[Treatment of inguinal hernia using laparoscopy. Clinical experiences apropos of 300 cases]. / Cure des hernies inguinales sous coelioscopie. Expérience clinique à propos de 300 cas.

300 laparoscopic treatments of inguinal hernia repair have be done in our hospital between may 1992 and juin 1994. 134 times we have seen a median hernia and 166 times a lateral one. In 44 patients (14%) we did the repair of hernia for bilateral disease. In 66 cases we underwent for recidive; 55 times after hernia repair by the Bassini technique or Shouldice technique, and only 8 times after laparoscopic repair. In 1.4% we have seen early recidivism, no more then in the classical technique. Of course philosophy of this technique is very different to the traditional repair of inguinal hernia, but the encouraging results, important decrease of pain after surgery and the early uptake of normal activity are the reasons why we use this technique for nearly all recidivism of hernia repair and even for a great number of important hernias.

[The rectosigmoid pouch. The Mainz pouch II. Apropos of 73 cases]. / La poche recto-sigmoïdienne. Poche de Mainz II. A propos de 73 cas.

The Mainz Pouch II, a low pressure rectosigmoid réservoir for urine is created without any bowel anastomosis. Antimesenteric opening of the intestine at the rectosigmoid junction and subsequent wide-to-side anastomosis are performed. Without the risque of damaging the mesentery blood supply, the pouch is fixed at the area of the pomontory or the psoas muscle to avoid the kinking of the ureteres and consecutive dilatation of the upper tract.

[Clinical tests on reno-ureteral lithiasis with a new Lithostar 2 model C shock wave generator system]. / Expérience clinique sur la lithiase réno-urétérale avec le nouveau système générateur d'ondes de choc modèle C du Lithostar 2.

Lithotripsy has confirmed its place in the treatment of urinary stones and there are now few indications for open surgery in this disease. Lithotripsy used to be rarely used, as it required a great deal of patience on the part of the patient, lying in the water bath, and the medical team. Increasing efficient systems are now available with a marked advantage for patients. Simple analgesia-sedation is often sufficient when requested by the patients and the duration of treatment has been considerably decreased. The authors present a review of their results with the new Lithostar 2 Model C shock wave generator system. The modifications made to this system take into account physical possibilities and medical requirements. As a result of the new configuration of this system, the treatment time per patient has been further decreased, a higher energy is applied to the stones and the disintegration rate is excellent.

[The continent ileocecal pouch. The Mainz pouch I]. / La poche iléo-caecale continente. Poche de Mainz I.

Since 1993 to July 1994, 374 patients underwent a Mainz Pouch procedure in their hospital. The follow up is between 4.2 +/- 2.6 years. The authors used this technique as well for bladder augmentation, bladder substitution as continent diversion. If possible, the appendix will be used for creating the continence system.

[Lung findings in filariasis]. / Lungenbefund bei Filariasis.

A solitary intrapulmonary mass, found accidentally, demands further investigations to assure the diagnosis. Even if we are unable to give an exact diagnosis, we should try to determine the character of the lesion; often the clinical findings can be helpful. If this is not the case, further possibilities to arrive at the correct diagnosis should be indicated.

Maximum androgen deprivation prior to radical retropubic prostatectomy in patients with stage T3 adenocarcinoma of the prostate.

Eighty-two patients with stage T3 carcinoma of the prostate were treated for 3 months prior to radical retropubic prostatectomy with a luteinizing-hormone-releasing hormone analogue and an antiandrogen. Based on digital rectal examination (DRE), reduction of prostate and tumor size was noted in all cases. Ultrasound demonstrated a decrease in prostatic volume between 0 and 62.5% (median 32%). Prostate-specific antigen levels (PSA, Hybritech) decreased substantially (mean PSA of 29.5 ng/ml before to a mean PSA of 1.3 ng/ml after hormonal treatment). Pathologically, only 15 patients (18.3%) had organ-confined disease (stage pT2), 44 (53.7%) had stage pT3 tumors and 22 (26.8%) had positive lymph nodes. In 1 surgical specimen (1.2%), no residual tumor was identified. In 5 patients with nodal metastasis and 13 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Compared to the preoperative needle biopsy, a decrease in the histological grade was found in only 7 tumors, while an increase was noted in 26. DRE, ultrasound and PSA suggest a downstaging of stage T3 prostate cancer after 3 months of maximum androgen deprivation. This cannot be confirmed pathologically. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.