Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar

Appendiceal pathology’s management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted

Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal

Background: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. Patients and Methods: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. Results: The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. Conclusion: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks

Alarming Mortality of Biliary Atresia in Two Senegalese Tertiary Hospitals: A Plea For Early Diagnosis

Background: The management of biliary atresia is challenging in low-income countries, with delayed diagnosis and its consequences. We aimed to report its epidemiological, diagnostic, therapeutic aspects and outcomes in Dakar, Senegal. Methods: We conducted a 5-year retrospective review, which included 16 patients, admitted in the pediatric surgery services of Aristide Le Dantec University Teaching Hospital and Diamniadio Children's Hospital. Results: The mean age at admission was 105.6 (1 - 420 days), with 10 girls. Cholestatic jaundice was found in all cases, discolored stools in 43.7%, dark urine and hepatomegaly in 31.2%.  All patients had biological cholestasis and cytolysis syndromes. The ultrasound was performed in all patients with a sensitivity of 56.2%.  The mean age at the time of surgery was 145 days (22 – 540 days). The surgical exploration was conducted in 10 cases and found type IV Biliary Atresia in 50%. The Kasai procedure was performed in 4 cases and liver biopsy in 9 cases.  Mortality occurred in 75% (50% post-operatively and 25% pre-operatively). In two cases, the postoperative course was unremarkable with the success of the Kasai Procedure after a 42-months follow-up. Two patients were lost to follow-up. Conclusion: Biliary atresia still has high mortality in our context. This is mainly due to delayed diagnosis, which is common in our environment. Multidisciplinary assessment of persistent neonatal jaundice is crucial to reduce biliary atresia-related mortalit

Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal

Objective Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department.Methods We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression.Results Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425).Conclusion The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment