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Slim K. Role of robotic surgery in enhanced recovery after pancreatoduodenectomy programs. J Gastrointest Surg 2024; 28:789. [PMID: 38704216 DOI: 10.1016/j.gassur.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, Pole Santé République, ELSAN Group, Clermont-Ferrand, France.
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Funk Debleds P, Chambrier C, Slim K. Postoperative nutrition in the setting of enhanced recovery programmes. Eur J Surg Oncol 2024; 50:106866. [PMID: 36914532 DOI: 10.1016/j.ejso.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Patients undergoing major surgery for gastrointestinal cancer are at high risk of developing or worsening malnutrition and sarcopenia. In malnourished patients, preoperative nutritional support may not be sufficient and so postoperative support is advised. This narrative review addresses several aspects of postoperative nutritional care in the setting of enhanced recovery programmes. Early oral feeding, therapeutic diet, oral nutritional supplements, immunonutrition, and probiotics are discussed. When postoperative intake is insufficient, nutritional support favouring the enteral route is recommended. Whether this approach should use a nasojejunal tube or jejunostomy is still a matter of debate. In the setting of enhanced recovery programmes with early discharge, nutritional follow-up and care should be continued beyond the short time in hospital. In enhanced recovery programmes, the main specific aspects of nutrition are patient education, early oral intake, and post-discharge care. The other aspects do not differ from conventional care.
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Affiliation(s)
- Pamela Funk Debleds
- Department of Supportive Care, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Cécile Chambrier
- Intensive Clinical Nutrition Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France; Francophone Group for Enhanced Recovery After Surgery, France.
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Kabanova D, Moret C, Albaladejo P, Slim K. Is a care pathway for enhanced recovery after colorectal surgery environmentally responsible? J Visc Surg 2024; 161:46-53. [PMID: 38114402 DOI: 10.1016/j.jviscsurg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Above and beyond the environmentally responsible operating theater, the environmental impact of the pathways of surgically treated patients seems essential but has seldom been considered in the literature. On a parallel track, enhanced recovery programmes (ERP) programs are presently deemed a standard of care. The objective of this review is to determine the carbon footprint of the ERP approach in colorectal surgery. METHOD This a narrative review based on articles referenced in PubMed. Our search was centered on the environmental impact of an ERP in the context of colorectal surgery. A number of measures included in the national and international guidelines were studied. We utilized the terms "carbon footprint", "sustainability", "energy cost", "environmental footprint", "life cycle assessment" AND a key word for each subject found in the ERP recommendations. RESULTS Most ERP measures in the context of colorectal surgery are factually or intuitively virtuous from an ecological standpoint. With a 3-day reduction in average hospital stay resulting from ERP, the program permits a reduction of at least 375kg CO2e/patient (Appendices 1 and 2). The most substantial part of this reduction is achieved during the perioperative period. While some measures, such as short fasting, are ecologically neutral, others (treatment of comorbidities, smoking cessation, hypothermia prevention, antibiotic prophylaxis, laparoscopy, absence of drains or probes, thromboprophylaxis, early feeding and mobilization…) lead to fewer postoperative complications, and can consequently be considered as environmentally responsible. Conversely, other measures, one example being robotic surgery, leave a substantial carbon footprint. CONCLUSION ERP is congruent with two pillars of sustainable development: the social pillar (improved patient recovery, and better caregiver working conditions fostered by team spirit), and the economic pillar (decreased healthcare expenses). While the third, environmental pillar is intuitively present, the low number of published studies remains a limitation to be overcome in future qualitative studies.
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Affiliation(s)
| | | | | | - Karem Slim
- Groupe francophone de Réhabilitation Améliorée après Chirurgie (GRACE), allée du Riboulet, 63110 Beaumont, France
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de'Angelis N, Conso C, Bianchi G, Rodríguez AGB, Marchegiani F, Carra MC, Lafont C, Canouï-Poitrine F, Slim K, Pessaux P. Systematic review of carbon footprint of surgical procedures. J Visc Surg 2024; 161:7-14. [PMID: 38087700 DOI: 10.1016/j.jviscsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4-814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.
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Affiliation(s)
- Nicola de'Angelis
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Christel Conso
- Service de chirurgie orthopedique, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Giorgio Bianchi
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Ana Gabriela Barría Rodríguez
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Francesco Marchegiani
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Maria Clotilde Carra
- Service of odontology, department of periodontology, Rothschild hospital, U.F.R. of odontology-Garancière, université de Paris, AP-HP, 75006 Paris, France
| | - Charlotte Lafont
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Florence Canouï-Poitrine
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Karem Slim
- Department of digestive surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), university hospital, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Patrick Pessaux
- Digestive surgery department, HPB unit, Nouvel Hôpital Civil, university of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Slim K, Tilmans G, Occéan BV, Dziri C, Pereira B, Canis M. Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers. J Visc Surg 2024; 161:76-89. [PMID: 38355331 DOI: 10.1016/j.jviscsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location. METHOD The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis "meta" version 6.5-0. RESULTS Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n=1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR=0.48 [0.24-0.95], p=0.04, I2=0%), and a longer operative time for RS (mean difference=39.11min [9.39-68.83], p<0.01, I2=96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5hours earlier after RS), and lymph node dissection (one more lymph node for LS). CONCLUSION This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.
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Affiliation(s)
- Karem Slim
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Gilles Tilmans
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Chadly Dziri
- Honoris Center for Medical Simulation, Tunis, Tunisia
| | - Bruno Pereira
- Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Canis
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Slim K, Villet R. Glossary of sustainable development for the ecofriendly surgeon. J Visc Surg 2024; 161:3-6. [PMID: 38216345 DOI: 10.1016/j.jviscsurg.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'eco-responsabilité en santé (CERES), Paris, France.
| | - Richard Villet
- Académies nationales de médecine et de chirurgie, Paris, France
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Chauvet P, Enguix A, Sautou V, Slim K. A systematic review comparing the safety, cost and carbon footprint of disposable and reusable laparoscopic devices. J Visc Surg 2024; 161:25-31. [PMID: 38272757 DOI: 10.1016/j.jviscsurg.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
INTRODUCTION The objective of this systematic review of the literature is to compare a selection of currently utilized disposable and reusable laparoscopic medical devices in terms of safety (1st criteria), cost and carbon footprint. MATERIAL AND METHODS A search was carried out on electronic databases for articles published up until 6 May 2022. The eligible works were prospective (randomized or not) or retrospective clinical or medical-economic comparative studies having compared disposable scissors, trocars, and mechanical endoscopic staplers to the same instruments in reusable. Two different independent examiners extracted the relevant data. RESULTS Among the 2882 articles found, 156 abstracts were retained for examination. After comprehensive analysis concerning the safety and effectiveness of the instruments, we included four articles. A study on trocars highlighted increased vascular complications with disposable instruments, and another study found more perioperative incidents with a hybrid stapler as opposed to a disposable stapler. As regards cost analysis, we included 11 studies, all of which showed significantly higher costs with disposable instruments. The results of the one study on carbon footprints showed that hybrid instruments leave four times less of a carbon footprint than disposable instruments. CONCLUSION The literature on the theme remains extremely limited. Our review demonstrated that from a medical and economic standpoint, reusable medical instruments, particularly trocars, presented appreciable advantages. While there exist few data on the ecological impact, those that do exist are unmistakably favorable to reusable instruments.
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Affiliation(s)
- Pauline Chauvet
- Gynecology and Obstetrics Department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
| | - Audrey Enguix
- Pharmacy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Sautou
- Clermont Auvergne University, CHU de Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000 Clermont-Ferrand, France
| | - Karem Slim
- Digestive Surgery Department CHU de Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé, Beaumont, France
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Slim K, Martin F. Surgery, innovation, research and sustainable development. J Visc Surg 2024; 161:63-68. [PMID: 38071141 DOI: 10.1016/j.jviscsurg.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.
