The European hernia society groin hernia classification: simple and easy to remember.

After reviewing the available classifications for groin hernias, the European Hernia Society (EHS) proposes an easy and simple classification based on the Aachen classification. The EHS will promote the general and systematic use of this classification for intraoperative description of the type of hernia and to increase the comparison of results in the literature.

The use of Dacron in the repair of hernias of the groin.

Two French surgical teams particularly interested in hernia problems detail the use of Dacron (Mersilene) mesh in the treatment of groin hernias for the reinforcement or the replacement of the fascia transversalis , as by an artificial endoabdominal fascia. The article reports the experiences and techniques of the two teams, which have used Dacron for 20 years, either by the inguinal or the preperitoneal abdominal approach. The good results reported allow the statement that, without ruling out classic techniques for simpler cases, surgical repair using prostheses offers an excellent opportunity for use and for preventing the recurrence of hernias.

Along with GREPA towards EHS, meeting AHS.

The popular proverb that says "Happy people have no history" is not true. This short chronicle, from experience inside GREPA-EHS, by one of its founding members, tells the contrary to the reader. It suggests that, by meeting together, hernia surgeons got much welfare through scientific assessment, a more efficient practice, and increased recognition of their art.

[Double breast and vertebral plasmacytoma. Acute myeloblastic leukemia 8 years later]. / Double plasmocytome mammaire et vertébral. Leucémie aiguë myéloblastique 8 ans plus tard.

We report in a 40 year-old woman a bifocal mammary and vertebral plasmocytoma attended by surgery and "preventive" chemotherapy. Eight years later, an acute and apparently non secondary myeloblastic leukemia is observed without sign of diffuse myelomatosis. Plasma cell tumors of the breast are uncommon. Eleven cases have been published, combining solitary plasmocytoma and infiltration occurring in multiple myeloma.

Unsutured Dacron prosthesis in groin hernias.

We have repaired difficult groin hernias during the past six years by an original procedure consisting of fitting an unsutured Dacron patch between the peritoneum and the muscular layers using a median lower abdominal incision. Our standard technic is described along with its variations and applications.

Current surgical treatment of post-operative eventrations.

A series of 247 post-operative eventrations (POE) is reported with a study of general features, such as: patients' sex and age, size, location and etiology of POE (serial laparotomies, parietal sepsis), classic predisposing factors. Pre-operative preparation involved the use of Goni-Moreno progressive pneumo-peritoneum in 18.5% of patients. The procedures used were: parietal suturing (25%), the same plus a dacron buttress (6%), or a large reinforcing Dacron Mesh prosthesis (67%). Early sepsis was slightly more frequent after Dacron use. The incidence of predisposing factors in this field is reported. Other complications of the use of Dacron Mesh are studied (hematomas, skin necrosis). The post-operative uncomplicated course rate is 91%. Follow-up of 77% of operated patients showed satisfactory overall results in 81% of patients treated with Dacron prosthesis and in less than 50% after parietal suturing. Aseptic recurrence factors and late sepsis factors are also studied. Finally the efficiency of POE prosthetic repair is stressed and mandatory rules for the safe of Dacron Mesh are underlined.

Pyloric stenosis: organic or functional? The need for an intraoperative test in peptic ulcer surgery.

A new method to evaluate and dilate pyloric stenosis in the presence of peptic ulcer is presented. The pylorus is explored by means of a probe (26 to 38 Ch) which is inserted orogastrically. This procedure is used in association with highly selective vagotomy (HSV). Healing of the ulcer and the pyloric stenosis was observed in 12 patients.

Prosthetic repair in the treatment of groin hernias.

Prosthetic repairs are an important development in herniology because of their excellent results. Reinforcement or replacement of the fascia transversalis is performed by interposition of a synthetic mesh between muscles and peritoneum aiming at the restoration of the tightness of the abdominal wall against the intra-abdominal pressure. All synthetic materials are not equally appropriate; Marlex mesh has been used exclusively in this report. The midline preperitoneal way allows the placement of large bilateral prostheses kept in place by intra-abdominal pressure; they need not be fixed nor associated with any suturing of the hernial hole. This is a very easy operation even in multirecurrent hernias. Because of the more disagreeable septic accidents after prosthetic repair, an important question is related to its indications, which must be selective. Randomized studies, comparing diverse techniques, are unlikely to lead to an exclusive choice because hernias are polymorphous lesions and also because of the time lag-factor and suturing must be followed up for 20 years. In socioeconomic terms, a prosthesis is the most appropriate treatment for hernias liable to recur. Nowadays it is impossible to reject the remarkable possibilities offered by prostheses in hernial surgery after the developments of the past 20 years.

