[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases]

Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. To compare the results of three techniques of varicocelecomy. Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the opensurgery by retro peritoneal way for 42 patients [GI], the varicocelectomie coelioscopique for 41 patients [GII] and the antegrade scrotal sclerotherapy done for 45 patients [GIII], between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67% of the cases, followed by the hypofertility in 20.3% of the cases and the association both in 12,5% of the cases. The varicocele was in leftsider in 71.1% of the cases, to the right side in 5.4% of the cases and was bilateral in 23.43% of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups. The global rate success was 81.2%, with the highest rate found in the group III which was treated by ant‚grade scrotal sclerotherapy [84.4%]. The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by ant‚grade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by ant‚grade scrotal sclerotherapy [13.3%]. The main postoperative complications were hydrocele [16%] followed by testicular hypotrophy [3 patients]. Three techniques of varicocele treatment, offer either a similar succes rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII]

[Results of laparoscopic treatment of morbid obesity: about 27 cases]

Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach. To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass. From May 2001 to July 2007, 27 patients were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 patients with gastric bypass. The primary endpoint was: excessive weight loss [EWL], BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion. The mean age was 36 years. There were 4 males and 23 females. The mean preoperative weight was 122, 4kg [range: 87-152] and the mean body mass index [BMI] was 42.5 kg/m2 [range 36,5 -52 kg/m2]. The mean hospital stay was 4.76 days [range: 3-8]. There were no postoperative deaths. Early complication was present in 3 patients. Late complications were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%.The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results

[Laparoscopic treatment of gastro-oesophageal refflux: a review of 51 cases]

The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. The purpose of this retrospectise study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance [persistence of symptoms of reflux on treatment], drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our Outcome measures were mortality, morbidity specifically, the conversion rate and functional outcome in the short and medium term. These 24 men and 27 women of average age 38 years [range: 17-71 ans].All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels [Nissen] and 34 without section of short vessels [Nissen-Rossetti]. The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients [7.8%]. Mortality was nil. The specific complications were observed in 2 patients [4%], a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non specific complications were dominated by pneumonia in 4 patients [7.8%]. In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphiagia, present in [77%] cases, was transient in 40 patients [62%] and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. The laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature

[Ureteral injuries in gynaecologic surgery]

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the cas of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject

Kyste de l'ouraque chez l'adulte. A propos d'un cas revue de la literature

Simple urachal cyst is a rare pathology in the adults. The diagnosis is rarely established clinically, it is based on ultra sonography and confirmed by anatomo-pathology. The autors report one case of urachal cyst in a 42-year old patient who present bladder irritation symptoms. The diagnosis has been established by ultra sonography. The mean complications of urachal cyst are infection and degenerescence. The treatment is usually surgical