[Laparoscopic Hartmann's reversal procedure after volvulus of the sigmoid]. / Retablissement de continuite sous laparoscopie apres Hartmann pour volvulus du sigmoïde.

the authors report the result of their first experiment of re-establishment of continuity colic coelio-assisted after a stomy for volvulus of sigmoid at a 29-year-old patient. The technical realization of the intervention profited from the trade-guild of a team from Dijon (France). Since its creation in 2001 the center of coelio surgery of Bamako in MALI profits from such a support. Technically an separation of the left as of the its gastrosplenic fasteners, pancreatic angle colic and fascia of left TOLD were necessary. Anastomosis was mechanical extra body by minis the pelvic parotomy. The duration of the intervention was of 76 min. The operational continuations were simple. The duration of the hospital stay was 7 days against 10 in the event of traditional re-establishment of continuity in the service. This re-establishment of continuity coelio-assisted mark the beginning of the surgery colic with the young center of Bamako.

Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients.

BACKGROUND AND STUDY AIMS: How to approach common bile-duct (CBD) stones discovered during laparoscopic cholecystectomy (LC) is still a subject for debate. After sequential strategies, the natural trend is now towards single-stage therapy. The aim of this study was to establish the feasibility of intraoperative endoscopic sphincterotomy (IOES) when CBD stones are discovered or strongly suspected on intraoperative cholangiography (IOC) during LC. PATIENTS AND METHODS: Out of a total of 2193 laparoscopic cholecystectomies, we reviewed 57 patients who, between 1991 and 1999, underwent IOES just after LC during the same anesthetic session. Under fluoroscopic guidance, one group of 32 patients (Dijon) underwent IOES in the prone position and a second group of 25 patients (Poitiers) in the left lateral position. RESULTS: IOES was successful in all cases (100%). CBD stones were definitively found in 49 cases (86%) but retrieved or released into the duodenum after IOES in only 46 cases (46/49, 93.9%). The mean duration of the intraoperative endoscopic procedure was 28 minutes (range 15-75). The short-term complication rate was 7%. The mean postoperative hospital stay was 5.3 days (range 2-14). CONCLUSIONS: IOES performed after LC during the same anesthetic session is feasible with low risk and with good results. It offers the opportunity to treat in one stage both cholecystolithiasis and choledocholithiasis without the need for surgical CBD exploration.

Expanded polytetrafluoroethylene patches used in the intraperitoneal or extraperitoneal position for repair of incisional hernias of the anterolateral abdominal wall.

BACKGROUND: Few large studies of the use of expanded polytetrafluoroethylene (ePTFE) in incisional hernia repairs have been done. We performed such a study of ePTFE patches implanted extraperitoneally or intraperitoneally. METHODS: The records of all patients in whom an ePTFE patch was used to repair an incisional hernia in 1987 to 1994 were reviewed retrospectively. RESULTS: An ePTFE patch was implanted in 158 patients, extraperitoneally in 98 and intraperitoneally in 60. There were no perioperative deaths. Serious postoperative complications, including 3 cases of sepsis (intraperitoneally placed patch), occurred in 6 patients (4%). With a mean follow-up of 37 months (range 12 to 90), there were 2 cases of late sepsis (with an extraperitoneal patch) and 6 recurrences (4 with an intraperitoneal patch). CONCLUSIONS: The ePTFE prostheses used in incisional hernia repair are well tolerated in the intraperitoneal position. Their effectiveness in the extraperitoneal position may be comparable to that of mesh but with a lower rate of sepsis.

[Laparoscopic treatment of inguinal hernias by extraperitoneal approach. Technique and results apropos of 864 hernias]. / Traitement laparoscopique des hernies de l'aine par voie extra-péritonéale. Technique et résultats è propos de 864 hernies.

The author presents the technique and intermediate results of retroperitoneal laparoscopic inguinal hernia repair in a series of 864 cases. The retroperitoneal technique is now well defined and the various key points are described. Analysis of the results shows the very good immediate post-operative course and the very low medium-term recurrence rate.

