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Background: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave’s syndrome) is seldom reported. Methods: From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. Results: Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. Conclusions: These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave’s syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition. [Copyright &y& Elsevier]

• Specialized surgeons were aware of the basics of damage control surgery after the Advanced Course for Deployment Surgery (ACDS). • This registry analysis showed a better use of preoperative imaging in ACDS group. • There is a trend toward a better compliance to damage control digestive surgery guidelines in ACDS group. • There was more reoperation for bleeding in the Control group. Non-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation. Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared. We included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p = 0.034) and more e-FAST detailed patients (35% vs. 21 %; p = 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n = 6 [6 %] vs. n = 12 [13 %]; p = 0.128), more temporary closure with abdominal packing (n = 17 [17 %] vs. n = 10 [11 %]; p = 0.327), and less re-operation for bleeding (n = 0 [0 %] vs. n = 5 [6 %]; p = 0.046). The French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients. [ABSTRACT FROM AUTHOR]

Objectives: To describe the management of war-related vascular injuries in the Kabul French military hospital.Methods: From January 2009 to April 2013, in the Kabul French military hospital, we prospectively included all patients presenting with war-related vascular injuries. We collected the following data: site, type, and mechanism of vascular injury, associated trauma, type of vascular repair, amputation rate and complications.Results: Out of the 922 soldiers admitted for emergency surgical care, we recorded 45 (5%) patients presenting with vascular injuries: 30 (67%) gunshot-related, 11 (24%) explosive device-related, and 4 (9%) due to road traffic accident. The majority of injuries (93%) involved limbs. Vascular injuries were associated with fractures in 71% of cases. Twelve (26.7%) had an early amputation performed before evacuation. Twenty (44.4%) patients underwent fasciotomy and three (6.6%) sustained a compartment syndrome.Conclusions: This was the first French reported series of war-related vascular injuries during the last decade's major conflicts. The majority of injuries occurred in the limbs. Autologous vein graft remains the treatment of choice for arterial repair. Functional severity of these injuries justifies specific training for military surgeons. [ABSTRACT FROM AUTHOR]

Background: This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war.Methods: From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included.Results: Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%.Conclusions: The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War. [ABSTRACT FROM AUTHOR]

Background: Hypertonic saline may be administered in the setting of lung transplantation but may affect the development of ischemia–reperfusion lung injury. This study investigated the effects of the pre-treatment by intravenous hypertonic saline in a pig model of single lung ischemia–reperfusion. Methods: Forty-three pigs (34 ± 4 kg) under mechanical ventilation were randomly assigned to a left lung ischemia–reperfusion alone or preceded by 4-ml/kg 7.5% hypertonic saline, 33-ml/kg normal saline, or by the infusion of the vasodilator nicardipine. Animals without ischemia served as controls. After euthanasia, the left lung was sampled for histologic analysis and measurement of lung water and alveolar–capillary permeability. Results: Ischemia–reperfusion resulted in high-permeability pulmonary edema, hypoxemia, and increased interleukin-6 serum level. Hypertonic saline pre-treatment worsened pulmonary edema of the left lung (6.6 ± 0.7 vs 4.8 ± 0.8 ml/kg of body weight, p < 0.05) and resulted in a higher ratio of the protein level in the alveolar fluid to the serum protein level (0.41 ± 0.04 vs 0.21 ± 0.09, p < 0.05) and in a higher histologic damage score (11 [range, 9–11.75] vs 6.5 [range, 4.5–7.5], p < 0.05) without promoting pulmonary or systemic inflammation. Lung injury was affected neither by normal saline nor by nicardipine pre-treatment. Nicardipine did not influence the deleterious effect of hypertonic saline. Conclusions: Pre-treatment by intravenous hypertonic saline worsened ischemia–reperfusion lung injury independently of its effects on the cardiac index or pulmonary circulation but probably through a direct effect of hyperosmolarity on endothelial permeability. [Copyright &y& Elsevier]