Some Additional Data That Might Be Useful for Diastasis Recti Assessment

Background: Diastasis recti (DR) is characterized by separation of both rectus muscles and protrusion of the median bulging, but besides median bulging DR can also entail global abdominal bulging. On other note, DR classification is based on the width of divarication, but measurement values are different at rest and at effort due to muscle contraction. Aim of the study is to provide additional features concerning the type of bulging and the width of divarication. Methods: Findings were retrospectively drawn from the data prospectively collected in the records of a continuous cohort of 105 patients (89 females, 16 males) referred for diastasis and concomitant ventral hernia repair. Results: There was a median bulging alone in 45 (42.9%) cases, a global bulging alone in 18 (17.1%) cases, both types combined in 37 (35.2%) cases and no bulging in 5 (4.8%). On 55 patients with a global bulging, 51 were females. Tape measurements values of DR width were closer to the values measured on the CT scan at leg raise than at rest. The differences were significant at rest as well as at leg raise. Though the difference at rest was highly significant (p = 0.000), the difference at effort was not far from being not significant (p = 0.049). Conclusion: Besides median bulging, presence or absence of the global bulging should be included in DR assessment. The difference between width of divarication at rest and on exertion raises the question of which value should be used for DR classification. The question is worth being debated.

[Laparoscopic treatment of recurrent inguinal hernia after only mesh]

The recurrences of inguinal hernia after onlay mesh may cause technical difficulties for a new repair. The aim of our study was to assess intraoperative findings, feasibility and results of laparoscopic transpreperitoneal mesh onlay in this indication. Twenty-one repairs were performed. In all cases, direct, internal, inguinal recurrences were observed, associated in two cases with an external or femoral recurrence. In 16 cases, there were no adhesions in the peritoneal cavity. The were no conversions and peritonealisation was always completed. The mean length of hospitalization was 2.7 days. Our study suggests that technical errors during the first procedure, insufficient mesh or wrongly positioned are responsible for recurrence and allow reinsertion of a mesh laparoscopy via transpreperitoneal in this indication.

[Treatment of inguinal hernia by laparoscopy. Four-year results of the transpreperitoneal approach]

The laparoscopic approach to inguinal hernia repair remains controversial. The authors report the results of 790 repairs performed during the first four years of their experience. The complication rate requiring surgical revision was 1.39%. None of these complications was related to the transpreperitoneal approach and all but one of them occurred during the first two years of the authors' experience. The recurrence rate for patients with a follow-up of more than two years was 5.01%. With experience, the size of the meshes has gradually increased. The authors' experience suggests that all types of hernia can be treated via this approach and that the recurrence rate makes this technique competitive compared to the results of other techniques reported in the literature.

[Impact of celioscopic surgery in general and digestive system surgery]

A retrospective study was conducted to evaluate the impact of laparoscopic surgery on activity in general and digestive surgery. From May 1990 to December 1994, 2256 laparoscopic procedures were performed for cholecystectomy (36%), appendicectomy (20.4%) or inguinal hernia (19.8%). 23.2% of all procedures performed in 1994 were done laparoscopically. The use of laparoscopy did not, in our experience, added any new indications from 1988 to 1994. The conversion rate was 8.15%. 24% of the conversion cases could not be predicted. Mortality was 0.18% and 1.19% of the patients had to undergo a second operation due to complications of laparsocopic surgery. The impact of laparoscopic procedures, 7 years after the first laparoscopic cholecystectomy has been great. The results of this surgical technique must be evaluated to determine its medical and economic impact.

[Value of celioscopy in the diagnosis of inguinal hernia]

OBJECTIVE

Prospectively compare laparoscopic findings with functional impairment and clinical diagnosis and classification of inguinal hernias.

METHODS

Fifty eight consecutive patients (mean age 55.3 years, range 22-87) presenting with 68 symptomatic hernial orifices and undergoing laparoscopic procedures for inguinal hernia were included in the study. Type of hernia was identified according to the Nyhus classification. Clinical examination found 73 hernias and laparoscopy identified 86 hernias.

RESULTS

Laparoscopic findings confirmed clinical diagnosis in 20 out of 30 type II hernias, 24 out of 37 type IIIA hernias, 2 out of 3 type IIIB hernias and 13 out of 16 type IV hernias.

CONCLUSION

Laparoscopic procedures can successfully confirm or refute the clinical diagnosis of inguinal hernia, especially important when the preoperative diagnosis is doubtful. The type of hernia can be clearly identified for adaptation of therapeutic indications.

Laparoscopic gastrectomy for obstructing duodenal ulcer

A case of bilateral truncal vagotomy and antrectomy for pyloric stenosis is presented. Other procedures for laparoscopic treatment of peptic ulcer disease are discussed.

[Tubular gastrostomy using celioscopy]

Surgical feeding gastrostomy is attended by a significant morbidity and mortality. Today, the percutaneous endoscopic route is regarded as the best method, but it is not feasible in case of pharyngo-oesophageal stenosis and has its own drawbacks. A new method using laparoscopy to perform a Depage-Janeway gastrostomy is presented here. The theoretical advantages of this method are clear: the limited parietal damage should avoid cicatricial complications, and the limited ventilatory aggression should reduce the amplitude of respiratory complications. Moreover, in surgical practice this is a simple, rapid and efficient operation.