A registry-based 2-year follow-up comparative study of two meshes used in transinguinal preperitoneal (TIPP) groin hernia repair.

PURPOSE: Onflex™ mesh has replaced Polysoft™ patch on the market, without being clinically evaluated thus far in the transinguinal preperitoneal (TIPP) technique. METHODS: All consecutive TIPP registered in our registry during the overlap period of availability of both meshes were included and studied with the chronic postoperative inguinal pain (CPIP) as primary endpoint, assessed with a verbal rating scale (VRS), and included in a patient-related outcome measurement (PROM) phone questionnaire. RESULTS: A total of 181 Onflex cases vs 182 Polysoft cases were studied with a 2-year follow-up rate of 92% vs 88%. The overall rate of pain or discomfort was not statistically different in the 2 studied subgroups (16.5% vs 17.6%; p = 0.71), while moderate or severe pain were significantly more frequent in the Polysoft subgroup (5.5% vs 11.6%; p = 0.01). These symptoms did not interfere with the patient daily life in 16% vs 16.5% of cases, and they were self-assessed as more bothersome than the hernia in only 0.5% vs 0.5% of cases, suggesting an overestimation of the pain by the VRS. Patients assessed the result of their hernia repair as excellent or good in 97.8% vs 96.7% and medium or bad in 2.2% vs 3.3% (p = 0.53). The cumulative recurrence rate was 0% vs 2.2%. Two reoperations (one for early and one for late recurrence) were reported in the Polysoft subgroup (1%), none related to the non-absorbable memory ring. CONCLUSIONS: These results suggest that TIPP with Onflex provides results at least similar than those with Polysoft.

Chronic pain and quality of life (QoL) after transinguinal preperitoneal (TIPP) inguinal hernia repair using a totally extraperitoneal, parietalized, Polysoft ® memory ring patch : a series of 622 hernia repairs in 525 patients.

INTRODUCTION: Little is known about both incidence of chronic pain and quality of life (QoL) after the transinguinal preperitoneal (TIPP) technique using a totally extraperitoneal, parietalized, memory ring patch. MATERIALS AND METHODS: Among 622 (428 unilateral and 194 bilateral) hernia repairs (HR) in 525 patients, 92 % had a postoperative clinical control. Thereafter, two sets of postal self-assessed questionnaires were sent. RESULTS: A total of 531 HR were studied with a mean follow-up of 17 ± 8 months. Only one recurrence was detected. In 151 (28.4 %) HR the patients alleged various symptoms, but in only 10 (1.9 %) HR they considered their discomfort more bothersome than the hernia they had before, and in just 2 (0.4 %) HR they judged their result as bad (one patch removal for sepsis and one for hematoma). Only mild pain (including no painful discomfort such as a foreign body sensation) or moderate pain was frequent. Pain was self-graded as severe in four cases. None of them reported any regular consumption of antalgics. None of them judged their result as bad. Dysesthesia (numbness 19, paresthesia 20) mentioned in 39 HR (7 %), associated with pain in 16 HR, was said to be more bothersome than the hernia treated in just 3 HR (0.6 %). The results of the entire series were self-assessed as good or excellent in 97 % of the HR. CONCLUSION: In our TIPP series, both the incidence of recurrences (0.2 %) and that of severe chronic pain (≤0.7 %) were very low, as well as patients' QoL was excellent. In our experience, the postoperative course was as painless as that of laparoscopic TEP we had been performing previously, but TIPP appeared more suited to day-case surgery.

[Appendiceal mucoceles, pseudomyxoma peritonei and appendiceal mucinous neoplasms: update on the contribution of imaging to choice of surgical approach]. / Mucocèles appendiculaires, pseudomyxomes péritonéaux et tumeurs mucosécrétantes du carrefour iléocaecal: apport de l'imagerie dans la stratégie thérapeutique et le choix de la voie d'abord laparoscopique ou classique.

INTRODUCTION: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008. PATIENTS AND METHODS: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02). RESULTS AND DISCUSSION: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.

[Medicamentous bezoar following pancreaticoduodenectomy: the combined use of cholestyramine and antisecretory medications as a risk factor in pancreatic surgery]. / Pharmaco-bézoar après duodénopancréatectomie céphalique, association Choléstyramine + antisécrétoires: situation à risque en chirurgie pancréatique?

