RESUMEN
BACKGROUND: Laparoscopic cholecystectomy is at present the gold standard treatment of gallbladder lithiasis. AIM: Assesment of Laparoscopic cholecystectomy METHODS: Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. RESULTS: There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepato-biliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases (4.6%), a conversion was necessary for different causes. We noted 11 surgical complications (2.2%) among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death.
Asunto(s)
Colecistectomía Laparoscópica , Cálculos Biliares/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica , Niño , Femenino , Cálculos Biliares/diagnóstico por imagen , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , UltrasonografíaRESUMEN
Liposarcomas are malignant mesenchymatous tumors developed from elements constituting the greasy tissue in various stages of differentiation. It is one of the most frequent mesenchymatous sarcomas. Retro-peritoneum is a privileged site of development in 12 to 15% of cases. During 9 years, from 1994 till 2002, we have colligated and operated 5 cases of retro-peritoneal liposarcomas. Average age was 50 years (extremes 34 to 79 years) with a sex-ratio of 1.5. Diagnosis was late beyond 6 months. Abdominal pain and the appearance of an enormous mass (20 cm) were the revealing signs. No imagery method allowed to evoke the diagnosis. The cyto-puncture realized once, was not able to determine with precision the histological type. Immunohistochimy occupies nowadays an important place to classify a sarcoma. Large surgical resection realized in 5 cases did not allowed the complete ablation of the tumour in 3 cases considering the advanced loco-regional extension, which was at the origin of 3 recurrences. Well differentiated histological type was noted in 3 cases, myxoid type in a case and not differentiated type in a case.
Asunto(s)
Liposarcoma , Neoplasias Retroperitoneales , Dolor Abdominal/etiología , Adulto , Anciano , Biopsia con Aguja , Femenino , Estudios de Seguimiento , Humanos , Liposarcoma/diagnóstico , Liposarcoma/diagnóstico por imagen , Liposarcoma/patología , Liposarcoma/cirugía , Masculino , Persona de Mediana Edad , Radiografía Abdominal , Reoperación , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Espacio Retroperitoneal/patología , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Our aim was to study the anatomo-clinic particularities and the therapeutic modes of the infectious abscesses of the liver. PATIENTS AND METHODS: Our retrospective study concerns 25 cases of the infectious abscesses of the liver collected on one period of 12 years from January 1992 to December 2003. They are 11 primitive abscesses and 14 secondary abscesses. RESULTS: We noted 14 women and 11 men, median age was 51.5 years. The Fontan triad was present in 7 cases. A liver mass with an abdominal sensitivity was found in 14 cases. Anomalies in the biologic exam of the liver were present in the 1/3 of the cases. We noted a double right and left localization in 3 cases and a multiple localization in 1 case. The hemoculture and the pyoculture permitted a bacteriological diagnosis in 52%. The percutaneous treatment achieved in 7 cases, permitted the recovery in 2 cases. One dead was noted following a severe cardiopathy. A surgical drainage has been achieved at 22 patients. 4 cases after the failure of the percutaneous treatment. Mortality rate was 20% (5 cases) related to the delay of diagnosis, the gravity of the septic shock. the advanced age and the flaws associated. CONCLUSION: The infectious abscess of the liver was a serious affection that affects the vital prognosis. The percutaneous treatment associated to the antibiotherapy. is the method of choice in the treatment of the abscesses of the liver. The surgical treatment must be reserved to the failure of the percutaneous treatment.
Asunto(s)
Absceso Piógeno Hepático/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Drenaje/estadística & datos numéricos , Infecciones por Escherichia coli/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae , Absceso Piógeno Hepático/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Choque Séptico/epidemiología , Infecciones Estreptocócicas/epidemiología , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Túnez/epidemiologíaRESUMEN
Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients (20 males, 2 females) aged between 26 and 79 years had anastomic ulcer relapses (1.38%) after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases (93%) associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases.
Asunto(s)
Úlcera Duodenal/cirugía , Complicaciones Posoperatorias/etiología , Úlcera/etiología , Vagotomía/efectos adversos , Adulto , Anciano , Anastomosis Quirúrgica , Femenino , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Through a series of 14 cases brought over a period of 12 years, we realized a retrospective, analytical and descriptive study of these traumatisms. We aimed to release recommendations to improve their management. It was 2 women and 12 men, whom mean age was 24.4 years (extremes: 50 and 60 years), divided into 10 pancreatic injuries, 2 duodenal injuries and 2 duodeno-pancreatic injuries. Etiology was dominated by traffic accidents 7 cases (50%). Trauma was closed in 13 cases (92%). Associated lesions were present among 13 patients (92%). The traumatism appeared by an urgent surgical abdomen among 9 patients, secondarily in 3 cases, tardily in 2 cases: a case of deep suppuration 3 months after a traumatism treated into ambulatory and a case of persistent ascites after a past unperceived traumatism. Abdominal ultrasonography was made among 4 patients. It allowed diagnosing only a case. Scanner was made among 4 patients. It allowed diagnosing all the cases. Only a patient was treated medically, it was a post-traumatic acute pancreatitis. Surgical treatment was made in 13 cases: conservative in 7 cases and radical in 6 cases. Follow-up was complicated in 11 cases (78%) and non-complicated in 3 cases. Mortality rate was 7.1%.
Asunto(s)
Duodeno/lesiones , Páncreas/lesiones , Heridas y Lesiones/cirugía , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/tratamiento farmacológico , Pancreatitis/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Túnez , Ultrasonografía , Heridas y Lesiones/diagnóstico por imagenRESUMEN
The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome (73%). The diagnosis was made pre or peroperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele (12 cases), a mucosal hyperplasia (8 cases) and a cystadenoma (2 cases). For 5 patients, the diagnosis of peritoneal pseudomyxoma (4 cases) or extraperitoneal (1 case) was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later.
Asunto(s)
Neoplasias del Apéndice , Cistoadenoma Mucinoso , Mucocele , Neoplasias Peritoneales , Seudomixoma Peritoneal , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicectomía , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/diagnóstico por imagen , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/cirugía , Apendicitis/diagnóstico , Apendicitis/cirugía , Apéndice/patología , Cistoadenoma Mucinoso/diagnóstico , Cistoadenoma Mucinoso/diagnóstico por imagen , Cistoadenoma Mucinoso/patología , Cistoadenoma Mucinoso/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mucocele/diagnóstico , Mucocele/diagnóstico por imagen , Mucocele/patología , Mucocele/cirugía , Recurrencia Local de Neoplasia/cirugía , Epiplón/cirugía , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/diagnóstico por imagen , Seudomixoma Peritoneal/patología , Seudomixoma Peritoneal/cirugía , Radiografía Abdominal , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. It is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 16 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only (23.1%) were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases (46.2%). The gravity of urgently operated patients burdened the post-operative morbidity in 38.5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated. In our series, we noted that the relapse rate is more frequent with women that with men (42%/21%), and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick (5/6). A post-operative medical treatment in the severe forms reduces the rate of relapses until 24%.