Does stoma modify compliance with enhanced recovery after surgery programs? Results of a cohort study.

PURPOSE: Few studies have focused on enhanced recovery programs (ERPs) in patients who have received a stoma after colorectal surgery. The objective of the study was to compare ERP compliant patients who have not received a stoma, those who received a colostomy, and those who received an ileostomy. METHODS: This study used data that had been prospectively collected as part of the ERP audit performed through the Groupe francophone de Réhabilitation Améliorée après Chirurgie [Francophone Group for Enhanced Recovery after Surgery] over a 4-year period. All patients who had undergone colorectal surgery were included and separated into three groups (no stoma, ileostomy, and colostomy). The primary outcome was ERP compliance, calculated through the use of 16 tracer items. RESULTS: Of the 422 recruited patients, 317 had not received a stoma (75.12%), 59 had an ileostomy (13.98%), and 46 had a colostomy (10.90%). ERP compliance was 73% in the non-stoma group, 66.6% in the ileostomy group, and 66% in the colostomy group (p < 0.001). Multivariate analysis showed that patients from the ileostomy group had a higher risk of bowel preparation [OR = 9.1; 95% CI = 1.16-71.65] and of maintaining their urinary catheter [OR = 0.3; 95% CI = 0.14-0.81] than the group which did not receive a stoma. Patients from the colostomy group required significantly more drainage than those in the non-stoma group (OR = 4.3; 95% CI = 1.33-14.02). CONCLUSION: ERP is feasible in colorectal surgery in the context of stomas, but in case of ileostomy protecting a rectal surgery, the audit system must be adapted to the protocols in use in the departments.

Anatomic and functional results of ventral biological mesh rectopexy for posterior pelvic floor disorders.

INTRODUCTION: Ventral mesh rectopexy (VMR) is the gold standard for rectal prolapse surgery, but the type of mesh reinforcement is still a matter of debate. The aim of this study was to assess the anatomic and functional results of a single center cohort of patients receiving ventral rectopexy with biological mesh compared to a reference group who had implantation of synthetic mesh. We also assessed the predictive factors for recurrence. PATIENTS AND METHODS: Seventy patients (2015-2021) were included in the biological mesh group and were compared to a reference group of 345 patients operated on with a synthetic mesh (2004-2017). RESULTS: In the biological mesh group, the mean age of patients was 65 years (53-72). The main disorders of the posterior pelvic floor were rectal prolapse (30 cases) or rectocele (37 cases). Two patients had solitary rectal ulcer syndrome and one had internal prolapse. VMR was performed by a laparoscopic approach with robotic assistance in 93%. After a median follow-up of 12 (4.5-23) months, the anatomic recurrence rate was 10%. The median satisfaction score assessed in a telephone interview by a semi-quantitative scale from 0 to 10 was 7. Compared to the synthetic group, neither the morbidity rate (Dindo>2) (0.6% synthetic versus 1.4% biological mesh), nor the recurrence rate (12% synthetic versus 10% biological (ns) with an average interval of 13.5 versus 14 months, respectively) were statistically significantly different. CONCLUSION: VMR with biological mesh represents an alternative to synthetic mesh. Despite its resorbable nature, biological mesh does not seem to increase the risk of recurrence and offers satisfying functional results after a medium term follow-up.

Unplanned readmissions after hernia repair.

INTRODUCTION: Several quality indices have been set up for evaluating the impact of the reduction of the length of stay (LOS), such as the 30-day unplanned readmission (UR30) rate. The main goal of our study was to analyze the UR30 following groin hernia repair (GHR), primary- (PVHR), and incisional ventral hernia repairs (IVHR). METHODS: A French registry-based multicenter study was conducted using prospective data from all consecutive patients registered from 2015 to 2021. RESULTS: The overall incidence of UR30 was 1.32%. This included 160/18,042 (0.87%) for GHR, 41/4012 (1.02%) for PVHR, and 145/3754 (3.86%) for IVHR. The leading cause of UR30 was postoperative complications (POC). The nature of the predominant complications varied among the three categories. The correlation between UR30 and POC (and risk factors for POC) was strong in GHR but was not in IVHR due to a 'protective' longer LOS in this subgroup. As the LOS has decreased over the last years, this has 'mechanically' resulted in an increase in the occurrence of UR30, but not in a rise of POC, neither in volume nor in severity. The reduction of LOS just shifted the problem from inpatient to outpatient settings. CONCLUSION: Since the steady development of day-care surgery, the prevention of the UR not only hinges on the prevention of the POC but newly on a better organization of outpatient care which is currently a huge challenge due to a GPs' and nurses' shortage in France.

Long-term results of sacral neuromodulation for the treatment of anorectal diseases.

INTRODUCTION: Sacral neuromodulation (SNM) aims to improve anorectal function in patients with disorders of anal continence and rectal emptying. The mechanism of action of SNM is not well known, and its indications are still under evaluation. We report the functional results and morbidity of a prospective cohort treated between 2002 and 2019. RESULTS: A total of 284 patients (of 423 tested) had implantation of a SNM. Five patients (1.8%) were lost to follow-up. Among those who had implantation, the indications for SNM were anal incontinence (n=376), refractory constipation (n=17), anterior resection syndrome (n=13), solitary rectal ulcer syndrome (n=7), and chronic inflammatory bowel disease (IBD) (n=10). The morbidity rate was 2.7% (Dindo-Clavien>2), 33 patients (11%) required explantation for infection (n=5), pain (n=2), inefficacy (n=24) or other reasons (rectal cancer) (n=3). It was necessary to change the stimulator in 68 patients (24%) during the follow-up period. Regarding the group of patients with anal incontinence, functional results showed improvement of the incontinence score in 40% and of quality of life in 25% after a mean follow-up of 55months. CONCLUSION: SNM constitutes a mini-invasive treatment associated with low morbidity. Its' efficacy in anal incontinence makes it a priority approach. Other indications are still under evaluation; while results are promising, they are highly variable.

Readmissions at 30 days after inguinal hernia repair: A series of 5126 patients.

INTRODUCTION: The evaluation of the re-admission rate within 30 days of inguinal hernia repair represents a patient management quality indicator. The goal of our study was to evaluate the re-admission rate at 30 days after inguinal hernia repair and identify the risk factors for re-admission. METHODS: Based on a prospective national registry, patient data were collected during two years. The number of and reasons for re-admissions were compiled. RESULTS: A total of 5126 patients, mean age 61 years, underwent inguinal hernia repair. Ambulatory surgery was performed in 4013 (78%) patients. Failed ambulatory surgery was recorded for 100 (2%) patients. Thirty-three (0.64%) patients were re-admitted within 30 days following surgery for 34 various reasons. The re-admission rate after ambulatory surgery was 0.5%. Half of patients re-admitted presented with a severe complication that required re-intervention. In multivariable analysis, emergency hernia repair (OR 4.899 [1.309-18.327]; P=0.01) and prolonged duration of operation (OR 1.023 [1.009-1.037]; P=0.001) were identified as independent risk factors for re-admission within 30 days after surgery. CONCLUSION: Within this prospective national cohort, the overall re-admission rate after inguinal hernia repair was 0.64%, slightly less among the patients undergoing ambulatory surgery. Half of re-admitted patients required surgical re-operation. Emergency hernia repair and prolonged duration of operation were risk factors for re-admission.

Evaluation of the efficacy and morbidity of radiofrequency thermocoagulation in the treatment of hemorrhoidal disease.

INTRODUCTION: Grade III hemorrhoidal disease may require surgical treatment. Several minimally invasive techniques can be offered to the patient, particularly ligation of the hemorrhoidal arteries/mucopexy or even stapled hemorrhoidopexy. A technique of radiofrequency thermocoagulation of hemorrhoids has recently been introduced. The aim of our study was to assess the efficacy and early morbidity of this procedure. METHODS: Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated. RESULTS: Seventy-four patients, with a mean age of 53 years, underwent operation during the study period. The major indication was grade III hemorrhoidal disease in 95% of patients. More than 80% of patients underwent operation as an outpatient. Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery for rectal bleeding and severe anal pain, respectively. Seven (9.5%) patients were re-admitted to hospital and 18 (24.3%) had an unscheduled early return visit within 30 postoperative days. At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients. CONCLUSION: Radiofrequency hemorrhoidal thermocoagulation is an effective technique in the treatment of grade III hemorrhoidal disease. Despite a non-negligible rate of minor postoperative complications requiring an early consultation or re-hospitalisation, severe complications occurred in less than 3% of operated patients.

Factors of selection and failure of ambulatory incisional hernia repair: A cohort study of 1429 patients.

BACKGROUND: Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias. AIM: To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures. METHOD: Surgeons of the French "Club Hernie" prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database. RESULTS: A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22-97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings. CONCLUSION: Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.

Outpatient groin hernia repair: assessment of 9330 patients from the French "Club Hernie" database.