[Generalized peritonitis as a result of perforation of diverticular sigmoiditis. Retrospective analysis of 32 cases]. / Péritonites généralisées par perforation des sigmoïdites diverticulaires. Analyse rétrospective de 32 cas.

A retrospective study of 32 cases. The authors relate about a series of thirty-two cases of diffuse peritonitis, complicating diverticular sigmo iditis in which the etiological features, means of diagnosis and surgical procedures are analysed. According to obtained results, the preference is given to Hartmann's intervention. They are convinced that the better results after that surgical technique are due to the better management of the stercoral peritonitis it offers, taking away the infectious segment. It is neither long to perform nor dangerous and prevents anastomotic fistula in these no-prepared colons. The global mortality of peritonitis in diverticular disease of the colon appears them still very high and they prefer the one stage prophylactic segmentary colectomy after one or two medically treated acute sigmo iditis , particularly in the young patient of who the liability to complications is high.

[The history of surgical management of hernias]. / Histoire du traitement chirurgical des hernies.

At the dawn of the third millennium, the aim of this brief historical review was to trace the evolution of the surgical management of hernias during the recent past centuries after the advent of true anatomical knowledge. Because it is a frequent and ubiquitous surgery, many surgeons have devised new techniques in order to perform more and more efficient procedures, suitable to the patients' demands, the health care economy and quality care control.

[Repair of inguinal hernias without tension and without suture using a large dacron mesh prosthesis and by pre-peritoneal approach. A method of reference for selective indication]. / La réparation des hernies de l'aine sans tension et sans suture par grande prothèse de tulle de Dacron et voie d'abord pré-péritonéale. Une méthode de référence d'indication sélective.

This original and now classical method was the first tensionless and sutureless repair of groin hernias proposed almost 30 years ago. Its authors recall its principles, technique and results. The discussion justifies the choice of the particular prosthetic material, demythifies the sepsis risk which is balanced by the recurrence risk, the potentially raising problems related to retroparictal sclerosis at reoperation on the bladder or external iliac vessels, and defines the indications and contraindications of the procedure.

[Treatment of postoperative incisional hernias by a composite prosthesis (polyester-polyglactin 910). Clinical and experimental study]. / Le traitement des éventrations post-opératoires par prothèse composée (polyester-polyglactine 910). Etude clinique et expérimentale.

Because of complications resulting from the use of intraperitoneal prosthetic materials, the authors studied a new double Layered composite mesh (formed by a Dacron mesh, and a polyglactin 910 mesh). The experimental study (40 rats) compared the composite mesh with Dacron mesh. Statistical analysis demonstrated the following conclusions. At 6 months, the poor fibroblastic activity with the composite mesh, indicated the absence of replacement of the polyglactin 910 mesh by a neo-tissue. The Dacron mesh remained in contact the abdominal viscera and contracted with them as many adhesions as when Dacron mesh was used alone. The composite mesh showed poor biological tolerance, lower than that of Dacron mesh. The clinical study concerned 24 patients, 3 recurrences were observed. In one case, we observed migration of the mesh in the small bowel. The unfavorable results of the experimentation, and the risk of visceral migration lead us to avoid the use of composite mesh in intraperitoneal sites.

[Cecal hernia through Winslow's foramen. Radiographic study of a case and review of the literature]. / Hernie caecale par l'hiatus de Winslow. Etude radiographique d'un cas et revue de la littérature.

A case of herniation of the cecum through the foramen of Winslow is reported in a 49-year-old man, admitted for acute abdominal pain. Diagnosis, suspected by abdominal plain films, and established by water-soluble enema, was confirmed by emergency surgical management. Herniation through Winslow's foramen represents the least common variety of internal hernias. Only 136 observations were previously reported, the cecum being involved in 25-30% of cases. Radiological diagnosis was made in only one patient out of ten. Although rare in occurrence, it carries a high mortality risk when diagnosis and treatment are delayed. A better appreciation of the classic radiological features will allow for earlier recognition and treatment. Therefore, the authors emphasize the interest of radiologic findings in this condition.

[Pitfalls of mechanical circular anastomoses]. / Les pièges des anastomoses circulaires mécaniques.

To the list of pitfalls of circular mechanical anastomoses the authors add another type of incident involving catching of an intestinal fold. While the pitfalls recently published by M. Adloff include occlusive stapling, those encountered by the authors make mechanical stapling impossible. Two diagrams illustrate the mechanism of failure of circular mechanical anastomoses and suggest an easy way of avoiding this pitfall.

[Prosthetic surgical treatment of inguinal hernias. Parietalization of the spermatic cord]. / Cure chirurgicale prothétique des hernies de l'aine. Pariétalisation du cordon spermatique.

