Faisabilité du traitement non-opératoire des plaies pénétrantes de l'abdomen en France (à partir de l'expérience de trois hôpitaux français)

INTRODUCTION: Dans les années 70, le traitement non-opératoire (TNO) fait partie de l'arsenal thérapeutique au cours de la prise en charge des plaies pénétrantes de l'abdomen. En France cette prise en charge est courante pour les traumatismes fermés mais pas pour les traumatismes ouverts. Le gold standard reste la laparotomie exploratrice. Le but de notre étude est d'évaluer la faisabilité du TNO dans 3 hôpitaux du sud-est de la France. MATERIEL et METHODE: Il s'agit d'une étude multicentrique initialement rétrospective de janvier 2009 à janvier 2010 puis prospective jusqu'à septembre 2012. Chaque patient victime d'une plaie pénétrante avérée de l'abdomen était inclus. Les patients instables hémodynamiquement ou avec une défense abdominale étaient immédiatement pris au bloc opératoire. Ceux qui étaient stables avec un examen clinique sans signe péritonite avaient systématiquement un scanner avec injection. S'il n'y a pas de lésion intra-abdominale nécessitant de chirurgie au scanner, les patients étaient surveillés en unité de soins continus. Les critères évalués étaient: échec de TNO, morbi-mortalité du TNO, taux d'intervention non-thérapeutique avec leur morbi-mortalité, durée d'hospitalisation et analyse de coût. RESULTATS: Ces patients ont été inclus, 27 ont été sélectionnés pour un TNO (20 plaies par arme blanche et 7 par arme à feu). Le taux de morbidité est de 18% il n'y avait pas d'échec et aucun décès. Soixante-douze ont été opérés, 22 interventions étaient non-thérapeutiques. Le taux de morbidité des interventions non-thérapeutiques est de 9%, il n'y a pas de décès. Les durées médianes d'hospitalisation sont 4 jours pour les TNO et 5,5 jours pour les interventions non-thérapeutiques. L'analyse de coût montre une économie de plus de 1000 euros par TNO. CONCLUSION: Le TNO est faisable même en France à condition que la population soit finement sélectionnée en fonction de l'examen clinique et du scanner. Cette prise en charge peut être également appliquée à certaine plaie par arme à feuAIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Response to "individualized care in patients undergoing laparoscopic cholecystectomy"

Comment onHow to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system. [Am J Surg. 2016]Individualized care in patients undergoing laparoscopic cholecystectomy. [Am J Surg. 2017]International audienceno astrac

Multiple blast extremity injuries: is definitive treatment achievable in a field hospital for local casualties?

PURPOSE: The objective of this report was to analyse injury patterns and definitive management of local casualties with multiple blast extremity injuries in the Kabul International Airport Combat Support Hospital. METHODS: A clinical prospective study was performed from July 2012 to January 2013. Afghan victims of a blast trauma with a minimum of two extremities injured and an Injury Severity Score (ISS) greater than 8 were included. Two groups were considered for analysis: group A including patients with amputations and group LS including patients with limb salvage procedures. RESULTS: During this period 19 patients were included with a total of 57 extremity injuries. There were six patients in group A and 13 patients in group LS, with a mean number of injuries of 3.5 and 2.8, respectively. The ISS, blood products utilization and overall time of surgery were significantly greater in group A. CONCLUSION: Reconstruction of multiple blast extremity injuries may be achieved in a field hospital despite limited resources and operational constraints. However, this activity requires the utilization of significant supplies and major investment from the caregivers deployed

The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects

Introduction The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)?called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)?has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. Methods Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. Results The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. Conclusion The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties

Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast

Introduction: The aims of this study were as follows: first to quantify and review the types of surgical procedures performed by military surgeons assigned to a forward surgical team (fst) providing medical support to the population (msp) in the ivory coast (ic), and second to analyze how this msp was achieved. Methods: Between 2002 and 2012, all of the local nationals operated on by the different fsts deployed in the ic were included in the study. The surgical activity was analyzed and divided into surgical specialties, war wounds, nonwar emergency trauma, nontrauma emergencies, and elective surgery. Demographics, circumstances of health care management, wounded organs, and types of surgical procedures were described. Results: Over this period, surgeons operated on 2,315 patients and performed 2,556 procedures. Elective surgery accounted for 78.7% of the surgical activity, nontrauma emergencies accounted for 12.7%, nonwar emergency trauma accounted for 8%, and war wounds accounted for 0.6%. The main surgical activities were visceral (43.8%) and orthopedic (including soft tissues) surgeries (38.5%). Conclusion: The fsts contributed widely to msp in the ic. This msp required limited resources, standardization of the procedures and specific skills beyond the original surgical specialties of military surgeons to fulfill the needs of the local population

Early Evaluation of a New French Surgery Course in the Best Practice of Dealing With Major Incidents and Mass Casualty Events

The main objective of this study is to evaluate the impact of a nationwide 5-month course aimed to prepare surgeons for Major Incidents through the acquisition of key knowledge and competencies. Learners' satisfaction was also measured as a secondary objective

Strategic proposal for a national trauma system in France

International audienceIn this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years