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Affiliation(s)
- Karem Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé (CERES), Beaumont, France.
| | - Frédéric Martin
- Private Hospitals of Versailles - Ramsay Santé, Versailles, France
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Slim K, Badon F, Darcha C, Regimbeau JM. Is systematic histological examination of the cholecystectomy specimen always necessary? J Visc Surg 2024; 161:33-40. [PMID: 38103976 DOI: 10.1016/j.jviscsurg.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The histological examination (HE) of all cholecystectomy specimens removed for cholelithiasis is a widespread practice to rule out unrecognized gallbladder cancer. (GBC). But this dogmatic practice has been called into question by recent published data. The aim of this literature review was to answer two questions: (1) can HE be omitted in specific cases; (2) under what conditions is a selective strategy indicated? METHODS A review of the literature was carried out that included selected multicenter studies, registry studies, or meta-analyses. A reliable technique for the surgeon's macroscopic examination of the specimen would allow the selection of dubious cases for HE. The cost-effectiveness of selective HE was discussed. The PICO methodology (population, intervention, comparator, outcome) was used in the selection of articles that compared routine and selective histological examination. RESULTS If cases from countries with a high prevalence of gallbladder cancer are excluded and in the absence of high-risk situations (advanced age, female gender, calcified or porcelain gallbladder, acute cholecystitis, polyps, abnormalities noted intra-operatively), the macroscopic examination of the gallbladder in the operating room has a reliability approaching 100% in the majority of published studies. This would make it possible to omit systematic HE without compromising the diagnosis and prognosis of patients with unsuspected GBC and with a very favorable cost-effectiveness ratio. CONCLUSION Through a selection of patients at very low risk of incidentally-discovered cancer and a routine macroscopic examination of the opened gallbladder, the strategy of selective HE could prove useful in both clinical and economic terms.
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Affiliation(s)
- Karem Slim
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Flora Badon
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Camille Darcha
- Pathology department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Slim K, Canis M. Sobriety in surgery (as well). J Visc Surg 2023; 160:398-401. [PMID: 37336648 DOI: 10.1016/j.jviscsurg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Karem Slim
- Francophone Group for Enhanced Recovery in Surgery (GRACE), Beaumont, France.
| | - Michel Canis
- Department of Gynecology, CHU Estaing, Clermont-Ferrand, France
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Pocard M, Slim K, Challeton C. The Journal of Visceral Surgery supports Open Science by providing free access to its archives. J Visc Surg 2023; 160:395-397. [PMID: 37949767 DOI: 10.1016/j.jviscsurg.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Marc Pocard
- Department of Digestive Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Cité University, Inserm, U1275 CAP Paris-Tech, 75010 Paris, France.
| | - Karem Slim
- French-speaking group for improved rehabilitation after surgery (GRACE), 9, allée du Riboulet, 63110 Beaumont, France
| | - Corinne Challeton
- Elsevier Masson SAS, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux, France
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Valla FV, Uberti T, Henry C, Slim K. Perioperative nutritional assessment and support in visceral surgery. J Visc Surg 2023; 160:356-367. [PMID: 37587003 DOI: 10.1016/j.jviscsurg.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Malnutrition in visceral surgery is frequent; it calls for screening prior to an operation, and its postoperative occurrence should be sought out and prevented, if possible. Organization of an individualized nutritional support strategy is based on systematic nutritional assessment and adapted to the type of surgery, the objectives being to forestall malnutrition and to reduce induced morbidity (immunosuppression, delayed wound healing, anastomotic fistulas…). Nutritional support is part and parcel of enhanced recovery after surgery (ERAS), and has shown effectiveness in the field of visceral surgery. Oral feeding should always be privileged to the greatest possible extent, complemented if necessary by nutritional supplements. If nutritional support is required, enteral nutrition should be favored over parenteral nutrition. As for the role of pharmaco-nutrition or immuno-nutrition, it remains ill-defined. Lastly, each type of visceral surgery entails specific modifications of the anatomy of the digestive system and is liable to have specific functional consequences, which should be known and taken into account in view of effectively tailoring nutritional support.
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Affiliation(s)
- Frederic V Valla
- Nutrition Support Team, Hospices Civils de Lyon, 69310 Lyon - Pierre-Bénite, France.
| | - Thomas Uberti
- Anesthesiology and Critical Care Department, Hôpital E.-Herriot Hospital, Hospices Civils de Lyon, 69003 Lyon, France
| | - Caroline Henry
- Nutrition Support Team, Hospices Civils de Lyon, 69310 Lyon - Pierre-Bénite, France
| | - Karem Slim
- Digestive Surgery Department and Ambulatory Surgery Unit, 63003 Clermont-Ferrand, France
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Slim K, Chambrier C. Comment on Impact of Preoperative Immunonutrition on the Outcomes of Colon Cancer Surgery: Results From a Randomized Controlled Trial. Ann Surg Open 2023; 4:e281. [PMID: 37601475 PMCID: PMC10431301 DOI: 10.1097/as9.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Karem Slim
- From the Department of Digestive Surgery, University Hospital Clermont-Ferrand, France
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - Cécile Chambrier
- Department of Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Keita-Perse O, Bruyère F, Goux CL, Slim K. Picture of Peri-Operative Antisepsis Practices (PPAP Survey) in France. Surg Infect (Larchmt) 2023. [PMID: 37253134 DOI: 10.1089/sur.2022.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Abstract Background: Surgical skin preparation is performed according to peri-operative antisepsis protocols. These protocols are based on clinical practice recommendations and may vary from institution to institution. Materials and Methods: The objective of the survey, conducted among 481 surgeons and 98 scrub nurses of five specialties (cardiac, gastrointestinal, obstetrics and gynecology, orthopedics, and urology) in France was to take stock of practices to identify the protocols used for surgical skin preparation, such as measures relating to pre-operative showering, hair removal, or antisepsis of the operating area. Results: Two pre-operative showers with hair washing are usually carried out on the same day as the procedure (63%) or the day before the procedure (37%), mostly with an antiseptic (54%, soap 42%). Hair removal and cleaning/scrubbing are most often performed before the procedure (in 62% and 79% of cases, respectively). Alcoholic povidone-iodine is the most widely used antiseptic, and 81% of surgeons opt for complete spontaneous drying. Before making the incision, 41% of surgeons use drapes and 62% opt for an operative field irrigation technique during or at the end of the procedure. Surgeons mainly use running subcuticular sutures or running locking sutures (39%) and 93% use dressings. Thirty-six percent of the surgeons surveyed said the antisepsis protocols described were likely to be adapted. Conclusions: The results showed that international and French recommendations are mostly well followed by surgeons and scrub nurses in France. However, some differences are observed between surgical specialties, depending on the clinical situations encountered and the type of practice.
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Affiliation(s)
- Olivia Keita-Perse
- Service Epidémiologie et Hygiène Hospitalière, Centre Hospitalier Princesse Grace, Monaco, France
| | | | | | - Karem Slim
- Service Chirurgie digestive et Unité de Chirurgie Ambulatoire, Université de Clermont Auvergne, CHU Estaing, Clermont-Ferrand, GRACE (Groupe de Réhabilitation Améliorée après Chirurgie), France
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Slim K. Enhanced recovery after surgery or in surgery? The difference is not only about semantics. J Visc Surg 2023:S1878-7886(23)00070-X. [PMID: 37100663 DOI: 10.1016/j.jviscsurg.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Karem Slim
- Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), 9, allée du Riboulet, 63110 Beaumont, France.
