de prise en charge chirurgical. Pour chaque type de cancer, colon, pancréas, œsogastrique, hépatocarcinome, la morbi-mortalité est rappelée et mise en parallèle avec le risque oncologique lié au retard à la chirurgie et/ou au temps de doublement de la tumeur. Cette comparaison permet de proposer des stratégies, ainsi pour les cancers coliques (T1-2, N0), il est souhaitable de retarder la chirurgie. Pour les lésions coliques avancées, il semble prudent de recommander une chimiothérapie néo adjuvante et d’attendre. Pour les cancers du rectum T3-4 et/ou N+, une radio-chimiothérapie est indiquée, une radiothérapie courte devra être discutée (suivie d’une période d’attente) afin de réduire le temps d’exposition à l’hôpital et d’éviter les infections. La majorité des chirurgies complexes à forte morbi-mortalité, œsogastrique, hépatique ou pancréatique doivent sans doute le plus souvent être reportée.
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Affiliation(s)
- J.-J. Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Auteur correspondant.
| | - A. Gangloff
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - F. Di Fiore
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - P. Michel
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - C. Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K. Slim
- Department of digestive surgery, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M. Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France
- Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - L. Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
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Venara A, Meillat H, Cotte E, Ouaissi M, Duchalais E, Mor-Martinez C, Wolthuis A, Regimbeau JM, Ostermann S, Hamel JF, Joris J, Slim K. Correction to: Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis. World J Surg 2020; 44:1331. [PMID: 31993721 DOI: 10.1007/s00268-020-05386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.
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Affiliation(s)
- A Venara
- Faculty of Medicine of Angers, Angers, France. .,Department of Visceral and Endocrinal Surgery (Service de chirurgie viscérale et endocrinienne), CHU Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France. .,UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, Rue Gaston Veil, 44035, Nantes, France.
| | - H Meillat
- Institut Paoli-Calmette, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - E Cotte
- Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite Cedex, France.,Université de Lyon, Lyon, France
| | - M Ouaissi
- Department of Visceral Surgery, CHU Tours, 2 Boulevard Tonnelé, 37000, Tours, France
| | - E Duchalais
- UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, Rue Gaston Veil, 44035, Nantes, France.,Department of Visceral Surgery, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - C Mor-Martinez
- Department of Visceral Surgery, Clinique de l'Alliance, 1 Boulevard A Nobel, 37540, Saint Cyr Sur Loire, France
| | - A Wolthuis
- Department of Abdominal Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J M Regimbeau
- Department of Visceral Surgery, CHU Amiens, Avenue Laennec, 80054, Amiens, France
| | - S Ostermann
- Hirslanden Clinique La Colline, Geneva, Switzerland
| | - J F Hamel
- Department of Methodology and Biostatistics, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - J Joris
- Department of Anesthesiology, CHU Liège, Domaine de Sart Tilman, Université de Liège, 4000, Liege, Belgium
| | - K Slim
- Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France
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Slim K, Reymond T, Joris J, Paul S, Pereira B, Cotte E. Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag? Colorectal Dis 2020; 22:95-101. [PMID: 31332910 DOI: 10.1111/codi.14785] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
AIM Enhanced recovery programmes (ERPs) involve early postoperative oral feeding. The aim of this study was to test the hypothesis that intolerance to early feeding was associated with a complicated postoperative course. METHOD A retrospective cohort analysis of the prospective multicentre database developed by the Francophone Group for Enhanced Recovery after Surgery (GRACE) was undertaken. Seventy-one centres in Belgium, France and Switzerland participated in the study. All patients were encouraged to eat within 24 h after surgery. Patients were separated into two groups according to whether early feeding was well tolerated (WT) or poorly tolerated (PT). The primary outcome measure was overall postoperative complications. Secondary outcome measures were unplanned reoperation, early mobilization rate and duration of postoperative hospital stay. RESULTS Among the cohort of 3034 patients, early feeding was WT in 2614 patients (WT group) and PT in 420 patients (PT group). There were significantly more postoperative complications in the PT group than in the WT group (52.1% vs 17.0%, respectively; P = 0.001), namely more unplanned reoperations, less early mobilization and longer postoperative hospital stay. Multivariate analyses confirmed that PT early feeding was the main and dominant independent factor for postoperative complications [OR 4.47 (95% CI3.49-5.72); P < 0.001], more unplanned reoperations and longer hospital stay. CONCLUSIONS This study demonstrates a close relationship between intolerance to early feeding and a complicated postoperative course. Whenever this simple very early red flag is observed, discharge should not be planned until postoperative complications have been ruled out.
