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Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

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Surgical Science 2015年第2期6卷 59-64页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Bourama Diarra Amadou Traoré Madiassa Konaté Boubacar Karembé Yacaria Coulibaly Mamby Keita Souleymane diallo Souleymane diallo gangaly diallo Faculty of Medicine and Odonto-Stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

关键词： Infections Operating Sites Bamako

Study of Hemorrhoid Disease in the Department of General Surgery of the Cs Ref of the Commune I Bamako

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Surgical Science 2024年第2期15卷 36-47页

作者： Tounkara Cheickna Diarra Issaka Sanogo Modibo Togola Modibo Camara Ladji Soma Dembele Bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana Ouattara Zanafon diallo gangaly Department of General Surgery The Reference Health Center in Commune I Bamako Mali Department of General Surgery The Gabriel Toure University Hospital Bamako Mali Department of Urology The Gabriel Toure University Hospital Bamako Mali

This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.

关键词： Hemorrhoid Surgery Cs Ref C I Bamako Mali

Antibioprophylaxy by the Surgery Staff in the Teaching Hospital Gabriel Touréin Mali

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Surgical Science 2015年第3期6卷 138-142页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Amadou Traoré Bourama Emmanuel Cissoko Madiassa Konaté Boubacar Karembé Yacaria Coulibaly Soumeila Keita Mamby Keita Souleymane diallo gangaly diallo Faculty of Medicine and Odonto-Stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Touré Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38;12.7%), diabetes (6;2%), and HIV (3;1%). The mean of intervention duration was 56.8?±?27.5 minutes. Four cases of intervention site infection were encountered caused by?Pseudomonas?aeruginosa?in 2 patients;?Escherichia coli?(1 case), and?Staphylococcus aureus?(1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

关键词： Antibioprophylaxy Infection Risky Factors Surgery

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

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Surgical Science 2014年第8期5卷 363-367页

作者： Alhassane Traoré Bakary Tientigui Dembélé Adégné Togo Lassana Kanté Madiassa Konaté Ibrahima Diakité Simo Notue Fabienne Laurence Boubacar Karembé Abdoulaye Diarra Amadou Traoré Mahamane Djibo Diango gangaly diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Faculty of Medicine and Odonto-Stomatology Bamako Mali

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

关键词： Peritonitis Postoperative Morbidity and Mortality Surgery

Evisceration of the Small Bowel in the Vagina Following Endo-Uterine Maneuvers for Clandestine Abortion (APC) at CHU Gabriel Touré, Bamako, Mali

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Surgical Science 2018年第4期9卷 148-152页

作者： Dabo Aminata Diop Thierno Madane Dembélé Bakary Tientigui Coulibaly Mahamadoun Doumbia Arouna Manganémoustapha Issa Abdoul Hamidou Almeimoune Traoré Alhassane Togo Adégné Téguété Ibrahima Django Djibo Mahamane diallo gangaly Universal Resuscitation Service at Gabriel Touré Teaching Hospital Bamako Mali General Surgery Service of CHU Gabriel Touré Bamako Mali Department of Obstetric Gynecologyof CHU Gabriel Touré Bamako Mali

Intra-uterine manual aspiration is the recommended maneuver for abortive endo-uterine evacuation. It must be performed in a medical setting for therapeutic purposes, while respecting its contraindications and asepsis rules essential for its implementation. The ignorance of anatomical structures by the authors of clandestine abortions is marked by the presence of utero-adnexal lesions, digestive lesions and vesical lesions or evisceration by the vagina. Vaginal evisceration of the small bowel is a rare and serious complication of manual intrauterine aspirations and induced abortions. Their late diagnosis and clandestine practice are responsible for unpredictable severe secondary complications and remain an important cause of morbidity and mortality. The development of a policy of continuous training of agents on the technique of manual intrauterine aspiration, broad information on contraceptive methods and a multidisciplinary, rapid and adequate management of complications will provide minimum morbidity and mortality. Conclusion: Abortion is a serious source of life-threatening complications.

关键词： Evisceration Abortion Surgery Mali

Treatment of Operative Pain in Visceral Cancer Surgery at CHU Gabriel Toure

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Surgical Science 2017年第1期8卷 47-51页

作者： Dembélé Bakary Tientigui Traoré Alhassane Togo Adégné Kante Lassana Diakité Ibrahim Konate Madiassa Traore Amadou Diakité Boubacar Bah Amadou Sidibé Yoro Koné Tany Diop Thiorno Madani Django Djibo diallo gangaly Department of General Surgery CHU Gabriel-Touré Bamako Mali

