[Predictive factors of esophagojejunal fistula after total gastrectomy in gastric cancer patients]. / Facteurs prédictifs du lâchage de l'anastomose oeso-jéjunale après gastrectomie totale pour cancer.

BACKGROUND: The main complication observed after total gastrectomy is the oesophagojejunal anastomosic fistla. Its incidence varies between 7.4% and 11.5%. The mortality after anastomic leafage is high at around 20%, representing 30% and 54% of global mortality after total gastrectomy. AIM: This study aimed to evaluate mortality and morbidity after total gastrectomy and to determine their predictive factor METHODS: this is retrospective study about 80 cases of total gastrectomy for gastric cancer, collected in the departmentof General Surgery of the University Hospital Habib Thameur Tunis during the period 1 January 1995 to 31 December 2010. Reconstruction of the alimentary tract was achieved by Roux-en-Y-jejunal-loop. RESULTS: Esophagojejunal anastomotic leeakage developed in 14 patients (17%). In 8 patients treatment of anastomotic leakage consisted of re-operation with surgical drainage and confection of jejunostomy. in one patient treatment required resutre of the anastomosis and drainage of an abscess. In one patient treatment required resuture of the anastomosis and drainage of an abscess. in 5 of the 14 patients with a proven leak of oesophagojejunal anastomosis, conservative treatment with parental alimentation, placement of an irrigation-aspiration system and systemic antibiotics was performed. This treatment was successful in all cases. The presence of anastomic fistula extends the median lenght of post operative stay in the hospital of 20 days compared for the payents withiut fistula.Global mortalilty was 8/80 (10%). After esophagojejunal anastomotic leakage, the mortality was 3/8 (21%). CONCLUSION: Leakage of the oesophago-intestinal anastomosis may occur after total gastrectomy for gastric cancer. it's serious complication contributes to mortality after total gastrectomy. Knowledge of the predective factors of esophagojejunal fistula after total gastrectomy in gastric cancer can decrease its incidence .

[Perineal recurrence of an aggressive angiomyxoma: Is an incomplete resection useful?]. / Récidive d'un angiomyxome périnéal agressif : une chirurgie d'exérèse incomplète est-elle utile?

Angiomyxoma is a rare but aggressive mesenchymal tumor. It commonly develops in the pelvis, perineum and groin and is more common in females. Angiomyxoma characteristically has a high incidence of local recurrence. The only treatment of recurrence is surgical re-excision. We report a case of recurrent aggressive angiomyxoma, which was only incompletely resected.

[Prophylactic antibiotherapy using cefapirin in the surgery of duodenal ulcer: a randomized clinical trial]. / Antibiothérapie prophylactique par céfapirine dans la chirurgie de l'ulcère duodénal: essai clinique randomisé.

A randomized clinical trial of antibiotic prophylaxis in patients undergoing gastroduodenal surgery for stenosing or bleeding duodenal ulcer was carried out from February 1990 to February 1991. Seventy-two patients were randomly assigned to either Group I (n = 33) and given 1 g of cefapirine intravenously every eight hours, four times, starting at induction of anaesthesia; or to Group II (n = 39), and not given any antibiotic. The surgical dressing was changed on the third postoperative day, and thereafter every two days in patients with fever. The efficiency of prophylaxis was assessed on the incidence of superficial or deep primary infection, and the length of hospital stay. Primary wound sepsis occurred in 7 Group II patients, and in none in Group I (n = 0.01). The results for those patients with stenosing ulcer (n = 53) were also significant: there was no primary wound infection in Group I (n = 25), whereas five occurred in Group II (n = 28) (p = 0.03). Hospital stay was shorter in Group I than in Group II (7 vs 9.5 days). Antibiotic prophylaxis also seemed to be efficient in patients with bleeding duodenal ulcers (n = 19), but their group was too small to reach levels of statistical significance. Again hospital stay was shorter in Group I than in Group II (8.5 vs 12.2 days). The efficiency of antibiotic prophylaxis was therefore confirmed for patients undergoing gastroduodenal surgery for stenosing duodenal ulcer.