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Pure large cell neuroendocrine carcinoma of the gallbladder is a rare disease. However, the prognosis of this aggressive tumor is poor with short survival after diagnosis. We are describing in this manuscript a case of pure large cell neuroendocrine carcinoma in which survival exceeded 26 months, after performing two curative surgeries. We are reporting the case of a 68-year-old woman with a history of recovered right breast carcinoma and operated 6 years later for a completely asymptomatic gallbladder tumor of 31 mm. In this case, curative surgery was performed allowing monobloc resection of the gallbladder and the hepatic segments IVb and V, a lymph node dissection was performed to. The histological examination of the specimen and immunohistochemistry confirms that the tumor was a grade 3 pure large cell neuroendocrine carcinoma of gallbladder with lymph node invasion, the hepatic and biliary surgical margins were free. Postoperative adjuvant chemotherapy was administered and the evolution was eventless until the discovery at 20 months of a lymph node considered being metastatic recurrence. A second surgery was performed allowing removal of three lymph nodes. This time, a different protocol of chemotherapy was administered to our patient who remains alive and without recurrence at 26 months from her first surgery. Surgical relentlessness with free margins resections associated with appropriate chemotherapy probably improves the survival of patients suffering from this rare and aggressive tumor.

Résumé: Avec la généralisation de la cholécystectomie laparoscopique, l’incidence des traumatismes opératoires des voies biliaires a augmentée de façon significative. La perte de la sensation haptique, la vision bidimensionnelle, et l’éclairage centré favorisent l’illusion aboutissant à des erreurs d’identifications, où le chirurgien confond voie biliaire principale et canal cystique. Ce phénomène explique l’augmentation des traumatismes biliaires à l’ère de la laparoscopie.Récemment, et grâce aux recommandations des sociétés savantes comme la SAGES sur les bonnes pratiques chirurgicales, l’incidence de ces traumatismes est en régression et tend a rejoindre celle décrite à l’ère de la chirurgie ouverte. Parmi ses recommandations, la SAGES met l’accent sur l’adoption par tous les chirurgiens de la « Critical View of Safety » durant la réalisation de la cholécystectomie par voie laparoscopique. L’objectif de cette mise au point est de décrire cette attitude, mais surtout analyser son efficacité et ses limites dans la prévention des traumatismes opératoires des voies biliaires.Abstract:With the generalization of laparoscopic cholecystectomy, the incidence of operative bile ducts injury has increased significantly, the loss of haptic sensation, the two-dimensional vision, and the centered lighting favor the illusion leading to misidentifications, as consequences the surgeon confuses the main bile duct and the cystic duct. This phenomenon explains this increase in the incidence of bile duct injuries in the era of laparoscopy.Recently, and thanks to the recommendations of some learned societies such as SAGES on good surgical practices, the incidence of these complications is declining and tends to join that described in the era of open surgery. Among its many recommendations, SAGES recommends the adoption by all surgeons of the “Critical View of Safety” during the performance of laparoscopic cholecystectomy, an attitude that we will describe, and analyze its effectiveness and its limits in prevention of operative bile ducts injury.

Hemorrhagic manifestations during COVID-19 infections are increasingly described in the literature. We report the first case of spontaneous subcapsular hematoma of the liver revealing a COVID-19 infection in a 44-year-old woman with no underlying health condition history, a computerized tomography evaluation showed an aspect of lung ground-glass opacities, with moderate impairment estimated about 20%. Reverse transcription-polymerase chain reaction confirmed the diagnosis of COVID-19 infection. During the COVID-19 pandemic, non-traumatic bleeding such as spontaneous hematomas in patients with no coagulation disorder could be a manifestation of COVID-19 infection.