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Slim K. Keep "statistically" significant to differentiate it from "clinically" relevant. Surgery 2023; 173:1102. [PMID: 36528404 DOI: 10.1016/j.surg.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
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Slim K. Robotic colonic surgery-the debate is not over. Colorectal Dis 2023; 25:497. [PMID: 36424362 DOI: 10.1111/codi.16431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery and Ambulatory Surgery Unit, University Hospital Clermont, France
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Dziri C, Slim K. Letter to the Editor: The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis. World J Surg 2023; 47:1336-1337. [PMID: 36786911 DOI: 10.1007/s00268-023-06951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Chadli Dziri
- Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia. .,Medical Simulation Center, Honoris United Universities, Tunis, Tunisia.
| | - Karem Slim
- Digestive Surgery, Clermont-Ferrand, France
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Abstract
Sleeve gastrectomy (SG) is the most frequently performed operation for morbid obesity in the world. In spite of its demonstrated efficacy, the Achilles' Heel of this procedure seems to be either pre-existing or de novo gastro-esophageal reflux disease (GERD) with its potential complications such as peptic esophagitis, Barrett's esophagus and, in the long-term, esophageal adenocarcinoma. According to factual literature, it appears clear that Roux-en-Y gastric bypass is the preferred choice in case of pre-existing GERD or hiatal hernia discovered during preoperative workup for bariatric surgery. Nonetheless, certain authors propose performance of SG with an associated antireflux procedure such as Nissen fundoplication. Strict endoscopic surveillance is recommended after bariatric surgery. Revisional surgery (conversion of SG into Roux-en-Y gastric bypass (RYGB)) is the treatment of choice for patients who develop GERD after SG when conservative treatment (modified lifestyle and proton pump inhibitors) has failed. Lastly, with regard to the risk of esophageal adenocarcinoma after SG, large scale studies with adequate follow-up are necessary to come to factual conclusions. In all cases, the management of this conundrum remains a major technical challenge that has to be taken in consideration in future years, especially because of the current expansion of bariatric surgery.
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Affiliation(s)
- J Veziant
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France.
| | - S Benhalima
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - K Slim
- CHU of Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), France
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Slim K, Gillion JF, Bonnet R. Could microbiological epidemiology guide the choice of antibiotic prophylaxis and implantation site for abdominal wall prostheses? J Visc Surg 2022; 160:81-84. [PMID: 36581515 DOI: 10.1016/j.jviscsurg.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- K Slim
- Digestive surgery Department, Hospital Center University of Clermont-Ferrand, 1, place Lucie Aubrac, 63003 Clermont-Ferrand cedex, France.
| | - J-F Gillion
- Digestive surgery Department Ramsay Santé, Antony private hospital, Clermont-Ferrand, France
| | - R Bonnet
- Bacteriology laboratory, Hospital Center University of Clermont-Ferrand, Clermont-Ferrand, France
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21
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Hamel JF, Joris J, Slim K, Régimbeau JM, Cotte E, Léger M, Venara A, Agut E, Alfonsi P, Alili A, Amraoui J, Andre A, Arimon JM, Arnalsteen L, Asztalos R, Audouy C, Aumont O, Auvray S, Baietto H, Balbo G, Aguilera MB, Beaupel N, Beaupel N, Lazreg ZB, Beguinot-Holtzscherer S, Beller JP, Bellouard A, Henda IB, Bentamene M, Bernard P, Berthon N, Biblocque A, Bievre T, Bilosi M, Blanc B, Blatt A, Blehaut D, Bock A, Bongiovanni JP, Bonnet M, Bouarroudj N, Boissier D, Boret H, Borg R, Bouchair Z, Bouchard F, Boumadani M, Bounicaud D, Bourdeix O, Bourseau JC, Bozio G, Brachet D, Brek A, Briez N, Buisset-Subiran C, Calvet B, Cartaux-Taieb A, Castiglioni M, Catinois M, Du Rieu MC, Chalumeau C, Chambrier G, Chamlou R, Chapel N, Chenet P, Chirac P, Chokkairi S, Chopin X, Christou N, Chuffart E, Corfiotti F, Craus C, Cuellar E, Dardenne G, de Angelis N, de Ioro U, Dechanet F, Dellis R, Demasles L, Denet C, Deroo B, Desfourneaux-Denis V, Dileon S, Douard R, Dorado C, Dorscheid E, Dumont F, Durame F, Duchalais E, Dupre A, Dufraisse S, Elghali MA, Hutin E, Emna A, Essome E, Fabre N, Faivre V, Faucheron JL, Favoulet P, Fernou P, Firtion O, Flamein R, Florea S, de la Fontaine C, Forestier D, Fourn E, Frentiu DV, Frisoni R, Frisoni A, Gautier T, Genty F, Georgeanu S, Germain A, Gibert S, Gilbert B, Gignoux B, Goasguen N, Goubault P, Gres P, Guedj J, Guignard B, Gugenheim J, Guaquiere C, Guiot JL, Guinier D, Hail K, Hatwel C, Iatan E, Janecki T, Jany T, Jaspart J, Journe F, Jouffret L, Kassoul A, Kattou F, Keller P, Knepfler T, Khouri T, Kothonidis K, Landreau P, Langlois G, Le Bartz G, Lebas S, Leonard D, Leonard D, Leporrier J, Lescure G, Lewandowski R, Liddo A, Longeville JH, Lucescu I, Mariani A, Mariani P, Martin G, Martinet O, Massalou D, Massard JL, Mauvais F, Mazza D, Katapile JM, Milou F, Mirre F, Martinez CM, Mensier A, Mergui C, Mestrallet JP, Meyer C, Mocellin N, Montagne S, Naseef O, Orville M, Ostermann-Bucher S, Ouaissi M, Paqueron X, Paquet C, Passebois L, Pichot-Delahaye V, Pillet M, Pottie JC, Plard L, Plumereau F, Poincenot J, Poisblanc M, Poupard B, Proske JM, Puche P, Raspado O, Riboud R, Rakotoarisoa B, Raynaud K, Razafindratsira T, Renaud M, Rio D, Rio D, Ripoche J, Roussel B, Denis MS, Salaun P, Sage PY, Scherrer ML, Sirisier F, Smeets B, Smejkal M, Steinmetz JP, Tavernier M, Thievenaz R, Tirca M, Toque L, Triki E, Tzanis D, Vacher B, Vanwymeersch S, Vauclair E, Verhaeghe R, Vetrila V, Vieuille C, Vermeulen F, Vignal JC, Voilin C, de Wailli P, Wolthuis A, Zaepfel S. Transversus Abdominis Block or Wound Infiltration Should be Performed in Colorectal Surgery Patients in an Enhanced Recovery Setting: a Propensity Score Analysis of a National Database. J Gastrointest Surg 2022; 27:798-802. [PMID: 36376728 DOI: 10.1007/s11605-022-05514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Francois Hamel
- Department of Biostatistics, Maison de La Recherche, University Hospital of Angers, 4 Rue Larrey, Cedex 9, 49933, Angers, France.,Faculty of Health, Department of Medicine, Angers, France
| | - Jean Joris
- Department of Anesthesiology, CHU Liège, Liège, Belgium
| | - Karem Slim
- Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Jean Marc Régimbeau
- Service de Chirurgie Digestive, CHU Amiens Picardie Et Université de Picardie Jules Verne, Amiens, France.,Unité de Recherche Clinique SSPC (Simplifications Des Soins Des Patients Complexes) UR UPJV 7518, Université de Picardie Jules Verne, Amiens, France
| | - Eddy Cotte
- Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite Cedex, France.,Université de Lyon, Lyon, France
| | - Maxime Léger
- Faculty of Health, Department of Medicine, Angers, France.,Department of Anesthesiology, University Hospital of Angers, 4 Rue Larrey, Cedex 9, 49933, Angers, France
| | - Aurélien Venara
- Faculty of Health, Department of Medicine, Angers, France. .,Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 Rue Larrey, Cedex 9, 49933, Angers, France. .,IHFIH, UPRES EA 3859, University of Angers, Angers, France.
