results of Laparoscopic treatment of the gallbladder lithiasis about 500 cases

Laparoscopic cholecystectomy is at present the gold st and ard treatment of gallbladder lithiasis. Assesment of Laparoscopic cholecystectomy. Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepatobiliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases [4.6%], a conversion was necessary for different causes. We noted 11 surgical complications [2.2%] among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death

[Fibrocystic mastopathy and Cancer of the breast. About 111 cases]

Objective: Our aim was to identify the predictive factors of degeneration of the fibrocystic mastopathy

Methods: This work is a retrospective survey of I 1 1 observations of isolated fibrocystic mastopathies or associated to a breast cancer among 542 women admitted for tumor of the breast during one period of 13 active years from 1991 to 2003. The diagnosis has been gotten by anatomo-pathologic exam in 95, 5% [106cas] on the operative piece and 4,5% [Scas] on a material of biopsy

Results: The fibrocystic mastopathy represented 30 % of the set of the benign tumors of the breast. They were associated to a breast cancer in 45 cases [40,5%]. The isolated benign fibrocystic mastopathy was observed in 66 cases with a middle age of 37 years. whereas the shapes associated to a breast carcinoma were noted in 45 cases. The middle age was 53 years. The non proliferative fibrocystic mastopathy is the most frequent histological type and repre-sent 54,6 % of the cases. The proliferative form with atypies was observed at 21 women [46,8%]. The carcinoma the more frequently associated to the fibrocystic mastopathy was the infiltrating canalled carcinoma in 91% of cases, with a pre-dominance of the 11 rank [SBR]

Conclusion: The discovery of a mastopathy must search a luteal failure and risk factors of breast cancer notably a proliferative shape of mastopathy with atypies

[Tuberculous encapsulating peritonitis, about 18 cases]

Our goal is to study the circumstances of diagnosis and the therapeutic modes of encapsulating peritonitis of tubercular origin. We report in this retrospective study 18 cases of encapsulating peritonitis of tubercular origin collected from 1982 to 2000. Symptoms and signs are dominated by the general signs of tubercular nature, found isolated or in association with other, in 14 patients. Abdominal pain was found in all patients. Gastrointestinal disorders were found in 11 patients. A typically sound abdominal mass was found in 3 cases. The ultrasonographic data associated with the biologic data, helped in making the diagnosis. Confirmation of the tubercular origin was provided by histological examination of the biopsies. Treatment was based on the anti-tuberculosis chemotherapy associating four antitubercubus drugs taken daily during two months repeated by the association of two antituberculous drugs during a period of six to 13 months. The outcome was favourable in 16 patients but the two patients died. Histological diagnosis and more rarely bacteriological examination, would be essential in order to start an early treatment. This diagnosis is confirmed by open coelioscopy when the ascitis is septated or by exploratory laparotomy in the fibro-adhesive forms. Radical surgery is indicated in case of complications

Maladie de Crohn intestinale: Aspects chirurgicaux et facteurs predictifs de risque des recidives. A propos de 26 cas

Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. If is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 1 6 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only [23.1%] were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases [46.2%]. The gravity of urgently operated patients burdened the post-operative morbidity in 38-5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated, in our series, we noted that the relapse rate is more frequent with women that with men [42% / 21%], and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick [5/6]. A post-operative medical treatment in the severe forms reduces fhe rate of relapses until 24%

tumeurs mucosecretantes de l'appendice. A propos de 22 cas

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome [73%]. The diagnosis was made pre or preoperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele [12 cases], a mucosal hyperplasia [8 cases] and a cystadenoma [2 caases]. For 5 patients, the diagnosis of peritoneal pseudomyxoma [4 cases] or extraperitoneal [1 case] was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later