C. Meyer

A direct approach for the treatment of parastomal hernias using a prosthesis

SummaryA technique for the surgical treatment of parastomal hernias is described which uses a direct approach and the insertion of a polyester prosthesis in the retro- or inter-muscular position. Fifteen patients have been so treated without immediate complications, namely infectious. Two recurrences have been recorded 8 and 18 months afterwards, the average follow-up being 4 years. This technique allows an effective treatment of these hernias even in the presence of associated complications (fistula, stenosis, prolapse).

Résultats de la fundoplicature par voie laparoscopique dans le traitement du reflux gastro-œsophagien. A propos de 224 cas

STUDY AIM: The aim of this paper is to evaluate prospectively immediate and 2-year results of laparoscopic fundoplicature (LF) for gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: Patients presenting GERD who had been previously submitted to a long-term medical treatment were included in this study. Preoperative workup included upper GI tract endoscopy, esophageal manometry and 24-hour pHmetry. Standard surgical procedure incorporated a Nissen-Rossetti 360 degrees fundoplicature. Short vessels division (Nissen operation) was performed in case of high strength of the wrap and a partial fundoplicature (Toupet 270 degrees) was performed when motility disorders of the esophagus were demonstrated by manometry. Postoperative morbidity and results were evaluated, with a clinical appreciation at 3 and 22 months, and by manometry and pHmetry at 3 months. RESULTS: Two hundred and thirty-five patients were observed, and 224 included in the study (143 men and 92 women). Nissen-Rossetti fundoplication was performed in 169 cases (80%), Nissen in 30 (14%) and Toupet in 13 (6%). In 12 cases (5%). LF was converted to an open Nissen-Rossetti procedure. There was no hospital mortality and complications were noted in three cases (1.5%): pneumonia (n = 2) and gastroplegia (n = 1). With a mean 22-month follow up, among the 103 patients who answered to a questionnaire, the rate of relapse of GERD was 14%, dysphagia was present in 2% and four patients had been reoperated on (one for a slipped Nissen, one for a stenosis of the esogastric junction and two incisional hernias). CONCLUSION: On the basis of this experience, LF for GERD is a safe and efficient operation, with 86% of good results at 2 years.

Die laparoskopische Fundoplicatio nach Nissen-Rossetti: Eine Auswertung von 87 Operationen

87 Patienten mit therapieresistentem gastroosophagealem Reflux wurden fur eine laparoskopische Durchfuhrung des chirurgischen Vorgehens ausgewahlt. Endoskopisch zeigte sich bei alien Patienten eine Re

Die Komplikationen der Kolondivertikulitis. Vergleich von Behandlung und Resultaten innerhalb von zwei verschiedenen Zeitperioden

170 Falle mit komplizierter Kolondivertikulitis sind retrospektiv analysiert worden. Das Ziel dieser Studie war es, sowohl die Entwicklung klinischer Parameter wie auch der chirurgischen Eingriffe und