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, University Hospital (CHU), Clermont-Ferrand, France.,Francophone Group for Enhanced Recovery after Surgery (GRACE), Beaumont, France
| | - T Reymond
- Department of Anaesthesia and Critical Care, University Hospital (CHU), Clermont-Ferrand, France
| | - J Joris
- Francophone Group for Enhanced Recovery after Surgery (GRACE), Beaumont, France.,Department of Anaesthesia, University Hospital, Liege, Belgium
| | - S Paul
- Department of Anaesthesia and Critical Care, University Hospital (CHU), Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit, Clinical Research and Innovation Department, University Hospital (CHU) of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Cotte
- Department of Colorectal Surgery, University Hospital (CHU), Lyon, France
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Slim K, Futier E. Comment on: Bioethical approach to robot-assisted surgery in the era of shared decision making. Br J Surg 2019; 106:1707-1708. [PMID: 31639202 DOI: 10.1002/bjs.11371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 11/06/2022]
Affiliation(s)
- K Slim
- Departments of Digestive Surgery, University Hospital Estaing, CHU Clermont-Ferrand, France
| | - E Futier
- Departments of Anaesthesia and Perioperative Medicine, University Hospital Estaing, CHU Clermont-Ferrand, France
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Slim K. Commentaries on the article "Prospective, multicentric, comparative study between sleeve gastrectomy and Roux-en-Y gastric bypass, 277 patients, 3-years follow-up". J Visc Surg 2019; 156:559. [PMID: 31080118 DOI: 10.1016/j.jviscsurg.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K Slim
- Digestive surgery unit, Clermont-Ferrand University Hospital, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
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Guillet C, Masgrau A, Mishellany-Dutour A, Blot A, Pereira B, Slim K, Robert M, Disse E, Feugier N, Leruyet P, Louvet C, Miolanne M, Farigon N, Goudable J, Laville M, Boirie Y. La chirurgie bariatrique affecte les besoins en protéines liés à l’obésité. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pouget M, Lemaire C, Gendre LA, Riquelme M, Gentes E, Farigon N, Palmier-Forestier C, Miolanne M, Slim K, Boirie Y. Un nouvel effet secondaire de la chirurgie bariatrique : la rhinorrhée post-prandiale. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beyer-Berjot L, Slim K. Colorectal surgery and preoperative bowel preparation: aren't we drawing hasty conclusions? Colorectal Dis 2018; 20:955-958. [PMID: 30199608 DOI: 10.1111/codi.14415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Affiliation(s)
- L Beyer-Berjot
- Department of Digestive Surgery, APHM, Hôpital Nord, Aix-Marseille University, Marseille, France.,Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - K Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France.,Department of Digestive Surgery, CHU Estaing, Clermont-Ferrand, France
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Slim K, Valverde A. Stoma without rod (or stoma with spur). J Visc Surg 2018; 155:403-406. [PMID: 30249428 DOI: 10.1016/j.jviscsurg.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- K Slim
- Service de chirurgie digestive, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
| | - A Valverde
- Groupe hospitalier Diaconesses-Croix-Saint-Simon, 75000 Paris, France
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Abstract
INTRODUCTION Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. METHODS In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. RESULTS Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. CONCLUSION Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.
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Affiliation(s)
- K Poirot
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Le Roy
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - L Badrikian
- Service d'hygiène hospitalière, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
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Affiliation(s)
- K Slim
- Service de chirurgie digestive et unité de chirurgie ambulatoire, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - J M Regimbeau
- Service de chirurgie viscérale, CHU Amiens, chemin de Longpré 80080 Amiens, France
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Affiliation(s)
- K Slim
- Service de chirurgie digestive, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - A Deneuvy
- Service de chirurgie digestive, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Affiliation(s)
- B Le Roy
- Service de chirurgie digestive, CHU Estaing, CHU de Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Estaing, CHU de Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
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Slim K. Role of peritoneal lavage for sigmoid perforation peritonitis surgery: What do the meta-analyses tell us? J Visc Surg 2017. [DOI: 10.1016/j.jviscsurg.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Slim K, Le Roy B. Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis - an example of surgical research failure. Colorectal Dis 2017; 19:208. [PMID: 28067988 DOI: 10.1111/codi.13598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/26/2016] [Indexed: 12/27/2022]
Affiliation(s)
- K Slim
- Department of Digestive Surgery, CHU Estaing, Clermont-Ferrand, France
| | - B Le Roy
- Department of Digestive Surgery, CHU Estaing, Clermont-Ferrand, France
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Launay-Savary MV, Mathonnet M, Theissen A, Ostermann S, Raynaud-Simon A, Slim K. Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature. J Visc Surg 2016; 154:29-35. [PMID: 27842907 DOI: 10.1016/j.jviscsurg.2016.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Enhanced recovery programs (ERP) are no longer questionable in the management of patients undergoing surgery. However, there is some doubt as to their feasibility and efficacy in the elderly. Our goal was to systematically review the evidence-based literature concerning the feasibility of ERP in elderly patients undergoing colorectal surgery. MATERIAL AND METHODS The PubMed and Cochrane Database for systematic reviews as well as the "grey" literature between 2000 and 2015 were sought. Articles were selected if they compared ERP in elderly patients to ERP in young patients (feasibility) or compared ERP to traditional post-operative management in the elderly (efficacy). RESULTS Sixteen articles were identified according to the inclusion criteria. All showed that an ERP was feasible in the elderly although post-operative morbidity was higher compared to younger patients. Compared to traditional management, ERP was effective since it decreased (as in the young) the overall rate of complications and thus the duration of hospital stay. There were not enough data on the degree of implementation of ERP and the medico-economic aspects to come to any formal conclusions. CONCLUSION This comprehensive systematic review of the literature showed that ERP was feasible and effective in the elderly undergoing colorectal surgery. Protocols should be adapted to the particular aspects of this population. Future research should target pre-operative evaluation and the place of pre-habilitation in geriatric ERP.
