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Indications and Techniques of Digestive Anastomoses at the Hospital in Koutiala District, Mali

Surgical Science 2020年第11期11卷 379-384页

作者： Mahamadou Coulibaly Drissa Traoré birama togola Souleymane Sanogo Bréhima Bengaly Drissa Ouattara Department of Surgery Koutiala Hospital Bamako Mali Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Purpose: Describe the indications and techniques of digestive anastomoses at the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study conducted in the general surgery department of the Koutiala District Hospital. Patients who benefited from digestive anastomosis between the hollow organs of the digestive tract during the period from August 1, 2017 to September 30, 2020 were included. The anastomoses with solid organs were not selected in this study. Results: One hundred and thirty-two patients were registered. Digestive anastomosis accounted for 11.5% of all surgical procedures. The average age was 38.6 years. Men were in the majority with 70.5%. The Karnofsky index was estimated to be less than 50% in 12 patients. Digestive anastomoses were indicated after resection of ileal necrosis in 43 patients (32.6%) followed by tumor resection in 32 patients (24.2%) and typhic perforations in 20 patients (15.1%). There were also 12 cases of digestive stoma (9.1%), 15 cases of volvulus of the sigmoid colon (11.4%), 7 cases of rectal prolapse (5.3%) and 3 cases of Hirschprung’s disease (2.3). Digestive anastomosis was performed in 89 patients in an emergency and was manual in all patients. Post-operative morbidity was 18.9%. These recorded complications, classified grade I (10 cases), grade II (3 cases), grade IIIa (2), grade IIIb (6 cases) and grade IV (4 cases) according to Clavien-Dindo, consisted of 8 cases of postoperative peritonitis (6.1%), 3 cases of external digestive fistula (2.3%), 2 cases of evisceration (1.5%), 12 cases of parietal suppuration (9.1%) and 4 cases of death (3.0%). Conclusion: Young male subjects are the most affected. Anastomoses are performed more often after the removal of the island necroses. Morbi-mortality is high. Success depends on several factors, including the general condition of the patient and the mastery of the anastomosis technique.

关键词： Digestive Anastomosis Surgery Indications Technical

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Acute Appendicitis: Epidemio-Clinical and Therapeutic Aspects in Koutiala, Mali

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Surgical Science 2020年第8期11卷 216-221页

作者： Mahamadou Coulibaly Drissa Traoré Bréhima Bengaly birama togola Drissa Ouattara Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Purpose: To assess the epidemiological, clinical and therapeutic aspects of acute appendicitis at the Koutiala Reference Health Centre. Methods: This was a prospective study conducted in the general surgery department of the Koutiala Reference Health Centre. Patient records admitted for simple and complicated appendicitis during the period from August 1, 2017 to August 31, 2018 have been collected. Patients operated on for simple and complicated acute appendicitis were included in the study. Patients who did not have surgery were excluded. Results: We collected records of 62 patients who had surgery for simple and complicated acute appendicitis. They accounted for 11.9% of surgical procedures (n-520) and 27.3% (n-227) of surgical emergencies. The average age was 33.1 years-15.7. Men were in the majority with 72.5%. Simple acute appendicitis accounted for 56.4% of cases (n-35) and complicated appendicitis 43.6% of cases (these were 16 cases of appendicular peritonitis, 09 cases of appendicular abscess and 02 cases of appendicular plastron). Therapeutically, appendectomy was performed in 58 patients. In 4 patients the appendix was completely necrotized. The average length of hospitalization was 3.3 days-0.8 for single acute appendicites and 6 days-2.7 for complicated appendicites. Postoperative morbidity of complicated appendicitis was 6.4% (no. 4) and mortality was zero. Conclusion: Simple acute appendicitis is more common. Laparotomy remains the only way at present. Postoperative morbidity is high in complicated appendicitis and mortality is zero.

