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Introduction: congenital diaphragmatic hernia has been rarely reported in Africa. It can manifests early or late. Prognosis mainly depends on associated malformations. The purpose of this study is to report our experience in the Albert Royer National Children's Hospital, Dakar, Senegal. Methods: we conducted a retrospective study of patients treated for congenital diaphragmatic hernia between January 2010 and December 2019. Results: twelve patients were enrolled, with an average age of 8.9 months. Bochdalek hernias were detected in 10 patients. The most common symptoms were respiratory symptoms (83.3%), followed by digestive symptoms (41.6%). Thoraco-abdominalX-ray was used to make a diagnosis in all patients. Three patients underwent preoperative stabilization. All patients underwent laparotomy. Hernia sac was found in 10 patients, and 50% of patients had a defect measuring between 5 and 10 cm. The postoperative course was simple in 10 patients; a polymalformed patient died. Conclusion: congenital diaphragmatic hernia is a reality in our environment; it most often manifests beyond the neonatal period. Prognosis is generally good in our context. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the diagnostic, therapeutic and evolutionary aspects of female inguinal hernia (ovarian hernia). Patients and methods: This was a prospective and descriptive study lasting 6 years (1st January 2014 to 31st December 2019). It included all girls aged 0 to 15 years old with ovarian hernia, received in the pediatric surgery department of the Hôpital National AmirouBoubacar Diallo in Niamey. The variables studied were the socio-demographic characteristics of the patients, personal and family history, and those related to diagnostic, therapeutic and evolutionary aspects. Results: With 23 recorded cases, ovarian hernia had a hospital frequency of 8.7%. The average age of the patients was 5.6 years (range: 4 months and 11 years). The average duration of evolution before diagnosis was 8 months (range: 0 days and 36 months). The hernia was mainly located on the right side: 14 cases (60.85%). The hernial sac during the operation was most often empty: 11 cases (47.85%). It contained at least the ovary for 10 patients (43.5%). There were 2 cases of strangulated hernia (8.6%). All the patients benefited from a herniotomy. The average operating time was 26.7 days (range: 0 days and 146 days). No deaths and no postoperative complications were recorded after a 3-month follow-up. Conclusion: Ovarian hernia in this study is a rare condition often encountered in young girls. In spite of a late treatment, the therapeutic results were satisfactory. [ABSTRACT FROM AUTHOR]

Goal: The aim of this study is to evaluate the clinical and biological parameters for detecting early complications of abdominal surgery at Kisangani University Clinics. Material and Methods This is a cross-sectional descriptive study from June 1st, 2017 to September 30th, 2018. It involved 78 patients, including 48 men and 30 women, aged 7 and 80 years. Data was analyzed with SPSS 20 software. Results The average age was 33.49 years, with 15.32 Standard Deviation. Abdominal pain and inguinal swelling were the main reasons for consulting patients. Inguinal hernia (23.5%) and appendicitis (18, 7%) were the predominant diagnoses. In the postoperative period, the persistence of fever, oliguria or pain as well as that of elevated inflammatory tests (C - reactive protein, White Cells and Sedimentation rate) were associated with the occurrence of complications dominated by parietal suppurations and postoperative peritonitis. These complications mainly concerned dirty procedures, ASA II and III and /or NNISS 2. The mortality rate was 6%, observed mainly in patients with generalized acute peritonitis (50%). Conclusion This works shows the place of clinicobiological parameters as indicators of occurrence of complications. The precariousness of patient health and the septicity of surgery favor these complications. [ABSTRACT FROM AUTHOR]

Secondary peritonitis is frequently reported in the literature. It is due to multiple causes. We report an exceptional cause of ileal perforation due to a foreign body during reduction of an inguinal hernia. It caused severe peritonitis with multiple organ failure. [ABSTRACT FROM AUTHOR]

