[Cephalic duodenopancreatectomy at the Hopital du Point G, Bamako]. / La duodenopancreatectomie cephalique (DPC) a l'Hopital du Point G, Bamako.

PURPOSE OF THE STUDY: to bring back the clinical and therapeutic aspects of 6 cases of DPC in the service of surgery A of the hospital of the POINT G. PATIENTS AND METHODS: descriptive retrospective study of 5 years and 6 months in the service. All the patients presenting a duodéno-pancreatic malignant tumour treated by DPC with histological diagnostic confirmation were included in the study. The palliative techniques of biliary and digestive derivations were not retained. RESULTS: 6 files of patients were collected. The average age of the patients was 63 years. The average time of consultation was 8 months. The abdominal pains, the jaundice and the cutaneous prurit were the reasons for consultation of first order. The functional signs were the cutaneous prurit and vomiting, the faded saddles (2 cases, 33.3%), and the dark urines (a case, 16,7% of the cases). The seat of pain was epigastric among 3 patients (50%), diffuse with epigastric starting point in a case, pain of the right hypochondre in one case. An epigastric mass was palpated by 4 patients (66,6%). A hepatomegaly and a large blister were palpated once (16,7% of the cases). High blood amylase rates are noted by 4 patients (66,7%). The rates of bilirubine free and total in blood were very high. The echographic image was that of a mass of the head of the pancreas and a dilation of the bile ducts will intra and extrahepatic as well as channel of Wirsung (4 cases, 66.7%). The computer tomodensitometry did not objectify local vascular invasion, hepatic metastases, or of ascite. The tomodensitometric images of the lesions were a cystic tumour of the head of the pancreas (one case), a pancreatic tumour + cholestase (one case), a tumour of the head of the pancreas with compression of duodenum (4 cases). Classes ASA II (4, 66.7%) and III (2, 33.3%) were only represented. The procedures of resection were practised according to the technique of WHIPPLE or its alternatives. The ganglionic clearing out related to the 5 classical chains. The early continuations were simple for 4 patients (66,6%). A case of parietal suppuration, a pancreatic leak (operated again at J3) and a death were recorded. The average duration of the hospital stay was 16 days. Two patients died between 0 and 3 months into postoperative, and 2 others died between the 3rd month (33,33%) and the 10th month (33,3%). The results of the histological examination were 4 cases of adenocarcinomists of the pancreas (66,6%), a adenocarcinomist inflammatory and necrotic, a fairly differentiated adenocarcinomist. CONCLUSION: the tumours of the head of the pancreas very often diagnosed at a late stage are of weak frequency in our context of exercise. The DPC is burdened with a made morbidity of pancréato-jejunal dents. The rate of survival at 5 years remains around 5%.

[Cancer of the head of the pancreas: clinical, diagnostic and therapeutic aspects at Bamako]. / Cancer du pancreas cepihalique: aspects cliniques, diagnostiques et thérapeutiques à Bamako.

OBJECT: to determine the relative frequency of the cancer of the head of the pancreas in our structures of 3(ieme) reference to Bamako as well as the diagnostic and therapeutic aspects. PATIENTS AND METHODS: It is about a descriptive retrospective study in the services of general surgery of the Hospital of the Point G and the Hospital Gabriel Touré from January 2000 to June 2004. Were included in the study all the patients presenting a malignant tumour of the head of the pancreas having been confirmed by a histological examination. RESULTS: 26 patients were listed, that is to say 0.3% of the hospitalizations for the period of the study. The reason for hospitalization was an abdominal mass in 57.14% of the cases. The average age of the patients was 58 years. The sex ratio was 4:2 in favour of the men. Clinical signs of cholestase with type of jaundice frankly accompanied by prurit were present at the clinical examination in 95.24% of the cases. The other signs were the pain, a palpable mass, a ascite representing respectively 71.43%, 66.67%, 23.81% of the cases, Abdomino-pelvic echography allowed the diagnosis in 90% of the cases and the scanner in 100% of the cases. The rate of bilirubine total and free as well as the rates of transaminases (ASAT, ALAT) was high in respectively 95.24% and 85.71% of the cases, The curative therapy consisted of a duodeno-pancreatectomy in 9 cases (39.16% of the cases). A double palliative bilio-digestive derivation was carried out in treatment in 53.84 of the cases, The histological type was the adenocarcinomist in 95.24% of the cases. The rate of survival to 1 year was 10.5% in the event of curative treatment and 5.3% in the event of palliative treatment. CONCLUSION: The diagnosis of cancers of the head of the pancreas is posed at late stages in our structures. The DPC is feasible but the rate of resecability is weak. The palliative treatment can help to improve the quality of life of the patients.

[Assessment of endoscopic surgery at the Hospital of Point G in Bamako]. / Bilan de 45 mois d'activites de coeliochirurgie a Bamako.

PURPOSE OF THE STUDY: To carry out the first 45 months assessment of activities of coeliochirurgie at the hospital of the Point G Bamako. PATIENTS AND METHODS: It was about a retrospective study of 45 months carried out in the service of surgery "A" of the CHU of the Point G All the patients having undergone an intervention by technique coeliochirurgicale with or without conversion into conventional surgery were retained. RESULTS: for 45 months, 426 patients profited from the technique, i.e., 18.99% of the patients operated in the service for this period. The most frequent indications were the gynaecological surgery (61.27%), with pathologies tubaires, followed digestive surgery (33.33%) with the lithiasic cholécystite and acute appendicitis. The parietal surgery and the "staging" of cancerous pathologies represented respectively (3.05%) and (2.35%). Conversion into conventional surgery related to 7.5% of patients. We listed few accidents and incidental per operational. The duration of the hospital stay shorter was compared with that of the conventional surgery. The operational continuations were simple in 97.9% of the cases. CONCLUSION: the coeliochirurgie is realizable and reliable under the conditions of exercise of the surgery in Mali. The indications are to be measured in order to avoid the complications inherent in the technique and to progress positively. The benefit of the technique is ensured for the patient and the hospital.