The authors describe a case of pharmaco-bezoar consisting of ingested cholestyramine which occurred post pancreaticoduodenectomy. Intestinal obstruction by a cholestyramine bezoar is a rare occurrence but is worthy of note in the post-pancreatectomy setting where there is often concomitant use of cholestyramine, proton pump inhibitors, and octreotide.

[Giant colonic or ileo-jejunal diverticulum and infra-mesocolic abdomial pseudocysts: diagnosis, pathalogical and clinical analysis]. / Diverticules géants du grêle et du côlon et formations pseudo kystiques sous-mésocoliques.

Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.

Inflammatory pseudotumor of the common bile duct.

An exceptional cause of obstructive jaundice is reported in the present case. A 51-year-old woman progressively developed jaundice with pruritus, and abdominal ultrasonography revealed dilated intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiography and endoscopic ultrasonography showed a tumor in the distal common bile duct, but failed to determine the nature of the lesion, and the patient underwent a pancreaticoduodenectomy. The final diagnosis was an inflammatory pseudotumor of the common bile duct. Inflammatory pseudotumors are uncommon, without evident pathogenesis, and are described in many organs. The localization in the common bile duct is exceptional. The prognosis is good, and a more conservative approach is possible if the diagnosis is certain before surgery.

[Criteria for suspected lithiasis of the common bile duct]. / I criteri di litiasi sospetta della via biliare principale.

Although the common bile duct is now accessed using a coelioscopic approach by an increasing number of surgical equipes, the problems related to the diagnostic iter of lithiasis of the common bile duct and the need to obtain a correct preoperative diagnosis, in order to select the most appropriate form of therapy, are of growing topical importance. Following a revision of the literature, the authors focus their attention on those studies which seem to be most interesting and important in relation to the criteria for suspected lithiasis of the common bile duct, studied in single, multivariable and preoperative analyses, namely without taking account of perioperative analyses, namely without taking account of perioperative criteria. These studies reveal the most statistically significant criteria for predicting lithiasis of the common bile duct. Although the application of these studies is not practicable, they undoubtedly arouse considerable interest. The authors have selected the simple criteria whose rigorous application may result in the selection of patients with 0 criteria, with a 1% risk of non-suspected lithiasis of the common bile duct. Perioperative cholangiography (POC) and echoendoscopy are closely correlated to these criteria. The authors outline their diagnostic iter within the framework of a prospective study they carrying out.

[Celioscopic treatment of choledocholithiasis: strategic problems. A clinical case]. / Trattamento della litiasi del coledoco per via coelioscopica: problemi strategici. Caso clinico.

The authors report a case of suspected calculosis of the common bile duct (CBD) associated with cholecystolithiasis, both of which were treated using a coelioscopic approach. Using a flexible Olympus 5 mm urethroscope and Schuller-type urethral dilator sound, it was possible to explore the choledochus visually using a transcystic route prior to dilating the latter gradually and attempting to extract calculi using Dormia's probe. In selected cases of calculosis of the common bile duct, with a dilated cystic duct, it is possible to explore the choledochus using a transcystic route but it is not yet possible to extract stones at the same time. If, on the other hand, the choledochus is further dilated, it is preferable and more satisfactory to perform a choledochotomy using a coelioscopic route. In the light of coelioscopic progress and its diagnostic and therapeutic possibilities, the authors report their criteria for suspected lithiasis of the common bile duct and attribute a precise and important role to echo-endoscopy since its results lead to a different therapeutic strategy.

[A trial of evaluation of cholecystectomy by celioscopic approach. Apropos of 2266 patients]. / Essai d'évaluation de la cholécystectomie par abord coelioscopique. A propos de 2,266 malades.

Facing enthusiasm and critics it is necessary to evaluate new surgical techniques. The aim of our study is to try to evaluate cholecystectomy by laparoscopy. 2266 patients operated on by laparoscopy in France are compared with 3390 patients operated on by laparotomy which were published in 1990 in American surgical revues. Both groups are comparable concerning age of patients and surgical indications. Even if 10% of the patients operated on by laparoscopy needed a laparotomy, the morbidity and the mortality were not significantly different in both techniques. This study allows to conclude that cholecystectomy done by laparoscopy offers the same security to patients than using laparotomy, with in addition a faster and better recovery and a much lower economic cost. However, some problems are not yet resolved, especially the one concerning main bile duct stones and the one concerning the necessity of a special training for these surgical laparoscopic technics.