Groin hernia in adults is a frequent affection in digestive surgery. Many repair techniques have been described to date, including laparoscopic surgery. Two methods are quickly adopted by the various practitioners for the surgical treatment of groin hernia using laparoscopy: laparoscopic totally extra-peritoneal (TEP) technique and laparoscopic transperitoneal inguinal hernia repair (TAPP). This study focused on the feasibility of groin hernia repair using coelioscopy, aiming to describe its outcomes in terms of recurrence and postoperative pain. We conducted a singlecenter, retrospective and cross-sectional study of patients who had undergone laparoscopic surgery for groin hernia repair in the Department of Surgery at La Rabta Hospital over a period of 8 years, from January 2006 to December 2013. The main evaluation criterion was hernia recurrence. Postoperative pain and complications were the secondary criteria of judgment. We collected data from 92 patients with 104 hernias, respecting the inclusion criteria in our study. The average age of patients was 48 years (19-83). TAPP was the most used technique: 94 TAPP (90%) versus 10 TEP. No intraoperative complication was reported. Conversion rate was 0. Operative mortality was also 0. Postoperative morbidity was 5% (5 patients). It included hematoma in 3 cases and serum in 2 cases. The mean lenght of stay in hospital was 1.2 days (1-4 days). Postoperative length of stay didn't exceed 2 days in 94% of patients. Only 2 patients had a recurrence. Postoperative chronic pain was reported only in 3 patients. Our study shows that laparoscopic surgery for groin hernia repair gives considerable comfort to our patients with regard to pain, length of stay in hospital and cessation of work. Outcomes are good and consistent with the results already published in the literature. This encourages surgeons to use these techniques and to monitor longer term outcomes. [ABSTRACT FROM AUTHOR]

Résumé: Données: La douleur chronique post-chirurgicale (DCPC) est une complication bien connue après amputation, thoracotomie, mastectomie et cure de hernie inguinale, mais a été peu évaluée après chirurgie obstétricale. Type d’étude.: Cohorte rétrospective. Objectif: Déterminer le taux de DCPC après césarienne, l’impact de ces DCPC sur la qualité de vie et les facteurs de risque (FDR) associés à cette complication. Méthodes: Un questionnaire était envoyé à 220 patientes, successivement césarisées sur une période de 6mois, à distance de la chirurgie. Les questions portaient sur la durée des douleurs cicatricielles après césarienne, leur sévérité et leur répercussion sur les activités quotidiennes. Parallèlement, un recueil rétrospectif de données cliniques (antécédents, détails de la chirurgie et de l’anesthésie) était effectué. Après une analyse descriptive de la population étudiée, une comparaison des patientes avec et sans DCPC était effectuée afin de mettre en évidence d’éventuels facteurs de risque. Résultats: Cent soixante-sept patientes (76 %) ont répondu au questionnaire avec un délai moyen de 10mois (8–13) après leur césarienne. La douleur postopératoire était résolutive chez la plupart des patientes dans les trois mois, mais persistait chez 25 patientes (15 %). Sept patientes (4 %) présentaient une altération de leur qualité de vie en raison de douleurs cicatricielles quotidiennes modérées à sévères. Les FDR associés à ces DCPC étaient la présence de douleurs aiguës en postopératoire, l’existence de douleurs préalables (céphalées/migraines, dorsalgies), un âge jeune et la réalisation d’une anesthésie générale sans locorégionale associée lors de la césarienne. Conclusion: La survenue de DCPC après césarienne pourrait être fréquente et peut être responsable d’une altération de la qualité de vie des patientes. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique. Methods: This study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patient''s satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed. Results: Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain. Discussion: Wound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory. [Copyright &y& Elsevier]

Summary: Pyoderma gangrenosum is a rare pathology of uncertain etiology. It is an inflammatory dermatosis that causes cutaneous necrosis with a characteristically rapid evolution. No precise diagnosis criteria has been established and pyoderma gangrenosum remains an exclusion diagnosis. In 40 to 50% of the cases, the evolution of pyoderma gangrenosum can be worsened by a nonspecific external stimulus such as a trauma or a surgery. This phenomenon, called pathergy, conduces to avoid any surgical excision of the lesion. However, the diagnosis is often omitted and the rapid evolution of the cutaneous necrosis forces the surgeon to perform a surgical debridement of the wound. It causes a pejoration of the lesion. It can have disastrous consequences. We present here three different case reports. [Copyright &y& Elsevier]

Abstract: Objectives: Laparoscopic treatment of inguinal hernias in children remains controversial. The inguinal approach is the only recommended procedure nowadays. The aim of our series was to precise the results of this technique and its advantages. Population and methods: We report our preliminary experience in laparoscopy for inguinal hernias in 212 children. Results: Laparoscopy allowed us to discover 26 controlateral hernias not previously diagnosed, 3 direct hernias with 1 of them associated with a patent process vaginalis, 2 femoral hernias associated with a patent process vaginalis, 1 double pouch hernia and 1 volvulus of a cyst developed from a patent process vaginalis. In case of recurrence after an inguinal approach, laparoscopy seemed to be helpful to evaluate the anatomical lesion. We observed only 1 recurrence. Discussion: Indications for laparoscopy in case of inguinal hernia in children are reviewed and discussed in the literature. Laparoscopic diagnosis for a precise diagnosis is no more discussed. Various techniques were proposed in case of laparoscopic treatment of inguinal hernias in children: most of surgeons realized only a suture of the sac. We prefer to dissect all the sac in order to avoid any recurrence. Advantages of laparoscopic approach become more obvious after the age of 2 years when the opening of the parietal wall is required in case of an inguinal approach and when local anaesthesia is no more recommended. The opportunity to diagnose a bilateral hernia when non diagnosed before surgery or to discover a femoral or a direct hernia, or in case of recurrence after an inguinal approach, the atraumatic dissection of the vas and spermatic vessels at the level of the internal inguinal ring, are the main advantages for laparoscopy. [Copyright &y& Elsevier]

Abstract: Abnormal persistence of the processus vaginalis in children predisposes to a complication that is strangulated inguinal hernia. The inguinal hernia is a frequent pathology because global incidence varies from 0,8 to 4,4% for children of any age and reaches about 30% in premature children. Strangulated inguinal hernia is rare (from 1,5 to 8%) and constitutes a surgical emergency. More frequently, reduction following sedation is possible (from 25 to 33%), and normally leads to delayed surgery. Current practice is to operate early in these children, including preterm infants, before any complication arises. This early surgery requires use of regional anaesthetic techniques such as spinal anaesthesia, ileo-inguinal ileohypogastric nerve blocks and caudal anaesthesia. However, although this pathology may appear to be routine commonplace it requires a specialized surgical and anaesthetic approach and specialized environment. [Copyright &y& Elsevier]

Abstract: Aims: To evaluate influence of surgical experience on inguinal hernia repair. Patients: From 1997 to 2003, 380 patients (mean age 55 years old) with primary unilateral inguinal hernia were treated by Lichtenstein technique. Methods: In this retrospective study, surgeons were classified in three groups: group 1: hernia repair was performed by an experimented surgeon (consultant or senior registrar) and a young surgical trainee (resident) (161 cases); group 2: surgery was performed by a junior surgeon (resident) under the control of an experimented surgeon (135 cases) and in the group 3 (84 cases), Lichtenstein technique was performed by two residents, alone, supervised by an experimented surgeon, in the operative room. Evaluation criterion were operative time, hospital stay, morbidity, time to return to normal and professional activities, recurrences and chronic pain with a follow up of, at least, 2 years. Results: The three groups were comparable in term of socio economic data, hernia and follow up. The only significant (P =0.01) difference concern operative time which increased from 20% for group 2 and 3 (residents) compared to the group 1. There was also no difference between junior and senior resident. Conclusion: Lichtenstein hernia repair should be performed by young surgeon in training alone in condition of precise teaching organization and experimented surgeon supervision. For patient, in this condition, there is no trouble in term of surgical results. [Copyright &y& Elsevier]

