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Aim of the Study: Total thyroidectomy has been advocated for the treatment of multinodular nontoxic and benign goiter. The aim of this study, based on our experience, was to define the surgical factors which permit to decrease morbidity related to total thyroidectomy for multinodular euthyroid benign goiter., Methods and Materials: In a retrospective study performed between January 1996 and September 2000, all records of total thyroidectomy for initial treatment of multinodular euthyroid benign goiter were reviewed. This study allowed to specify recurrent and parathyroid morbidity after surgery., Results: There were 51 women and 13 men with a mean age of 47 years. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another (1.6%). Transient hypocalcemia was found in 8 patients (12.5%). One patient had permanent hypocalcemia (1.6%)., Conclusion: The results of our serie are comparable to previous reports. Systematic identification of the recurrent laryngeal nerve, and preservation of the parathyroid blood supply permit to decrease the surgical morbidity.

Aim of the Study: To evaluate the prevalence of pancreatic pseudocyst after persistent fistula closure with somatostatin or octreotide. To compare the patient characteristics according to the subsequent presence or absence of pseudocyst., Patients and Methods: This retrospective study from January 1994 to August 1999 included 15 patients with an external pancreatic fistula. Fistula closure was observed for all patients with somatostatin or octreotide. CT scan was performed 66 +/- 34 days after the end of this treatment., Results: CT scan was normal in 9 patients (favorable group) and showed pancreatic pseudocyst (failure group) in 6 patients. Pancreatic fistula etiologies were different between the two groups. The 5 patients presenting pancreatic fistula after duodenopancreatectomy belonged to the favorable group. Six of the 10 patients presenting pancreatic fistula after pseudocyst drainage belonged to the failure group. There were no other differences between the two groups., Conclusion: Persistent pancreatic fistula can be cured with somatostatin or octreotide. However, fistulas occurring after duodenopancreatectomy are more easily cured with somatostatin or octreotide than fistulas occurring after external pseudocyst drainage. Somatostatin or octreotide cannot be considered to be an effective treatment for pancreatic fistula occurring after pseudocyst drainage, despite the fact that 40% of them were permanently cured.

Surgery is the treatment of acute calculous cholecystitis. Mortality and morbidity are considerable for patients with anesthetic risk factors. In this context, ultrasound-guided percutaneous drainage seems to be a alternative to urgent surgery. The place of this technic and its results have not been determined with certainty. We report our experience of percutaneous drainage in acute calculous cholecystitis, based on a series of 27 patients treated between May 1992 and May 1996. A favorable course was observed after drainage in 26 patients, one patient was operated urgently for purulent peritonitis on D1. One drain migrated into the gallbladder and required cholecystenterostomy en D30. Seventeen patients underwent cholecystectomy after the acute episode. Surgery was contra-indicated in light patients: two presented recurrence of acute calculous cholecystitis and six remained asymptomatic. The aim of this study was to define the place of this technic in the treatment of acute calculous cholecystitis, and estimate the results in terms of mortality, morbidity and recurrence.

Laparoscopic splenectomy has been extensively developed since its first description by Delaître in 1991. From May 1993 to July 1994, 12 patients underwent laparoscopic splenectomy in the "service de Chirurgie C" of the "CHU de Nancy". Six of them were successful. 6 women with a mean age of 27.7 years. The mean operating time was 2 h 30 min. For all cases, the indication was idiopathic thrombocytopenic purpura. No mortality and no morbidity was reported. One patient needed a blood transfusion. The postoperative stay ranged from 3 to 7 days. Splenectomy appears to be another procedure that may be successfully performed under laparoscopic guidance with satisfactory conditions of safety. The outcome evaluation should be continued in order to accurately define the real advantages and risks of this new technique.

A randomized prospective trial was carried out between September 1987 and February 1989 to compare 3 different absorbable sutures (polyglactine 910, polydioxanone I, polydioxanone II) for closure of the abdominal wall after upper midline laparotomy for elective operations. The technique used to close the fascia was always a continuous suture. The criteria used to assess the results were the development of wound infection and wound dehiscence in the early postoperative period, and the development of suture sinuses and incisional hernia 1 year after operation. The early postoperative results in 235 patients revealed no wound infection and no -wound dehiscence. Suture sinuses developed in 4 patients (2%) 2 months after operation, but resolved spontaneously. We reviewed 203 patients after one year. The total number of incisional hernias detected 1 year postoperatively was 22 cases (11%), (polyglactine 910, 14.2%; polydioxanone I, 11.2%; polydioxanone II, 8.4%). The difference between the 3 groups was not statistically significant. The results of the trial indicate that absorbable sutures have a very low incidence of suture sinuses, and that polydioxanone II seems to be a good choice for closing laparotomies.

After a review of the literature and their own experience, the authors relate the various dilemmas of infantile varicocele. These dilemmas are diagnostic and therapeutic. On the basis of clinical, epidemiological, etiological and pathological studies, the authors conclude that grade III and grade II varicoceles associated with testicular hypotrophy must be operated, while the others must be followed.