Plug repair of groin hernias: a 10-year experience.

From April 1990 to July 2000 we performed 4,024 hernia operations and implanted 3,332 plugs in groin hernias. This technique was performed on a continuous, progressive basis. Between 1990 and 1994, the percentage of plugs was 67%, with the proportion rising to 92% since 1995. Although we initially used them only for indirect inguinal hernias (1990-1994), in 1995 we began inserting plugs in direct defects [Marlex Perfix Plug, (Bard Company, 78196 Trappes, France) January 1995-July 1997]. On the basis of our own cases of recurrence, we reoperated and modified plugs using a new prosthesis (Obtura Mesh, Cousin Company, Wervicq Sud 559558, France). Maximum follow-up was 10 years, with 84% of the patients followed for more than 1 year. Postoperative mortality was zero, local infection occurred in 20 patients (0.6%) and testicular atrophy was observed with 27 patients (0.8%). The recurrence rate was 1.4%.

[Repair of hernia by a prosthetic dacron plug. Experience with 600 cases]. / L'oblitération de trajets herniaires par bouchon de tulle prothétique. Expérience de 600 cas.

In some cases of inguinal hernia and of recurrence, the hernial gap can be selectively filled with a plug made of tull or dacron. In our opinion, the merit of this technique is that it limits incisions, detachments and structures of muscular and aponeurotic structures. Thus the operation is particularly non-traumatic and well tolerated by patients, who are discharged after 30 to 40 minutes and can often resume work on the very same day.

[Saphenectomy by invagination over thread under local anesthesia (modified J. van der Stricht technic)]. / Les saphènectomies par invagination sur fil sous anesthésie locale (technique de J. van der Stricht modifiée).

The indications of classic stripping have decreased, in the past few years, because of the patients' reluctance for this type of treatment. These legitimate worries have encouraged the recent development of a new simple surgical techniques, using local anesthesia, and often unfortunately at the expense of effectiveness. This is especially true in case of essential varicose veins with valvular incompetency. The saphenectomy by invagination over thread, described by J. van der Stricht in 1962, combines a specific technical procedures (invagination) and systematic use of local anesthesia. This original concept in the surgical treatment of varicose veins responds very well, nowadays, to our concerns for effectiveness, safety, comfort and savings. The atraumatic nature of this procedure allows us to slightly modify the technic of local anesthesia which may be only be outlined along the saphenous vein.

[Surgical management of left colon and rectal radiation injuries (author's transl)]. / Traitement chirurgical des radiolésions du colon gauche et du rectum.

A. First of all, we can affirm after the analysis of 132 records: the predominance of gynecologic cancers and the frequent responsibility of medical associations in the determinism of advanced radiation injuries of colon and rectum; the typically variable appearence of these injuries with an usual delay going from 6 months to a year and limits from 2 months to 35 years; the difficulty of diagnosis between radiation injurie and recurrence of cancer especially in case of fistula and the severe forecost in case of cancer radiation injurie association. B. The surgical management exist only for non-indications and failures of medical treatment; the one stage resection with end to end anastomosis will be made exclusively on advanced, therefore non evolving and limited injuries; in most cases, the multiple stage resection must be preferred: first derivation in selected part (sigmoid or transverse colon) and secondary resection in healthy area; as regards the closure of colostomy, it must never occur before a 6 months delay and anastomosis radiologic check.