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L'hémolyse chronique prédispose les patients drépanocytaires au développement de lithiases pigmentaires noires, à l'origine de la survenue fréquente de complications aiguës biliaires. Afin d'en éviter la survenue, une cholécystectomie à froid est recommandée, en France, chez tout patient drépanocytaire avec lithiase détectée. Cependant, toute chirurgie, notamment abdominale, entraine un risque accru de complications vaso-occlusives dans la période péri- et post-opératoire, dont la plus redoutée est le syndrome thoracique aigu. La transfusion préopératoire a démontré son intérêt dans plusieurs études afin de diminuer les complications aiguës postopératoires, mais expose à un risque d'allo-immunisation définitive, voire d'hémolyse post-transfusionnelle retardée, justifiant une tendance récente à l'économie transfusionnelle. Les conditions pour surseoir à la transfusion pour une chirurgie simple et fréquente comme la cholécystectomie reposent sur une balance bénéfices-risques, et doivent être discutées au cas par cas par le médecin spécialiste de la drépanocytose. Il semble en particulier tout à fait justifié de réaliser une transfusion prophylactique préopératoire chez les patients présentant des antécédents de crise vaso-occlusive ou de syndrome thoracique aigu récents (dans les 6 mois préopératoires), et ceux opérés en urgence, qui sont particulièrement à risque d'évènements post-opératoires. Chronic haemolysis exposes patients with sickle cell disease (SCD) to the development of black pigment gallstones, which can trigger biliary complications. In order to avoid these complications, elective cholecystectomy is recommended in France for all SCD patients with detected gallstones. However, all surgeries, and especially abdominal surgeries, entail an increased risk of vaso-occlusive complications in the peri- and post-operative periods, the most dreadful one being the acute chest syndrome. Preoperative transfusion has been shown in several studies to reduce acute postoperative complications, but exposes the patient to definitive alloimmunization, or even delayed post- transfusion haemolysis, justifying a recent trend towards transfusion sparing. The conditions for avoiding transfusion for a simple and frequent surgery such as cholecystectomy are based on a benefit- risk balance, and must be discussed on a case-by-case basis by the SCD specialist. In particular, it seems fully justified to perform prophylactic preoperative transfusion in patients with a history of recent vaso-occlusive crisis or acute chest syndrome (within 6 months preoperatively), and those operated on in an emergency setting, who are particularly at risk of postoperative events. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has led to global changes in healthcare systems. The purpose of this study was to investigate the effects on surgical care of patients. Methods: We performed a retrospective analysis of routine data from the largest hospital group in Germany (68 acute hospitals). Included were inpatients who underwent cholecystectomy between March 19, 2020 (beginning of the first lockdown in Germany) and September 22, 2020. These patients were compared with those treated in the same interval in 2019. Results: In the 2020 study period, 4035 patients met the inclusion criteria (2019: 4526 patients). During the first lockdown, there was a significant reduction in the number of cholecystectomies performed (51.1% decrease). More patients with a higher risk profile underwent urgent operations, which were accompanied by a significant increase in conversion from laparoscopic to open cholecystectomy. The patients were treated as inpatients for a longer duration than 2019, and the mortality rate increased significantly to 1.3% (2019: 0.1%). The complication rate also showed a significant increase. After the end of the first lockdown, daily admission rates normalized very quickly. However, it was not possible to fully address the backlog of operations. Conclusion: There is still a "patient stagnation" 6 months after the first German lockdown. Extrapolated to the national level, this corresponds to almost 21,000 fewer cholecystectomies performed in Germany in 2020. It remains to be seen whether surgical rates will return to pre-pandemic levels and whether complications will arise in the future due to the lack of operations. [ABSTRACT FROM AUTHOR]

La coeliochirurgie est la technique de référence pour le traitement de la lithiase vésiculaire symptomatique. Jusquà ce jour, seuls 42 cas de cholécystectomie laparoscopique chez des patients présentant un situs inversus ont été publiés. Ainsi, nous rapportons un nouveau cas d'un patient, suivi pour cardiopathie congénitale complexe à type de ventricule unique sur situs inversus et dextrocardie. C'est un patient qui était hospitalisé pour prise en charge chirurgicale de lithiase vésiculaire symptomatique. Une cholécystectomie laparoscopique était réalisée. La disposition des trocarts et l'abord chirurgical étaient complètement inverses et symétrique par rapport à l'abord laparoscopique normal.

