[Fistula between Wirsung and psoas muscle]. / Fistule wirsungopsoïque. A propos d'un cas.

We describe a rare case of fistula between the Wirsung duct and the right psoas muscle. The initial clinical presentation was localised in the thigh and successful treatment was achieved by exclusive mini-invasive techniques.

[Percutaneous ultrasound-guided drainage in the surgical treatment of acute severe pancreatitis]. / Place du drainage percutané échoguidé dans le traitement chirurgical de la pancréatite aiguë grave.

AIM OF THE STUDY: To report results of percutaneous ultrasound-guided drainage, performed by a surgeon, in the treatment of complications of acute pancreatitis (AP), and to determine the role of this technique in the therapeutic armamentarium of severe AP. PATIENTS AND METHODS: From 1986 to 2001, 59 patients were included in this retrospective study. All patients initially had severe necrotizing AP (mean Ranson score = 4.1 ; range : 2-7). Anatomical lesions included pancreatic abscess in 6 patients and necrosis in 53 (17 stage D and 36 stage E according to Balthazar's classification). Necrosis was infected in 42 and sterile in 11 respectively. Drainage was performed under ultrasound guidance and local anaesthesia using small-diameter drains (7-14 French). RESULTS: Drainage was performed on average 23 days after onset of AP. Infection was proven by fine-needle aspiration in 47 (80 %) patients (41 infected necrosis and 6 localized abscess). In one patient, culture of aspirated fluid was negative but necrosis was infected (one false negative). Culture of aspirated fluid was negative and necrosis was sterile in 11 patients. Nineteen (32%) patients healed without subsequent surgery: 7 (16%) in the infected necrosis group, 6(55%) in the sterile necrosis group, and 6 (100%) in the abscess group. Forty (68%) patients had subsequent necrosectomy including 8 (14%) who died. Twenty (34 %) digestive fistulas healed spontaneously, except one treated by diversion stomia. Of the 16 (27 %) pancreatic fistulas, 6 needed subsequent interventional treatment. CONCLUSION: In selected patients, percutaneous drainage can represent an alternative to surgery with a 14% mortality rate. The high rate of subsequent necrosectomy suggests that drains with larger diameter, possibly associated with continuous irrigation, should be used.

[Retromuscular prosthetic repair: experience from France]. / Retromuskuläre Netzplastik: Erfahrungen aus Frankreich.

Large incisional hernias cannot be cured without prosthetic material. A large pore size prosthetic tissue seems to be the best alternative, since connective invasion of the mesh provides a very strong fixation of the prosthesis. In our view, the mesh should be placed in the rectus sheath, in a position we have described as "retromuscular prefascial". With this technique, a good result can be achieved in 98% of very large incisional hernias.

[Identification of recurrent inferior laryngeal nerve during a thyroid lobectomy]. / La recherche du nerf laryngé inférieur ou récurrent lors d'une lobectomie thyroïdienne.

Based an their findings during thyroid operations and pathological examination of 100 specimens, the authors report the principal steps for identification and dissection of recurrent nerve during a thyroid lobectomy.