Internal Lateral Sphincterotomy in Yaounde: Comparative Short-Term Results of Open versus Closed Techniques

Background: Chronic anal fissure is a benign disorder which is associated with considerable discomfort. Aim of the Work: The aim of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term. Patient and Methods: We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15 months. Patients were evaluated for each technique by several variables, including duration of surgery, post-operative pain, recurrence, surgical wound infection, gas and/or stool incontinence, and healing time with follow-up up to 12 months postoperatively. Results: A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotomies (group 1) and 31 closed lateral internal sphincterotomies (group 2). There were 35 men and 28 women with a sex ratio of 1.25. The mean age was 35.36 ± 10.16 years with extremes ranging from 19 to 62 years. The typical presentation was pain on defecation. The majority of fissures were located at the posterior commissure. The average duration of the procedure was longer in patients in group 1 (15.34 minutes) compared to 5.22 minutes in patients in group 2. We found 3.12% of surgical wound infections in patients in group 1 and neither patient in group 2. Gas incontinence was 6.45% in group 2 patients and 28.12% in group 1. The mean intensity of pain at 24 hours post-operative was between 4 and 6 on the visual analogue scale in patients in group 2 and between 7 and 10 in group 1. Wound healing time was 8.9 days in group 1 and 4 days in group 2 patients. The hospital stay was 24 hours for both groups of patients. No recurrence was noted during the 6-month follow-up period. Conclusion: Closed lateral internal anal sphincterotomy is the treatment of choice for chronic anal fissures because it is effective and associated with a lower complication rate than the open sphincterotomy technique.

MIPPO technique and LCP internal fixation for open tibial shaft fractures

Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and locking compression plate (LCP) for open tibial shaft fractures.Methods From March 2005 to May 2009,16 cases with open tibial

Should we resect colorectal cancer in patients over the age of 85?

BACKGROUND The prevalence of colorectal cancer in the elderly is rising,with increasing numbers of older patients undergoing surgery.However,there is a paucity of information on the surgical outcomes and operative techniques used in this population.AIM To evaluate the post-operative outcomes for patients≥85 years old following colorectal cancer resection as well as evaluating the outcomes of laparoscopic resection of colorectal cancer in patients over 85.METHODS Patients who underwent colorectal cancer resection at our institution between January 2010 and December 2018 were included.The study was divided into two parts.For part one,patients were divided into two groups based on age:Those age≥85 years old(n=48)and those aged 75-84 years old(n=136).Short term surgical outcomes and clinicopathological features were compared using appropriate parametric and non-parametric testing.For part two,patient’s over 85 years old were divided into two groups based upon operative technique:Laparoscopic(n=37)vs open(n=11)colorectal resection.Short-term postoperative outcomes of each approach were assessed.RESULTS The median length of stay between patients over 85 and those aged 75-85 was eight days,with no statistically significant difference between the groups(P=0.29).No significant difference was identified between the older and younger groups with regards to severity of complications(P=0.93),American Society of Anaesthesiologists grading(P=0.43)or 30-d mortality(2%vs 2%,P=0.96).Patients over 85 who underwent laparoscopic colorectal resection were compared to those who underwent an open resection.The median length of stay between the groups was similar(8 vs 9 d respectively)with no significant difference in length of stay(P=0.18).There was no significant difference in 30-d mortality rates(0%vs 9%,P=0.063)or severity of complication grades(P=0.46)between the laparoscopic and open surgical groups.CONCLUSION No significant short term surgical differences were identified in patients≥85 years old when compared to those 75-85 years old.There is no difference in short term surgical outcomes between laparoscopic or open colorectal resections in patients over 85.

Laparoscopic distal pancreatectomy: Up-to-date and literature review

Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.