We confirm the advantages offered by "parietalization" of the spermatic chord components in prosthetic repair of inguinal hernias. The term is particularly well suited to the procedure when the abdominal approach is used: there is no need to split the dacron mesh to let the chord through; the zigzagging transparietal course of the chord is extended laterally. We must add that ligation of the epigastric vessels is unnecessary with the abdominal approach.

[A simple technic of true pyroloclasia: crushing with a rubber-sheathed clamp]. / Une technique simple de pyloroclasie vraie: l'écrasement au clamp gainé.

For more than 10 years the authors have been using a pyloroclasia derived from the Hivet and Lagadec technique of digital dilatation, in place of gastric drainage pyloroplasty. The procedure is simple, effective and easily reproducible. It only requires a rubber sheathed clamp to crush the anterior part of the pyloric annulus; the pyloroclasia is then confirmed by digital exploration. This technique has been used regularly without any per-operative problem and post-operative complications ascribable to pyloroclasia. The long-term results have been satisfactory with complete absence of gastric stasis or biliary reflux. When performed, post-operative radiography and fibroscopy have shown adequate gastric emptying and little changes in pyloric morphology. Pyloroclasia is simpler and less septic than pyloroplasty, and it reduces the incidence of dumping syndrome. Pyloroclasia with a rubber sheathed clamp is simpler and more reproducible than digital pyloroclasia. In view of its regularly good results it can certainly be recommended.

[Conservative treatment of esophagus ruptures and perforations. Esophageal diversion by minimal pharyngostomy]. / Traitement conservateur des ruptures ou des perforations de l'oesophage. Diversion oesophagienne par pharyngostomie a minima.

In ruptures or perforation of the oesophagus, the difficult choice between conservative methods (suture or drainage) and total exclusion of the organ can be avoided by minimal pharyngostomy. This procedure, which supersedes lateral oesophagostomy and makes use of an aspiration silicone-lined catheter to divert the oesophageal contents, is simple, rapid, effective and reversible. It is carried out in a region devoid of dangerous anatomical variants, in the avascular space below the greater cornu of the hyoid bone (a palpable landmark), the incision being made on the convexity of a curved clamp which pushes back the pharyngeal wall at the level of the sinus pyriformis. This technique has been used in 13 patients with satisfactory results.

[Complications in hernia surgery]. / Complications de la chirurgie herniaire.

Like Hernia Surgery, itself, its complications must be regularly reviewed for permanent teaching. The necessity of this information is linked to the daily frequency of hernia cures. Complications are rather infrequent in classical repairs, where difficulties and pitfalls have been listed since a long time. Nevertheless their list is large and deserves to be recalled. Coelioscopic hernia surgery, recently appeared, revealed some complications which were unknown in classical surgery; its evaluation, to day in progress, should take account of these.

[The common channel syndrome associated with cystic dilatation of the common bile duct. Apropos of a case complicated by lithiasis of the common channel]. / Le syndrome du canal commun associé à une dilatation kystique de la voie biliaire principale. A propos d'un cas compliqué de lithiase du canal commun.

Perduodenoscopic retrograde cholangiography in a 15 year old boy with cystic dilatation of common bile duct demonstrated lithiasis of Vater's ampulla and collateral shunt for Wirsung's duct in the form of a functional Santorini duct. Cases of combined cystic dilatation of common bile and Vater's ducts reported in the literature are reviewed and a study conducted of frequency of cystic dilatation of common bile duct, its classification as described by Longmire and Hadat (enlarging that proposed by Alonso-Leij), and its diagnosis and complications. Routine retrograde cholangiography can delect lithiasis of Vater's ampulla and allow preoperative determination of therapy. Current investigatory procedures for these anomalies have allowed rediscussion of the etiopathogenicity of cystic dilatation of common bile duct and a tendency towards a duoalist hypothesis, without its definite confirmation at the present time.

[Surgical treatment of supraumbilical eventrations]. / Traitement chirurgical des éventrations médianes sus-ombilicales.

Among postoperative incisional hernias, mid-epigastric eventrations have peculiar features for physiopathological reasons that are summed up in general and specifically in the first paragraph of this paper; they are characterized by the quick retraction of the lateral belt, with the chondrocostal margin of the thorax participating as the upper limit of the cleft, and by the rapidly irreducible diastasis--hence the importance of an early decision to operate. The authors propose three regular procedures with which they are experienced: repair with a large retromuscular nonabsorbable synthetic tulle prosthesis for extensive epigastric eventrations, fillup aponeuroplasty using the sheath of the rectus abdominis associated with a premuscular patch in case of diastasis or of multiple superimposed orifices and suture associated with a small retromuscular auxiliary patch to treat small incisional hernias. The article, mainly dealing with the technical details of the three procedures and of their variants, is concluded by a brief report of the personal results obtained with a series of 616 postoperative eventrations, including 91 mid-epigastric ones, controlled after an average time lapse of 5.5 years.