Editorial: Towards a necessary evolution in emergency surgery

One of the peculiarities of the organization of emergency surgery in France is… that there is no specific organization! While few departments of emergency surgery exist, nearly all surgical departments that participate in this activity have neither a dedicated organization nor specialized practitioners. And yet, emergency surgery represents a major portion of activity in our discipline. Despite this high volume of emergency cases, the present-day image, dynamism and attractiveness of academic emergency surgery does not correspond with its rich history, particularly for young surgeons. It is time to recognize these difficulties and to seriously reflect on the organization and quality of care in France in the light of experience from other countries, in order to restore emergency surgery to the place it deserves

The laborious structuring of traumatology in France

Any surgeon on call is familiar with the acute tension that appears on the arrival of a patient presenting with unstable abdominal trauma. The atmosphere has to do not only with the life-threatening nature of the injury, but also with an urgent need to decide rapidly and collegially on decisive action, as well as possible surgical hemostasis in a hostile context of massive hemoperitoneum. While these extreme emergency situations galvanize medical residents, they are often dreaded by young surgeons, who are lacking in training and practice. Traumatology activities have recently undergone considerable change, and the four articles published in this issue of the Journal of Visceral Surgery [1], [2], [3], [4] shed light on ongoing and upcoming evolution

Laparoscopie et cancer du rectum (résultats à court terme de 104 résections conservatrices)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Use of a self-adherent parietal traction mesh to close laparostomy (with video)

The increase of damage control surgery in visceral trauma as in other emergency situations (mesenteric ischemia, peritonitis) may require leaving the abdomen open, i.e. laparostomy at the end of the procedure. This approach can prevent or treat an abdominal compartment syndrome, which is associated with high morbidity and mortality. In cases of open abdomen, the use of a negative pressure system by vacuum-assisted closure (VAC) is the preferred technique to isolate and cover the abdominal contents

Les plaies par arme blanche et leur prise en charge aux urgences

Les plaies par armes blanches représentent la cause la plus fréquente de plaies pénétrantes et surviennent principalement au décours d’une agression ou d’une tentative de suicide. La gravité dépend du caractère superficiel ou pénétrant de la plaie, de sa localisation, et des organes lésés. La prise en charge doit être connue car le risque vital est engagé quand la plaie est pénétrante. Les patients dont l’hémodynamique est instable doivent être opérés sans délai après réalisation d’une radio de thorax et d’une échographie Focus assisted sonography for trauma –FAST- guidant la voie d’abord. Chez les patients stables, l’examen clinique orienté, l’exploration de la plaie et des examens d’imagerie dépistent les lésions nécessitant une prise en charge chirurgicale. Les plaies pénétrantes par armes blanches requièrent une étroite et rapide collaboration entre les équipes, adaptée aux moyens de l’établissement d’accueil

Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database

In industrialised countries, trauma is a public health challenge. Despite disposing of a highly evolved and complex health care system, France does not dispose of a national trauma registry or trauma system. Little is known about the epidemiology of trauma in France. This study aims at describing, using the national billing database, the epidemiology of French trauma.MethodsA retrospective population-based cohort study has been conducted on trauma patients in France using the National Hospital Discharge Data Set Database for 2016. Patients were selected using the Trauma Audit and Research Network (TARN) criteria, inspired by the UK trauma system. Sociodemographic, clinical information and hospital characteristics were collected. The main outcome was 30-day mortality.ResultsAmong 1,144,596 patients hospitalised in French hospitals for trauma in 2016, 144,058 patients were included based on the TARN criteria. The mean age of the patients was 64?years (±?24). Women (50.8%) were over-represented among patients older than 75 years. The 30-day mortality was 5.9%, and regional variations were identified. In multivariate analysis, age, gender, area-level deprivation, injury localisation, co-morbidities, injury severity, transfusion, surgery, and ICU admission were independent factors of risk for 30-day mortality. Age and injury severity were the stronger predictors for mortality and area-level deprivation was associated with higher mortality.ConclusionThe national burden of trauma care was assessed with medico-administrative data in a country without a trauma system. The 30-day mortality associated with trauma in France was around 6%, with regional variations

An Experimental Study of Intraluminal Hyperpressure Reproducing a Gastric Leak Following a Sleeve Gastrectomy

International audienceIntroduction A gastric leak (GL) represents the main post-operative complication following a sleeve gastrectomy (SG) and occurs most commonly at the top of the stapling, without any clear explanation. Objective This experimental study evaluates the biomechanical behavior of post-SG gastric specimens using both insufflation and tensile tests. Materials and Methods A total gastrectomy followed by an ex vivo SG was performed in 15 pigs. The Bsleeved^stomachs were subjected to intraluminal hyperpressure until failure. Uniaxial circumferential and longitudinal tensile tests were performed using gastric strips obtained from the Bresected^stomachs. All the deformations and burst pressures were recorded and analyzed. Results A GL appeared in the upper third of the stapling in 73% of cases. The mean burst pressure was 26.3 ± 5.3 mmHg and was significantly correlated with the volume of the Bsleeved^stomachs (p = 0.02). The overall deformation of the Bsleeved^stomachs was comparable in the frontal (38.3%) and profile (40.5%) planes. The greatest displacement was observed at the failure zone (11 mm on average). The biomechanical behavior of the stomach wall differed according to the strip orientation. The circum-ferential strips presented a higher strain-to-failure rate (97%) and a lower Young's modulus (0.99 MPa) when compared to the longitudinal strips (45% and 2.58 MPa, respectively). Conclusion This preliminary study reproduced a GL in the same location as observed during clinical practice. The volume of the SG influenced the burst pressure. Further experimental studies and numerical simulations should evaluate the impact of shape modifications on an SG

Pharmacologic Venous Thromboprophylaxis After Bariatric Surgery

International audienc

Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. Single-incision laparoscopic surgery has recently emerged as a less invasive potential alternative to conventional three- or four-port laparoscopy. However, the feasibility of single-incision laparoscopic cholecystectomy (SILC) remains unclear, and there are no rigorous criteria in the literature. Identifying patients at risk of failure of this new technique is essential. The aim of our study was to determine risk factors that may predict failure of the procedure. From May 2010 to March 2012, 110 consecutive patients underwent SILC and were reviewed retrospectively. The main feasibility criterion was the procedure failure rate, defined as addition of supplementary port(s) and prolonged (>60 min) operative time. The factors evaluated were age, gender, height, weight, body mass index, previous abdominal surgery, indication for surgery and gallbladder suspension. There was conversion in 16 patients (14.5 %), and the operative time exceeded 60 min for 20 patients (30.9 %). Univariate analysis showed a significant independent association between additional port requirement and each of weight as a continuous value, weight e80 kg, BMI >26.5 kg/m2 and height >172 cm. Univariate analysis also showed a significant independent association between prolonged operative duration (>60 min) and each of height and weight as continuous values, height >172 cm and previous abdominal surgery. In the multivariate analysis, only weight remained independently associated with additional port requirement, and height remained independently associated with prolonged operative duration. Preoperative identification of the factors increasing the risk of conversion may assist surgeons in making decisions concerning the management of patients, including appropriate use of SILC