[ lithiasic acute cholecystitis: laparoscopic treatment [about 106 cases]]

Summary To assess the feasibility and the advantages of the coelioscopy in the treatment of the acute cholecystitis. From January 1996 to December 2001, 106 laparoscopic cholecystectomies for acute cholecystitis have been collected. The diagnosis of acute cholecystitis has been confirmed for all cases by the pathologic exam. These 106 cases represent 12.4% of the set of the laparoscopic cholecystectomies practiced during the same period of survey. They are 78 women and 28 men. The mean age was 51.7 years. Eight patients [7.6%] presented an elevated operative risk [ASA III]. The diagnosis of acute cholecystitis has been kept before operation in 45.3% of the cases. Major or minor intraoperative incidents have been observed in 18.9% of the cases. The rate of conversion was 17%. The reasons are dominated by the difficulties of dissection in 10 cases [55.5%] and hemorragea in 6 cases. The research of the predictive factors of conversion found 5 factors, the hyperleucocytosis, the operative delay superior to 72 hours, the adhesions around the gallbladder, the gangrenous gallbladder and the pediculitis. The post operative mortality was nul. The morbidity rate was 12.3%. Among the 13 patients who had postoperative complications, 8 were after conversion. These results showed that the laparoscopic cholecystectomy for acute cholecystitis is an effective and good alternative with acceptable morbidity that should decrease with learning curve

[Epidemiological, etiological and evolutionary aspects of children cirrhosis in a develping country: Experience of the pediatric department of SFAX University hospital, Tunisia]

Cirrhosis is rare in pediatrics. The children cirrhosis is particular by the ascendancy of biliairy cirrhosis and cirrhosis due to an innate error of metabolism and by the relative frequency of the cases where an etiological treatment is possible. However in developing countries, the children cirrhosis still put problems of etiological diagnosis and of therapeutic coverage. To study epidemiological and etiological particularities, therapeutic modalities and outcome of cirrhosis in the sooth of Tunisia. We led a retrospective study over 15 years [1990-2004] having allowed to depict 71 cirrhotic children followed in the service of general pediatric department of SFAX University hospital [Tunisia]. Our patients divide up into 36 girls and 35 boys. The age of revelation of the disease was variable [15 days to 15 years]. Jaundice and hepatomegaly were the most two clinical signs frequently found in the clinical exam. On the etiological plan, biliairy cirrhosis [Extra hepatic biliary atresia, dilatation of choledocal cyst, progressive familial intrahepatic cholestasis...] were the most frequent [40%] followed by metabolic cirrhosis[tyrosinemia type I, Wilson disease...] [17%] and post-hepatitic cirrhosis [17%]. In 27%of cases, no etiology was found. Besides the symptomatic treatment, an etiological treatment was tempted in some cases. No patient benefited from hepatic transplantation. The follow-op of the children cirrhosis was grave becaose 30 children [42%] died, 19 children are lost-sight and 22 children [31%] are still alive. The children cirrhosis pose still in our country of the problem of etiological diagnosis because of the not availability of some specific additional exams and especially problems of coverage for lack of a program of hepatic transplantation