Actinomycosis is a rare chronic granulomatous infection caused by Actinomyces species. We report the case of a 47-year-old man with no previous medical history, who presented with a slowly growing abdominal mass extending to the abdominal wall, initially mimicking a malignant tumor. A diagnosis of an Actinomyces abscess was confirmed through surgical resection and histopathological examination. This case is presented to highlight the morphological characteristics and emphasize the diagnostic difficulties of this disease.

BackgroundOccult cystobiliary fistula (CBF) is a common complication of hepatic hydatid cyst (HHC). It is often the cause of high morbidity of conservative treatment of HHC. This study aimed to determine the predictive factors of occult CBF to establish the indications for the investigation and treatment of these CBFs.MethodsThis was a prospective study that included all operated HHCs over a 3-year period. HHCs complicated with large CBFs were not included in the study. Systematic cholecystectomy and methylene blue test for all cysts were performed.ResultsA total of 46 patients operated on with 113 cysts were included in this study. The median cyst size was 6.7 cm (IQR, 1-38). A total of 114 CBFs were detected in 51 cysts (45.1%). The postoperative course was simple in 95.0% of cases. The specific morbidity rate was 2.7%. In a bivariate study, absence of mass and abdominal pain on palpation, hemoglobin level >11.55 g/dL, negative hydatid serology, cyst size, absence of calcifications, vascular compression, existence of a single cyst, and localization at segment VIII were predictive factors of occult CBF. At the end of the multivariate study, cyst size was determined to be the only predictive factor for occult CBF. A threshold of 3 cm was used.ConclusionCyst size is a major predictive factor for occult CBF.

Sclerosing angiomatoid nodular transformation of the spleen (SANT) is a rare benign tumor. Its epidemiological and morphological characteristics remain unknown. The main objective of this work is to reveal the epidemiological, biological and morphological characteristics of a SANT. Seventy-three publications were included in this review describing 188 cases of SANT. The average age of the patients was 45.9 years and the gender ratio was 0.66. SANT was found incidentally in 60

Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge. A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful. Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.

Introduction: Spontaneous perforation of the common bile duct (SPCBD) is an exceptional disease, especially in adults. The cause is often idiopathic once trauma and choledochal cyst are excluded. Early diagnosis is often difficult because of its often-misleading appearance. Case presentation: The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days. Clinical findings and investigations: On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage. After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up. Discussion: SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging. Conclusion: This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.

Emphysematous cystitis (EC) is a severe infection of the bladder that usually affects older women with diabetes mellitus. In rare situations, EC can lead to serious complications such as necrotizing fasciitis. We report the case of a 77-year-old woman who developed emphysematous cystitis complicated with rapidly progressive, gas-producing, necrotizing inflammation located on the right lower abdominal wall. The patient had aggressive drainage and debridement in order to control the extensive necrosis. To our knowledge, this is the third case report that describes a possible association between EC and NF requiring aggressive surgical intervention for both diseases.

Primary aortoduodenal fistula (ADF) is a serious life-threatening condition. Unlike secondary ADF which occurs in patients who had previous aortic prosthetic reconstruction, primary ADF is uncommon. Its diagnosis is often unsuspected until surgery or postmortem. We report a rare case of primary ADF presenting as massive gastrointestinal bleeding.

Introduction and importance: Broad ligament hernia is a rare type of internal hernia caused by the protrusion of viscera through an abnormal defect on the broad ligament. The diagnosis is difficult and challenging. Usually, it requires an urgent laparotomy to avoid intestinal necrosis or even the death of the patient. Case presentation: A 34-year-old woman, with no medical or surgical history, presented to our educational hospital with acute abdominal pain and recurrent vomiting for the last two days. After clinical and radiological investigations, the diagnosis of an internal hernia through the broad ligament was confirmed. An emergent laparoscopic repair was performed and the postoperative course was uneventful. Clinical discussion: We report a rare case of an internal hernia through the broad ligament and we describe the challenges associated with the preoperative diagnosis and therapeutic approach. The defect in the broad ligament may be unilateral or bilateral and congenital or acquired. There are no specific clinical and radiologic findings. Surgery remains the cornerstone of the treatment. Conclusion: Early diagnosis and rapid management of broad ligament hernia are necessary to prevent catastrophic sequelae. It is important to keep in mind that internal hernia like broad ligament hernia can occur in patients with no surgical history.

