Benjamin Darnis, Louise Tedeschi, Marie-Cécile Blanchet, Vincent Frering, Jessica Crozet, Benoit Gignoux, Christophe Duchamp
{"title":"Management of pilonidal sinus and recurrences in 2025.","authors":"Benjamin Darnis, Louise Tedeschi, Marie-Cécile Blanchet, Vincent Frering, Jessica Crozet, Benoit Gignoux, Christophe Duchamp","doi":"10.1016/j.jviscsurg.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.jviscsurg.2024.12.005","url":null,"abstract":"<p><p>Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.</p>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The benefits and drawbacks of music in the operating room.","authors":"Karem Slim, Alain Valverde","doi":"10.1016/j.jviscsurg.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jviscsurg.2024.12.001","url":null,"abstract":"<p><strong>Introduction: </strong>A significant proportion of surgeons listen to music in the operating room (MOR) during a surgical procedure. Over the last twenty years, this practice has been widely studied. The aim of this article is to analyze the effects of MOR on surgical performance, postoperative history and, more generally, on communication in the operating theater.</p><p><strong>Method: </strong>A comprehensive review of the factual literature (randomized trials and systematic reviews) was carried out.</p><p><strong>Results: </strong>Given the heterogeneity of the published studies, it was not possible to achieve results with a high level of evidence. Above and beyond a probably lightened mental load ascribable to MOR, our review did not demonstrate significant benefits of music (a \"Mozart effect\") regarding enhanced surgical performance in a clinical setting or a reduced number of perioperative or postoperative adverse events. The major drawbacks of MOR include team communication impediments, surgeon distraction, and frustration felt by team members.</p><p><strong>Conclusion: </strong>MOR implementation should presuppose dialogue and agreement among all members of a caregiving team. Do the advantageous aspects of MOR indeed (finally) consist in lessened mental load and heightened surgeon well-being?</p>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renxi Li, Jayati Atahar, Ahmed Noureldin, Susan Kartiko
{"title":"Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients.","authors":"Renxi Li, Jayati Atahar, Ahmed Noureldin, Susan Kartiko","doi":"10.1016/j.jviscsurg.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.jviscsurg.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA.</p><p><strong>Methods: </strong>Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005-2021. Patients with a Modified Frailty Index (mFI)≥2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA.</p><p><strong>Results: </strong>Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, P=0.04), superficial surgical site infection (aOR 0.450, P=0.03), and discharge not to home (aOR 0.792, P<0.01). In addition, frail patients who underwent LA had shorter operation time (58.42±25.26 vs 67.60±37.17 mins, P<0.01) and a shorter length of stay (0.45±2.30 vs 0.57±2.96 days, P<0.01).</p><p><strong>Conclusion: </strong>Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs.</p>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clément Baratte, Hugues Sebbag, Laurent Arnalsteen, Thomas Auguste, Marie-Cécile Blanchet, Simon Benchetrit, Adel Abou-Mrad, Fabian Reche, Laurent Genser, Robert Caiazzo, Andrea Lazzati, Jean-Marc Catheline, Guillaume Pourcher, Pierre Leyre, Sandrine Kamoun-Zana, Fabien Stenard, Thibaut Coste, Adrien Sterkers, Claire Blanchard, Tigran Poghosyan, François Pattou, Silvana Perretta, Maud Robert
{"title":"Position statement and guidelines about Endoscopic Sleeve Gastroplasty (ESG) also known as \"Endo-sleeve\".","authors":"Clément Baratte, Hugues Sebbag, Laurent Arnalsteen, Thomas Auguste, Marie-Cécile Blanchet, Simon Benchetrit, Adel Abou-Mrad, Fabian Reche, Laurent Genser, Robert Caiazzo, Andrea Lazzati, Jean-Marc Catheline, Guillaume Pourcher, Pierre Leyre, Sandrine Kamoun-Zana, Fabien Stenard, Thibaut Coste, Adrien Sterkers, Claire Blanchard, Tigran Poghosyan, François Pattou, Silvana Perretta, Maud Robert","doi":"10.1016/j.jviscsurg.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jviscsurg.2024.12.003","url":null,"abstract":"<p><p>IS ESG EFFECTIVE IN THE TREATMENT OF OBESITY AND ASSOCIATEDCOMORBIDITIES?: Endoscopic Sleeve Gastroplasty (ESG) is more effective than lifestyle modifications alone for weight loss and improving obesity-related comorbidities. While it has less effect on weight loss compared to Laparoscopic Sleeve Gastrectomy (LSG) in the short to medium term, it offers similar comorbidities resolution to LSG. IS ESG A SAFE PROCEDURE, AND WHAT ARE ITS RISKS?: The safety profile of ESG is consistently supported in the literature. Surgical complications after ESG, ranging from 1.5 to 2.3%, such as bleeding, perforation, fistula, or upper bowel obstruction, are rare and typically managed endoscopically. The incidence of new-onset gastro-esophageal reflux disease (GERD) is deemed negligible and occurs less frequently after ESG compared to SG. WHAT ARE THE INDICATIONS AND MANAGEMENT METHODS?: Multidisciplinary care for patients undergoing ESG should be provided in an accredited center