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

But de l’etude Etudier les resultats de la prise en charge chirurgicale du kyste hydatique du foie (KHF). Patients et methodes Etude retrospective monocentrique portant sur les patients operes pour KHF au service de 2013 a 2019. Resultats Trois cent cinquante-quatre patients etaient operes pour KHF, Il s’agissait de 163 hommes et 191 femmes, l’âge moyen etait de 43 ans [15–91] ans. Le mode de revelation du KHF chez nos patients etait domine par la douleur abdominale (56 %). Trois cent douze de ces patients ont beneficie d’un traitement conservateur, 35 patients avaient un KHF rompu dans les voies biliaires. Le traitement consistait a une resection du dome saillant chez 87 % de patients, une perikysstectomie dans 10 % des cas et une resection hepatique reglee chez 3 % de ces patients. La morbidite etait de 30,5 % pour le traitement conservateur dominee par les fistules biliaires externes avec duree de sejour de 11,25 jours et de 22 % pour le traitement radical avec duree de sejour de 7,5 jours. La mortalite etait de 0,3 %. Conclusion Le traitement chirurgical radical du KHF; quand il est possible; permet de diminuer la morbidite et de reduire la duree du sejour postoperatoire.

Background: The cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means or adequate professional environment. So, to know the real practices of surgeons, a survey was conducted.Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons.Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalisation recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalisation.Conclusions: We recommend publication of guidelines of good practices adapted to the socio-professional and economic context of countries.

Highlights • Rare complication of abdominal drainage 7 cases published. • Our decrypted case is the 8th. • Expose our original surgical Laparoscopic method “two trocars approach”. • In-out visual control of the site drain evisceration and closure “safer + + + ”. • Table: brief review of published cases., Introduction Peritoneal cavity drainage is not riskless and several publications reported drain induced complications. However, till this day, abdominal drainage is still a subject of divergence between necessity and usual operative practice. We describe in this publication an exceptional complication of drainage, which is the drain site evisceration of the appendix. Case presentation We report the case of a 47-years-old patient, initially operated for perforated ulcer peritonitis, in whom an evisceration occured 48 h after the removal of an intraperitoneal drain placed in the Douglas pouch, the physical examination predicated the presence of a herniated omentum fringe, as a precaution a laparoscopic exploration was performed and revealed that the eviscerated organ was the vermiform appendix, then a two trocars appendectomy was performed and the orifice of the evisceration was safely closed. Discussion Since the first description in 1995, only seven cases were reported in the literature, we propose a new management of the drain site evisceration of the appendix, including laparoscopic exploration, and both side control of the drain site defect closure, our technique seems safer. Conclusion The laparoscopic approaches must have a place in the management of the drain site eviscerations.

RésuméIntroduction: l’objectif de notre travail est d’analyser les facteurs histo-pronostiques des cancers du rectum non métastatique opérés au service de chirurgie «A» de Tlemcen à ouest Algérien durant une période de six ans. Méthodes: étude rétrospective de 58 patients qui avait un adénocarcinome rectal. Le critère de jugement était la survie. Les paramètres étudiés, le sexe, l’âge, stade tumoral, et les récidives tumorales Résultats: l’âge moyen était de 58 ans. Avec 52% d’hommes contre 48% femmes avec sex-ratio (1,08). Le siège tumoral était: moyen rectum avec 41,37%, 34,48% au bas rectum et dans 24,13% au haut rectum. La classification TNM avec 17,65% au stade I, 18,61% au stade II, 53, 44% au stade III et 7,84% au stade IV. La survie médiane globale était de 40 mois ±2,937 mois. La survie en fonction du stade tumoral, le stade III et IV avait un faible taux de survie (19%) a 3 ans contre le stade I, II avait un taux de survie de (75%) (P=0,000) (IC 95%). Les patients avec récidives tumorales avaient un taux de survie faible à 3 ans par rapport à ceux n’ayant pas eu de récidive (30,85% Vs 64,30% P=0,043). Conclusion: dans cette série, l'étude uni varié des différents facteurs pronostiques conditionnant la survie n'a permis de retenir que trois facteurs influençant la survie, à savoir la taille tumorale, le stade, et les récidives tumorales. En analyse multi variée en utilisant le modèle Cox un seul facteur été retenu la récidive tumorale.English abstractIntroduction: the aim of our study was to analyze histoprognostic factors in patients with non-metastatic rectal cancer operated at the division of surgery "A" in Tlemcen, west Algeria, over a period of six years.Methods: retrospective study of 58 patients with rectal adenocarcinoma. Evaluation criterion was survival. Parameters studied were sex, age, tumor stage, tumor recurrence. Results: the average age was 58 years, 52% of men and 48% of women, with sex-ratio (1,08). Tumor seat was: middle rectum 41.37%, lower rectum 34.48% and upper rectum 24.13%. Concerning TNM clinical staging, patients were classified as stage I (17.65%), stage II (18.61%), stage III (53.44%) and stage IV (7.84%). Median overall survival was 40 months ±2,937 months. Survival based on tumor staging: stage III and IV had a lower 3 years survival rate (19%) versus stage I, II which had a survival rate of 75% (P = 0.000) (95% ). Patients with tumor recurrences had a lower 3 years survival rate compared to those who had no tumoral recurrences (30.85% vs 64.30% P = 0.043) . Conclusion: in this series, univariate analysis of prognostic factors affecting survival allowed to retain only three factors influencing survival: tumor size, stage and tumor recurrences. In multivariate analysis using Cox’s model only one factor was retained: tumor recurrence.Key words: Rectal adenocarcinoma, survival, recurrence

Introduction L'objectif de notre travail est d'analyser les facteurs histo-pronostiques des cancers du rectum non métastatique opérés au service de chirurgie «A» de Tlemcen à ouest Algérien durant une période de six ans. Méthodes Etude rétrospective de 58 patients qui avait un adénocarcinome rectal. Le critère de jugement était la survie. Les paramètres étudiés, le sexe, l’âge, stade tumoral, et les récidives tumorales. Résultats L’âge moyen était de 58 ans. Avec 52% d'hommes contre 48% femmes avec sex-ratio (1,08). Le siège tumoral était: moyen rectum avec 41,37%, 34,48% au bas rectum et dans 24,13% au haut rectum. La classification TNM avec 17,65% au stade I, 18,61% au stade II, 53, 44% au stade III et 7,84% au stade IV. La survie médiane globale était de 40 mois ±2,937 mois. La survie en fonction du stade tumoral, le stade III et IV avait un faible taux de survie (19%) a 3 ans contre le stade I, II avait un taux de survie de (75%) (P = 0,000) (IC 95%). Les patients avec récidives tumorales avaient un taux de survie faible à 3 ans par rapport à ceux n'ayant pas eu de récidive (30,85% Vs 64,30% P = 0,043). Conclusion Dans cette série, l’étude uni varié des différents facteurs pronostiques conditionnant la survie n'a permis de retenir que trois facteurs influençant la survie, à savoir la taille tumorale, le stade, et les récidives tumorales. En analyse multi variée en utilisant le modèle Cox un seul facteur été retenu la récidive tumorale.

La définition du goitre plongeant, la plus couramment employée, est tout goitre ne siégeant pas dans la région cervicale en position opératoire. Le but d'évaluer sa prise en charge, en insistant plus particulièrement sur les examens préopératoires, les difficultés chirurgicales et les complications postopératoire. Etude rétrospective étalée sur 16 ans; portant sur 50 cas colligés au service de chirurgie viscérale du CHU Tlemcen. L'intervention a consisté en une thyroïdectomie totale par voie cervicale dans 94% des cas. Ont été notées essentiellement, les hématomes, des paralysies récurentiels et les hypoparathyroïdie. L'âge moyen est de 54,76 ±11,992 ans Le caractère plongeant du goitre à été retrouvé chez 52% (n=26) parune échographie thyroïdienne. Le scanner cervico-thoracique était pratiqué chez 25 patients 50%. Il a permis de confirmer le caractère plongeant du goitre. Tous nos patients ont bénéficié eu un geste radicale (thyroïdectomie totale n=45, 90%), alors que 5 patients (10%) ayant déjà ont eu un geste sur la thyroïde, ont subi une totalisation. L'examen histologique à confirmé la bénignité dans 48 cas 96 %. Trois patients (6 %) avaientune paralysie récurentielle transitoire et un cas (2%) de paralysie récurentielle persistante. L'hypoparathyroïdie transitoire était notée chez (14%). Les goitres plongeants représentent une éventualité assez fréquente. Souvent révélés à l'occasion d'un examen clinique. L'examen tomodensitométrique qui permet l'exploration des espaces peu accessibles à l'imagerie conventionnelle. L'imagerie par résonance magnétique nucléaire paraît constituer une technique d'avenir.Keywords: Goitre plongeant, région cervicale, ouest algérien

Transomental hernia is the rarest form of internal hernias. Clinical expression of this pathology is ambiguous and diagnosis is often made at complication phase, after irreversible strangulation of the herniated loop. Radiological diagnosis is still difficult and intraoperative exploration usually allows discovering this pathology when patient is operated for acute intestinal obstruction. Treatment is surgical and aims to treat intestinal obstruction and prevent recurrence. We describe the case of a 65 years old male operated for a preoperatively suspected internal hernia; surgical exploration found a transomental hernia trough the greater omentum.

