[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

[Buschke lowenstein tumor: unusual bilateral localization]

The tumor of buschke lowenstein or giant condyloma acuminata is a pseudo-epitheliomatous profileration bilonging to verrucous carcinoma group due to their aggressive local evolution.A malignant change as mic invasive carcinoma or epidermoiz keratinizing carcinoma well-differentiated was reported.Diagnosis and surgical treatment represents an efficient alternative at the moment that must be precocius and large due to the frequencies of local recurrences and malignant change. We present in this stady an observation of an unusual localization of buschke Lowenstein tumor with review of literature 50 year-old men presented with bilateral tumours it the battock area whose diagnosis of buschke Lowenstein tumour h been clinically suspected and confirmed by biopsy and histopathologic study .The cover has been achieved by VY fasciocutaneous flaps of the muscle gluteus maximus

[Sigmoido-vesical fistula: a case report]

Background: Colovesical fistula is a rare complication of inflammatory and neoplasic pelvic diseases [0.2%]

Aim: To report a new case

Case: We report the case of a 74-year-old woman, with a charged previous medical history and had not had hysterectomy. She was admitted because of cystitis with haematuria associated to faecaluria and pneumaturia confirmed by an intravenous pyelogram. Water-soluble contrast medium show the sigmoidovesical fistula. A sigoid sticture is identified at colonoscopy and biopsy was realised. The patient had had sigmoidectomy with Hartmann's procedure. Histologic study confirm the diverticulatis with preidiverticular abcess and fistula

We suggest that early diagnosis and management of sigmoid diverticulatis is required to prevent complicatins like stricture and fistula

traitement laparoscopique de la lithiase choledocienne

In a period of five years we operated 52 patients affected by choledocolithiasis. 38 patients had a laparoscopic approach, 10 patients had directly a laparotomy and 4 patients benefit of a sequential treatment, The conversion rote was 39% because we don't select candidates to laparoscopy, including even patients with acute cholangitis. Main causes of conversion were wedged calculi in the papilla, multiple stones and high inflammation of the common bile duct. Mortality and morbidity were nil. Duration of laparoscopic operation was in a mean of 165 minutes with 8,8 days of hospital stay. Two residual stones were successfully removed by endoscopic sphincterotomy. Lapnroscopic treatment of choledocolithiasis is an effective, safe method; it seems to be the best therapeutic alternative. This technique needs an additional and costly instrumentation and good laparoscopic skills. in order to reduce the conversion rate it is recommended to avoid the laparoscopic approach for patients with acute chotangitis and multiple common bile duct stones