2 research outputs found
Ăvaluation dâun 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 âs 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 TĂ©lĂ©brix 24 hours after admission : ALGOBRIX. Aim of the study: to assess algorithm âs 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 didnât 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 isnât confirmed in multivariate analysis. Conclusion: As shown by ScottĂ© et al. in 2017, the usefulness of TĂ©lĂ©brix is limited. But ALGOBRIX leads to a shorter length of stay in univariate analysis, which is consistent with Dombertâs recent study.Those findings need to be confirmed with further, randomized study.Introduction : Le traitement non opĂ©ratoire optimal des occlusions sur brides sans critĂšre de gravitĂ© et lâintĂ©rĂȘt de lâutilisation de produit de contraste hydrosoluble sont dĂ©battus. Un algorithme de prise en charge a Ă©tĂ© instaurĂ© dans le service en 2016, avec utilisation de TĂ©lĂ©brix 24h aprĂšs lâentrĂ©e : ALGOBRIX. But de lâĂ©tude : Ă©valuer lâefficacitĂ© et la sĂ©curitĂ© de cet algorithme. MatĂ©riel et mĂ©thodes : ALGOBRIX a Ă©tĂ© Ă©valuĂ© en comparant deux groupes de patients pris en charge en 2014-2015 et 2017-2018. Le critĂšre de jugement principal Ă©tait la durĂ©e de sĂ©jour. Les donnĂ©es ont Ă©tĂ© recueilles rĂ©trospectivement. RĂ©sultats : 186 patients ont Ă©tĂ© inclus. Lâinstauration de lâalgorithme nâa pas permis de diminuer la durĂ©e de sĂ©jour entre les deux pĂ©riodes, ni le taux de complication. Cependant lâapplication dâALGOBRIX permet une rĂ©duction de la durĂ©e de sĂ©jour de 5 jours, ainsi quâune rĂ©duction du taux de complication en univariĂ©, mais cette derniĂšre diffĂ©rence nâest pas retrouvĂ©e en multivariĂ©. Conclusion : ConformĂ©ment aux donnĂ©es de la littĂ©rature, lâutilisation de TĂ©lĂ©brix reste dâun intĂ©rĂȘt limitĂ©, mais lâalgorithme ALGOBRIX permet une diminution de la durĂ©e de sĂ©jour en analyse univariĂ©e. Ce rĂ©sultat est Ă confirmer par une Ă©tude randomisĂ©e
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