Prognostic factors in gastric carcinoma after R0 resection with DH lymph node dissection. Tunisian experience

Curative resection with adequate lymph node dissection is the treatment of choice for gastric cancer. To determine the prognostic factors after R0 resection with DII lymph node dissection. We retrospectively assessed 126 patients who underwent R0 resection with DII lymph node dissection for gastric cancer [excluding the upper third of the stomach] in a single institution between 1991 and 2006 with median follow-up of 38.5 months [6 - 219]. Prognostic factors were assessed by Cox proportional hazard model. There were 45 women and 81 men. The median age was 60 years [21 - 87]. Four patients died [3.2%]. Postoperative hospital morbidity was 16.7%. The pathologic review of the slides revealed that 50% of the tumors were stage T3 [63 cases]. The median number of lymph node removed was 11 [8-40], 50% were involved. Five and 10 years survival rates were respectively 56.9% and 40.2%. In multivariable analysis, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were found to be independent prognosis factors. After R0 resection with DII lymphadenectomy, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were independent predictive factors for survival

Acute peritonitis complicating Crohn's disease: epidemiologic and physiopathological characteristics

An uncommon event in the natural course of Crohn's disease is the spontaneous perforation. It's the most serious intestinal complication. To report the incidence of this complication and to discuss the mechanism of the perforation. We report, retrospectively, 4 cases [3 men and one woman; median age: 30 years] of peritonitis complicating Crohn's disease and study their clinical characteristics intra operatively findings and course evolution. Steroid therapy was administrated to all patients before the perforation. The perforation sites are on the ileum in three cases and on the jejunum in one case. The treatment consists in a resection of the perforated intestine with stoma in all cases. Perforation in Crohn's disease is a rare event. The exact mechanism of the perforation is still unknown and many hypotheses are presented

[Anatomic variations of the hepatic artery: a study of 33 cases and review]

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

[Laparoscopic appendicectomy versus conventional appendicectomy prelliminary results of a retrospective comparative study]

The value of laparoscopic surgery in appendicitis is not established. Studies suffer from many controversies. The aim of this study is to compare the safety and benefits of laparoscopic versus open appendectomy in patients with clinically non complicated acute appendicitis. One hundred thirty nine patients wore analyzed retrospectively following either laparoscopic or open appendectomy. We excluded peritonitis, appendicular abscesses and patients with history of digestive surgery. The main outcome measures wore operative duration, postoperative complications and length of hospital stay. There was no mortality. The overall complication rate was similar in both groups [13,9%versus 7,4%in the laparoscopic and open groups respectively p=0,22]. Operating duration was significantly longer in the laparoscopic group [62 minutes versus 40 minutes p=0,001] while there was no difference in length of stay. Laparoscopic appendectomy did not offer a significant advantage over open appendectomy in acute non complicated appendicitis. The choice of the procedure should be based on surgeon or patient preferences

Traitement medico-laparoscopique du kyste hydatique du foie mythe ou realite! Resultats preliminaires. a propos de 27 cas

The laparoscopic treatment of hydatic cyst of the liver is at present condified. These last years, several progresses were obtained in the laparoscopic approach of hydatic cyst by avoiding the risk of preoperative hydatic peritoneal scattering. The aim of this study is to evaluate the effect of albendazole given before a laparoscopic management of the hydatic cyst of the liver