AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives i...AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses ...Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonanc...BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.展开更多
Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to c...Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.展开更多
Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic t...Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.展开更多
BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI mod...BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI models,particularly those based on machine learning,have demonstrated potential in predicting surgical complications and recovery trajectories.AIM To evaluate the role of AI in predicting outcomes for GI surgeries,focusing on its efficacy in enhancing surgical planning,predicting complications,and optimizing post-operative care.METHODS A systematic review of studies published up to March 2025 was conducted across databases such as PubMed,Scopus,and Web of Science.Studies were included if they utilized AI models for predicting surgical outcomes,including morbidity,mortality,and recovery.Data were extracted on the AI techniques,performance metrics,and clinical applicability.RESULTS Machine learning models demonstrated significantly better performance than logistic regression models,with an area under the curve difference of 0.07(95%CI:0.04–0.09;P<0.001).Models focusing on variables such as patient demographics,nutritional status,and surgical specifics have shown improved accuracy.AI’s ability to integrate multifaceted data sources,such as imaging and genomics,contributes to its superior predictive power.AI has improved the early detection of gastric cancer,achieving 95%sensitivity in real-world settings.CONCLUSION AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes.However,challenges related to data quality,model transparency,and clinical integration remain.展开更多
BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To a...BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.展开更多
Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating ...Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.展开更多
BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus...BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.展开更多
BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric...BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.展开更多
Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly ma...Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.展开更多
Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in periph...Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.展开更多
Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively i...Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.展开更多
Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environm...Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.展开更多
The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristic...The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.展开更多
Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical depar...Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical department of Kankan Regional Hospital. Patients and Methods: This was a retrospective descriptive study covering the files of patients who had undergone intestinal resections in the surgery department of the Kankan regional hospital over a period of 4 years from 1st January 2019 to December 31, 2022. Results: We collected 164 cases of intestinal resection representing 4.19% of all surgical procedures. (N = 3909). The average age of our patients was 37.78 years with extremes of 1 and 90 years. The male gender was predominant (64.6%) and the sex ratio was 1.8. The majority of patients consulted after 72 hours. Acute intestinal obstruction was the pathology motivating the most intestinal resection 42.90% followed by acute peritonitis 33%, digestive fistula 4.3%, tumors 3.6% and wounds 2.4%. Intestinal necrosis with 91 cases (56.5%) constituted the first indication for resection in our study followed by intestinal perforations 41 cases (24.9%). We performed an anastomotic resection of the small intestine in 70 cases (42.9%), an ileostomy in 4 cases (2.4%), a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), segmental colectomy plus immediate anastomosis in 57 cases (34.2%) and 5 cases of colostomy. We recorded 48 deaths (29.3%). Conclusion: Intestinal resection is a common procedure in our context. These indications are multiple. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.展开更多
Background: The incidence of intracranial metastases (ICMET) has been steadily rising, and its frequency with respect to primary brain tumours is relatively high. Objective: The objectives of this study were to elucid...Background: The incidence of intracranial metastases (ICMET) has been steadily rising, and its frequency with respect to primary brain tumours is relatively high. Objective: The objectives of this study were to elucidate the current epidemiology and describe the clinical, diagnostic and therapeutic features of ICMET in Yaounde. Method and findings: A descriptive cross-sectional study was done in the neurosurgery departments of the General and Central Hospitals of Yaounde during the period from January 2016 to December 2022. We included all medical booklets of patients admitted for a tumoral intracranial expansive process with our target population being patients with histological evidence of ICMET, and did a retrospective inclusion of data using a pre-established technical form aimed at collecting sociodemographic data, clinical