Service de chirurgie generale

Sousse, Tunisia

Service de chirurgie generale

Sousse, Tunisia
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Nadour K.,Service dORL et CCF | Moujahid M.,Service de Chirurgie Generale
The Pan African medical journal | Year: 2016

Cervicothoracic cystic lymphangiomas are rare benign tumors developing from sequestration of embryonic lymph sac which is gradually filled with lymph fluid. The diagnosis is based on clinical signs (laterocervical swelling) and imaging (ultrasound and CT scan), then confirmed by histology after surgery which constitutes the basis of treatment. We here report a case of cervicothoracic cystic lymphangioma and review of the literature.


Bozio G.,Service de chirurgie generale
Journal of visceral surgery | Year: 2011

The goal of this review is to evaluate, through a review of the surgical literature, the role of esophagectomy in the management of Barrett's esophagus as it evolves histologically from intestinal metaplasia through increasing grades of dysplasia to adenocarcinoma. We precisely define the indications and therapeutic modalities of esophagectomy for high-grade dysplasia, superficial adenocarcinoma, and invasive adenocarcinoma. Copyright © 2011 Elsevier Masson SAS. All rights reserved.


Zacharias T.,Service de Chirurgie Generale | Ferreira N.,Service de Chirurgie Generale | Carin A.-J.,Service de Chirurgie Generale
European Journal of Clinical Nutrition | Year: 2014

Background/Objectives:The value of preoperative nutritional support in liver resection remains questionable. The aim of the present study was to compare the incidence of postoperative complications after liver resection between those patients that received preoperative immunonutrition versus those patients without preoperative nutritional support.Subjects/Methods:Patients undergoing elective liver resection between 9 November 2007 and 14 May 2013 were considered for the study: 84 with preoperative immunonutrition (Oral-Impact, Nestle, 3 × 237 ml per day for seven days at home) and 63 control patients without preoperative nutritional support. To reduce selection bias, propensity score matching was performed. Primary endpoint was the overall complication rate. Secondary endpoints were infectious and major complications.Results: Ninety-eight patients could be matched (49 in each group). Seventy-seven patients (78.6%) had a minor and 21 patients (21.4%) a major liver resection. The two groups were balanced for age, gender distribution, American Society of Anesthesiology score ≥3, NRS 2002 score, weight loss>10%, cirrhosis, steathosis, preoperative chemotherapy, pathology, major liver resection and extrahepatic procedures. No significant differences were observed in the overall complication rate (53.0% versus 51.0%), infectious complications (38.7% versus 28.5%) and major complications (12.2% versus 10.2%) for the immunonutrition and control group, respectively.Conclusions:The present study did not permit to demonstrate an impact of preoperative immunonutrition with Oral-Impact on postoperative complications after minor liver resection. © 2014 Macmillan Publishers Limited All rights reserved.


Poghosyan T.,Service de chirurgie generale
Journal of visceral surgery | Year: 2011

Functional disorders such as delayed gastric emptying, dumping syndrome or duodeno-gastro-esophageal reflux occur in half of the patients who undergo esophagectomy and gastric tube reconstruction for cancer. The potential role for pyloroplasty in the prevention of functional disorders is still debated. Antireflux fundoplication during esophagectomy can apparently reduce the reflux but at the cost of increasing the complexity of the operation; it is not widely used. The treatment of functional disorders arising after esophagectomy and gastroplasty for cancer is based mainly on dietary measures. Proton pump inhibitors have well documented efficiency and should be given routinely to prevent reflux complications. Erythromycin may prevent delayed gastric emptying, but it should be used with caution in patients with cardiovascular disorders. In the event of anastomotic stricture, endoscopic dilatation is usually efficient. Problems related to gastrointestinal functional disorders after esophageal resection and gastric tube reconstruction do not significantly impair long-term quality of life, which is mainly influenced by tumor recurrence. Copyright © 2011 Elsevier Masson SAS. All rights reserved.


Chalret du Rieu M.,Service de chirurgie generale
Journal of visceral surgery | Year: 2011

Chylothorax is a rare but severe complication of thoracic and esophageal surgery. The anatomical relations of the thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At an early stage, chylothorax can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. Optimal management of chylothorax can decrease mortality. It is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated at diagnosis and results in resolution of the chylothorax is achieved in 50 to 70% of cases. In case of either high flow rate chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery. Copyright © 2011 Elsevier Masson SAS. All rights reserved.


Chirica M.,Service de chirurgie generale
Journal of visceral surgery | Year: 2010

The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy. Copyright © 2010. Published by Elsevier Masson SAS.