[Two-year results of celioscopic hernioplasties using an intraperitoneal ePTFE patch. A prospective multicenter study of 184 cases. Groupe CHIC (Cure des hernies inguinocrurales sous coelioscopie)]. / Résultats à deux ans des hernioplasties coelioscopiques par patch intrapéritoneal de ePTFE. Etude prospective multicentrique de 184 cas. Groupe CHIC (Cure des hernies inguinocrurales sous coelioscopie).

Two hundred and four groin hernias in 173 patients were laparoscopicaly treated using an intraperitoneal ePTFE patch and prospectively studied. Two patients died for diseases unrelated to their hernia nor their hernioplasty. Eight patients were lost to follow up (5.2%), 163 were followed up for at least 1 year, without recurrence at their last examination, and 155 were followed up for at least 2 years. This study concerns these 155 patients accounting for 184 hernioplasties. Twelve recurrences (6.5%) were found in 11 patients, 10 of 12 occurred within the first year after operation. After each surgeon's 20th hernioplasty the recurrence rate was 3 of 113 hernioplasties (2.6%) (p < 0.05). Late local pain around the patch and its staples was found in 12 patients, slight in 10 cases, mild in 1 case and serious in 1 case. Local hypoesthesia of the upper internal part of the thigh was found in one patient. Not any testicular atrophy, nor intraperitoneal complications were observed. This study suggests that: 1) the 2-year recurrence rate of intraperitoneal ePTFE hernioplasties is not very different, after the learning phase, from those of many other procedures; 2) their expensive price lead to use these techniques only when other efficient procedures are not feasible, for example in the challenged treatment of recurrent hernia after failure of a preperitoneal prosthetic hernioplasty.

[Celioscopic treatment of recurrence of inguinal hernia after insertion of a prosthesis. Value of the intraperitoneal technique with ePTFE patch? Group CHIC (Cure des Hernies Inguino-Crurales sous Coelioscopie)]. / Cure coelioscopique des récidives sur prothèse des hernies de l'aine. Intérêt de la technique intra-péritonéale avec patch de ePTFE? Group CHIC (Cure des Hernies Inguino-Crurales sous Coelioscopie).

From April 1993 to December 1994, 14 failures of classic prosthetic herniorraphies in 13 patients (13 men) were treated by a laparoscopic intraperitoneal onlay mesh technique (IPOM) using an ePTFE patch. The mean age of these patients was 55.69 +/- 13.11 years (28 to 70). The mean operating time was 72.5 +/- 24 mn (40 to 120). The technique could not be performed in one case. The mean postoperative pain at D1, evaluated by a visual analog scale graduated from 0 to 10 was 2.36 (2 to 3). The mean hospital stay was 1.64 days (1 to 3). One inguinal hematoma occurred and resolved after a short incision. The mean time to return to work or normal activity was 12.14 +/- 7.25 days (3 to 30). All patients were reviewed. The mean follow-up was 13.37 +/- 2.87 months (6 to 25). No testicular atrophy was observed. One recurrence occurred at M6 treated at M9 by an open procedure. Our study suggests that this technique, avoiding extensive preperitoneal dissection, thus decreasing vascular and genital risks, would be useful in the treatment of failures of prosthetic herniorraphies.

[Celioscopic treatment of inguinal hernias by intraperitoneal patch of ePTFE according to Spaw. Preliminary results of a prospective study of 162 hernioplasties in 135 patients. Groupe CHIC (Cure des hernies inquinocrurales sous coelioscopie)]. / Cure coelioscopique des hernies de l'aine par patch intraperitonéal de ePTFE selon Spaw. Résultats préliminaires d'une étude prospective de 162 hernioplasties chez 135 patients. Groupe CHIC (Cure des hernies inguinocrurales sous coelioscopie).

