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COVIDSurg Collaborative Co-authors.

Br J Surg. 2021 Jul 6:znab183.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score ( Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Elias D(1), Souadka A, Fayard F, Mauguen A, Dumont F, Honore C, Goere D.

INTRODUCTION: The prognosis of peritoneal carcinomatosis (PC) is highly dependent on the extent of the PC. This extent is calculated by the peritoneal cancer index (PCI). In the future, the indications for complete cytoreductive surgery (CRS) +  hyperthermic intraperitoneal chemotherapy (HIPEC) should be partially based on the PCI. This raises the question of the concordance between the PCI scores calculated by different surgeons, and a possible variation before and after CRS.

OBJECTIVE: To analyze variations in the PCI score between surgeons and according  to when it is determined (before and after surgery).

PATIENTS AND METHODS: Prospective recording of the PCI score independently calculated by senior and junior surgeons, before CRS (when the surgeon decided to perform this procedure), and after CRS, in 75 consecutive patients. A concordance analysis was conducted.

RESULTS: The origins of the PC were colorectal (n = 38), pseudomyxoma (n = 22), mesothelioma (n = 8) and miscellaneous lesions (n = 7). Concordance between the PCI score was very high (close to 90%) among the senior surgeons and junior surgeons before and after CRS. After CRS, the mean PCI score increased by 1.75 (IC-95%: 2.09-1.41). This high concordance was similar whatever the level of the  PCI score and whatever the origin of the tumor.

CONCLUSION: The PCI is a reliable tool for measuring the extent of PC. It is easy to use and inter-surgeon concordance is high. It increases by approximately 2 before and after CRS.

DOI: 10.1016/j.ejso.2012.01.001

PMID: 22281154  [Indexed for MEDLINE]

Eur J Surg Oncol. 2012 Jun;38(6):503-8. doi: 10.1016/j.ejso.2012.01.001. Epub 2012 Jan 26.

Majbar MA, Majbar Y, Benkabbou A, Amrani L, Bougtab A, Mohsine R, Souadka A.

Background: The learning environment is one of the most influential factors in training of medical residents. The Dutch Residency Educational Climate Test (D-RECT) is one of the strongest instruments for measuring the learning environment. However, it has not been translated in French. The objective of this study is the psychometric validation of the DRECT French version.

Material and methods: After translation of the D-RECT questionnaire into French, residents of five Moroccan hospitals were invited to complete the questionnaire between July and September 2018. Confirmatory factor analysis was used to evaluate the validity of the construct using the standardized root mean square residual (SRMR), the root mean square error approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker- Lewis Index (TLI). Reliability analysis was analysed using Internal consistency and Test-retest.

Results: During the study period, 211 residents completed the questionnaire. Confirmatory factor analysis showed an adequate model fit with the following indicators: SRMR = 0.058 / RMSEA = 0.07 / CFI = 0.88 / TLI = 0.87. The French translation had a good internal consistency (Cronbach alpha score > 0.7 for all subscales) and a good temporal stability (correlation score between two measurements = 0.89).

Conclusion: This French version has an acceptable validity of the construct, a good internal consistency and good temporal reliability, and may be used to evaluate the learning climate. Additional research is necessary in other French-speaking contexts, in order to confirm these results.

Benkabbou A(1), Castaing D, Salloum C, Adam R, Azoulay D, Vibert E.

Author information:

(1)AH-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.

BACKGROUND: Roux-en-Y hepaticojejunostomy (RYHJ) is the most well-accepted treatment for most post-cholecystectomy bile duct injuries (BDI). RYHJ failure is a complex situation that requires expert planning and the possibility of using a  combination of operative, radiologic, and endoscopic techniques. The aim of this  study was to report our experience with a multidisciplinary approach to failed RYHJ after post-cholecystectomy BDI.

METHODS: Between January 1996 and March 2008, 44 consecutive patients were managed for RYHJ failure in our department. They presented with recurrent cholangitis in 40 patients (91%) and/or jaundice in 9 (20%). First-line treatment consisted of primary revisionary surgery in 26 cases (59%; repeat RYHJ in 22 and  hepatectomy in 4) and a percutaneous approach in 18 cases (41%; biliary interventions in 16 and portal vein embolization in 2).

RESULTS: Postoperative mortality was nil. Postoperative morbidity was 11% after repeat RYHJ without hepatectomy, 80% (bile leaks) after hepatectomy, and 10% (mild cholangitis and hemobilia) after a percutaneous approach. Delayed revisionary surgery with the intent to wait for bile duct dilation failed in all  5 patients. With a mean follow-up of 49 ± 40 months, second- or third-line treatment was attempted in 7 patients (16%). One patient (2%) died because of suicide. Overall clinical success defined by the absence of incapacitating biliary symptoms after treatment was achieved in 39 patients (89%).

CONCLUSION: An immediate, multidisciplinary approach including repeat biliary surgery and/or a percutaneous approach in a tertiary hepatobiliary center is required to obtain good, long-term results when treating the failure of RYHJ post-cholecystectomy BDI.

Copyright © 2013 Mosby, Inc. All rights reserved.

DOI: 10.1016/j.surg.2012.06.028

PMID: 23044267  [Indexed for MEDLINE]

Surgery. 2013 Jan;153(1):95-102. doi: 10.1016/j.surg.2012.06.028. Epub 2012 Oct 6.

