The Role of Diet and Hygiene in the Management of Digestive Haemorrhages on Peptic Ulcer Disease

Introduction: Digestive hemorrhage on peptic ulcer is one of the major digestive emergencies. Therapeutic progress in recent years has been based on the removal of risk factors. Our objective was to evaluate the impact of diet and hygiene on digestive haemorrhage in peptic ulcer disease.            Patients and method: Our study was prospective, monocentric, reported on digestive haemorrhages on peptic ulcer over a period of 3 months. The variables studied included: age, gender, toxic and drug habits, diet, and change in a 1-month follow-up. The Epiinfo statistical test analyzed the data. A p-value of less than 0.05 was considered significant.  Results: Fifty-two cases were retained at the end of the study. The odds ratio between irregular meal schedules and GI bleeding was OR = 18.90 [4.39 - 81.20]. Dietary habits included: chocolate (15.38%), acidic meals (61.54%), spices (30.77%). Three (5.7%) patients had relapsed.                Conclusion: The diet recommended in our study was a diet rich in soluble fiber with proscription of toxic habits. The rate of recurrence after one month of regression was low, however our study was limited by its low statistical power.&nbsp

Acute Appendicitis Seen at Analankininina University Hospital during the Covid-19 Pandemic

Acute appendicitis was often diagnosed at the complication stage during the Covid19 pandemic at CHU Analankininina Toamasina. Our objective was to discuss the particularity of the management of appendicitis during the pandemic. Our study was prospective, descriptive for 6 months and took place in the general surgery department of the Analankininina Toamasina University Hospital Center, Madagascar from March 2020 to August 2020. We had collected 28 patients. The sex ratio was 3.66. The average age was 27.57 years. Appendicular abscess represented 64.29% (n=18) of the appendicular patients operated in emergency. Appendicular plastron occupied 14.29% (n=2) and generalized acute peritonitis was 7.14% (n=2). Post-operative follow-up was simple in 71.43% (n=20). The average length of hospitalization was 4 days. Acute appendicitis is often complicated during the Covid 19 pandemic in our hospital center. Surgery was systematic in our hospital, contrary to some literature which advocated antibiotic therapy at an early stage in front of the health emergency

Post-traumatic Hemothorax: Management in a Limited-medium Structure

Post-traumatic hemothorax is common in young adults in the context of road accidents. Explorations of the lesions may be limited by the technical platform. The objective of our study is to discuss the difficulty of managing post-traumatic hemothorax in a limited-medium structure. This was a 20-month retrospective study (01 May 2018-31 December 2019), involving 38 patients treated for post-traumatic hemothorax, whether or not associated with pneumothorax, in the general surgery department of the CHU Analankinina Toamasina. The hospital frequency was 1.66%, with a mean age of the patients of 31.89 years, and a male predominance (73.68%). The main provider of hemothorax was the civil liability accident (52.63%). Chest X-rays were performed in almost all patients (94.74%). Complications had been found in 4 patients with secondary surgery, with favorable outcomes. The frequency of hemothorax is constantly increasing in Madagascar, where the civil liability accident is the main cause. Chest X-ray remains the most accessible examination to be carried out in emergency. An early and efficient thoracic drainage generally ensures a favorable evolution without after-effects

Evaluation nutritionnelle peri-operatoire en chirurgie digestive majeure

Introduction: La dénutrition péri-opératoire est une des complications qui peut entraver la réhabilitation postopératoire et augmenter la morbimortalité dans les chirurgies digestives. Il est actuellement recommandé d'évaluer l'état nutritionnel, notamment pré-opératoire des patients. L'objectif de cette étude était d'évaluer l'état nutritionnel péri-opératoire dans les chirurgies digestives majeures au Centre Hospitalier d'Antananarivo. Méthodes: Etude prospective de douze mois, chez des patients allant être opérés d'une chirurgie digestive nécessitant une exclusion intestinale prolongée postopératoire, programmée. Avant et après l'intervention, une pesée a été faite, la notion d'amaigrissement a été recherchée, le taux d'albumine mesuré et les indices de masse corporelle et du risque nutritionnel calculés. La stratification nutritionnelle de chaque patient a été réalisée. Résultats: Trente patients, à prédominance masculine et d'âge moyen de 46,9 ans, ont été retenus pour l'étude. Un amaigrissement moyen de 15,1% du poids usuel a été constaté dans 86,7%. Seize patients (53,3%) ont présenté un risque nutritionnel élevé. Un grade nutritionnel côté à 4 a été retrouvé dans 73,3% ; celui-ci étant significativement corrélé avec la perte pondérale, l'indice de masse corporelle et la valeur de l'albuminémie (p<0,05). En postopératoire, 73,3% des patients, ont perdu en moyenne 4,1kg. La variation pondérale péri-opératoire était significativement influencée par le début (p=0,0184) et la durée (p=0,0364) de la nutrition. Le taux d'albuminémie a augmenté dans 53,3% des cas. Aucune complication majeure n'a été retrouvée. Conclusion: Dans notre contexte, le risque nutritionnel des patients est encore élevé. La recherche de signes pertinents de dénutrition et la stratification des patients s'avèrent essentielles d'autant plus que la chirurgie est majeure. Cette évaluation permet de mieux prendre en charge le patient avant son intervention.Key words: Chirurgie digestive majeure, dénutrition péri-opératoire, évaluation nutritionnelle, grade nutritionnel, indice de masse corporelle, indice de risque nutritionne

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Digestive Surgical Emergencies at Analankininina Toamasina Madagascar University Hospital during the Covid-19 Pandemic

During the period of total containment during the Covid-19 pandemic; our department became the sole treatment center for all surgical emergencies. The influx of many patients made the task very difficult for the surgeon. This is a 3-month descriptive prospective study in the visceral surgery department at the Analankininina Toamasina University Hospital Center. Of the 81 patients hospitalized during the study, 32 patients were admitted for digestive surgery emergency, i.e. 39.50%. The mean age was 34.87 years with a sex ratio of 1.66, predominantly male. Abdominal pain occupied 43.75% of the reason for consultation, the most frequent pathologies were acute intestinal obstruction (18.75%) and acute appendicitis (18.75%). An exploratory laparotomy is performed on 40.62% of patients. Many patients were operated on for proctologic emergency (18.75%). The average length of hospitalization is 4.18 days. The visceral emergencies are present despite the presence of the Covid-19 pandemic and the activities of the health personnel are uninterrupted

Acute Appendicitis Seen at Analankininina University Hospital During the Covid-19 Pandemic

Acute appendicitis was often diagnosed at the complication stage during the Covid19 pandemic at CHU Analankininina Toamasina. Our objective was to discuss the particularity of the management of appendicitis during the pandemic. Our study was prospective, descriptive for 6 months and took place in the general surgery department of the Analankininina Toamasina University Hospital Center, Madagascar from March 2020 to August 2020. We had collected 28 patients. The sex ratio was 3.66. The average age was 27.57 years. Appendicular abscess represented 64.29% (n=18) of the appendicular patients operated in emergency. Appendicular plastron occupied 14.29% (n=2) and generalized acute peritonitis was 7.14% (n=2). Post-operative follow-up was simple in 71.43% (n=20). The average length of hospitalization was 4 days. Acute appendicitis is often complicated during the Covid 19 pandemic in our hospital center. Surgery was systematic in our hospital, contrary to some literature which advocated antibiotic therapy at an early stage in front of the health emergency

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease