Résumé Le trichobézoard gastrique est une affection rare, dont le diagnostic est facile en présence d’un contexte évocateur. Son traitement peut être endoscopique, mais il est le plus souvent chirurgical. Nous rapportons le cas d’une... more
Résumé Le trichobézoard gastrique est une affection rare, dont le diagnostic est facile en présence d’un contexte évocateur. Son traitement peut être endoscopique, mais il est le plus souvent chirurgical. Nous rapportons le cas d’une patiente âgée de 19 ans, ayant des antécédents de trichophagie, présentant des épigastralgies avec une volumineuse masse épigastrique à l’examen clinique. La gastroscopie a permis le
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Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and... more
Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.0...
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Le paragangliome gangliocytique (GP) duodenalestconsiderecommeunetumeur neuroendocrine rare ayant un pronostic favorable contrairement aux autrestumeursneuroendocrinesde 1ier grade, et qui se presente sous formedune masse polyploïde de... more
Le paragangliome gangliocytique (GP) duodenalestconsiderecommeunetumeur neuroendocrine rare ayant un pronostic favorable contrairement aux autrestumeursneuroendocrinesde 1ier grade, et qui se presente sous formedune masse polyploïde de la 2ieme portion du duodenumcausantunehemorragie digestive haute. Le diagnostic positifestconfirme par letudehistologique et immunohistochimique de la piece operatoireou de la biopsie, la priseen charge therapeutiquedependessentiellement de la taille tumorale et lextensionlocoregionale.
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La prise en charge des TIPMP ne fait pas encore consensus. Elle a largement evolue depuis les annees 1980. Initialement, toutes les TIPMP benignes ou malignes etaient resequees. Puis lanalyse histologique des pieces operatoires, la... more
La prise en charge des TIPMP ne fait pas encore consensus. Elle a largement evolue depuis les annees 1980. Initialement, toutes les TIPMP benignes ou malignes etaient resequees. Puis lanalyse histologique des pieces operatoires, la constatation que les lesions etaient souvent benignes et en dysplasie de bas grade, la morbi-mortalite non negligeable de la chirurgie pancreatique et des sequelles a long terme (insuffisance pancreatique endocrine notamment) ont fait reflechir. Lattitude est devenue plus attentiste, et lon differencie les lesions a risque de degenerescence, qui necessitent une resection prophylactique, des lesions a faible risque pouvant faire lobjet dune surveillance etroite. Ajoute a cela lemergence de nouvelles techniques dablation kystiques endoscopiques echo guidees le clinicien va faire face a un certain nombre de defis pour pouvoir decider de la meilleure prise en charge.
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Les auteurs rapportent 14 cas de diversion duodenale totale. La technique standard est realisee chez 7 malades alors que des adaptations techniques ont ete necessaires chez les 7 autres (antecedents de chirurgie hiatale (4 cas) et de... more
Les auteurs rapportent 14 cas de diversion duodenale totale. La technique standard est realisee chez 7 malades alors que des adaptations techniques ont ete necessaires chez les 7 autres (antecedents de chirurgie hiatale (4 cas) et de gastrectomie (3 cas). L'indication a ete un reflux gastro-œsophagien post-operatoire dans 5 cas, une oesophagite severe stenosante ou avec muqueuse de Barret dans 3 cas, un echec d'une cure anti-reflux dans 3 cas, une gastrite biliaire post-operatoire dans 2 cas et enfin un cas de reflux alcalin. La mortalite operatoire est nulle, un cas de fistule anastomotique est note et a necessite une reintervention pour diriger la fistule. Une malade a presente une stenose spontanement resolutive de l'anastomose gastro-jejunale. Apres un recul allant de 7 mois a 10 ans, le resultat fonctionnel est juge tres bon chez tous les malades. Ceci confirme que la diversion duodenale totale est efficace pour traiter certaines œsophagites jugees complexes.
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Although hemorrhoidal disease is known since antiquity, is still a topical question because of treatment difficulties. Through this retrospective work concerning 200 cases of hemorroidectomy with the Milligan-Morgan operation, the authors... more
Although hemorrhoidal disease is known since antiquity, is still a topical question because of treatment difficulties. Through this retrospective work concerning 200 cases of hemorroidectomy with the Milligan-Morgan operation, the authors point out the importance of the surgical procedure.The average age is 43 years (19-78 years), with net male predominance. A complementary act has been associated to the hemorrhoidectomy 68 times. The mean follow-up is 5 years. There was no mortality, and the morbidity was observed in 7,5% of cases with 2% of anal stricture. The efficiency of the surgical procedure is established in several series and confirmed by our study.
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Philosophy and Medicine
The most common symptoms of Mullerian cyst are abdominal discomfort and palpable abdominal mass. The diagnosis is based on the histological findings. Retroperitoneal Mullerian cysts should be completely excised. We report a case of a 41... more
The most common symptoms of Mullerian cyst are abdominal discomfort and palpable abdominal mass. The diagnosis is based on the histological findings. Retroperitoneal Mullerian cysts should be completely excised. We report a case of a 41 years old woman treated for 2 retroperitoneal Mullerian cysts completely resected surgically. Retroperitoneal mullerian cyst is rare, the diagnosis is difficult preoperatively due to the lack of pathognomonic clinical and radiologic features. Its surgical excision is necessary to avoid recurrences. Mullerian cyst of the retroperitoneum is an extremely rare disease. Only 15 cases have been reported in the literature. They are characterized by the development of Mullerian epithelium-lined cysts in the retroperitoneum similar to the lining epithelium of the fallopian tubes and the endometrium.
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La fissure anale est une affection autonome et acquise. C’est un motif frequent de consultation proctologique. Sa pathogenie repose sur plusieurs hypotheses. Le facteur ischemique a ete incrimine dans la genese de la fissure, entretenu... more
La fissure anale est une affection autonome et acquise. C’est un motif frequent de consultation proctologique. Sa pathogenie repose sur plusieurs hypotheses. Le facteur ischemique a ete incrimine dans la genese de la fissure, entretenu par l’hypertonie sphincterienne constante dans cette affection. Le traitement chirurgical repose sur la sphincterotomie, avec ou sans exerese de la fissure, pour diminuer l’hypertonie sphincterienne et permettre la cicatrisation. Cependant un traitement medical ayant le meme principe est en train de se developper avec des resultats prometteurs. Les auteurs rapportent leur experience a travers l’etude retrospective de 188 fissures anales colligees sur 9 ans. La leiomyotomie avec anaplastie a ete pratiquee chez 90,4% avec des resultats satisfaisants dans 95,8% des cas, 1% d’incontinence transitoire et 3% de recidive. Ce travail comporte egalement une revue des dernieres donnees de la litterature.
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Desmoid tumors are fibrous proliferations that have an aggressive and an infiltrating character which tend te reccur locally without gaving any metastasis. Ther are rare repressenting less than 0,03% of all tumors. Mostly, they are... more
Desmoid tumors are fibrous proliferations that have an aggressive and an infiltrating character which tend te reccur locally without gaving any metastasis. Ther are rare repressenting less than 0,03% of all tumors. Mostly, they are sporadic, but in 2% of the cases they come in a genetic context “The Gardner Syndrome”. Desmoid tumors are localized, appearing in a decreasing order of frequency in the structures of the abdominal wall, the peripheral muscle fascia or more rarely in the intra-abdominal contents (mesentery, retroperitoneum). We report the case of a 32 years old female patient who had a desmoid tumor of the abdominal wall discovered during pregnancy. And from this clinical case we will focus on the difficulties of their therapeutic management, recalling through a literature review, the clinical, paraclinical and therapeutic features of these tumors.
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Differentiated thyroid cancer represent 90% of all thyroid cancer. Their prognosis is often excellent. It puts the question of the radicality of the initial treatment: is it necessary to be radical or conservative towards the thyroid... more
Differentiated thyroid cancer represent 90% of all thyroid cancer. Their prognosis is often excellent. It puts the question of the radicality of the initial treatment: is it necessary to be radical or conservative towards the thyroid parenchyma : lobectomy with isthmectomy or total thyroidectomy? Lymph node recurrence and mortality maky put the question on the utility and the extent of lymphadenectomy. Operative morbidity is mainly recurrential palsy and hypoparathyroidism. Radio iodine and hormonal therapy are the post-operative therapy.
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Ce travail retrospectif concerne l'etude de 300 cas de fistules anales operes sur une periode de 5 ans. L'âge moyen est de 37 ans (extremes 16 - 71 ans). Le sexe masculin est majoritaire (83%). Les fistules anales... more
Ce travail retrospectif concerne l'etude de 300 cas de fistules anales operes sur une periode de 5 ans. L'âge moyen est de 37 ans (extremes 16 - 71 ans). Le sexe masculin est majoritaire (83%). Les fistules anales intersphincteriennes et trans-sphincteriennes basses sont les plus frequentes. Le traitement a consiste en une fistulotomie seule dans 41% et une fistulotomie lente dans 59%. La mortalite est nulle, alors que la morbidite est de l'ordre 9,3% et comporte 4% de recidives et 1,7% d'incontinence anale transitoire, 1,3% de prurit anale, 1,3% de suintement anal, et 1% d'hemorragie postoperatoire. Ces resultats satisfaisants sont le fruit d'une bonne appreciation preoperatoire de l'etat sphincterien et du respect des principes de fistulotomie.
Background: Over 20 million inguinal hernia repairs are performed in the world every year. These repairs require the use of various techniques. The goal of this study was to audit the results of the surgical treatment of inguinal hernia... more
Background: Over 20 million inguinal hernia repairs are performed in the world every year. These repairs require the use of various techniques. The goal of this study was to audit the results of the surgical treatment of inguinal hernia repairs in adults in Morocco. Methods: This nationwide cross-sectional prospective study has been conducted by the Moroccan Society of Surgery and the Moroccan Society of Digestive Surgery. It included male patients aged 18 and above, with an inguinal hernia was repaired during the 30 days recruitment phase. The measured outcomes were: anesthesia type, preoperative antibiotic treatment, surgical technique, length of inhospital stay and intraoperative and postoperative complications up to 30 days. Results: The response rate of the survey was 88.78% which led to the study of 95 cases. 12 patients (12.6%) received general anesthesia, 82 patients (86.3%) regional anesthesia, and 1 patient (1.1%) local anesthesia. No prophylactic antibiotics were prescrib...
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Introduction: This study aimed to investigate burnout rates and the impact of the learning climate on general surgery residents in Rabat, Morocco. Methods: Between September and November 2015, all general surgery residents in the Mohammed... more
Introduction: This study aimed to investigate burnout rates and the impact of the learning climate on general surgery residents in Rabat, Morocco. Methods: Between September and November 2015, all general surgery residents in the Mohammed the Vth University in Rabat were contacted to participate in the study via an online questionnaire. The online questionnaire included four sections. The first one assessed demographics and professional activity. The second section included 8 satisfaction questions, using a five point Likert scale. The third section assessed burnout using the validated Maslash Burnout inventory. The fourth section assessed the learning climate using the Dutch Residents Educational Climate Test (D-RECT). Factors associated to burnout were analyzed using adequate statistical methodology. Results: Among 32 residents contacted by mail, 24 (75%) volunteered to respond to the questionnaire. The mean age was 30.9 years. Fourteen residents (58.3%) had a burnout. Residents w...
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Les stenoses malignes des voies biliaires representent l’un des problemes les plus complexes de la chirurgie hepato-biliaire. Les methodes palliatives consistent a decomprimer les voies biliaires et soulager l’ictere et le prurit. Certes,... more
Les stenoses malignes des voies biliaires representent l’un des problemes les plus complexes de la chirurgie hepato-biliaire. Les methodes palliatives consistent a decomprimer les voies biliaires et soulager l’ictere et le prurit. Certes, l’endoscopie et la radiologie interventionnelle ont connu de nombreux progres mais la chirurgie garde toujours sa place dans l’arsenal therapeutique de ces stenoses. La cholangiogastrostomie selon Dogliotti modifie est l’une des meilleures alternatives chirurgicales offerte a ces malades; c’est une technique facile dont les resultats fonctionnels sont satisfaisants. A propos de 4 cas colliges dans notre service et a travers une revue de la litterature, le principe et les resultats de cette technique sont precises.
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Aim: To describe the technique and indications of ISR and review the oncological and functional results of this technique in the management of very low rectal adenocarcinoma. Methods: This is a literature review of intersphincteric... more
Aim: To describe the technique and indications of ISR and review the oncological and functional results of this technique in the management of very low rectal adenocarcinoma. Methods: This is a literature review of intersphincteric resection in the management of rectal adenocarcinoma. Results: Intersphincteric resection allows extending the indications of sphincter-sparing surgery to very low rectal adenocarcinoma. Morbidity, mortality, pathological data and long-term oncological outcomes are good. Functional outcomes are good in 51% of the cases. Conclusion: These results would help the physician to better inform patients with low rectal tumors about the predictive outcomes of this technique and assist him in choosing among the different options available.
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The mental being of healthcare workers with the COVID 19 pandemic is a determinant of their resilience. We investigated the psychological impact of healthcare workers during novel Coronavirus 2019-nCoV times in Morocco. A cross-sectional... more
The mental being of healthcare workers with the COVID 19 pandemic is a determinant of their resilience. We investigated the psychological impact of healthcare workers during novel Coronavirus 2019-nCoV times in Morocco. A cross-sectional study conducted among healthcare workers of an University Hospital. We evaluated the knowledge of the protective means against nCov-19, incidence and the degree of anxiety and depression according to health workers characteristic. Among 287 health workers; 54% have been trained regarding protection procedures, and 94.8% declared that they are aware of individual protection measures. The incidence of anxiety and depression was respectively 77.4% and 73.9%. High degree of anxiety and depression was associated with female gender. However, Higher degree of anxiety was also related to function, specialty of practice ,and knowledge of the protective measures against COVID-19.
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La tuberculose surrenalienne est une affection rare, dont le diagnostic est facile quand le contexte est evocateur. Ailleurs, elle n'est qu'une surprise histologique. Nous rapportons le cas d'une jeune patiente de 26 ans, sans... more
La tuberculose surrenalienne est une affection rare, dont le diagnostic est facile quand le contexte est evocateur. Ailleurs, elle n'est qu'une surprise histologique. Nous rapportons le cas d'une jeune patiente de 26 ans, sans antecedents pathologiques qui, a la suite d'une alteration de l'etat generale et d'un syndrome inflammatoire, la tomodensitometrie a objective une hypertrophie surrenalienne droite evoquant une tumeur. En l'absence d'un dosage hormonal, la malade a subi une surrenaleclomie droite per-cœlioscopique. L'examen anatomo-pathologique a confirme la tuberculose. Un traitement anti- tuberculeux a ete instaure pendant 6 mois. Les auteurs insistent sur l'interet d'un examen clinique soigneux, a la recherche des signes discrets d'insuffisance surrenalienne et la realisation d'examens biologiques, qui permettent d'orienter le diagnostic.
Introduction : La pathologie hydatique primitive de la rate est tres rare et encore plus rare a provoquer (toute complication . . . pancreatite.). Habituellement, les kystes hydatiques spleniques sont secondaires, resultant soit dune... more
Introduction : La pathologie hydatique primitive de la rate est tres rare et encore plus rare a provoquer (toute complication . . . pancreatite.). Habituellement, les kystes hydatiques spleniques sont secondaires, resultant soit dune propagation spontanee des kystes, soit survenant apres des operations impliquant une hydatidose dans dautres regions. Ici, nous rapportons un cas dun kyste hydatique splenique primaire isole traite avec une approche chirurgicale classique. Ce rapport de cas et cette revue de la litterature decrivent la prise en charge de lenvahissement splenique hydatique. Presentation Du Cas : Il sagit dune patiente de 33 ans, sans antecedent particulier qui nous a ete adresse pour prise en charge dun kyste splenique de decouverte fortuite a lechographie lors dun bilan de routine avec serologie hydatique positive a Eccinochoccus granulosa. Lexamen clinique etait sans particularite. Le scanner abdominal realise objectivait la presence dun volumineux kyste hydatique sple...
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Mullerian cyst of the retroperitoneum is extremely rare. Only 15 cases have been reported in the literature. We report a case of a 41 year-old woman treated for 2 retroperitoneal mullerian cysts misdiagnosed as ovarian tumors that were... more
Mullerian cyst of the retroperitoneum is extremely rare. Only 15 cases have been reported in the literature. We report a case of a 41 year-old woman treated for 2 retroperitoneal mullerian cysts misdiagnosed as ovarian tumors that were completely resected surgically. With a short review of the literature, we focus on clinical, radiologic and histological features of this lesion.
Le lymphangiomekystique du pancreasestunetumeurbenigne, resultantdune obstruction de la circulation lymphatiquepancreatique. Son diagnostic estconfirme par letudehistologique de la lesion, lexerèsechirurgicaleest son traitement de choix.... more
Le lymphangiomekystique du pancreasestunetumeurbenigne, resultantdune obstruction de la circulation lymphatiquepancreatique. Son diagnostic estconfirme par letudehistologique de la lesion, lexerèsechirurgicaleest son traitement de choix. Une surveillance post-operatoireprolongeesimposeafin de detecter les recidiveslocoregionales.
Background: Surgical audit experiments have shown a positive, rapid and cost-effective impact on complication rates, recurrence rates, and overall survival even in the absence of interventional measures in digestive cancers. This study... more
Background: Surgical audit experiments have shown a positive, rapid and cost-effective impact on complication rates, recurrence rates, and overall survival even in the absence of interventional measures in digestive cancers. This study audit the quality of surgical procedures for digestive cancers. Methods: This is a multi-centric prospective non-comparative observational study performed in 4 surgical departments in 2 university centers. Eligible patients are adults scheduled for elective surgery for a proven or suspected digestive cancer, in a curative or palliative intent; or included no later than 72 hours after surgery in case of an emergent procedure. The Cancer should be proven or suspected in the following digestive tract: colon, appendix, anus, rectum, esophagus, stomach, esogastric junction, bile ducts, ampulla of Vater, pancreas, duodenum, small intestine and liver. Patients are excluded in case of 1) surgical intervention indicated for: a condition that is not a digestive...
BACKGROUND Anastomotic leakage (AL) is an important cause of morbidity after surgery for rectal cancer. AIM to analyze the risk factors associated with anastomotic leakage after anterior resection for rectal adenocarcinoma. METHODS We... more
BACKGROUND Anastomotic leakage (AL) is an important cause of morbidity after surgery for rectal cancer. AIM to analyze the risk factors associated with anastomotic leakage after anterior resection for rectal adenocarcinoma. METHODS We collected data from all the patients who had surgical resection with an anastomosis, for rectal adenocarcinoma at the Surgical Clinic C (Ibn Sina Hospital, Rabat, Morocco), between January 2001 and December 2010. The associations between variables and anastomotic leakage were studied using univariate and multivariate analysis. RESULTS Our study included 130 patients. Anastomotic leakage occurred in 28 patients (21.5%). Univariate and multivariate analysis showed that the rate of anastomotic leakage was significantly higher in patients who received preoperative radiotherapy (34.2% vs. 12 %, p = 0.002 - OR 3.8 - CI 95%: 1.5 - 9.4). There was no significant difference in the rate of AL between patients with or without a protective stoma. In the group of p...
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Humans, Female, Male, Young Adult, Risk factors, and 5 moreAged, Middle Aged, Adult, Risk Factors, and Adenocarcinoma
Le synovialosarcome abdominal primitifestunetumeurmesenchymateuse rare, qui se presente sous formedune masse intra-abdominale de croissancelente, ayant un aspect heterogene avec des calcifications excentriques. Letudeanatomopathologique... more
Le synovialosarcome abdominal primitifestunetumeurmesenchymateuse rare, qui se presente sous formedune masse intra-abdominale de croissancelente, ayant un aspect heterogene avec des calcifications excentriques. Letudeanatomopathologique de la biopsieou de la piece operatoirepermet de confirmer le diagnostic. Le traitement de referencecest la chirurgie exerese large , Cependant, le risque de recidiveresteeleve, cest pour cela le diagnostic precoceest optimal.
La fistule oeso-bronchique sur diverticule de l’oesophage medio-thoracique constitue 3% de l’ensemble des fistules oeso-bronchiques d’etiologie benigne et acquise. Les auteurs rapportent le cas d’un homme de 70 ans sans antecedents... more
La fistule oeso-bronchique sur diverticule de l’oesophage medio-thoracique constitue 3% de l’ensemble des fistules oeso-bronchiques d’etiologie benigne et acquise. Les auteurs rapportent le cas d’un homme de 70 ans sans antecedents pathologiques se plaignant d’un pyrosis, aggrave par une dysphagie aux liquides et accompagne de toux et d’expectorations. Le diagnostic est evoque par l’endoscopie et le transit oesophagien associe a une bronchoscopie. La radiographie du poumon et la tomodensitometrie pulmonaire montrent un syndrome bronchique et un foyer parenchymateux de type alveolaire. Une diverticulectomie, fistulectomie et suture des deux defects oesophagien et bronchique sont realisees. Apres un recul de deux ans et demi, le malade va bien sans recidive. A travers une revue de la litterature, les auteurs discutent les aspects diagnostiques, evolutifs et therapeutiques de cette affection.
