Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Expérience française de la technique chirurgicale du STEP (Serial Transverse Enteroplasty) dans la prise en charge des enfants atteints d'un syndrome du grêle court

ObjectiveShort Bowel Syndrome (SBS) is one of the main causes of intestinal failure in children, due to various underlying diseases. Surgical management by small bowel lengthening, such as serial transverse enteroplasty (STEP), is feasible in selected cases. Literature regarding long-term results of this technique is scarce. The aim of this study was to report the long-term outcomes of the STEP procedure for children with SBS.MethodsWe performed a multicenter national retrospective study reviewing medical charts of all the children that underwent a STEP technique between 2000 and 2022 in 6 university hospitals.Collected data included demographics, SBS cause and history, surgical procedures, enteral or parenteral nutrition, STEP technique, complications, and current follow-up (clinical status, feeding, digestive symptoms, growth).ResultsOverall, 36 patients underwent a STEP for SBS, caused by gastroschisis in 38.8% (n=14), intestinal atresia in 27.7% (n=10), necrotizing enterocolitis (NEC) in 22.2% (n=8), midgut volvulus in 5.5% (n=2), and total intestinal Hirschsprung disease in 5.5% (n=2). The median age at first STEP was 0.8 years [0.3; 4.9], with a median weight of 9.7 kg [4.5; 18.4]. The STEP procedure significantly increased bowel length (47 vs 70cm, p<0.01), with a median gain of 16 cm [10.75; 25] or increase of 34%. At surgery, 91.2% of children had PN (n=33). A second STEP was performed in 27.7% (n=10) and a third STEP in 2.7% (n=1). Two children had an intestinal transplantation (5.5%). With a median follow-up of 10.8 years [6.1; 16.2], 52.7% of children still require parenteral nutrition (PN) (n=19) with a median NPE/REE ratio (Non-Protein Energy/Resting Energy Expenditure) of 82% [65; 122]. Among the 33 children that had PN before surgery, 42.4% were weaned (n=14) and 2 still have exclusive enteral nutrition (6%). Glucagon-like Peptide 2 (GLP-2) treatment was administered to 9 children (25%), with a median duration of treatment of 2.3 years [1.1; 3.4]. The average length gain was +50% (±59%), for 21cm (±15). Among 17 children symptomatic with dilatations and bacterial overgrowth, 12 (70%) are currently asymptomatic. Out of the 19 with extreme SBS with PN, 7 have been weaned from PN (36.8%). Out of the 20 with chronic obstructive symptoms, 9 (45%) have complete oral feeding autonomy, 3 have complete enteral autonomy including oral feeding and enteral nutrition (15%), and 8 (40%) still require parenteral nutrition associated to oral feeds.ConclusionSTEP remains an effective surgical therapy in the management of children with SBS, allowing PN weaning in 42%. Further studies are required to investigate the combined effect STEP and GLP-2.Objectif Le syndrome de l'intestin court (SBS) est l'une des principales causes d'insuffisance intestinale de l'enfant, causé par différentes étiologies. Une prise en charge chirurgicale par allongement du grêle restant, comme l'entéroplastie transversale en série (STEP), est possible dans certains cas. Peu de données existent concernant les résultats à long terme de cette technique. L'objectif de cette étude était de rapporter les résultats à long terme du STEP chez les enfants atteints de SBS en France. Méthodes Il s’agit d’une étude rétrospective nationale multicentrique rassemblant les cas d’enfants opérés par la technique du STEP entre 2000 et 2022 dans 6 hôpitaux universitaires français. Les données recueillies comprenaient les données démographiques, l’étiologie et l'histoire du SBS, les interventions, la nutrition entérale ou parentérale, la technique du STEP, les complications et le suivi actuel (état clinique, alimentation, symptômes digestifs, croissance). Résultats Au total, 36 patients ont bénéficié d’un STEP pour un SBS. Les étiologies étaient un laparoschisis dans 38,8 % (n=14), une atrésie intestinale dans 27,7 % (n=10), une entérocolite nécrosante (NEC) dans 22,2 % (n=8), un volvulus du grêle dans 5,5 % (n=2) et une maladie de Hirschsprung intestinale totale dans 5,5 % (n=2). L'âge médian lors du STEP était de 0,8 ans [0,3 ; 4,9], avec un poids médian de 9,7 kg [4,5 ; 18,4]. Le STEP a permis une augmentation significative de la longueur de l'intestin (47 vs 70cm, p<0,01), avec un gain médian de 16 cm [10,75 ; 25] soit une augmentation de 34%. Au moment de la chirurgie, 91,2% des enfants avaient une nutrition parentérale (NP) (n=33). Un deuxième STEP a été réalisée chez 27,7% (n=10) et un troisième STEP chez 2,7% (n=1). Deux enfants ont eu une transplantation intestinale (5,5%). Avec un suivi médian de 10,8 ans [6,1 ; 16,2], 52,7% des enfants nécessitent encore une NP (n=19) avec un ratio médian NPE/REE (énergie non protéique/dépense énergétique de repos) de 82% [65 ; 122]. Parmi les 33 enfants qui avaient une NP avant la chirurgie, 42,4% ont été sevrés (n=14) et 2 ont toujours une nutrition entérale exclusive (6%). Un traitement par Glucagon-like Peptide 2 (GLP-2) a été administré à 9 enfants (25%), avec une durée médiane de traitement de 2,3 ans [1,1 ; 3,4]. Le gain moyen de longueur était de +50% (±59%), soit 21cm (±15). Parmi les 17 enfants symptomatiques avec dilatation et pullulation bactérienne, 12 (70%) sont actuellement asymptomatiques. Sur les 19 enfants atteints de SBS majeur non sevrable de la NP, 7 ont été sevrés (36,8%). Sur les 20 patients présentant des symptômes obstructifs chroniques, 9 (45%) ont actuellement une autonomie PO, 3 nécessitent une nutrition entérale en plus de l’alimentation orale (15%), et 8 (40%) ont une nutrition parentérale associée à une alimentation orale. Conclusion Le STEP reste un traitement chirurgical efficace dans la prise en charge des enfants atteints de SBS, permettant le sevrage de la NP dans 42% des cas. D'autres études sont nécessaires pour examiner l'effet combiné de la STEP et du GLP-2