data, paraclinical data, and the treatment procedures. Analysis was done using the SPSS statistical software. A total of 614 cases of intracranial tumors were included among whom 35 presented histological evidence of ICMET. This gives a frequency of 5.7%. The sex ratio was 0.94, the mean age was 55.68 +/- 14.4 years, extremes 28 and 86 years and the age range 50 - 59 was affected in 28.57% of cases. The clinical presentation included signs of raised intracranial pressure (headache, blurred vision, vomiting) in 26 cases (74.3%), motor deficit 48.6%, seizures 17.1%. The mode of onset was metachronous in 71.4% and synchronous in 28.6%. The imaging techniques were cerebral CT scan in 82.9%, cerebral MRI in 40%, TAP scan in 22.9%. The metastatic lesions were supratentorial in 94.3% and single in 62.9%. The primary cancers found were breast cancer (31.4%), lung cancer (25.7%), prostate cancer (17.1%), thyroid cancer (5.7%), colon cancer (2.9%), and melanoma (2.9%). The therapeutic modalities were total resection (68.6%), radiotherapy (37.1%). Conclusion: Intracranial metastases are relatively frequent. There is a female sex predominance and the age group 50 - 59 years is the most affected. Brain metastases mostly occur in patients with a history of known primary tumor. The clinical signs mainly include signs of raised intracranial pressure, motor deficit, seizures and mental confusion. Cerebral CT Scan is the main imaging technique used. Most of the lesions are single and supratentorially located. The primary cancers most represented include breast cancer, lung cancer and prostate cancer. Surgery is the main treatment procedure. The adjuvant treatment (radiotherapy, chemotherapy) was limited.展开更多
BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient mana...BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.展开更多
Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear pathogenesis.They account for less than 2%of exocrine pancreatic neoplasms.This study aimed to per...Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear pathogenesis.They account for less than 2%of exocrine pancreatic neoplasms.This study aimed to perform a systematic review of the main clinical,surgical and oncological characteristics of pancreatic SPTs.Data sources:MEDLINE/PubMed,Web of Science and Scopus databases were systematically searched for the main clinical,surgical and oncological characteristics of pancreatic SPTs up to April 2021,in accordance with the preferred reporting items for systematic reviews and meta-analyses(PRISMA)standards.Primary endpoints were to analyze treatments and oncological outcomes.Results:A total of 823 studies were recorded,86 studies underwent full-text reviews and 28 met inclusion criteria.Overall,1384 patients underwent pancreatic surgery.Mean age was 30 years and 1181 patients(85.3%)were female.The most common clinical presentation was non-specific abdominal pain(52.6%of cases).Mean overall survival was 98.1%.Mean recurrence rate was 2.8%.Mean follow-up was 4.2 years.Conclusions:Pancreatic SPTs are rare,and predominantly affect young women with unclear pathogenesis.Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.展开更多
基金Supported by Instituto de Investigación Sanitaria ISABIAL,No.P42022-0275.
文摘AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.
文摘Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.
文摘BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the new faculty research fund of Ajou University School of Medicine(No.M-2024C0460-00064)。
文摘Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.
文摘Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.
文摘BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI models,particularly those based on machine learning,have demonstrated potential in predicting surgical complications and recovery trajectories.AIM To evaluate the role of AI in predicting outcomes for GI surgeries,focusing on its efficacy in enhancing surgical planning,predicting complications,and optimizing post-operative care.METHODS A systematic review of studies published up to March 2025 was conducted across databases such as PubMed,Scopus,and Web of Science.Studies were included if they utilized AI models for predicting surgical outcomes,including morbidity,mortality,and recovery.Data were extracted on the AI techniques,performance metrics,and clinical applicability.RESULTS Machine learning models demonstrated significantly better performance than logistic regression models,with an area under the curve difference of 0.07(95%CI:0.04–0.09;P<0.001).Models focusing on variables such as patient demographics,nutritional status,and surgical specifics have shown improved accuracy.AI’s ability to integrate multifaceted data sources,such as imaging and genomics,contributes to its superior predictive power.AI has improved the early detection of gastric cancer,achieving 95%sensitivity in real-world settings.CONCLUSION AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes.However,challenges related to data quality,model transparency,and clinical integration remain.
基金Supported by Universiti Sains Malaysia,Short-Term Grant,No.R501-LR-RND002-0000000342-0000.
文摘BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.
文摘Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.
文摘BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.
文摘BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.
文摘Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.
文摘Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.
文摘Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.
文摘Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.
文摘The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.