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Introduction: Our purpose is to report the clinical presentation of a rare coexistence of pyloric stenosis, peptic esophageal stricture associated with hiatal hernia, and discuss the therapeutic strategy decided with criterion of... more
Introduction: Our purpose is to report the clinical presentation of a rare coexistence of pyloric stenosis, peptic esophageal stricture associated with hiatal hernia, and discuss the therapeutic strategy decided with criterion of decision-making and outcome. Presentation of Case: We experienced a case of 67-year-old man with history of duodenal ulcer presenting a co-existing pyloric stenosis, peptic esophageal stricture and hiatal hernia. Clinical presentation consisted of an evolving gastrooesophageal reflux disease GERD symptoms along with gastric discomfort. Further exploration characterized a benign stricture between middle and lower esophagus with sliding hiatal hernia, a stasis stomach attaining pelvic area, and a second post-bulbar stenosis with double bubble aspect. The therapeutic strategy decided was medical preparation with subsequent endoscopic esophageal dilatation, followed by a Roux-en-Y diversion with antrectomy surgery and bilateral vagotomy. Evolution was uneventfu...
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Introduction: The hydatid disease is a zoonotic infection due to the tapeworm echinococcus granulosus (TEG). In 50-70% of the cases, the hydatid cyst is observed with a hepatic localization. The trans-diaphragmatic extension of a liver... more
Introduction: The hydatid disease is a zoonotic infection due to the tapeworm echinococcus granulosus (TEG). In 50-70% of the cases, the hydatid cyst is observed with a hepatic localization. The trans-diaphragmatic extension of a liver hydatid cyst is rarely reported in the literature. Here, we report the singularity of our observation which focuses on-an abdominal approach rather than a thoracotomy and the way we handle the diaphragmatic defect. Observation: A 34-year-old male patient presented with a right hypochondriac pain evolving since 2 years. The abdominal examination found a bulging just below the right costal margin. The ultrasound and computed tomography (CT) scan images show an enormous liver hydatid cyst covering the entire posterior right section and extending beyond the diaphragm to the right hemi-thorax. Our therapeutic strategy consisted of a resection of the protruding dome with aspiration and evacuation of all the hydatid material. We did not close the diaphragmat...
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Local recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device... more
Local recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device is rarely reported. We present the case of a 75-year-old woman with perineal skin recurrence on the site of Lone Star Retractor™ from rectal adenocarcinoma. The patient underwent a curative proctectomy followed by a hand-sewn coloanal anastomosis using Lone Star Retractor™ 2 years ago for a tumor of the lower rectum. The recurrence was most likely caused by the seeding of exfoliated tumor cells into the perianal skin which was abraded by the retractor. This case is the fourth case reported in the literature and highlights the importance of the use of less traumatic endoanal retractors to prevent such perianal recurrence. Recurrence on the perineal wound caused by anal retractor device is rare but possible. Further studies are needed to define preven...
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Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in... more
Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...
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The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in... more
The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included. There were 35 (50.7 %) men with a median age of 53 years. Forty-seven patients had tumors located below 8 cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4 %) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4 %. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (p = 0.007, Exp. 19.9; CI (95 %) 2.2–177.4) and tumors located 8 cm above the anal verge (p = 0.028, Exp. 5.23, CI (95 %) 1.2–22.8). Twenty-two patients (31.9 %) had a complicated postoperative course. Only male gender was associated with postoperative complications (p = 0.01, CI (95 %) 1.3–11.8). Our study showed that conversion rate is influenced by surgeon’s experience, and height of the tumor and that male gender is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons’ experience in laparoscopic proctectomies for rectal adenocarcinoma.
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Surgical treatment of achalasia of lower oesophageal sphincter is Heller's myotomy, usually associated with a fundoplication due to an high risk of postoperative gastro-oesophageal reflux. The value of this fundoplication is... more
Surgical treatment of achalasia of lower oesophageal sphincter is Heller's myotomy, usually associated with a fundoplication due to an high risk of postoperative gastro-oesophageal reflux. The value of this fundoplication is discussed. The aim of this study was to evaluate retrospectively the results of Heller's myotomy without fundoplication but performed according to a precise technique preventing postoperative reflux. Between 1975 and 1999, 123 patients underwent Heller's myotomy without systematic fundoplication. Diagnosis of achalasia was performed clinically and confirmed by investigations: baryum meal, fibroscopy and manometry. Myotomy was performed through an abdominal approach in 117 (95%) patients. Dissection preserved fixity of abdominal oesophagus in all cases, particularly its posterior meso. Myotomy was performed on abdominal oesophagus but not below the cardia. Posterior fundoplication was associated in 2 patients. One patient (0,8%) died from massive aspi...