No abstract

Introduction: Liver abscess is a serious condition due to its complications. The most frequent complication is rupture. Our aim is to determine the predictive risk factors of liver abscess rupture at the Saint Louis Regional Hospital Center. Material and methods: This is a prospective descriptive and analytical study over the period of 1 st January 2016 to 28 th February 2019. We included liver abscess records regardless of age. An univariate and then multivariate analysis according to a Cox model allowed us to determine the factors associated with the occurrence of rupture. Results: We collected 138 cases with 78 cases of amoebic abscess (55.3%) and 60 cases of pyogenic abscess (42.6%). We had 36 cases of rupture (26%), including 29 cases in the peritoneal cavity. The mean age was 28 years ± 18. The sex ratio (M:F) was 3.7. There were 35.5% (n= 49) of patients aged under 15 years. The mean consultation time was 18.8 days ± 4.5. The localization was the right lobe in 76.7%, the left lobe in 9.3% and bi lobar in 14%. The mean diameter of abscesses was 8 cm ± 7.5 (Range: 3.7; 16 cm). The abscesses were unique in 85.5% of cases, and sub-capsular in 15.2% of case. Gas was present in 5.7% of cases. The commonest germ found was Staphylococcus aureus in 14.5% of patients. The predictive risk factors of rupture found after univariate analysis were: diameter (p <0.001), age less than 15 years (OR= 4.3; p<0.001), pyogenic origin of abscesses (OR= 4.3, p <0.001), undernutrition (OR=2.3, p= 0.038), jaundice (OR = 4.5, p = 0.009) , left-lobe localization (OR= 7, p = 0.002), subcapsular localization (OR=8.6, p <0.001); the presence of gas (p <0.001). Multivariate analysis identifi ed 5 variables considered as independent risk factors for rupture: the pyogenic origin (HR= 22.51, p<0.001); age less than 15 years (HR= 2,296, p= 0.049); abscess diameter (HR= 1.411, p= 0.004); left lobe localization (HR= 18.68, p <0.001) and sub-capsular localization (HR= 2.689, p= 0.017). Conclusion: In our study, predictive risk factor for liver abscess rupture were: pyogenic origin, age less than 15 years, abscess diameter, left-lobe and subcapsular localization. The knowledge of these factors allows early and appropriate treatment to avoid complications.

Introduction: Despite the advances in minimally invasive surgery in developed countries, laparoscopy remains less used in low-resource settings. Our aim is to describe our first experience in laparoscopic surgery at the Saint-Louis Hospital (Senegal). Methods: This is a descriptive cross-sectional study over the period from November 1, 2018, to June 31, 2020. We included patients operated on by laparoscopy. The parameters studied were age, sex, indications, operative time, reasons, conversion rate, intraoperative difficulties, hospital stay, and postoperative complications. Results: We operated on 83 patients. The mean age was 33.3 years (range, 11-74 years). There were 37 men (44.5%) and 46 women (55.5%). The procedures included appendectomy (49.3%), cholecystectomy (18.1%), exploration of infertility (10.8%), exploratory laparoscopy (7%), and transabdominal preperitoneal (TAPP) for inguinal hernia repair (5.1%). The conversion rate was 9.6% (n = 8). The mean operative time was 81 min (range, 20-210 min). The average length of hospital stay was 2.7 days (range, 1-8 days). The mortality rate was 2.4% (n = 2). Conclusion: Laparoscopy has a real benefit even in a low-resource context. To develop minimally invasive surgery, emphasis must be placed on training the medical team and improving equipment.

Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl). Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software. Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04. Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use. Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section

Introduction: Gallstone disease is a disorder characterised by the formation of stones in the biliary tract. It is the most common biliary condition accounting for more than 98% of all gallbladder and biliary tract disorders. In Africa, previous studies have shown a relative rarity of this condition with a prevalence less than 5%; since it is between 2 and 5 times higher in other continents. A good knowledge of the profile of patient with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. To our knowledge, there was no previous study about gallstone disease in this region even if there is a high prevalence of metabolic factors of gallstone disease.Methods: This study objective is to describe the epidemiological, diagnostic and therapeutic profile of patients with gallstone disease at the Department of General Surgery of Saint-Louis Hospital (Senegal). It will be a single-centre retrospective cohort study in a period of 5 years (January 2015 -December 2020). The patients' record of the department of general surgery will be consulted and the patient contacted if there are missing data. Patients with gallstone disease diagnosed with imaging (ultrasonography and/or CT scan) regardless the presentation (asymptomatic, biliary colic, cholecystitis, common bile duct lithiasis, angio-cholitis, pancreatitis) will be included. Adults and paediatric patients will be enrolled. Patient records lacking sufficient data will be excluded. Studied parameters will be epidemiological, clinical, paraclinical and therapeutic aspects.Ethics and dissemination: Anonymity and confidentiality of information collected in patients will be respected. This research protocol will be submitted to the Ethics Committee of our institution for approval. The knowledge of the profile of patients with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. Finally, it will help to reduce the burden of gallstone disease.