ANZ Journal of SurgeryEarly View IMAGES FOR SURGEONS Strangulated peristomal eventration into a stomal prolapse Haitham Rejab PhD, Haitham Rejab PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorSami Fendri MD, Sami Fendri MD orcid.org/0000-0001-8885-8818 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorKais Fourati MD, Kais Fourati MD orcid.org/0000-0002-3215-9134 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ResourcesSearch for more papers by this authorAhmed Tlili MD, Ahmed Tlili MD Sfax Medical School, University of Sfax, Sfax, Tunisia Department of Surgery, Gabes University Hospital, Gabes, Tunisia Contribution: ​InvestigationSearch for more papers by this authorYoussef Majdoub MD, Youssef Majdoub MD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ​InvestigationSearch for more papers by this authorMeriam Triki MD, Meriam Triki MD Sfax Medical School, University of Sfax, Sfax, Tunisia Pathology Department, Habib Bourguiba Hospital, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorNozha Toumi PhD, Nozha Toumi PhD orcid.org/0000-0002-7046-1430 Sfax Medical School, University of Sfax, Sfax, Tunisia Department of Radiology, Habib Bourguiba Hospital, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorLassaad Chtourou PhD, Lassaad Chtourou PhD Sfax Medical School, University of Sfax, Sfax, Tunisia Gastro-enterology Department, Hedi Chaker Hospital, Sfax, Tunisia Contribution: ValidationSearch for more papers by this authorAyman Trigui PhD, Ayman Trigui PhD orcid.org/0000-0003-2291-7250 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: SupervisionSearch for more papers by this authorSalah Boujelbene PhD, Salah Boujelbene PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: SupervisionSearch for more papers by this author Haitham Rejab PhD, Haitham Rejab PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorSami Fendri MD, Sami Fendri MD orcid.org/0000-0001-8885-8818 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorKais Fourati MD, Kais Fourati MD orcid.org/0000-0002-3215-9134 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ResourcesSearch for more papers by this authorAhmed Tlili MD, Ahmed Tlili MD Sfax Medical School, University of Sfax, Sfax, Tunisia Department of Surgery, Gabes University Hospital, Gabes, Tunisia Contribution: ​InvestigationSearch for more papers by this authorYoussef Majdoub MD, Youssef Majdoub MD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ​InvestigationSearch for more papers by this authorMeriam Triki MD, Meriam Triki MD Sfax Medical School, University of Sfax, Sfax, Tunisia Pathology Department, Habib Bourguiba Hospital, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorNozha Toumi PhD, Nozha Toumi PhD orcid.org/0000-0002-7046-1430 Sfax Medical School, University of Sfax, Sfax, Tunisia Department of Radiology, Habib Bourguiba Hospital, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorLassaad Chtourou PhD, Lassaad Chtourou PhD Sfax Medical School, University of Sfax, Sfax, Tunisia Gastro-enterology Department, Hedi Chaker Hospital, Sfax, Tunisia Contribution: ValidationSearch for more papers by this authorAyman Trigui PhD, Ayman Trigui PhD orcid.org/0000-0003-2291-7250 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: SupervisionSearch for more papers by this authorSalah Boujelbene PhD, Salah Boujelbene PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: SupervisionSearch for more papers by this author First published: 05 March 2023 https://doi.org/10.1111/ans.18366Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Aditya K, Vivek C, Vishal S, Harjeet S. Parastomal evisceration: a report of two cases and review of literature. Cureus 2019; 11: e5750. https://doi.org/10.7759/cureus.5750. 2Hazem B, Affes N, Rejab H et al. Les complications chirurgicales des colostomies. Tunis. Med. 2014; 92: 482–7. 3Makoto K, Masahisa O, Muneyuki K et al. Evaluation of the outcome of local surgery for Stomal prolapse. J. Clin. Med. 2021; 10: 5438. https://doi.org/10.3390/jcm10225438. 4Pearson R, Knight S, James C, et al. Stoma-related complications following ostomy surgery in 3 acute care hospitals: a cohort study. J. Wound Ostomy Contin. Nurs. 2020; 47: 32–8. https://doi.org/10.1097/WON.0000000000000605. 5Stoffels B, Sommer N, Berteld C et al. Late complications of permanent intestinal stomata. Zentralbl Chir 2018; 143: 603–8. https://doi.org/10.1055/a-0649-1230. 6Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M. Éventrations péristomiales Étude de la Fédération des stomisés de France. J Chir Visc. 2011; 148: 494–501. 7Zhang HY, Wang ZJ, Han JG. Risk factors and prevent strategy of parastomal hernia. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25: 970–5. https://doi.org/10.3760/cma.j.cn441530-20220712-00303. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