Most of gallbladder tumors are benign and asymptomatic. These tumors are characterized by an elevation of the gallbladder wall that project into the lumen. Polyps are the most common benign tumors of the gallbladder with a prevalence estimated between 4 to 7 %. Gallbladder adenomas are commonly detected on ultrasound and distinguished from cholesterol pseudopolyps and focal adenomyomatosis. Cholecystectomy should be performed if gallbladder polyp is greater than 10mm, in patients with risk factors for gallbladder malignancy or fast growing polyp. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: La cholécystectomie laparoscopique est le gold standard de la prise en charge des calculs vésiculaires symptomatiques. Il existe une importante controverse quant au fait de savoir si elle devrait être pratiquée en chirurgie ambulatoire ou dans le cadre d'une chirurgie avec hospitalisation d'une nuit pour ce qui concerne la sécurité des patients. Le but du travail est d'évaluer l'impact de la cholécystectomie laparoscopique en chirurgie ambulatoire versus en chirurgie avec hospitalisation d'une nuit sur les critères de jugement axés sur le patient, tels que la mortalité, les graves événements indésirables et la qualité de vie. METHODES: il s'agit d'une étude transversale descriptive réalisée au sein du service de chirurgie générale de l'hôpital Habib Thameur, sur la période allant de Mai 2009 à Février 2010. Cette étude porte sur 67 malades porteurs d'une lithiase vésiculaire symptomatique ayant eu une cholécystectomie laparoscopique en ambulatoire (CLA). Étaient exclus de l'étude: les malades ASA III et IV, les diabétiques sous sulfamides ou sous insuline, les grands obèses, les malades de plus de 65 ans et moins de 18 ans, ceux avec un antécédent de chirurgie abdominale majeure, les malades suspects d'une lithiase de la voie biliaire principale, d'une cholécystite aiguë ou d'une pancréatite. Pour être traité par CLA, le malade devait résider à moins de 50 km de l'hôpital, et avoir la possibilité d'une présence adulte à ses côtés. RESULTATS: dix-sept patients étaient inclus puis exclus de notre étude devant la découverte per opératoire de signes de cholécystite aigue ou devant des difficultés de dissection amenant le chirurgien à mettre un drain de Redon en sous hépatique en fin d'intervention. Finalement, 50 patients ont été retenus: 7 hommes et 43 femmes d'âge moyen de 48 ans. L'intervention se déroulait selon les modalités habituelles. A la sortie de la salle de réveil, le patient était dirigé en secteur ambulatoire où une alimentation liquide était autorisée. Le malade était revu avant 19 h et la sortie décidée si une analgésie orale était possible, si une alimentation liquide était tolérée, seil n'existait aucun trouble de la diurèse, et si le patient acceptait un retour à domicile avec un traitement antalgique et anti-inflammatoire à la demande. Trente neuf patients (78%) ont quitté l'hôpital et 11 ont été gardés. L'âge à 45 ans, la durée de l'anesthésie à 70 minutes et la fatigue post opératoire ont été identifié comme facteur de risque de sorties ratées. Aucune réadmission n'a été observée. Les patients qui ont pu être mis sortants ont été satisfaits du protocole de prise en charge avec des réponses majoritairement de type excellent et bon (94%). CONCLUSION: la chirurgie ambulatoire semble tout aussi sûre que la chirurgie avec hospitalisation d'une nuit dans la cholécystectomie laparoscopique avec un faible taux de complication et de réadmission chez des malades sélectionnés, et avec une réduction du coût de l'intervention.

