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.

Cure of inguinal hernias with large preperitoneal prosthesis: Experience of 2,312 cases.

It is clear that the recurrence rates after nonprosthetic methods for the repair of inguinal hernias, like McVay, Bassini or Shouldice techniques, are high (6-10%). Since 20 years, we are convinced, in the GREPA-EHS group, about the advantages of the use of a prosthetic mesh in majority of patients for repairs of primary or recurrent inguinal hernias and incisional hernias. We describe our typical technique for the cure of all inguinal hernias. We place a large supple mesh, by open inguinal route, posterior to the transversalis fascia and anterior to the peritoneum. We have made a double modification in the initial technique of Rives - the use of a very large unsplit prosthesis (15 × 17 cm) and the parietalization of the spermatic cord helped by a wide opening of the Fruchaud's orifice by diversion of the epigastric vessels. The positioning of the mesh is about the same as in the TEP technique but with the advantages of reduction in the vital laparoscopic risks and reinforcement of the wall by a short tension-free McVay technique.For this prospective study, we repaired 2,312 consecutive hernias in 1,828 patients, 284 of which were recurrent. We present our results in terms of quality of repairs, recurrence rates (0.4%), morbidity rate (8%), and mortality rate (0.8%).This technique involves the placement by an open incisional route of a large preperitoneal sheet of mesh for initial treatment of all inguinal hernias - including scrotal, giant or femoral - to ensure a definitive solid muscular wall, even for recurrent hernias.

Parietal mesh abscess as an original presentation of cancer of the caecum.

We report a case of cancer of the caecum in a 71-year-old male who presented with parietal mesh abscess. Two years before, he was treated for a right inguinal hernia by insertion of a Dacron mesh. CT scan then colonoscopy determined the existence of a voluminous caecal tumor perforated in the abdominal wall with an important abscess around the mesh. Right colectomy and parietal muscles excision were performed completed with postoperative radiochemotherapy. At 2 years, there is no evidence of recurrence. Atypical features with a hernia mesh repair associated with a sudden change in the patient's condition should alert the clinician to the possibility of a further subjacent pathological process.

Elective laparoscopic-assisted colectomy for diverticular disease. A prospective study in 50 patients.

BACKGROUND: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question, we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid colon for diverticular disease. METHOD: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn anastomosis. RESULTS: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150-280 min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days. CONCLUSIONS: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.

[Laparoscopic appendectomy in the adult]. / Appendicectomie laparoscopique chez l'adulte.

AIM OF THE STUDY: The benefits of laparoscopic appendectomy remain controversial. The aim of the study was to evaluate the advantages and disadvantages of this technique. MATERIAL AND METHODS: Four hundred and forty-eight patients operated on for suspected appendicitis during a 5-year period were analysed in a retrospective study. The preoperative diagnosis was corrected in 21.4% of the cases (8.1% for males and 28.7% for females) and the conversion rate was 9.7%. There were 17 patients with generalized peritonitis and 28 with localized peritonitis. During the past year, this surgical method was introduced in another hospital and a prospective study included 92 consecutive patients operated on for appendicitis. The operating time was 53 minutes and the conversion rate was 7.6%. There were five patients with generalized peritonitis and eight with localized peritonitis. RESULTS: There were no postoperative deaths. In the first period, the morbidity rate was 2.3% in the laparoscopic group without conversion. After pathological examination, there was a 14.2% rate of normal appendix. The mean hospital stay was 4.3 days. In the second period, there were only three minor complications and the mean hospital stay was 4.19 days. CONCLUSION: The choice of laparoscopic approach is associated with some advantages: corrections of the diagnosis (mainly in young women) and simplification of the postoperative course, provided that the surgeon has sufficient experience.

Extensive spread of a squamous cell carcinoma in situ of the esophagus: an unusual case.

A case of extensive squamous cell carcinoma in situ along the esophageal height in a 58-yr-old female is presented. After subtotal esophagectomy, the course was favorable 11 months later. The pathological study of the specimen showed that the tumor was confined to the epithelium. The lesion was located diffusely along the entire esophageal height and one-third of its circumference. Neither foci of dysplasia or inflammatory erosions nor metastatic nodes were observed. Problems pertaining to the terminology, histopathological interpretation, pathogenesis, and management of such unusual lesion are reviewed. The necessity of large radical resection of the esophagus was validated upon histological confirmation that the resected stump is cancer free.

Dieulafoy's ulcer: combined endoscopic and laparoscopic treatment.

Dieulafoy's disease is a rare, but dangerous cause of upper gastrointestinal hemorrhage. We report here the case of a patient in whom the failure of endoscopic therapy necessitated a surgical approach by combining endoscopy and laparoscopy. The intraoperative endoscopic examination located the site of the lesion precisely, allowing a limited adapted wedge resection to be carried out laparoscopically.

[Laparoscopy-assisted colonic surgery. Initial experience. Apropos of 49 cases]. / Chirurgie colique coelio-assistée. Expérience préliminaire. A propos de 49 cas.

From November 1993 to December 1995, 49 colonic operations were performed by a videolaparoscopic assisted approach. Indications were malignant conditions in 10 cases, benign diseases in 39 cases (diverticular disease: 28, benign tumour: 9, reversal of Hartmann's procedure: 1, volvulus: 1). Conversion to a classical procedure was necessary in 6 patients. There was no mortality and 6 postoperative complications (3 reoperations). Colonic surgery this type of (laparoscopic-assisted operations) is technically feasible. It reduces the rate of post-operative wound complications and decreases the post-operative stay. It can be recommended for the surgical treatment of benign colonic diseases.

Recurrent inguinal hernia: surgical repair with a sheet of Dacron mesh by the inguinal route.

