Appendagite épiploïque primitive: à propos de cinq cas

La torsion de frange épiploïque (ou appendagite) est une pathologie rare qui survient principalement chez les adultes entre 20 et 50 ans.L'incidence de cette pathologie n'est pas réellement connue et elle varie de 2 à 7% chez les patients hospitalisés pour suspicion d'appendicite oude sigmoïdite. Nous rapportons cinq cas d'appendagites dont nous précisons les particularités cliniques, radiologiques et thérapeutiques. Il s'agit de 5 patients dont l'âge moyen est de 34.6 ans (24-55). Le sexe ratio est de 1.5. Le principal motif de consultation était un syndrome douloureux de l'abdomen principalement au niveau de la fosse iliaque droite. L'examen abdominal montrait toujours une sensibilité localisée. La fièvre était présente chez 3 patients. Le bilan biologique révèle un syndrome inflammatoire biologique chez trois patients. Les examens complémentaires radiologiques en particulier échographie abdominale et TDM abdominale ont éliminé formellement une urgence chirurgicale et ont évoqué le diagnostic d'appendagite dans trois cas. Trois patients ont bénéficié d'une coelioscopie diagnostique confirmant le diagnostic  d'appendagite. L'évolution était favorable chez tous les patients. Les appendagites épiploïques primitives sont des étiologies rares et  sous-estimées de syndrome abdominal aigu. Le diagnostic peut être affirmé par imagerie notamment avec le scanner hélicoïdal injecté,  permettant d'instaurer ainsi un traitement médical premier et d'éviter un traitement chirurgical et des hospitalisations excessives

Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study

Background: Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods: An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results: In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions: In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials

Benchmarking of minimally invasive distal pancreatectomy with splenectomy: European multicentre study

BACKGROUND: Benchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS). METHODS: This retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABCTM) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk. RESULTS: A total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m2 (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87). CONCLUSION: The benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes