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Objectives: To evaluate the relationship between socioeconomic deprivation and postoperative outcomes in patients who underwent colonic resection for sigmoid diverticulitis (SD). Background: The potential impact of socioeconomic inequalities on the management of SD has been scarcely studied in the literature. Considering other gastrointestinal pathologies for which lesser access to optimal treatment and poorer survival have been shown, we hypothesize that deprivation could be associated with outcomes for SD. Methods: This multicenter retrospective study was conducted at 41 French hospitals between January 1, 2010, and August 31, 2021. The main outcome was the occurrence of severe postoperative complications on postoperative day 90, according to the Clavien- Dindo scale (≥3). The European Deprivation Index was used to approximate deprivation for each patient. Multiple imputations by a chained equation were performed to consider the influence of missing data on the results. Results: Twenty percent of the 6415 patients operated on had severe postoperative complications at 90 days. In the multivariate regression analysis, increasing age, male sex, American Society of Anesthesiologists score ≥3, conversion to laparotomy or upfront open approach, surgical procedures, and perioperative transfusion were independent risk factors for severe postoperative complications. After adjusting for age, sex, body mass index, American Society of Anesthesiologists score, emergent setting, blood transfusion, indications for surgery, surgical approach, and procedures, the probability of severe postoperative complications increased with socioeconomic deprivation (P=0.026) by day 90. Conclusions: This study highlights the potential influence of socioeconomic deprivation on the surgical outcomes of SD. Socioeconomic deprivation should be considered as a risk factor for severe postoperative complications during the preoperative assessment of the patient's medical conditions. [ABSTRACT FROM AUTHOR]

The observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis. The primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results. Between 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks. The present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis. [ABSTRACT FROM AUTHOR]

• Iatrogenic injuries of the ureter are a rare complication in colorectal surgery. • No prophylactic measure has been proven to be effective. • CT scan with intravenous contrast and retrograde urography are the reference examinations for the diagnosis of ureteral injuries. • Diagnostic delay is a major factor of poor prognosis. • Endoscopic treatment with a double-J ureteral catheter stent is the first-line treatment for simple injuries, with a high success rate. • Surgical repair of complex injuries is associated with greater morbidity but the success rate is comparable to endoscopic treatment. Iatrogenic ureteral injury (IUI) is a rare but formidable complication of any abdominal or pelvic surgery. The aim of this study was to describe the epidemiology of IUI in colorectal surgery in the Basse-Normandie region over the period 2004–2022, as well as to review the literature on the management of this complication. This multicenter retrospective analysis of clinical data (medical records and operative reports) concerned 22 patients (13 men and 9 women) who suffered an IUI during colorectal surgery between 2004 and 2022. Ureteral resections for oncological purposes and endoluminal instrumental injuries (post-ureteroscopy) were excluded from the study. We also carried out a review of the literature concerning the incidence of IUI in colorectal surgery. The incidence of IUI was 0.27% over the study period (22 ureteral injuries out of 8129 colorectal procedures). Colorectal cancer and sigmoid diverticulitis were the dominant surgical indications (85% of cases). Proctectomy and left colectomy were the most performed resection procedures (75% of cases). Surgery was scheduled in 68% of cases. The approach was open laparotomy in 59% and laparoscopy in 41% of cases. The IUI involved the left ureter in 63% of cases and the pelvic ureter in 77% of cases. Conservative endoscopic treatment by insertion of a double-J catheter stent had a success rate of 87.5%. Surgical repairs consisting of re-implantation techniques and uretero-ureteral anastomosis had a success rate of 75%. The nephrectomy rate was 13.6% (3/22) and the mortality rate 9% (2/22). A literature review identified sixteen studies, where the incidence of IUI varied from 0.1 to 4.5%. IUI occurring during colorectal surgery is a rare occurrence but remain a formidable complication. No means of prevention has proven its effectiveness to date, but guidance devices using illuminated ureteral catheters or dyes seem to constitute a promising approach. Injuries to the left pelvic ureter are the most common, and the majority can be treated endoscopically if diagnosed early. [ABSTRACT FROM AUTHOR]

• Following uncomplicated sigmoid diverticulitis, long-term quality of life does not substantially differ between patients having undergone antibiotic therapy and those having only received symptomatic treatment. • Following Hinchey I/II sigmoid diverticulitis, while prophylactic surgery generally seems to improve quality of life, it has little or no beneficial effect on a sub-group of patients with small-sized abscesses. • Following sigmoid diverticulitis, emergency surgery seems to have little or no impact on quality of life. However, colorectal anastomosis with or without a protective stoma improves quality of life after Hartmann's procedure. Diverticular disease, including diverticulitis, begins when the patient becomes symptomatic. Sigmoid diverticulitis corresponds to inflammation/infection of a diverticulum of the sigmoid colon. Among diverticulosis patients, 4.3% develop diverticulitis, a frequent pathology that can entail major functional disorders. Following sigmoid diverticulitis, few studies have assessed functional disorders and quality of life, a multidimensional concept comprising physical, psychological and mental dimensions, as well as social relations. The purpose of this work is to report current published data on the quality of life of patients having had sigmoid diverticulitis. Following uncomplicated sigmoid diverticulitis, long-term quality of life does not substantially differ between patients having undergone antibiotic therapy and those having only received symptomatic treatment. As for patients having experienced recurrent events, their quality of life seems improved by elective surgery. Following Hinchey I/II sigmoid diverticulitis, elective surgery seems to improve quality of life, notwithstanding a 10% risk of postoperative complications. Following sigmoid diverticulitis, while emergency surgery seems not to have greater impact on quality of life than elective surgery, the surgical technique employed in an emergency setting seems to have an impact, particularly with regard to the physical and mental components of quality of life. Assessment of quality of life is of fundamental importance in diverticular disease and should orient operative indications, particularly in an elective context. [ABSTRACT FROM AUTHOR]

• Avoiding splenic flexure mobilization during left colectomy for sigmoid diverticulitis does not increase significantly severe postoperative complications at day 90. • The prevalence of anastomotic leakage, hemorrhage, and the need to return to the operating theatre was similar between the patients with and without splenic flexure mobilization. • This is the first study using propensity score matching that included almost 1000 patients who were operated on for sigmoid diverticulitis. [ABSTRACT FROM AUTHOR]

Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence. Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described. During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P =.0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01–109] P =.049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23–154] P =.033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04–91.4] P <.001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15–14.4] P =.030) as predictors of recurrence. The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data. [ABSTRACT FROM AUTHOR]

Patients over 60 years old undergoing bariatric surgery is still increasing. First, to assess the impact of age (>60 years) on the 90-day morbidity and mortality of both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG), and second, to determine the effectiveness of surgical weight loss and resolution of obesity-related comorbidities for patients 60 years of age and older over a 2-year period. Bicentric study from University Hospital of Caen and Memorial Hospital of Saint Lô, France. This is a retrospective review of a prospectively maintained database of patients with morbid obesity undergoing laparoscopic bariatric surgery from October 2005 to April 2019. Patients 60 years of age and older were defined as cases (elderly group [EG], n = 137), and patients younger than 60 years of age were defined as controls (young group [YG], n = 1544). The primary endpoint of the study was the prevalence of severe postoperative complications within 90 days of surgery determined by a propensity-score-matching (PSM) analysis. The PSM population included 133 patients in the EG who were matched 1:2 with 266 patients in the YG. There was no mortality in either group. Although not significant (with an absolute difference of 4.5% between the EG and the YG), the odds of severe postoperative complications were 2.5 times higher in the EG than in the YG (7.5% versus 3.0%, P =.053). At 90 days postoperatively, the prevalences of overall morbidity (31.6% versus 22.9%, P =.044), leakage (5.3% versus 1.1%, P =.026), and reoperation (5.3% versus 1.1%, P =.026) were significantly higher in the EG than in the YG. This propensity-matched study suggests that laparoscopic bariatric surgery is probably an effective treatment in obese elderly patients (EPs) in terms of weight loss and resolution of comorbidities. However, the EP should be warned of the increased risk of severe postoperative complications within 90 days, including leakage and reoperation rates, especially after RYGB. • The number of patients ≥60 years requesting bariatric surgery had progressively increased. • We would like to perform postoperative results in bariatric surgery in elderly population compared to young population using propensity score analysis. • Severe postoperative complications were significantly more frequent in elderly group compared with Younger group in unadjusted (8% vs 4.1%, P =.038) and IPWT (8.1% vs 3.6%, P =.019) populations. • Although not significant, the prevalence of severe postoperative complications was 2.5 times higher in the EG compared to the YG (7.5% vs 3.0%, P =.053) in the PSM population. • Patients ≥60 years should be warned of the increased risk of severe postoperative complication, leak and reoperation within 90 days after either LRYGB or LSG. [ABSTRACT FROM AUTHOR]

With the rising number of rectal cancer survivors, more patients with sphincter-preserving surgery are having to live with a potentially impaired quality of life. The survey aimed to assess bowel and genitourinary sequelae and their impact on quality of life in an unselected registry-based population of rectal cancer survivors. This cross-sectional cohort survey (registered at ClinicalTrials.gov ; ID: NCT03459235) included patients with rectal cancer who underwent curative surgery with sphincter-preserving surgery from January 1, 2007 to January 31, 2015. Patients with recurrent disease, intestinal stoma, or cognitive disorders were excluded. Validated scoring system included the Urinary Symptom Profile in women and the International Prostate Symptom Score in men for urinary function, International Index for Erectile Function 5 in men and Female Sexual Function Index in women for sexual function, and Core 30/ Colo Rectal 29 questionnaires for quality of life and Low Anterior Resection Syndrome score for bowel function. The impact of functional sequelae on global quality of life was evaluated by multiple linear regression. Responders (45.3%, 92/203 patients) and nonresponders were comparable according to sex, age, tumor stage, and neoadjuvant chemoradiation. With a mean follow-up of 6.5 years, 65.2% of the rectal cancer survivors had bowel dysfunction, of whom 41.3% experienced major Low Anterior Resection Syndrome and 80% of rectal cancer survivors experienced genitourinary dysfunction. In multiple linear regression, poor bowel function was a significant predictor of global quality of life in men (P =. 04) and women (P =. 0003). This survey highlights the importance of sexual and bowel dysfunction in rectal cancer survivors and the strong correlation between high Low Anterior Resection Syndrome score and inferior quality of life. Further studies are needed to improve knowledge on how to predict bowel dysfunction and how to best support patients with bowel dysfunction. [ABSTRACT FROM AUTHOR]

Background Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy. Methods The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well. Results Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001). Conclusions Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: To determine the best initial procedure for performing preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma (PHCC).Materials and Methods: MEDLINE/PubMed and the Cochrane database were searched for all studies published until June 2016 comparing endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. Meta-analysis was performed by using Review Manager 5.3 software.Results: Four retrospective studies were identified that met the criteria. The analysis was performed on 433 patients who underwent preoperative biliary drainage for resectable PHCC. Of those, 275 (63.5%) had EBD and 158 (36.5%) had PTBD as the initial procedure. The overall procedure-related morbidity rate was significantly lower in the PTBD group than in the EBD group (39 of 147 [26.5%] vs 82 of 185 [44.3%]; odds ratio [OR], 2.23; 95% confidence interval [CI], 1.39-3.57; P = .0009). The rate of conversion from one procedure to the other was significantly lower in the PTBD group than in the EBD group (8 of 158 [5.0%] vs 73 of 275 [26.5%]; odds ratio, 4.76; 95% CI, 2.71-8.36; P < .00001). Pancreatitis occurred only in the EBD group (25 of 275 [9.0%] vs 0 of 158; OR, 7.46; 95% CI, 3.02-18.44; P < .0001). The cholangitis rate was significantly lower in the PTBD group than in the EBD group (12 of 158 [7.6%] vs 93 of 275 [33.8%]; OR, 5.41; 95% CI, 2.75-10.63; P < .00001).Conclusions: This meta-analysis shows that PTBD has a lower rate of complications than EBD as the initial procedure to perform preoperative biliary drainage in resectable PHCC. PTBD is associated with less conversion and lower rates of pancreatitis and cholangitis. [ABSTRACT FROM AUTHOR]

Background Few studies have established that obesity promotes all types of urinary incontinence and disorders of the pelvic floor. The role of bariatric surgery in urinary incontinence remains poorly studied. Objective To determine the effect of bariatric surgery on urinary incontinence, dysuria, and fecal incontinence before and 1 year after bariatric surgery. Setting University hospital expert in bariatric surgery Methods This was an observational cohort study of 140 patients who underwent bariatric surgery between September 2013 and September 2014. Patients prospectively completed 4 questionnaires, 2 for urinary symptoms and 2 for fecal incontinence. Eighty-three women and 33 men completed 4 questionnaires the day before surgery when arriving in the department and 1 year after surgery. Results Of the 140 patients, 116 completely responded to the 4 questionnaires. The rate of urinary incontinence was 50.9% before surgery and 19% at 1-year follow-up ( P <.0001). After bariatric surgery, there was improvement in the rate of stress urinary incontinence: 39.7% before surgery versus 15.5% at 1 year ( P <.0001). In addition, there was an improvement in urinary urge incontinence: 36.8% versus 7.9% at 1 year ( P <.0001). The dysuria rate was 19.8% before surgery versus 3.4% at 1 year ( P <.0001). Bariatric surgery improved the quality of life related to urinary symptoms ( P <.0001). One year after surgery, there was no significant difference in terms of prevalence and severity of fecal incontinence. Conclusion We confirmed with our study that weight loss after bariatric surgery improves stress urinary incontinence, urge incontinence, dysuria, and quality of life. However, we did not find any positive effect on fecal incontinence. [ABSTRACT FROM AUTHOR]

Introduction To assess the role of Body Surface Area (BSA) in predicting pancreatic fistula and mortality after pancreaticoduodenectomy. Methods The data of patients who underwent pancreaticoduodenectomy between January 1992 to December 2012 at the University Hospital of Caen were collected prospectively and analyzed retrospectively. Pancreatic fistula was determined according to the ISPGF (International Study Group for Pancreatic Fistula) criteria. The Clavien and Dindo classification was used for grading post-operative complications and BSA was calculated according to the Boyd formula. Patients were classified as “large” and “non-large” using a BSA value ≥1.82 to define the large group and the non-large group. The primary end points were post-operative mortality rate, and the rate and grade of post-operative pancreatic fistula. Results 411 patients underwent pancreaticoduodenectomy with a mean age of 61.2 (±12.1) year. Six patients (1.45%) died post-operatively. Patients with a BSA ≥1.82 had a significantly higher risk of post-operative death: OR 3.55 [1.43–8.80] (p < 0.0005). Eighty-five patients (20.7%) developed a post-operative pancreatic fistulas. The grade A pancreatic fistula rate was 87.1%. Patients with a BSA ≥1.82 had a significantly higher risk of developing overall post-operative pancreatic fistula (p < 0.038). Multivariate analysis showed that “large” patients (1.86, 95% CI[1.09–3.92], p = 0.0229), soft pancreas (6.5, 95% CI[2.39–9.31], p = 0.0155) and a BMI ≥ 25 (1.09, 95% CI[1.031–1.163], p = 0.0407) were independent risk factors of pancreatic fistula. Conclusion Body Surface Area is a useful factor after pancreaticoduodenectomy to predict mortality and post-operative fistula. [ABSTRACT FROM AUTHOR]

Background Colorectal resection in cirrhotic patients is associated with high mortality and morbidity related to portal hypertension and liver insufficiency. Methods This retrospective study evaluated the clinical outcomes of cirrhotic patients who underwent transjugular intrahepatic porto-systemic shunt (TIPS) placement before colorectal resection for cancer. Main outcomes measures were postoperative morbidity and mortality rates. Results TIPS placement was successful in all eight patients and significantly decreased the mean hepatic venous pressure gradient from 15.5 ± 2.9 to 7.5 ± 1.9 mmHg ( p = 0.02). Surgical procedures included right colectomy ( n = 3), left colectomy ( n = 2), and proctectomy with total mesorectal excision ( n = 3). Post-operatively, two patients (25%) died of multiple organ failure. The overall postoperative morbidity rate was 75%, and major complications were seen in 25%. Conclusion Portal decompression via TIPS placement may enable selected cirrhotic patients with severe portal hypertension to undergo colorectal resection for cancer. [ABSTRACT FROM AUTHOR]