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Anass M. Majbar, Amine Benkabbou, Raouf Mohsine, Amine Souadka

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VI, n 3, February 2020; Pages: 724-733;

Abstract:

The COVID 19 outbreak has caused the cancellation of most elective oncological surgery around the world to limit the risk of virus dissemination. As we are exiting the crisis, surgical teams will face strong challenges while resuming normal elective surgery. The accumulation of cases will have to be managed by defining strong selection criteria, taking into account the patient and the disease conditions. In order to reduce the risk of infection, non-COVID patients should be treated in dedicated non-COVID areas, preferably in separate buildings or hospitals. Departments, units and operative theaters should put in place rigorous actions and protocols to protect the patient and healthcare workers. Adequate protective equipment must be readily available for healthcare workers and patients. Finally, teams should keep an adaptive mindset by preparing strategies to maintain surgical activity in case of repeated COVID 19 waves.

Keywords: COVID 19, Guidelines, Lockdown ease, Surgical oncology



Chaimae Charoui, Amine Souadka, Saber Boutayeb, Rachida Latib, Laila Rifai, Laila Amrani, Amine Benkabbou, Raouf Mohsine, Mohammed Anass Majbar

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VII, n 1, June, 2020. Pages: 764-769

Abstract:

Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.

Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients’ point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).

Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.

Keywords: Decision making, Quality improvement, Multidisciplinary concertation meeting, MDT-MODe, Morocco



Imad Marzak, Mohammed Anass Majbar, Kholoud Houssaini, Amine Benkabbou, Amine Souadka, Raouf Mohsine, Mohamed Raiss, Abdelmalek Hrora

Journal of Medical and Surgical Research. Volume 6, Pages 697-701

Abstract:

Background: Over 20 million inguinal hernia repairs are performed in the world every year. These repairs require the use of various techniques. In Morocco, there is a prominent disparity in terms of types of structure, human assets and available equipment, patient selection, and perioperative management protocols. The goal of this study was to audit the results of the surgical treatment of inguinal hernia repairs in adults in Morocco.

Methods: This nationwide cross-sectional prospective study has been conducted by the Moroccan Society of Surgery (la Société Marocaine de Chirurgie) and the Moroccan Society of Digestive Surgery (la Société Marocaine de Chirurgie Digestive). It included male patients aged 18 and above, with an inguinal hernia that has been clinically diagnosed by a surgeon and repaired during the recruitment phase that extends over a period of 30 days. The measured variables consist of the anesthesia type, preoperative antibiotic treatment, surgical technique, length of in-hospital stay and intraoperative and postoperative complications up to 30 days.

Results: The response rate of the survey was 88.78% which led to the study of 95 cases. 12 patients (12.6%) received general anesthesia , 82 patients (86,3%) regional anesthesia , and 1 patient (1.1%) local anesthesia. No prophylactic antibiotics were prescribed to 14.7% of the patients while they were systematically administered to 84.2% of the patients at the induction, and a few days prior to surgery for one patient. Various approaches were used to repair the inguinal hernia. 83.2% of the patients were operated with the Lichtenstein technique. Laparoscopic transabdominal preperitoneal approach (TAPP) was performed on 11.6% of the patients. Outpatient surgery was performed on 2.1% of the patients. 12 patients developed a postoperative seroma, of which 5 patients were operated using laparoscopic TAPP. Only 2 patients previously operated using the Lichtenstein open mesh repairs have developed a postoperative hematoma. 1 patient (1.1%) died postoperatively.

Conclusion: This study showed disparities in the perioperative management of inguinal hernia in Morocco. Potential improvement opportunities were determined through the conducted nationwide study. In this regard, scholarly societies could play a significant role by programming ongoing training sessions, with the aim of sensitizing surgeons to the best practice of inguinal hernia repair.

Keywords: Inguinal Hernia, laparoscopic Repair, Lichtenstein Repair, Morocco, Surgical Audit

 

 



Souadka A, Majbar MA, Essangri H, Amrani L, Benkabbou A, Mohsine R, Souadka A.

J Surg Oncol. 2020 Jun 20. doi: 10.1002/jso.26074. Online ahead of print.

Abstract

Background and objectives: Pseudocontinent-perineal colostomy (PCPC) following abdominoperineal resection (APR) is a promising technique associated with good quality of life. This study evaluates over time the functional results after PCPC using the Kirwan score.

Methods: All PCPC patients operated on from January 2001 to January 2016 were followed with their functional results assessed at four checkpoints. A/B Kirwan scores and a 48 to 72 hours colonic irrigation rhythm were considered « good » and « convenient » and their overall variations over time were assessed by means of Cochran’s Q test corrected by Bonferroni post hoc test.

Results: Fifty-seven eligible patients were included in the study with 33 (58%) women. We noted a significant difference in both Kirwan score and colic irrigation rhythm during the four checkpoints in follow-up with Q(1) = 85.01 and Q(2) = 69. 86. By the fourth checkpoint, 86% of patients had a Kirwan score of A/B. Concerning the rhythm of colonic irrigation, there was a significant improvement between 6 months and other checkpoints. In the second year, 63% of patients reduced their colonic irrigation rhythm.

Conclusions: The functional results of PCPC after APR improve and stabilize from 6 months to 1 year after surgery thus making PCPC a good alternative that surgeons can present to their patients.

Keywords: Kirwan score; Schmidt’s technique; abdominoperineal resection; pseudocontinent-perineal colostomy; rectal adenocarcinoma.



Souadka A, Benkabbou A, Majbar MA, Essangri H, Amrani L, Mohsine R, Ghannam A, El Ahmadi B, Belkhadir Z.
Oncologist. 2020 Jun 14:10.1634/theoncologist.2020-0360. doi: 10.1634/theoncologist.2020-0360.

Abstract

The COVID‐19 pandemic has overwhelmed health system capacity and affected cancer centers worldwide. This letter to the editor proposes the need to prepare for a long‐lasting battle.



GlobalSurg Collaborative

BJS Open. 2019 Feb 28;3(3):403-414. doi: 10.1002/bjs5.50138. eCollection 2019 Jun.

Abstract

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.

Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.

Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).

Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.


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