Intestinal resection is the removal of part of the intestine with its meso [1] . It is indicated in tumor lesions, inflammatory lesions, vitality lesions of the intestinal loop, traumatic and ischemic lesions of the small intestine and colon [2] . Intestinal resection techniques have evolved significantly over the last 20 years. In fact, since 1991, when the first series of laparoscopic colectomies were published, it has been technically possible to perform colectomies and total coloprotectectomies with ileo-anal anastomosis laparoscopically, particularly in chronic inflammatory diseases of the intestine or cancers of the right colon [3] . However, for the majority of studies from expert centers, the place of laparoscopy is still of little importance today, probably due to the need to have experience in laparoscopic colorectal surgery [3] .

In France in 2008, an intestinal resection was performed in 20% of children three years after the diagnosis of CD [4] .

In Africa, several authors report intestinal resection for various pathologies of the small intestine and colon such as intestinal obstructions with necrosis, intestinal perforations of infectious origins, intestinal wounds and tumor lesions [5] .

In Cameroon, according to a study carried out by Bwelle G.R et al. in 2016, intestinal resection with anastomosis was the most commonly performed surgical procedure in 14 cases, or 53%) [6] .

In Guinea, Camara NLY et al. in 2023 collected 51 cases of digestive ostomy representing 15.93% of all surgical procedures in the department (N = 320) [7] .

The objective of this study was to contribute to the study of intestinal resections in the general surgery department of the Kankan regional hospital.

This was a 4-year descriptive retrospective study, from 1^st January 2019 to December 31, 2022, relating to the files of patients who underwent intestinal resections in the general surgery department of the Kankan regional hospital during the study period.

All complete files of patients who underwent intestinal resection were included in this study, regardless of the pathology involved during our study period. Incomplete and unusable patient files were excluded.

We made an exhaustive inventory of all the files of patients who were operated on and benefited from resection of any part of the intestine in the department during the study period.

Our study variables were qualitative and quantitative divided into epidemiological and therapeutic data. For qualitative variables, we determined the proportions (prevalence) estimated as a percentage (%) with the calculation of the ratio for sex. For the quantitative variables, we divided them into classes, calculated the mean, the standard deviation, the median then identified the minimum and the maximum. These data were entered into kobocollect and analyzed in the SPSS software in version 21. The data were collected anonymously and the principle of confidentiality was respected.

Out of a total of 3909 cases of surgical interventions, there were 164 cases of intestinal resections during the period of our study, or 4.19%. The average age of our patients was (37.78 ± 21.93) with extremes of 1 and 90 years; the age group ≤20 years was the most affected with 27.4% ( Table 1 ).

Men were the most affected with 106 cases (64.6%) compared to 58 women (35.4%) with a sex ratio of 1.8 ( Figure 1 ).

In our series of 132 cases, 80.5% of resections were performed in patients who consulted 72 hours after the onset of symptoms ( Table 2 ).

One hundred patients, or 60.9%, had already undergone surgery and had a laparotomy scar. In our series, acute intestinal obstruction with necrosis was the pathology leading to intestinal resection n = 70 or 42.9%. It is followed by acute peritonitis 54 cases or 33% of which ileal perforation probably of typhoid origin is the first cause, digestive fistula 13 cases or 7.9% which were often complications of surgical interventions carried out in the structures of lower level and unauthorized structures ( Table 3 ).

Table 4. Distribution of patients according to the indications for resection.

Medial laparotomy above and below the umbilical was the rule in our study 98.8%. We performed a one-stage small bowel anastomosis resection in 70 cases (42.7%) and an ileostomy in 4 cases (2.4%). We performed a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), a segmental resection plus immediate anastomosis in 57 cases (34.2%) and 5 patients. Benefited from a colostomy (4 cases of Hartman and 1 case of Bouilly Walkman) ( Table 4 ). During exploration, we noted 55.1% (n = 91) of necrosis; 25.4% (n = 42) perforations ( Table 5 ).

Speaking of the duration of intervention 88.4% (n = 145) were operated on between 1 hour and 2 hours; 18 patients or 11% had been operated on after 2 hours ( Tables 6-8 ).

Sout of 3909 cases of surgical interventions performed there were 164 cases of intestinal resections during the period of our study, i.e. 4.19%. Our result is superimposable to that of Niangalya A [8] in 2019 who reported a frequency of 5.9% of intestinal resections in the general surgery department of Somie Dolo hospital in Mopti. In our context this relatively high frequency of resection would be justified by the frequency of peritonitis due to typhoid perforation, intestinal obstructions with intestinal necrosis, the delay in consultation, the proliferation of clandestine clinics with incompetent staff and the insufficient number of specialists in visceral surgery. in the Kankan region.

The average age of our patients was (37.78 ± 21.93) with extremes of 1 and 90 years; the age group ≤20 years was the most affected with 27.4% Toure C.T [9] in Senegal reported in his study on emergency colectomies in sigmoid volvulus a mean age of 42 years. Lebau R [10] in 2006 also reported an average age of 40 years. In our context, this result could be explained by the structure of the population which is predominantly young and also by the fact that the indications for intestinal resections are due to pathologies in young adults [9] .