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Futier E, Jaber S, Garot M, Vignaud M, Panis Y, Slim K, Lucet JC, Lebuffe G, Ouattara A, El Amine Y, Couderc P, Dupré A, De Jong A, Lasocki S, Leone M, Pottecher J, Pereira B, Paugam-Burtz C. Effect of oral antimicrobial prophylaxis on surgical site infection after elective colorectal surgery: multicentre, randomised, double blind, placebo controlled trial. BMJ 2022; 379:e071476. [PMID: 36328372 PMCID: PMC9631300 DOI: 10.1136/bmj-2022-071476] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate whether oral antimicrobial prophylaxis as an adjunct to intravenous antibiotic prophylaxis reduces surgical site infections after elective colorectal surgery. DESIGN Multicentre, randomised, double blind, placebo controlled trial. SETTING 11 university and non-university hospitals in France between 25 May 2016 and 8 August 2019. PARTICIPANTS 926 adults scheduled for elective colorectal surgery. INTERVENTION Patients were randomised to receive either a single 1 g dose of ornidazole (n=463) or placebo (n=463) orally 12 hours before surgery, in addition to intravenous antimicrobial prophylaxis before surgical incision. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients with surgical site infection within 30 days after surgery. Secondary outcomes included individual types of surgical site infections and major postoperative complications (Clavien-Dindo classification grade 3 or higher) within 30 days after surgery. RESULTS Of the 960 patients who were enrolled, 926 (96%) were included in the analysis. The mean age of participants was 63 years and 554 (60%) were men. Surgical site infection within 30 days after surgery occurred in 60 of 463 patients (13%) in the oral prophylaxis group and 100 of 463 (22%) in the placebo group (absolute difference -8.6%, 95% confidence interval -13.5% to -3.8%; relative risk 0.60, 95% confidence interval 0.45 to 0.80). The proportion of patients with deep infections was 4.8% in the oral prophylaxis group and 8.0% in the placebo group (absolute difference -3.2%, 95% confidence interval -6.4% to -0.1%). The proportion of patients with organ space infections was 5.0% in the oral prophylaxis group and 8.4% in the placebo group (absolute difference -3.4%, -6.7% to -0.2%). Major postoperative complications occurred in 9.1% patients in the oral prophylaxis group and 13.6% in the placebo group (absolute difference -4.5%, -8.6% to -0.5%). CONCLUSION Among adults undergoing elective colorectal surgery, the addition of a single 1 g dose of ornidazole compared with placebo before surgery significantly reduced surgical site infections. TRIAL REGISTRATION ClinicalTrials.gov NCT02618720.
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Affiliation(s)
- Emmanuel Futier
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
- Inserm U-1103, CNRS UMR 6293, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Samir Jaber
- Département Anesthésie et Réanimation B, Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Montpellier, France
- Inserm U-1046, Université Montpellier, Montpellier, France
| | - Matthias Garot
- Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France
| | - Marie Vignaud
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Yves Panis
- Département de Chirurgie Colorectale, Assistance publique-Hôpitaux de Paris, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France
| | - Karem Slim
- Service de Chirurgie Digestive et Hépatobiliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Jean-Christophe Lucet
- Unité d'Hygiène et de Lutte Contre les Infections Nosocomiales, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- IAME, Université Paris Sorbonne Nord, UMR 1137 Inserm, Paris, France
| | - Gilles Lebuffe
- Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France
| | - Alexandre Ouattara
- Service Anesthésie et Réanimation, Centre Medico-chirurgical Magellan, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
- Biologie des Maladies Cardiovasculaires, Université de Bordeaux, UMR 1034 Inserm, Pessac, France
| | - Younes El Amine
- Département Anesthésie et Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Philippe Couderc
- Service de Chirurgie Viscérale et Digestive, Centre Hospitalier de Pau, Pau, France
| | - Aurélien Dupré
- Département de chirurgie oncologique, Centre Léon Bérard, Lyon, France
- Inserm, LabTAU, Université Claude Bernard Lyon 1, Lyon, France
| | - Audrey De Jong
- Département Anesthésie et Réanimation B, Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Angers, Angers, France
| | - Marc Leone
- Service Anesthésie et Réanimation, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Hôpital Nord, Marseille, France
| | - Julien Pottecher
- Service d'Anesthésie Réanimation et Médecine Périopératoire, Hôpitaux Universitaires de Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - Bruno Pereira
- Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France
| | - Catherine Paugam-Burtz
- Département Anesthésie Réanimation, Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
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Dziri C, Slim K. What the surgeons need to know about meta-analyses in 2023, beyond the simple Odds ratio. J Visc Surg 2022; 159:480-485. [PMID: 36333183 DOI: 10.1016/j.jviscsurg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- C Dziri
- Medical School of Tunis, Tunis El Manar University Tunisia, Honoris Medical Simulation Center Tunis, avenue Khaireddine Pacha, 1002 Tunis, Tunisia.
| | - K Slim
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France; Service de chirurgie digestive, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Venara A, Hamel JF, Régimbeau J, Gillet J, Joris J, Cotte E, Slim K. Acute urinary retention and urinary tract infection after short-course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group. Colorectal Dis 2022; 24:1164-1171. [PMID: 35536237 PMCID: PMC9796259 DOI: 10.1111/codi.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 01/01/2023]
Abstract
AIM The aim was to define the risk factors for acute urinary retention (AUR) and urinary tract infections (UTIs) in colon or high rectum anastomosis patients based on the absence of a urinary catheter (UC) or the early removal of the UC (<24 h). METHOD This is a multicentre, international retrospective analysis of a prospective database including all patients undergoing colon or high rectum anastomoses. Patients were part of the enhanced recovery programme audit, developed by the Francophone Group for Enhanced Recovery after Surgery, and were included if no UC was inserted or if a UC was inserted for <24 h. RESULTS In all, 9389 patients had colon or high rectum anastomoses using laparoscopy, open surgery or robotic surgery. Among these patients, 4048 were excluded because the UC was left in place >24 h (43.1%) and 97 were excluded because the management of UC was unknown (1%). Among the 5244 colon or high rectum anastomoses patients included, AUR occurred in 5.2% and UTI occurred in 0.7%. UCs were in place for <24 h in 2765 patients (52.7%) and 2479 did not have UCs in place (47.3%). Multivariate analysis showed that management of the UC was not significantly associated with the occurrence of AUR and that risk factors for AUR were male gender, ≥65 years old, having an American Society of Anesthesiologists score ≥3 and receiving epidural analgesia. Conversely, being of male gender was a protective factor of UTI, while being ≥65 years old, having open surgery and receiving epidural analgesia were risk factors for UTIs. The management of the UC was not significantly associated with the occurrence of UTIs but the occurrence of AUR was a more significant risk factor for UTIs. CONCLUSION UCs in place for <24 h did not reduce the occurrence of AUR or UTI compared to the absence of UCs.