Arapis K.,Service de chirurgie generale
Journal of visceral surgery | Year: 2012

There are conflicting results concerning the bariatric effectiveness of adjustable gastric banding in super-obese patients with a Body Mass Index (BMI) more or equal to 50 kg/m(2). A cohort of 186 patients with a BMI greater or equal to 50 kg/m(2) who underwent adjustable gastric banding (AGB) at the Bichat-Claude-Bernard University Hospital (Paris, France) were prospectively entered into a database. The following data were recorded: BMI, percentage of BMI loss, percentage of excess weight lost (%EWL), complications, and surgical re-interventions. Loss of greater than 50% of excess weight was considered a success (primary endpoint). A %EWL of less than 25% after one year, or the removal of the gastric band was considered a failure. Thirty-five men (18.8%) and 151 women (81.2%), with a mean age of 38.9 years (range: 16-65) underwent AGB between September 1995 and December 2007. The mean BMI was 55.06 kg/m(2) (range: 50-74.4). Mean follow-up was 112.5 months with a minimum of 28 months and a maximum of 172 months. The follow-up rate was maintained at 89% at ten years. The technique of AGB was by "peri-gastric dissection" in the first 115 patients (61.82%) and by "pars flaccida dissection" in 71 patients (38.17%). The gastric band was removed in 87 of 186 patients (46.8%); band ablation was due to a complication of the gastric band in 62 of these cases (33.3%), to failure of weight loss in 23 cases (12.4%), and to patient request in two cases (1%). The major complications requiring re-operation were: chronic dilatation of the proximal gastric pouch (27 patients - 14.5%), acute dilatation (21 patients - 11.3%), intragastric migration of the prosthesis (six patients - 3.2%), reflux esophagitis (six patients - 3.2%), infection of the gastric band (one patient - 0.5%), and Barrett's esophagus (one patient - 0.5%). No statistically significant difference was found between the two operative techniques with regard to the possibility of preserving the gastric band for ten years. For patients who underwent band removal, no further follow-up analysis of patient data after band ablation was performed. The results were best at two years after AGB with a median BMI of 42.72 kg/m(2), a band removal rate of 8.6% (16 of 186 patients), and a failure rate of 16.4% (28 of 170 patients) of those patients who still had their band in place. However, at 10 years, the picture was completely reversed with a band removal rate of 52.2% (47 of 90 patients), a failure rate of 22% (seven of 33 patients) of those who still had their band in place, and a median BMI of 43.43 kg/m(2). Laparoscopic gastroplasty using the adjustable gastric band appeared to be a promising intervention for super-obese patients when the results at two years were analyzed - fairly simple to perform, with perioperative morbidity and mortality near zero. However, these results do not persist in the long-term for super-obese patients. At ten years, only 11% of patients (nine of 80) have successful bariatric results (%EWL>50%) and we were forced to remove the gastric band in 52.2% of patients (47 of 90) because of complications, regardless of the initial operative technique used. Given these results, AGB gastroplasty is not a recommended method for super-obese patients and we believe that a BMI greater or equal to 50 kg/m(2) is a contra-indication for this procedure. Copyright © 2012. Published by Elsevier Masson SAS.


Sleeve resection at the bronchial division is an alternative to pneumonectomy when pedicle invasion is limited to the bronchial division or the terminal part of the main bronchus with no major involvement of the pulmonary vessels.However, double bronchial and arterial resections/anastomoses are possible in favorable oncological and anatomical situations, broadening the possibilities for conservative surgery.These procedures, initially reserved for patients who, for reasons of respiratory function, could not undergo pneumonectomy, are performed today every time they are technically feasible because morbidity and mortality of these resections are lower than for pneumonectomy for an undoubtedly identical oncologic result and better quality of life. © 2010 Société de Pneumologie de Langue Française (SPLF).


Miloudi N.,Service de chirurgie generale
Journal of visceral surgery | Year: 2012

Lipomas of the colon are relatively rare benign tumors. Colo-colonic intussusception is an unusual complication of colonic lipoma. We report the case of a 79-year-old man who presented with spasmodic, self-limiting abdominal pain associated with rectal bleeding. Colonoscopy revealed a submucosal mass suggestive of a benign tumor but that was too large for endoscopic resection. CT scan demonstrated an endoluminal fatty mass in the transverse colon, typical of lipoma, and suggested colo-colonic intussusception due to the mass. The mass was removed laparoscopically. Recovery was uneventful. Copyright © 2012. Published by Elsevier Masson SAS.


Miloudi N.,Service de chirurgie generale
Journal of visceral surgery | Year: 2012

Acute appendicitis is the most frequent surgical emergency arising during pregnancy. Definitive diagnosis is often difficult. The therapeutic options remain the same, i.e. appendectomy. We present a series of 29 pregnant women who underwent surgery for acute appendicitis over a period of 10 years. The mean age was 28.6 years. Mean gravidity was 1.75 and mean parity was 0.84. The average period of gestation was 18 weeks and 5 days since the last menses. Seven patients underwent surgery during the 1st trimester, 15 during the 2nd trimester, and seven during the 3rd trimester. Eighteen patients underwent appendectomy through a laparoscopic approach and 11 through a McBurney incision. The postoperative course was uncomplicated in 27 patients. Two patients miscarried in the week following surgery. Acute appendicitis puts both maternal and fetal prognosis at risk. Management should be prompt and undertaken by a multidisciplinary team approach. Morbidity and mortality are not negligible. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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