Le syndrome de la pince aorto-mésentérique «SPAM » ou syndrome de Wilkie, est une obstruction duodénale secondaire à une pince anatomiquement acquise qui résulte de la compression du troisième duodénum par l'artère mésentérique supérieure « AMS » en avant, et l'aorte en arrière suite à la disparition du tissu graisseux périvasculaire. Les états de dénutrition avancés en sont souvent la cause, et le SPAM se manifeste cliniquement par des vomissements, des plénitudes et des douleurs post prandiales. Le traitement est médical, mais en cas d’échec la chirurgie s'impose. Nous rapportons un cas de SPAM survenu chez un patient âgé de 78 ans présentant une broncho-pneumopathiechronique obstructive, une démence sénile et une anorexie, consultant pour vomissements répétés remontant à plus d'une semaine.

Le syndrome de la pince aorto-mesenterique «SPAM » ou syndrome de Wilkie, est une obstruction duodenale secondaire a une pince anatomiquement acquise qui resulte de la compression du troisieme duodenum par l'artere mesenterique superieure « AMS » en avant, et l'aorte en arriere suite a la disparition du tissu graisseux perivasculaire. Les etats de denutrition avances en sont souvent la caus e, et le SPAM se manifeste cliniquement par des vomissements, des plenitudes et des douleurs post prandiales. Le traitement est medical, mais en cas d'echec la chirurgie s'impose. Nous rapportons un cas de SPAM survenu chez un patient âge de 78 ans presentant une broncho-pneumopathiechronique obstructive, une demence senile et une anorexie, consultant pour vomissements repetes remontant a plus d'une semaine. Key words : syndrome de la pince aorto-mesenterique, syndrome de Wilkie, obstruction duodenale