A Horseshoe Intralobar Lung Sequestration Resection by Bilateral Robot-Assisted Surgery

International audienceWe present the case of a 20-year-old male patient presenting a right lower intralobar pulmonary "horseshoe" sequestration extending into the left cavity supplied by 4 aberrant arteries from the thoracic descending aorta. The surgical approach for this exceptional and challenging presentation was based on thorough analysis of the chest computed tomography scan aided by 3-dimensional reconstructions. The latter helped us better understand this complex malformation. Surgery was done by robot-assisted bilateral approach with en bloc extraction through the left side

Mowat Wilson syndrome and Hirschsprung disease: a retrospective study on functional outcomes

International audienceAim of the study: Mowat Wilson syndrome (MWS) is a complex genetic disorder due to mutation or deletion of the ZEB2 gene (ZFHX1B), including multiple clinical features. Hirschsprung disease is associated with this syndrome with a prevalence between 43 and 57%. The aim of this study was to demonstrate the severe outcomes and the high complication rates in children with MWS, focusing on their complicated follow-up.Methods: A retrospective comparative study was conducted on patients referred to Robert-Debré Children's Hospital for MWS from 2003 to 2018. Multidisciplinary follow-up was carried out by surgeons, geneticists, gastroenterologists, and neurologists. Data regarding patient characteristics, surgical management, postoperative complications, and functional outcomes were collected.Results: Over this period of 15 years, 23 patients were diagnosed with MWS. Hirschsprung disease was associated with 10 of them (43%). Of these cases, two patients had recto-sigmoïd aganglionosis (20%), three had aganglionic segment extension to the left colic angle (30%), two to the right colic angle (20%), and three to the whole colon (30%). The median follow-up was 8.5 years (2 months-15 years). All patients had seizures and intellectual disability. Six children (60%) presented with cardiac defects. At the last follow-up, three patients still had a stoma diversion and 7 (70%) were fed orally. One patient died during the first months. Eight (80%) of these children required a second surgery due to complications. At the last follow-up, three patients reported episodes of abdominal bloating (42%), one recurrent treated constipation (14.3%), and one soiling (14.3%). Genetic analysis identified three patients with heterozygous deletions, three with codon mutations, and three with frameshift mutations.Conclusions: MWS associated with Hirschsprung disease has a high rate of immediate surgical complications but some patients may achieve bowel function comparable with non-syndromic HD patients. A multidisciplinary follow-up is required for these patients

Long-term quality of life is better after laparoscopic compared to open pancreatoduodenectomy

Background: Three randomized controlled trials have reported improved functional recovery after Laparoscopic pancreatoduodenectomy (LPD), as compared to open pancreatoduodenectomy (OPD). Long-term results regarding quality of life (QoL) are lacking. The aim of this study was to compare long-term QoL of LPD versus OPD. Methods and patients: A monocentric retrospective cross-sectional study was performed among patients < 75 years old who underwent LPD or OPD for a benign or premalignant pathology in a high-volume center (2011-2021). An electronic three-part questionnaire was sent to eligible patients, including two diseases specific QoL questionnaires (the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire for cancer (QLQ-C30) and a pancreatic cancer module (PAN26) and a body image questionnaire. Patient demographics and postoperative data were collected and compared between LPD and OPD. Results: Among 948 patients who underwent PD (137 LPD, 811 OPD), 170 were eligible and 111 responded (58 LPD and 53 OPD). LPD versus OPD showed no difference in mean age (51 vs. 55 years, p = 0.199) and female gender (40% vs. 45%, p = 0.631), but LPD showed lower BMI (24 vs 26; p = 0.028) and higher preoperative pancreatitis (29% vs 13%; p = 0.041). The postoperative outcome showed similar Clavien-Dindo ≥ III morbidity (19% vs. 23%; p = 0.343) and length of stay (24 vs. 21 days, p = 0.963). After a similar median follow-up (3 vs. 3 years; p = 0.122), LPD vs OPD patients reported higher QoL (QLQ-C30: 49.6 vs 56.3; p = 0.07), better pancreas specific health status score (PAN20: 50.5 vs 55.5; p = 0.002), physical functioning (p = 0.002), and activities limitations (p = 0.02). Scar scores were better after LPD regarding esthetics (p = 0.001), satisfaction (p = 0.04), chronic pain at rest (p = 0.036), moving (p = 0.011) or in daily activities (p = 0.02). There was no difference in digestive symptoms (p = 0.995). Conclusion: This monocentric study found improved long-term QoL in patients undergoing LPD, as compared to OPD, for benign and premalignant diseases. These results could be considered when choosing the surgical approach in these patients