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Affiliation(s)
- Aurélien Venara
- Department of Visceral and Endocrinal SurgeryUniversity Hospital of AngersAngers Cedex 9France,Faculty of HealthDepartment of MedicineAngersFrance,Univ Angers, [CHU Angers], HIFIH, SFR ICAT, F‐49000 Angers, FranceUniversity of AngersAngersFrance
| | - Jean François Hamel
- Faculty of HealthDepartment of MedicineAngersFrance,Univ Angers, [CHU Angers], HIFIH, SFR ICAT, F‐49000 Angers, FranceUniversity of AngersAngersFrance,Department of Biostatistics, Maison de la RechercheUniversity Hospital of AngersAngers Cedex 9France
| | - Jean‐Marc Régimbeau
- Service de Chirurgie DigestiveCHU Amiens Picardie et Université de Picardie Jules VerneAmiensFrance,Unité de Recherche Clinique SSPC (Simplifications des Soins des Patients Complexes) UR UPJV 7518Université de Picardie Jules VerneAmiensFrance
| | - Julien Gillet
- Department of Visceral and Endocrinal SurgeryUniversity Hospital of AngersAngers Cedex 9France,Faculty of HealthDepartment of MedicineAngersFrance
| | - Jean Joris
- Department of AnaesthesiologyCHU LiègeLiègeBelgium
| | - Eddy Cotte
- Department of Visceral Surgery, Centre Hospitalier Lyon‐SudCHU LyonPierre‐Bénite CedexFrance,Université de LyonLyonFrance
| | - Karem Slim
- Department of Visceral SurgeryCHU Clermont‐FerrandClermont‐FerrandFrance
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Ripollés-Melchor J, Abad-Motos A, Cecconi M, Pearse R, Jaber S, Slim K, Francis N, Spinelli A, Joris J, Ioannidis O, Zarzava E, Şentürk NM, Koopman S, Goettel N, Stundner O, Vymazal T, Kocián P, El-Hussuna A, Pędziwiatr M, Gudaityte J, Latkauskas T, Santos MD, Machado H, Zahorec R, Cvetković A, Miric M, Georgiou M, Díez-Remesal Y, Jammer I, Mena GE, Zorrilla-Vaca A, Marino MV, Suárez-de-la-Rica A, García-Erce JA, Logroño-Ejea M, Ferrando-Ortolá C, De-Fuenmayor-Valera ML, Ugarte-Sierra B, de Andrés-Ibañez J, Abad-Gurumeta A, Pellino G, Gómez-Ríos MA, Poggioli G, Menzo-Wolthuis A, Castellano-Paulis B, Galán-Menéndez P, Aldecoa C, Ramírez-Rodríguez JM. Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study. J Clin Anesth 2022; 80:110752. [PMID: 35405517 DOI: 10.1016/j.jclinane.2022.110752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
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Veziant J, Bonnet M, Occean BV, Dziri C, Pereira B, Slim K. Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2022; 14:nu14153066. [PMID: 35893922 PMCID: PMC9332115 DOI: 10.3390/nu14153066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be included in enhanced recovery programmes (ERP). Secondary aims were to answer practical questions precisely on the best formulation and the type and timing of probiotics or synbiotics in CRS. Method: This systematic review and quantitative meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Inclusion criteria were randomised trials comparing perioperative probiotics/synbiotics with a placebo or standard care in elective colorectal surgery. Exclusion criteria were non-randomised trials. Overall infectious complications and surgical site infections (SSIs including both deep abdominal infections and wound (skin or under the skin) infections) were the primary outcomes. Secondary outcomes were pulmonary and urinary infections, wound infections, and anastomotic leaks. The databases consulted were Medline, Cochrane Database of Systematic Reviews, Scopus, and Clinical Trials Register. Risk of bias was assessed according to the GRADE approach. The analysis calculated the random effects estimates risk ratio (RR) for each outcome. Results: 21 trials were included; 15 evaluated probiotics, and 6 evaluated synbiotics. There were significantly fewer infectious complications (risk ratio (RR) 0.59 [0.47–0.75], I2 = 15%) and fewer SSI (RR 0.70 [0.52–0.95], I2 = 0%) in the probiotic or synbiotic group. There were also significantly fewer pulmonary infections (RR 0.35 [0.20–0.63]) and urinary infections RR 0.41 [0.19–0.87]) as opposed to anastomotic leaks (RR 0.83 [0.47–1.48]) and wound infections (RR 0.74 [0.53–1.03]). Sensitivity analyses showed no significant difference between probiotics and synbiotics in reducing postoperative infections (RR 0.55 [0.42–0.73] versus RR 0.69 [0.42–1.13], p = 0.46). Conclusions: Based on the finding of this study, probiotics/synbiotics reduce infectious complications after colorectal surgery. The effect size was more pronounced for pulmonary and urinary infections. From a practical aspect, some of the questions related to formulations and duration of probiotics or synbiotics need to be answered before including them definitively in enhanced recovery after colorectal surgery programmes.
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, University Hospital Lille, 59000 Lille, France;
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France
- M2iSH UMR 1071 Inserm/Clermont Auvergne University, USC-INRAE 2018, CRNH, 63000 Clermont-Ferrand, France;
| | - Mathilde Bonnet
- M2iSH UMR 1071 Inserm/Clermont Auvergne University, USC-INRAE 2018, CRNH, 63000 Clermont-Ferrand, France;
| | - Bob V. Occean
- Department of Statistics, University Hospital, 30000 Nîmes, France;
| | - Chadly Dziri
- Honoris Medical Simulation Center, Tunis 1000, Tunisia;
| | - Bruno Pereira
- Department of Statistics, University Hospital CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Karem Slim
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France
- Department of Digestive Surgery, University Hospital CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- Correspondence:
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27
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Affiliation(s)
- L Brunaud
- University of Lorraine, CHRU Nancy, Hospital Brabois Adultes, Department of Gastrointestinal, Visceral, and Metabolic Surgery (CVMC), INSERM U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - K Slim
- University Hospital, CHU Clermont-Ferrand, Department of Digestive Surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
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Faucher P, Carette C, Jannot AS, Gatta-Cherifi B, Van Straaten A, Piquet MA, Raverot G, Alligier M, Batisse T, Ziegler O, Drui D, Bretault M, Farigon N, Slim K, Genser L, Poghosyan T, Vychnevskaia K, Blanchard C, Robert M, Gronnier C, Poitou C, Czernichow S. Five-Year Changes in Weight and Diabetes Status After Bariatric Surgery for Craniopharyngioma-Related Hypothalamic Obesity: a Case-Control Study. Obes Surg 2022; 32:2321-2331. [PMID: 35524022 DOI: 10.1007/s11695-022-06079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Craniopharyngiomas are tumors located in the hypothalamic region which leads to obesity in about 50% of cases. Long-term efficacy and safety of bariatric surgery are lacking in this peculiar population. The aim of this study is to determine the 5-year weight loss and resolution of type 2 diabetes (T2D) after bariatric surgery in patients operated on craniopharyngioma who had developed hypothalamic obesity. MATERIALS AND METHODS This is a multicenter french retrospective case-control study. Subjects with craniopharyngioma (n = 23) who underwent sleeve gastrectomy (SG) (n = 9) or Roux-en-Y gastric bypass (RYGB) (n = 14) (median age 35 years [25;43] and BMI 44.2 kg/m2 [40.7; 51.0]; 8/23 with T2D) were individually matched to 2 subjects with common obesity for age, gender, preoperative body mass index, T2D, and type of surgery. RESULTS TWL% after 1 and 5 years was lower in the craniopharyngioma group than in the control group: 23.1 [15.4; 31.1] (23/23) vs 31.4 [23.9; 35.3] at 1 year (p = 0.008) (46/46) and 17.8 [7.1; 21.9] (23/23) vs 26.2 [18.9; 33.9] at 5 years (p = 0.003) (46/46). After RYGB, TWL% was lower in the craniopharyngioma group compared to the control group (p < 0.001) and comparable after SG both at 1 and 5 years. No difference between the two groups was observed in T2D remission rate and in early and late adverse events. No hormonal deficiency-related acute disease was reported. CONCLUSIONS Bariatric surgery induced a significant weight loss in the craniopharyngioma group at 1 and 5 years, but less than in common obesity. SG may be more effective than RYGB but this remains to be demonstrated in a larger cohort.
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Affiliation(s)
- Pauline Faucher
- Nutrition Department, French Reference Center for Prader-Willi Syndrome, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, INSERM UMRS NutriOmics, Sorbonne University, 75013, Paris, France. .,Service de Nutrition, Hôpital Pitié Salpêtrière, 47-83 Bd de l'hôpital, 75671, Paris Cedex 13, France.