ANZ Journal of SurgeryVolume 93, Issue 5 p. 1377-1378 IMAGES FOR SURGEONS Bilateral giant intramuscular hemangioma of the buttocks: an unusual diagnosis in an 80 year-old man Haitham Rejab PhD, Haitham Rejab PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorSami Fendri MD, Corresponding Author Sami Fendri MD [email protected] orcid.org/0000-0001-8885-8818 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ​Investigation, MethodologySearch for more papers by this authorBassem Abid PhD, Bassem Abid PhD Sfax Medical School, University of Sfax, Sfax, Tunisia Departement of Anatomy, Sfax medical School, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorAyman Trigui PhD, Ayman Trigui PhD orcid.org/0000-0003-2291-7250 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: Writing - original draftSearch for more papers by this authorYoussef Majdoub MD, Youssef Majdoub MD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: VisualizationSearch for more papers by this authorSalma Ketata MD, Salma Ketata MD Sfax Medical School, University of Sfax, Sfax, Tunisia Anesthesiology Department, Habib Bourguiba Hospital, Sfax, TunisiaSearch for more papers by this authorSalah Boujelbene PhD, Salah Boujelbene PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: Supervision, ValidationSearch for more papers by this author Haitham Rejab PhD, Haitham Rejab PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ConceptualizationSearch for more papers by this authorSami Fendri MD, Corresponding Author Sami Fendri MD [email protected] orcid.org/0000-0001-8885-8818 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: ​Investigation, MethodologySearch for more papers by this authorBassem Abid PhD, Bassem Abid PhD Sfax Medical School, University of Sfax, Sfax, Tunisia Departement of Anatomy, Sfax medical School, Sfax, Tunisia Contribution: Writing - review & editingSearch for more papers by this authorAyman Trigui PhD, Ayman Trigui PhD orcid.org/0000-0003-2291-7250 General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: Writing - original draftSearch for more papers by this authorYoussef Majdoub MD, Youssef Majdoub MD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: VisualizationSearch for more papers by this authorSalma Ketata MD, Salma Ketata MD Sfax Medical School, University of Sfax, Sfax, Tunisia Anesthesiology Department, Habib Bourguiba Hospital, Sfax, TunisiaSearch for more papers by this authorSalah Boujelbene PhD, Salah Boujelbene PhD General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia Sfax Medical School, University of Sfax, Sfax, Tunisia Contribution: Supervision, ValidationSearch for more papers by this author First published: 21 November 2022 https://doi.org/10.1111/ans.18172Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Arun BN, Manjula BV, Balasubramanyam AM. Intramuscular haemangioma of mylohyoid muscle: a case report. Indian J. Surg. 2010; 72: 344– 6. 2Ranero-Juarez AG, Rosales-Galindo VM, Leon-Takahashi AM, Arenas-Guzman R, Garcia C. Intramuscular hemangiomas of the extremities: report of six cases. Int. J. Dermatol. 2009; 48: 875– 8. 3Griffo S, Stassano P, De Luca G, Di Tommaso L, Monaco M, Spiezia S. Intramuscular hemangioma of the chest wall: an unusual tumor. J. Thorac. Cardiovasc. Surg. 2007; 134: 1368– 9. 4Jin W, Kim GY, Lee JH et al. Intramuscular hemangioma with ossification. J. Ultrasound Med. 2008; 27: 281– 5. 5Allen PW, Enzinger FM. Hemangioma of skeletal muscle: an analysis of 89 cases. Cancer 1972; 29: 8– 22. 6Quinn PS, Sieunarine K, Lawrence-Brown M, Tan P. Intramuscular haemangiomas: hookwire localization prior to surgical excision: report of four cases. ANZ J. Surg. 2001; 71: 62– 6. 7Wisniewski SJ, Newcomer K, Stanson AW. Intramuscular hemangioma of the foot: a diagnostic dilemma. Med. Sci. Sports Exerc. 2005; 37: 1655– 7. 8Uslu M, Beşir H, Turan H, Bozkaya H, Erdem H. Two different treatment options for intramuscular plantar hemangioma: surgery versus percutaneous sclerotherapy. J. Foot Ankle Surg. 2014; 53: 759– 62. 9Picci P, Sudanese A, Greggi T et al. Intramuscular hemangioma in infancy: diagnostic and therapeutic consideration. J. Pediatr. Orthop. 1989; 9: 72– 5. Volume93, Issue5May 2023Pages 1377-1378 ReferencesRelatedInformation

