Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver.

BACKGROUND AND STUDY AIMS: Hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for treatment of the hydatid cyst of the liver. However, it is still associated with high mortality and morbidity. The aim of the study was to evaluate the predictive factors for specific morbidity after conservative surgical treatment of the hydatid cyst of the liver. PATIENTS AND METHODS: A total of 120 patients who underwent conservative surgical treatment between 2001 and 2011 were evaluated retrospectively. RESULTS: Of the 120 patients, 64 were female subjects and 56 male subjects; the median age was 33 years (14-83 years). The mortality rate was 0%. The overall morbidity rate was 26.6%. The specific morbidity rate was 16.6%. The major specific complications were infection of the residual cavity in 10 cases and an external biliary fistula in eight cases. The predictive factors of morbidity in univariate analysis were bilious cyst content, location of the cyst in the hepatic dome, and size >10 cm. After multivariate analysis, only the size of the cyst was an independent predictive factor of morbidity. CONCLUSION: The size of the cyst was the significant predictor of morbidity of conservative surgery for liver hydatid cyst.

[Les fistules recto-vaginales d'origine obstétricale: aspects épidémiologiques et approaches thérapeutiques. Etude multicentrique tunisienne]. / Rectovaginal obstetrical fistulas. Therapeutic attitudes. A Multicenter tunisian study.

BACKGROUND: Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. The aquired etiology caused by child birth are still frequent in many countries. AIM: to describe epidemiology of obstetrical recto vaginal fistula in our country and discuss therapeutic modalities Materiel and methods: A retrospective multicentric study among 19 hospital departments from February 1982 to January 2007 of obstetrical recto-vaginal fistulas including 41 patients. RESULTS: The median diameter of the fistula was 12 mm. the treatment consist on excision of the fistula and perineal suturing in 34 cases, Advancement flaps was used in four cases, the Musset technique repair in two cases, Gracilis transposition for repair was used in one case. Forty five patients had satisfactory anatomic and functional satisfactory results. One patient had reported dyspareunia. Definitive failure was reported in four cases. CONCLUSION: Our study suggests a regression in obstetrical RVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology. Surgical treatments have good results. However prevention of this complication is the best treatment because a major handicap for women regarding socioeconomic, functional and psychological effects.

[Transcystique drainage after laparoscopic exploration of common bile duct: an efficient and safe method]. / La cholédocotomie semi idéale : une méthode sure pour drainer la voie biliaire après exploration laparoscopique de la voie biliaire principale.

BACKGROUND: laparoscopic exploration is one of the modalities of treatment of choledocolithiasis. Modalities of biliary decompression after laparoscopic common bile duct exploration are controversial. AIM: to assess the benefits, the efficacity and harms of trancystic biliary drainage following laparoscopic common bile duct stone exploration methods: we report retrospectively twenty patients which were operated in our department by laparoscopy and have done a transcystic biliary drainage. RESULTS: the mean age was 52 years. They were twenty patients (13 women and 7 men). The median operating time was 165 minutes. Post operative course was uneventful in 17 cases. Biliary complications were present in three patients (2 biliary fistulas and one biliary peritonitis. Residual stones were found in two cases. One of the residual stone was treated with endoscopic sphincterotomy.There were no post operative deaths. There were no biliary stricture and no recurrent ductal stones. CONCLUSION: despite of our short experience, the transcystic biliary drainage following laparoscopic management for choledocolithiasis seems to be a safe and an efficient method.