[Laparoscopic treatment of abdominal incisional hernias]. / Traitement laparoscopique des éventrations de la paroi abdominale.

Current management of incisional hernias is based on the tension free parietoplasty with prosthesis. This option is considered as the gold standard leading to a recurrence rate lower than 10%. Laparoscopic approach involves the placement of a composite intraperitoneal prosthesis obstructing the wall defect without anatomic reconstruction or peritoneal excision. This article describes the standard technique of the laparoscopic insertion of a prosthesis.

[The excluded jejunal loop in the shape of a question mark. A simplified technic]. / Anse jéjunale exclue en point d'interrogation. Une simplification technique.

The question mark-shaped loop is a simplified excluded loop which combines the advantages of being prepared as rapidly as the Tomoda procedure modified by Hivet and of having the same functional benefits as Roux's Y-shaped loop. It is essentially an omega-shaped loop the afferent segment of which is severed a few centimetres upstream of its higher point. The two sections can be sutured manually or with mechanical staplers. The loop can be brought up through the mesocolon as easily as the Y-shaped loop without dissection of the mesentery and can be used to re-establish continuity after total gastectomy. It can also be passed through the mesocolon and behind the stomach to perform hepato-jejunal anastomoses. Finally, it can be used for double or triple derivations in the conservative treatment of chronic pancreatitis.

[Implantable infusion devices. Experience of 360 cases]. / Boîtiers de perfusion implantables. Expérience de 360 cas.

Between january 1, 1983 and december 31, 1986, 360 implantable infusion devices were inserted for systemic chemotherapy. Most of the devices were Port A Cath systems. The main complications observed were thrombosis (18 cases, 5%) and infection (8 cases, 2.2%). Since one year the catheters are being introduced by subcutaneous puncture of the subclavian vein, the chambers being placed in a small lateral subclavicular cavity. Intra-operative radiography is necessary to minimize the risk of malposition and thrombosis. These systems, relayed by external pumps, enable chemotherapeutic regimens to be administered sequentially over a 24-hour period.

[Recurrent inguinal hernia]. / Récidives herniaires.

Inguinal hernias that recur after parietal herniorraphy are still frequent, the mean recurrence figures obtained from a review of the literature being 7.3, 5.2 and 1.1 percent respectively after the Bassini, Mc Vay and Shouldice repair techniques. The variability of bibliographical data and the factors which facilitate recurrence are analyzed; the choice of the approach route and of the most reliable repair technique is discussed. Although the present tendency is increasingly towards the use of preperitoneal prostheses, there is still room for reoperative surgery by the inguinal route, combining herniorraphy with hernioplasty, and without prosthesis.

[Histological study of livers conserved for long periods (author's transl)]. / Etude histologique des conservations hépatiques de lognue durée.

33 pig livers were preserved using two comparative methods: extra-corporeal perfusion and immersion in hypothermia. The duration of conservation varied between 2 and 24 hours. A macroscopic and microscopic study carried out in all cases permitted us to define four cytological stages for the lesions, completed by an ultrastructural study showing the cyto-pathological course of the hepatocytes in two distinct cell series. The interest of this study is to better appreciate the degree of aggression of the lobule in relation to the metabolic gradient and that of the hepatic parenchyma. Analysis of the results is in favour of conservation of the liver by immersion.

[Cancer of the so-called "gastric stump". Review of the literature apropos of 4 cases]. / Les cancers dits "du moignon gastrique". Revue de la littérature à propos de quatre observations.

On the basis of four cases of cancer of the stomach occurring after surgery for benign gastroduodenal lesions, the authors analyse 1690 cases published in the literature. The development of these cancers, which occur much more frequently than in the normal population, is favoured by all of the local pathophysiological consequences of the initial operation, although no one factor is predominant. These cancers have a very poor prognosis, with a mean 5 year survival of 6.9%. These very disappointing results can only be improved by early detection as a result of systematic endoscopic follow-up.

[Superficial cancer of the stomach]. / Les cancers superficiels de l'estomac.

The authors report 17 cases of superficial carcinomas collected amongst a series of 100 gastric carcinomas. Three principal points are analysed: clinical picture, diagnostic and treatment. Clinical problems indicate the multiplicity of classifications used and their sometimes incomplete nature. This led the authors in 1970 to develop a classification with 4 parameters, derived from the T N M classification and from that of Gutmann. The diagnostic problems raises yet again for these superficial carcinomas the need for routine screening which is the only way to increase early diagnoses, and hence the effectiveness of treatment. The therapeutic problem is concerned with the discussion of the limitations of wide excision as a matter of principle.

[Indications and future of the Hartmann operation. Cooperative study of 126 cases (author's transl)]. / Indications et devenir de l'intervention de Hartmann. Etude coopérative de 128 cas.

The main indications for the Hartmann operation are cancer and sigmoiditis. It is done as an emergency in 70% of the time, more often for peritonitis, generally from diverticulitis. (45% of the time) than for occlusion usually due to cancer (30% of the time). The high mortality (33%) is due to the precarious condition of the patients, and only 25% are due to the operation, usually from disruption of the rectal stump. The reestablishment of the intestinal continuity, now facilitated by the clip forceps, was possible in 37 cases with no mortality. This represents 28.9% of the group, but only 52.1% were alive six months later. Only 6.8% of the cancer cases were benefited; however, 51% of the sigmoiditis cases and 87.5% of the cases of traumatic perforation were benefited. These results plus the advantages furnished by the autosuturing forceps justify renewal of interest in this operation first described 60 years ago.

[Pre-operative preparation of the colon: a controlled prospective multicentre study in 215 patients (author's transl)]. / La préparation colique à la chirurgie. Etude multicentrique prospective contrôlée (215 cas).

Three procedures for pre-operative preparation of the colon were compared during a controlled multicentre study in 215 patients. Though mechanical irrigation with a 10 p. cent mannitol solution is definitely superior as far as the degree of intestinal emptying obtained, no significant difference was noted in the frequency or severity os postoperative infections after conventional preparations by digestive tract irrigation with or without intestinal antibiotics. This method is limited by its tolerance (67 p. cent), its advantages are its rapidity and cost, elective indications being ascending colon lesions with little or no stenosis in young subjects. In other circumstances it has to be compared with the conventional methods of preparation, which should still be employed before operation in subjects who are elderly and/or have moderate to severe stenosis. The addition of antibiotics (neomycin, metronidazole by mouth) reduces the incidence of postoperative sepsis to a marked but non-significant degree, independently of the lesion (cancer, sigmoiditis) and its site. A recent study by F. Lazorthes has led him to prefer an association of antibiotics active against aerobic and anaerobic flora: orally preoperatively, and systemically during surgery.