Prognostic Factors of Postoperative Morbidity and Mortality of Adult Strangulated Groin Hernia.

The aim of this work is provide the results of the surgical treatment of strangulated groin hernias and determine morbidity and mortality risk factors. It is a retrospective study related to the 288 records of patients aged 15 years and more, who underwent emergency surgery for strangulated groin hernia from January 2007 to December 2012. Postoperative evolution was assessed on the morbidity, mortality, and length of hospital stay. Mortality and morbidity risk factors were studied. The statistical analysis was conducted with the chi-square test and Fischer's exact test with a significance level of 5 %. Strangulated groin hernias account for 42.2 % of the overall groin hernia operations conducted during the study period (288/697). Necroses were present in 59 (20.5 %) patients. The mortality rate was 6.2 % (n = 18). Admission time superior or equal to 48 h (p = 0.002), American Society of Anesthesiologists (ASA) class superior or equal to III (p = 0.002), presence of preoperative strangulated groin hernia complication (peritonitis, occlusion, hernia abscesses) (p = 0.001), bowel necrosis (p = 0.000), and bowel resection (p = 0.000) were statistically related to a high risk of death. Forty-two (n = 42) postoperative complications were recorded in 34 (11.8 %) patients. These complications were outnumbered by postoperative parietal suppuration (n = 26) which led to three cases of evisceration. Bowel necrosis was related to a high risk of postoperative complications (p = 0.002). Reoperation was necessary for 13 patients. The length of stay in hospital was 4 days (range between 1 and 28 days). The average follow-up period was 7 months. No recurrence was noticed during this period. Delay in consultation, high ASA class, and moreover, bowel necrosis requiring bowel resection are the factors of unfavorable postoperative results. Groin hernias are an avoidable death cause provided that early treatment of strangulated hernias and the elective treatment of non-complicated hernias are conducted.

Lymph node involvement beyond peripancreatic region in pancreatic head cancers: when results belie expectations.

OBJECTIVES: Surgery remains the standard therapy for curative management of pancreatic duct adenocarcinoma (PDA) involving the head of pancreas. This study aimed to report our experience in PDA about the prognostic value of lymph node (LN) invasion (N⁺) at the root of the superior mesenteric artery (SMA) and in N2 subgroup. METHODS: From January 2005 to September 2009, 110 patients were included for pancreaticoduodenectomy or total pancreatectomy. RESULTS: Etiologies were PDA (n = 87) or ampullary carcinomas (n = 23). Sixty-five percent of patients were N⁺, with N1/N2/N3 location, respectively, 63.6%, 9.1%, and 2.7%. Forty-four percent had a LN identified intraoperatively at the origin of the SMA, of whom only 12% were N⁺. In multivariate analysis (whole series), complication grade greater than II, location of positive LN (N1 to N3) and vascular resection were associated with a poorer survival. In the exocrine PDA subgroup, only location of positive LN and vascular resection were associated with a poorer survival. N⁺ SMA was not statistically correlated with survival, recurrence, or disease-free survival. CONCLUSIONS: N⁺ at the origin of the SMA was not a significant prognostic factor for PDA and should no longer be considered as a formal contraindication for curative surgery. Conversely, N2 invasion remains an unfavorable prognostic.

Recurrences after surgical resection of intraductal papillary mucinous neoplasm of the pancreas: a single-center study of recurrence predictive factors.

OBJECTIVE: The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection. METHODS: All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base. RESULTS: From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence. CONCLUSION: The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion.

[Amebic liver abcess at Bouake Teaching Hospital: diagnostic and therapeutic aspects about 46 cases]. / Abces amibien du foie au CHU de Bouaké: etude diagnostique et therapeutique a propos de 46 cas.

AIMS: To describe the diagnosis and therapeutic aspects of amebic liver abscesses. MATERIAL AND METHODS: Retrospective study of 46 cases of amebic liver abcesses seen at Bouaké Teaching Hospital during the period from January 1997 to June 2002. RESULTS: Three clinical pictures were carried out: painful and feverish hepatomegaly (n=28, 60.9%), fever with pain of the right hypochondrium (n=3, 6.5%) and diffuse acute peritonitis (n=15, 32.6%). Forty-one liver abcesses were diagnosed with abdominal ultrasonography and the remaining 5 cases were diagnosed during laparotomy. Fifteen patients had peritonitis due to rupture of liver abcesses and one among them had a gangrenous left colon. Amoebiasis was diagnosed by positive amebic serology among all patients. All the patients received antibiotic treatment, 16 patients were treated by needle aspiration under ultrasound and 15 patients underwent a laparotomy. Post-operative morbidity was of 4 parietal suppurations. Morbidity of needle aspiration was nil. One death occurs as the consequence of hepatocellular insufficiency. CONCLUSION: This study stresses ultrasound examination place in the diagnosis and the treatment of amebic liver abscess. Laparotomy is still performed to deal with complicated forms such as intraperitoeal rupture.