[Laparoscopy for perforated duodenal ulcer: conversion and morbidity factors: retrospective study of 290 cases]

Feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity. Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease

Budd-Chiari syndrome

The Budd-Chiari syndrome is a rare disease, often fatal if not treated optimally. It is characterized by a blocked hepatic venous outflow tract. This review attempted to present pathophysiology, aetiologies,diagnosis and therapeutic modalities of the Budd-Chiari syndrome. Review of literature. Budd-Chiari syndrome is a complex disease with a wide spectrum of aetiologies and presentations. Hematologic abnormalities, particularly myeloproliferative disorders, are the most common causes of the Budd-Chiari syndrome. The clinical presentation is governed by the extent and rapidity of the hepatic vein occlusion. Doppler-ultrasound, computed tomography or magnetic resonance imaging of hepatic veins and inferior vena cava are usually successful in demonstrating non-invasively the obstacle or its consequences. A therapeutic strategy has been proposed where anticoagulation, correction of risk factors, diuretics and prophylaxis for portal hypertension are used first; then angioplasty for shortlength venous stenosis; then Transjugular Intrahepatic Portosystemic Shunt [TIPS]; and ultimately liver transplantation. Treatment progression is dictated by the response to previous therapy. This strategy has achieved 5-year survival rates approaching 70%.Medium-term prognosis depends on the severity of liver disease. The diagnosis of the Budd-Chiari syndrome must be considered in any patients with acute or chronic liver disease. Management of this syndrome should follow a step by step strategy

model of end-stage liver disease [MELD] score in predicting postoperative liver failure after hepatic resection of hepatocellular carcinoma in cirrhotic patients: the Tunisian experience

Hepatocellular carcinoma [HCC] is one of the most frequent cancers in the world. Factors associated with prognosis following resection remain ill defined. The model for end-stage liver disease [MELD] is considered as an index of hepatic functional reserve. This study evaluates the reliability of the MELD score in the prediction of liver failure after hepatic resection for HCC in cirrhotic patients. A retrospective chart review was undertaken of patients with HCC and cirrhosis undergoing hepatic resection between January 1991 and December 2007. A total of 26 cirrhotic patients underwent curative hepatic resection for HCC at our department. Patient information included demographic features, American Society of Anesthesiologists [ASA] class, etiology of cirrhosis, laboratory test results, type of surgical procedure, duration of hospitalization, and Child-Turcotte-Pugh and MELD score. Six patients [23.1%] developed postoperative liver failure. AS much as 66.66% of liver failures were seen in patients who have had major hepatectomy. Using receiver operating characteristic curve analysis, we identified that a MELD score equal to or above 9.5 is the best cut-off value for predicting postoperative liver failure. Patients were divided into two groups: MELD below 9.5 [group A] and MELD equal to or above 9.5 [group B]. The highest prevalence of postoperative liver failure of 83.33% was observed in group B. MELD score >/= 9.5 and low serum sodium are strongly predictive of increased postoperative liver failure in patients with cirrhosis undergoing hepatic resection of HCC. The presence of liver cirrhosis is an important factor that affects the prognosis of patients with hepatocellular carcinoma [HCC]. Cirrhotic patients with a high MELD score are at high risk of postoperative liver failure and complications and should be referred for non-surgical treatment