Rupture of ovarian dermoid-cyst is rare case. We report the case of a woman admitted for acute post-traumatic abdominal pain due to ruptured ovarian cyst. The patient was operated and we found a very abundant peritoneal effusion with left ovarian cyst which was broken. we performed a left adnexectomy.

Spontaneous perforation of the extrahepatic bile duct (SPEBD) is an exceptional disease especially in adults. Early diagnosis and aggressive therapy are crucial to avoid the high mortality. We report a biliary peritonitis secondary to bile duct perforation in adult man and we propose a surgical management algorithm

we report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. he had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. it was peroperatively two small-bowel metastasis from lung cancer that we resect.

Introduction: in colon cancer surgery, anastomotic fistula (AF) is considered the most feared complication. The purpose of this study was to identify predictive factors associated with anastomotic fistula after colon cancer surgical resection and to describe the impact of this complication on mortality and postoperative length of stay. Methods: we conducted a retrospective, descriptive and analytical study in the Department of General Surgery at the Habib Bourguiba Hospital in Sfax, Tunisia from 1st January 2013 to 31 December 2020. Results: we collected data from the medical records of 163 patients who had undergone surgery for colon cancer. The average age of patients was 62.7 years with a sex ratio of 1.36. The postoperative course was uneventful in 64.4% of cases and complicated in 35.6% of cases. Surgical morbidity was mainly due to anastomotic fistulas (22 patients). This study demonstrated that predictors of the development of this complication were: diabetes p = 0.04, smoking p = 0.01, hypoalbuminaemia p = 0.01, preoperative haemoglobin less than 10g/dl, p < 0.01, anastomotic fistula located in the left colonic angle p = 0.02, perioperative transfusion p <0.01, and duration of surgery longer than 180 min p = 0.04. Moreover, the occurrence of anastomotic fistula was associated with specific mortality rate (9%) and significantly prolonged postoperative length of stay. Conclusion: the prevention of anastomotic fistulas should be part of a multimodal approach based on the correction of nutritional deficiencies and possible pre-operative anemia.

