Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report.

BACKGROUND: Primary closure of the perineum with drainage after abdominoperineal excision of the rectum for carcinoma, is widely accepted. However hematoma, perineal abscess and re-operation are significantly more frequent after primary closure than after packing of the perineal cavity. Those complications are frequently related to the patients' clinical antecedent (i.e radiotherapy, diabetes, smoking). CASE PRESENTATION: In the present report, vacuum assisted drainage was used after abdominoperineal excision for carcinoma in the very first step due to intraoperative gross septic contamination during tumor resection. The first case: A 57-years old man with a 30-years history of peri-anal Crohn's disease, the adenocarcinoma of the lowest part of the rectum and Crohn colitis with multiple area of severe dysplasia required panproctocolectomy with a perineal resection. The VAC system was used during 12 days (changed every 3 days). We observed complete healing 18 days after surgery. The second case: A 51-year-old man, with AIDS. An abdominoperineal resection was performed for recurrence epidermoid anal cancer. The patient was discharged at day 25 and complete healing was achieved 30 days later after surgery. CONCLUSION: The satisfactory results showed in the present report appear to be favored by association of omentoplasty and VAC system. Those findings led us to favor VAC system in the case of pelvic exenteration associated with high risk of infection.

Experience of two trauma-centers with pancreatic injuries requiring immediate surgery.

BACKGROUND/AIMS: Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases. METHODOLOGY: From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7). RESULTS: There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage. CONCLUSIONS: Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.

Pancreatic cancer and pancreaticoduodenectomy in elderly patient: morbidity and mortality are increased. Is it the real life?

BACKGROUND/AIMS: The aim of this study was to compare post-operative outcomes of two groups of patients aged more or less than 70 years old METHODOLOGY: From January 1990 to January 2006, 150 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinomas (PA) were reviewed at the Department of Digestive Surgery of University Hospital. Twenty five patients Group A> or =70 and Group B<70 years old, were well matched for gender, diagnosis, body mass index, American Society of Anesthesiologists (ASA) score, and texture of pancreatic parenchyma. RESULTS: There was no intraoperative death. Mean operative hospital and intensive care unit stays were in Group A, B: 21+/-9; 4.5+/-8 vs. 19+/-7; 3+/-3 NS respectively. There were four deaths in A and no death in B at three months of hospital discharge. More patients had complications in Group A (56% vs 36% NS). Medical complications seem to be more frequent in Group A (40%vs 12% NS). The median survivals were 20 and 27 months for A and B, respectively. CONCLUSION: We observed an increased rate of morbidity and mortality in patients aged more than 70 years.

[Retroperitoneal non-secreting paraganglioma. Apropos of a case]. / Paragangliome non sécrétant rétropéritonéal. A propos d'une observation.

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. These tumors are most commonly found in the adrenal gland but other locations are possible. A 79-year-old woman with abdominal pain underwent computed tomography (CT scan). Surgery was indicated because of the increase in the size of the tumor. Histopathological examination revealed a non secreting paraganglioma in the left retroperitoneum. Paragangliomas are rare neuroendocrine tumors. They have a greater potential for malignancy than pheochromocytomas due to metastases or local recurrence making surgical excision the treatment of choice.