[Sclerotherapy of a simple, solitary kidney cyst using intraluminal ethanol instillation in a Swiss Fleckvieh cow]. / Sklerotherapie einer einfachen, solitären Nierenzyste mittels intraluminaler Ethanolinstillation bei einer Swiss Fleckvieh-Kuh.

INTRODUCTION: Renal cysts are fluid-filled cavities with an epithelial lining that, depending on their size, can cause clinical symptoms and thus require conservative or surgical therapy. Nephrectomy is primarily used in cattle for simple kidney cysts while sclerotherapy is well established in humans and individual case reports have been published in small animal medicine. This case report describes the first successful treatment of a solitary, perirenal cyst using a right-sided laparotomy and intraluminal instillation of 96% ethanol solution in a Swiss Fleckvieh cow. Diagnostics, surgical procedures and aftercare are descripted and risks are compared to other methods. Sclerotherapy is an organ-preserving alternative to nephrectomy that is suitable for buiatric practice, the methodology should be confirmed in subsequent intervention studies.

INTRODUCTION: Les kystes rénaux sont des cavités remplies de liquide avec une muqueuse épithéliale qui, en fonction de leur taille, peuvent provoquer des symptômes cliniques et nécessitent donc un traitement conservateur ou chirurgical. Alors que la sclérothérapie pour le traitement des kystes rénaux simples est bien établie chez l'homme et que des rapports de cas individuels ont également été décrits en médecine des petits animaux, la néphrectomie est principalement utilisée chez les bovins. Ce rapport de cas décrit pour la première fois le traitement réussi d'un kyste périrénal solitaire par instillation intraluminale d'une solution d'éthanol à 96% après une laparotomie droite chez une vache de race Swiss Fleckvieh. Les aspects du diagnostic, des procédures chirurgicales et des soins de suivi sont expliqués et les risques par rapport aux autres méthodes sont discutés. La sclérothérapie est une alternative de préservation des organes à la néphrectomie qui convient à la pratique buiatrique et dont la méthodologie doit être confirmée dans des études d'interventions ultérieures.

[Impact of the LACC study. A SFOG survey]. / Impact de l'étude LACC. Une enquête de la SFOG.

INTRODUCTION: The LACC (Laparoscopic Approach to Cervical Cancer Trial) study, released in 2018, described oncological findings in favour of open surgery compared to the minimally invasive pathway in the management of early stage cervical cancers. Our aim was to assess the impact of this study on surgical practices in France. METHOD: Online questionnaire, consisting of 13 questions addressed to gynecology oncology french society (SFOG) surgeons. RESULTS: Forty questionnaires were collected. The median annual number of radical hysterectomy was 5 (0-20). Prior to the study, 92.5 % of cervical cancer patients had radical hysterectomy by minimally invasive surgery. In case of laparoscopy or robot, the uterine manipulator was used in 67.6 % and the colpotomy was performed intra-abdominally (78.4 %). After the LACC study, 60 % changed their practice. Open surgery was favored by 75 % of those who modified their practice. Among those continuing to perform minimally invasive surgeries, the manipulator and the intracorporeal colpotomy were discontinued. One-third of surgeons have changed their surgical practice for endometrial cancer in parallel. CONCLUSION: The results of the LACC study led to a change in surgical practices with an increase in open surgery and a stop in the use of the uterine manipulator and the laparoscopic/robotic intracorporeal colpotomy in the surgical management of early stage of cervical cancer.

Adrenocortical carcinoma: Impact of surgical treatment.

Compared to benign adrenal lesions, secreting or otherwise, malignant adrenocortical carcinoma is rare. Overall prognosis is poor, with <50% 5-year survival. Various prognostic factors have been identified, some tumor-related and others directly linked to surgical treatment. Surgery is the only possible curative treatment, and is decided upon in a multidisciplinary medical-surgical team meeting. Surgical approach (laparotomy vs. laparoscopy) remains a matter of debate. In the light of a recent literature search, the present review reassesses the prognostic criteria of surgical resection, the quality of which determines overall and recurrence-free survival.

[Orthotopic neobladder reconstruction for bladder cancer: robotic-assisted versus open-radical cystectomy for perioperative outcomes, functional results and quality of life]. / Morbidité, résultat fonctionnel, et qualité de vie des néovessies après cystectomie pour cancer : comparaison de la voie ouverte vs robotique.