BACKGROUND: Groin hernia repair (GHR) is one of the most frequent surgical interventions practiced worldwide. Outpatient surgery for GHR is known to be safe and effective. AIM: To assess the outpatient practice for GHR in France and identify predictive factors of failure. METHOD: Forty one surgeons of the French "Club Hernie" prospectively gathered data concerning successive GHR over a period of 4 years within a multicenter database. RESULTS: A total of 9330 patients were operated on during the period of the study. Mean age was 61.8 (1-100) years old and 8245 patients (88.4%) were males. 6974 GHR (74.7%) were performed as outpatient procedures. In 262 patients (3.6%), the outpatient setting, previously selected, did not succeed. Upon multivariate analysis, predictive factors of ambulatory failure were ASA grade ≥ III (OR 0.42, p < 0.001), bilateral GHR (OR 0.47, p < 0.001), emergency surgery for incarcerated hernia (OR 0.10, p < 0.001), spinal anesthesia (OR 0.27, p < 0.001) and occurrence of an early post-operative complication (OR 0.07, p < 0.001). The more frequent complications were acute urinary retention and surgical site collections. 2094 patients (21.5%) were not selected preoperatively for 1-day surgery. CONCLUSION: More than 74% of the patients benefited from outpatient surgery for GHR with a poor failure rate. Predictive factors of outpatient GHR failure were ASA grade ≥ III, bilateral GHR, emergency surgery for incarcerated hernia, spinal anesthesia and occurrence of an early post-operative complication. Ambulatory failures were often related to social issues or medical complications. Outpatient surgery criteria could become less restrictive in the future.

Complete genome sequence and description of Lactococcus garvieae M14 isolated from Algerian fermented milk.

We describe using a polyphasic approach that combines proteomic by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) analysis, genomic data and phenotypic characterization the features of Lactococcus garvieae strain M14 newly isolated from the fermented milk (known as raib) of an Algerian cow. The 2 188 835 bp containing genome sequence displays a metabolic capacity to form acid fermentation that is very useful for industrial applications and encodes for two bacteriocins responsible for its eventual bioprotective properties.

[Conservative surgery in the treatment of infectious mitral valve insufficiency]. / La chirurgie mitrale conservatrice dans le traitement de l'insuffisance mitrale infectieuse.

In order to analyse the results of conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis, the authors reviewed the cases of 48 patients operated between 1974 and April 1993 (36 operations having been performed after 1989, a period during which only 3 patients underwent mitral valve replacement for the same indication). Thirty-four patients were operated after sterilisation of the infective endocarditis, and 14 patients were treated during the active phase. There were 32 men and 16 women with an average age of 45 +/- 13 years. In two thirds of the cases, the causative organism was a streptococcus. Half of the patients were operated during the acute stage because of their poor haemodynamic status, 5 because of residual bacterial vegetations after one or more embolic events and two because of the infection itself. On the other hand, patients were operated after the infective phase because of severe mitral regurgitation, responsible for severe symptoms (NYHA Class III) in 16 cases. From the anatomical point of view, the peroperative finding of 14 patients operated in the acute phase included dilatation of the annulus (N = 9), ruptured chordae (N = 9), perforation (N = 8) or vegetations (N = 8); in the patients operated later, the incidence of perforation and vegetations was much lower (20%) whereas dilatation of the annulus was almost constant (91%).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative genomics analysis of Lactobacillus species associated with weight gain or weight protection.

BACKGROUND: Some Lactobacillus species are associated with obesity and weight gain while others are associated with weight loss. Lactobacillus spp. and bifidobacteria represent a major bacterial population of the small intestine where lipids and simple carbohydrates are absorbed, particularly in the duodenum and jejunum. The objective of this study was to identify Lactobacillus spp. proteins involved in carbohydrate and lipid metabolism associated with weight modifications. METHODS: We examined a total of 13 complete genomes belonging to seven different Lactobacillus spp. previously associated with weight gain or weight protection. We combined the data obtained from the Rapid Annotation using Subsystem Technology, Batch CD-Search and Gene Ontology to classify gene function in each genome. RESULTS: We observed major differences between the two groups of genomes. Weight gain-associated Lactobacillus spp. appear to lack enzymes involved in the catabolism of fructose, defense against oxidative stress and the synthesis of dextrin, L-rhamnose and acetate. Weight protection-associated Lactobacillus spp. encoded a significant gene amount of glucose permease. Regarding lipid metabolism, thiolases were only encoded in the genome of weight gain-associated Lactobacillus spp. In addition, we identified 18 different types of bacteriocins in the studied genomes, and weight gain-associated Lactobacillus spp. encoded more bacteriocins than weight protection-associated Lactobacillus spp. CONCLUSIONS: The results of this study revealed that weight protection-associated Lactobacillus spp. have developed defense mechanisms for enhanced glycolysis and defense against oxidative stress. Weight gain-associated Lactobacillus spp. possess a limited ability to breakdown fructose or glucose and might reduce ileal brake effects.