Comparative study of biological versus synthetic prostheses in the treatment of ventral hernias classified as grade II/III by the Ventral Hernia Working Group.

AIM OF THE STUDY: The implantation of biological prostheses in an at-risk environment has seen increasing use. Their markedly higher cost compared to synthetic prostheses makes it important to analyse their usefulness in terms of actual benefit and cost-effectiveness. This study aims to examine the relevance of bioprostheses during surgical repair of Grade II/III ventral hernias as classified by the Ventral hernia working group (VHWG). MATERIALS AND METHODS: This study analysed the data of 119 patients requiring non-emergency repair of VHWG II/III grade hernias between 2010 and 2017. The results of patients who were treated with a bioprosthesis (n=59) were compared to those receiving a synthetic prosthesis (n=60). The primary outcome was surgical site infection (SSI) at 90 days. The secondary endpoints were hernia recurrence rate, cost of the prosthesis, duration of hospital stay and re-hospitalisation rate. RESULTS: The two groups were shown to be comparable by analysis of demographic, pre- and intraoperative data. The SSI rate was significantly higher in the bioprosthesis group (20% vs. 7%; P=0.010), as was the recurrence rate (56% vs. 28%; P=0.003) with a median follow-up of 40 months. The cost of the bioprosthesis was significantly higher than that of the synthetic prosthesis (€3363 vs. €249; P<0.010). CONCLUSION: In this retrospective study, the use of a bioprosthesis for repair of VHWG II/III ventral hernias was associated with a higher rate of both SSI and hernia recurrence at a cost 13 times greater than the use of a synthetic prosthesis.

Subcutaneous emphysema of thorax, neck and face after elective left colectomy: A case report.

INTRODUCTION: Anastomotic leakage is a severe complication after colorectal surgery which causes substantial morbidity and mortality and impairs the oncologic and functional outcomes. The incidence rate varies in the literature from 4% to 26%. Diagnosis is difficult. Clinical presentation and time management are closely related to prognosis. If subcutaneous emphysema is an obvious clinical sign, its etiology is complex to determine, particularly in the post-operative course of colorectal surgery. PRESENTATION OF CASE: We report our experience in the management of a patient with early colorectal anastomotic leakage after left colectomy, whose only physical sign was subcutaneous emphysema of thorax, neck and face. This presentation is not described to date. Emergency CT-scan with injection of contrast revealed a pneumoperitoneum with extradigestive air in the pelvis, pneumomediastinum and subcutaneous emphysema. Suture, drainage and defunctioning ileostomy have been performed in emergency with good results. The subcutaneous emphysema resolved spontaneously without specific treatment. DISCUSSION: There are many differential diagnoses of subcutaneous emphysema and its etiology is potentially lethal. This case is original by the clinical manifestation of anastomotic leakage in the immediate post-operative course of colorectal surgery; this presentation is not described to date. CONCLUSION: Isolated subcutaneous emphysema after left colectomy should suggest first a post-intubation tracheal wound. This case shows that an anastomotic leakage must be evocated and eliminated in order to provide the best outcome for these patients.

Rubber transcystic drainage reduces the post-removal biliary complications in liver transplantation: a matched case-control study.

PURPOSE: Bile duct (BD) complications continue to be the "Achilles' heel" of liver transplantation, and the utilization of bile duct drainage is still on debate. We describe the results of a less invasive rubber trancystic biliary drainage (TBD) compared to a standard silicone T-tube (TT). METHODS: The transplanted patients (n = 248), over a period of 5 years with a TBD (n = 20), were matched 1:2 with control patients with a TT (n = 40). Primary end points were the overall incidence of BD complications and graft and patient survival. Secondary end points included the complications after the drainage removal. RESULTS: Although the bile duct leakage rates were not significantly different between both groups, the TT group had a significantly higher rate of overall 1-year BD stenosis (40 versus 10 %) (p = 0.036). Three-year patient/graft survival rates were 83.2/80.1 and 84.4/84.4 % for the TT and TBD groups, respectively. The postoperative BD complications, after drainage removal (peritonitis and stenosis), were significantly reduced (p = 0.011) with the use of a TBD. CONCLUSION: The use of rubber TBD in liver transplant recipients does not increase the number of BD complications compared to the T-tube. Furthermore, less BD anastomotic stenosis and post-removal complications were observed in the TBD group compared to the TT group.

[Liver transplantation in a patient with alcoholic cirrhosis: discussion about nonabstinence]. / Discussion d'une transplantation hépatique chez un patient cirrhotique alcoolique incomplètement sevré.

Liver transplantation is the recognized treatment for serious cases of alcoholic cirrhosis. However, due to their poor image within society, patients with alcoholic cirrhosis are often less referred to transplant centres. This is even more surprising since in terms of patient' and graft's survival, the results of transplantation are comparable, if not better, than in other indications. Transplantation is the treatment for the liver disease, not a treatment for alcoholism. In the case of severe alcoholic disease, a relapse is neither surprising nor unacceptable or insignificant if severe. In this case, it has an impact on the long-term survival, notably due to mortality by cancer. All the medical teams carrying out transplants agree that abstinence is necessary when a patient is being evaluated for liver transplantation. However, it is not proven that a set period of 6 months' abstinence prior to the transplantation can modify the results. The problem of alcoholism must be treated specifically in terms of addiction both before and after transplantation.

[Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients]. / Traitement des complications biliaires après cholécystectomie par coelioscopie: étude rétrospective de 27 patients.

UNLABELLED: Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%. AIM OF THE STUDY: Describe the management of biliary injuries after laparoscopic cholecystectomy in our center. PATIENTS: Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%). RESULTS: Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2). CONCLUSION: Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.

[Spontaneous haemoperitoneum due to a ruptured intra-abdominal varix with cirrhosis: report of two cases]. / Hémopéritoine spontané par rupture de varices intra-abdominales chez le patient cirrhotique.

Spontaneous haemoperitoneum due to ruptured intra abdominal varices with cirrhosis is rare and the diagnosis is generally difficult. Two cases of spontaneous intraperitoneal bleeding due to ruptures varices with cirrhosis are reported. One case is a ruptured portal cavernome and the other one is a ruptured varix of the gastrosplenic ligament. The combination of hypovolemic shock with increasing abdominal girth should impose the diagnosis. This is a surgical emergency and the mortality rate is high.

[Surgical management of a preaortic paraganglioma: Report of one case]. / Prise en charge chirurgicale d'un paragangliome préaortique: à propos d'un cas.

Paragangliomas (PG) are rare and often diagnosed in the young adult. One case of retroperitoneal preaortic paraganglioma localised between the celiac trunk and the superior mesenteric artery is reported. The management of paraganglioma involves endocrinologists, geneticists and surgeons but the only potentially curative treatment remains surgical resection. Pathology reports can not always discriminate between benign or malignant tumors. Hereditary in paraganglioma occurs in approximately 25% of cases. Genetic investigation is therefore mandatory in all patients with PG. Since the type of genetic mutation is correlated with tumoral aggressiveness, genetic investigation results should be taken into account when a surgical procedure is planned.

[Complicated diverticulitis during pregnancy]. / Diverticulite sigmoïdienne compliquée en cours de grossesse.

The authors report a case of perforated diverticulitis with presence of a fistulous tract between a peridiverticular abscess and the uterus during pregnancy with favorable outcome under medical treatment. The purpose of this case report is to illustrate specific imaging findings and clinical management of diverticulitis during pregnancy.