Abstract: Inguinal hernias are due to the patent vaginoperitoneal canal; surgical treatment lead to a definitive cure. The aim is to describe the inguinal hernias of male children and report our experience in their management. We conducted a retrospective study of the hernias on male children from 1993 to 2003. We analyzed its prevalence, its clinical characteristics, the associated malformations and the results of the treatment. Inguinal hernias represented 18% of the consultations over the period of study. Diagnosis was delivered within 3.6 months on average with extremes of 1 day and 15 years. It was associated to prematurity in 8% of the cases. They were inguino-scrotal in 54% of the cases and predominantly in the right side in 59% of the cases. They were associated to other genito-urinary abnormalities in 9%. Incarceration was the clinical pattern in 16% of the cases. The cure had been made by the vaginoperitoneal canal ligature, and a prefunicular link of the conjoint tendon and the inguinal ligament in 100% of the cases. The postoperative complications were 2.4% with one recurrence; the mortality was 0.7% due to incarcerations. The inguinal hernia of the male is known as a benign pathology but it can be fatal when not recognized in its incarceration form with late treatment. [Copyright &y& Elsevier]

Abstract: The inguinal hernia, malformations caused by persistence of peritonea-vaginal duct, is frequent in children. It is a benign affection as long as it is not strangled. During our five-year-retrospective study, we have found 32 cases (30 boys and 2 girls) of strangled inguinal hernia. There are 78,12% of cases under five years old. In 54%, the hernia was on the right side. Malnutrition and inguinoscrotal hernia are very exposed to strangulation. We observed obstruction syndrome in 81,25% of cases. We have to deplore one case of scrotal fistulae by intestinal necrosis and two cases of testicle necrosis. For all of our patients, the peritonea-vaginal duct was closed with ligature, associated with pre-funicular parietal refection. One case of recurrence is found in postoperative time. [Copyright &y& Elsevier]

Acute neonatal appendicitis is a rare surgical emergency. Prognosis depends on early diagnosis and management.Case report. – A three and a half-month-old premature infant needed an urgent laparotomy because of an occlusive syndrome and sepsis with an inflammatory skin reaction. The per-operative diagnosis was suppurative acute appendicitis with local peritonitis, the appendix being strangulated into the inguinal hernia.Discussion. – Neonatal appendicitis represents 0.1% of all infantile appendicitis. Fifty percent of such cases occur in premature infants. Two clinical presentations exist, whose diagnosis is often made during surgery. The abdominal presentation (2/3 of the cases) can mimic necrotizing enterocolitis; the diagnosis is often late and evolution leads to diffuse peritonitis in the majority of the cases, while the mortality rate is higher than 50%. The intra-hernial presentation (1/3 of the cases), instead, is usually diagnosed and managed early due to the inguino-scrotal induration, while mortality rate is near zero.Conclusion. – The high frequency of inguinal hernia in premature infants should not mask the risk for intra-hernial appendicitis. Inguino-scrotal inflammation should evoke the diagnosis. Prognosis depends on early and urgent surgical management. [Copyright &y& Elsevier]

Objective. – To determine on a national level the factors associated with the use of laparoscopy for digestive surgery.Study design. – Nation wide study using a large representative sample (3 days of anaesthesia in France).Methods. – Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care (« SFAR ») including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy.Results. – Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when ≥71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when ≥3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendicetomy: age >15 years (AOR 1.9–2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when ≥3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy.Conclusion. – These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public. [Copyright &y& Elsevier]

Prosthetic repair is now considered as a standard in hernia surgery. The authors describe herein the technique of placement of Prolene Hernia System (PHS®) which has the feature of a “3 in 1 system” according to the principles of Rives and Stoppa on one hand and those of Lichtenstein on the other hand. The steps of surgical technique are described. [Copyright &y& Elsevier]