[Mechanical circular colorectal anastomosis using a transanal approach. Apropos of a series of 51 cases]. / Les anastomoses mécaniques circulaires colo-rectales par voie trans-anale. A propos d'une série de 51 cas.

Automatic circular suture forceps offer new technical possibilities for the confection of colorectal anastomosis. A retrospective study was conducted in 51 patients, representing a homogeneous group of anastomoses performed by the same surgeon using the same operative technique and with routine review by barium enema examination on the 8 th postoperative day. Technical difficulties during operation were encountered in 10 patients (19.6%) requiring supplementary sutures in 3 cases and protective colostomies in 3 others. Review examinations revealed anastomotic dehiscence in 7 cases (13.7%), only 3 (5.9%) of these radiologic fistulae provoking clinical manifestations, and only one of these (1.9%) necessitating recovery operation. Perfect compliance with conditions of use of the mechanical forceps and a minute technique identical to those of manual sutures produced excellent early result with circular mechanical suturing using EEA forceps when compared with manual suturing methods. This was particularly true in Goligher's series in which there were 51% of radiologic fistulae. Under certain difficult conditions, the use of EEA forceps simplifies performance of a colorectal anastomosis, mechanical anastomosis using the circular forceps constituting an undeniable technical progress in colorectal surgery with conservation of anal sphincter.

[Activity of almitrine bismesylate on pulmonary hemodynamics and on the liberation of prostanoids in the lymph nodes in sheep]. / Activité du bismésilate d'almitrine sur l'hémodynamique pulmonaire et sur la libération de prostanoïdes dans la lymphe pulmonaire chez la brebis.

Almitrine Bismesylate (0.25 mg X kg-1) was perfused for 10 minutes into the pulmonary artery of 4 sheep (40 kg) which were anaesthetized, paralysed and ventilated with 50% oxygen in air and prepared according to Staub et al (J. Surg. Res. 19:315, 1975). The preparation was followed for 2 hours baseline and for four hours after perfusion and comparisons made using analysis of variance. We noted a transitory phase marked by a peak of pulmonary vascular resistance (PVR) at 25 +/- 15 minutes due to a rise in mean pulmonary artery pressure PAP from 14 +/- 2 to 23 +/- 5 cm H2O. PO2 fell from 220 +/- 40 to 180 +/- 25 Torr. A stable haemodynamic state was attained after 90 minutes. PAP was slightly above control and PaO2 significantly elevated (230 +/- 30 Torr P less than 0.05). Left atrial pressure, PCO2, pH, and lung lymph flow did not change. The mild stable vasoconstriction associated to a rise in PaO2 at constant ventilation and high PaO2 does not suggest a straightforward role for chemoreceptors. It is compatible with redistribution of VA/Q ratios by local mediators. Lung lymph was assayed for prostanoids using radio immunological methods. A significant rise in 6 keto PGF1 alpha immunoreactivity was found posterior to the haemodynamic peak. HPLC is required to quantify further this rise.

[Dimethylnitrosamine hepatic cirrhosis in the rat (author's transl)]. / La cirrhose du rat au diméthylnitrosamine. Essai de corrélation clinique, biologique et anatomo-pathologique en fonction des doses de D.M.N.A. et de l'espèce.

Chronic intoxication with dimethylnitrosamine (D.M.N.A.) in the rat induced an experimental cirrhosis which seems stable in time. The intoxication was done by forcible feeding either with 7 or 8 mg/kg of D.M.N.A., three consecutive days a week, for 9 weeks. Chronical intoxication resulted in 50% of hepatic cirrhosis in the 7 mg/kg group and 63% in the 8 mg/kg group. --The diagnostic of hepatic cirrhosis was done by pathological study on the left lobe. --In all cirrhotic rats, verified by histology, biological test were disturbed in a significant way, compared to untreated rats, but not to non cirrhotic intoxicated rats. There was no correlation between pathological anatomy and biology. --Cirrhosis persists after the intoxication but survival duration is much shorter in the group intoxicated with 8 mg/kg of D.M.N.A. --There was no difference in the constitution of cirrhosis between Wistar and Sprague Dawley strains. Therefore the best procedure to induce cirrhosis in rats is chronical intoxication by administration of 7 mg/kg of D.M.N.A. during 3 consecutive days a week for 9 weeks. Pathological study are the only reliable tests to determine the constitution of cirrhosis.