Spaw's (original and modified) was technique evaluated in a prospective, multicentre study: from november 1992 to september 1993, 162 intraperitoneal laparoscopic herniorraphies were carried out in 135 patients for recurrent hernias or for hernias associated with a high risk of recurrence. Three needed an open procedure. Three early complications (2 periprosthetic hematomas, 1 microscopic bladder injury) were treated by another laparoscopy; a bowel loop retained in a trocar orifice was reintegrated under local anesthesia; dysesthesias of the lateral cutaneous nerve of the thigh in 1 patient and nonspecific parietal pain in 2 patients resolved within three weeks. Three seromas resolved after only one percutaneous aspiration. The mean post operative pain, evaluated by a visual analogic scale graduated from 1 to 10 was 1.8 (0 to 6) at D1, 05 (0 to 2) at D2 and the mean duration of analgesic requirments was 1.7 (0 to 15) days. The mean hospital stay was 2 (1 to 17) days for unilateral herniorraphies and the mean time to return to work or normal activity was 10 (2 to 44) days, even in heavy workers (35 patients). All patients were reviewed. The mean follow-up was 4 (1 to 10) months. Two complications needed further laparoscopic treatment: 1 recurrence at the internal edge of the patch, easily restapled with a stronger stapler, 1 bowel adhesion between patch and bladder revealed by pain without obstruction. The recurrence rate was 0.6% (1/162). The conversion rate was 2% (3/162) and the overall morbidity was 7.5% (12/162), decreasing respectively to 0 and 4% after the learning curve. This study confirms that Spaw's technique and its variant are feasible, and allows us to continue this study, and suggest these techniques would be useful in the treatment of some recurrent inguinal hernias.

Laparoscopic extraperitoneal treatment of inguinal hernias in adults. A series of 200 cases.

Laparoscopic repair of 200 inguinal hernias by the preperitoneal approach is described. The technique uses a large mesh either of polypropylene or of ePTFE-Goretex. The average duration of the procedure was 45 minutes for unilateral hernias and 71 minutes for bilateral hernias. Postoperative pain was minimal and complications rare (no infection, one deep vein thrombosis). The mean duration of hospital stay was 44 hours. At a maximum follow-up of 22 months only one hernia has recurred. This technique of hernia repair has the advantage of minimal postoperative pain and early return to work with minimal recurrence of the hernia.

[Peritoneovenous shunt (Leveen's valve) : need for radiological control of the position of the distal tube during operation (author's transl)]. / Shunt péritonéo-veineux (valve de Leveen). Nécessité d'un contrôle radiologique per-opératoire de la position du tube distal.

The observation of 3 cases with dysfunction of a peritoneovenous shunt due to malposition of the distal tube suggests the need for systematic radiological control of the position of tube in the superior vena cava during the operation. In patients with postoperative dysfunction the first step should be opacification of the distal tube by transcutaneous puncture in order to locate the site of the proximal or distal obstruction and to decide on the further operative procedures necessary (replacement of the value or the distal tube).

[Severe digestive hemorrhage from ulcers on the posterior surface of the first part of the duodenum: clinical aspects and therapeutical results in 107 cases (author's transl)]. / Les hémorragies graves des ulcères de la face postérieure du premier duodénum. Problèmes pratiques et données actuelles du traitement. A propos de 107 cas.

The mode of onset, and clinical, radiological, and endoscopic findings in 107 cases of digestive hemorrhage are described, as well as variations in the period elapsing between onset and surgical intervention. Indications for surgery and the results obtained are analyzed. Operation consisted of subdiaphragmatic truncal vagotomy in 74 cases (followed by pyloroplasty in 68 and gastroenterostomy in 6 cases), gastroduodenal resection in 23 cases (with subsequent gastrojejunal anastomosis in 17 and gastroduodenal anastomosis in 6 cases), resection for exclusion operation as described by Finsterer in 8 patients, and highly selective vagotomy with pyloroplasty in 2 cases. Hemorrhage reoccurred in 12 patients (11.2 p. cent), after vagotomy and pyloroplasty in 11 patients (with 3 deaths), and one case after resection. Of the 8 early relapses, 4 were treated medically, leading to 2 recoveries and 2 deaths, the other 4 patients being treated by gastroduodenal resection, with subsequent recovery in 5 cases and one death. The 4 patients with late recurrences were successfully treated medically (2 cases) or surgically (2 cases). Though Weinberg's operation can still be considered as the basic operation in patients with hemorrhage from ulcers on the posterior in patients with hemorrhage from ulcers on the posterior wall of the duodenum, immediate gastric resection is still a valid procedure for large ulcers with thickened walls. Early relapse of hemorrhage after Weinberg's operation should be treated by resection.