Summary: Botryomycosis is an uncommon chronic bacterial infection, which usually involves the skin and the subcutaneous tissues. Visceral involvement often occurs in immunodepressed patients. We describe the case of a 4-year-old boy who presented a right inguinal inflammatory mass associated with pruritic papules without fever. Blood analyses showed a substantial inflammatory syndrome and blood hypereosinophilia. Histological examination of the right inguinal lymph node showed granulomatous adenitis with a Splendore–Hoeppli phenomenon surrounding Gram-positive bacteria, corresponding to Staphylococcus aureus after biopsy culture. The diagnosis of S. aureus lymph node botryomycosis was made and the child was successfully treated with a double dose of oxacillin over 3 weeks. [Copyright &y& Elsevier]

Abstract: Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful. [Copyright &y& Elsevier]

We describe one case of intra-scrotal hernia of the right ureter. The anomaly was recognized on a pre-operatory urogram. It was an extra-peritoneal ureteral hernia. There are two types of ureteral hernia: the para-peritoneal hernia with a peritoneal sac; the extra-peritoneal type with only a fatty hernia. The mecanism of the latter illustrated by our case is a prolapse of the retro-peritoneal fat. It is not possible to practice an urogram before the cure of every inguinal hernia, so the prevention in this rare situation of the damage of ureter is to be cautious in the resection of huge lipomas and sliding fat when operating on inguinal hernias. [Copyright &y& Elsevier]

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure. [Copyright &y& Elsevier]

Introduction: notre expérience dans la cure d’hernie inguinale par voie laparoscopique dans la première année de vie, pour souligner les avantages de la procédure dans cet âge. Méthodes: Dans une période de 2 ans, nous avons traités 315 patients avec hernie inguinale unilatérale par vois laparoscopique et 50 avaient moins de 1 année. Notre attention sera concentrée sur ce groupe de 50 enfants. Le rang d’âge était de 1 jusqu’ à 12 mois avec un poids médian de 5,5 kg. 5/50 patients ont présenté une hernie incarcérée. Nous avons utilisé la technique de Montupet modifié. Résultats: temps opératoire : 22 minutes. 35 procédures effectuees en hôpital de jour, 15 patients déchargées le jour après le procédé. Dans 22 patients on a trouvé une pervietè contralatéral et on a realisé une herniorraphie bilatéral. Dans une fille il y avait la coexistence d’une hernie oblique externe, une hernie directe du côté droit et les deux orifices ont été suturés en laparoscopie. Au follow up minimum de 1 an il y avait 1 récidive sur 73 herniorraphies. Conclusions: dans notre expérience la réparation laparoscopique de l’hernie inguinale dans les enfants au dessous de 1 an par les mains expertes est une procédure efficace, qui permet de soigner au même temps toutes les formes d’hernies inguinales. [ABSTRACT FROM AUTHOR]

Les auteurs présentent un cas d’occlusion intestinale aiguë par incarcération d’une anse dans un sac herniaire invaginé par réduction manuelle. Garçon de 24 mois transféré pour un syndrome occlusif persistant après réduction manuelle d’une hernie inguinale droite engouée, avec une échographie abdominale éliminant une invagination intestinale aiguë. La palpation abdominale de cet enfant pâle, geignard et adynamique, montre un abdomen sensible. Une 2e échographie confirme l’absence d’invagination et montre une anse intestinale figée, latéro-vésicale droite, décrite comme incarcérée. La coelioscopie indiquée sur l’absence d’amélioration clinique et radiologique, trouve une masse pariétale attenante à la paroi abdominale antérieure de la fosse iliaque droite recouverte de péritoine, et une anse ischémique incarcérée dans ce sac herniaire inguinal bombant dans la cavité abdominale. L’anse est désincarcérée après ouverture du collet du sac, sa vitalité contrôlée, suivie par la cure herniaire avec vérification de la récupération d’un testicule droit ischémique. Les suites sont simples. Ce diagnostic n’a, à notre connaissance, jamais été rapporté dans la littérature. Il illustre l’efficacité diagnostique et thérapeutique de la coelioscopie dans ce type de pathologie inhabituelle. [ABSTRACT FROM AUTHOR]