Is histological analysis of pilonidal sinus useful? Retrospective analysis of 731 resections.

The pilonidal sinus (SP) is a common pathology. The treatment is a surgical excision. Many surgeons continue to systematically send this SP in histological analysis. The objective of our retrospective study was to evaluate the interest of this systematic histological analysis. The retrospective analysis of patients undergoing surgery was performed between 1 January 2006 and 31 December 2014. The primary observation was the presence of a malignant disease on the surgical specimen. Secondary observations were the wound healing time and the rate of recurrence. Seven hundred and thirty-one patients were analyzed. There was no malignant lesion. For 323 patients, the histological analysis did not describe the resection margins. Two hundred and eighty five patients had complete resect on and 38 were incomplete. Twenty-four patients had recurrence (7%). There was no significant difference between those who had complete and incomplete resection. The healing time was 61 days. Our study raises the question about the value of systematic histological analysis of the PS specimen.

Laparoscopic incisional hernia repair: long term results.

OBJECTIVE: The aim of this prospective monocenter study was to evaluate the long-term results of laparoscopic treatment of incisional hernias using intra-peritoneal prosthetic mesh. PATIENTS AND METHODS: Seventy-seven patients underwent laparoscopic treatment of incisional hernia between January 2002 and January 2008. All patients were followed for at least five years after surgery. The parameters assessed were hernia recurrences and post-operative pain. In case of doubt as to the diagnosis of recurrence or pain, a CT examination was performed. RESULTS: Nine patients were excluded: four patients refused to participate in the study and five died of unrelated disease during follow-up. Sixty-eight patients (89.7%) were followed for a mean of 92.3 (± 19.8)months. Mean age of patients was 58 (± 11.3)years. There were no deaths and no conversions. The mean operative time was 104 (± 48)minutes. The morbidity rate was 13.2%. Major complications included one case each of mesh infection, post-operative peritonitis (bowel injury), and surgical site pain requiring revisional surgery. Five patients developed seroma. The mean duration of hospitalization was 4.5 (± 2.3) days. The long-term recurrence rate was 8.8%. The average interval to onset of recurrence was 45.8 (± 31.1)months. Trocar site hernias were observed in three patients. Four patients had post-operative pain requiring long-term medical treatment. CONCLUSION: Laparoscopic incisional hernia repair using intra-peritoneal prosthetic mesh is a safe technique with satisfactory long-term outcome. One major complication occurred: bowel injury. Suture closure of 10mm trocar sites should be routine.

[Ruptured hepatocarcinoma. Report of 20 cases and review of the literature]. / Les hépatocarcinomes rompus. Rapport de 20 observations et revue de la littérature.

Hepatocellular carcinomas may rupture in rare cases (5 to 15%) creating a serious short-term and mid-term situation. Over a period of 10 years, 20 patients (19 males, 1 female, mean age 68 years, range 38-82) were treated for ruptured hepatocellular carcinoma involving a cirrhotic (ethylic) liver in 12 cases, haemochromatosis in 2 and a normal liver in 6. Twelve patients underwent emergency surgery for acute haemoperitonium operation was delayed until after exploratory investigations (CT scan and arteriography +/- embolization) for pain in the right hypochondria associated with partitioned effusion and anaemia. The diagnosis of cancer had been known in 5 patients and rupture was the first manifestation in 15 others. Emergency procedures, 7 excisions, 3 sutures, were performed but 2 patients died during vascular clamping. Four deaths occurred within 8 days due to liver failure. There were no postoperative deaths after programmed procedures, 6 excisions, 1 ligature. One patient underwent embolization peroperatively and died 6 days later due to digestive haemorrhage and liver failure. Lesions were localized in the left liver (9), right liver (6) and in both with multiple nodules (5). Among the 13 survivors, 7 died within a delay of 2 to 30 months, 1 due to recurrent rupture (5%). Six patients are still living with a follow-up of 3 to 36 months (including 2 hepatocellular carcinomas on a healthy liver and 1 with haemochromatosis). A review of the literature confirms the severity of such events whatever the initial management. Acute rupture of hepatocellular carcinoma usually requires emergency procedures with a high risk of mortality (50%). Fissuration authorizes explorations and possibly peroperative embolization with better immediate results.

[Posterior fundoplication of 270 degrees. pH results after one and 5 years]. / Fundoplicature postérieure de 270 degrees. Résultats ph-métriques à 1 an et 5 ans.

This prospective study compared pre- and postoperative pH monitoring one and five years after a 270 degrees posterior fundoplication. Thirty-six consecutive patients with gastroesophageal reflux were included over a period of 3 years. All patients had preoperative esophagoscopy and 3 hour post-prandial pH monitoring. Thirty-three patients had esophagitis. At one year follow-up, pH monitoring was performed in 31 patients and esophagoscopy in 29. At five years, 23 patients accepted a new pH control. Appraisal of efficacy was assessed by Kaye's acid reflux score (normal < or = 90) and the percentage of time (t) below pH 5 (normal < or = 10%). Among the 23 patients who were submitted 3 times to pH monitoring, Kaye's acid reflux score evolved from 149 (+/- 68) before fundoplication to 1.1 (+/- 2) and 16 (+/- 29) after one and five years respectively. The value of t decreased from 20% (+/- 16) to 0.4% (+/- 0.8) after one year and to 2.5% (+/- 3) after five years. The 270 degrees posterior valve corrects pH recordings at one year. Its efficacy remained steady after 5 years, although there was a slight increase in acid reflux scores. The mean value of these scores was always within normal limits.

[Left pancreatectomy with preservation of the spleen without its pedicle. Apropos of 13 cases]. / Pancréatectomies gauches avec conservation de la rate sans son pédicule. A propos de treize cas.

Overwhelming post splenectomy infections in childhood were first described by King and Shumaker in 1952. This septic risk, although a matter of controversy, also exists in adults. Thus, splenic conservation must become a surgical concern in left pancreas resections for benign or traumatic diseases. The authors report their experience with a simplified procedure in which the splenic pedicle is resected "en bloc" with the left pancreas. This technique has been employed in thirteen patients, in whom spleen could be preserved in twelve, without operative mortality and a low morbidity rate.