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Demouron M, Selvy M, Dembinski J, Mauvais F, Cheynel N, Slim K, Sabbagh C, Regimbeau JM. Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study. J Am Coll Surg 2022; 234:840-848. [DOI: 10.1097/xcs.0000000000000123] [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: 12/07/2022]
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Siembida N, Sabbagh C, Chal T, Demouron M, Rossi D, Dembinski J, Regimbeau JM. Absence of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis is a valid strategy. Surg Endosc 2022; 36:7219-7224. [PMID: 35122148 DOI: 10.1007/s00464-022-09080-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Management of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis (LGTP) is not a standardized procedure. A monocentric study was carried out in 2016 in our centre. (PI study) to evaluate the interest of drainage. Our objective was to revaluate, our actual use of abdominal drainage after peritonitis (PII study). STUDY DESIGN We examined retrospectively patients who underwent surgery for secondary sub-mesocolic community-acquired peritonitis (January 2016-December 2019). Study exclusion criteria were primary peritonitis, peritoneal dialysis, nosocomial peritonitis, postoperative peritonitis, upper gastrointestinal tract peritonitis, peritonitis due to appendicitis, peritonitis requiring the implementation of Mikulicz's drain, and peritonitis in which the peritoneum was not described in the surgical report (i.e., the same criteria that the PI study which included 141 patients from January 2009 to January 2012). The primary endpoint was the rate of abdominal drainage. The secondary endpoints were the patient rate without a peritoneum description, major complications rate (Clavien ≥III), abscess rate, mortality rate and the length of stay in the non-drain group (D - ) and in the drain group (D + ) in PII study. Primary and secondary endpoints were also compared between PI and PII studies. Risk factors for post-operative abscess were also research. RESULTS Of the 150 patients included 33% were drained vs 84% of the 141 patients included in PI study (p < 0.001). In PII study peritoneum was described in 80.3% of patients vs 69% in PI study (NS, p = 0.06). Comparing the two groups D - and D + , no significant differences were found in major complications (respectively 45% vs 32%, p = 0.1), reoperation rate (respectively 25% vs 22%, p = 0.7), death rate (respectively 25% vs 14%; p = 0.1) and mean length of stay (respectively 12 days vs 13 days, p = 0.9). The abscess rate was significantly lower in the D - group (10% vs 30%, p = 0.002). Comparing PI and PII studies, there was no difference about major complications (35% vs 35%, p = 0.1), reoperation (16% vs 17.5%, p = 0.5), abscess rate (15% vs 8.5%, p = 0.1) and mortality (14.5% vs 17.5%, p = 0.7). The length of stay was longer in PI study than in P II (14 days vs 9 days, p = 0.03). Drainage (p = 0.005; OR = 4.357; CI [1.559-12.173]) and peritonitis type (p = 0.032; OR = 3.264; CI [1.106-9.630]) were abscess risk factors. CONCLUSION This study therefore showed that drainage after surgery for LGTP may not be necessary and that, at least at the local level, surgeons seem to be inclined to discontinue it systematically. It may therefore be worthwhile to conduct a randomised control trial to establish recommendations on drainage after surgery for LGTP.
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Affiliation(s)
- Nicolas Siembida
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Tami Chal
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France
| | - Marion Demouron
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Davide Rossi
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France. .,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France.
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Forzini T, Demouron M, Uhl M, Mesureur S, Renard C, Klein C, Haraux E. Computed tomograpy evaluation of ureteral length in children. J Pediatr Urol 2019; 15:555.e1-555.e5. [PMID: 31324475 DOI: 10.1016/j.jpurol.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/22/2018] [Accepted: 06/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although ureteral length (UL) is highly variable in children, reliable data on this topic are scarce. During urinary tract surgery, the use of an inappropriately dimensioned ureteral stent is associated with adverse effects. This study aimed to evaluate UL as a function of the child's age, using contrast-enhanced computed tomography (CT) of the abdomen and pelvis, and to calculate a new equation for predicting UL (and thus the optimal length of ureteral stents) in children. MATERIAL AND METHODS A retrospective, single-centre study of children (younger than 16 years) who are free of abdominal mass syndrome and severe scoliosis was conducted. After three-dimensional reconstruction of the CT data, the ureter was measured between the ureteropelvic junction and ureterovesical junction by two observers. The lengths of the right and left ureters were analyzed by age, with at least 10 CT measurements per age class. RESULTS The mean ULs on the right and left were, respectively, 9.7 and 9.91 cm before the age of 1 year, 20.10 and 21.08 cm at the age of 7 and 26.55 and 27.46 cm at the age of 16. The interobserver reproducibility of UL determination was high (intraclass correlation coefficient [95% confidence interval]: 0.97 [0.94-0.99]). On the basis of these results, the length of the double-J catheter should be equal to the child's age +12 cm (Table 1). CONCLUSION Computed tomography measurement of the UL in healthy children is reproducible and reliable and enabled the estimation of the UL by age group. This knowledge should facilitate the choice of the stent used in ureteral surgery. To confirm the study results, the stent size suggested here should be evaluated in routine practice.
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Affiliation(s)
- T Forzini
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - M Demouron
- Department of Visceral Surgery, Amiens University Hospital, Amiens, France
| | - M Uhl
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - S Mesureur
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - C Renard
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - C Klein
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - E Haraux
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, Amiens, France.
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Parpex G, Demouron M, Arapis K, Chosidow D, Rebibo L, Msika S. The Distance between the Pylorus and Left Vagus Nerve during Sleeve Gastrectomy. Clin Anat 2019; 33:562-566. [PMID: 31381184 DOI: 10.1002/ca.23443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
The sleeve gastrectomy (SG) can be performed with or without antral preservation (distance from the pylorus <50 mm). The objective of this study was to evaluate the distance between the pylorus and the end of the left vagus nerve in order to determine whether it could be used as a constant anatomical landmark to start gastric transection. This was a prospective, nonrandomized study of 120 patients undergoing SG from January to October 2018. The distance measurement between pylorus and vagus nerve was performed at the beginning of the SG. The primary endpoint was the distance between the beginning of the pylorus and the end of the second branch of the vagus nerve on the upper edge of the antrum. The secondary endpoints was the correlation factors between the preoperative data and the position of the end of the vagus nerve. A total of 120 patients, with a mean body mass index of 42.2 kg/m2 , underwent primary SG. The mean distance between pylorus and the end of the vagus nerve was 50.4 mm (35-64) on the upper part of the antrum. When considering the inferior part of the antrum, the minimum distance was 50 mm. No correlations were found between preoperative data and distance measurements. The vagus nerve can be considered as a constant and reliable anatomical landmark for performing SG with antral preservation. However, no correlation was found between the preoperative data and the location of the end of the vagus nerve. Clin. Anat. 33:562-566, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Guillaume Parpex
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
| | - Marion Demouron
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
| | - Konstantinos Arapis
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
| | - Denis Chosidow
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
| | - Simon Msika
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France
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