关键词： Appendix Abscess Peritonitis Plastron Surgery

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Skin Graft in the Surgery Department “B” of the CHU du Point “G” about 50 Cases

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Surgical Science 2020年第7期11卷 187-193页

作者： Mahamadou Coulibaly Bréhima Bengaly Drissa Ouattara Traoré Drissa Diallo Siaka Souleymane Sanogo birama togola Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali

Aim: To analyze the practice of skin grafting in the surgery department “B” of the CHU of Point “G” in Bamako. Patients and Methods: This was a retrospective and prospective study carried out between 1980 and 2014, covering all patients who underwent a skin graft and hospitalized. It covered all patients who underwent a skin transplant and were hospitalized in the department during the study period. Result: There were 50 patients including 25 women and 25 men. The mean age was 25.2 ± 19 years. The average duration of lesion evolution was 1 year. The lesions to be grafted were located in the lower limbs in 60%. The average area of substance loss was 13.2 cm2. The indication for skin graft was asked for loss of substance following scar bridles in 40%, ulcerative-necrotic wounds of infectious or traumatic origin (32%), malignant skin tumor (14%). In pathology, there were 5 cases of malignant melanoma and 2 cases of squamous cell carcinoma. Thin skin grafting was the most used technique (62%). The postoperative follow-ups were simple in 94%. There were 3 cases of graft necrosis. The average length of hospital stay was 28 days. The esthetic result was judged satisfactory in 84% of the cases (n = 42), average in 14% of the cases (n = 7) and unsatisfactory in 2% of the cases (n = 1). The sensitivity was good in 36 patients (72%), average in 12 patients (24%) and poor in 2 patients (4%). Conclusion: They mainly affect young people. The reduction of accidents on the public highway, good management of burn injuries, wounds and good hygiene of the population will considerably reduce the rate of its affections.

关键词： Skin Graft Surgery Postoperative Operations

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Acute Peritonitis Generalized at the Koutiala Reference Health Center, Mali: Epidemiological, Etiological and Therapeutic Aspects

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Surgical Science 2020年第6期11卷 111-116页

作者： Mahamadou Coulibaly birama togola Traoré Drissa Bréhima Bengaly Souleymane Sanogo Drissa Ouattara Diallo Siaka Madiassa Konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

History: In Mali, several studies have been carried out on acute peritonitis but in the Koutiala circle it is a first. Aim: To evaluate the epidemiological, etiological and therapeutic aspects of generalized acute peritonitis at the Koutiala reference health center. Method: This was a 14-month prospective and descriptive study from August 1, 2017 to November 30, 2019, covering all patients admitted and operated for generalized acute peritonitis. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and postoperative operations. Result: The number was 93 cases, 72 men and 21 women. The average age was 34.2 years (Extremes: 2 - 75 years). The hospital frequency was 2.0%. The incidence rate of generalized acute peritonitis in the circle was 12.4 cases per 100,000 population. The clinical picture was still of peritonitis. The Widal-Félix serology was positive in 19 cases. Perioperative bacteriological sampling was systematic. The etiologies were dominated by digestive perforations in 81 cases (87%) of which 33 were located at the ileal level, postoperative peritonitis (6 cases) and ruptured pyocholecyst (2 cases). There were also 3 cases of primary peritonitis and 1 case of gynecological peritonitis. Excision-suturing was the most used surgical technique with 35.5% (n = 33). Postoperatively, we identified 10 cases of parietal suppuration (10.8%), 6 cases of postoperative peritonitis (6.5%), 2 cases of external digestive fistula (2.2%) and 7 cases of death (7.5%). Conclusion: Acute peritonitis occupies second place in abdominal surgical emergencies in the Koutiala circle. The etiologies are multiple and varied and are dominated by the ileal perforation which is secondary to typhoid fever more often. In most cases the surgical treatment is done by excision-suturing of the perforation. Mortality and morbidity remain high.

关键词： Generalized Acute Peritonitis Emergency Koutiala

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Epidemiological Profile of Intestinal Obstructions in Koutiala, Mali: About 65 Cases

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Surgical Science 2020年第6期11卷 117-121页

作者： Mahamadou Coulibaly Drissa Traoré birama togola Souleymane Sanogo Bréhima Bengaly Drissa Ouattara Siaka Diallo Madiassa Konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

Aim: To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. Patients and Method: This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. Result: The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). Conclusion: Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.

