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Gastro-intestinal stromal tumors [GIST] are the most common mesenchymal gastrointestinal tumors. The Gastric location represents 60% of cases [1,2]. Complete surgical excision remains the treatment of reference for the localized forms. This surgery can be made by laparoscopy when the lesion's size doesn't exceed 5 cm. Some principles must e respected: a mono-block complete surgical resection, with healthy margins and without effraction. This technique will be reserved for trained teams and for selected cases according to the size and location. We herein try to explain the surgical laparoscopic excision of gastric stromal tumors explaining
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Crohn's disease [CD] is a chronic inflammatory disease of the intestine that can cause an attack by contiguity of the urinary tract. Although the shape is common and fistulizing 35% of all patients with CD, entero-urinary fistulas are rare and only seen in 2-8% of patients. To report the frequency of occurrence of this complication among the group of surgical forms of CD. Describe the different pathophysiological mechanisms of occurrence of entero-vesical fistula [EVF] during the CD. We report, retrospectively, seven observations of EVF complicating MC made during the period from 01/01/1998 until 31/12/2010. The mean age of patients was 30 years. There were 3 men and 4 women. All patients had clinical signs and radiological EVF. In six patients, CD was ileo-caecal and the ileo-vesical fistula was between the last loop and the bladder. In one patient, the CD was located only in colon, and the fistula was between sigmoid colon and bladder. Level of the bladder, it was a false EVF in five patients and a true EVF in two patients. In these last two, the fistula of 2 mm, was on the top of the bladder. Treatment consisted in all cases by a disconnect between the digestive tract and bladder, resection with restoration of digestive continuity, and if the case of true EVF, a freshening the edges of the fistula with suture of the bladder's wall and drainage. The postoperative course was uneventful in six patients and marked by an outbreak intraperitoneal abcess in one patient who had evolved under medical treatment. After a mean of eleven months, no recurrence surgery was noted. Despite advanced treatment in the context of CD, the indication in EVF is a surgical treatment. Surgery helps fight against the consequences of septic urinary tract, but also to launder bowel disease and reduce the risk of recurrence in the short term
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The sigmoid diverticulitis is the most common complication of diverticulosis of the colon. The remaining questions concern the current risk factors for recurrence after a first acute episode, radiological asking immediately upon suspicion of diverticulitis and therapeutic management including the indications of surgical treatment, what to conduct and its principles. Literature review. Risk factors of recurrence are: persistent or recurrent diverticulitis, abscess, stenosis and / or fistula. Abdominal CT is recommended in all patients clinically suspected diverticulitis of the colon. Treatment of acute diverticulitis is medical. The emergency surgical treatment depends on the stage of Hinchey. Stage I: In case of failure of medical treatment, resection-anastomosis in an emergency time delay to be proposed. Stage II: a percutaneous drainage followed by resection-anastomosis in 1 time. Stage III: surgery in emergency sigmoid colectomy based on. Stage IV: Hartmann procedure is the procedure of reference. Prophylactic colectomy is proposed in the case of presence of risk factors of recurrence. Comparison with other literature review were allowed to find that ultrasound made by an experienced radiologist could replace abdominal CT, and for stage III and IV Hinchey, laparoscopic resection can be performed with an immediate restoration of digestive continuity in well selected patients
Assuntos
Humanos , Doenças do Colo Sigmoide , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia , Imageamento por Ressonância Magnética , Endoscopia , Gerenciamento ClínicoRESUMO
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
Assuntos
Humanos , Feminino , Masculino , Fístula Pancreática , Fatores de Risco , Complicações Pós-OperatóriasRESUMO
Curative resection with adequate lymph node dissection is the treatment of choice for gastric cancer. To determine the prognostic factors after R0 resection with DII lymph node dissection. We retrospectively assessed 126 patients who underwent R0 resection with DII lymph node dissection for gastric cancer [excluding the upper third of the stomach] in a single institution between 1991 and 2006 with median follow-up of 38.5 months [6 - 219]. Prognostic factors were assessed by Cox proportional hazard model. There were 45 women and 81 men. The median age was 60 years [21 - 87]. Four patients died [3.2%]. Postoperative hospital morbidity was 16.7%. The pathologic review of the slides revealed that 50% of the tumors were stage T3 [63 cases]. The median number of lymph node removed was 11 [8-40], 50% were involved. Five and 10 years survival rates were respectively 56.9% and 40.2%. In multivariable analysis, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were found to be independent prognosis factors. After R0 resection with DII lymphadenectomy, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were independent predictive factors for survival
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Caroli's disease is a congenital dilatation of the intrahepatic biliary duct. To analyse and discuss diagnostic and therapeutics difficulties through 16 patients with Caroli's disease. Between January 1990 and September 2010, 16 patients underwent surgical procedure for Caroli's disease. Data recorded for each patient included clinical symptoms, biologic findings, previous biliary procedures, and the presenting symptoms. The distribution of the biliary lesions, the surgical procedure and the postoperative outcomes and follow up were detailed. The mean age was 55 years. the mean interval between the first symptoms and diagnosis was 27 months. Five of 16 patients had undergone 12 surgical or dneoscopic procedures prior to liver resection. Before the definitive diagnosis, 9 patients presented 15 episodes of acute cholangitis. The diagnosis was established preoperatively in 13 cases, 5 among them underwent previous biliary surgical procedures. The diagnosis was documented peroperatively in 2 cases and postoperatively in 1 case. The distribution of the biliary lesions was monolobar in 13 and bilobar in 3 patients. 13 patients underwent liver resection, in two cases we performed bilio-jejunostomy and the last one had endoscopic sphyincterotomy. There was no mortality and the overall postoperative morbidity is about 43%. The follow-up shows that 12 patients still alive with a mean follow up for 53 months, from whom only one patient have intrahepepatic lithiasis. The clinical course of Caroli's disease is often complicated by recurrent episodes of angiocholitis and requires iterative surgery. The hepatectomy which prevented septic complications and degenerescence is possible only in a restricted number of patients