ABSTRACT
Despite the establishment of effective medical therapies in peptic ulcer disease, gastric outlet obstruction remains one of the most common health problem in Tunisia. Various operations have been attempted, which may lead to postoperative morbidity. Gastrointestinal [GI] motility dysfunction is the most common complications. To determine the predictive factor of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis. Methods: We carried out a retrospective study to evaluate the postoperative recovery of the motility of the upper gastrointestinal tract after gastrojejunostomy for peptic ulcer stenosis. During the 9- year study, 138 patients underwent operations for ulcer peptic stenosis. Among the patients, 116 [84,1%] were treated with gastrojejunostomy. Descriptive statistics, univariate and multivariate analyses were performed. The mean age of patients was 47.85 years [range: 19- 92years] and most. Were male [84, 5 %]. Ninety two [79.3%] patients had a documented history of peptic ulcer disease. The duration of symptoms ranged from 10 to 372 days [mean: 135.86 days]. Eighty two [71%] patients were operated on through laparotomy. Laparoscopic procedure was performed in 29% of the patients. There was no operative mortality. Perioperative morbidity occurred in 12.4% [14 patients]. Gastrointestinal motility dysfunction occurred in 12 patients [10.3%]. It was treated by nasogastric aspiration and prokinetics. By univariate analysis; diabetes [0,010], cachexia [0,049], ASA class [0.05] were all statistically associated with gastrointestinal motility dysfunction in this series. Multivariate logistic regression analysis [table 2] showed that the cachexia [0,009], ASA class [0.02] were the main predictors of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis in the followed patients. Gastrointestinal motility dysfunction is the most common complications after gastrojejunostomy for pyloric adult stenosis. Surgery must be preceded by careful medical preparation. It is more likely to occur in patients with an ASA class 2 or greater. Those patients should be considered for other treatment options, such as endoscopic balloon dilation
ABSTRACT
The hepatic artery is prone to numerous anatomic variations dictated by certain variables of the organogenesis. To research study the anatomic variations of the hepatic artery as well as their implications within surgical practice. Study of a post-mortem series of 33 cases of dissection of the hepatic pedicle with fresh corpses [deaths amounting no longer than 24 hours], carried out in conditions that are quite close to those met with the living ones. The common hepatic artery was divided at the foot of the hepatic pedicle into a gastro duodenal artery and into a proper hepatic artery in 94% of the cases. In 6% of the cases, we noticed a three level change, a branching of the average hepatic artery into a gastro duodenal artery, a right hepatic artery and a left hepatic artery. The proper hepatic artery represented the pedicle segment of the hepatic artery in 94% of the cases. In 36% of the cases, the liver was irrigated by two hepatic arteries. In 12% of the cases, there was the matter of the right hepatic artery, branch of the mesenteric artery. In 24% of the cases, there was the matter of the left hepatic artery branch of the left gastric artery. The perfect knowledge in preoperative and preoperative stages of the anatomic variations of the hepatic pedicle is quite essential. Actually, the lack of knowledge of these variations exposes to the risk of certain complications which are sometimes deadly during hepatic transplants, pancreatic surgery, cholecystectomies, through laroscopic way as well as in the treatment of gastro-esophagus surging