International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery.

PURPOSE: To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. METHODS: A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidence-based literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question. RESULTS: A consensus was reached regarding a definition of chronic groin pain. The recommendation was to identify and preserve all three inguinal nerves during open inguinal hernia repair to reduce the risk of chronic groin pain. Likewise, elective resection of a suspected injured nerve was recommended. There was no recommendation for a procedure on the resected nerve ending and no recommendation for using glue during hernia repair. Surgical treatment (including all three nerves) should be suggested for patients who do not respond to no-surgery pain-management treatment; it is advisable to wait at least 1 year from the previous herniorraphy. CONCLUSION: The consensus reached on some open questions in the field of post-herniorrhaphy chronic pain may help to better analyze and compare studies, avoid sending erroneous messages to the scientific community, and provide some guidelines for the prevention and treatment of post-herniorraphy chronic pain.

[Incarceration of a calibrating band after vertical banded gastroplasty for morbid obesity: diagnostic and therapeutic implications]. / Incarcération d'une bandelette de calibrage après gastroplastie verticale calibrée pour obésité: implications diagnostiques et thérapeutiques.

About a case of migration of the strip of grading placed during a gastroplasty, and revealed by a severe complication on the occasion of the transformation of a typical Mason gastroplasty in Mac Lean gastroplasty, we formulate the following propositions: 1) The staple line dehiscence of Mason's vertical gastroplasty can be bound (connected) to an excessive tightening of the strip and let us suggest lengthening (stretching out) his 2 cm length with regard to the usually recommended dimension. 2) It is necessary to look for systematically this confinement, in case of reintervention for staple line dehiscence; to ignore it is to expose itself, if we transform the Mason surgery into Mac Lean surgery, to deteriorate a fistula which the staple line dehiscence had until then contributed to hide (darken).

[How to manage biliary injuries caused by Dormia catherers?]. / Comment gérer les plaies biliaires induites par la sonde de Dormia?*

The authors report the complications of intraoperative biliary exploration, particulary for the utilisation of basket Dormia. If the biliary injury, in general, are an problem for the surgeon, the especific injury for the basket Dormia are underestimate. The authors makes, for theirs observations, an review of the literature and an clasification anatomical-clinic are propose for help therapy repair.

[Treatment of inguinal hernias by Mc Vay's technique. Apropos of 1332 cases]. / Traitement des hernies de l'aine par la technique de Mc Vay. A propos de 1332 cas.

Surgical repair of inguinal hernias still constitutes an unresolved problem, which has been brought up to date by the introduction of laparoscopic surgery as a treatment option. The objective of this study, based on 1332 "first-hand" hernias, operated by the same operator from 1979 to 1992, was twofold: -to determine whether Mc Vay's technique is suitable for simple hernias, -to prevent, by means of a technical modification, introduced in the middle of the study (1st January 1985), the development, which we consider to be frequently underestimated, of residual pain and long-term functional sequelae, which impair the results of herniorraphies. This modification consists of the deliberate dissection and preservation of all of the nervous network of the groin. The recurrence rate was less than 3%. Mc Vay's technique is perfectly suitable for external oblique hernias and direct hernias, which represent 90% of all hernias. On the other hand, very large hernias with abdominal wall deterioration or recurrent hernias, especially when the initial surgical repair appeared to be satisfactory, would be better treated by direct or retroperitoneal insertion of a prosthesis. Systematic complete nerve preservation decreased residual pain. The frequency of all forms of functional symptoms and pain was divided by a factor of 3. Minor symptoms, often minimal and transient, decreased from 24% to 8%, but, most importantly, major symptoms, discomfort on effort, persistent and disabling pain, decreased from 3% to 1%. The results were considered to be good or excellent in 96% of cases.

[Acute Budd-Chiari syndrome of traumatic origin]. / Syndrome de Budd-Chiari aigu d'origine traumatique.

The diagnosis of Budd-Chiari syndrome is based on clinical signs including liver enlargement and ascitis and findings of complementary examinations: echography, echo-Doppler, CT-scan, magnetic resonance imaging, angiography, pressure readings, laparoscopy and biopsy. Trauma is rarely reported as a cause of acute Budd-Chiari syndrome. In some cases, the trauma is so violent the supra-hepatic veins are ruptured and the dramatic outcome leaves no time for the syndrome to develop. In others, the resulting haematomas form a compression block of the suprahepatic vessels. The mechanism of the trauma in our case appears to have been unreported to date. Four days after a violent motorcycle accident, a 33-year-old man developed an acute Budd-Chiari syndrome probably due to partial and temporary thrombosis of the left and middle suprahepatic veins. A side-to-side porto-cava anastomosis with a calibrated venous graft was performed in an emergency procedure. Outcome was quite favourable and after a 4 year follow-up, the patient is in good health.

[The contribution of gallbladders' infusion tomography in the diagnosis of acute cholecystitis (author's transl)]. / Diagnostic des cholécystites aiguës par pariétographie vésiculaire. 82 observations.

The detection of opacification of the wall of the gallbladder after the intravenous injection of hydrosoluble iodinated contrast medium (gallbladder parietography) was sought in 82 patients suspected of suffering from acute cholecystitis. In 35 cases, the examination was negative and operation or the clinical course made it possible to eliminate the diagnosis of acute cholecystitis. In 47 cases, it was positive. The diagnosis was confirmed in 39 cases out of 40 patients undergoing surgery. The appearance of the opacification makes it possible to distinguish two types of positive gallbladder parietography: -- with a thin wall and gallbladder of normal size, corresponding to moderate inflammatory lesions; -- with a thickened wall associated with a large gallbladder corresponding to major inflammatory lesions. The examination is simple, reliable, may be carried out as an emergency and combined with intravenous urography. The diagnosis of acute cholecystitis may be made in difficult causes, and appropriate therapeutic steps taken.