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Collard MK, Christou N, Lakkis Z, Mege D, Bridoux V, Millet I, Sabbagh C, Loriau J, Lefevre JH, Ronot M, Maggiori L. Adult appendicitis: Clinical practice guidelines from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging. J Visc Surg 2021; 158:242-252. [PMID: 33419677 DOI: 10.1016/j.jviscsurg.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The French Society of Digestive Surgery (SFCD) and the Society of Abdominal and Digestive Imaging (SIAD) have collaborated to propose recommendations for clinical practice in the management of adult appendicitis. METHODS An analysis of the literature was carried out according to the methodology of the French National Authority for Health (HAS). A selection was performed from collected references and then a manual review of the references listed in the selected articles was made in search of additional relevant articles. The research was limited to articles whose language of publication was English or French. Articles focusing on the pediatric population were excluded. Based on the literature review, the working group proposed recommendations whenever possible. These recommendations were reviewed and approved by a committee of experts. RESULTS Recommendations about appendicitis in adult patients were proposed with regard to clinical, laboratory and radiological diagnostic modalities, treatment strategy for uncomplicated and complicated appendicitis, surgical technique, and specificities in the case of macroscopically healthy appendix, terminal ileitis and appendicitis in the elderly and in pregnant women. CONCLUSION These recommendations for clinical practice may be useful to the surgeon in optimizing the management of acute appendicitis in adults.
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Affiliation(s)
- M K Collard
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - N Christou
- Department of digestive, general and endocrine surgery, CHU Dupuytren, Limoges, France
| | - Z Lakkis
- Department of visceral, digestive and oncological surgery, CHU Besançon, Besançon, France
| | - D Mege
- Department of digestive and general surgery, Timone hospital, Marseille, France
| | - V Bridoux
- Department of digestive surgery, Charles-Nicolle hospital, Rouen, France
| | - I Millet
- Radiology department, Lapeyronie hospital, Montpellier, France
| | - C Sabbagh
- Department of digestive surgery, CHU Amiens-Picardie, Amiens, France
| | - J Loriau
- Department of digestive surgery, Saint-Joseph hospital, Paris, France
| | - J H Lefevre
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - M Ronot
- Radiology department, Beaujon hospital, Clichy-la-Garenne, France
| | - L Maggiori
- Department of digestive, oncologic and endocrine surgery, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université de Paris, Paris, France.
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Collard MK, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corté H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche R, Vicaut E, Panis Y, Brouquet A. A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort. J Crohns Colitis 2021; 15:409-418. [PMID: 33090205 DOI: 10.1093/ecco-jcc/jjaa217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Few prospective data exist on outcomes of surgery in Crohn's disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage. METHODS From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups. RESULTS Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159]. CONCLUSIONS Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.
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Affiliation(s)
- M K Collard
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - S Benoist
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - P Zerbib
- Digestive Surgery Department, University Hospital of Lille, Lille, France
| | - J H Lefevre
- Digestive Surgery Department, Saint-Antoine Hospital Saint-Antoine, APHP, Paris VI University, Paris, France
| | - Q Denost
- Digestive Surgery Department, Saint-Andre University Hospital, Bordeaux, France
| | - A Germain
- Digestive Surgery Department, University Hospital of Nancy, Nancy, France
| | - E Cotte
- Digestive Surgery Department, Lyon-Sud University Hospital, Pierre-Benite, France
| | - L Beyer-Berjot
- Digestive Surgery Department, Marseille-Nord University Hospital, Marseille, France
| | - H Corté
- Digestive Surgery Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - V Desfourneaux
- Digestive Surgery Department, University Hospital of Rennes, Rennes, France
| | - A Rahili
- Digestive Surgery Department, University Hospital of Nice, Nice, France
| | - J P Duffas
- Digestive Surgery Department, Rangueil University Hospital, Toulouse, France
| | - K Pautrat
- Digestive Surgery Department, Lariboisiere Hospital, Paris VII University, Paris, France
| | - C Denet
- Digestive Surgery Department, Montsouris Institute, Paris, France
| | - V Bridoux
- Digestive Surgery Department, University Hospital of Rouen, Rouen, France
| | - G Meurette
- Digestive Surgery Department, University Hospital of Nantes, Nantes, France
| | - J L Faucheron
- Digestive Surgery Department, Digestive Surgery Department, University Hospital of Grenoble, La Tronche, France
| | - J Loriau
- Digestive Surgery Department, Saint-Joseph Hospital, Paris, France
| | - R Souche
- Digestive Surgery Department, University Hospital of Montpellier, Montpellier, France
| | - E Vicaut
- Department of Clinical Research, Fernand Widal Hospital, APHP, Paris VII, Paris, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - A Brouquet
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
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Calmels M, Collard MK, Cazelles A, Frontali A, Maggiori L, Panis Y. Local excision after neoadjuvant chemoradiotherapy versus total mesorectal excision: a case-matched study in 110 selected high-risk patients with rectal cancer. Colorectal Dis 2020; 22:1999-2007. [PMID: 32813899 DOI: 10.1111/codi.15323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/06/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of this comparative study was to report a 10-year experience of an organ preservation strategy by local excision (LE) in selected high-risk patients (aged patients and/or patients with severe comorbidity and/or indication for abdominoperineal excision) versus total mesorectal excision (TME) after neoadjuvant radiochemotherapy (RCT) for patients with locally advanced (T3-T4 and/or N+) low and mid rectal cancer with suspicion of complete tumour response (CTR) or near-CTR. METHOD Thirty-nine patients with rectal cancer who underwent LE after RCT for suspicion of CTR were matched to 71 patients who underwent TME according to body mass index, gender, tumour location and ypTNM stage. Operative, oncological and functional results were compared between groups. RESULTS In the LE group, ypT0, ypTis or ypT1N0R0 were noted in 28/39 (72%). Overall morbidity was observed in 10/39 (26%) in LE vs 46/71 in the TME group (65%) (P = 0.001). Severe morbidity (Clavien-Dindo ≥ 3) was noted in 1/39 patients from the LE group (3%) vs 3/71 (4%) from the TME group (P = 1.000). After a mean follow-up of 63 ± 4 months (range 56-70 months), local recurrence was noted in 2/39 (5%) from the LE group vs 2/71 (3%) from the TME group (P = 0.601). Definitive stoma was noted in 2/39 (6%) from the LE group vs 8/71 (12%) from the TME group (P = 0.489). Major low anterior resection syndrome was noted in 5/23 (22%) from LE group vs 11/33 (33%) from the TME group (P = 0.042). CONCLUSION The accuracy of response prediction after RCT was 72% after LE. In high-risk patients, LE represents a safe alternative to TME with better functional results and the same long-term oncological outcome.
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Affiliation(s)
- M Calmels
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
| | - M K Collard
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
| | - A Cazelles
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
| | - A Frontali
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
| | - L Maggiori
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
| | - Y Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy Cedex, France
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Collard MK, Lefèvre JH, Batteux F, Parc Y. COVID-19 heath crisis: less colorectal resections and yet no more peritonitis or bowel obstruction as a collateral effect? Colorectal Dis 2020; 22:1229-1230. [PMID: 32542838 PMCID: PMC7323089 DOI: 10.1111/codi.15199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/21/2022]
Affiliation(s)
- M. K. Collard
- Digestive Surgery DepartmentSaint‐Antoine Hospital, APHPSorbonne UniversityParisFrance
| | - J. H. Lefèvre
- Digestive Surgery DepartmentSaint‐Antoine Hospital, APHPSorbonne UniversityParisFrance
| | - F. Batteux
- Department of Strategy and TransformationAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Y. Parc
- Digestive Surgery DepartmentSaint‐Antoine Hospital, APHPSorbonne UniversityParisFrance
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Collard MK, Torcivia A, Genser L. Descriptive anatomy and closure modalities of inter-mesenteric spaces in laparoscopic Roux-en-Y gastric bypass. J Visc Surg 2020; 157:418-422. [PMID: 32981885 DOI: 10.1016/j.jviscsurg.2020.09.002] [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: 10/23/2022]
Affiliation(s)
- M K Collard
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France
| | - A Torcivia
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France
| | - L Genser
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France.
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Collard MK, Genser L, Vaillant JC. Re Re : laparoscopic direct feeding jejunostomy. J Visc Surg 2020; 157:167-168. [PMID: 31959468 DOI: 10.1016/j.jviscsurg.2020.01.004] [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: 11/25/2022]
Affiliation(s)
- M K Collard
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - L Genser
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - J C Vaillant
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
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Affiliation(s)
- M K Collard
- Service de Chirurgie Digestive, Hépato-bilio-pancréatique et Transplantation Hépatique, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Institut hospitalo-universitaire ICAN, Paris, France
| | - L Genser
- Service de Chirurgie Digestive, Hépato-bilio-pancréatique et Transplantation Hépatique, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Institut hospitalo-universitaire ICAN, Paris, France.
| | - J C Vaillant
- Service de Chirurgie Digestive, Hépato-bilio-pancréatique et Transplantation Hépatique, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Institut hospitalo-universitaire ICAN, Paris, France
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