La cholécystite gangreneuse alithiasique postopératoire est une complication grave et sévère, surtout chez les malades hospitalisés en réanimation. Elle survient le plus souvent au décours d'une chirurgie vasculaire ou digestive majeure, d'un polytraumatisme, dans un contexte septique ou dans un contexte de choc. Nous rapportons l'observation d'un homme âgé de 74 ans opéré d'une fracture du col du fémur, au sixième jour postopératoire il a développé un tableau clinique d'une cholécystite aigue dont les explorations radiologiques ont confirmé son caractère alithiasique. Après une cholécystectomie en urgence, l'étude anatomopathologique a conclu à une cholécystite gangreneuse alithiasique.

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patient âgé de 59 ans ayant consulté pour un syndrome douloureux et fébrile de l'hypochondre droit évoluant depuis quatre jours. La palpation trouvait une défense et la biologie montrait un syndrome inflammatoire biologique associé à une cholestase anictérique. A l'échographie la vésicule biliaire était distendue, multi lithiasique, à paroi épaissie, associée à un aspect hypoéchogène du segment IV du foie et une thrombose de la branche portale gauche. L'exploration per opératoire, montrait un pyocholécyste, une vésicule biliaire enchâssée dans le foie avec une importante pédiculite et un segment IV induré sans abcès hépatique. Une cholécystectomie avec drainage étaient réalisées. L'examen anatomopathologique était en faveur d'un carcinome épidermoïde bien différencié occupant toute la vésicule biliaire et infiltrant toute la paroi en dépassant la séreuse. Cette tumeur était classée stade pT3 selon la classification TNM et la limite d'exérèse proximale était tumorale. Malgré une chimiothérapie palliative à base de Gemzar-Cisplatine l'évolution était rapidement défavorable.

Déterminer la faisabilité de la cholécystectomie laparoscopique pour cholécystite aiguë lithiasique dans notre contexte d'exercice, et d'en évaluer les résultats. Nous rapportons une série de 22 patients ayant bénéficié d'une cholécystectomie laparoscopique pour cholécystite aiguë lithiasique sur une période de 16 mois (Décembre 2013- Mars 2015). Sur 22 patients été opérés, il y avait une nette prédominance féminine (20 femmes soit 91%). La durée moyenne de l'intervention était de 90 mn avec des extrêmes de 38 et 142 mn. L'âge moyen de nos patients était de 42 ans avec des extrêmes de 16 à 65 ans. La durée d'hospitalisation a été de 2 à 6 jours avec une moyenne de 3 jours. Le taux de conversion en laparotomie était de 4.5%.Les suites opératoires immédiates ont été simples dans 90.9% des cas. Les complications concernaient 2 patients (9.1%) dont 1 suppuration pariétale et 1 hémorragie de paroi. La cholécystectomie laparoscopique pour cholécystite aigue lithiasique est faisable dans notre contexte au delà des 72 heures d'évolution sans majoration de risques.

Le volvulus de la vésicule biliaire (VVB) est une affection rare et de diagnostic difficile; le plus souvent per opératoire. Nous rapportons 1 cas de VVB avec gangrène de la vésicule biliaire chez un enfant de 10 ans. Le diagnostic a été porté à l'exploration chirurgicale réalisée en urgence pour un syndrome occlusif fébrile. Il s'agissait d'un volvulus total de la vésicule biliaire. A cette occasion, nous rappelons les aspects diagnostiques et thérapeutiques de cette affection.

L'association pancréatite aigue et grossesse est rare mais non exceptionnelle, le diagnostic de la pancréatite au cours de la grossesse est difficile, vu la non spécificité de la symptomatologie et vu que très souvent les douleurs et les vomissements peuvent être rattachés à la grossesse elle-même pouvant ainsi être responsable du retard diagnostic L'échographie abdominale, qui est certes anodine pour le fétus, ne permet pas de poser le diagnostic, par contre la TDM a une sensibilité, et une spécificité voisine de 100%, mais elle est irradiante elle n'est utilisable qu'au delà de 36SA et en post partum, et par conséquent l'IRM abdominale trouve tout son intérêt au 1er et au 2ème trimestre. Cependant la biologie reste plus spécifique et c'est essentiellement l'élévation de la lipasémie à partir de 3fois la normale, qui peut redresser le diagnostic. Le traitement consiste au 1er trimestre a une abstention thérapeutique et cholécystectomie au 2ème trimestre, au 2ème trimestre : Cholécystectomie par célioscopie, au 3ème trimestre : Sphinctérotomie, et en post partum, la cholécystectomie séimpose. A travers nos 6 cas et une revue de la littérature nous soulignons les caractéristiques diagnostiques, thérapeutiques et pronostiques de cette affection et nous invitons les praticiens à penser à la pancréatite chez toute femme enceinte avec douleur abdominales ce qui permettrait d'éviter les retards du diagnostic et d'améliorer le pronostic materno fétal.

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gallstone disease is one of the most common gastroenterological diseases and represents a major burden for our heath care systems. Cholesterol gallstones, responsible for about 90% of stones, represent a multifactorial disease with an important genetic component. Most gallstone-carriers remain asymptomatic and hence in general, they not need any therapy. In contrast those with symptomatic (biliary colic) or complicated gallstone disease (cholecystitis, obstructive cholangitis, biliary pancreatitis) have to be treated interdisciplinarily by surgeons and endoscopists. Laparoscopic cholecystectomy represents the causal therapy to avoid recurrent symptoms as well as the therapy of choice for cholecystitis as the most common complication of gallstone disease. Bile duct stones and the associated complications (cholangitis, biliary pancreatitis) are primarily treated endoscopically. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Hereditary spherocytosis (HS) is the commonest inherited disorder of the erythrocyte membrane in Northern Europe and North America. It is marked by a regenerative anemia which varies widely from asymptomatic patients to severe hemolysis. In 75% of HS patients, inheritance is autosomal dominant. The diagnosis of HS is easily made when there are a family history, hemolytic anemia, reticulocytosis, spherocytes and increased hyperdense cells. Specialized testing to clarify the nature of membrane disorder is required when the film appearance is atypical without a positive family history, in the absence of a family history, in the newborn and before the splenectomy, to rule out the stomatocytosis which is contraindicated. The indication for splenectomy is dependent on the degree of anemia and its clinical manifestation. [Copyright &y& Elsevier]

Summary: Objective: Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. Methods: from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. Results: All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23min (17–60min), the mean surgery duration was 55min (40–110min), and the mean anesthesia duration was 78min (88–135min). Postoperative complications occurred in 9 patients: acute chest syndrome (n =2), postoperative hemolysis (n =5), vaso-occlusive crisis (n =2). Conclusion: Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery. [Copyright &y& Elsevier]

Study aim. – Sickle cell affection is a public health problem in Africa. The aims of this prospective study were to evaluate the early results of laparoscopic cholecystectomy in sickle cell patients in Senegal.Method. – From January 1998 to June 2002 all the sickle cell patients undergoing a laparoscopic cholecystectomy were included. Intra- and post-operative protocol (blood transfusion if Hb < 9 g/dl, rehydratation, oxygenotherapy) was standardized.Results. – Forty-two patients with sickle cell of types SS-33 and AS9 were operated upon by same surgeon. One case of conversion due to an effraction of biliary junction was reported. One homozygote patient died post-operatively because of peritonitis. Two acute thoracic syndromes, three vaso-occlusive crisis, and two cases of wound infection constituted the post-operative morbidity. No case of complication was noted in those who underwent pre-operative transfusion.Conclusion. – Laparoscopic cholecystectomy can be carried out in sickle cell patients with biliary lithiasis provided that general anaesthetic rules are respected. [Copyright &y& Elsevier]

