Surgical treatment of Crohn's disease: indications, results and predictive factors of recurrence and morbidity.

BACKGROUND: Crohn's disease management represents a major problem in gastroenterology and general surgery because it affects young subjects and has a major impact on their quality of life. The aims of our study were to identify the indications for surgery in Crohn's disease, the results and the complications of surgery in our series, and to identify possible predictive factors of recurrence and postoperative morbidity. METHODS: A retrospective descriptive study including 38 cases of patients with Crohn's disease who underwent surgical treatment in the department of surgery in Mongi Slim Hospital, during the period between January 1992 and December 2011 was performed. RESULTS: The occurrence of stenosis was the most common indication for surgical treatment in Crohn's disease in our series, and ileocecal resection was the most performed surgery. Twenty six patients (58%) received maintenance therapy after surgery. Twenty two patients relapsed and 13 had surgical management for recurrence. In univariate analysis, predictive factors of post operative morbidity in our study were leukocytosis, penetrating phenotype and intraabdominal sepsis. Ileocecal location was the only factor that significantly improved the incidence of recurrence. In multivariate analysis, only penetrating phenotype was a predictive factor or post operative morbidity. CONCLUSION: Despite the development of medical treatment, surgical treatment keeps large indications for the management of complications of Crohn's disease. The surgery should be an alternative to immunosuppressive therapy. Currently, prevention postoperative recurrence is well codified, reducing the risk of complications.

Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas. MATERIAL AND METHODS: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment. RESULTS: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different. CONCLUSION: Our results showed the efficacy and safety of percutaneous ablation treatments (radiofrequency ablation and ethanol injection) in patients with small hepatocellular carcinoma.

[Chronic pancreatitis: clinical and therapeutic study. Six years of experience of a gastroenterology department]. / La pancréatite chronique calcifiante: Etude Clinique et thérapeutique Expérience de 6 ans d'un service de gasto-entérologie.

BACKGROUND: The chronic pancreatitis is an inflammatory chronic affection of the pancreatic parenchyma characterized by a mutilating fibrosis with a progressive set up. The endoscopic treatment is actually considered as the first-line treatment and can sometimes be complementary to surgery. AIM: To determine the epidemiological, clinical, para-clinical and therapeutic characteristics during chronic pancreatitis. METHODS: a retrospective study including patients having a chronic pancreatitis hospitalized in the gastroenterology department of Habib Thameur hospital between 2002 and 2008 was performed. RESULTS: Sixteen patients were included in this study (mean age 43 years, sex ratio 7). All the patients were symptomatic at the time of the diagnosis and the epigastric pain was the main symptom. A complication was noted at the time of diagnosis in 12 patients: endocrine and exocrine pancreatic failure was noted in respectively 5 and 3 patients, while other complications were less frequent: acute pancreatitis (2 patients), cholestatic jaundice (2 patients) and pancreatic pseudo-cyst (2 patients). The endoscopic treatment was performed in 62% of the patients with success of 63%. The surgical treatment was indicated in 37% of the cases. Mean follow up was 16 months. Survival rate was 93% at one year. One patient died because of hypoglycemia. No pancreatic neoplasia was noted in our study. CONCLUSION: In chronic pancreatitis, the contribution of endoscopic treatment is considerable but not without a certain risk. Therefore, collaboration between surgeons and endoscopists is needed and the best treatment should be considered individually.