[Retrospective and comparative study of the medicoeconomical impact of a new mesh in the treatment of anterior abdominal wall incisinal hernia]. / Etude comparative rétrospective de l'impact médicoéconomique d'un renfort innovant dans la cure des éventrations de la paroi abdominale antérieure.

STUDY AIM: Determine the gain of hospitalization cost using a new intraperitoneal mesh compared to the retro-muscular pre-fascial implantation of a polyester mesh. PATIENTS AND METHODS: From January 1998 to June 2000, 52 patients with incisional hernia of the anterior abdominal wall were operated using intraperitoneal Parietex composite Mesh. The cost of surgery, anesthesia and hospitalization in this group were compared to similar data from a group of 21 patient where a Mesrsuture mesh in a prefascial retromuscular position was used. RESULTS: Parietex Composite Mesh in intraperitoneal position allows a significative reduction in surgery time, anesthesia time and hospitalization. The clinical results were confirmed by cost savings. CONCLUSION: Using new innovative medical device changing surgery technique insures significant cost saving despite its initial additional cost and increases patient's comfort during hospitalization.

CT of small bowel obstruction in adults.

The increasing use of computed tomography in evaluating patients with acute abdominal pain has revolutionized the diagnosis of small bowel obstruction in adults. Computed tomography is incontestably the most useful and powerful tool to make positive, topographic, and etiologic diagnoses of small bowel obstruction. Good knowledge of some key signs and rigorous analysis of computed tomographic images by radiologists should lead to improved diagnosis and appropriate treatment.

[Sigmoid volvulus: value of CT]. / Volvulus du sigmoïde: intérêt et apports de l'étude scanographique.

We report a case of sigmoid volvulus. CT findings are presented. The value of CT compared to abdominal plain radiographs and contrast enema is described.

Small bowel obstruction secondary to phytobezoar CT findings.

A rare cause of small bowel obstruction due to a phytobezoar is reported. CT demonstrated an ovoid intraluminal mass with mottled gas pattern within the small bowel and intestinal obstruction signs. We believe that these CT findings are pathognomonic of this condition.

[Surgical treatment of Verneuil's disease (hidradenitis suppurativa): 15 cases]. / Traitement chirurgical de la maladie de Verneuil: 15 cas.

INTRODUCTION: Verneuil's disease (hidradenitis suppurativa) is a chronic inflammatory, suppurating and fistulizing disease of apocrine sweat gland-bearing skin. The aim of this study was to describe the surgical treatment, conducted in 15 patients suffering from this disease. PATIENTS AND METHODS: We retrospectively analyzed 15 observations (9 men, 6 women, mean age 38.6). The mean delay between beginning of the symptoms and diagnosis was 55.5 months. Surgery was conducted at the stage of abscesses, fistulization and keloids in all patients. The first surgical step was wide and deep excision of affected skin and subcutaneous fat. The second step was secondary intention healing, or ideal suture, Z plasty or dorsalis major flap. RESULTS: Only four patients had complications: two axillary strictures, one anal margin stenosis and one hypertrophic scarring. Three relapses occurred, treated by excision under local anesthesia. CONCLUSION: Surgical treatment seems to be the only definitive treatment of Verneuil's disease.

[Surgical treatment of cervical disk displacement. Anterior or posterior approach?]. / Le traitement chirurgical des hernies discales cervicales. Abord antérieur ou abord postérieur?

PURPOSE OF THE STUDY: This study is a retrospective analysis of the treatment of cervical soft disc herniation comparing anterior and posterior approach. MATERIAL AND METHODS: Twenty eight patients presenting with cervico-brachial radiculopathy secondary to acute soft posterolateral disc herniation were reviewed. Cases with myelopathy or radiculopathy secondary to chronic spondylosis were excluded. Involved level was C5-C6 or C6-C7 in most cases. There were 14 females and 14 males. Age at operation averaged 44 years. Fourteen patients underwent an anterior approach with discectomy and fusion using autologous iliac bone graft. Average age was 46 years in this group with an average follow-up of 30 months. Average duration of surgery was 2 hours. Average hospital stay was 6 days. Fourteen patients underwent a posterior approach with partial lateral laminotomy extending medially for several millimeters over the facet joint. Extruded disc material was removed in 10 cases. No curettage was performed. Average age at surgery was 41 years with an average follow-up of 36 months in this group. Average duration of surgery was 70 minutes. Average hospital stay was 6 days. RESULTS: Patients were evaluated 3 months post-operatively and at their maximum follow-up. At 3 months follow-up, no patient complained of radicular pain; occasional cervical pain was present in 5 cases following posterior surgery but was not observed at late follow-up. Return to work was possible on an average of 3 months in both series. Results were graded as excellent, good, fair and poor. At late follow-up, in patients with a posterior approach, there were 8 excellent results, 5 good results with neck fatigue at work, and 1 fair result requiring analgesics. In patients with an anterior approach, there were 7 excellent results, 6 good results, and 1 fair result. Two patients complained of pain at the iliac donor site. DISCUSSION: These results suggest that the anterior approach gives better short term results, but no significant difference is observed between anterior and posterior approaches a few years after surgery. Although the anterior approach is more appropriate than the posterior one for the treatment of central disc herniation, the posterior approach may be considered as an alternative to anterior discectomy and fusion for antero-lateral soft disc herniation.