Learning trauma surgery through cytoreductive surgery.

OBJECTIVES: Regarding war surgery (WS), the initial and continuing education of French military gastrointestinal surgeons (FMGIS) is considered flawed and inappropriate. This results from the low incidence of gastrointestinal (GI) trauma, its predominantly non-surgical management, and a daily surgical practice that strongly differs from WS. Conversely, cytoreductive surgery (CRS) of peritoneal metastases has similarities with WS which led us to assess its potential contribution to the initial and continuing education of FMGIS in WS. METHODS: We reported the activities of the GI surgery departments of the military teaching hospitals of Percy and Begin. The first one dedicated to traumatology and the second to CRS. We then specifically looked into the surgical procedures conducted by the FMGIS during deployment from January 2004 to December 2014. RESULTS: Amongst the 600 severe trauma patients admitted to the Percy trauma center between January 2019 and December 2020, 17 underwent abdominal surgery with a total of 25 procedures performed. During the same period, 61 patients undertook CRS in Begin with an average of 7 surgical processes per patient carried out and a total of 418 abdominal surgical procedures. Outside abdominal packing and nephrectomy (not performed in CRS), the numbers of splenectomy, gastrointestinal / gynecological resections (hysterectomy and/or adnexectomy), or liver resection were higher during CRS compared to abdominal trauma surgery with 10 times less patients (10 vs 1, 43 vs 9, 20 vs 0, 6 vs 0, respectively). CONCLUSION: CRS, through its similarities with WS, seemed to be an appropriate tool for the initial and continuing education of FMGIS in WS and, to an extent, of civilian trauma surgeons who could eventually treat terrorist attacks casualties on the national territory.

Pre-hospital management of pediatric polytrauma during modern conflict: experience and limits of the French military health service.

BACKGROUND: French military physicians serving in deployment are confronted with pediatric polytrauma patients (PPP) during the provision of medical aid to civilian populations. The objectives of this study were to describe the current care of PPPs during these missions, to report difficulties encountered and to evaluate the training of doctors for management of PPPs in the field. METHODS: A descriptive epidemiological study based on a questionnaire sent to physicians who had been deployed overseas. RESULTS: 91 doctors participated. Their mean age was 35 years. 86% of the doctors managed children whilst serving overseas, of which 54% were PPPs. The incidence of pediatric polytrauma varied according to the country, but overall from 1129 emergencies reported during overseas missions, 11% were PPPs. Penetrating traumas represented 37% of cases; 24% were circulatory distress and 19% were massive bleeding. 80% of the doctors reported a lack of pediatric trauma experience, less than 5% had received appropriate in-service training and only 9% had worked in pediatric emergency facilities in France. The equipment available for PPPs in the field was often poorly understood and frequently considered to be insufficient. CONCLUSIONS: The occurrence of PPPs of war is rare and complex, but care of older children it is similar to that required for adults. Preparation for PPP management, it could be optimized by identifying risks which alter depending on the country of deployment, such as the logistical organization of the battlefield chain of care. Improvements in doctors' pediatric trauma training should be individualized, based on their mission needs. LEVEL OF EVIDENCE: III.