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Affiliation(s)
| | - M Mathonnet
- Service de Chirurgie Digestive, Centre Hospitalo-Universitaire Limoges, France
| | - A Theissen
- Service d'Anesthésie-Réanimation, centre Hospitalier Princesse Grace, Monaco
| | - S Ostermann
- Service de Chirurgie Digestive, Clinique de la Colline Hirslanden, Genève, Suisse
| | - A Raynaud-Simon
- Service de Gériatrie, Centre Hospitalo-Universitaire de Bichat, Paris, France
| | - K Slim
- Service de Chirurgie Digestive, Centre Hospitalo-Universitaire Estaing, Clermont-Ferrand, France.
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- 9 allée du Riboulet, Beaumont, France
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Le Roy B, Fetche N, Buc E, Pereira B, Genty F, Antomarchi O, Gagnière J, Pezet D, Slim K. Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach. J Visc Surg 2016; 153:327-331. [PMID: 27118171 DOI: 10.1016/j.jviscsurg.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the publication of laparoscopic cholecystectomy (LC) using three ports instead of four, no significant evolution has impacted on our clinical practice in order to improve length of stay, postoperative pain, time of recovery and cosmetic results. Recently, a renewed interest has been observed with the suprapubic approach, called occult scar laparoscopic cholecystectomy (OSLC). The aim of this prospective multicentric study was to evaluate the feasibility of OSLC in 2 French centers. METHODS From March to September 2014, 60 patients were prospectively included in this study. The operation incisions consisted of an umbilical incision for camera; an incision in the right groin for maneuvers of exposition and a suprapubic incision for instrumental dissection and clipping. Outcome was by operative time, operative complications, hospital length of stay, analgesia required after surgery, and cosmetic outcomes. The Patient Satisfaction Scale and Visual Analog Score (VAS) also were used to evaluate the level of cosmetic result and postoperative pain. RESULTS No laparoscopy was converted to an open procedure, the mean operative time was 53±20min. No patient had intraoperative bile duct injury or significant bleeding. The mean length of stay was 1.70±0.76 days. Two patients (3%) experienced postoperative complication (1 intra-abdominal abscess treated by antibiotics and 1 subcutaneous seroma of the 11-mm port wound treated successfully by needle aspiration). CONCLUSION The technique proved to be safe and feasible with no specific complication and without specific instrument. It offers satisfactory postoperative pain level and good cosmetic results.
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Affiliation(s)
- B Le Roy
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - N Fetche
- Digestive Surgery Department, Jacques-Lacarin Hospital, 1, boulevard Deniere, 03200 Vichy, France
| | - E Buc
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France
| | - F Genty
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - O Antomarchi
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Gagnière
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - D Pezet
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - K Slim
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Abstract
Enhanced recovery programs (ERP) are without any doubt a major innovation in the care of surgical patients. This multimodal approach encompasses elements of both medical and surgical care. The goal of this in-depth review is to analyze the surgical aspects of ERP, underlining the scientific rationale behind each element of ERP after surgery and in particular, the role of mechanical bowel preparation before colorectal surgery, the place of minimal access surgery, the utility of nasogastric tube, abdominal drainage, bladder catheters and early re-feeding. Publication of factual data has allowed many dogmas to be discarded.