authorized to perform bariatric and metabolic surgery, with validation through a multidisciplinary consultation meeting (RCP). Perioperative management should be personalized and ideally modeled after the protocols already in place for bariatric and metabolic surgery to ensure satisfactory and lasting weight and metabolic outcomes. Adherence to follow-up visits is a significant predictor of successful weight loss outcomes after ESG. Additionally, all endoscopic surgical procedures should be documented in a registry affiliated with a recognized scientific society, as is standard for other bariatric surgical procedures. WHICH HEALTHCARE PROFESSIONALS CAN PERFORM ESG?: ESG must be performed by a practitioner trained in endoscopy and obesity management, capable of ensuring thorough preoperative care and comprehensive postoperative follow-up, supported by an experienced multidisciplinary team. In France, Notice No. 2021.0040/AC/SEAP of June 10, 2021, issued by the Haute Autorité de santé (HAS) college, specifies that \"the technology of ESG via the trans-oral approach, involving wide plication of the greater gastric curvature […] with an endoscopic suture placement device, enables a gastroenterologist or a visceral and digestive surgeon to perform gastric plication through digestive endoscopy by placing sutures in the stomach\". Ideally, this should take place in an accredited center authorized to perform bariatric and metabolic surgery, such as those approved by the Agence régionale de santé (ARS), in accordance with Article R6123-212 of December 2022 of the French Public Health Code. WHAT ARE THE RECOMMENDATIONS AND VIEWS OF OTHER INTERNATIONAL SCIENTIFICSOCIETIES?: ESG is an integral part of the therapeutic arsenal available to bariatric and metabolic surgeons, offering an effective and valuable treatment option for obesity in specific patient populations. The International Federation for the Surgery of Obesity (IFSO) Bariatric Endoscopy Committee, following a comprehensive systematic r","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy of CycloMesh™+Ropivacaine in the treatment of uncomplicated inguinal hernia after the Lichtenstein procedure: Results of a prospective multicentric double-blind study.","authors":"Frank-Olivier Breleur, Haitham Khalil, André Dabrowski, Francois Mauvais, Phiphia Pipia, Mathieu Messager, Mégane Homa, Jean-Marc Regimbeau","doi":"10.1016/j.jviscsurg.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.jviscsurg.2024.11.006","url":null,"abstract":"<p><strong>Background: </strong>Twenty to 30% of patients undergoing inguinal hernia surgery (20 million patients per year worldwide) present early postoperative pain. The aim of this study was to assess the interest of a mesh (CycloMesh™, Cousin Biotech) soaked with ropivacaine for managing early postoperative pain.</p><p><strong>Materials and methods: </strong>This was a randomized, phase III, comparative superiority, double-blind, international multicenter study. From October 2019 to February 2022, 290 patients underwent surgery for uncomplicated inguinal hernia, under general anesthesia, using the Liechtenstein technique. Each patient was randomly assigned to either the experimental group (mesh soaked in ropivacaine hydrochloride 10mg/mL) or the control group (mesh soaked in physiological saline solution). The primary endpoint was the pain at cough assessment with the visual analogue scale (VAS) at H6 after the surgery. The secondary endpoints were the global pain assessment at H2, H4, H6, day 1, day 2, day 3, day 7, 1month, 1year, and 2years after the surgery, assessment of antalgic consumption, description of the surgical procedure and postoperative complications rate, hospitalization and post-hospital discharge data (number of conversions from outpatient to inpatient care), and recurrence.</p><p><strong>Results: </strong>Of the 290 patients included in the study, 150 and 140 patients were in the experimental or control group respectively. The per-protocol (PP) population (240 patients) comprised 125 patients in the ropivacaine group and 115 in the control group. The mesh soaking solution had no significant effect on the pain at cough at H6, either in the intention-to-treat population (3.3 vs 3.2, P=0.12) or in the PP population (3.3 vs 3.7, P=0.15). The ropivacaine-soaked prosthesis resulted in a reduction in overall pain at H2 (2.3 vs 3.2, P<0.0001), H4 (2.3 vs 3.1, P<0.0001) and H6 (2.3 vs 2.7, P=0.0039). There was no difference between the two groups in terms of antalgic consumption, postoperative complications, or the number of ambulatory conversions.</p><p><strong>Conclusion: </strong>The placement of CycloMesh™ soaked with ropivacaine did not reduce the pain at cough at H6 but did reduce overall pain in the first 6hours after surgery and could simplify patient management.</p>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Construction of J-shaped ileal reservoir and manual or stapled ileo-anal anastomosis.","authors":"Maxime K Collard, Jérémie H Lefèvre, Yann Parc","doi":"10.1016/j.jviscsurg.2024.09.009","DOIUrl":"10.1016/j.jviscsurg.2024.09.009","url":null,"abstract":"","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":" ","pages":"382-390"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}