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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]

• 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]

Abstract Introduction The transcriptional activity of the UGT1A1 gene is modulated by a variable number of repetitions of the dinucleotide (TA) within its promoter region. By comparison to the most common allele (TA) 6 (UGT1A1*1), decreased activity is observed with increasing TA repetitions. The aim of this study was to determine whether the presence of the variant allele UGT1A1*28, harbouring seven TA repetitions, (TA) 7 , in the homozygous state, is associated with precancerous colonic lesions and/or with specific colorectal cancer characteristics. Material and methods All patients treated for colorectal cancer in a tertiary care centre, between January 2009 and December 2013, who had routine UGT1A1 genotyping for irinotecan dose-adjustment were included. Data were retrospectively collected. Results 292 patients were enrolled, including 23 UGT1A1 *28/*28 homozygous (7.9%), 137 wild type homozygous (46.9%) and 132 heterozygous (45.2%). There were no significant differences in phenotypic colonic characteristics between homozygous and heterozygous patients carrying the UGT1A1*28 allele as compared to *1/*1 homozygous. Patients treated with aspirin were significantly more common in the UGT1A1 *28/*28 homozygous group than in the other groups (7/23 (30.4%) compared to 22/269 (8.2%), p = 0.001). Conclusion Dinucleotide polymorphism in the promoter region of the UGT1A1 gene is not associated with a specific colonic phenotype in patients with sporadic colorectal cancer. [ABSTRACT FROM AUTHOR]

Preclinical models based on patient-derived xenografts have remarkable specificity in distinguishing transformedhuman tumor cells fromnon-transformed murine stromal cells computationally.We obtained 29 pancreatic ductal adenocarcinoma(PDAC) xenografts fromeither resectable or non-resectable patients (surgery and endoscopic ultrasound-guided fine-needle aspirate, respectively). Extensive multiomic profiling revealed two subtypeswith distinct clinical outcomes. These subtypes uncovered specific alterations inDNA methylation and transcription as well as in signaling pathways involved in tumor-stromal cross-talk. The analysis of these pathways indicates therapeutic opportunities for targeting both compartments and their interactions. In particular, we show that inhibiting NPC1L1 with Ezetimibe, a clinically available drug, might be an efficient approach for treating pancreatic cancers. These findings uncover the complex and diverse interplay between PDAC tumors and the stroma and demonstrate the pivotal role of xenografts for drug discovery and relevance to PDAC. [ABSTRACT FROM AUTHOR]

Background The efficacy and safety of treating elderly patients with colorectal cancer (CRC) is of concern. This study aimed to compare the short- and long-term outcomes of elective laparoscopic vs. open surgery to treat CRC in very elderly patients. Methods All patients aged >80 years and who had undergone a colectomy for CRC without metastasis between July 2005 and April 2012 were considered for inclusion. Demographic, clinical, operative, and postoperative data, plus overall and disease-free survival rates, were retrospectively collected and compared between two groups of patients that underwent an open procedure (OP group) or laparoscopy (LG). Results 123 patients were enrolled (55 OPG, 68 LG). Median age was similar between the groups (84 vs. 83 years, respectively; NS). Duration of surgery was significantly lower in OPG (170 vs. 200 min; p = 0.030). Overall mortality at 3 months was 8.3%: it tended to be greater in the OPG (16.5% vs. 1.5%, NS). Morbidity was significantly greater in the OPG compared to the LG (52.7% vs. 27.5%; p = 0.021), resulting in significantly longer hospital stay (12 vs. 8 days, respectively; p < 0.001). Pathological findings were similar between the two groups. Cumulative overall survival rates at 3 and 5 years were significantly greater after laparoscopy (85% and 72%) compared to open surgery (58.2% and 48%, respectively; p < 0.001). Conclusions Our study suggests that laparoscopy is safe and could increase overall survival compared to open surgery in elderly patients suffering from CRC. Summary This retrospective study compared the short- and longer-term outcomes of patients aged >80 years and undergoing elective laparoscopic or open surgery for CRC between 2005 and 2012. [ABSTRACT FROM AUTHOR]