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Affiliation(s)
- P Mariani
- Département de Chirurgie Oncologique, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex 05, France.
| | - K Slim
- Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire CHU Estaing Clermont-Ferrand et GRACE (Groupe Francophone de Réhabilitation Améliorée après Chirurgie), France
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Abstract
Enhanced recovery programs (ERP) after surgery are now being increasingly applied in daily practice. The purpose of this article is to review specific aspects and advantages of this approach. Beyond the reduction in overall morbidity (found for multiple surgical specialties), ERP include issues and stakes that affect patient care, the care team and society in general. Data from the literature are in agreement, emphasizing that, in this clinical pathway, the patient has thus become an actor in his own care, whose active participation is paramount to the success of the program. In parallel with this, a spirit of teamwork is required and the program contributes substantially to cohesion within the team. Finally, all studies show that ERP have a beneficial effect in economic terms for society.
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Affiliation(s)
- K Slim
- Service de Chirurgie Digestive, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), 63110 Beaumont, France.
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Veziant J, Raspado O, Entremont A, Joris J, Pereira B, Slim K. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg 2016; 154:159-166. [PMID: 27638322 DOI: 10.1016/j.jviscsurg.2016.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery program (ERP) has now surpassed the stage of clinical research in certain specialties and currently poses the problematic of large-scale implementation. The goal of this study was to report the experience during the first year of implementation in three French-speaking countries. MATERIAL AND METHODS This is a prospective study in which 67 healthcare centers, all registered in the Grace-Audit databank, participated. Included were patients undergoing colorectal (CRS), bariatric (BS) and orthopedic hip and knee surgery (OS), performed within an ERP. The main endpoints were duration of hospital stay, postoperative morbidity, the degree of compliance with the elements of the ERP, the relation between the extent of application of the elements and postoperative hospital stay, and finally the completeness of data inclusions in the databank. RESULTS A total of 1904 patients were included in the Grace-Audit databank between January 1, 2015 and January 31, 2016, undergoing CRS (n=490), BS (n=431), and OS (n=983). The mean implementation rate was 83.7±10.0% for CRS, 75.0±23.7% for BS, and 83.5±14.9% for OS. The duration of hospital stay was 6.5 days for CRS, 2.6 days for BS and 3.4 days for OS. Overall postoperative morbidity (onset of postoperative undesirable event), surgical morbidity (superficial or deep organ space surgical site complications such as bleeding, infection or defective healing) and readmission rates were 20.6%, 7.5%, and 5.7% for CRS; 2.5%, 1.4%, and 1.6% for BS and 2.9%, 0.2%, and 2% for OS, respectively. A statistically significant relationship was found between the degree of compliance of the elements of ERP and the duration of hospital stay for CRS and BS; hospital stay was reduced when at least 15 of the 22 elements of the program were applied (P<0.001). The patients included in the Grace-Audit databank represented less than 20% of the patients undergoing operation in the same establishments during the study period for all three specialties. CONCLUSIONS This study shows that large-scale ERPs are feasible and safe in French-speaking countries. Nonetheless, although encouraging, these preliminary results highlight that implementation must be improved in specialties such as bariatric surgery and that more complete data collection is needed.
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Affiliation(s)
- J Veziant
- Service de chirurgie digestive, CHU Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
| | - O Raspado
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France; Infirmerie protestante, 69300 Caluire, France
| | - A Entremont
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
| | - J Joris
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France; Service d'anesthésie et de réanimation, CHU de Liège, 4000 Liège, Belgium
| | - B Pereira
- Département de statistiques, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France.
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- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
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Carrier G, Cotte E, Beyer-Berjot L, Faucheron J, Joris J, Slim K. Post-discharge follow-up using text messaging within an enhanced recovery program after colorectal surgery. J Visc Surg 2016; 153:249-52. [DOI: 10.1016/j.jviscsurg.2016.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Slim K, Futier E. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth 2015; 115:801-802. [DOI: 10.1093/bja/aev338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Affiliation(s)
| | - K Slim
- Digestive surgery service, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Canis M, Bouchet P, Botchorichvili R, Bourdel N, Pouly JL, Slim K. Long-Term Evaluation of Clinical Results and Quality of Life for Deeply Infiltrating Pelvic Endometriosis. J Minim Invasive Gynecol 2015; 22:S172. [PMID: 27678942 DOI: 10.1016/j.jmig.2015.08.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M Canis
- Department of Gynecology and Obstetrics, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - P Bouchet
- Department of Gynecology and Obstetrics, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - R Botchorichvili
- Department of Gynecology and Obstetrics, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - N Bourdel
- Department of Gynecology and Obstetrics, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - J-L Pouly
- Department of Gynecology and Obstetrics, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - K Slim
- Department of Digestive and General Surgery, CHU de Clermont Ferrand, Clermont-Ferrand, France
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