文摘Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical department of Kankan Regional Hospital. Patients and Methods: This was a retrospective descriptive study covering the files of patients who had undergone intestinal resections in the surgery department of the Kankan regional hospital over a period of 4 years from 1st January 2019 to December 31, 2022. Results: We collected 164 cases of intestinal resection representing 4.19% of all surgical procedures. (N = 3909). The average age of our patients was 37.78 years with extremes of 1 and 90 years. The male gender was predominant (64.6%) and the sex ratio was 1.8. The majority of patients consulted after 72 hours. Acute intestinal obstruction was the pathology motivating the most intestinal resection 42.90% followed by acute peritonitis 33%, digestive fistula 4.3%, tumors 3.6% and wounds 2.4%. Intestinal necrosis with 91 cases (56.5%) constituted the first indication for resection in our study followed by intestinal perforations 41 cases (24.9%). We performed an anastomotic resection of the small intestine in 70 cases (42.9%), an ileostomy in 4 cases (2.4%), a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), segmental colectomy plus immediate anastomosis in 57 cases (34.2%) and 5 cases of colostomy. We recorded 48 deaths (29.3%). Conclusion: Intestinal resection is a common procedure in our context. These indications are multiple. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.
文摘Background: The incidence of intracranial metastases (ICMET) has been steadily rising, and its frequency with respect to primary brain tumours is relatively high. Objective: The objectives of this study were to elucidate the current epidemiology and describe the clinical, diagnostic and therapeutic features of ICMET in Yaounde. Method and findings: A descriptive cross-sectional study was done in the neurosurgery departments of the General and Central Hospitals of Yaounde during the period from January 2016 to December 2022. We included all medical booklets of patients admitted for a tumoral intracranial expansive process with our target population being patients with histological evidence of ICMET, and did a retrospective inclusion of data using a pre-established technical form aimed at collecting sociodemographic data, clinical data, paraclinical data, and the treatment procedures. Analysis was done using the SPSS statistical software. A total of 614 cases of intracranial tumors were included among whom 35 presented histological evidence of ICMET. This gives a frequency of 5.7%. The sex ratio was 0.94, the mean age was 55.68 +/- 14.4 years, extremes 28 and 86 years and the age range 50 - 59 was affected in 28.57% of cases. The clinical presentation included signs of raised intracranial pressure (headache, blurred vision, vomiting) in 26 cases (74.3%), motor deficit 48.6%, seizures 17.1%. The mode of onset was metachronous in 71.4% and synchronous in 28.6%. The imaging techniques were cerebral CT scan in 82.9%, cerebral MRI in 40%, TAP scan in 22.9%. The metastatic lesions were supratentorial in 94.3% and single in 62.9%. The primary cancers found were breast cancer (31.4%), lung cancer (25.7%), prostate cancer (17.1%), thyroid cancer (5.7%), colon cancer (2.9%), and melanoma (2.9%). The therapeutic modalities were total resection (68.6%), radiotherapy (37.1%). Conclusion: Intracranial metastases are relatively frequent. There is a female sex predominance and the age group 50 - 59 years is the most affected. Brain metastases mostly occur in patients with a history of known primary tumor. The clinical signs mainly include signs of raised intracranial pressure, motor deficit, seizures and mental confusion. Cerebral CT Scan is the main imaging technique used. Most of the lesions are single and supratentorially located. The primary cancers most represented include breast cancer, lung cancer and prostate cancer. Surgery is the main treatment procedure. The adjuvant treatment (radiotherapy, chemotherapy) was limited.
文摘BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.
文摘Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear pathogenesis.They account for less than 2%of exocrine pancreatic neoplasms.This study aimed to perform a systematic review of the main clinical,surgical and oncological characteristics of pancreatic SPTs.Data sources:MEDLINE/PubMed,Web of Science and Scopus databases were systematically searched for the main clinical,surgical and oncological characteristics of pancreatic SPTs up to April 2021,in accordance with the preferred reporting items for systematic reviews and meta-analyses(PRISMA)standards.Primary endpoints were to analyze treatments and oncological outcomes.Results:A total of 823 studies were recorded,86 studies underwent full-text reviews and 28 met inclusion criteria.Overall,1384 patients underwent pancreatic surgery.Mean age was 30 years and 1181 patients(85.3%)were female.The most common clinical presentation was non-specific abdominal pain(52.6%of cases).Mean overall survival was 98.1%.Mean recurrence rate was 2.8%.Mean follow-up was 4.2 years.Conclusions:Pancreatic SPTs are rare,and predominantly affect young women with unclear pathogenesis.Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.
