[Practice of French urologists concerning the checklist of the operating room]. / Les pratiques professionnelles des chirurgiens urologues en France concernant la check-list au bloc opératoire.

INTRODUCTION: In 2018, the French High Authority of Health (HAS) included a "time-out" phase in the latest version of the checklist for the operating room in order to improve the safety of operated patients. The aim of this study is to evaluate the practice of French urologists concerning the check list (CL) of the operating room. MATERIAL AND METHODS: A survey of 30 items was developed by the committee of accreditation of the French Association of Urology (AFU) and other contributors. It was centered on the characteristics of the urologists, the details of application of the CL, and the evaluation of the current version. After validation, the questionnaire was emailed as an online form in July 2021 for all the members of the AFU and AFUF. RESULTS: Overall, 369 form the 1700 contacted urologists responded to the survey. The majority were more than 40 years old (70.11%) and less than 20 year of experience (54.49%). The engagement in individual or team accreditation was observed in 222 (60.7%) and 145 (39.84%) urologists, respectively. Almost half of them were present at the beginning of the CL (47.18%), and prescribed postoperative medication with the anesthesiologist (55.56%). The CL has modified the practice in 47.54%, however, with greater administrative burden, and 80% preferred that the AFU adapts the CL to the urology field. CONCLUSION: The practice of CL between urologists is variable. On multivariate analysis, the engagement in team accreditation was the only variable to influence the practice of time out.

Technique of the transobturator puborectal sling in fecal incontinence.

BACKGROUND: The puborectoplasty in fecal incontinence (FI) has been described through retropubic approach. Here, we describe a puborectal sling placement through transobturator approach with a device used for vaginal vault prolapse and report long-term outcome at 5 years. METHODS: Six women with FI for whom usual treatments (including sacral nerve stimulation) have failed were enrolled in a pilot study. Cleveland Clinic Incontinence Score (CCIS) and FI quality of life (FIQL) were used to evaluate results. RESULTS: The median CCIS was significantly improved at 12 months (18.5 [15-20] vs 7.5 [4-20] in postoperative assessment; p = 0.037). The median FIQL was improved at 12 months (6.05 [5.6-7] vs 10.2 [5.6-12.5]; p = 0.0542). No adverse event was recorded except the distension of the device in one patient. Finally, at 5 years, 3 patients were improved, 1 had recurrence of FI symptoms (at 24 months) and 2 had no change. CONCLUSION: This technique is a minimally invasive surgical treatment and constitutes a new therapeutic option for FI in case of failure of conventional treatment.

[One year implemention of the safe surgery checklist in France, what has been achieved so far, what could be improved?]. / Check-list "Sécurité du patient au bloc opératoire". Quels acquis, quelles perspectives, un an après son implantation en France.

Despite important advances accomplished during the last ten years, patient safety in the OR remains a subject high on everyone's priority list: healthcare professionals, organisations and of course, patients. In this setting, the French National Authority for Health (Haute Autorité de santé, HAS) conducted a study with the scientific societies of professionals working in the OR. This study resulted in the adaptation of a tool which has already demonstrated, in a convincing manner, its efficacy in reducing perioperative morbimortality: the World Health Organisation's (WHO) "Surgical Safety Surgery" checklist. In order to promote its, HAS integrated this important tool for improving patient safety into the framework of its certification process of health care organisations beginning in January 1, 2010. Additionally, the organisations receive HAS certification are partners for the programme's promotion. One year after its institution, HAS is undertaking its first evaluation of the lessons and perspectives from the checklist's utilisation.

[Check-list "Patient Safety" in the operating room: one year experience of 40,000 surgical procedures at the university hospital of Nice]. / Check-list "Sécurité du patient au bloc opératoire": une année d'expérience sur 40 000 interventions au centre hospitalier universitaire de Nice.

OBJECTIVES: The implementation of the check-list "Safe surgery saves live" (CL) has proven effective to reduce morbidity and perioperative mortality. Since 1st January 2010 it is a requirement of the HAS as part of the process of certification of hospitals. The CL has been established on all the operating rooms of our hospital after the onset of a near accident. METHODS: The CL has been computerized to facilitate its adoption by professionals. An internal benchmarking was immediately implemented to allow each surgical specialty to benchmark themselves with other teams. We conducted an audit concerning the CL and periodic assessments in order to learn more precisely concerning the expectations and feelings of medical and nursing teams. RESULTS: Nearly 40 000 CL were collected in the patient record. The completeness of information of some items seems to reflect the difficulty for professionals to realize the difference between traceability and information sharing within the team on the implementation of a protocol. This audit has confirmed the difficulty in sharing information orally. CONCLUSIONS: The CL is involved in developing a safety culture in the operating room and led to the establishment of a risk mapping in the operating room and the recovery room and participation in the program error prevention procedure and surgical site through international program "High 5s" whose purpose is to improve the safety of care.

The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception.

AIM: Optimal treatment of anal incontinence in a patients with a normal anal sphincter is controversial, as is the role of intra-anal rectal intussusception in anal incontinence. We evaluated the results of abdominal ventral rectopexy on anal continence in such patients. METHOD: Forty consecutive patients with incontinence and intra-anal rectal intussusception without a sphincter defect were treated by abdominal ventral mesh rectopexy without sigmoidectomy. The Cleveland Clinic Incontinence Score (CCIS), patient satisfaction and constipation before and after surgery and recurrence were recorded. RESULTS: The mean CCI scores were 13.2 (=/-4.25) preoperatively and 3 (±3.44) postoperatively (P<0.0001). Patient assessment was reported as 'cured' in 26 (65%), 'improved' in 13 (32.5%) and 'unchanged' in one (2.5%) patient. Constipation was induced in two (5%) patients and was cured in 13 of 20 (65%) patients who were constipated before surgery. One case of recurrent prolapse occurred after a mean follow-up of 38 months. CONCLUSION: Intra-anal rectal intussusception may be associated with anal incontinence. For these patients, abdominal ventral mesh rectopexy appears to be an adequate treatment.

Efficacy of synthetic glue treatment of high crypoglandular fistula-in-ano.

OBJECTIVES: In France, seton drainage followed by fistulotomy is currently the standard treatment for high cryptoglandular fistula-in-ano. Biological or synthetic glues, such as Glubran(®) 2, have been recently proposed for sealing the fistula tract. The purpose of this study is to determine the healing rate with glubran 2 and to assess the functional outcome after cure of fistula-in-ano. PATIENTS AND METHODS: From July 2006 to July 2008, 34 patients (20 males; median age 48.5 years, range 22-55 years) with high cryptoglandular anal fistulas were treated with glubran 2. Patients were seen for physical examination at 1, 3 and 6 months, then interviewed by telephone at 1 and 2 years, and in September 2009. The Fecal incontinence severity index (FISI) score was used to assess continence. RESULTS: The healing rate at 1 month was 67.6% (23 patients); the fistula failed to heal in 11 patients. All 23 patients with a healed fistula remained recurrence-free, with no continence disorders noted, during the median 34-month follow-up period (range 21-43 months). One patient was lost to follow-up after 6 months. CONCLUSION: Glubran 2 provides an effective treatment for high fistula-in-ano, with no change in continence. In future, a randomized comparison of this agent with fibrin glues should be useful.

[Do we need a surgical safety checklist?]. / Pourquoi une check-list au bloc opératoire ?

Various studies have shown that the use of a checklist in the operating room lowers mortality and morbidity related to the act of anaesthesia and surgery. The WHO launched a program in June 2008 to improve the safety of surgical care; the main point is the rational use of a simple tool: the Surgical Safety Checklist. Therefore, the HAS, with various representatives of colleges and professional associations of surgeons, anaesthesiologists and operating room nurses including CNGOF and SCGP, established recommendations and proposed a single checklist for all. This list should be used by any team of operative room: nurses, anaesthesiologists, surgeons before anaesthetic induction and before surgery and after the last act before leaving the room. This checklist can of course be supplemented by other checklists specific from specialty teams or places but it can never be abridged or altered. The HAS provides for the promotion of the implementation of this checklist, the certification of health facilities with its introduction into the V2010 and accreditation of doctors.

Preliminary results of peripheral transcutaneous neuromodulation in the treatment of idiopathic fecal incontinence.

PURPOSE: Few therapeutic tools are available for treating idiopathic anal incontinence. Sacral neuromodulation appears to be effective in selected patients but requires surgical implantation of a permanent electrical stimulator. The aim of this work was to assess the efficiency of posterior tibial nerve (PTN) transcutaneous electrical nerve stimulation (TENS) in the treatment of anal idiopathic incontinence. METHODS: Ten women were treated by PTN TENS, 20 min a day for 4 weeks. Functional results were evaluated by Wexner's incontinence score and anorectal manometry. RESULTS: Eight of the ten patients showed a 60% mean improvement of their incontinence score after 4 weeks. This improvement remained stable over the 12-week follow-up period. Manometric parameters did not differ before and after stimulation. CONCLUSION: PTN neuromodulation without surgically implanted electrode could represent a safe and low-cost alternative to permanent sacral neuromodulation for idiopathic anal incontinence.

Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses.