| | - Claire Carette
- Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service de Nutrition, Hôpital Européen Georges Pompidou, Centre Spécialisé Obésité Ile-de-France Sud, 75015, Paris, France.,Université de Paris, 75015, Paris, France
| | - Anne-Sophie Jannot
- Université de Paris, 75015, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service d'informatique Médicale, Santé Publique Et Biostatistiques, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Blandine Gatta-Cherifi
- Department of Endocrinology, Diabetology, and Metabolic Diseases (B.G.), Haut Leveque Hospital, Pessac, University of Bordeaux, 33076, Bordeaux, France
| | - Alexis Van Straaten
- Université de Paris, 75015, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service d'informatique Médicale, Santé Publique Et Biostatistiques, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Marie-Astrid Piquet
- Centre Hospitalier Universitaire Caen Normandie, Service d'Hépato-gastro-entérologie Nutrition et Chirurgie digestive, Centre Spécialisé de L'Obésité du CHU Caen Normandie, 14000, Caen, France
| | - Gerald Raverot
- Fédération d'endocrinologie, Centre de Référence Des Maladies Rares Hypophysaires, Groupement Hospitalier Est, 8 av Doyen Lepine, 69677, Hospices Civils de LyonBron Cedex, France.,INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, 69372, Lyon, France
| | - Maud Alligier
- Fédération d'endocrinologie, Centre de Référence Des Maladies Rares Hypophysaires, Groupement Hospitalier Est, 8 av Doyen Lepine, 69677, Hospices Civils de LyonBron Cedex, France.,F-CRIN/FORCE Network, Human Nutrition Research Center, Lyon, France
| | - Thibault Batisse
- Centre Hospitalier Régional Universitaire Nancy Brabois, Centre Spécialisé de L'Obésité du CHRU Nancy Brabois, 54500, Vandoeuvre-Les-Nancy, France
| | - Olivier Ziegler
- Specialized Obesity Center and Department of Endocrinology, Diabetology, Nutrition, CHRU-Nancy, Brabois Hospital, Université de Lorraine, 54500, Vandoeuvre-Les-Nancy, France
| | - Delphine Drui
- Department of Endocrinology, L'Institut Du Thorax, Centre Hospitalier Universitaire de Nantes, 44093, Nantes, France
| | - Marion Bretault
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Service d'Endocrinologie Diabétologie Nutrition, 92100, Boulogne-Billancourt, France
| | - Nicolas Farigon
- Service Nutrition Clinique, Centre Hospitalier Universitaire de Clermont Ferrand, 63003, Clermont Ferrand, France
| | - Karem Slim
- Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont Ferrand, France
| | - Laurent Genser
- Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Tigran Poghosyan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de chirurgie digestive, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Karina Vychnevskaia
- Department of Surgery and Oncology, Ambroise Paré Hospital, AP-HP, 92100, Boulogne-Billancourt, France
| | - Claire Blanchard
- Clinique de Chirurgie Digestive Et Endocrinienne (CCDE), CHU de Nantes, 44093, Nantes Cedex 1, France.,L'institut Du Thorax, Université de Nantes, CHU Nantes, CNRS, INSERM, 44000, Nantes, France
| | - Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hopital Edouard Herriot, Hospices Civils de Lyon, 69437, Lyon, France.,Fédération Hospitalo-Universitaire DO-IT, Centre Intégré Et Spécialisé de L'Obésité de Lyon, CRNH-RA, Hospices Civils de Lyon, Lyon, France
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Magellan University Hospital, Bordeaux, France.,Bordeaux Medicine University, 33076, Bordeaux, France
| | - Christine Poitou
- Nutrition Department, French Reference Center for Prader-Willi Syndrome, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, INSERM UMRS NutriOmics, Sorbonne University, 75013, Paris, France
| | - Sébastien Czernichow
- Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service de Nutrition, Hôpital Européen Georges Pompidou, Centre Spécialisé Obésité Ile-de-France Sud, 75015, Paris, France.,Université de Paris, 75015, Paris, France
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Slim K, Boudemaghe T, Delaunay L, Léger L, Bizard F. Favorable effect of enhanced recovery programs on post-discharge mortality: a French nationwide study. Perioper Med (Lond) 2022; 11:14. [PMID: 35491425 PMCID: PMC9059370 DOI: 10.1186/s13741-022-00252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Enhanced recovery programs (ERPs) imply early discharge but few papers have assessed the effect of ERPs on post-discharge mortality (PDM).
Methods
A multicenter nationwide case control study based on administrative data was carried out between March and December 2019. Coding for every episode of care whether in the setting of ERP or not is mandatory for hospital funding (public or private). Twelve surgical specialties or procedures were included. The episodes of care coded with ERP were matched with those without ERP code for several factors such as the type of hospital (public or private), age, gender, month of discharge, and updated Charlson score. Ninety-day PDM was the main outcome.
Results
Of 420,031 patients in the database, 78,119 had an ERP code. Finally, 132,600 patients with 66,300 matched pairs were considered for the study. Overall, PDM was significantly reduced after ERPs: 0.075% vs 0.138% (p = 0.00042). Significant one-half and two-thirds reduction in PDM was observed respectively after hip arthroplasty (odds ratio 0.48 [95% CI 0.21–0.99]) and colectomy (odds ratio 0.36 [95% CI 0.16–0.74]).
Conclusion
The findings, based on a large database and a rigorous matching, strongly suggest that ERPs reduce PDM particularly after colectomy and hip arthroplasty. This is likely due to better post-operative care in ERPs.
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Demouron M, Selvy M, Dembinski J, Mauvais F, Cheynel N, Slim K, Sabbagh C, Regimbeau JM. Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study. J Am Coll Surg 2022; 234:840-848. [DOI: 10.1097/xcs.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Foulon A, Alfonsi P, Slim K, Bourdel N, Fauvet R, Villefranque V, Canlorbe G, Simonet T, Azaïs H, Philippe HJ. To what extent is enhanced recovery in surgery used in French obstetrics and gynecology departments?: use of enhanced recovery in gynecologic and obstetric surgery in France. J Gynecol Obstet Hum Reprod 2022; 51:102374. [PMID: 35395433 DOI: 10.1016/j.jogoh.2022.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
The objective of the present study was to evaluate the implementation of Enhanced Recovery in Surgery (ERS) in French obstetrics and gynecology departments. To achieve this objective, we drafted an online questionnaire about ERS protocols for caesarean sections and hysterectomies with a benign indication and put a hyperlink on the 'French National College of Gynecologists and Obstetricians' (Collège National des Gynécologues et Obstétriciens Français) website. We obtained 112 analyzable responses. Respectively 66% and 34% of the surveyed departments had established ERS protocols for cesarean sections and for hysterectomies with a benign indication. However, not all of the key ERS items were sufficiently implemented: despite the establishment of written protocols, the degree of compliance with the guidelines issued by the French-Speaking Group for Enhanced Recovery After Surgery (Groupement Francophone de Réhabilitation Améliorée Après Chirurgie) was variable. There are few published data on the implementation of ERS in obstetrics and gynecology departments worldwide. In 2010, the Enhanced Recovery After Surgery® Society issued guidelines and a checklist for an ERS protocol. The literature data suggest that for most surgical disciplines, the main ERS criteria are not well known or not widely applied. ERS protocols are still not widespread in French gynecologic surgery departments. Moreover, the application of some of the major ERS items differs markedly from one ERS program to other, which is likely to reduce the level of effectiveness. It therefore appears to be essential to formalize and promote ERS protocols in gynecological surgery.
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Affiliation(s)
- Arthur Foulon
- Center of Gynecology-Obstetrics, University Picardie Jules Verne, CHU Amiens Picardie, 1 rue du Professeur Christian Cabrol, F-80054 Amiens, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris cedex 14, France
| | - Karem Slim
- Digestive Surgery Department and Ambulatory Surgery Unit, University of Clermont Auvergne, CHU Estaing, 1 Place Lucie Aubrac 63003 Clermont-Ferrand, France and GRACE (French-Speaking Group for Enhanced Recovery after Surgery)
| | - Nicolas Bourdel
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003 Clermont Ferrand, France
| | - Raffaèle Fauvet
- Obstetrics and Gynecology Department, Caen Normandy University Hospital, 1 avenue de la côte de Nacre, F-14000 Caen, France; Université Caen Normandie, Esplanade de la Paix, CS 14032, F-14032 Caen, France; INSERM ANTICIPE Unit, Centre François Baclesse, 3 Ave du Général Harris, BP 5026, F-14076 Caen, France
| | - Vincent Villefranque
- Maternity Department, Simone Veil Hospital, 14 rue de Saint Prix, F-95600 Eaubonne, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Gynecological oncological surgery unit, Faculté de Médecine UPMC, Sorbonne Université, F-75013 Paris, France
| | - Thérèse Simonet
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen F-14033, France
| | - Henri Azaïs
- AP-HP, Hôpital Européen Georges-Pompidou, department of gynecological oncological surgery, F-75015 Paris, France
| | - Henri-Jean Philippe
- Ambulatory Surgery Department, Paris Descartes University, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, F-75014 Paris, France
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Slim K, Veziant J, Joris J. Bowel preparation for colorectal surgery: Questions to answer. Surgery 2022; 171:1700-1701. [PMID: 35216821 DOI: 10.1016/j.surg.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Karem Slim
- Francophone Group for Enhanced Recovery after Surgery (GRACE), Beaumont, France.
| | - Julie Veziant
- Department of Digestive and Oncologic Surgery, University Hospital Lille, France
| | - Jean Joris
- Department of Anesthesia, University Hospital Liege, Belgium
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Bizard F, Boudemaghe T, Delaunay L, Léger L, Slim K. Medico-economic impact of enhanced rehabilitation after surgery: an exhaustive, nation-wide claims study. BMC Health Serv Res 2021; 21:1341. [PMID: 34906137 PMCID: PMC8672636 DOI: 10.1186/s12913-021-07379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. Methods Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. Results The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million). Conclusions Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07379-z.