Aim: To compare clinical presentation, operative management and short- and long-term outcomes of congenital bile duct cysts (BDC) in adults with children. Methods: Retrospective multi-institutional Association Francaise de Chirurgie study of Todani types I+IVB and IVA BDC. Results: During the 37-year period to 2011, 33 centers included 314 patients (98 children; 216 adults). The adult population included more high-risk patients, with more active, more frequent prior treatment (47.7% vs 11.2%; p < 0.0001), more complicated presentation (50.5% vs 35.7%; p = 0.015), more synchronous biliary cancer (11.6% vs 0%; p = 0.0118) and more major surgery (23.6% vs 2%; p < 0.0001), but this latter feature was only true for type I+IVB BDC. Compared to children, the postoperative morbidity (48.1% vs 20.4%; p < 0.0001), the need for repeat procedures and the status at follow-up were worse in adults (27% vs 8.8%; p = 0.0009). However, severe postoperative morbidity and fair or poor status at follow-up were not statistically different for type IVA BDC, irrespective of patients' age. Synchronous cancer, prior HBP surgery and Todani type IVA BDC were independent predictive factors of poor or fair long-term outcome. Conclusion: BDC is a more indolent disease in children compared to adults, except for Todani type IVA BDC. [ABSTRACT FROM AUTHOR]

Five patients with pancreatic tumors and chronic portal vein (PV) thrombosis underwent PV stent placement before surgery. The patients either had resectable tumors or locally advanced tumors with stable, partial, or complete response to neoadjuvant therapy. PV stent placement removed periportal collaterals in all cases, with no complications, in a mean time of 150 minutes. Patients received a daily dose of subcutaneous low-molecular-weight heparin until 12 hours before surgery, and low-molecular-weight heparin was resumed for 30 days after surgery. Surgery was performed 1 day to 3 months after PV stent placement, with no complications related to periportal collaterals. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the morbidity of laparoscopic subtotal colectomy (STC) with or without anastomosis in patients with acute or severe colitis (SAC) complicating inflammatory bowel disease (IBD) who failed medical treatment. Methods: Forty patients undergoing laparoscopic STC for SAC complicating IBD were identified and well-matched for age, gender, ASA score, and IBD severity at the time of colectomy (acute colitis vs steroid dependence only) with 48 patients undergoing open STC. Results: There was no operative mortality. Mean (±SD) operative time was similar after laparoscopic and open STC (253 ± 56 vs 231 ± 75 min; NS). Two patients (5%) required conversion into laparotomy due to intensive adhesions (n = 1) and colonic fistula (n = 1). Overall morbidity and hospital stay was similar after laparoscopic STC and open STC (35% vs 56%) (9 ± 3 vs 12 ± 7 days) (P > .1) respectfully. After laparoscopic STC, 84% of the patients underwent restorative intestinal continuity (with either ileorectal or ileoanal anastomosis) through reoperative laparoscopy (n = 15) or elective incision at the site of previous stoma (n = 16). Conclusions: This case-matched study suggests that laparoscopic STC was as safe and effective as open STC for IBD patients with SAC. A laparoscopic STC allows restoration of intestinal continuity restoration (ie, ileal pouch anal or ileorectal anastomosis) through a laparoscopic approach or elective incision for the majority of the patients. For these reasons, laparoscopic approach represents the best approach for colitis-complicating IBD. [Copyright &y& Elsevier]

Background: About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma results in lower mortality rates than Hartmann's procedure (HP) in patients with diverticular peritonitis.Study Design: We conducted a multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI (Primary vs Secondary Anastomosis for Hinchey Stage III-IV Diverticulitis) trial. Follow-up duration was up to 18 months. A random sample of 102 eligible participants with purulent or fecal diverticular peritonitis from tertiary care referral centers and associated centers in France were equally randomized to either a PA arm or to an HP arm. Data were analyzed on an intention-to-treat basis. The primary end point was mortality rate at 18 months. Secondary outcomes were postoperative complications, operative time, length of hospital stay, rate of definitive stoma, and morbidity.Results: All 102 patients enrolled were comparable for age (p = 0.4453), sex (p = 0.2347), Hinchey stage III vs IV (p = 0.2347), and Mannheim Peritonitis Index (p = 0.0606). Overall mortality did not differ significantly between HP (7.7%) and PA (4%) (p = 0.4233). Morbidity for both resection and stoma reversal operations were comparable (39% in the HP arm vs 44% in the PA arm; p = 0.4233). At 18 months, 96% of PA patients and 65% of HP patients had a stoma reversal (p = 0.0001).Conclusions: Although mortality was similar in both arms, the rate of stoma reversal was significantly higher in the PA arm. This trial provides additional evidence in favor of PA with diverting ileostomy over HP in patients with diverticular peritonitis. ClinicalTrials.gov Identifier: NCT 00692393. [ABSTRACT FROM AUTHOR]

