[ 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

[Complications of the Meckel's diverticulum, about 42 cases]

Our aim was to report the main complications of the Meckel's diverticulum. Our retrospective study concerns 42 cases of complicated Meckel's diverticulum, collected during one period of 18 active years from January 1988 to December 2005. The yearly impact is 2, 33 cases / year. We excluded the asymptomatic Meckel's diverticulum, of fortuitous discovery during intervention. The middle age of our patients is 25 years, with extremes going from 2 to 74 years. The sex-ratio is 3, 2. The diagnosis before intervention of the complicated Meckel's diverticulum was not evoked in any time. The clinical features were an acute intestinal closure in 22 cases, an appendicitis in 13 cases, an appendicular peritonitis in 6 cases, and an acute intestinal intussusceptions in one case. In any case, it is the surgical exploration that permitted to confirm the diagnosis of a complicated Meckel's diverticulum. The approach way was median in 27 cases, Mac Burney in 13 cases, and laparoscopic in 2 cases. The surgical exploration showed peritonitis in 16 cases, one diverticulitis in 23 cases, an acute intestinal intussusception in one case, a tumour in one case, and haemorrhagic diverticulum's ulcer in one case. The treatment consisted in a segmental resection of ileum with end to end anastomosis [37 cases] and a cuneiform resection [5 cases]. The histological exam showed heterotopy of gastric tissue in 12 cases, of pancreatic tissue in two cases, and a Burkitt's lymphoma on a diverticulum in one case. We noted a precocious death following a septic shock. The Meckel's diverticulum constitutes a most common benign malformation of the digestive tube. The prognosis is related extensively to the gravity of its complications that can benefit, not only of the contribution of the laparoscopic diagnosis, but also therapeutic

results of Laparoscopic treatment of the gallbladder lithiasis about 500 cases

Laparoscopic cholecystectomy is at present the gold st and ard treatment of gallbladder lithiasis. Assesment of Laparoscopic cholecystectomy. Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepatobiliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases [4.6%], a conversion was necessary for different causes. We noted 11 surgical complications [2.2%] among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death

acute hyperlipemic pancreatitis [2 cases]

The aim of this work was to study the clinical and therapeutic features of this affection. Our retrospective study concerned two cases of hyperlipemic pancreatitis treated during 6 years from 1998 to 2003. The incidence of this affection was 1.42%. Our patients were respectively a man aged 32 years without any significant history and a pregnant woman aged 24 years with a positive history of dyslipidemia. Clinical, biologic and radiological data didn't differ from those of other causes of acute pancreatitis. The hyperlipemic origin was confirmed by a lactescent serum and a rate of triglycerides greater than 10 g/1. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/1. Plasmapheresis and administration of heparin and/or insulin seem to be efficient in reducing the serum level of triglyceride and in improving the course. Hygieno-dietary measures and hypolipemiant treatment were necessary for the level of triglyceirdes in serum below 10 g/1. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. the clinical pattern of acute hyperlipemic pancreatitis doesn't include any specific elements, but its treatment and prevention must take into account the associated hyperlipidemia

[Retro-Peritoneal liposarcoma. About 5 cases and revue of literature]

Liposarcomas are malignant mesenchymatous tumors developed from elements constituting the greasy tissue in various stages of differentiation. It is one of the most frequent mesenchymatous sarcomas. Retro-peritoneum is a privileged site of development in 12 to 15% of cases. During 9 years, from 1994 till 2002, we have colligated and operated 5 cases of retro-peritoneal liposarcomas. Average age was 50 years [extremes 34 to 79 years] with a sex-ratio of 1.5. Diagnosis was late beyond 6 months. Abdominal pain and the appearance of an enormous mass [20 cm] were the revealing signs. No imagery method allowed to evoke the diagnosis. The cyto-puncture realized once, was not able to determine with precision the histological type. Immunohistochimy occupies nowadays an important place to classify a sarcoma. Large surgical resection realized in 5 cases did not allowed the complete ablation of the tumour in 3 cases considering the advanced loco-regional extension, which was at the origin of 3 recurrencs. Well differentiated histological type was noted in 3 cases, myxoid type in a case and not differentiated type in a case

[Late post-operative adhesive small bowel occlusions. About 258 cases]

This retrospective study reports a series of 258 patients operated on for late developing post-operative adhesive occlusions. The impact of anterior interventions on these occlusions. The impact of anterior interventions on the occlusions as well as the clinical and paraclinical patterns are discussed before any approach to the different therapeutic aspects of this complication. Previous surgery had an impact not by number of the operations performed [80% of patient had undergone only one intervention on the pelvis or abdomen] but essentially by the nature of the operations since most of the adhesions occurred following surgery on the appendix. The diagnosis should be made urgently on basis of findings yielded by physical examination and plain abdominal x-rays [ct-scan of the abdomen is hardly indicated for the absence of hydroaeric levels on the plain abdominal film does not definitely exclude the strangulation]. Laparoscopic adhesiolysis an adequate treatment in case of a single adhesion. This laparoscopic is an adequate treatment in case of a single adhesion. This laparoscopic procedure practised on 11 patients had to be transformed in 3 cases into an open laparoctomy. Resection rate was 11.6%. Mortality and morbidity rates were 2% and 17% respectively

[pyogenic liver absecesses: a study of 25 cases]

