[Risk factors associated with pancreatic fistula after distal pancreatectomy]

Pancreatic leak [PL] remains a major cause of postoperative morbidity in patients undergoing pancreatic resection. To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy [DP]. 35 patients underwent DP during a 10-year period [2000- 2009]. Informations regarding diagnosis, operative details, and perioperative morbidity and mortality were collected. Nine risk factors were examined. Results: Indications for DP included primary pancreatic disease [n=23; 66%] and non-pancreatic disease [n = 12; 34%]. Postoperative morbidity rate was 43% and none patient died. No patients required a reoperation. Pancreatic fistula was occurred in 11 patients [31%]. On univariate analysis, incidence of pancreatic fistula rate was not significantly associated with these risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, additional procedures, intra operative bleeding and texture of pancreatic parenchyma. We observed significant statistical difference between male and female, 47% of females experienced a pancreatic fistula, while 17% males developed a pancreatic leakage [p =0.05]. The role of the technique of pancreatic stump closure in the development of pancreatic leak remains unclear because of the few number of patients on who we used stapler. The rate of pancreatic fistula after left pancreatectomy is 31%. The female was identified as a risk factor for occurrence of pancreatic fistula after left pancreatectomy. The role implicated in the use of a mechanical claw for the treatment of pancreatic stump requires a larger number of patients to conclude. The body mass index has not been studied in our series

[Malignant intraductal papillary mucinous tumours of the pancreas: a three cases report]

Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery

[Early gastric adenocarcinoma]

the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, therapeutic as well as his its prognosis. Over a period of 14 years [1990-2004], 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery [A] La Rabta. The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years. It was about 8 men and 8 women. Two patients was followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrium in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65.6%. The recurrence had interested only one patient. the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the DI-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump

Laparoscopic ileocecal resection for crohn's disease

The aim was to evaluate the reliability and safety of laparoscopic ileocecal resection for Crohn's disease and to report our preliminary results. A retrospective analysis of 20 patients undergoing a laparoscopic ileocecal resection for Crohn's disease was carried out between November 2003 and June 2005. First of all, we defined the inclusions and exclusions criteria which allowed us to select the patients who would be resected laparoscopically. Fistulizing disease, emergent surgery [perforation, occlusion], large mass and patients with previous laparotomy were excluded. Duration of operation, rate of conversion, complications and time from discharge from hospital were evaluated. Median operation time was 160 min. Conversion to laparotomy was needed in three cases. There was no death. Minor complications occured in 2 patients. Median postoperative time for discharge was 5 days. These preliminary results indicate that laparoscopic ileocecal resection is a feasible and safe alternative in patient with Crohn's disease offering many advantages thanks to a strict patient selection