Évaluation d’un algorithme de prise en charge des occlusions sur brides avec utilisation de produit de contraste hydrosoluble (ALGOBRIX)

Introduction: small bowel adhesive obstruction without gravity criteria ’s best non operative management and the usefulness of water soluble contrast agent are still under debate. An algorithm has been introduced in our visceral surgery department in 2016, with use of Télébrix 24 hours after admission : ALGOBRIX. Aim of the study: to assess algorithm ‘s efficacy and safety. Material and methods: ALGOBRIXwas evaluated by comparing outcomes in patients admitted in 2014-2015 and in 2017-2018. The primary outcome was the hospital length of stay. Data were recorded retrospectively. Results: 186 patients met inclusion and exclusion criteria. Algorithm introduction didn’t decreased length of stay between the two periods nor complication rate. However, ALGOBRIX application in both periods leads to a length of stay decrease of 5 days, and to a complication rate decrease in univariate analysis. The complication rate decrease isn’t confirmed in multivariate analysis. Conclusion: As shown by Scotté et al. in 2017, the usefulness of Télébrix is limited. But ALGOBRIX leads to a shorter length of stay in univariate analysis, which is consistent with Dombert’s recent study.Those findings need to be confirmed with further, randomized study.Introduction : Le traitement non opératoire optimal des occlusions sur brides sans critère de gravité et l’intérêt de l’utilisation de produit de contraste hydrosoluble sont débattus. Un algorithme de prise en charge a été instauré dans le service en 2016, avec utilisation de Télébrix 24h après l’entrée : ALGOBRIX. But de l’étude : évaluer l’efficacité et la sécurité de cet algorithme. Matériel et méthodes : ALGOBRIX a été évalué en comparant deux groupes de patients pris en charge en 2014-2015 et 2017-2018. Le critère de jugement principal était la durée de séjour. Les données ont été recueilles rétrospectivement. Résultats : 186 patients ont été inclus. L’instauration de l’algorithme n’a pas permis de diminuer la durée de séjour entre les deux périodes, ni le taux de complication. Cependant l’application d’ALGOBRIX permet une réduction de la durée de séjour de 5 jours, ainsi qu’une réduction du taux de complication en univarié, mais cette dernière différence n’est pas retrouvée en multivarié. Conclusion : Conformément aux données de la littérature, l’utilisation de Télébrix reste d’un intérêt limité, mais l’algorithme ALGOBRIX permet une diminution de la durée de séjour en analyse univariée. Ce résultat est à confirmer par une étude randomisée

Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study

International audienceObjective: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19.Methods: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21).Results: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity.Conclusion: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality