Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

BACKGROUND: Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. METHODS: We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. RESULTS: We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). CONCLUSION: These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Infected urachal cyst in an adult, report of two observations.

INTRODUCTION: Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it. CASE PRESENTATION: Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection. CLINICAL DISCUSSION: Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery. CONCLUSION: Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

[Malignant infantile osteopetrosis revealed by choanal atresia: A case report]. / Ostéopétrose maligne infantile révélée par une atrésie des choanes : à propos d'un cas.

Malignant infantile osteopetrosis is a rare genetic disease characterized by increased bone density due to osteoclastic dysfunction. We report on the case of a 3-month-old girl who was referred to our hospital by the ENT department for severe anemia in the context of bilateral choanal atresia. Clinical examination showed failure to thrive, anemia, respiratory distress, bilateral choanal atresia, and chest deformation. The abdomen was soft with large hepatosplenomegaly. We noted a lack of eye tracking, no optical-visual reflexes, and left nerve facial paralysis. The blood count showed normocytic normochromic anemia with severe thrombocytopenia. The infectious work-up and blood smears were negative. The skeleton X-ray showed diffuse bone densification of the skull, long bones, pelvis, vertebrae, and ribs. The facial bone CT confirmed membranous choanal atresia. The molecular biology search for the TCIRG1 gene mutation was not available. The patient had supportive treatment (transfusion, oral steroid, vitamin D, oxygen, nutrition). Bone marrow transplantation was indicated but not available. She died at 6 months in a context of severe anemia and bleeding. Malignant infantile osteopetrosis is rare and symptoms are nonspecific. Diagnosis should be considered in young infants presenting refractory anemia, particularly in the context of choanal atresia. Bone marrow transplantation remains the only curative treatment.

[Schistosoma-induced granulomatous panniculitis. An unusual presentation of cutaneous schistosomiasis]. / Panniculite granulomateuse bilharzienne. Une présentation inhabituelle de la bilharziose cutanée.

BACKGROUND: Cutaneous schistosomiasis is extremely rare, even in endemic regions. It usually leads to non-specific papulonodular lesions in the perigenital area. We report a case of cutaneous schistosomiasis presenting as panniculitis. CASE REPORT: An 8-year-old girl was admitted for a large multinodular, indurated plaque over the perineum that gradually spread over a year in a setting of hypereosinophilia. Ultrasonography showed thickening of the bladder and a significant bilateral ureteral hydronephrosis. Histological examination revealed numerous granulomas Schistosoma haematobium ova at their centre and within the hypodermis. Treatment with praziquantel 40 mg/kg resulted in regression of cutaneous lesions within 3 weeks. DISCUSSION: We report a case of Schistosoma-induced granulomatous panniculitis that is noteworthy in terms of its clinical appearance, perineal location, association with severe urinary involvement and rapid regression under treatment. The current extent of endemic schistosomiasis and its severity justify greater awareness of this unusual cutaneous presentation, which to our knowledge has never previously been reported.