Chirurgie; memoires de l'Academie de chirurgie最新文献

We report 35 cases of laparoscopic repair after prosthesis surgery using the classic open technique (19 cases) or laparoscopic technique (16 cases). Most difficulties were observed after intraperitoneal laparoscopy. Hernia repair was preferentially intrapreperitoneal (31 cases). Post-operative morbidity was low with two cases of serohematic effusion treated by puncture. Mean hospital stay was 2.5 days. Patients returned to normal activity within 7 days but work stoppage in active patients depended more on patient motivation than the initial surgical procedure. There were no reiterative recurrences although follow-up is too short (mean 21.2 months) for definitive results.

Treatment of hepatocellular carcinoma has become multidisciplinary. Liver resection, when technically feasible, remains the procedure of choice for non cirrhotic patients. On the contrary, its indications are decreasing for cirrhotics with the emergence of interventional therapies and since selected patients with small tumors and sufficient life-expectancy have become candidates to liver transplantation. Better results have to be obtained by adjuvant therapies in order to decrease the propension of the hepatocellular carcinoma to recur inside the liver. Intraarterial injection of lipiodol iodine-131 seems to give encouraging results in reducing the local recurrence rate after liver resection.

Beginning in 1990, the tension-free inguinal hernioplasties were adopted for the treatment of primary groin hernias in men. 1252 tension-free hernioplasties were performed in 1,076 men and followed for one to six years. Lichenstein's tension-free hernioplasty and Gilbert's sutureless hernioplasty were used, usually in combination. Anesthesia was local in 97% of the operations. 15 complications occurred (1.2%): one wound infection, one seroma, 12 hematomas, and one ilioinguinal neuralgia, 6 recurrences occurred (0.5%): 4 indirect, one direct and one femoral. No indirect recurrences have occurred since placing Gilbert's cone shaped plug in the deep ring. Tension-free hernioplasties consisting of a patch of polypropylene mesh plus a cone plug of the same material, placed in the deep ring when an indirect hernia is present, produce excellent results and are the preferred methods to manage the majority of primary inguinal hernias in men.

We describe herein a new model of surgical approach of an early mammalian embryo. Indeed the developmental mechanisms of numerous congenital anomalies, such as bladder exstrophy, remain obscure, and progresses in their knowledge must be achieved to propose better treatments. But up to now all the successful reports in experimental models of early produced malformations concerned birds or batracians, whose development is very different from human. We used the rabbit. Twenty-five time matted does were operated at 12.5 days of gestation. Out of their 247 embryos, 99 underwent a surgical procedure. Forty-eight were injured in order to produce an exstrophy. In 18 cases, the embryo extruded from the uterine cavity and could not be reintegrated, and 2 sacs were found empty. The remaining 31 were only exteriorized. Nine additional does received intravenous teratogen at 12.5 days of gestation. In the group of operated embryos we obtained 6 full-term fetuses, one of whom had a cloacal exstrophy. No exstrophy was noted among the intact embryos, neither in the 87 fetuses submitted to the teratogen. We conclude that: it is possible to operate on an early mammalian embryo, and to obtain further growth until term and that the exstrophy we observed in one case resulted from the surgical specific procedure.

This study concerns the fatigue behavior of a C/Peek hip implant. It is now well-established that the extent of bone loss around a total hip arthroplasty stem is related to stress shielding process. Due to a modulus mismatch between the bone and the implant material, the load transfer to the stem decreases the mechanical stimulus needed by the bone to maintain its structure. Because of its low modulus of elasticity and its good resistance to fatigue in aeronautical applications, the Fiber Carbon/Peek composite could potentially replace some of the metal alloys used in hip stem implant. After a literature survey on biomechanical performances of some fiber carbon composites, including AS4/Peek, experimental quasi-static and fatigue compression tests have been performed on AS4/Peek hip implants. The structural and mechanical characterization of the injection moulded composite material has been realized. The prosthesis compression and fatigue behaviour have been studied with a joint-stimulating apparatus immersed in a physiological solution temperature controlled. Instead of the low specimen homogeneity, no fatigue damage has been revealed either by X-ray observations of stiffness measurements, till ten millions of cycles. The quasi-static compressive fracture morphology has been analyzed by S.E.M. and have shown a good fiber matrix bonding. This mechanical results would suggest that AS4/Peek hip stem are worthy of further investigation as implantable prostheses.

Plain radiograms are insufficient to evaluate the integrity of a graft used to replace acetabular tissue loss in reoperations for total hip replacement. The aim of this work was to compare radiographic, computed tomographic and magnetic resonance imaging findings. Two groups of patients including 12 hip joints in each were evaluated 5 years after undergoing reoperation for annular support. Allografts (5 cases) or xenografts (7 cases) were used in one group. Plain radiograms. CT-scan and MRI were performed in each patient. The graft-receiver bone borders were visible on the CT-scans but were not distinguishable on the radiograms. Bone and graft density and structure in contact with the implant could be determined on the CT-scan. MRI was difficult to interpret in most cases due to implant-induced artefacts and is not recommended in this type of reconstruction.

With the experience obtained in a surgical air borne unit and the long term results in a rear zone hospital, we analyse treatments of bone and joint acute traumas in a field hospital. This injuries appear in a particular context: delayed treatments with little staff and equipment. The surgeon has to be fast with protective measures, debridement of soft tissues, bone stabilisation and vascular repair. We discuss the respective place of each treatment: amputations are dictated by the gravity of the wounds; orthopedic methods are used for the upper limb, for the lower limb they are waiting technics; external fixation stabilizes fastly bone injuries, facilitates transportation and permits delayed reconstruction technics. Indications have to be adapted to circumstances: in a surgical unit with rear evacuation possibility the dramatic choice of amputation is often avoided by external fixator; in a short time mission for civilian populations, amputations are more often used but if conservative treatment is preferred, external fixator must be widely used.

We inserted a calibrated coral callus to lock addive medial osteotomy of the tibia in 38 patients. We followed these patients for 1 to 6 years evaluating clinical, radiological and histological outcome. Rehabilitation was very insufficient. In our later cases, the porosity of the coral insert was improved, apparently facilitating bone penetration.

The authors have reviewed 37 patients aged 64 to 91 years or their charts in the purpose to evaluate the results of surgical treatment of severe acquired contractures of arms hands and legs. They describe the deformations, surgical technique, morbidity, and the results. 4 patients deceased within the first week after surgery; morbidity was very low. The results were satisfactory: nursing was greatly facilitated and pain during nursing care and toilet disappeared, the patients could again seat in a wheel chair. They conclude that this surgery can be very helpful for these disabled patients.

Abdominal wall and contents can be used out of the coeliac cavity, as tissues donors site, for filling up or covering defects. Microsurgical technology mastery can extend their use in all the human body parts, especially in the craniofacial area. More than 110 digestive free transplants have been used during a 8 year period in head and neck surgical repairs. The report shows how to exploit at their best the anatomical and physiological properties of diverse abdominal tissues. Beyond this, the possible association of these transplants with other repair techniques opens new therapeutical perspectives, such as chimerical flaps whose pedicle distributes to heterogenous (or heteroclite) components, double flaps with a single or a double pedicle, replacing, at one single operative time, each missing tissue by the most adequate transplant. In consideration of this, abdominal tissues are an inexhaustible source of transplants, even through some imperfections must be managed.