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Laparoscopic Appendectomies at Brazzaville University Hospital

Surgical Science 2024年第4期15卷 183-194页

作者： murielle etiennette julie note madzele Pierlesky Elion Ossibi Bhodeho Medi Monwongui Didace Massamba Miabaou Giresse Bienvenu Tsouassa Wa Ngono Prude Pertinie Avala Gilles Niengo Outsouta Noé Henschel Motoula Latou Carmich Nzaka Moukala Cédrick Du Bonheur Alima Koya Gilbert Fabrice Otiobanda Digestive Surgery Department Brazzaville University Hospital Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo General Intensive Care Unit Brazzaville University Hospital Brazzaville Republic of the Congo

Introduction: Acute appendicitis represents an urgent surgical condition, requiring the removal of the vermiform appendix. Laparoscopy is the standard surgical approach. This study aimed to outline the epidemiological, clinical, therapeutic, and outcome characteristics of patients undergoing laparoscopic surgery for acute appendicitis. Patients and Methods: A descriptive, retrospective analysis was carried out in the Emergency and Digestive Surgery departments of the University Hospital Center of Brazzaville, spanning two years from January 1, 2021, to December 31, 2022. The study included all patients who underwent laparoscopic surgery for non-complicated acute appendicitis. Results: The study included 12 cases of non-complicated acute appendicitis treated with urgent laparoscopy. The mean age of the patients was 37 ± 8.9 years, with a sex ratio of 0.7. The predominant symptom leading to consultation was pain in the right iliac fossa, with an average time to consultation of 6.4 ± 5.7 hours. Patient histories included diabetes in one case, obesity in two cases, and one case of prior abdominoplasty. During surgery, a phlegmonous appendix was observed in nine patients. The average duration of hospital stay was 3.6 ± 1.3 days, with all patients experiencing uncomplicated recoveries. Conclusion: The practice of emergency laparoscopic appendectomy is still relatively infrequent in our setting and presents an ongoing challenge.

关键词： Acute Appendicitis Appendectomy Laparoscopy Emergency

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Surgical Treatment of Hemorrhoidal Disease at Brazzaville University Hospital Center

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Surgical Science 2024年第3期15卷 159-168页

作者： murielle etiennette julie note madzele Pierlesky Elion Ossibi Rody Stéphane Ngami Didace Massamba Miabaou Clausina Philestine Mikolele Ahoui Apendi Noé Henschel Motoula Latou Bhodeho Medy Monwongui Giresse Bienvenu Tsouassa Wa Ngono Prude Pertinie Avala Carmich Nzaka Moukala Cédrick Du Bonheur Alima Koya Blaise Irénée Atipo-Ibara Digestive Surgery Department Brazzaville University Hospital Center Brazzaville Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Gastroenterology and Internal Medicine Department Brazzaville University Hospital Center Brazzaville Congo

Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to analyze the epidemiological, clinical, therapeutic and evolving aspects of hemorrhoidal disease at the stage of surgical treatment at the University Hospital Center of Brazzaville. Patients and Methods: We conducted a retrospective and descriptive study carried out from January 2020 to December 2021, a 24 months period, in the Digestive surgery department of the University Hospital Center of Brazzaville. It concerned patients who underwent a surgical procedure for hemorrhoidal disease. Results: 21 cases were collected, representing a hospital frequency of 2.3%, with a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9 years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding. We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%) of hemorrhoidal prolapse including 12 cases requiring manual integration (Goligher grade III) and four irreducible permanent cases (Goligher grade IV). The Grade III prolapse was associated with a polyp in one patient and with posterior anal fissure in another patient. Out of the 21 patients, 14 underwent a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients underwent mono- and bipedicular hemorrhoidectomy with resection of associated lesions and five patients underwent emergency thrombectomy. The outcome was favorable for all our patients. The average length of hospital stay was 1.5 ± 2.1 days. Conclusion: In the event of failure of medical and instrumental treatment, the hemorrhoidal cure according to Milligan and Morgan is the surgical treatment of reference for hemorrhoidal disease at the University Hospital Center of Brazzaville.

关键词： Hemorrhoidal Disease Surgery Milligan and Morgan

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Recurrent Sigmoid Volvulus after Sigmoidectomy: 3 Clinical Cases

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Surgical Science 2023年第12期14卷 712-719页

作者： murielle etiennette julie note madzele Didace Massamba Miabaou Pierlesky Elion Ossibi Moïse Service Yanguedet Noé Henschel Motoula Latou Prude Pertinie Avala Giresse Bienvenu Tsouassa Wa Ngono Meddi Bhodého Monwongui Carmich Nzaka Moukala Department of Digestive Surgery University Hospital Center of Brazzaville Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Introduction: Recurrent sigmoid volvulus is a medical and surgical emergency. It is the recurrence of a twisting of the sigmoid loop around its mesenteric axis initiating an occlusion by strangulation. The risk factors of colonic volvulus are: a dolichosigmoid, a chronic constipation, a tumor, …In Western countries, recurrences of sigmoid volvulus after surgery are rare and due to a non resection of a dolicho-megacolon. Most African studies do not report any recurrence of sigmoid volvulus after sigmoidectomy. This work aims to describe three original cases of recurrence of sigmoid volvulus after sigmoidectomy recorded at the University Hospital of Brazzaville and to analyze their causes and surgical management. Clinical Observation: We studied the cases of three male patients, whose average age was 73 years, each of them having a history of chronic constipation and sigmoidectomy for sigmoid volvulus with an average delay of recurrence of 5.3 years. They all underwent emergency laparotomy for acute intestinal obstruction on scarred abdomen. The surgery permitted to unfold a recurrent volvulus of the sigmoid associated with circumferential scar fibrosis on the volvulated sigmoid loop. A second colectomy was performed. The histological results of the surgical specimens were normal for two patients and revealed signs of tissue necrosis for the third patient. The postoperative outcome was without incident for two patients. The third patient died after developing a septic shock. Conclusion: Recurrent sigmoid volvulus after sigmoidectomy is rare. The etiological factors for our three patients were incomplete sigmoidectomy during the first operation and chronic constipation.