Various technologies exist to remove surgical smoke. Despite high significance in surgical practice, comparative in-vivo performance data are missing. The performance of five smoke management technologies (venting, passive filtering, active filtering, circular filtration, electrostatic precipitation) was analysed in-vivo by three different laparoscopic interventions (cholecystectomy, atypic liver resection, colon surgery) with high-energy surgical instruments. Surgical smoke formation/evacuation was characterised by various aerosol-analytical instruments. In addition, operational parameters like CO 2 consumption and capnoperitoneal pressure were determined. The half-life of particle concentration was found to be a suitable parameter to describe smoke elimination efficacy and varied between (10 - 45) s. It is shown that the efficacy of smoke elimination technologies based on particle removal by evacuation can also be predicted by simple equations. Furthermore, it was found that the combination of surgical cutter and tissue defines charge and polarity of surgical smoke that influences especially the efficacy of electrostatic precipitation. Depending on the smoke elimination technology, the CO 2 consumption varied between (0.5 - 16) L/min, the capnoperitoneal stability between (2 - 17) %. Each smoke elimination technology showed advantages and disadvantages. Simple charcoal filters rapidly degrade and should be exchanged regularly during surgery. Active filtering is efficient for smoke management, but the unstable capnoperitoneum interferes with surgery. Circular filtration forms a stable capnoperitoneum, but the valveless trocar promotes relevant levels of smoke release into the environment. Electrostatic precipitation was found to be most efficient for smoke management with minimal CO 2 consumption and highly-stable capnoperitoneum. • Exposure of surgical staff by surgical smoke during laparoscopic surgery is an issue. • Surgical smoke management technologies exist, but no comparative performance data. • Five surgical smoke management technologies were comparative characterised in-vivo. • Particle concentration half-life is a suitable descriptive performance parameter. • Electrostatic precipitation is more efficient than steady carbon dioxide exchange. [ABSTRACT FROM AUTHOR]

Background: In the COVID-19 crisis, laparoscopic surgery is in focus as a relevant source of bioaerosol release. The efficacy of electrostatic aerosol precipitation (EAP) and continuous aerosol evacuation (CAE) to eliminate bioaerosols during laparoscopic surgery was verified.Study Design: Ex-vivo laparoscopic cholecystectomies (LCs) were simulated ± EAP or CAE in Pelvitrainer equipped with swine gallbladders. Release of bioaerosols was initiated by performing high-frequency electrosurgery with a monopolar electro hook (MP-HOOK) force at 40 watts (MP-HOOK40) and 60 watts (MP-HOOK60), as well as by ultrasonic cutting (USC). Particle number concentrations (PNC) of arising aerosols were analyzed with a condensation particle counter (CPC). Aerosol samples were taken within the Pelvitrainer close to the source, outside the Pelvitrainer at the working trocar, and in the breathing zone of the surgeon.Results: Within the Pelvitrainer, MP-HOOK40 (6.4 × 105 cm-3) and MP-HOOK60 (7.3 × 105 cm-3) showed significantly higher median PNCs compared to USC (4.4 × 105 cm-3) (p = 0.001). EAP led to a significant decrease of the median PNCs in all 3 groups. A high linear correlation with Pearson correlation coefficients of 0.852, 0.825, and 0.759 were observed by comparing MP-HOOK40 (± EAP), MP-HOOK60 (± EAP), and USC (± EAP), respectively. During ex-vivo LC and CAE, significant bioaerosol contaminations of the operating room occurred. Ex-vivo LC with EAP led to a considerable reduction of the bioaerosol concentration.Conclusions: EAP was found to be efficient for intraoperative bioaerosol elimination and reducing the risk of bioaerosol exposure for surgical staff. [ABSTRACT FROM AUTHOR]