The male gender was the most affected with 106 cases (64.6%) with a M/F ratio = 1.8. In our series, as in most African series involving intestinal resection, male predominance is the rule [11] . This male predominance is explained by the fact that certain pathologies, notably strangulated hernias, and certain peritonitis were more frequent in men [12] .

In our series, 132 cases (80.5%) of resections were performed in patients who consulted 72 hours after the onset of symptoms. As in the Lebeau R series [10] , the long consultation period is a determining factor in intestinal resection because it is generally considered to be an important factor in necrosis. Often the cause of late consultations is attributable to patients and two main factors can be blamed according to Kurt [13] : socio-economic difficulties but also ignorance; as was the case in our study.

One hundred (100) patients or 60.9% had already undergone surgery and had a laparotomy scar. Indeed, the laparotomy scar exposes one to acute intestinal obstruction (bridle, adhesion, volvulus, etc.) which can lead to necrosis, which is a common and costly complication of abdominal surgery [14] .

In our series, acute intestinal obstruction with necrosis was the pathology most motivating intestinal resection in 70 cases or 42.9%. It represents the second surgical emergency in terms of frequency in the series of Magagi in Niger (27.49%) [15] , Gaye in Dakar (22.9%) [16] with a high frequency of necrosis which has no treatment as intestinal resection. In our context this is due to the multiplicity of causes of this condition (hernia strangulation, bridles, colonic tumors, volvulus, etc.). It is followed by acute peritonitis 54 cases or 33% of which ileal perforation probably of typhoid origin is the primary cause; Kassegne [17] found 67.9% of all peritonitis. Digestive fistula 13 cases or 7.9% which were often complications of surgical interventions carried out in lower-level structures and unauthorized private structures.

Midline laparotomy above and below the umbilical was the rule in our study 98.8%; as in most African series (Adamou et al. 2015 [18] , Choua et al. 2015) [19] .

This route offers a view of the entire peritoneal cavity while facilitating exploration and performance of procedures complementary to resection such as peritoneal toilet.

Intestinal necrosis with 50 cases (31.6%) on the small intestine, 41 cases (24.9%) on the colon constituted the first indication for resection in our study followed by intestinal perforations 42 cases (25.8%). The predominance of necrosis in this study is justified by the frequency of intestinal obstructions by strangulation (bridles, volvulus, strangulated hernias).

Indeed, the delay in consultation and treatment has negatively influenced the occurrence of necrosis. Harouna Y [20] in Niger and Lebeau R [10] in Ivory Coast reported intestinal necrosis by strangulation in the respective proportions of 87% and 25%. According to Harouna Y [11] in occlusions by strangulation from the 25^th hour, the frequency of necrosis increases proportionally to the diagnostic and therapeutic delay and increases from 28% to 52% beyond the 96^th hour. Perforation of the small intestine of probably typhoid origin is very common and very often surgical treatment requires the performance of an intestinal resection plus anastomosis, which theoretically allows the sutures to be placed in a healthy area, logically protecting against subsequent intestinal perforations. on the pre-perforated areas [21] . Colic or intestinal wounds are secondary to trauma to the abdomen. El Bechir [21] in Morocco in 2012 noted 49 cases of traumatic colonic wounds with 12% anastomotic resection.

Harouna Y [20] reported intestinal resection for colorectal cancers in 100% of cases; Ayite [22] in Lomé reported 100% resection for small bowel cancer in 1996. Intestinal resection in cases of intestinal tumors is done with the aim of removing obstacles to intestinal transit and total excision of the tumor.

We performed a one-stage small bowel anastomosis resection in 70 cases (42.7%) and an ileostomy in 4 cases (2.4%).

Resection and anastomosis is preferable whenever the patient’s general condition allows it [20] . A stoma is justified by the theoretical risk of suture release to which re-connection in a septic environment exposes [11] .

However, this diversion technique is rarely used in our practice due to the problems of maintenance and especially resuscitation that it requires in a hospital where the technical platform is insufficient.

We performed a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), a segmental resection plus immediate anastomosis in 57 cases (34.2%) and 5 patients. benefited from a colostomy (4 cases of Hartman and 1 case of Bouilly Walkman).

Speaking of the duration of intervention 88.4% (n = 145) were operated on between 1 hour and 2 hours; 18 patients or 11% had been operated on after 2 hours. This long duration could be explained by the number and severity of lesions found intraoperatively.

In our practice, colostomy presents significant morbidity: the hot and hostile climate, the problem of ostomy equipment, are sources of defective hygiene and local and general complications. Added to these are Muslim religious considerations, a negative psychological impact of colostomy on the experience of the patient who tends to “let go”.

The postoperative course was simple in 87 cases (53%), we recorded 29 cases of postoperative complications (17.7%) and 48 deaths (29.3%).

Mortality itself in our study would be attributable not to intestinal resection per se but rather to the indication for resection such as intestinal necrosis, wounds, perforations, tumors and infection.

The average length of hospital stay was 13 days with a range of 1 to 58 days. Our average stay is proportionally equal to that of Coulibaly [23] (18.4 days). On the other hand, a longer average stay is found in Kouame’s study [24] . Long hospital stay is linked to postoperative complications.

Intestinal resection is a relatively common procedure in our context, it is often performed in young adult males. Indications for resection were frequent for which patients consulted late. Mortality is much more linked to the indication for resection, diagnostic delay and treatment than to intestinal resection. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.