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Affiliation(s)
| | - Thierry Boudemaghe
- Department of Medical Informatics (S.I.M.M.E.R.), Nîmes University Hospital, Pl Pr Robert Debré, 30 029, Nîmes, France. .,Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Nîmes University Hospital, Montpellier, France.
| | | | - Lucas Léger
- Department of Medical Informatics (S.I.M.M.E.R.), Nîmes University Hospital, Pl Pr Robert Debré, 30 029, Nîmes, France
| | - Karem Slim
- MD. Department of Digestive Surgery, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Abstract
Researchers and practitioners are faced with an exponential increase in the number of systematic reviews (SRs) (with or without meta-analysis), a so-called `secondary' research method that synthesizes data from primary research. This growing number, sometimes with discordant results on the same subject or with non-conclusions, has led to the introduction of the concept of reviews to synthesize SR in order to combine scientific knowledge useful to practitioners. These so-called ``umbrella reviews'' (UR) constitute a new tertiary research tool. Surgical research is no exception to this development but umbrella surgical reviews remain relatively rare. Any UR must be transparent and meet rigorous methodological criteria. The UR could thus provide answers to practical questions in the field of surgery, but only on condition that the bias of the included SRs is limited. Let us not forget that the base requirement of clinical surgical research remains the good methodological quality of clinical studies (primary research). Only thus can SRs or URs (secondary or tertiary research) be more useful and decisive.
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Affiliation(s)
- K Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, place Lucie Aubrac, 63003 Clermont-Ferrand, France.
| | - T Marquillier
- University of Lille, CHU Lille, Pediatric dentistry, 59000 Lille, France; Sorbonne Paris Nord University, Health Education and Practices Laboratory, LEPS UR 3412, 93017 Bobigny, France
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Affiliation(s)
- K Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Selvy
- Surgery Department, Centre Hospitalier de Béziers, Bézier, France
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Mattevi C, van Coppenolle C, Selvy M, Pereira B, Slim K. Systematic review and meta-analysis of early removal of urinary catheter after colorectal surgery with infraperitoneal anastomosis. Langenbecks Arch Surg 2021; 407:15-23. [PMID: 34599682 DOI: 10.1007/s00423-021-02342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection. METHODS We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model. RESULTS Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8). CONCLUSION This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.
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Affiliation(s)
- Catherine Mattevi
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | | | - Marie Selvy
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Hospital CHU, Clermont-Ferrand, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France. .,Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France. .,, Clermont-Ferrand, France.
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Abstract
INTRODUCTION Immunonutrition (IN) is generally used before major visceral surgery with the intent to reduce postoperative complications, especially infectious ones. However, the conclusions of published meta-analyses are conflicting. The purpose of this review is to synthesise the data of published systematic reviews on the effectiveness of IN. METHODS AND ANALYSIS This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols guidelines. This is an umbrella review of systematic reviews comparing IN (delivered orally 5-7 days preoperatively) with normal diet or isocaloric isonitrogenous feeding before visceral surgery performed on any of several viscera (colorectum, stomach, pancreas, liver, oesophagus). We search the systematic reviews included in the main bibliographic databases. To assess the efficacy of IN, several outcomes will be considered: the main outcome is infectious complications (surgical site infections, pulmonary infections or urinary infections) and secondary outcomes are overall morbidity, hospital length of stay and mortality. Identified reviews will be screened by two independent assessors. The methodological quality of relevant included reviews will be assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) instrument. The data extracted from included reviews will be synthesised using the r-Metafor package considering separate groups according to the viscus of interest. Publication bias will be evaluated, and subgroup analyses will be performed according to the quality of studies and preoperative nutritional status. ETHICS AND DISSEMINATION An umbrella review based on published data from systematic reviews needs no ethical approval. Furthermore, no patient will be involved in the review. Once terminated, the review will be submitted for publication in an open access journal to ensure wide dissemination of the findings. PROSPERO REGISTRATION NUMBER CRD42021255177.
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Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, CHU, Clermont-Ferrand, France
| | - Flora Badon
- Department of Digestive Surgery, CHU, Clermont-Ferrand, France
| | - Charles-Hervé Vacheron
- Department of Anaesthesiology, Hospices Civils de Lyon, Lyon, France
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France
| | - Chadli Dziri
- Director of Honoris Medical Simulation Center, Tunis, Tunisia
| | - Thomas Marquillier
- School of Dentistry, Department of Pediatric Dentistry, University of Lille, Lille, France
- Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne North Paris University - Bobigny Campus, Bobigny, France
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Slim K, Regimbeau JM. Intraoperative cholangiography: A century-old practice and still debated. ANZ J Surg 2021; 91:1633. [PMID: 34402169 DOI: 10.1111/ans.16994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, University Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France.,SSPC (Simplification of Surgical Patients Care) Clinical Research Unit, University of Picardie Jules Verne, Amiens, France
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Brustia R, Mariani P, Sommacale D, Slim K. The impact of enhanced recovery program compliance after elective liver surgery: Results from a multicenter prospective national registry. Surgery 2021; 170:1457-1466. [PMID: 34176602 DOI: 10.1016/j.surg.2021.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/16/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Enhanced Recovery Program after surgery is a multimodal, evidence-based protocol of care developed to minimize the response to surgical stress. Data on the influence of ERP on outcomes, particularly according to the complexity of liver surgery, are lacking. METHODS A prospective multicenter cohort of patients undergoing liver surgery and exposed to Enhanced Recovery Program from 2016 to 2020 in France was analyzed. High Enhanced Recovery Program compliance was defined as more than 70% of items (15 out of 21). The outcomes were the rate of complications, length of stay, and functional recovery according to Enhanced Recovery Program compliance. RESULTS A total of 297 patients were included in the study, and they had 61.9% overall compliance (median = 13 items, interquartile range 11-15). Complications were observed in 32.2% (n = 95) of cases, and the mean length of hospital stay was 7.28 (±7.15) days overall. A longer duration of liver surgery was associated with an increase in the complication rate, while high compliance was independently associated with a reduced risk of complications in the multivariable analysis. CONCLUSION High Enhanced Recovery Program compliance was associated with a lower rate of postoperative complexity.
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Affiliation(s)
- Raffaele Brustia
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepato-pancreatic-biliary Surgery, Hôpital Henri-Mondor, Créteil, France; Simplification of Surgical Patients Care, University of Picardie Jules Verne, Amiens, France.
