[The ilioinguinal and iliohypogastric nerves. The anatomic bases in preventing postoperative neuropathies after appendectomy, inguinal herniorraphy, caesareans]. / Nerfs Ilioinguinal et Iliohypogastrique. Bases anatomiques de prévention des névralgies résiduelles après appendicectomies, cure de hernies inguinales, césariennes.

STUDY AIM: To identify danger areas in surgical incisions (appendectomy, inguinal and Pfannenstiel incisions) by mapping the course of ilioinguinal and iliohypogastric nerves. MATERIAL AND METHODS: The courses of the ilioinguinal and iliohypogastric nerves from 37 unembalmed adult cadavers were mapped from their lateral emergence on the internal obliquus nerve to their midline termination in reference to anatomic landmarks (anterior superior iliac spine, midline, upper border of the pubic symphysis). With use of a mapping technique, the standard courses of both nerves were compared with sites of standard abdominal surgical incisions. RESULTS: Sixty seven ilioinguinal and sixty four iliohypogastric nerves were identified and mapped. On average the ilioinguinal nerve perforated the internal obliquus muscles 3.30 cm medial and 3.27 inferior to the anterior superior iliac spine, and terminated its course 2.50 cm lateral to the midline and 1.92 cm superior to the upper border of the pubic symphysis. On average the iliohypogastric nerve perforated the internal obliquus muscles 2.30 cm medial and 1.20 cm inferior to the anterior superior iliac spine, and terminated its course 3.10 cm lateral to the midline and 4,80 cm superior to the upper border of the pubic symphysis. CONCLUSION: Surgical incisions performed below the level of the anterior superior iliac spine carry the risk of injury to the ilioinguinal and iliohypogastric nerves.

Nerfs ilioinguinal et oliohypogastrique. Bases anatomiques de prévention des névralgies résiduelles après appendicectomies; cure de hernies inguinales; césariennes

But : Determiner des zones a risque en evaluant le trajet des deux nerfs par rapport aux incisions parietales abdominales classiques. Materiel et methodes : Le trajet des nerfs ilioinguinal et iliohypogastrique a ete etudie chez 37 sujets anatomiques adultes; non embaumes; de mort recente; par dissection des regions inguinales. Les points d'emergence des nerfs au niveau du muscle oblique interne et les points de terminaison ont ete determines. Ont ete mesurees les distances de ces points d'emergence et de terminaison par rapport a l'epine iliaque antero-superieure; a la ligne mediane et au bord superieur de la symphyse pubienne. Ont ete egalement mesurees les distances entre les epines iliaques antero-superieures; entre les epines iliaques antero-superieures et l'ombilic; entre le bord superieur de la symphyse pubienne et l'ombilic. Sur un schema etabli a partir des diffe- rents reperes anatomiques et mesures moyennes; le trajet standard des deux nerfs etait compare aux incisions parietales abdominales classiques. Resultats : Le nerf ilioinguinal etait retrouve dans 67 cas; le nerf iliohypogastrique dans 64 cas. Le trajet de ces nerfs etait extremement variable. L'emergence du nerf ilioinguinal au niveau du muscle oblique interne etait situee a 3;30 cm en dedans et a 3;27 cm en dessous de l'epine iliaque anterosuperieure. La terminaison du nerf ilioinguinal etait situee a 2;50 cm en dehors de la ligne mediane et a 1;92 cm au-dessus de la symphyse pubienne. L'emergence du nerf iliohypogastrique au niveau du muscle oblique interne etait situee a 2;30 cm en dedans et a 1;20 cm en dessous de l'epine iliaque antero-superieure. La terminaison du nerf iliohypogastrique etait situee a 3;10 cm en dehors de la ligne mediane et a 4;80 cm au-dessus de la symphyse pubienne. Conclusion : Les incisions chirurgicales faites dans la region hypogastrique; au-dessous de la ligne biiliaque comportent un risque eleve de lesion des nerfs ilioinguinal et iliohypogastrique

[Voluminous right scrotal inguinal hernia: interest in treatment of the hernia without tension according to Lischtenstein technique--an observation]. / Volumineuse hernie inguino scrotale droite: interet du traitement sans tension des hernies de l'aine selon la technique de Lichtenstein--une observation.

We report the observation of right scrotal ingino hernia (tropical hernia) on a young subject of 31-years-old. Tropical hernia have become rare and are faced with a therapeutic taking charge of problem. This tropical hernia has been treated by the settlement of a prosthesis without tension according to Lichtenstein technic. It's about a simple technic of rapid realisation which gives good results and a long term recurrence rate, under 1%.

[Results of the surgical treatment of hemorrhoids according to Milligan and Morgan technique - report of 56 cases]. / Resultats du traitement chirurgical de la maladie hemorroidaire belon la technique de Milligan et Morgan--a propos de 56 cas.

AIM OF THE STUDY: To study the results of the surgical treatment of haemorrhoid disease according to Milligan and Morgan technique. MATERIAL AND METHOD: It is about a retrospective study in the unit of the digestive surgery of the teaching hospital of Braszaville. From March 1992 to february 2002, 56 patients who had hemorrhoid disease have undergone a pedicular hémorroïdectomy of Milligan and Morgan type. The diagnosis of the hemorrhoid has been established from the clinical and endoscopic elements in the search of associated lesions. RESULTS: There were 36 men (64.28%) and 20 women (35.72). The average age of our patients was 36 years old (extremes: 18 and 62 years old). Post surgical effects have been simple in 52 cases and complicated in 4 cases. 2 cases of anal oozing with an occasional incontinence of having wind and 2 cases of post surgical stenosis. No death has bees noticed. The average time spent in hospital was five days. (Extremes: 6 and 11 days). There was no case of surgical resumption. At the functional level was the disappearance of pains, hemorrhoid and prolapse. CONCLUSION: The pedicular haemorrhoidectomy of Milligan and Morgan is a well codified surgery where good results are provided.