INTRODUCTION: Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming. OBJECTIVE: To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol). PATIENTS AND METHODS: From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC. RESULTS: We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P<0.001) but length of stay was 5 days shorter (median 12 vs 17 days; P<0,05). Patients in RARC group had less blood transfusion (0 vs 23.6%; P<0.05), but a higher rate of uretero-ileal anastomosis stenosis and eventration at long term (respectively 25.5 vs 3.6% et 23 vs 2%; P<0.05). No statistical differences were found concerning quality of life items and functional results between the groups. CONCLUSION: RARC with totally IC ONB reconstruction lead to less perioperative morbidity with a reduced rate of blood transfusion and a reduced hospital length of stay. At long term, RARC could provide higher rates of uretero-ileal stenosis and eventration. RARC and ORC do not have any differences in terms of functional outcomes and Qol at long term after ONB reconstruction. LEVEL OF EVIDENCE: 3.

[Prevention of bleeding during laparotomic myomectomy in Sub-Saharan Africa: Contribution to the tourniquet on the uterine isthmus]. / Prévention de l'hémorragie per myomectomie en Afrique subsaharienne : apport du garrot sur l'isthme utérin.

OBJECTIVES: To appreciate the decrease of bleeding by myomectomy by the use of a tourniquet on the uterine isthmus. METHODS: We conducted a case-control retrospective study from March 2014 to February 2016 in the Gynecology and obstetrics Department of the university hospital of Yopougon (Abidjan, Ivory Coast). It interested 100 patients of which 50 had a myomectomy with the tourniquet on the uterine isthmus and 50 without the tourniquet. None of the patients received pre-operative preventive treatment. The criteria for comparison were the blood loss per operative and the pre-and post-operative hemoglobin levels. RESULTS: The average age of patients was 33 years. Nulliparous women were the group most affected (68% of our patients) with 32% infertile women in the group with the tourniquet and 18% in the group without the tourniquet. Patients without tourniquet presented more bleeding than patients with tourniquet (X2=13.61) with a higher proportion of anemic patients in the group without the tourniquet. The differences were significant. The tourniquet has made it possible to realize the resection of a larger number of myoma. The duration of hospital stay was 4 days on average in both groups and no complications were observed. CONCLUSIONS: The application of a tourniquet on the uterine isthmus during laparotomic myomectomy has a benefit in reducing intraoperative blood loss.

[Why and how to perform an ultrasound-guided transversus abdominis plane block: A step-by-step approach]. / Le TAP block échoguidé pas à pas : pourquoi et comment le réaliser ?

Used in clinical practice as part of a multimodal analgesic regimen, the transversus abdominis plane block (TAP block) is a relative novel procedure in which local anaesthetic agents are injected into the anatomic neurofascial space between the internal oblique and the transversus abdominis muscle. It allows a significantly prolonged duration of analgesia during the early postoperative stage in abdominal surgery. This regional anesthesia technique provides analgesia to the skin, muscles of the anterior abdominal wall and parietal peritoneum in order to decrease the incision-related pain. Thus, it reduces postoperative opiate requirements and opioids-related side effects (nausea, vomiting, delayed resumption of intestinal transit, drowsiness, respiratory depression, urine retention). Additionally, the TAP block appears particularly interesting when neuraxial techniques or opioids are contraindicated. Moreover, the ultrasound-guided procedure provides a significant success rate of this block and additionally avoids major complications. We describe our technique of ultrasound-guided TAP block and discuss its indications, contraindication and potential complications.

[Nursing procedures carried out with an intestinal obstruction]. / Soins infirmiers lors d'une occlusion intestinale.

In addition to the evacuation of the liquid which has accumulated above the intestinal obstruction, the nurse performs various tasks such as the monitoring of the patient's hydration status. She also follows up the patient in the event of complications and if the doctor decides to perform a coelioscopy or laparotomy.

[Single procedure treatment of complex nephrolithiasis: about a modern series of anatrophic nephrolithotomy]. / Traitement en un temps de la lithiase rénale complexe : à propos d'une série moderne de néphrotomies bivalves.