Hemorrhagic cholecystitis is a rare complication of acute cholecystitis. Hemorrhage in the gallbladder can occur for a variety of reasons (gallstone cholecystitis, secondary to trauma, percutaneous procedures, neoplasms, bile parasites, or disorders of hemostasis).CT scan can help the diagnosis. We report a case of hemorrhagic cholecystitis complicated by gallbladder perforation

Ileal Gastrointestinal tumor are usually asymptomatic and small bowel obstruction is a rare condition.

in colon cancer surgery, anastomotic fistula (AF) is considered the most feared complication. The purpose of this study was to identify predictive factors associated with anastomotic fistula after colon cancer surgical resection and to describe the impact of this complication on mortality and postoperative length of stay.we conducted a retrospective, descriptive and analytical study in the Department of General Surgery at the Habib Bourguiba Hospital in Sfax, Tunisia from 1st January 2013 to 31 December 2020.we collected data from the medical records of 163 patients who had undergone surgery for colon cancer. The average age of patients was 62.7 years with a sex ratio of 1.36. The postoperative course was uneventful in 64.4% of cases and complicated in 35.6% of cases. Surgical morbidity was mainly due to anastomotic fistulas (22 patients). This study demonstrated that predictors of the development of this complication were: diabetes p = 0.04, smoking p = 0.01, hypoalbuminaemia p = 0.01, preoperative haemoglobin less than 10g/dl, p < 0.01, anastomotic fistula located in the left colonic angle p = 0.02, perioperative transfusion p <0.01, and duration of surgery longer than 180 min p = 0.04. Moreover, the occurrence of anastomotic fistula was associated with specific mortality rate (9%) and significantly prolonged postoperative length of stay.the prevention of anastomotic fistulas should be part of a multimodal approach based on the correction of nutritional deficiencies and possible pre-operative anemia.

Abstract Background and Aim Despite the development and standardization of surgical techniques in the treatment of localized gastric adenocarcinoma, the loco‐regional and metastatic recurrence rate remains high. A combined radiochemotherapeutic regimen (the MacDonald regimen) as well as perioperative chemotherapy allows a significant improvement in the survival of patients with localized gastric adenocarcinoma with a reduction in the recurrence rate compared to surgery alone. The purpose of this review is to specify the best therapeutic approach in the treatment of localized gastric cancer. Methods We performed a systemic search of Medline, Embase, and the Cochrane Central Register of Controlled Trials using PubMed, Google Scholar, and Ovid without language restriction. Hazard ratio (HR) with 95% confidence interval (CI) was reported. Results We pooled 727 patients from two phase III randomized controlled trials. There was a benefit of perioperative chemotherapy versus surgery alone on the overall survival (OS) (HR = 0.72, 95% CI: 0.55–0.95) and on disease free survival (DFS) (HR = 0.65, CI: 0.50–0.85). Adjuvant chemotherapy was superior to surgery alone based on OS and disease free survival (CLASSIC study HR = 0.72, CI: 0.52–1 and HR = 0.56, CI: 0.44–0.72, respectively). Adjuvant radiochemotherapy was superior to surgery alone (HR = 1.35, 95% CI: 1.09–1.66; P = 0.005). Conclusion A face‐to‐face comparison of perioperative chemotherapy versus adjuvant chemotherapy versus chemoradiotherapy is necessary.

Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001). Similarly, LHP laser treatment was significantly superior to surgical treatment in terms of operative duration (p < 0.00001), intraoperative bleeding (p < 0.00001), postoperative pain at H12 and H24 (p < 0.00001 and p = 0.0003), and postoperative bleeding rate (p < 0.001). The laser represents a revolution in the field of proctology mainly in the treatment of hemorrhoidal pathology. It is a safe, effective, and less painful mini-invasive technique. More rigorous studies will be needed to better evaluate this technique.