关键词： Epidemiology Intestinal Obstruction Koutiala

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Environmental Risk Factors for Stomach Cancer in an African Setting about 193 Cases at the CHU Point G in Bamako/Mali

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Surgical Science 2021年第2期12卷 23-30页

作者： Souleymane Sanogo Drissa Traoré Mamadou Coulibaly birama togola Bréhima Bengaly Ousmane Ibréhima Touré Drissa Ouattara Bréhima Coulibaly Babou Ba Siaka Diallo Nouhoum Ongoiba Surgery B CHU Point G Bamako Mali USTTB Faculty of Medicine Bamako Mali Koutiala Regional Hospital Koutiala Mali

CHU (University Hospital Center) Point G: The department of surgery B is a surgical department of CHU Point G. The department is par excellence a reference department for cases of visceral surgery, cancer surgery, cardiovascular surgery, plastic and endocrinology surgery. As a reminder, the CHU Point G is the largest 3rd level referral hospital in Mali. Aim: To study the environmental risk factors of stomach cancer in the B surgery department of the Point G University Hospital in Bamako. Patients and Methods: We performed a cross-sectional study with retrospective collection from January 2008 to June 2018 (126 months). Results: We have identified 380 cases of digestive cancer, including 193 cases of stomach cancer or 50.79% of digestive cancers. The mean age of the patients was 57.21 ± 13 years. Male sex represented 55% (n = 106). Eating habits were dominated by the consumption of tô with potash (cereal paste) with 64.76% (n = 185). The main methods of preserving meat and fish were curing and smoking with 57.51% (n = 111). Chronic smoking was found in 24.35% (n = 47), alcohol + tobacco consumption in 2.59% (n = 5). The low socio-economic class represented 126 cases or 65.38%. Housewives and cultivators were respectively 37.82% (n = 73) and 227.97% (n = 54). 20.20% (n = 39) had a history of epigastric pain. Epigastralgia was the most common functional sign with 84.5% of cases (n = 169). An epigastric mass was found in 72 patients or 37.3%. Adenocarcinoma represented 97.4% (n = 188). Palliative surgery concerned the majority of our

关键词： Stomach Cancer Environmental Risk Factors African Setting CHU Point G

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Premature Division of the Inferior Laryngeal Nerve in Surgery and in ENT and Cervico-Facial Surgery in Mali

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Forensic Medicine and Anatomy Research 2019年第1期7卷 1-7页

作者： Drissa Traoré Abdoulaye Kanté Youssouf Sidibé Bréhima Bengaly Bréhima Coulibaly Babou Ba Drissa Ouattara Siaka Diallo Mariam Daou birama togola Nouhoum Ongoiba Service of Surgery B.CHU Point G BamakoMali Laboratory of Anatomy of the Faculty of Medicine and Odontostomatology BamakoMali ENT and Head and Neck Surgery Department CHU“Mother-Child”BamakoMali Service of Neurology CHU Gabriel TouréBamakoMali

The purpose of this study was to study the frequency of premature division of the inferior laryngeal nerve and its consequences in thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery B to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the CHU “mother-child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were included. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the lower laryngeal nerve realized during the surgical operations on the thyroid 95.1% of the cases, the nerve had a single branch;in 4.1% of the cases, the nerve had two branches;and in 0.8% of the cases, the nerve had more than 2 branches. Conclusion: The complications of the thyroid surgery in touch with the hurts of the lower laryngeal nerve are known. However, our study shows that these do not seem to be influenced by the premature division of the lower laryngeal nerve.

关键词： Anatomy Inferior Laryngeal Nerve Recurring Nerve Thyroid Surgery Goiter

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Total Thrombosis of Bifurcated Endoprosthesis: A Rare Complication of Endovascular Treatment of Abdominal Aortic Aneurysm

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Surgical Science 2019年第9期10卷 338-345页

作者： birama togola Bréhima Bengaly Madiassa Konaté Laurent Muller Olivier Szymoniak Mahamadou Coulibaly Drissa Traoré Bréhima Coulibaly Skaiste Vaitkevicienne Michel Peret Nouhoum Ongoiba Jean Louis Debrux Department of Surgery “B” CHU Point “G” Bamako Mali Department of General Surgery Hospital Gabriel Touré Bamako Mali Department of Vascular and Thoracic Surgery of CH Cholet France Department of Vascular Surgery in Park Polyclinic of Cholet Cholet France Department of Thoracic and Cardiovascular Surgery Angers CHU Angers France