PURPOSE: Advances in endourology have significantly reduced indications of open surgery in the treatment of staghorn calculi. However, in our experience, open surgery is still the treatment of choice in some cases. This study presents the results of a series of selected patients and discusses the results in terms of efficacy and morbidity. MATERIALS: A cohort of 26 patients underwent anatrophic nephrolithotomy by lombotomy to treat a complex staghorn calculus. RESULTS: The mean stone size was 68,5mm, 70% were complete staghorn calculi. The operative time was 100minutes. Blood loss was 225mL, with a postoperative transfusion rate of 15.4%. The hospital stay was 8.4 days. The stone free rate following the procedure was 92%. The creatinine clearance (MDRD) at 3 months was improved from 5.9mL/min/m(2) on average over the entire series. CONCLUSION: There are clearly still indications for open surgery in staghorn stones management, with good results in this contemporary series on both stone removal and nephronic preservation. Yet, it appears that this technique is no longer taught. LEVEL OF EVIDENCE: 5.

[Penetrating abdominal wounds caused by weapons in the service of general surgery in the Gabriel Touré teaching hospital]. / Plaies penetrantes abdominales par armes dans le service de chirurgie generale du CHU Gabriel Toure.

INTRODUCTION: Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects. MATERIALS AND METHODS: This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included. RESULTS: We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%. CONCLUSION: Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia.

INTRODUCTION: La prise en charge des plaies pénétrantes de l'abdomen est encore sujet à controverses. Les objectifs de ce travail étaient d'étudier les aspects épidémiologiques, cliniques et thérapeutiques. MATÉRIELS ET MÉTHODE: Cette étude rétrospective de 4 ans, de janvier 2006 à janvier 2010 portant sur 70 cas de plaies pénétrantes de l'abdomen, a été réalisée dans le service de chirurgie générale du CHU Gabriel Touré. Les plaies non pénétrantes et les encornements ont été non inclus. RÉSULTATS: A l'issue de l'étude, nous avons colligé 70 cas de plaies pénétrantes abdominales;ce qui a représenté 1,2% des hospitalisations. L'âge moyen des patients a été de 27,7 ans(extrêmes 12 et 59 ans) avec un sex ratio de 9 pour les hommes. Vingt sept patients (38,36%) viennent de la commune I et II. L'agression criminelle a été la circonstance de survenue la plus fréquente (70%). Trois de nos patients avaient un antécédent psychiatrique et 45,7% consommaient des stupéfiants. L'épiploon et le grêle ont été les organes les plus éviscérés (51,4%).Dix sept patients sur 53 ont bénéficié du traitement non opératoire. Notre taux de laparotomie blanche a été de 30,2% et la morbidité post opératoire était de 15,1%. CONCLUSION: La gestion des plaies pénétrantes abdominales reste difficile. Une bonne sélection des patients permet de diminuer le taux de laparotomie blanche.

[Heterotopic ossification on a midline laparotomy scar after digestive surgery: etiopathogenic discussion about two cases]. / Ossification heterotopique sur cicatrice mediane abdominale apres chirurgie digestive: discussion etiopathogenique a propos de deux cas.

Heterotopic ossification (HO) is rarely seen after abdominal surgery and usually occurs after orthopedic surgery. It is a benign affection with an unknown mechanism and an unpredictable occurrence rate; but some etiopathogenic hypotheses have been put forward. Therapeutic attitudes were not assessed in this study. We report two observations of heterotopic ossification on mid-line laparotomy scar which could support the etiopathogenic hypothesis of osteoblastic cells migration in granulation tissue from the neighbouring bone tissue, particularly from the sternum or pubian structures. The etiopathogenic mechanism and treatment of this affection are discussed with regards to previously published literature.

L'ossification hétérotopique (OH) est rare au cours de la chirurgie abdominale et intéresse surtout la pathologie orthopédique. C'est une affection bénigne, de survenue imprévisible, de mécanisme encore discuté et des hypothèses étiopathogéniques sont proposées. L'attitude thérapeutique n'est pas codifiée. Nous rapportons deux observations d'ossification hétérotopique sur cicatrice médiane sus ombilicale qui pourraient supporter l'hypothèse étiopathogénique d'une greffe de cellules ostéoblastiques au sein du tissu de granulation à la faveur d'un tissu osseux de voisinage notamment les structures osseuses xiphoïdiennes ou pubiennes. L'étiopathogénie et le traitement de cette affection sont discutés à la lumière des données de la littérature.