Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst

Introduction Surgery remains the basic treatment of hepatic hydatid cyst (HHC). However, it is associated with significant morbidity. The aim of our study was to evaluate mortality and morbidity of surgery of the HHC and to highlight the risk factors. Methods A retrospective study was conducted from January 1, 1996 to December 31, 2006. 391 patients hospitalized for HHC and operated in the Department of General Surgery “A” of the Rabta Hospital in Tunis, Tunisia. Results The overall mortality rate was 0.7% while the overall morbidity rate was 20.4%. About 16.6% suffered from specific complications, while 3.8% suffered from non-specific complications. Predictors of morbidity in a univariate analysis included cysts larger than 9 cm, dome cysts, cysts with bilious contents, type II, III, IV or V on ultrasound classification, fissured cysts and intrabiliary rupture of hepatic hydatid cyst. The multivariate study consisted of independent predictors of disease at the site of the liver dome, the cysto-biliary fistula and intrabiliary rupture of hepatic hydatid cyst Conclusion The hepatic hydatid cyst of the dome and the existence of preoperative complications in particular intrabiliary rupture of hepatic hydatid cyst are the main factors of morbidity. A better understanding of these factors allows the surgeon to choose the appropiate surgical technique that is associated with less morbidity.Pan African Medical Journal 2012; 13:2

Résultats de la chirurgie laparoscopique pour la hernie de l’aine: l’expérience Tunisienne

La hernie de l'aine de l'adulte reste une affection fréquente en chirurgie digestive. De nombreuses techniques de réparation ont été décrites à ce jour dont les procédés laparoscopiques. Deux méthodes furent rapidement adoptées par les différents praticiens pour le traitement chirurgical des hernies de l'aine par laparoscopie: la méthode laparoscopique totalement extra péritonéale (TEP) et la méthode laparoscopique transpéritonéale (TAPP). Le but était d'étudier la faisabilité de la cure de hernie de l'aine par coelioscopie et de décrire ses résultats du point de vue récidive herniaire et douleur post opératoire. Ce travail était une étude rétrospective, uni centrique, et transversale, portant sur des patients opérés par des chirurgiens du service de chirurgie A La Rabta pour hernie de l'aine par voie laparoscopique, sur une période de 8 ans allant de janvier 2006 à décembre 2013. Le principal critère de jugement était la récidive herniaire. La douleur post opératoire et les complications étaient les critères de jugement secondaires. Nous avons colligés 104 hernies chez 92 patients respectant les critères d'inclusion de notre étude. La moyenne d'âge de nos patients était de 48 Ans (19-83). L'approche TAPP était la plus utilisée: 94 cas (90%) TAPP contre 10 cas TEP. Aucune complication per opératoires n'a été signalée. Le taux de conversion de notre série était nul. La mortalité opératoire était aussi nulle. La morbidité postopératoire était de 5% (5 patients). Elle était à type d'hématome dans 3 cas et de sérum dans 2 cas. La durée moyenne d'hospitalisation était de 1.2 jours (1- 4jours). Le séjour post opératoire n'avait pas dépassé 2 jours chez 94% des patients. Seulement 2 patients avaient présenté une récidive. Les douleurs chroniques postopératoires étaient notées chez seulement 3 patients. Notre étude a montré que la cure de hernie de l'aine par laparoscopie a apporté un confort considérable à nos patients en ce qui concerne les phénomènes douloureux, les durées d'hospitalisation et d'arrêt de travail. Les résultats obtenus dans cette série sont bons et conformes aux résultats déjà publiés dans la littérature. Ceci nous encourage à poursuivre l'utilisation de ces techniques et à contrôler nos résultats à plus long terme

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A uterine fibroid presenting as an incarcerated epigastric hernia: a case report and review of the literature

Abstract Background Uterine fibroids incarcerated in abdominal wall hernias during pregnancy are rare, with only six cases reported in umbilical hernias. This case report presents the first reported case of an incarcerated uterine fibroid in an epigastric hernia. Case presentation A 31-year-old primigravid Caucasian woman at 28 weeks gestational age presented with sudden onset abdominal pain and vomiting. Physical examination revealed an incarcerated epigastric hernia containing a non-reducible firm mass. Ultrasound showed a healthy fetus, and during surgery, a subserosal and sessile fibroid originating from the anterior uterine wall was found in the hernia sac. It was easily reduced, and the hernia was repaired with no complications. The patient proceeded to deliver a healthy baby boy by cesarean section at full term. Conclusion Uterine fibroids incarcerated in abdominal wall hernias during pregnancy are rare and affect mostly primigravid women in the third trimester. Abdominal ultrasound may facilitate the diagnosis, and pedunculated fibroids may be resected while sessile fibroids should be simply reduced. Clinicians should consider incarcerated fibroid as a differential diagnosis in pregnant women with irreducible ventral abdominal wall hernias. This case report aims to contribute to the literature and optimize the management of abdominal wall hernias in pregnant women

Acute Pancreatitis as an Uncommon Complication of Hydatid Cyst of the Liver: A Case Report and Systematic Literature Review .

Abstract BackgroundHydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. Case presentationA thirty-year-old woman was referred to our emergency unit for acute epigastric pain evolving for four days. We found fever associated with epigastric guarding on physical examination. Laboratory tests showed inflammatory biological syndrome with frankly high serum lipase level and abnormal liver tests. The diagnosis of acute pancreatitis was set. We decided then to perform an abdominal ultrasound that showed dilatation of intra and extrahepatic biliary tracts without gallbladder stones. A cystic mass of the left liver was additionally found. On CT-scan, we found a C grade acute pancreatitis. Furthermore, a hydatid cyst of the left liver ruptured in the biliary tracts and daughter vesicles within were found. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence.ConclusionCysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.</jats:p