ABSTRACT
The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. Aim: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence.A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients [7%] developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases [reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases], a necrosis in 5 cases [reconfection of the colostomy], a plicature in 2 cases [reconfection of the colostomy] a peristomal abscess in 2 cases [reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case] and a strangulated parastomal hernia in 1 case [herniorrhaphy]. The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course
ABSTRACT
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