Intérêt du lavage-drainage laparoscopique des péritonites sigmoïdiennes Hinchey III

Objective: To evaluate laparoscopic lavage (LL) compared to the Hartmann (H) procedure for the treatment of Hinchey III purulent diverticular peritonitis. Background: Laparoscopic lavage is a recent treatment for Hinchey III peritonitis, which has experienced strong development, but recent publications question this technique. Method: This is a monocentric retrospective study performed at Grenoble University Hospital. All patients who underwent Hinchey III perforated diverticulitis were included. We compared the techniques used: laparoscopic lavage (LL), Hartmann intervention (H) and resection anastomosis. The primary endpoint was postoperative morbidity and mortality according to Dindo Clavien (DC). Secondary outcomes were duration of hospitalization, readmission rate at 90 days, and final stoma rate. Results: Between 2004 and 2017, 122 patients underwent emergency surgery for sigmoiditis at Grenoble University Hospital, including 90 Hinchey III peritonitis. 56 (62.2%) patients received LL and 34 (37.8%) had Hartmann surgery Patients in the LL group had a lower ASA score and less severe peritonitis. The serious morbidity rate (DC>=3) was 26.8% for the LL group and 58.8% for the H group (p = 0.0051). The mortality rate was 1.8% for the LL group and 23.5% for the H group (p = 0.0030). The duration of hospitalization was shorter in the LL group (11 days (IQR 8-17) versus 18 days (IQR 14-27) for H p 3) était de 26,8% pour le groupe LL et de 58,8% pour le groupe H (p = 0,0051). Le taux de mortalité était de 1,8% pour le groupe LL et de 23,5% pour le groupe H (p = 0,0030). La durée de l’hospitalisation était plus courte dans le groupe LL (11 jours (IQR 8-17) contre 18 jours (IQR 14-27) pour H p <0,0001). Le taux de stomies définitives était plus faible dans le groupe LL (17,8% vs 60,6% p <0,0001). Il n'y avait aucune différence entre les deux groupes sur le taux de réadmission à 90 jours. Conclusion : La technique du lavage laparoscopique peut toujours être retenue pour le traitement des péritonites Hinchey III chez des patients sélectionnés

Surgical Gastrostomy in Delayed Emergency: Indications, Morbidity and Mortality in 293 Patients from a Single Center Experience

International audiencePurpose: Monocentric retrospective 5-years study evaluation of indications and morbi-mortality rates of surgical gastrostomies.Methods: 293 patients under went surgical gastrostomy according to the Witzel technique. Age, gender, indication, type of anesthesia, complications and 30-days mortality were analyzed. Complications were detailed according to type minor (tube site infection, gastric tube removal, obstruction, breakage or leakage, intra-abdominal displacement, parietal hematoma) or major (gastric bleeding, aspiration pneumonia, gastroesophageal reflux, peristomal hernia, peritonitis, digestive perforation, incisional hernia), time of occurrence early (≤ 30 days) or late (> 30 days) and Dindo-Clavien's classification.Results: Mean age was 63-years-old. Gastrostomies were performed for enteral nutrition or gastric decompression in 85% and 15% of cases respectively. The main indications were neurological pathologies (48%), and tumors (oto-rhino-laryngeal tumors (17%), lung tumors (8%), peritoneal carcinomatosis (8%), other digestive cancers (5%), urological cancers (2%), and various abdominal diseases (12%)). Overall mortality at 30-days was 16.3%. Sixty-nine (23.5%) complications occurred, with 13.6% minor and 9.8% major complications. According to Dindo-Clavien's classification, complication were graded respectively in 1-2 (66%), 3(22%) and 4-5 (12%). Patients with the highest mortality rates at 30 days were patients with a complication or procedural failure after endoscopic or radiological gastrostomy (20%), patients with lung tumor (50%), patients with airway pathology (18.9%) and patients with peritoneal carcinomatosis requiring a gastric decompression (16.7%).Conclusion: This single-center experience gives an overview of the results after surgical gastrostomies in delayed emergency. The high morbi-mortality in some groups must challenge the surgical choice versus other endoscopic and radiological procedures, by evaluating the risk to benefit ratio for critically ill patients, taking into account short-term outcome and quality of life

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

Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals

International audienceBackgroundThe observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis.MethodThe primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results.ResultsBetween 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index &lt;18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks.ConclusionThe present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis