Access to kidney transplantation for patients with end-stage renal failure in Maghreb countries: state of art and recommendations / Accès à la transplantation rénale des patients en insuffisance rénale chronique terminale dans les pays du Maghreb : état des lieux et recommandations

We present an overview of kidney transplantation activity in the Maghreb countries, based on data from the 9th Colloque France-Maghreb (Paris, May 20 and 21, 2022). For Algeria, Morocco and Tunisia, the incidence of end stage renal failure is respectively 120, 130 and 130 per million inhabitants, its prevalence 626, 900 and 833 per million inhabitants and the part of patients with a functional graft of 10.3, 1.8 et 8.5% with an annual number of transplants of 6.5, 0.8 and 8.7 per million inhabitants. Living donor transplants account for 99% of transplants in Algeria, 93% in Morocco and 80% in Tunisia. In conclusion, access to transplantation remains low in the Maghreb countries. All the modalities (living donor with enlargement of the circle of donors, deceased donors) must be further developed. Recommendations were issued to support activity.

Nous présentons un état des lieux de l'activité de transplantation rénale dans les pays du Maghreb à partir des données du 9e Colloque France-Maghreb (Paris, 20 et 21 mai 2022). Pour l'Algérie, le Maroc et la Tunisie, l'incidence de l'insuffisance rénale chronique terminale est respectivement de 120, 130 et 130 par million d'habitants, sa prévalence de 626, 900 et 833 par million d'habitants et la part des patients porteurs d'un greffon fonctionnel est de 10,3, 1,8 et 8,5 % avec un nombre annuel de transplantations de 6,5, 0,9 et 7,7 par million d'habitants. La transplantation avec donneur vivant représente 99 % des transplantations en Algérie, 93 % au Maroc et 80 % en Tunisie. En conclusion, l'accès à la transplantation reste faible dans les pays du Maghreb. Toutes les modalités (donneur vivant avec élargissement du cercle des donneurs, donneurs décédés) doivent être développées. Des recommandations ont été émises pour soutenir cette activité.

Sarcomatoid carcinoma of the gallbladder: A rare and aggressive form of gallbladder cancer.

Sarcomatoid carcinoma is a rare type of gallbladder cancer with less than 100 cases reported in the literature. Preoperative diagnosis is difficult due to nonspecific clinical and radiological findings. Its prognosis is poor due to rapid progression and a high short-term recurrence rate. The definitive diagnosis relies on histopathological examination.

Tuberculous abdominal cocoon: A rare variant of peritonitis.

Cocoon abdomen is an uncommon condition characterized by bowel entrapment in a cocoon-like membrane. Its clinical presentation is usually non-specific. Rarely, it may present with perforation peritonitis. The therapeutic approach depends on the stage of the disease. Surgery is essentially reserved for those with acute surgical complications.

Huge mesenteric desmoid-type fibromatosis with unusual presentation: A case report.

Introduction: Desmoid-type fibromatosis, also known as desmoid tumors, are rare fibroblastic neoplasms that account for less than 3% of all soft tissue tumors. Although they are benign neoplasms without metastatic potential, they are known to be locally aggressive and may invade adjacent structures leading to fatal complications. Case presentation: We describe the case of a 26-year-old woman who presenting with the clinical picture of acute peritonitis. Emergency surgery was performed and a large poorly-circumscribed heterogeneous tumor was found, occupying the jejunum mesentery and infiltrating the jejunal wall causing its perforation into the abdominal cavity. En bloc resection of the tumor and the involved jejunum was performed. Histology and immunohistochemistry confirmed it to be mesenteric desmoid-type fibromatosis. The postoperative course was uneventful and the patient had no evidence of recurrence 18 months after tumor resection. Conclusions: Mesenteric desmoid-type fibromatosis is a rare condition with insidious growth and locally aggressive behavior. Serious complications such as bowel perforation are rare but possible, as shown in our presentation. Complete surgical resection is the first-line treatment bur high recurrence rates remain problematic.

Actinomycosis mimicking a pancreatic head neoplasm: A case report.

INTRODUCTION: Actinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive, facultative anaerobic bacterium Actinomyces. Abdominal actinomycosis accounts for 10 to 20% of reported Actinomyces infections and pancreatic involvement is extremely rare. PRESENTATION OF CASE: We report the case of a 64-year-old man who presented with a 3-week history of abdominal pain, nausea, weight loss, and icterus. Abdominal CT scan revealed a 3.5 cm heterogeneously enhanced mass of the pancreatic head, associated with mild dilation of the main bile duct and the Wirsung duct. The diagnosis of pancreatic head malignancy was highly suspected and surgical management was decided. Intraoperatively, a 3 cm indurated mass of the pancreatic head was found. Whipple's procedure was performed. Histopathological examination revealed pancreatic actinomycosis. DISCUSSION: Pancreatic actinomycosis is extremely rare. To our knowledge, only 18 cases have been reported in the English literature to date. It commonly presents as a slow-growing mass with bile and pancreatic ducts obstruction, which can mimic malignancy. Therefore, it has often been misdiagnosed and over-treated with futile surgery, when medical treatment based on antibiotherapy is the only required treatment. CONCLUSION: We reported a rare observation of surgical management of actinomycosis mimicking a pancreatic head neoplasm. As clinical and radiological findings are nonspecific, the accurate diagnosis can only be made by histology. Through our case, we aim to highlight the importance of preoperative suspicion of pancreatic actinomycosis, given the still relevant morbidity of pancreatic resections.

[Digestive stomas: which professional impact?] / Les stomies digestives: quel impact professionnel?

INTRODUCTION: digestive stomas result from a certain number of surgical interventions. They may be temporary or definitive. The patient with stoma has potentially damaging physical and psychological problems. Therefore patient´s adaptation to the changes and acceptance of this temporary or permanent situation is essential. This study aims to assess the impact of intestinal stomas on patients´ quality of life and professional life. METHODS: we conducted a retrospective study from January 2010 to December 2014. During the study period, 115 patients had intestinal stomas. Among these patients, sixty were of working age, had a fixed employment and had resumed their work; they made up the study population. Data were collected using a specific questionnaire: the Short Form-36 (SF-36) health questionnaire conducted in the post-operative period. RESULTS: the average score for the overall quality of life for patients with stoma was 41. Forty patients had poor quality of life with a score SF-36 less than 50. Our study showed that patients with stoma experienced difficulties at work. Forty-eight patients reported discomfort directly linked to stoma during their professional activities. The causes mentioned were physical in 6 cases and psychological in 3 cases. Six patients were moved into more adapted working positions. CONCLUSION: the management of patients with digestive stomas should aim to an adequate social and professional reintegration. This can only be done by involving the occupational physician, the psychologist, the stoma therapist and the associations.

Recommandations of the Tunisian Association of Surgery for the practice of visceral surgery during COVID-19 pandemic.

The World Health Organization declared on March 11, 2020 that the COVID-19 epidemic has become a pandemic. In Tunisia, the Ministry of Health has recommended enhanced preventive hygiene measures to contain and limit the spread of the virus. Following the entry of Tunisia into phase 4 of the COVID-19 epidemic, the Tunisian Association of Surgery proposed recommendations related to surgical activity. Surgical emergencies must be treated urgently and without delay. Non-tumor pathologies which require surgery in an elective situation and for which the risk of aggravation or complication is considered low shoud be postponed. For digestive tumor pathology, and apart from complicated forms, neoadjuvant treatment is highly recommended in the context of multidisciplinary concertation staff.

Resected colorectal cancer liver metastases : Prognostic study about 110 patients.

INTRODUCTION: The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring. OBJECTIVE: The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases. METHODS: This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality. The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05. RESULTS: Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival. CONCLUSIONS: colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies.

Pathological response of colorectal liver metastases treated after induction treatment.

BACKGROUND: Mortality for colorectal cancer is mainly due to liver metastases, surgical resection remains the curative treatment and use of neoadjuvant therapy improves resectability of metastases. Pathological response is an important prognostic factor. AIM: To evaluate tumor response by Tumor regression grade (TRG) according Rubbia-Brandt et al and correlation with survival. To establish chemotherapy-related liver injury. METHODS: Thrity-eight patients resected for colorectal cancer liver metastases after neoadjuvant chemotherapy were enrolled in this study. Tumor regression grade (TRG) according to Gradding Rubbia-Brandt et al. was evaluated. RESULTS: Sex ratio was 1.5 with an average age of was 55 years. Twenty-five patients were in stage IV (65.7% of patients with synchronous liver metastases). Overall survival was 62% at 12 months, 42% at 24 months and 21% at 36 months. Thirty-four patients (89.5%) received Oxaliplatin and nine (23.7%) irinotecan. Twenty patients (52.6%) had no histologic response (TRG 4 and 5), nine (23.7%) had a major response (TRG 1 and 2) and nine had a partial response (TRG3). Survival was more important with major pathologic response than with partial response or no response. No statistically significant relation was found between survival and the different types of response. Chemotherapy-related liver injury were present in 21 patients (55.2%).  Conclusions: Scoring system with three grades are currently recommanded to evaluate pathological response and new histopathological data are proposed. Larger studies are required to validate these items and their utility for therapeutic decisions.

Open liver trauma causing hepatico caval fistula successfully treated by embolization.

INTRODUCTION: Traumatic arteriovenous fistula results from a breach of vascular integrity between a vein and an adjacent artery. Hepato caval fistula is a rare entity. Open surgical approaches have increasingly given way to radiological embolization techniques in the treatment of these arteriovenous fistulae, especially in intrahepatic locations. CASE REPORT: We report the case of a patient diagnosed with a fistula, from the right branch of the liver artery to the right hepatic vein, developed following an open liver trauma. Successful embolization through the transarterial route was achieved with simple outcomes. CONCLUSION: The interventional radiology for endovascular management has revolutionized the treatment of hepatic liver traumas. The conservative treatment is henceforth the common approach even if hepatic artery or hepatic veins are involved in case of arteriovenous fistula.

[The POSSUM: a good scoring system for predicting mortality in elderly patients undergoing emergency surgery?] / Le POSSUM: un bon score pour prédire la mortalité du sujet âgé opéré en urgence?

INTRODUCTION: POSSUM (Physiologic and Operative Severity Score for the enumeration of Mortality and morbidity) is a scoring system for predicting mortality which is largely used in elective aortic and abdominal surgery. The aim of our study was to validate POSSUM with regards to elderly patients (> 70 years) undergoing digestive emergency surgery. We wanted to determine the optimal threshold for POSSUM, consisting of a physiological score and of an operative score for predicting mortality in this population. METHODS: This is a case-control analytic retrospective study of 291 patients aged ≥70 years undergoing digestive emergency surgery. These patients were divided into two groups each comprising 50 patients. Group "DC": patients died in the immediate postoperative period and Control group "SURV" chosen by lot. We analyzed the reliability of POSSUM in predicting mortality and morbidity. Subsequently, we created ROC curve to find the thresholds with the best sensitivity/specificity couple. RESULTS: The physiological score, operative score and mortality and morbidity rates predicted by POSSUM and mortality predicted by P-POSSUM are predictors of mortality (P < 0.0001). The threshold values for the physiological and operative score with the best sensitivity/specificity couple were 23 and 15 respectively. CONCLUSION: Predicting mortality in patients allows to target care management programs and to inform the patient and his family of the risks.

[Post traumatic anterior abdominal wall hernia]. / Hernie post traumatique de la paroi abdominale antérieure.

Post traumatic anterior abdominal wall hernia can be ignored in emergency settings. We here report the case of a 32-year-old patient with a BMI of 30 kg/m2, suffering from anterior abdominal wall hernia as a result of a road accident. This lesion wasn't detected during clinical examination. Abdominal tomodensitometry showed a defect of 8 cm in the anterior abdominal wall. The patient underwent surgery during which a musculoaponeurotic defect of 12 cm was detected. The repair was carried out using interrupted suture. The postoperative course was marked by a secondarily infected skin necrosis. The evolution was satisfactory after directed cicatrization. At 3 months postoperatively the patient was doing well with a healed wound and a strong abdominal wall.

Huge Aneurysm of the Proper Hepatic Artery.

Hepatic artery aneurysms are rarely diagnosed. It is mainly because of non specific symptoms. They are generally an incidental findings during imaging studies. They are usually detected in the sixth decade, predominantly in men. We report herein a case of an 80 year-old man with a huge hepatic artery aneurysm revealed by abdominal pain and chronic anemia. It was treated by embolisation. Hepatic artery aneurysms are second among visceral aneurysms. They may cause abdominal pain, jaundice and hemorrhagic events.

Incidental gallbladder cancer diagnosed on cholecystectomy specimens: a study of 30 cases.

Background - The gallbladder cancer is a rare cancer with poor prognosis. The association with gallstone disease is the main risk factor of this cancer. Aim - Describe the demographics, clinic-pathologic and therapeutic management of incidentally gallbladder cancer diagnosed on cholecystectomy specimens. Methods - retrospective study including 30 cases of gallbladder cancer incidentally detected on cholecystectomy specimens. Results - The incidence of gallbladder cancer incidentally discovered was 0.83%. The sex ratio M/F was 0.5 and the average age was 68 years. The main risk factor was cholelithiasis (38%). Adenocarcinoma was the most frequent histological type found in 86.6% of cases and it was biliary-type in 56.6% of cases. 76,7% of the tumors were classified in early stages (stages 0, I and II) and 23,3% were in advanced stages (III and IV). A simple cholecystectomy was curative in 66.7% of cases. Overall survival rate was 56.7% at one year. The best survival rate was for the early stages: 100% stages 0-I and 45.4% stage II. Conclusions - The gallbladder cancer has poor prognosis because of its late diagnosis. Thorough sampling and careful attention on histological examination of all parts of cholecystectomy specimens allows detection of early cancer with better prognosis.

Rectal adenocarcinoma: 154 cases prognosis study.

BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS:   We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS:   Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76%  at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION:   A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.

Rectal adenocarcinoma: 154 cases prognosis study.

BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS:   We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS:   Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76%  at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION:   A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.

[Laparoscopic colectomy versus colectomy performed via laparotomy in the treatment of non-metastatic colic adenocarcinomas]. / Colectomie laparoscopique versus colectomie par laparotomie dans le traitement des adénocarcinomes coliques non métastatiques.

INTRODUCTION: Laparoscopic colectomy is considered with increasing frequency the gold standard treatment for colorectal cancer. Our study aims to show that short-term results and the oncological safety of laparoscopy are at least equivalent to those of laparotomy in the treatment of non-metastatic colic adenocarcinomas. We also highlight the impact of the learning curve on outcomes after laparoscopy in patients with these cancers. METHODS: We conducted a retrospective study of all patients undergoing surgery for resectable colic adenocarcinomas over a period of 6 years. The study population was divided into 2 groups based on the surgical procedure used initially. The group "OC" included 35 patients who underwent midline laparotomy and the group "LAC" included 30 patients who underwent laparoscopy. All data were analyzed using SPSS software version 19.0. RESULTS: Our study showed that there was no significant difference in short-term outcomes between the 2 groups, namely intraoperative morbidity, hospital stay, intensive care unit stay as well as postoperative morbidity and mortality. Regarding the long-term outcomes, there was also no significant difference in the incidence of late complications, type of recurrence, overall survival and disease-free survival. Oncological safety based on the limits of resection and the number of lymph nodes removed was not significantly different between the two groups. Operative time was significantly longer in the laparoscopic group (p <0.001). Convertion rate was 33%. It went from 67% in the first 2 years of the study to 13% in the last 2 years. The conversion from laparoscopy to laparotomy had no significant impact neither on early postoperative outcomes nor on overall survival and disease-free survival. CONCLUSION: Laparoscopy is a surgical procedure resulting in at least equivalent short and long term outcomes as laparotomy. The learning curve representing a "prerequisite" has no negative impact on the outcomes of laparoscopic treatment of non-metastatic colic cancers.