Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis

BACKGROUND

Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa.

METHODS

We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes.

RESULTS

We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443).

CONCLUSION

These results confirm that LGHR is safe and feasible and would be recommended in our African context.

[Superior mesenteric artery syndrome in gastric cancer: a case report]

Superior mesenteric artery syndrome or Wilkie syndrome is due to the compression of the third duodenum between the superior mesenteric artery and the aorta. It causes acute or chronic upper bowel occlusion. Abdominal CT scan facilitates the diagnosis. Severe malnutrition is its main etiological factor. Medical treatment can be based on aspiration of gastric contents and parenteral nutrition. If this fails, surgery is necessary. We here report the case of a 46-year-old patient, with a history of smoking, presenting with profuse postprandial bile and food vomiting. He had had weight loss of 7% over a period of 6 months. Upper GI endoscopy revealed non-stenotic antro-pyloric tumour mass. Histological examination showed poorly differentiated tubular gastric adenocarcinoma. Staging was without any peculiarity and allowed for the detection of superior mesenteric artery syndrome at an angle of 8°C. The patient received parenteral nutrition for 10 days, followed by inferior pole gastrectomy and gastrojejunal anastomosis (omega loop). The postoperative course was uneventful. Adjuvant chemotherapy was indicated.

Infected urachal cyst in an adult, report of two observations

INTRODUCTION

Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it.

CASE PRESENTATION

Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection.

CLINICAL DISCUSSION

Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery.

CONCLUSION

Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

Cystic mesenteric lymphangioma: A case report

INTRODUCTION

Cystic lymphangioma is a benign malformative tumor. The abdominal localization is rare. The diagnosis is not easy in preoperative period. The surgery is the choice in the abdominal and symptomatic localization.

PRESENTATION OF CASE

We report a 26 years old women. She consulted with left hypochondrial pain. The exam found left hyphochondrial swelling with 10 cm of diameter. The biologic screeming was normal. The ultrasound showed a multiloculated cyst which measured 130*80 mm. the CT scan showed a mesenteri cyst mass measured 15 cm. A fine needle aspiration cytology guided by abdominal ultrasound was realized and the cytology doesn't show malignant cell. A median laparotomy found a mesenteric cystic mass measured 15 cm of diameter. A resection was realized. The histologic exam membranous fibrosis cyst limited by an endothelium.

CONCLUSION

Mesenteric localization of cyst lymphagioma is rare. The surgery is safe and efficiency for the treatment.