Laparoscopic treatment for varicocele.

The study group consisted of 14 male children 7 to 14 years old (mean age 12 years old) who underwent laparoscopic treatment of 15 variococeles between March 1994 and March 1995. The authors describe the technique for laparoscopic ligation of the spermatic vein. This allows easy localization of the enlarged veins on each side and above the internal inguinal ring as well as the presence of collateral veins, which cause recurrence. They use two 5-mm trocars for instrumentation and one 10-mm trocar for the telescope. The technique is simple, inexpensive, and has all the advantages of minimal access surgery.

Laparoscopic treatment of incarcerated posttraumatic diaphragmatic hernia.

An 8-year-old girl was admitted in acute respiratory distress after a direct blunt trauma to the posterior thorax. X-Rays denoted the stomach containing air and fluid within the left thoracic cavity. The authors performed laparoscopic reduction of the hernia and sutured the posterior diaphragmatic rent. The patients condition improved immediately and she was discharged in very good condition 48 h later. The advantages of the technique are presented.

Extramucosal pyloromyotomy by laparoscopy.

Since 1990, we have performed extramucosal pyloromyotomies by laparoscopy in 70 infants presenting with congenital hypertrophic pyloric stenosis. Ever since the first cases, the technique and the instruments have been adapted. The surgical technique and the precautionary measures are here explained again. This technique is beneficial for infants with a better postoperative course and avoidance of any skin scar.

[Pyloric stenosis in infants. Contribution of ultrasonography and video-surgery]. / Sténose du pylore du nourrisson. Apport de l'échographie et de la vidéochirurgie.

Hypertrophic pyloric stenosis is the commonest condition requiring abdominal surgery in infancy. The Fredet-Ramstedt pyloromyotomy gives a very rare morbidity rate as shown by a review of 300 personal cases. The diagnostic value of sonography is gaining significance over contrast roentgenography, a pyloric diameter of more than 14 mm and a muscular thickness of more than 4 mm being required for the diagnosis. Over the last 18 months, we performed extramucosal pyloromyotomies using laparoscopy in 19 infants. This new surgical technique using laparoscopy with precautionary measures for the pneumoperitoneum appears to be very promising and should become a widespread technique in the future.

[An unusual germ causing a limp: Eikenella corrodens]. / Un curieux germe pour une boiterie: l'Eikenella corrodens.

A case of retroperitoneal appendicular abscess due to Eikenella corrodens is reported. This facultative anaerobe is normally found on the respiratory and intestinal mucosa and may be responsible for opportunistic infections. Culture is difficult and growth is slow. There have been few previous reports of the localization reported herein. A limp was the first manifestation of the infection. The differential diagnosis and pathophysiology of this symptom are discussed.

[Contribution of continuous peridural analgesia to neo-natal surgery]. / Apport de l'analgésie péridurale continue dans la chirurgie néo-natale.

UNLABELLED: Continuous epidural analgesia is an common technique in neo-natal surgery. It will be possible with a fitting material. Principal indications are: omphalocele, gastroschisis, oesophagol atresia an diagphragmatic hernia. TECHNIQUE: our protocol has been approved by the Regional Ethical Committee and informed written consent has been obtained from parents. General anaesthesia was induced and children were placed in lateral position. After skin preparation, the interspace L 3-L 4 has been punctured to identify the epidural space by loss of resistance. An epidural catheter (19 to 27 G) has been placed. 0.5 ml.kg-1 of 0.25% bupivacaine have been immediately injected, followed by a continuous injection of 0.3 ml.kg-1h-1 of the same bupivacaine. Epidural has been kept for four to five days. ADVANTAGES: very good analgesia; abdominal and vascular pressures decreased; to wean from respirator very quickly. No accident was founded.

[Surgical treatment of postoperative eventration with a prosthetic grid. 62 cases]. / Cure chirurgicale des éventrations post-opératoires par plaque prothétique. 62 observations.

The treatment of post-operative eventration with major loss of parietal substance often justifies the use of prosthetic material. 62 post-operative patients from a series of 345 benefited from such a procedure. In the majority of cases they were patients who had undergone multiple surgery and also one or many attempts to cure the eventration (55%). The eventrations were of large volume and complex and one or more operative risk factors were present (81%). A Mersilene grid, implanted retromuscularly in all but one case, was the prosthetic material used in 96% of cases. Operative mortality in this series was zero, but unfortunately post-operative hematomas occurred in 27% of cases and one half of these became infected. Recurrent eventration (11%) was seen in all but one case where post-operative infection occurred. In five out of six cases under these circumstances this became apparent during the first post-operative year. The authors stress the fundamental importance of peri-operative care during such interventions; the quality of post-operative results depends, to a large extent, on this care and on the respect of the peroperative technical principles defined by the authors.