In this report we describe our technique for repair of recurrent inguinal hernia, using a large sheet of Mersilene mesh placed by the inguinal route. After division of the epigastric vessels, the inguinal canal is opened widely. A large sheet of Dacron mesh is inserted and the muscles are closed without tension by the McVay technique. We have repaired 142 recurrent hernias by this method. One patient died (0.7%) and morbidity included hole in the bladder (n = 3), wound discharge-(n = 2), wound haematoma (n = 5), cardiac arrhythmia (n = 1), and urinary retention (n = 2). The mesh had to be removed in two cases. No further recurrences were observed. This technique, thanks the placement of a large "tension free" sheet of mesh, ensures solid, definitive repair and is recommended for initial treatment of recurrent inguinal hernia.

Laparoscopic procedure for suspected appendicitis. A prospective study in 283 consecutive patients.

Between September 1990 and December 1993, 283 consecutive patients were admitted with clinical symptoms of acute appendicitis. These patients underwent primary laparoscopic approach so that an appendicectomy could be performed by this method. In 49 cases (17.3%), primary laparoscopic examination corrected the preoperative diagnosis and the appendix was left in situ. Appendicectomy was performed in 234 cases (149 women, 85 men) with a mean age of 30 years. Requirement for open surgery occurred in 29 cases. The main cause of unsuccessful procedures was inflammation due to local or generalized peritonitis. Median operative time for a successful procedure was 60 min (range, 25-160). Four postoperative complications (one related to laparoscopic procedure), one case of wound infection, and no mortality resulted. After laparoscopic appendicectomy, the median hospital stay was 3 days (range, 1-16). These results suggest that a laparoscopic approach for suspected appendicitis is reliable, allowing abdominal exploration and safe appendicectomy.

Role of laparoscopic surgery in the management of acute abdomen in the HIV-positive patients.

Emergency open laparotomy in patients infected with HIV is accompanied by high mortality. The authors investigated the potential role of a laparoscopic approach for the management of acute abdomen in such patients. Prospectively, 10 patients with HIV disease (9 with AIDS) underwent laparoscopy for acute abdomen. The treatment was exclusively laparoscopic in 6 patients. A conversion to laparotomy was necessary in 4 patients but through guided elective incision in 3 of them. The postoperative course was uneventful in all patients but 1, who died. We advocate a laparoscopic approach, when feasible, as an initial step in the management of acute abdomen in HIV-positive patients.

Stented hepaticojejunostomies after resection for cholangiocarcinoma allow access for subsequent diagnosis and therapy.

A method is described for stenting hepaticojejunostomies after resection for hilar carcinomas. The small size of the catheters allows the intubation of all biliary anastomoses, in order to decrease the morbidity rate and allow postoperative internal radiotherapy.

Paracolostomal hernia: repair with use of a Dacron prosthesis.

Several surgical procedures have been described for the repair of paracolostomal hernia. We describe a local technique approach using stoma relocation with insertion of a Dacron prosthesis. Among 14 patients operated on for paracolostomal hernia, this technique was used in 10 patients. There was no mortality or morbidity (no prosthesis infection). During follow-up there was one recurrence, which was reoperated with a good final result. This technique can be recommended for the few patients in whom a surgical repair is mandated.

[Celioscopic appendectomy. Results in 137 consecutive patients]. / Appendicectomie coelioscopique. Résultats chez 137 malades consécutifs.

Between September 1990 and August 1992, laparoscopic appendicectomy was attempted in 137 patients: 98 females and 39 males (sex-ratio: 2.5:1) with a mean age of 31 years (range: 15-85). The patients were operated on by 9 surgeons. Laparoscopic appendicectomy was possible in 120 patients (87.6%). In 19 patients the procedure was converted into open surgery. The main causes of unsuccessful laparoscopic procedures were: retrocaecal appendix (n = 5) and injury of appendiceal artery (n = 4). The rate of unsuccessful procedures was 31% in retrocaecal appendix and 9.4% in the other cases (P < 0.02). In exclusively laparoscopic procedures, the mean operating time was 63 (2.9) minutes. It was 49 (3) minutes for experienced surgeons and 69 (3.3) for other surgeons (P < 0.05). Histological examination of the appendix revealed inflammatory signs in 97 specimens (71%). There were no wound infections after successful laparoscopic appedicectomy. One female patient developed an abscess in the pouch of Douglas. The median postoperative hospital stay was 3 days (range: 1-16). These results suggest that laparoscopic appendicectomy is a safe technique, with low morbidity allowing short postoperative hospital stay.

[Chylous ascites caused by retroperitoneal neoplastic obstruction of lymphatic vessels. Treatment by peritoneo-jugular shunt. A case]. / Ascite chyleuse par obstruction lymphatique néoplasique rétropéritonéale. Traitement par dérivation péritonéo-jugulaire. Une observation.

A case of chylous ascites due to retroperitoneal tumoral compression is reported. Following failure of a medical treatment which consisted of paracentesis and medium-chain triglyceride (MCT) diet, the ascites dried up after installation of a peritoneum-jugular vein shunt valve. This operation is seldom performed in patients with chylous ascites since the medical treatment with paracenteses, MCT diet or even total parenteral nutrition succeeds in drying the effusion in almost 50 percent of the cases, notably those with postoperative lesion.

Percutaneous surgery of biliary cyst: a case report.

Biliary cysts are uncommon and often asymptomatic. Once symptoms occur, treatment is needed. Though percutaneous drainage is possible, the recurrence rate is high. Open drainage is associated with the morbidity of laparotomy. We report a case of laparoscopic treatment of a large biliary cyst.