Laparoscopic liver resection: initial experience in a north-african single center

Background: Over past decades laparoscopic liver resection [LLR] has gained wide acceptance among hepatobiliary surgeons community. To date, few data are available concerning LLR programs in developing countries. This study aimed to assess feasibility and safety of LLR in a Moroccan surgical unit

Methods: From June 2010 to February 2013, patients that received LLR were identified from a prospective "liver resection" database and included in this study. Parenchymal transection was performed using Harmonic scalpel and bipolar clamp with no Intraoperative ultrasound use or systematic pedicle clamping. LLR difficulty was categorized into 3categories according to Louisville-statement [I-III]. Demographic informations, liver lesion informations, operative details, pathological tumor-margin and 1-months postoperative morbidity according to Clavien-Dindo[C-D] classification were analyzed

Results:Among 104 patients who underwent liver resection 13[12,5%] had LLR. There were 7 females and 6 males with mean age of 57,5 +/- 17 years. LLR was performed for benign lesions in 3 cases and malignant ones in 10 [77%] patients: hepatocarcinoma in 7 patients and synchronous rectal-liver metastasis in 3 patients. Lesions were solitary in 12 [92%] patients with median size of 50mm [15mm-150mm]. Patients with liver metastasis received combined laparoscopic rectal and liver resection. We used pure laparoscopic approach in 12 [92%] patients and hybrid one in 1 patient. LLR difficulty was category I, II and II in respectively 3[23%], 6[46%] and 4[31%]patients. Conversion rate to open liver resection was 15%. Mean blood loss was 395min +/- 270min with no hepatic pedicle clamping or peroperative blood transfusion. All resections were tumorfree margin. Mortality rate was nil and morbidity occurred in 4[30%] patients: ascites [C-D 2] and pelvic sepsis in combined resections [CD 3b]. Median hospital stay was 6 days

Conclusion: Laparoscopic liver resection in our context is safe in selected patients, since no operative mortality, blood transfusion requirement or palliative resection was recorded and liver related morbidity rate was low. Intraoperative ultrasound liver examination capacities are mandatory to improve laparoscopic liver resection program's quality and extend indications

[Surgical management of bilateral pheochromocytoma]

The aim of this retrospective study was to assess our experience in surgical management of bilateral pheochromocytoma [BP] and to report diagnosis methods and therapeutic results of a series of 10 patients treated in "surgical clinique A" department. From 1986 to 2005, we studied all cases of histological confirmed BP in their clinical, biochemical and radiological aspects. We analyzed all of therapeutic attitudes suggested and their results Ten patients underwent adrenalectomy for BP: 6 men and 4 women with age average of 37, 1 [13-60]. Eight of them were synchronous BP versus two metachronous ones. Eight patients were symptomatic. One of them had a Von Hippel Lindeau syndrome and 2 others had a familial form of BP. For the two asymptomatic cases: the first one was an incidentaloma and the second one was discovered in a MEN IIb screening. As a primary biochemical diagnostic measure, the determination of the excretion rate of cathecholamine in the 24h urine was high among 6 patients. The ultrasonic imaging and CT scaning were done to localize the tumor site. The surgical treatment consisted in a bilateral adrenalectomy in one phase for 5 patients and in two phases for the 5 others [one double laparoscopy]. An enucleating of a pancreatic nodule was an associated act practiced on a patient. Perioperative incidents were related in heart rythme dysfonctions, crises of hypertension among 6 patients and a cardiac arrest rehabilitated. In postoperative phase we assess a death case of sepsis chock, an acute adrenal insufficiency, an acute pancreatitis and a liver metastasis one year after the adrenalectomy. All patients were under hydrocortisone [30mg] for life. Bilateral adrenalectomy is the basic treatment of a BP. A familial screening must be systematically carried out. Laparoscopic adrenalectomy has good results

[Isolated tuberculosis of pancreas and peripancreatic lymph nodes: diagnosis challenge]

Isolated tuberculosis of pancreas and peripancreatic lymphnodes is very rare and difficult to recognise. It may mimic pseudocyst, cystic tumor or carcinoma of pancreas and lead to unusefull and potentially morbid surgery. We report 3 cases diagnosed in peropeative and postoperative situations. Thirty four- year-old and 50-year-old women presented with obstructive jaundice. Abdominal CT scan showed resecable head of pancreas tumour. In first patient, peroperative biopsies suggested tuberculosis and resection was avoided. The second patient underwent Whipple procedure. Third case was a 48-year-old alcoholic man who presented with recent history of painful mass of left hypochondre. Cystic tumor of pancreas tail and pseudocyst were suggested in CT scan. En bloc resection of tumor, pancreas tail and spleen was performed. The three patients had antitubercular therapy after histological confirmation of pancreatic tuberculosis. Follow-up is respectively 3 years, 5 months and 2 years free of recurrence. Radio or echoendoscopical fine needle ponction can contribute to the diagnosis. Surgery remains the main treatment of complications [fistulas, bleedings, obstructions] and the last diagnosis option. Tuberculous origin of an isolated pancreatic mass may be suspected in young people and immunocompromised especially in endemic areas