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Résumé: But de l’étude. – La mise en place d’un renfort de paroi en situation intrapéritonéale dans le traitement des éventrations est une option thérapeutique, qui présente l’avantage de diminuer la dissection, de réduire la durée opératoire et la douleur postopératoire. Il est cependant rapporté un taux plus important d’adhérences viscérales. Pour pallier cet inconvénient, une prothèse recouverte sur une face par un film hydrophile résorbable (Parietex® Composite) a été proposée. Le but de cette étude a été de comparer le taux d’adhérences viscérales par détection échographique après utilisation d’une prothèse en polyester versus utilisation de la prothèse hydrophile. Patients et méthode. – Vingt-six patients ayant reçu une prothèse Parietex® Composite ont été prospectivement comparés à une série rétrospective de 26 patients asymptomatiques ayant reçu une plaque Mersilène®. Pour détecter les adhérences viscérales, nous avons utilisé un examen échographique qui a été dans un premier temps validé dans les deux groupes en comparant les données échographiques préopératoires aux données macroscopiques peropératoires, puis utilisé pour comparer ces deux groupes. Résultats. – Avec un suivi moyen de 33 mois, les deux groupes étaient équivalents en termes de critères d’inclusion sauf pour l’âge qui était plus élevé dans le groupe Mersilène®. Pour la détection des adhérences intrapéritonéales, l’échographie avait une sensibilité de 72 %, une exactitude de 69 % et une valeur prédictive négative de 67 %. En utilisant l’échographie, 81 % des patients du groupe Mersilène® présentaient des adhérences versus 27 % dans le groupe Parietex® Composite (p = 0,0002, χ2). Conclusion. – L’échographie semble fiable pour la détection des adhérences intrapéritonéales postopératoires. Une réduction significative du taux d’adhérences dans le groupe Parietex® Composite a été montrée. [Copyright &y& Elsevier]

Because of the increase of ultrasonographic exams, nonparasitic cyst of the liver is frequently encountered. Some giant cysts have complications. The surgical treatment for complicated forms consists in resection of the protruding part. We report a case of a giant non parasitic cyst of the liver which was responsible of a compression of the inferior vena caval with thrombus. The resection of the thrombus was performed after a double control of the veina cava and a control of the aorta. The fenestration of the cyst was performed in a second time. [Copyright &y& Elsevier]

Introduction. – The aim of this retrospective study was to evaluate the immediate and long-term outcome of pancreaticojejunostomy (PJ) in the treatment of chronic pancreatitis.Material and methods. – From 1980 to 1997, 140 patients with chronic pancreatitis with dilated Wirsung duct were treated by PJ and were studied retrospectively. There were 123 men and 17 women, with a mean age of 46 years (range: 18–79 years). Ongoing alcoholic addiction was present in 116 patients (83%). Chronic pain uncontrolled by major analgesics was the indication of PJ in 126 patients (90%).Results. – The mortality rate was 1.4% (n = 2). The morbidity rate was 11% (n = 16). Mean hospital stay was 16 days (range: 8–25 days). The mean follow-up was 7.4 years (range: 2–15 years) in 94 patients. Functional results were good or mild in 93% of cases (n = 87). In seven patients (7%), the results were bad with persistence of chronic pain requiring major analgesics. A mean weight increase of 5.8 kg (range: 1–16 kg) was observed in 74 patients (79%). Twelve patients (13%) developed de novo diabetes mellitus. In the 43 patients with preoperative diabetes, 24 patients suffered deterioration of their status. No patient recovered from exocrine insufficiency.Conclusions. – In case of dilated Wirsung, PJ must be indicated preferentially because of its good efficiency on pain relief with low mortality and morbidity rates. [Copyright &y& Elsevier]

