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.

Estimates of serious fungal infection burden in Côte d'Ivoire and country health profile

Due to limited access to more powerful diagnostic tools, there are few data on the burden of fungal infections in Côte d'Ivoire, despite a high HIV and TB burden and many cutaneous diseases. Here we estimate the burden of serious fungal infections in this sub-Saharan country with a health profiling description. National demographics were used and PubMed searches to retrieve all published articles on fungal infections in Côte d'Ivoire and other bordering countries in West Africa. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE (www.LIFE-Worldwide.org). The population of Côte d'Ivoire is around 25 million; 37% are children (≤14 years), and 9% are>65 years. Tinea capitis in children is common, measured at 13.9% in 2013. Considering the prevalence of HIV infection (2.6% of the population, a total of ∼500,000) and a hospital incidence of 12.7% of cryptococcosis, it is estimated that 4590 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 2640 new cases occur each year with the prevalence of 11% of newly diagnosed HIV adults, and 33% of children with HIV/AIDS. Disseminated histoplasmosis is estimated a 1.4% of advanced HIV disease - 513 cases. An estimated 6568 news cases of chronic pulmonary aspergillosis (CPA) occur after pulmonary tuberculosis (a 5-year prevalence of 6568 cases [26/100,000]). Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) were estimated in 104/100,000 and 151/100,000 respectively, in 1,152,178 adult asthmatics. Vulvovaginal candidiasis (VVC) is common and recurrent VVC affects ∼6% of women in their fertile years - 421,936 women. An unknown number develop candidaemia and invasive aspergillosis. The annual incidence of fungal keratitis is estimated at 3350. No cases of sporotrichosis, mucormycosis and chromoblastomycosis are described, although some cases of mycetoma and Conidiobolus infection have been reported. This study indicates that around to 7.25% (1.8 million) of the population is affected by a serious fungal infection, predominently tinea capitis in children and rVVC in women. These data should be used to inform epidemiological studies, diagnostic needs and therapeutic strategies in Côte d'Ivoire.

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.

Adult ileocecal intussusception induced by adenomatous ileal polyp: case report and literature review

Intussusception is a rare cause of bowel obstruction in adults, and has generally an organic etiology. However, adenomatous polyp of the small bowel is an uncommon etiology. Moreover, there’s a great difference with childhood intussusception in its presentation, etiology and management. We describe herein a case of adult ileocecal intussusception due to an adenomatous ileal polyp with a preoperative diagnosis made on computed tomography. We performed a right hemicolectomy, without attempting to reduce the intussusception, and an end-to-end ileotransverse anastomosis. The pathological examination of the surgical specimen revealed an adenomatous polyp with a high grade dysplasia on the terminal ileum, being the cause of the ileocecal intussusception.

Strangulated lumber hernias in adults: A case report and review of the literature

Strangulated lumbar hernia is a very rare condition, with no more than 30 cases reported in the literature so far. Therefore, there is no specific management guideline and the diagnosis remains difficult. By reporting the case of a Senegalese male patient who had a preoperative diagnosis of strangulated lumbar hernia, we aim to discuss the diagnosis and therapeutic modalities of this rare entity, which is often misdiagnosed.

[Evaluation of the efficacy of medical screening of blood donors on preventing blood transfusion-transmitted infectious agents]

BACKGROUND

The aim of this study was to evaluate the efficacy of medical screening to retain blood donors in window period by comparing the seroprevalence of infectious agents (HIV, hepatitis B and C, syphilis) in deferred versus accepted blood donors.

MATERIALS AND METHODS

This prospective and transversal study was performed during 4 months in the National Blood Transfusion Center in Dakar (Senegal). We conducted a convenience sampling comparing the seroprevalence of infectious agents (HIV, HBsAg, HCV and syphilis) in deferred versus accepted blood donors after medical selection.

RESULTS

In total, 8219 blood donors were included. Medical selection had authorized 8048 donors (97.92%) and deferred donors were 171 (2.08%). The prevalence of HIV was higher in the deferred than in accepted blood donors (1.75% vs. 0.05%) (P=0.0003; OR=35.91), as well as for HBsAg (12.87% vs. 7.35%) (P=0.006; OR=1.86). HCV antibodies were present in 0.71% of accepted blood donors and 0.58% in deferred blood donors (P=0.65; OR=0.82). Only accepted donors had brought the infection of syphilis (0.34%) (P=0.56; OR=0).

CONCLUSION

Medical selection is efficient to exclude blood donors at high risk of HIV transmission and to a lesser extent of HBV. However, current medical screening procedures do not allow us to exclude donors asymptomatic carriers of HCV and syphilis.

Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

[Prevalence and morbidity of G6PD deficiency in sickle cell disease in the homozygote]

Sickle cell disease and G6PD deficiency have similar prevalence of 8 to 10% in Senegalese population. Our objectives were to determine the prevalence of G6PD deficiency in Hb S carriers and normal subjects, and to assess the interaction of G6PD deficiency on clinical severity of sickle cell disease. G6PD activity was measured in 319 sickle cell patients and in 318 subjects without HbS. Clinical severity was compared in male homozygous sickle cell patients (11 with G6PD deficiency and 19 without deficit). In homozygous sickle cell patients, the G6PD status was assessed after correction of reticulocyte count following the micro-centrifugation method of Herz. We found that prevalence of G6PD deficiency was higher in sickle cell disease patients (21.6 %) than in normal subjects (12.3 %) (p = 0.001). No difference was found in the two groups of male sickle cell disease patients concerning number of vaso-occlusive crisis, number of transfusion, frequency of infectious episodes, number of chronic complications, disturbances on patient's activity and total index severity.

[Non-Hodgkin's lymphoma in Dakar: study of 107 cases diagnosed between 1986 and 1998]

Non-Hodgkin's Lymphomas (NHL) are the most prevalent malignant hemopathies in Senegal. In this study we have investigated the epidemiological aspects considering the HIV infection pandemic, and evaluated the diagnosis means and evolutive features of this disease in Dakar. Between 1986 and 1998 (13 years), we collected 107 cases of NHL, all histologically confirmed. Average age of patients was 31.4 years (2-85 years) and sex ratio was 21. HIV infection was found in three out of 62 patients tested (4.8%). At moment of diagnosis, 72% of patients were in stage III or IV according to the Ann Arbor Staging System. Large cell lymphomas were predominant (67.2%), followed by small lymphocyte lymphomas (24.2%) and follicular lymphoma with 8.4% of cases. Localization of lymphomas was exclusively nodal (30.8%) or extra nodal (31.7%) or mixed (37.3%). In therapeutical field, 21.5% of patients were treated with only symptomatical means. Chemotherapy was used in 54 patients (78.2% of treated patients), surgery was performed in 6 patients (8.6%), association of radiotherapy and chemotherapy in 5 patients (7.2%) and 4 patients (5.7%) were treated with surgery + chemotherapy. The average survival time was 344 days. Four patients (3.7%) were alive 3 years after diagnosis and only 2 patients (1.8%) after 5 years.

[Protein C, protein S and antithrombin III at normal delivery and during abruptio placentae]

Protein C, Protein S and Antithrombin III were screened in one hundred patients admitted for abruptio placentae and one hundred women who delivered normally in Dakar university hospital. We found a reduction of Protein S at normal delivery which is linked to hypercoagulation activity during this process. PC and PS were significantly decreased during abruptio placentae in relation with the disseminated intravascular coagulation which was found in our study. We recommend to include these tests to explore aetiologies of abruptio placentae and to confirm their congenital deficit two months after delivery.

[Management of lupus nephritis in Senegal]

Systemic lupus erythematosus is a disease considered as seldom in Senegal. Nevertheless its incidence is increasing these last years. The prognosis is significantly related to the renal involvement, classified into 6 classes by the WHO. The treatment of these different forms is variable, consisting on abstention or symptomatic treatment for the class III (with low activity index), class II, I, and V (without renal failure). In the other hand a vigorous treatment is indicated in the class III, with consistent activity index, class IV and class V with renal failure. The most frequent of these treatment remains the association using corticosteroids and immunosuppressants. Among immunosuppressants, cyclophosphamide and azathioprine are the most commonly used. The case we reported is about a 41 years old woman who presented a class IV lupic nephropathy, with a good outcome after a 18 months corticosteroid and immunosuppressants association treatment. This case leads us to some recommendations. Considering our poor socioeconomical conditions, we suggest to treat all patients presenting proteinuria higher than 2 mg/24h. However it is more judicious to perform renal biopsy on patients with signs evocating renal impairement and to treat the class III, IV and V whatever would be the degree of activity and chronicity indexes. This treatment must associate immunosuppressive drugs and corticosteroids; the modalities and duration depending on clinical presentation, histologic features and evolution.

Presenting features at diagnosis and complications of hemophilia in Dakar: apropos of 25 cases

In order to describe the presenting features at diagnosis and complications of hemophilia in Dakar, we conducted a study of hospital records between October 1991 and January 1993. Twenty-five cases of hemophilia were identified. We found that only 4% of our patients were diagnosed in the first 6 months of life whereas 64% of patients were diagnosed between 6 months and 5 years of age, 32% were detected between 5 years and 14 years of age. The presenting feature at diagnosis was external bleeding in 60% of cases and internal bleeding in 40%. 92% of cases were hemophilia type A and only 8% hemophilia type B. 56% of patients had mild hemophilia, 40% moderate and only 4% severe disease. Hemophiliac arthropathy was present on radiography in 76%. Complications were dominated by repeated joint bleeding, which was present in 92% of patients, and repeated hematomas (80% of patients). A functional handicap was present in 60% of cases. 12% of transfused hemophiliacs developed an inhibitor and 4% of patients were HIV positive. Greater awareness of hemophilia amongst the medical community as well as continued efforts to improve care for hemophiliacs in Senegal are necessary.

Epidemiology and therapy of malignant hemopathies in Senegal

The objectives of this study were to determine the prevalence of malignant hemopathies among patients in Dakar hospital and to examine the current methods of treatment in Senegal. A retrospective analysis of patients diagnosed in Dakar hospitals from 1st January 1986 to 31st December 1992 revealed 210 cases of malignant hemopathies, but only 155 patient records were retrieved (73.8%). The prevalence of malignant hemopathies was 7/1000 and males were predominant with a sex ratio of 1.6 (p = 0.0001). Acute leukaemias (AL) appeared mainly in young people with a mean age of occurrence of 18.8 years, while immunoproliferative syndromes (IS) and myeloproliferative syndromes (MS) were mostly found in adults with respective mean ages of occurrence of 38.9 and 38.7 years (p = 0.000004 AL vs IS, p = 0.00001 AL vs MS). Concerning therapy, 14.2% of patients died without treatment and 26.1% received only symptomatic treatment. Chemotherapy was employed in 61% of cases, complete remission being obtained in 20.6% of these patients but of no remission in the remaining 79.4%. Mean survival was 2 months for AL, 5 months for IS and 6 months for MS. Close collaboration between haematologists and clinicians and creation of a specialized clinical haematology department will be necessary to overcome current difficulties in the treatment of these affections.