Our aim was to study the anatomo-clinic particularities and the therapeutic modes of the infectious abscesses of the liver. Our retrospective study concerns 25 cases of the infectious abscesses of the liver collected on one period of 12 years from January 1992 to December 2003. They are 11 primitive abscesses and 14 secondary abscesses. We noted 14 women and 11 men, median age was 51,5 years. The Fontan triad was present in 7 cases. A liver mass with an abdominal sensitivity was found in 14 cases. Anomalies in the biologic exam of the liver were present in the 1/3 of the cases. We noted a double right and left localization in 3 cases and a multiple localization in 1 case. The hemoculture and the pyoculture permitted a bacteriological diagnosis in 52%. The percutaneous treatment achieved in 7 cases, permitted the recovery in 2 cases. One dead was noted following a severe cardiopathy. A surgical drainage has been achieved at 22 patients, 4 cases after the failure of the percutaneous treatment. Mortality rate was 20% [5 cases] related to the delay of diagnosis. The gravity of the septic shock, the advanced age and the flaws associated. The infectious abscess of the liver was a serious affection that affects the vital prognosis. The percutaneous treatment associated to the antibiotherapy, is the method of choice in the treatment of the abscesses of the liver. The surgical treatment must be reserved to the failure of the percutaneous treatment

[Fibrocystic mastopathy and Cancer of the breast. About 111 cases]

Objective: Our aim was to identify the predictive factors of degeneration of the fibrocystic mastopathy

Methods: This work is a retrospective survey of I 1 1 observations of isolated fibrocystic mastopathies or associated to a breast cancer among 542 women admitted for tumor of the breast during one period of 13 active years from 1991 to 2003. The diagnosis has been gotten by anatomo-pathologic exam in 95, 5% [106cas] on the operative piece and 4,5% [Scas] on a material of biopsy

Results: The fibrocystic mastopathy represented 30 % of the set of the benign tumors of the breast. They were associated to a breast cancer in 45 cases [40,5%]. The isolated benign fibrocystic mastopathy was observed in 66 cases with a middle age of 37 years. whereas the shapes associated to a breast carcinoma were noted in 45 cases. The middle age was 53 years. The non proliferative fibrocystic mastopathy is the most frequent histological type and repre-sent 54,6 % of the cases. The proliferative form with atypies was observed at 21 women [46,8%]. The carcinoma the more frequently associated to the fibrocystic mastopathy was the infiltrating canalled carcinoma in 91% of cases, with a pre-dominance of the 11 rank [SBR]

Conclusion: The discovery of a mastopathy must search a luteal failure and risk factors of breast cancer notably a proliferative shape of mastopathy with atypies

traumatismes doudeno-pancreatiques, a propos de 14 cas

Through a series of 14 cases brought over a period of 12 years, we realized a retrospective, analytical and descriptive study of these traumata. We aimed to release recommendations to improve their management. It was 2 women and 12 men, whose mean age was 24.4 years [extremes: 50 and 60 years], divided into 10 pancreatic injuries, 2 duodenal injuries and 2 duodeno-pancreatic injuries. Etiology was dominated by traffic accidents 7 cases [50%]. Trauma was closed in 13 cases [92%]. -Associated lesions were present among 13 patients [92%]. The traumatism appeared by an urgent surgical abdomen among 9 patients, secondarily in 3 cases, tardily in 2 cases: a case of deep suppuration 3 months after a traumata treated into ambulatory and a case of persistent ascites after a past unperceived traumata. Abdominal ultrasonography was made among 4 patients. It allowed diagnosing only a case. Scanner was made among 4 patients. It allowed diagnosing all the cases. Only a patient was treated medically, it was a post-traumatic acute pancreatitis. Surgical treatment was made in 13 cases: conservative in 7 cases and radical in 6 cases. Follow-up was complicated in 11 cases [78%] and non-complicated in 3 cases. Mortality rate was 7.1%

[Anastomotic ulcer after vagotomy for duodenal ulcer]

Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients [20 males, 2 females] aged between 26 and 79 years had anastomic ulcer relapses [1.38%] after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases [93%] associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases

Maladie de Crohn intestinale: Aspects chirurgicaux et facteurs predictifs de risque des recidives. A propos de 26 cas

Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. If is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 1 6 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only [23.1%] were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases [46.2%]. The gravity of urgently operated patients burdened the post-operative morbidity in 38-5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated, in our series, we noted that the relapse rate is more frequent with women that with men [42% / 21%], and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick [5/6]. A post-operative medical treatment in the severe forms reduces fhe rate of relapses until 24%

tumeurs mucosecretantes de l'appendice. A propos de 22 cas

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome [73%]. The diagnosis was made pre or preoperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele [12 cases], a mucosal hyperplasia [8 cases] and a cystadenoma [2 caases]. For 5 patients, the diagnosis of peritoneal pseudomyxoma [4 cases] or extraperitoneal [1 case] was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later

Tumeurs carcinoides de l'appendice. A propos de 46 cas

Carcinoid tumors of the appendix are rare. The appendix constitutes the most frequent localization of these tumors. We studied of a retrospective way all cases that had an appendectomy in the service of general surgery of sfax on a period of 7 years going from 1995 to 2001. during this period 9584 patients had an appendectomy in our service. Among which, 46 cases [0.48%] of carcinoid tumor of the appendix have been diagnosed. In more than 95% of cases, patients were admitted due to acute appendicitis; but none of them had the signs of the carcinoid syndrome. The treatment was a simple appendectomy in 44 cases [95%]. The right hemicolectomy was necessary in two cases, because of an invasion of the appendicular base in a case and a tumor greater than 2 cm in the other case. There is no reported case of lymph node or systemic metastasis. The authors discuss data in the literature and analyse the features of the clinical picture, diagnosis, and try to define a convenient attitude of treatment of these tumors