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Cherif M, Mesbahi M, Zaafouri H, Zebda H, Khedhiri N, Hadded D, Ben-Maamer A. LAPAROSCOPIC APPENDICECTOMY: RISK FACTORS FOR CONVERSION TO LAPAROTOMY. Arq Bras Cir Dig 2023; 36:e1737. [PMID: 37283393 DOI: 10.1590/0102-672020230019e1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is the gold standard surgical procedure currently performed for acute appendicitis. The conversion rate is one of the main factors used to measure laparoscopic competence, being important to avoid wasting time in a laparoscopic procedure and proceed directly to open surgery. AIMS To identify the main preoperative parameters associated with a higher risk of conversion in order to determine the surgical method indicated for each patient. METHODS Retrospective study of patients admitted with acute appendicitis who underwent laparoscopic appendectomy. A total of 725 patients were included, of which 121 (16.7%) were converted to laparotomy. RESULTS The significant factors that predicted conversion, identified by univariate and multivariate analysis, were: the presence of comorbidities (OR 3.1; 95%CI; p<0.029), appendicular perforation (OR 5.1; 95%CI; p<0.003), retrocecal appendix (OR 5.0; 95%CI; p<0.004), gangrenous appendix, presence of appendicular abscess (OR 3.6; 95%CI; p<0.023) and the presence of difficult dissection (OR 9.2; 95%CI; p<0.008). CONCLUSIONS Laparoscopic appendectomy is a safe procedure to treat acute appendicitis. It is a minimally invasive surgery and has many advantages. Preoperatively, it is possible to identify predictive factors for conversion to laparotomy, and the ability to identify these reasons can aid surgeons in selecting patients who would benefit from a primary open appendectomy.
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Affiliation(s)
- Mouna Cherif
- Habib Thameur Hospital, Visceral Surgery - Tunis, Tunisia
| | - Meryam Mesbahi
- Habib Thameur Hospital, Visceral Surgery - Tunis, Tunisia
| | | | - Helmi Zebda
- Habib Thameur Hospital, Visceral Surgery - Tunis, Tunisia
| | - Nizar Khedhiri
- Habib Thameur Hospital, Visceral Surgery - Tunis, Tunisia
| | - Dhafer Hadded
- Habib Thameur Hospital, Visceral Surgery - Tunis, Tunisia
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Zaafouri H, Jouini R, Khedhiri N, Khanchel F, Cherif M, Mesbahi M, Daghmouri A, Mahmoudi W, Akremi S, Sabbah M, Benzarti Y, Hadded D, Gargouri D, Bader MB, Maamer AB. Comparison between signet-ring cell carcinoma and non-signet-ring cell carcinoma of the stomach: clinicopathological parameters, epidemiological data, outcome, and prognosis-a cohort study of 123 patients from a non-endemic country. World J Surg Oncol 2022; 20:238. [PMID: 35858903 PMCID: PMC9297662 DOI: 10.1186/s12957-022-02699-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/29/2022] [Indexed: 02/08/2023] Open
Abstract
Background Signet-ring cell carcinoma of the stomach (SRCC) is a particular gastric cancer entity. Its incidence is increasing. Its diagnosis is pathological; it corresponds to adenocarcinoma with a majority of signet-ring cells component (> 50%). These histological features give it its aggressiveness characteristics. This has repercussions on the prognostic level and implications for the alternatives of therapy, especially since some authors suggest a potential chemoresistance. This survey aimed to identify the epidemiological, pathological, therapeutic, and prognostic characteristics of SRCC as a separate disease entity. Methods This was a retrospective study of 123 patients admitted for gastric adenocarcinoma to Habib Thameur Hospital in Tunis over 11 years from January 2006 to December 2016. A comparative study was performed between 2 groups: the SRCC group with 62 patients and the non-SRCC (non-signet-ring cell carcinoma of the stomach) with 61 patients. Results The prevalence of SRCC in our series was 50%. SRCC affected significantly younger patients (55 vs 62 years; p = 0.004). The infiltrative character was more common in SRCC tumors (30.6 vs 14.8%; p = 0.060), whereas the budding character was more often noted in non-SRCC tumors (78.7 vs 58.1%; p = 0.039). There was no significant difference in tumor localization between both groups. Linitis plastica was noted in 14 patients with SRCC against a single patient with non-SRCC (p = 0.001). The tumor size was more important in the non-SRCC group (6.84 vs 6.39 cm; p = 0.551). Peritoneal carcinomatosis was noted in 4.3% of cases in the SRCC group versus 2.2% of cases in the NSRCC group (p = 0.570). Total gastrectomy was more often performed in the SRCC group (87 vs 56%; p = 0.001). Resection was more often curative in the non-SRCC group (84.4 vs 78.3%; p = 0.063). Postoperative chemotherapy was more commonly indicated in the SRCC group (67.4 vs 53.3%; p = 0.339). Tumor recurrence was more common in the non-SRCC group (35.7 vs 32%; p = 0.776). The most common type of recurrence was peritoneal carcinomatosis in the SRCC group (62.5%) and hepatic metastasis in the non-SRCC group (60%; p = 0.096). The overall 5-year survival in the SRCC group was lower than in the non-SRCC group, with no statistically significant difference (47.1 vs 51.5%; p = 0.715). The overall survival was more important for SRCC in early cancer (100 vs 80%; p = 0.408), whereas it was higher for non-SRCC in advanced cancer (48.1 vs 41.9%; p = 0.635). Conclusion Apart from its epidemiological and pathological features, SRCC seems to have a worse prognosis. Indeed, it is diagnosed at a more advanced stage and has a worse prognosis in advanced cancer than non-SRCC. It is therefore to be considered as a particular entity of gastric adenocarcinoma requiring a specific therapeutic protocol where the place of chemotherapy remains to be more investigated.
