Efficacy of laparoscopic surgery in the treatment of hepatic abscess: A systematic review and meta-analysis.

BACKGROUND: Liver abscess is a common cause of intra-abdominal infection and its treatment depends on the presentation. Laparoscopy, in addition to its classic benefits, has particular advantages in the management of liver abscess but its role is not well defined and studies done in that field are heterogenous. The objective of this systematic review is to evaluate the efficacy of laparoscopic surgery in the management of liver abscess. METHODS: We realized a systematic review and meta-analysis including studies published in the 20 last years. The primary outcome was the pooled prevalence of recurrent or residual liver abscess after laparoscopic treatment. RESULTS: We retrieved 190 studies regarding laparoscopic surgery in liver abscess and 17 studies were included in the quantitative and qualitative synthesis. A total of 608 patients was included and 299 of them (49.1%) were treated by laparoscopic surgery. The indications were mainly failure of first line treatment (antibiotic treatment and/or percutaneous drainage and/or needle aspiration) and ruptured multiloculated, or caudate lobe liver abscess. The surgical gesture performed was laparoscopic drainage in all studies. The post-operative rate of recurrent or residual liver abscess after treatment by laparoscopy was 4.22% (95% CI: 2.29-7.07). CONCLUSIONS: This systematic review showed that laparoscopic drainage had a considerable place in the management. The post-operative rate of recurrence was low with no mortality suggesting that laparoscopy is safe and feasible for liver abscess management.

[Anaesthesia in on-pump cardiac surgery for congenital heart diseases at the Cuomo Pediatric Cardiology Center (Senegal)]. / Prise en charge anesthésique des cardiopathies congénitales opérées sous circulation extra - corporelle au Centre de Chirurgie Cardiaque Pédiatrique Cuomo (Sénégal).

Congenital heart diseases account for 0.5-1% of births. The management of children with cardiac malformation requires treatment in a suitable center, adequate medical equipment and specific anesthetic and surgical knowledge. The purpose of this study was to evaluate the anesthetic management of patients with congenital heart diseases in our center after the first year of activity and to compare the obtained results with literature reported data. We conducted a retrospective, descriptive study over a 1-year period, from January to December 2017. All patients undergoing on-pump cardiac surgery for congenital heart disease during this period were included. We collected data from 80 records of patients undergoing surgery for congenital heart disease. Out of these 80 patients, 60 underwent on-pump cardiac surgery (75%). The average age of patients was 7.41 years, with a sex-ratio of 1.22. The mean duration of on-pump cardiac surgery was 82.82 min and the mean duration of aortic clamping was 58.31 min. At the end of the procedure catecholamine production was found in 70% of patients. The most common complication in the postoperative period was right-side heart failure (69%). The average length of stay in the Emergency room was 4.33 days. One patient died, bringing mortality to 1.6%. Congenital heart diseases are complex and highly variable. Improved management techniques have strongly reduced morbi-mortality.