BACKGROUND: The aim of the study was to assess the influence of partial excision of the superior portion of the anal canal (AC) when necessary for tumor margin clearance in distal rectal cancer on fecal continence after coloanal anastomoses. METHODS: Between 1977 to 1993, 209 patients with middle and lower third rectal cancers underwent complete rectal excision and coloanal anastomoses. For very low tumors, located at or below 5 cm from the anal verge (AV), varying portions of the superior segment of the AC were excised for tumor margin clearance. The magnitude of resections was inversely proportional to the height of the anastomosis from the AV. The patients were categorized into 3 groups according to their level of anastomoses from AV: group 1, patients with anastomoses from 0.5 to less than 2 cm from AV (1 to 2.5 cm of AC resected, i.e., major resection); group 2, anastomoses at 2 to less than 3 cm from AV (less than 1 cm of AC resected, i.e., minor resection); group 3, with anastomoses at 3 to 3.5 cm from AV (AC completely preserved). A standard questionnaire, physical examination, and anal manometry at intervals of 3, 6, 12, 24, 36, and 48 months were performed prospectively to assess anal continence. RESULTS: The patients in the 3 categories were matched for age, gender, stage, presence or absence of a colonic J-pouch, preoperative neoadjuvant radiotherapy and surgical technique. Fourteen patients with postoperative radiotherapy were excluded from the clinical assessment. Mean follow-up was 33.5 months. There were 43 patients in group 1, 75 in group 2, and 73 in group 3 for clinical assessment. In the first year, there was progressive improvement in anal continence in all 3 groups. At 2 years, 50% in group 1, 73% in group 2, and 62% in group 3 were fully continent. The proportion of patients fully continent in group 1 remained unchanged as compared to continued improvement for groups 2 and 3 following the first year. At 4 years, 50% in group 1, 80% in group 2, and 68% in group 3 were completely continent. The difference among the 3 groups was not statistically significant. CONCLUSIONS: For distal rectal cancer, where tumor margin clearance necessitates partial resection of the superior portion of the AC, when limited to less than 1 cm, the proportion of patients remaining fully continent is similar to those with complete AC preservation. More substantial excisions of the AC can still result in satisfactory anal continence, such that following the fourth year, one half of the patients can expect to be fully continent.

Is rectal intussusception a cause of idiopathic incontinence?

PURPOSE: The cause of rectal intussusception in patients primarily dominated by symptoms of anal incontinence has not been fully elucidated, especially for patients with idiopathic incontinence. METHODS: Between 1991 and 1996, 51 patients referred with a diagnosis of idiopathic incontinence were prospectively evaluated by standard questionnaire, clinical examination, defecography, and anal manometry. Fourteen female patients were identified with rectal intussusception and were treated by transabdominal rectopexy. Postoperatively, clinical assessment and anal manometry were performed at regular intervals. RESULTS: Continence was improved after rectopexy (P < 0.01). The postoperative increases in the anal resting pressure, maximum squeeze pressure, and maximum tolerated volume were not statistically significant. CONCLUSIONS: Rectopexy improved anal incontinence in patients with rectal intussusception. The cause of rectal intussusception in anal incontinence could not be explained by functional improvement of the internal anal sphincter tone or an increase in the maximum tolerated volume. Rectal intussusception may be a cause of idiopathic incontinence in patients; however, larger prospective studies are required to support this concept.

[Incidence of colorectal cancer in the Haute-Garonne Department. Evaluation of 2 years of registration (1982-1983)]. / Incidence du cancer colo-rectal dans le département de la Haute-Garonne. Bilan de deux années d'enregistrement (1982-1983).

During a two-year period ending in 1983, 882 colorectal cancers (CRC) were diagnosed among 820,000 residents in the department of Haute-Garonne (France). The age-standardized incidences were 24.3 and 19.1 per 100,000 in men and 15.2 and 9.5 per 100,000 in women, for colon and rectal carcinomas respectively. The Haute-Garonne population-based registry showed one of the highest rates of risk of CRC in Europe. A relatively high incidence of rectal cancer, a marked male preponderance particularly in left-side colon cancers, and a higher mean age in female patients (67.1 +/- 11.6 and 70.2 +/- 11.9 (p less than 0.001] was observed. Distribution of CRC within the department was heterogeneous. Although there was no significant difference between urban and rural areas, some regions showed a higher incidence (the "Volvestre" in both sexes and the "Riviere" in women) whereas the "Pyrénées Centrales" showed a lower incidence in women only. CRC was often diagnosed at an advanced stage (Dukes A: 26.1 p. 100, Dukes B: 22.2 p. 100, Dukes C: 27.4 p. 100, visceral metastases: 24.4 p. 100 especially in women (p less than 0.02). Among symptom-free patients (4.5 p. 100) cancers limited to the colonic wall represented 71.4 p. 100 of cases. This suggests that prognosis of CRC could be improved by routine screening of healthy populations. Surgery was performed in 91 p. 100 of colonic cancers and 85 p. 100 of rectal cancers but was considered to be curative in only 55 p. 100 of all cases.