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.

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.

[Very long duration anaesthesia (V. L. D. A.) considered by the surgeon (author's transl)]. / Les anesthésies de très longue durés (A. T. L. D.). Point de vue du chirurgien.

In the experience of the Universitary Surgical Clinic of Amiens, anaesthesia of more than 8 hours duration appears for 3 p. thousand of the total amount (9/3 000 on 1978). The authors distinguish between them "provided" very long duration operations and the "involuntary" ones (complex multitrauma, unexpected difficulties, etc.); that distinction is justified by many reasons among which one must consider mostly the team work setting up. The authors briefly report V. L. D. A. events in their own experience as in that reported in the medical literature. Also the practical difficulties resulting of V. L. D. A. in the intra-operative or post-operative periods are appraised. Then the authors propose some means able to reduce the number of V. L. D. A. and to assure a better proceeding of very long duration operations.