[Longo's technique in the treatment of hemorrhoids grade III and IV]

The purpose of this study is to show the interest of the Longo technique in the treatment of hemorrhoidal prolapse stage III and IV as to report as results too. Twenty-one patients were operated by the Longo technique. Hemorrhoids were classified as stage III and IV respectively in 13 and 8 patients. They have been followed in consultation at two months, six months and one year, allowing data collection. The mean duration of intervention was 38 minutes. The mean duration hospital stay was 2.2 days. There were no incidents during surgery. The mortality rate was zero. The complication rate is estimated at short, medium and long term, it was 23.80% [n=5]: two hemorrhages [9.52%] at the staple line, two acute urinary retention [9.52%] and external hemorrhoidal thrombosis [4.76%]. All patients didn't need any local treatment. The postoperative follow-up detected a bleeding at defecation in one patient; another one had a recurrence of the prolapse associated with rectal bleeding, the third had a completely asymptomatic moderate stenosis stapling site easily dilatable. Eighteen patients [85.71%] had no symptoms and were completely satisfied, two patients were moderately satisfied, and one was dissatisfied. The circular anopexy is an effective technique with 85.71% of patients satisfied in one year. The complication rate is low and the quality of results depends on the technical gesture

[Preoperative portal vein embolization]

The liver failure is a severe complication of major hepatectmies. Preoperative portal vein embolization allows a prior interruption of the portal flow in the liver territories that are to be resected, inducing their atrophy and the compensatory hypertrophy of the futur liver that persists after this removal. It is interesting to discuss the feasibility of this technique in our contexte starling from accessibles means for obtaining satisfactory results. Patient aged 55 years old, who presented for two months a cholestatic jaundice cutaneous mucosal. The Magnetic Resonnance Imaging abdominal showed an appearance very evocative of a cholangiocarcinoma of the biliary confluence reaching the right hepatic duct type IIIA of bisthmuth and cornette. Three weeks after portal vein embolization, an hypertrophy of the futur remaining liver is obtained. Finally, we perfomed a right hepatectomy extended to segments IV anterior and I. The postoperative course was uneventful. The major hepatectomy carries the risk of postoperative liver failure. Portal vein embolization of the liver to resect aims to redistribute the portal flow to induce a hypertrophy of the futur liver remnant. Portal obstruction can be used by an embolization with biological glue, acrylic adhesives, alcohol, or by a ligation. It can be done by ultrasound guided percutaneous transhepatic or by catheterization of an ileocolic vein. However, given the specific equipment required for the percutaneous and human skills still not widespread, it is best in our context the ileal way that is accessible to all surgeons and also effective. Major liver surgery is developing in our country, thus preoperative portal vein embolization can now make extensive liver resections with less risk and complications

Cancer colon and pregnancy

We are reporting a case of colonic adenocarcinoma in a 18 weeks pregnant woman aged 42 years. We realised a left segmental colectomy completed by an adjuvant chemotherapy after a normal delivery. For months later, bilateral ovarian metastases were diagnosed. Therfore, hysterectomy and a bilateral ablation of annexes with an omentectomy was done. The ovulation was good without recurrence for four months later. Discussion: The advised therapeutical attitde is to stop pregnancy before intervention during the first trimester, in the scond trimester surgical treatment is indicated regardless pregnancy, in the third trimester, it is necessary to wait until full pulmonary maturity of the foetus is reached, then intervene by a caesarian section and a curative surgical treatment at the same time. The diagnosis of cancer colon associated with pregnancy is difficult and needs a strong multidisciplinary collaboration. The prognosis of cancer colon is aggravated in pregnant women. It can not be improved except with an early diagnosis