Messager M(1), Lefevre JH, Pichot-Delahaye V, Souadka A, Piessen G, Mariette C; FREGAT working group – FRENCH.


Collaborators: Arnaud JP, Balon JM, Bonnetain F, Borie F, Brachet D, Brigand C, Carrere N, D’Journo XB, Dechelotte P, Delpero JR, Dhari A, Fabre S, Fernandez M,  Flamein R, Gillet B, Glaise A, Glehen O, Goéré D, Guilbert M, Guiramand J, Hebbar M, Huten N, Kraft K, Leteurtre E, Louis D, Mabrut JY, Mathieu B, Meunier B, Michalak S, Michot F, Millat B, Paye F, Peschaud F, Pezet D, Pocard M, Poisson A, Prudhomme M, Regimbeau JM, Thiébot T, Thomas PA, Tsilividis B, Vandois F.


Author information:

(1)Department of Digestive Surgery, Angers University Hospital, Angers, France.


OBJECTIVE: The aim of this retrospective study was to evaluate the survival impact of perioperative chemotherapy (PCT) in patients with gastric signet ring cell (SRC) adenocarcinoma.

BACKGROUND: PCT is a standard treatment for advanced resectable gastric adenocarcinoma (GA). SRC has a worse prognosis compared to non-SRC and the chemosensitivity of SRC is uncertain.

METHODS: Among 3010 patients registered in 19 French centers between January 1997 and January 2010, 1050 (34.9%) were diagnosed with SRC. Of those treated with curative intent (n = 924), 171 (18.5%) received PCT with surgery (PCT group), whereas 753 (81.5%) were treated with primary surgery (S group). PCT was based mainly on a fluorouracil-platinum doublet or triplet regimen.

RESULTS: The groups were comparable regarding age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, tumor location and cTNM stage. 60 patients did not undergo resection because of tumor progression (10) or metastases (50) found at operation. The R0 resection rates were 65.9% and 62.3% in the S and PCT groups, respectively (P = 0.308). Fewer patients received adjuvant chemotherapy in the S group than in the PCT group (35.2% vs. 66.5%, P <  0.001). At a median follow-up of 31.5 months, the median survival was shorter in  the PCT group (12.8 vs. 14.0 months, P = 0.043). On multivariate analysis, PCT was found to be an independent predictor of poor survival (HR = 1.4, 95% CI 1.1-1.9, P = 0.042).

CONCLUSIONS: PCT provides no survival benefit in patients with gastric SRC. Clinical record: ADCI001, Clinical identifier NCT01249859.


DOI: 10.1097/SLA.0b013e3182352647

PMID: 22005144  [Indexed for MEDLINE]


Ann Surg. 2011 Nov;254(5):684-93; discussion 693. doi: 10.1097/SLA.0b013e3182352647.

2017 and 2015 European Society of Coloproctology (ESCP) collaborating groups.

 2018 Sep;20 Suppl 6:69-89. doi: 10.1111/codi.14371.



Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice.


Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V.


Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001).


Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection.

PMID: 30255643 / DOI: 10.1111/codi.14371

Benkabbou A(1), Afifi R(2), Souadka A(3).


Author information:

(1)Mohammed V University in Rabat, Faculty of Medicine, Surgical Department, Rabat, Morocco.

(2)Mohammed V University in Rabat, Faculty of Medicine, Surgical Department, Rabat, Morocco; Medical Department, Ibn Sina University Hospital, Rabat, Morocco.

(3)Mohammed V University in Rabat, Faculty of Medicine, Surgical Department, Rabat, Morocco. Electronic address:


DOI: 10.1016/j.surg.2016.03.025

PMID: 27216832  [Indexed for MEDLINE]


Surgery. 2016 Sep;160(3):818-20. doi: 10.1016/j.surg.2016.03.025. Epub 2016 May 20.

GlobalSurg Collaborative.

 2018 May;18(5):516-525. doi: 10.1016/S1473-3099(18)30101-4. Epub 2018 Feb 13.



Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.


This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN’s Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with, number NCT02662231.


Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).


Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.

PMID: 29452941 / PMCID: PMC5910057 / DOI: 10.1016/S1473-3099(18)30101-4

Benmansour A(1), Laanaz S(2), Bougtab A(1).


Author information:

(1)Department of Surgical Oncology, National Institute of Oncology, Rabat, Morocco.

(2)Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.


The Stewart-Treves syndrome was first described in 1948, it’s an angiosarcoma developed on a longstanding lymphadenomatous limb, more often after radical mastectomy. Diagnosis is made on skin biopsy and the prognosis is poor when radical surgery can’t be performed. We report the case on a Stewart-Treves syndrome in a sixty-six years old woman who underwent radical mastectomy for breast carcinoma ten years earlier. Surgery was not feasible at the time of diagnosis, and we lost touch of the patient even if chemotherapy was decided. Radical surgery is the best treatment to date for this rare disease.

Conservative surgery with adjuvant radiotherapy is also possible. Systemic chemotherapy is reserved for locally advanced unresectable and metastatic forms. We advocate long term follow-up for every post mastectomy lymphedema to diagnosis this fatal disease when curable.


DOI: 10.11604/pamj.2014.19.2.4178

PMCID: PMC4282868

PMID: 25574331  [Indexed for MEDLINE]


Pan Afr Med J. 2014 Sep 1;19:2. doi: 10.11604/pamj.2014.19.2.4178. eCollection 2014.


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