Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Intraperitoneal insufflation of carbon dioxide rescues intestinal damage in an experimental murin model of colitis

International audienceObjectives: Necrotizing enterocolitis (NEC) is a severe neonatal surgical condition, associated with a prolonged pro-inflammatory state, leading to high mortality and morbidity rates. Carbon dioxide (CO2) insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to evaluate the effects of CO2-insufflation on experimental colitis.Methods: Acute colitis was induced in 6-week-old Balb/c mice by the administration of 2%-dextran sulfate-sodium (DSS) during 7 days (n = 45). On Day 4, two groups received intraperitoneal insufflation (duration: 30 mn, pressure: 5 mmHg) of CO2 (“DSS+CO2”) or air (“DSS+air”). A group received no insufflation (“DSS”). Groups were compared for clinical severity using the disease activity index (DAI—body weight loss, stool consistency, and bleeding), histological severity (histopathological activity index, colon length, and ulcerations), colonic mucosecretion, and inflammation.Results: DAI was significantly decreased in DSS+CO2 group, compared to DSS (p &lt; 0.0001) or DSS+air (p &lt; 0.0001) groups. Colon length was increased in DSS+CO2 treated mice compared to DSS (p = 0.0002). The histopathological activity index was lower in DSS+CO2 (vs. DSS, p = 0.0059/vs. DSS+air, p = 0.0389), with decreased ulcerations (3.77 vs. 10.7, p = 0.0306), and persistent mucosecretion with increased mucin-secreting cells.Conclusions: CO2-insufflation attenuates DSS-induced colitis and improves both clinical and histological scores. Laparoscopy with CO2 insufflation represents a therapeutic anti-inflammatory strategy for NEC

Assessment of quality of life after laparoscopic GERD surgery in children: a prospective study

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Influence of social deprivation and remoteness on the likelihood of sphincter amputation for rectal cancer: a high-resolution population-based study

International audienceBACKGROUND:Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality.METHODS:The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage.RESULTS:A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046-2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178).CONCLUSION:This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation

Laparoscopic Treatment of Wilms’ Tumor: Criteria of SIOP-UMBRELLA Protocol may be Updated

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Outcome of long gap esophageal atresia at 6 years: A prospective case control cohort study

International audienceBackground data: EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years.Methods: A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed.Results: Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group.Conclusions: Long gap strongly influenced digestive morbidity at age 6 years.Keywords: Complications; Dysphagia; Esophageal atresia; Esophageal replacement; Gastro-esophageal reflux disease; Long gap esophageal atresia; Midterm outcomes

Pulmonary Consequences of Surgical Treatment in Children's Primary Lung Tumors: A National Retrospective Study

International audienceABSTRACT Background and aims Primary lung tumors (PLTs) in children are rare, and surgery remains the key to ensure remission. Here we describe the PLTs clinical characteristics, their management, and the pulmonary outcome following surgery. Methods We carried out a French national cohort of pediatric PLTs from 2013 to 2023 from the FRACTURE rare pediatric tumors national database. We included children under 18 years at diagnosis who underwent surgery for a histologically proven PLT, with a minimum of 6 months of follow‐up (FU) post surgery. Results Sixty‐two patients were included. The median age at diagnosis was 3.6 years [3; 11], sex ratio 1.07. Pleuropulmonary blastoma was the most frequent tumor retrieved ( n = 31). Sixty patients underwent surgery: 32 lobectomies, 15 wedges, five segmentectomies, and five pneumectomies. A thoracoscopic approach was carried out in 14% of the cases. At 6 months post surgery and at the last follow‐up (median time of 5.7 years [3.4; 7.6]), respectively, 11 and eight patients presented with pulmonary symptoms, and 10 and three patients presented with surgical complications. During the post‐surgery period, 22 children benefited from an evaluation of their respiratory function by pulmonary function tests, and four of them remained with abnormal results. Conclusions Surgery is key to ensure remission in PLTs and seems secure. However, respiratory symptoms are noted in 13% of children during the FU, and this rate is probably underestimated. Therefore, we suggest a systematic pulmonary FU to optimize postoperative pulmonary rehabilitation and, therefore, the child's pulmonary outcome

OVARIAN TORSION IN PREPUBERTAL GIRLS : CLINICAL CHARACTERISTICS, BIOLOGICAL AND RADIOLOGICAL FEATURES, RECCURENCY RATE.

International audienceIntroduction: The diagnosis of ovarian torsion is made with delay among pre-pubertal girls and the management after the surgical detorsion is poorly codified. We interested in the French experience during the last two decades.Methods: Retrospective study in French pediatric surgery centers from January 2000 to December 2022 concerning girls who presented with at least 1 episode of ovarian torsion in the prepubertal period. Data collected included patient history, symptomatology, biological and imaging assessment at first episode, emergency surgery, follow-up including recurrence.Results: Thirty centers participated and we included 502 girls diagnosed with ovarian torsion during a surgical procedure performed due to abdominal pain (with or without ovarian mass). The girls had a mean age of 7.9 years (± 2.8) and a median age of 8.3 years (Q1 5.97; Q3 10.12) at the time of the first episode of torsion. Nausea or vomiting was present in 71% of cases. Fever was present in 23% of cases and was more displayed 24 hours after the onset of abdominal pain (p &lt; 0.0001). Mean follow-up was 2.1 (± 2.61) years. Only 42 out of 142 (30%) girls with enlarged ovaries (&gt; 97th percentile) were referred to the endocrinologist to assess the existence of hormonal anomalies. Of the 482 girls without oophoropexy after the first episode of torsion, 71 (14.7 %) experienced at least one recurrence. Among them: 10 (7.5%) had an ovarian mass and 42 (55%) enlarged ovaries.Conclusion: Symptoms of ovarian torsion in pre-pubertal girls are not specific and clinicians should be aware of this insidious presentation in this group. These girls should be systematically referred to endocrinologists