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Affiliation(s)
- Haithem Zaafouri
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia.
| | - Raja Jouini
- Department of Cytopathology, Habib Thameur Hospital, Tunis, Tunisia
| | - Nizar Khedhiri
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Fatma Khanchel
- Department of Cytopathology, Habib Thameur Hospital, Tunis, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Meryam Mesbahi
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Aziz Daghmouri
- Department of Anesthesiology, Habib Thameur Hospital, Tunis, Tunisia
| | - Wiem Mahmoudi
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Soumaya Akremi
- Department of Anesthesiology, Habib Thameur Hospital, Tunis, Tunisia
| | - Meriam Sabbah
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia
| | - Yazid Benzarti
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Dhafer Hadded
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Dalila Gargouri
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia
| | - Mourad Ben Bader
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib Thameur Hospital, Tunis, Tunisia
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Zouaghi A, Bellil N, Ben Abdallah K, Hadded D, Zaafouri H, Cherif M, Ben Maamer A. Case Report: Portal cavernoma related to multiple liver hydatidosis: A rare case of fatal cataclysmic haemorrhage. F1000Res 2021; 10:1097. [PMID: 34900234 PMCID: PMC8630548 DOI: 10.12688/f1000research.74012.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
Clinical presentation of liver hydatidosis can vary from asymptomatic forms to lethal complications. We report herein a rare case of a 27-year-old male from a rural Tunisian region who presented with large-abundance haematemesis, haemodynamic instability, and marked biological data of hypersplenism. Endoscopy showed bleeding esophageal varicose veins that were ligated. Abdominal ultrasound concluded the presence of three type CE2 hydatic liver cysts causing portal cavernoma with signs of portal hypertension. Despite resuscitation, the patient died of massive rebleeding leading to haemorrhagic shock. Hepatic hydatid cyst should be considered as an indirect cause of gastrointestinal bleeding in endemic countries. Early abdominal ultrasound in varicose haemorrhage is essential in orienting the diagnosis.
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Affiliation(s)
- Alia Zouaghi
- Department of General Surgery, Habib Thameur Hospital, Tunis, 1008, Tunisia
| | - Nawel Bellil
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, 1008, Tunisia
| | | | - Dhafer Hadded
- Department of General Surgery, Habib Thameur Hospital, Tunis, 1008, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib Thameur Hospital, Tunis, 1008, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib Thameur Hospital, Tunis, 1008, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib Thameur Hospital, Tunis, 1008, Tunisia
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Zouaghi A, Hadded D, Meryam M, Benzarti Y, Cherif M, Zaafouri H, Ben Massoud K, Chamekhi C, Ben Maamer A. Case Report: An unusual case of small bowel volvulus associated with pneumatosis intestinalis. F1000Res 2021; 10:951. [PMID: 36483602 PMCID: PMC9706145 DOI: 10.12688/f1000research.73042.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/04/2023] Open
Abstract
Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis.
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Affiliation(s)
- Alia Zouaghi
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Dhafer Hadded
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mesbahi Meryam
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Yazid Benzarti
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Khalil Ben Massoud
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Chiraz Chamekhi
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
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Zouaghi A, Hadded D, Meryam M, Benzarti Y, Cherif M, Zaafouri H, Ben Massoud K, Chamekhi C, Ben Maamer A. Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature. F1000Res 2021; 10:951. [PMID: 36483602 PMCID: PMC9706145 DOI: 10.12688/f1000research.73042.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis associated to an acute abdomen.