Objective. – To determine on a national level the factors associated with the use of laparoscopy for digestive surgery.Study design. – Nation wide study using a large representative sample (3 days of anaesthesia in France).Methods. – Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care (« SFAR ») including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy.Results. – Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when ≥71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when ≥3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendicetomy: age >15 years (AOR 1.9–2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when ≥3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy.Conclusion. – These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public. [Copyright &y& Elsevier]

Acalculous cholecystitis represents 2% to 14% of cholecystectomies performed for acute cholecystitis. Its main etiology is ischemia of the gallbladder wall, which mainly occurs in critically ill patients, particularly in case of cardiovascular previous disease or diabetes. Acalculous cholecystites associated with VIH are rarer and have a better prognosis. Other etiologies are exceptional. Diagnosis of acalculous cholecystitis is difficult, with a lack of specificity of abdominal ultrasound for the diagnosis of ischemic cholecystitis. In all cases, cholecystectomy is a definitive treatment allowing certain diagnosis. Percutaneous drainage must be reserved to patients whose general condition does not allow general anesthesia. Medical treatment alone is not indicated in acalculous cholecystitis. [Copyright &y& Elsevier]

The laparoscopic technique is the procedure of choice for cholecystectomy. This procedure is done on ambulatory setting in the United States and Europe but no experience was reported in France.Aim of the study: To report the organisation and results of our initial 100 consecutive patients operated for a laparoscopic cholecystectomy on an outpatient basis.Patients and methods: After assessement of the prevention of pain and nausea or vomiting after laparoscopic cholecystectomy on hospitalized patients, a prospective trial was done on our first 100 patients for outpatient laparoscopic cholecystectomy on routine basis.Results: During the period, 27,4% of patients were entered on an ambulatory basis. 72% of patients did not need any medication post-operatively in the structure. 17 patients were admitted: in five cases, decision was done pre-operatively, one patient went back home against medical advising; in three cases, peroperatively, and in 10 cases postoperatively. Four patients were readmitted between the fifth and sixteenth post-operatoire day.Conclusion: An adequat organisation for day case surgery, a good selection of patients on medical, surgical and environnemental criteria, simple procedures to prevent pain or nausea vomiting post-operatively allow use to assert that hospitalisation is unjustified for laparoscopic cholecystectomy in a quater of patients. [Copyright &y& Elsevier]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy. [Copyright &y& Elsevier]

Can we accept the statistics provided by the Ministry of Health, which uses large computerized databases? Through MEDECHO, the Ministry provides to hospital managers, reports cards on different interventions. These reports compare different hospitals performances. Surgeons involved in the process hesitate to accept this information. Using the results of the performance of cholecystectomy provided by this system (Gr: A), we compared the same cohort (1 April–31 December 1996 = 346 cholecystectomies) but using specific criteria determined as relevant to our surgeons (Gr: B). The rate of complication gives a crude aftermath and no attempt was used to adjust for severity. The MEDECHO data are adjusted for severity. The global rate of complications is similar Gr: A 11%, Gr: B 12%. Major complication rate for pulmonary embolism, hemorrhage and biliary duct trauma are identical. The rate of surgical site infection is higher in Gr: B (5% vs. 2%). The patients are seen in the outpatient clinic and these observations are not included by the analytical system unless the patient has been readmitted. For our hospital, the MEDECHO data are valid and reliable even though they underestimated the wound infection rate. These results could be explained by an appropriate interpretation of the code system by the archivist and by the surgeons’ precision to complete the summary sheet of hospitalization. We can conclude that these data can be used as a means to evaluate the quality of outcome of a surgical service. [Copyright &y& Elsevier]

Emphysematous cholecystitis is a rare but real entity, which have to be recognized early in order to quickly start the best treatment. We report a case of acute emphysematous cholecystitis diagnosed with computed tomography. A successful outcome was obtained by antibiotherapy and cholecystectomy in emergency. [Copyright &y& Elsevier]

Copyright of Langenbeck's Archives of Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)