The objectives were to determine the frequency of pain in cancer patients and its intensity in cancer pathologies and to evaluate the evolution of pain intensity after analgesic treatment;the effectiveness of its management study involved 121 cases of operated gastrointestinal cancers, which accounted for 85.82% (141) of operated cancers and 16.78% (721) of all operated patients;the average age of our patients was 49.93 years with extremes 17 and 78 years. Standard deviation: 15.75;with a sex ratio of 1.46. The majority of our patients had WHO III (54/121) or 44.6%;46.3% (56/121) of patients were in stage IV of the TNM classification. The main digestive cancers were cancer of the esophagus 4 cases (3.3%);of the stomach 61 cases (50.4%);of the pancreas 7 cases (5.8%);of the liver 4 cases (3.3%);gall bladder 2 cases (1.6%);colon 33 cases (27.3%);rectum 6 cases (4.9%) and hail 4 cases (3.3%). The average pain intensities were 3 to 6 hour;2 to 24 hour;1.6 to 48 hour;and 1.2 to 72 hour. The majority of our patients had a treatment protocol involving nefopam, and paracetamol was 58%. The pain was exacerbated especially during exercise. Vomiting and vein burning were the main side effects encountered.

关键词： Pain Cancer Bamako Surgery Mali

Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré

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Surgical Science 2017年第9期8卷 414-421页

作者： Alhassane Traoré Bakary Tientigui Dembélé Ibrahima Diakité Adégné Togo Lassana Kanté Amadou Traoré Madiassa Konaté Boubacar Karembé Abdoulaye Diarra Amadou Bah Boubacar Sidibé Tany Koné Astan Koné Nouténé Koné Djibo Mahamane Diango gangaly diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Anesthesia and Intensive Care CHU Gabriel Touré Bamako Mali

Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel;2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings);3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated lesions in 37.5% (48 cases). The surgical treatment consisted of 60.15% suture excision (77 cases), 25% anastomosis resection (32 cases)

关键词： Abdominal Trauma Small Perforation Surgery Mali

Urgent Surgical Management of Acute Lower Gastrointestinal Bleeding with Intraoperative Colonoscopy: A Case Report

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Surgical Science 2018年第9期9卷 300-305页

作者： Traore Amadou Konate Madiassa Diarra Abdoulaye Keita Soumaila Kone Tani Karembe Boubacar Amadou Issa Sidibe Boubacar Bah Amadou Maiga Amadou Diakite Ibrahim Dembele Bakary Tientigui Traore Alhassane Togo Adegne Kante Lassana Samake Moussa Mangane MoustaphaIssa Diop Thierno Madane Diakite Adama diallo gangaly Gabriel Toure University Hospital Bamako Mali

Lower gastrointestinal bleeding (LGIB) is defined as bleeding from a source distal to the Ligament of Treitz. The primary step is to identify severe hemorrhages that may be life-threatening for patients (10% of cases of LGIB). The management depends on the severity of the bleeding, the diagnostic and therapeutic means of the patient’s reception center. Patient with acute LGIB, in case of negativity of endoscopic and radiological examinations, can be a surgical indication with possibility of intraoperative colonoscopy. We report a case of urgent surgical management with intraoperative colonoscopy in a patient with severe acute LGIB.

关键词： Lower Gastrointestinal Bleeding Surgery Gabriel Toure

Diverticular Fistula of the Female Urethra on Lithiasis at the District Health Center (CSREF) in Communeii, Bamako, Mali

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Surgical Science 2019年第3期10卷 83-88页

作者： Tounkara Idrissa Diarra Abdoulaye Traoré Amadou Coulibaly B. Bakary Kanté Abdoulaye Dembélé Dabéré Ives Thiam Souleymane Ouattara Kassoum Kanté Lassana Konate Madiassa Koné Assitan Ongoiba Oumar Sangaré Modibo Dembélé Bakary Tiètiki Diakité Ibrahim Sidibé Yoro Bah Amadou Coulibaly Yakaria Togo Adégné diallo gangaly Chirurgie générale du Centre de santé de référence de la commune II de Bamako Mali Chirurgie générale du Centre Hospitalier Universitaire de Kati Mali Chirurgie générale Centre Hospitalier Universitaire Gabriel TOURE de Bamako Mali Chirurgie générale du Centre Hospitalier Universitaire du POINT G de Bamako Mali Hopital régional de Gao Mali Hopital régional de Tombouctou Mali

The diverticulum of the female urethra or sub-urethral pouch is in the form of a cul-de-sac lined with mucous membrane through the muscular layer of the urethra. Thus, it is a site of stasis, urinary infection, formation of calculus or even malignant tumor. The diverticula of the urethra or sub-urethral pouches in women have a prevalence of 0.5% to 6% depending on the series. We report the case of a 61-year-old patient operated for a diverticulum on fistulized urethra complicated lithiasis. Our patient had five pregnancies and five births when she consulted for dysuria, urinary burns evolving since a year. The urogenital examination revealed a partially stenotic urethral meatus and a 3-cm large fistulized intravaginal peri-urethral mass allowing urine leak. The mass was painful and hard at palpation. We performed transvaginal diverticulectomy. The follow-up was simple and the probe was removed two weeks after the surgery. An atomo-pathological examination of the resected diverticulum concluded an aspect compatible with lithiasis urethritis.

关键词： Diverticulum Urethral Fistula Lithiasis Bamako