关键词： Recurrent Volvulus Sigmoid Sigmoidectomy

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Lymphadenectomy for Colorectal Cancer: Experience of the Brazzaville Teaching Hospital

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Surgical Science 2022年第3期13卷 79-90页

作者： Pierlesky Elion Ossibi murielle etiennette julie note madzele Noé Hensnel Motoula Latou Didace Massamba Miabaou Prude Pertinie Avala Jile Florient Mimiesse-Monamou Arnaud Mongo-Onkouo Rody Stéphane Ngami Fabien Gael Mouamba Eliane Ndounga Alexis Fortuné Bolenga Liboko Régis Franck Moyikoua Freznel Ngoma Mabonzo Apendi Philestine Clausina Ahoui Gilbert Fabrice Otiobanda Blaise Irénée Atipo Ibara Department of Digestive Surgery Brazzaville Teaching Hospital Brazzaville Congo Department of Gastroenterology Brazzaville Teaching Hospital Brazzaville Congo Anatomy and Pathological Cytology Department Brazzaville Teaching Hospital Brazzaville Congo Department of Oncology Brazzaville Teaching Hospital Brazzaville Congo Department of Radiology Brazzaville Teaching Hospital Brazzaville Congo Department of Intensive Care Brazzaville Teaching Hospital Brazzaville Congo

Introduction: Lymph node (LN) metastasis are important biomarkers in the resection of colorectal cancer translating into accurate disease staging. It is therefore obvious that lymph node dissection in the curative treatment of colorectal cancer is a prognostic factor that influences survival and guides management strategy. This study aims to evaluate lymph node dissection in colorectal cancers (CRC) managed at the Teaching Hospital, Brazzaville, Congo. Patients and Method: We carried out a descriptive prospective study during a period of 18 months from October 2020 to March 2021 involving patients who underwent curative treatment for colorectal cancer at the visceral surgery department of the Brazzaville Teaching Hospital. Results: Thirty (30) cases of CRC were recorded out of 738 hospitalizations in the visceral surgery departments, which constitute 4.06% of the in-patient activity of the department during the period under study. Mean age was 55.13 years and a male predominance was observed with a sex ratio of 1.14. Colonic involvement was predominant in our series and was found in 22 of the patients. 25 patients underwent surgical resection while 5 patients could not undergo operative treatment. 17 out of the 25 patients underwent curative treatment, 6 were offered palliative care, whereas surgical abstention was decided in 2 patients. The average number of lymphadenectomies per patient was 16.43. Lymphadenectomy was greater than or equal to 12 in 88% of patients. Nine patients had vascular emboli whereas 10 patients had perineural invasion. The tumor was staged as T3 in 15 patients;six patients had a negative lymph node and 11 patients had at least one lymph node invasion. Distant metastasis status could not be determined in 10 patients. Conclusion: Lymphadenectomy is a hallmark in the curative treatment of colorectal cancer as it allows for optimal staging. This represents a strong prognostic factor that defines adjuvant therapy and overall patient outcome.

关键词： Lymphadenectomy Surgery Cancer Colorectal

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Comparison of the fatty acid composition of the serum phospholipids of controls, prediabetics and adults with type 2 diabetes

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Journal of Diabetes Mellitus 2012年第4期2卷 393-401页

作者： Lu-Te Chuang Robert H. Glew Chia-Chun Li Dorothy J. VanderJagt julie S. Broyles Gretchen M. Ray Vallabh O. Shah Department of Biochemistry and Molecular Biology University of New Mexico Albuquerque USA Department of Biotechnology Yuanpei University Hsinchu Taiwan Department of Internal Medicine School of Medicine University of New Mexico Albuquerque USA Department of Pharmacy Practice and Administrative Sciences College of Pharmacy University of New Mexico Albuquerque USA

Objective: Although abnormalities in the fatty acid composition of serum and red cell membrane phospholipids of patients with type 2 diabetes are well-documented, lacking are studies of this issue in prediabetic individuals. Materials/Methods: For this cross-sectional study, we recruited 180 subjects (30 - 80 years), 56 of whom were normal with regard to glucose control (HbA1c, 6.5%). Serum phospholipids were isolated and analyzed for fatty acids. Results: Most importantly, the fatty acid compositions of the controls and prediabetic subjects were not different for 19 fatty acids. However, the fatty acid profile of the phospholipids of the patients with diabetes differed from the other two groups;the 14 to 18-carbon saturated fatty acids were decreased by 12% - 26% whereas the unsaturated fatty acids 16:1n-7, 18:1n-9, 18:2n-6, 20:3n-6 and 20:4n-6 were increased by 45% - 64%. Of note, the docosahexaenoic acid (DHA) status of individuals in all three study groups was remarkably low compared with international values, as indicated by DHA proportions in the 1.62% - 2.07% range, and there were no differences between groups. The mean melting point of the phospholipid fatty acids of the diabetic patients (32.2℃) was significantly lower (p < 0.001) than that of the prediabetic subjects (38.1℃) and the controls (39.9℃) which were not different from each other. Conclusion: These observations indicate that the fatty acid changes associated with type 2 diabetes follow the onset of the disease as opposed to being a causative factor of poor glucose control and insulin insensitivity.

关键词： Pre-Diabetes Type 2 Diabetes Fatty Acids Phospholipids Fluidity

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