Purpose of the study. – To assess clinical, therapeutic and diagnostic findings of strangulated obturator hernias.Patients and method. – Retrospective study of 17 patients (16 women, 1 man; average age: 81.7 years), all treated in the same service, for strangulated obturator hernia. The studied criteria were: clinical characteristics (general status, obstruction, sign of Romberg-Howship), morphologic exams, mean delay for surgical treatment, and occurrence of postoperative complications.Results. – The clinical examination revealed small bowel obstruction in 94% of the patients (n = 16) and incomplete obstruction in 1 patient; 23.5% of the patients presented a sign of Romberg-Howship. A major slimming was observed in 82% of the cases. A computed tomography, performed in 3 patients, showed the presence of air in the under-pubic channel. Preoperative diagnosis of obturator hernia was suspected in 23.5% of the cases. Surgical treatment was performed after a mean delay of 5.3 d. The mortality and morbidity rates were respectively 35 and 18%.Conclusion. – Due to the low specificity of clinical examination, preoperative diagnosis of obturator hernia remains difficult. Computed tomography can be of great help for the diagnosis. Any therapeutic delay increasing mortality rate, surgery is mandatory in case of small bowel obstruction in order to make the diagnosis and the treatment of such rare pathology. [Copyright &y& Elsevier]

The authors report two cases of gallbladder volvulus. The diagnosis of this rare pathology is mainly identified preoperatively. Ultrasonographic findings include a "floating gallbladder" with thickened hypoechoic walls. The treatment is emergency cholecystectomy.

Aim: The aim of this study was to determine the results and the complications of the treatment of hemorrhoids with circular stapler with a follow-up of 18 months, and to review the complications in the literature., Methods: From April 1998 to August 1999, 140 patients (83 males and 57 females) with an average age of 43.8 years (range: 19-83 years) underwent haemorrhoidectomy using a circular stapler in three university hospital centers. The degree of hemorrhoids has been classified: three cases of degree II, 97 cases of degree III, and 40 cases of degree IV. All the patients were prospectively evaluated at two weeks, two and 18 months after surgery., Results: The average length of the operation was 18 minutes (range: 8-60 minutes). Mean hospital stay was 36 hours (range: 8-72 hours). There was no intraoperative complication. There was no mortality. The postoperative complication rate was 7.8% (N = 11): there were five cases of bleeding that two complicated by a submucosal hematoma (one was infected and needed a rectotomy on day 21), two cases of urinary retention, and two cases of external hemorrhoid thrombosis. The bleeding occurred in the 12 hours after surgery except for one patient with antivitamin K whith presented a secondary bleeding on day 16. At 18 months, five patients presented a moderate asymptomatic stricture dilated on digital examination. Two patients complained of persistent skin tags. Neither functional trouble nor incontinence to gas, liquids, or solids was presented. With a mean follow-up of 40 months, 90% (N = 112) of the patients were fully satisfied., Conclusions: Treatment of hemorrhoids with circular stapler appears to be effective with 96% of patients fully satisfied at 18 months. The morbidity rate was low, and no higher than the diathermy excision hemorrhoidectomy. The results are directly dependent on the practice that required a learning, and not on the technique itself.

Aim of the Study: Intraperitoneal (IP) ventral hernia repair is advantageous because of reduced dissection, shorter operative time and less postoperative pain. However, the IP positioning of the mesh is suspected to increase the risk of visceral adhesion and induce complications. To overcome these drawbacks, an innovative mesh: Parietex Composite (RC) was developed with one side protected by a hydrophilic resorbable film. The purpose of this study was to compare using ultrasonography the rate of visceral adhesions after IP placement of a conventional mesh (RP) versus RC mesh., Patients and Methods: Twenty-six patients who received a Parietex Composite were prospectively compared to a retrospective series of 26 consecutive asymptomatic patients who received a non protected polyester mesh (RP). In order to objectively assess visceral adhesion toward the abdominal wall, an ultrasound specific examination was used after previous validation by comparison of preoperative ultrasonographic data with peroperative gross appearance in both groups., Results: With a mean follow up of 33 months, both groups were equivalent in term of inclusion criteria excepted for age which was older the RP group. US validation data were: sensitivity 72%, accuracy 69%, negative predictive value 67%. Using this procedure, 81% of the patients exhibit visceral adhesion to the mesh in the RP group, versus 27% in the PC group (P =0.0002, chi2)., Conclusion: US examination represents a suitable tool to evaluate postoperative adhesions to the abdominal wall. A significant reduction of visceral adhesion in the RC group was shown.