S S133 COX2. Interestingly, RANKL showed nuclear expression in pancreatic cancer cells suggesting a potential role in transcription. The presence of RANK in tumor might predict stage of disease and patient prognosis. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.328 339. Long-term outcomes after hepatic resection for hepatocellular carcinoma. A single-centre experience A. Petrou, K. Neofytou, E. Prassas, E. Felekouras 1 Nicosia Teaching Hospital, Department of Surgical Oncology/Div.HPB, Nicosia, Cyprus 2 The Royal Marsden NHS Trust, Department of Academic Surgery, London, United Kingdom King’s College Hospital, Institute of Liver Studies, London, United Kingdom University of Athens Medical School, LAIKON Teaching Hospital, First Department of Surgery, Athens, Greece Background: Hepatic resection is the mainstay of the curative treatment of primary hepatic tumors, with constantly improving short and long term results. Radiofrequency ablation (RFA)-assisted liver resection is a relatively new method of transection of the liver parenchyma with favorable intraand perioperative results. The aim of this study was to investigate the oncological efficacy (long term overall survival/OS and disease free survival/DFS) and to confirm the favorable short term morbidity and mortality. Materials and methods: Between May 2004 and January 2007, 28 patients underwent 32 resections with removal of 50 hepatocellular carcinoma (HCC) lesions at the First Department of Surgery, University of Athens Medical School, Athens, Greece. Results: Thirty-day morbidity and mortality were 42.8 and 0% respectively. Blood transfusion required 28.5% of the patients. The median hospital stay was 16.5 days (range 5e34). The 1and 3-year OS were 92.9 and 65.7%, respectively. The 1and 3-year DFS were 62.3 and 54.6% respectively. No patient developed metastatic disease or local recurrence at the margin site. Twelve patients (42.5%) developed inetheeliver recurrence away from the resection area. Conclusion: RFA-assisted liver resection is a safe and oncologically efficacious method for the surgical treatment of HCC with results comparable to other surgical techniques. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.329 340. Surgical treatment of cancer of the gallbladder N. Boudjenan Serradj, B. Tabeti, A. Tidjane, T. Bouhadiba, N. Cherrak, N. Benmaarouf 1 EHU-1St November 1954, Service de Chirurgie H epatobiliaire et Greffe du Foie, Oran, Algeria Introduction: Late diagnosis and prognosis; cancer of the gallbladder always requires the interest of different medical and surgical teams. Aim of the study: Evaluate the preliminary results and complications of cancer surgery of the gallbladder in our service. Materials and methods: This is a prospective study from September 2009 to April 2014 and 314 cases were identified. This study includes: epidemiological e pane patients (age-sex-location and tumor staging) therapeutic e pane: gesture e curative palliative, morbidity, mortality Results: -female: 230 femmes (73%) of 84 men (27%). Average 62-year age. -reason for consultation: right upper quadrant pain and jaundice Hundred and twenty-eight patients were operated on, the gesture was: Curative: 59 patients (46%). Workaround: 48 patients (37%) immediate post-operative morbidity minimal. immediate post-operative mortality: two cases. Conclusion: Improved prognosis of cancer of the gallbladder only be done by taking early and specialized load and better diagnostic and therapeutic mastery of this type of cancer. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.330 341. ypT0, ypN0, ypM0 resection in locally advanced pancreas ductal adenocarcinoma with synchronous liver metastases, following neoadjuvant chemoradioimmunotherapy and surgery A. Giakoustidis, D. Morrison, A. Gaya, S. Mudan 1 Barts Cancer Institute, Department of Surgery, London, United Kingdom The London Clinic, Department of Surgery, London, United Kingdom Guy’s and St Thomas’ Hospital, Department of Clinical Oncology, London, United Kingdom The Royal Marsden Hospital NHS Trust and Faculty of Medicine Imperial College London, Department of Surgery, London, United Kingdom Background: Pancreatic ductal cancer is a highly lethal disease which is refractory to chemotherapy or radiation. Only 10e20% of patients are resection candidates as the majority have locally advanced and/or metastatic disease at presentation. There has been some advance in borderline resectable cases treated in the neoadjuvant fashion, however surgery to the primary in the presence of metastatic disease is still considered an absolute contraindication. We would like to illustrate our recent experience deploying multiple axes of therapy combining systemic cytotoxic chemotherapy, radiation and immunotherapy to achieve complete pathological response as proven by surgical resection of the primary and metastatic sites. MaterialseMethodseResultseCase report: A 72 year-old previously fit and well female was reviewed for symptoms of abdominal discomfort, backache and weight loss. Initial ultrasound (U/S) and subsequent staging by CT, FDG-PET, laparoscopy and EUS indicated a T4 N1 cancer in the head of the pancreas. The patient underwent laparotomy with view to pancreatoduodenectomy in February 2012. Exploration showed the common hepatic artery and the coeliac axis to be encased by tumour and the patient was deemed inoperable as the results of pancreatoduodenectomy for cancer requiring arterial resection are uniformly reported as poor. Two weeks after recovery from explorative surgery the patient was randomized into a clinical trial of Gemcitabine with or without heat killed whole cell Mycobacterium obuense (IMM101 e NCT 01303172), and allocated to the active arm. CT scanning after 12 weeks showed a RECIST criteria partial response in both the primary and liver metastases. In August 2012, with a Ca19.9 of 38000 U/L, nab-paclitaxel (Abraxane) was added to Gemcitabine & IMM101. In view of the dramatic response, consolidation chemoradiation to the primary tumour and vascular encasement followed in February 2013 to a dose of 59.4 Gy in 33 fractions with concomitant capecitabine; the patient continued with immunotherapy throughout radiation treatment. Four months post chemoradiotherapy, CT and PET scanning showed no active FDG uptake in either primary tumour or liver, and that the primary tumour appeared to have regressed from the coeliac and common hepatic artery but maintained involvement of the portomesenteric junction. In November 2013 the patient underwent a Whipple’s procedure and a left lateral hepatectomy. Detailed histopathological analysis showed a complete pathological response to neoadjuvant therapy in both the primary site and liver metastasis. Conclusion: Complete pathological regression of both primary pancreatic and metastatic disease is exceptionally rare to achieve and a combination of immunotherapy with chemotherapy and/or radiation would potentially aim to increase resection rates and survival outcomes.