Single umbilical incision laparoscopic cholecystectomy: initial experience of the Coelio Club.

AIM: To assess the initial results of single umbilical incision laparoscopic cholecystectomies (SUILC) performed by the members of the Club Coelio. PATIENTS AND METHODS: This multicenter study involved 65 consecutive patients undergoing SUILC between September 2008 and December 2009. The operation was performed with a 0° scope in 35 and with a 30° scope in 30 patients. There were 56 women and nine men with a mean age of 49 ± 14 years and a mean body mass index of 25 ± 4. The main perioperative parameters analyzed were duration of operation, conversion, morbidity and duration of hospitalization. One month after surgery, the esthetic result was assessed by each patient on a visual analogue scale (VAS). A VAS score between 9 and 10 was considered as an excellent result. RESULTS: During laparoscopy, some degree of cholecystitis was seen in 10 patients. Intraoperative cholangiography was performed in 57 patients and the mean duration of operation was 68 ± 22 min. Conversion to conventional laparoscopic cholecystectomy (CLC) was required in eight patients (12%). We noted three complications (4%): two wound abscesses and one hemoperitoneum. The mean hospital stay was 2 ± 1 days. The esthetic result was considered as excellent by 45 patients (69%). Multivariable analysis revealed that duration of operation was shorter after five procedures (61 ± 25 vs. 72 ± 18 min, regression coefficient: -7, P<0.032) and when a 30° scope was used (56 ± 18 vs. 76 ± 20 min, regression coefficient: -14, P<0.011), the conversion rate was higher in cholecystitis (60% [6/10] vs. 4% [2/55], OR: 33, P<0.002) and the percentage of excellent esthetic results was greater in patients who did not required a conversion to CLC (77% [44/57] vs. 12% [1/8], OR: 18, P<0.012). CONCLUSIONS: Our study showed that SUILC is feasible with low morbidity but duration of operation is long and conversion to CLC is frequent in cholecystitis. However, duration of operation decreases with rising experience of the surgeon and when a 30° scope is used. The major value of this technique is cosmetic.

[Laparoscopic cure of gastroesophageal reflux disease. Results of a multicenter trial]. / Cure de reflux gastro-oesophagien par coelioscopie. Résultats d'une étude multicentrique.

OBJECTIVES: The aim of our trial was to assess preoperative assessment and short-term results of laparoscopic cure of gastroesophageal disease performed by digestive surgeons not specialized in this disease. METHODS: 335 consecutive cures were performed by 11 surgeons. RESULTS: 29% of patients had pH-metry, 52% had manometry. The procedure was: Nissen-Rossetti in 66% of cases, Toupet in 17%, and Nissen in 16% of cases. The conversion rate was 13%. The intraoperative complication rate was 3.28% and 2.08% of patients had a reoperation. One patient died. 5% of patients had dysphagia more than three months after the operation. CONCLUSION: Our results show an absence of consensus concerning preoperative assessment. They suggest that careful intraoperative management, with a high conversion rate, reflecting our initial experience, allows similar results to those of teams specialized in laparoscopic surgery and better than laparotomy series.

[Time off of work after inguinal hernia repair. Results of a multicenter prospective study]. / Arrêt de travail après cure de hernie inguinale. Résultats d'une étude prospective multicentrique.

A multicentre prospective study was conducted to evaluate the effective duration of time off work following inguinal hernia repair. From 1st October to 30 November 1997, 14 surgeons repaired 459 hernias in 359 patients, corresponding to 28.8% of salaried workers, 10.9% self-employed and 4.8% civil servants. 46% of patients were retired. Only 6.9% of patients were treated by reconstruction of the inguinal floor without mesh, 59.6% were operated by laparoscopy and a conventional prosthesis repair was performed in 33.2%. There were 0.6% of complications or modifications of the postoperative course. The mean effective time off work was 17.5 days after unilateral repair and 24.7 days after bilateral repair. For unilateral repairs, no significant difference was observed between occupational groups in terms of effective time off work, in the absence of complications. In contrast, patients of these occupational groups presented a shorter time off work following an uncomplicated TAPP repair than after plug-Lichtenstein repair. In the group of salaried workers, a significant difference was observed between patients undergoing TAPP or TEP repair and those undergoing plug-Lichtenstein repair.

[Treatment of the loss of major wall substance in children using synthetic resorbable mesh. Apropos of 10 cases]. / Traitement des pertes de substance pariétale majeures chez l'enfant par treillis synthétique résorbable. A propos de 10 cas.

Ten children with a major parietal defect, abdominal or thoracic, were operated by using a resorbable polyglactine network, during these three last years. On six children, the parietal defect was only deep, according to the surgical ablation of a parietal malignant tumor; on four other children, the defect was total, interesting the muscular and aponeurotic plan, but also the skin (two gastroschisis, and two septic eviscerations). Neither reject nor suppuration were observed. In case of total defect, a parietal reflection may be necessary in the long term.

[Lumbar sympathectomy in the aged subject: surgery or phenolization? Prospective study of early results]. / Sympathectomie lombaire chez le sujet âgé chirurgie ou phénolisation? Etude prospective des résultats précoces.

Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia. Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.

[Anal plasty after excision of giant condyloma acuminata]. / Plastie anale après exérèse de condylomes acuminés géants.

Giant condyloma acumination, also called Bürschke-Loewenstein disease, is a pseudo-tumoral epithelial proliferation of viral origin (human papilloma virus). Surgery is the most effective of all treatments, but it results in loss of all tissues covering the anal canal. We suggest a reconstruction technique, performed under colostomy, in which the rectal mucosa is brought down and three sliding flaps are constructed from the skin of the ischio-anal fossae.