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Affiliation(s)
- Alia Zouaghi
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Dhafer Hadded
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mesbahi Meryam
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Yazid Benzarti
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Khalil Ben Massoud
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Chiraz Chamekhi
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
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Hadded D, Mesbahi M, Zouaghi A, Marouani M, Chamekhi C, Ben Maamer A. Adult small bowel obstruction due to congenital peritoneal belt: A case report. Int J Surg Case Rep 2021; 84:106016. [PMID: 34153692 PMCID: PMC8220543 DOI: 10.1016/j.ijscr.2021.106016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Peritoneal bands on the virgin abdomen are an extremely rare etiology of occlusive syndrome. Congenital bridles can be in 0.7 to 2% a cause of small bowel obstruction. Presentation of case We report a case of a 21-year-old woman who was admitted with symptoms of bowel obstruction. The patient had no surgical or traumatic history. Laparotomy was done and the findings showed a congenital belt extending from the antimesenteric wall of the ileum to the vesical dome, causing bowel strangulation. Band's ligation proceeded smoothly after the operation. Discussion Congenital flanges present an uncommon situation. These bands are usually difficult to classify and define. They are usually observed in childhood. Therefore, this situation represents an unusual surgical problem in diagnosing clinically unexpected elderly patients. Conclusion Congenital or spontaneous flanges are an uncommon cause of occlusion, which presents a challenging diagnosis. Exploratory laparotomy or laparoscopy is mandatory. Peritoneal bands on the virgin abdomen are an extremely rare etiology of the occlusive syndrome, representing an unsual problem clinically unexpected in elderly patients. Their management is based on surgical treatment, and laproscopy is much more preferred.
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Affiliation(s)
- D Hadded
- Department of General Surgery at Habib, Thameur Hospital, Tunisia
| | - M Mesbahi
- Department of General Surgery at Habib, Thameur Hospital, Tunisia.
| | - A Zouaghi
- Department of General Surgery at Habib, Thameur Hospital, Tunisia
| | - M Marouani
- Radiology Department at Habib Thameur Hospital, Tunisia
| | - C Chamekhi
- Radiology Department at Habib Thameur Hospital, Tunisia
| | - A Ben Maamer
- Department of General Surgery at Habib, Thameur Hospital, Tunisia
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Jouini R, Khanchel F, Sabbah M, Helal I, Gharsallah A, Ferchichi M, Hadded D, Zaafouri H, Ben Brahim E, Ben Maamer A, Debbiche AC. Prognostic significance of poorly cohesive gastric carcinoma in Tunisian patients. Heliyon 2020; 6:e03460. [PMID: 32195384 PMCID: PMC7078324 DOI: 10.1016/j.heliyon.2020.e03460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/07/2019] [Accepted: 02/18/2020] [Indexed: 02/05/2023] Open
Abstract
Background While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of poorly cohesive carcinoma (PCC) is rising. The prognostic significance of gastric PCC remains a subject of debate. Objective To analyze the prognosis of gastric PCC in a Tunisian cohort. Methods A total of 122 gastric adenocarcinoma patients who underwent curative gastrectomy from 2001 to 2014 at Habib Thameur hospital in Tunis, Tunisia were included. The clinicopathological parameters and prognosis of PCC were analyzed in comparison with non PCC (NPCC). Results Sixty one patients (50%) presented PCC. Patients were younger in PCC group (p = 0,001). There was no difference in sex distribution between the two groups. PCC was more likely to be stage T4 (55.7% vs 34.4%; p = 0.033), N3 (67.8% vs 30%; p < 0.001) and have a higher metastatic lymph node ratio (p < 0.001). Hepatic metastases were more frequent in NPCC group (p = 0.031) whereas peritoneal carcinomatosis was more common in PCC group (p = 0.004). Perineural invasion was more frequent in PCC group (p = 0.001). Resection margins were more often positive in PCC group (31.1% vs 9.8%; p = 0.004). There was no difference in recurrence rate between the 2 groups (p = 0.348). The 5-year survival was similar in the NPCC and PCC (respectively 43% vs 23 %; p = 0.247). Survival rates were also comparable in early stage (100% vs 80% respectively for PCC and NPCC; p = 0.527) as well as for advanced stage (16% vs 35% respectively for PCC and NPCC; p = 0.538). PCC was not a prognostic factor for survival. Interestingly, advanced age, adjacent structures invasion, positive resection margins were specific prognostic factors for PCC. Conclusion In our study PCC was not a prognostic factor for survival. Advanced age, adjacent structures invasion and positive resection margins were specific prognostic features for this histological subtype.
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Affiliation(s)
- Raja Jouini
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
- Corresponding author.
| | - Fatma Khanchel
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Meriam Sabbah
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Imen Helal
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | | | - Marwa Ferchichi
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Sciences of Tunis, Tunis El Manar University, Tunisia
| | - Dhafer Hadded
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
- Department of Surgery, Habib Thameur Hospital, Tunisia
| | - Haithem Zaafouri
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
- Department of Surgery, Habib Thameur Hospital, Tunisia
| | - Ehsen Ben Brahim
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Anis Ben Maamer
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
- Department of Surgery, Habib Thameur Hospital, Tunisia
| | - Aschraf Chadli Debbiche
- Department of Pathology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
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