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
Despite the growing number of therapeutic methods and the recent introduction of new drugs more active in the therapeutic arsenal, lesions of the ano-perineal Crohn's disease remains difficult to support. Hyperbaric oxygen [HBO] was made before the era of infliximab, an interesting therapeutic approach in which the current position remains unclear. To assess HBO efficacy in the treatment of anal fistulas refractory Crohn's disease. Literature review. Hyperbaric oxygen therapy was used in the 90's when the biotherapy was not part of the armamentarium for Crohn's disase. Research conducted has identified only nine publications evaluating the efficacy of hyperbaric oxygen therapy in the treatment of anal fistulas refractory Crohn's disease. Among the nine publications, we have retained only four: two clinical trials and two clinical cases. The total number of patients was 22: 12 women and 10 men. The average age of patients was 37 years. The average number of session was 42 sessions. Remission was observed in 15 patients [68.18%] whereas with Infliximab rate is 66%. Adverse events were observed in 2 patients [16.6%]. Indeed, instead of considering them as two different alternatives, it should be combined to obtain a synergy to increase response rates, shorten the healing and especially to decrease the recurrence rate. Only a prospective randomized controlled trial [with two arms: biotherapy versus biotherapy associated with hyperbaric oxygen therapy] could accommodate this technique in the armamentarium of perineal lesions of Crohn's disease