[Early outcome of digestive surgery in a tropical setting]. / Evolution post-opératoire précoce en chirurgie digestive en milieu tropic.

OBJECTIVE: The purpose of this report was to describe early outcome of surgical management of digestive disease in a tropical setting. Study design. This retrospective, descriptive study was carried out in Benin over the three-year period from January 1, 2002 to December 31, 2004. PATIENTS AND METHODS: A total of 613 patients admitted to the intensive care unit (ICU) following surgical treatment for digestive disease were studied. Data were collected on cards from ICU patient admission records, duty register, and patient charts. The data obtained by exact transcription from cards was entered into the Epidata 3.02 software package and analyzed using the Stata 8.0 software package. RESULTS: Patients undergoing surgery for digestive disease accounted for 32% of admissions to the ICU during the study period. Mean patient age was 30 years (range, 1 day to 85 years). Surgery was carried out under emergency conditions in 510 patients and elective conditions in 103. The most common surgical indications were peritonitis, acute bowel occlusion, and malignant tumors. Overall postoperative morbidity was 25.8% with a strong male prevalence (27.6% after emergency procedures and 16.5% after elective procedures). Most complications (74.7%) occurred within 4 days after the procedure. Complications rare occurred after the 6th post-operative day. Overall mortality was 13% (13.3% after emergency procedures and 11.6% after elective surgery). The most frequent cause of death was sepsis. In the vast majority of the cases (78.7%) death occurred in the first 72 hours. CONCLUSION: Post-operative morbidity and mortality remain high in our ICU especially after surgical management of digestive disease. Although this finding is correlated with inadequate technical and human resources, it is mainly due to delayed treatment or slow evacuation time with most patients being admitted in extremely critical condition. Elective surgery was usually performed on patients presenting advanced-stage malignancy. Delayed management with subsequent deterioration of the patient's clinical state was frequently due to prior treatment by practitioners of traditional medicine.

[Use of ilio-inguinal iliohypogastric nerve block for herniorraphy: a prospective study in a 35-case series at the Lome University Hospital Center in Togo]. / Pratique du bloc ilio-inguinal ilio-hypogastrique pour cure herniaire: étude prospective à propos de 35 cas colligés au CHU de Lomé, Togo.

The purpose of this prospective-descriptive study was to evaluate the quality of anaesthesia and analgesic effect achieved by ilio-inguinal iliohypogastric nerve block (IINB) in patients undergoing herniorraphy. Study was carried out over a 6-month period in the Anaesthesia Intensive Care Department of the Lomé University Hospital Centre in Togo. All patients indicated for unilateral herniorraphy were enrolled. A total of 35 patients underwent herniorraphy with IINB. Mean patient age was 32 years. Farmers accounted for 57% of the population. Men accounted for 86.7%. The anaesthesia classification was ASA I or II in 88.6% of cases. Complete sensory block was obtained within 15 minutes after induction in 71.43% of cases. Additional sedation using ketamine and/or fentanyl was used in 51.43% of cases. Conversion from IINB to general anaesthesia was necessary in three cases including 2 due to extension of the surgical incision and one for the surgeon's convenience. The mean duration of the procedure was 70 minutes. Intraoperative complications included nausea in one case, dizziness in 2 cases, and bitterness in mouth in 3 cases. Postoperatively, extension to the femoral nerve was observed in 2 cases. Five patients presented a visual analogue pain scale (VAS) > or = 4 within 18 hours after the procedure. This study shows that IINB is a useful alternative to general anaesthesia for herniorraphy. Specific training is necessary to allow more widespread use.

[Knowledge and acceptance of obstetric peridural analgesia: survey of pregnant women in Togo]. / Niveau de connaissance et acceptabilité e l'analgésie péridurale: enquête auprès des femmes enceintes au Togo.

The purpose of this study was to evaluate knowledge and acceptance of obstetric peridural analgesia among pregnant women in Togo. A prospective, descriptive survey was carried out over a period of one month. A standardized survey form was used to collect data. A total of 303 pregnant women with a mean age of 27 +/- 6 years were interviewed. A proportion of primiparous and multiparous was the same, i.e., 50%. Among multiparous women, 83.5% described labor pain during previous deliveries as severe. Twelve percent of the pregnant women interviewed claimed knowledge of techniques to control labor pain. Three pregnant women reported a detailed understanding of peridural analgesia obtained from the Internet. A total of 253 women (83.5%) replied affirmatively when asked if they would opt for peridural analgesia if it was offered free of charge for delivery at the end of the current pregnancy. Acceptance was motivated by better delivery conditions for the newborn (112 women) and comfort achieved by pain relief (130 women). Refusal was motivated by a religious belief that painful delivery was in the natural order (31 women). Among the six Moslem women that refused painless delivery, two from the Djerma ethnic group stated that pain was the best expression of their femininity. The acceptance rate fell from 83.5% to 70% if peridural analgesia was offered at extra charge. Most pregnant women in Togo expressed interest in trying peridural analgesia. It is compulsory in medical indications.