| | - Pascale Mariani
- Department of Surgical Oncology, Institut Curie, PSL Research University, Paris, France; Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - Daniele Sommacale
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepato-pancreatic-biliary Surgery, Hôpital Henri-Mondor, Créteil, France; Paris Est Créteil University, UPEC, Créteil, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Karem Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France; Digestive Surgery Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France, Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
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Slim K, Joris J. Comment on: Safety and efficacy of low pressure pneumoperitoneum in laparoscopic colorectal surgery. Br J Surg 2021; 108:e277. [PMID: 34113982 DOI: 10.1093/bjs/znab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022]
Abstract
Feasibility of low-pressure pneumoperitoneum is feasible in expert hand. Its efficacy within enhanced recovery programmes and its safety need to be demonstrated in future studies
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France.,Francophone Group for Enahnced Recovery After Surgery (GRACE)
| | - J Joris
- Francophone Group for Enahnced Recovery After Surgery (GRACE).,Department of Anaesthesia, University Hospital Liege, Belgium
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Brolet EA, Joris JL, Monseur JJ, Donneau AFH, Slim K. Impact of non-steroidal anti-inflammatory drugs on the efficiency of enhanced recovery programmes after colorectal surgery: a retrospective study of the GRACE database. Anaesth Crit Care Pain Med 2021; 40:100880. [PMID: 33965647 DOI: 10.1016/j.accpm.2021.100880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multimodal analgesia is considered a key element of enhanced recovery programmes (ERPs) after colorectal surgery. We investigated the effects of NSAIDs, a major component of multimodal analgesia on adherence to ERP, incidence of postoperative complications, and length of hospital stay (LOS). METHODS This was a retrospective study of the GRACE database that included 8611 patients scheduled for colorectal surgery with an ERP between February 2016 and November 2019. Primary endpoints were adherence to the postoperative protocol, the rate and type of postoperative complications, and LOS. Data are median [IQR] and number (per cent). Multivariate models were used to assess the effects of NSAIDs on these variables taking into account potential confounding factors. RESULTS Data from 8258 patients were analysed and classified into four groups according to whether NSAIDs had been given intra- and/or postoperatively or not at all; 4578 patients were given NSAIDs intra- and/or postoperatively and 3680 patients received no NSAIDs. Use of NSAIDs was significantly (P<0.001) associated with improved adherence to the postoperative protocol (4.0 [3.0-4.0] vs. 3.0 [2.0-4.0] items), a reduced incidence of complications (21.1% vs. 29.2%), and a shortened LOS (5.0 [3.0-7.0] vs. 6.0 [4.0-9.0] days) compared to the no-NSAIDs group. Multivariate analyses adjusted for the confounding factors confirmed a significant (P<0.001) beneficial impact of NSAIDs on these three primary endpoints. CONCLUSION This study suggests that perioperative NSAID use results in better adherence to the postoperative protocol, fewer postoperative in-hospital complications, and shorter LOS after colorectal surgery.
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Affiliation(s)
- Etienne A Brolet
- Department of Anaesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Jean L Joris
- Department of Anaesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium; Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France.
| | - Justine J Monseur
- Biostatistics Unit, Department of Public Health, University of Liège, Liège, Belgium
| | | | - Karem Slim
- Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France; Service of Digestive Surgery and Unit of Ambulatory Surgery, CHU Estaing, 63003 Clermont-Ferrand, France
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- Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France
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Reskot F, Vacheron C, Friggeri A, Piriou V, Slim K, Chambrier C. L’immunonutrition préopératoire ne réduit pas la morbidité postopératoire dans la chirurgie pour cancer colorectal dans le cadre d’un programme de réhabilitation améliorée. Une étude prospective. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The aim of this article is to present the concept of "4P medicine" i.e., medicine that is Personalized, Preventive, Predictive, and Participatory. We will discuss the evolution from cure-focused traditional medicine toward personalized medicine based on genome analysis. This new approach is illustrated by several clinical examples such as prevention of cardiovascular diseases (primary and secondary), prophylactic cancer surgery, targeted therapies, targeted peri-operative care and patient participation in their care. Finally, it will discuss the impact of this development on the health system of the future and the ethical questions raised by this new approach.
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Affiliation(s)
- K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France.
| | - M Selvy
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - J Veziant
- Department of digestive surgery, CHU Clermont-Ferrand, place Lucie et Raymond-Aubrac, 63003 Clermont-Ferrand, France
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Affiliation(s)
- J Veziant
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France.
| | - O Antomarchi
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - K Slim
- Department of digestive and hepatobiliary surgery, CHU Clermont-Ferrand, CHU Estaing, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
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Abstract
Pancreatic fistula is the most common and dreaded complication after pancreatic resection, responsible for high morbidity and mortality (2 to 30%). Prophylactic drainage of the operative site is usually put in place to decrease and/or detect postoperative pancreatic fistula (POPF) early. However, this policy is currently debated and the data from the literature are unclear. The goal of this update is to analyze the most recent evidence-based data with regard to prophylactic abdominal drainage after pancreatic resection (pancreatoduodenectomy [PD] or distal pancreatectomy [PD]). This systematic review of the literature between 1990 and 2020 sought to answer the following questions: should drainage of the operative site after pancreatectomy be routine or adapted to the risk of POPF? If a drainage is used, how long should it remain in the abdomen, what criteria should be used to decide to remove it, and what type of drainage should be preferred? Has the introduction of laparoscopy changed our practice? The literature seems to indicate that it is not possible to recommend the omission of routine drainage after pancreatic resection. By contrast, an approach based on the risk of POPF using the fistula risk score seems beneficial. When a drain is placed, early removal (within 5 days) seems feasible based on clinical, laboratory (C-reactive protein, leukocyte count, neutrophile/lymphocyte ratio, dosage and dynamic of amylase in the drains on D1, D3±D5) and radiological findings. This is in line with the development of enhanced recovery programs after pancreatic surgery. Finally, this literature review did not find any specific data relative to mini-invasive pancreatic surgery.
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Affiliation(s)
- J Veziant
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Selvy
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Buc
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - K Slim
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), Beaumont, France
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Affiliation(s)
- Laurent Delaunay
- Department of Anesthesia, 74295Clinique Generale d'Annecy, Vivalto Santé, Annecy, France
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - Karem Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
- Department of Digestive Surgery, 55174University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Reskot F, Vacheron C, Slim K, Friggeri A, Piriou V, Chambrier C. In real-life, preoperative immunonutrition did not reduce postoperative morbidity in elective oncological colo-rectal surgery with an enhanced recovery protocol. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Slim K, Joris J. Failure of enhanced recovery after surgery: what is it? Colorectal Dis 2020; 22:1830-1831. [PMID: 32810372 DOI: 10.1111/codi.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023]
Affiliation(s)
- K Slim
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Francophone Group for Enhanced Recovery After Surgery, Beaumont, France
| | - J Joris
- Francophone Group for Enhanced Recovery After Surgery, Beaumont, France.,Department of Anaesthesia, University Hospital Liège, Liège, Belgium
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Paracchini S, Bustos B, Aviles R, Bourdel N, Canis M, Rabischong B, Slim K, Botchorishvili R. Equipment failures in laparoscopic surgery: Causes and consequences. J Visc Surg 2020; 158:476-480. [PMID: 33223479 DOI: 10.1016/j.jviscsurg.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess incidence, causes and consequences of equipment failures in a high volume, advanced endoscopic surgery department. METHODS This is a prospectical observational single centre study between April and July of 2019 in the Gynecological surgery department of the Estaing University Hospital of Clermont-Ferrand, France. During the study period, 171 laparoscopies were observed. Data were collected real time by three supernumerary observers. RESULTS In total, 66 (38.6%) laparoscopies were complicated by equipment failures. The bipolar cable and forceps accounted for 31% of the total amount of malfunctions in laparoscopy. Causes of malfunctions were in 45% due to the instrument per se and in 43% due to the incorrect combination of elements. Less commonly, the equipment was not available or a mismatched was reported. The total length of the surgery increased by 1.35% due to the malfunctions. Human error was identified in 50% of cases. No morbility, neither mortality was reported in this series; however we observed 34 malfunctions that could have led to serious consequences for the patients and 3 incidents induced a real consequence on the operation workflow. CONCLUSIONS Equipment failure is a common event in endoscopy. On the opposite, time wasted for the malfunctions is low in laparoscopy, as it only accounts for 1.35% of the overall surgical time. Human decisions contributed to malfunctions in almost half of cases. This alarming finding may advise for intensification in training on instruments of the whole surgical team.
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Affiliation(s)
- S Paracchini
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Department of Surgical Sciences, AOU Città della Scienza e della Salute di Torino, Torino, Italy.
| | - B Bustos
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Hospital Parroquial de San Bernardo, Region Metropolitana, Chile
| | - R Aviles
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, Hospital Dr. Luis-Valentìn-Ferrada, Universidad Finis-Terrae, El-Carmen, Maipù, Chile
| | - N Bourdel
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - M Canis
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - B Rabischong
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Estaing, Clermont-Ferrand, France
| | - R Botchorishvili
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France
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Guerin R, Slim K. Should Epidural Analgesia Be Abandoned for Open Pancreatoduodenectomy? JAMA Surg 2020; 156:103-104. [PMID: 33112381 DOI: 10.1001/jamasurg.2020.4382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Renaud Guerin
- Department of Perioperative Medicine, University Hospital CHU Clermont-Ferrand, France
| | - Karem Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
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