Background: Aortic stents are a therapeutic alternative to open surgery of abdominal aortic aneurysms. We report a case of treatment of an abdominal aortic aneurysm with a bifurcated stent, complicated by total thrombosis. Aim: The purpose of this presentation was to understand the causes, mechanisms, incidents and accidents that contributed to this complication. Case Presentation: A 48-year-old man patient with a history of high blood pressure, ischemic heart disease, chronic obstructive pulmonary disease, who was found during a surveillance check-up, an infra-renal abdominal aorta aneurysm measured at 56 mm in diameter, asymptomatic but progressive. The indication of an endovascular treatment by the placement of a bifurcated prosthesis was posed and accepted. Thrombosis of the two limbs was intra-operative, upper-end migration without endoleak at 4 months postoperative, total thrombosis of the stent at 13 months postoperatively. Explantation of the stent followed by aortobi-iliac bypass was finally performed in the 15th month. Conclusion: The cardiopulmonary antecedents, the anatomical and evolutionary characteristics of the aneurysm could have played a role in the occurrence of the complications observed in this patient.

关键词： Aneurysm Abdominal Aorta Endovascular Complications Stent Thrombosis

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Volvulus Acute of the Colonist Sigmoid to Mopti:Diagnostic and Therapeutic Aspects

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Surgical Science 2018年第11期9卷 446-453页

作者： Bréhima Bengaly Abdoulaye Kanté Drissa Ouattara Bréhima Coulibaly Drissa Traoré birama togola Babou Ba Souleymane Sanogo Siaka Diallo Djibril Traoré Moustapha Issa Magané Mariam Daou Nouhoum Ongoiba Service of Surgery B CHU Point GBamakoMali Service of General Surgery Somine Dolo of Mopti HospitalMali Laboratory of Anatomy of the Faculty of Medicine and Odontostomatology BamakoMali Service of Anesthesia and Resuscitation CHU Gabriel TouréBamakoMali Service of Neurology CHU Gabriel TouréBamakoMali

In 7 years, we brought together 100 cases of volvulus of the colon sigmoid to the hospital Sominé Dolo of Mopti among which the handle volvule was found without necrosis in 66 cases and necrosis 34 cases. Seventy-six patients benefited from a sigmoidectomy followed by a colorectal anatomize at a time, twenty one patients of an intervention of Hartmann. A surgical distortion was realized at 3 patients. All the patients operated by these last two techniques had a restoring of the digestive continuity for an average deadline of 90 days. The post-operative complications consisted of 11 cases of parietal suppuration and a case of evisceration. The average duration of follow-up was of 210 days. The post-operative mortality was 14%. It was about a state of toxic shock with visceral multi-failure (n = 13), and of a pulmonary embolism (n = 1). The treatment of the volvulus requires a fast diagnostic and therapeutic coverage. The best treatment consists of a resection of the sigmoid as a matter of urgency followed by an immediate anastomosis if the following conditions are carried achieved: state general voucher, experimented surgeon and if the resuscitation meadow, per and post-operative can be assured.

关键词： Pelvic Colonist Volvulus Treatment Mopti Mali

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VNUS Closure<sup>®</sup>FAST Radiofrequency of the Great Saphenous Vein for Superficial Venous Insufficiency: Experience of the CH of Cholet in France

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World Journal of Cardiovascular Surgery 2021年第5期11卷 43-50页

作者： birama togola Laurent Muller Bréhima Bengaly Drissa Traoré Drissa Ouattara Cheick Sekou Ahmed Touré Mahamadou Coulibaly Abdoulaye Kanté Hamadoun Dicko Boubacar Diallo Michel Peret Nouhoum Ongoiba Jean Louis Debrux Department of Surgery “B” of the CHU Point “G” Bamako Mali Department of Vascular and Thoracic Surgery of the CH de Cholet France Department of Anesthesia and Intensive Care of the “CHU Point G” Bamako Mali Department of Thoracic and Cardiovascular Surgery CHU Angers France

Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.

关键词： Varicose Great Saphenous Vein Endovenous Therapy Radiofrequency Ablation

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