Endoscopic-assisted repair of combined ventral hernias and diastasis recti: minimizing seroma incidence by quilting.

Background: To reduce the incidence of seromas, we have adapted the quilting procedure used in open abdominoplasty to the endoscopic-assisted repair of concomitant ventral hernia (VH) and diastasis recti (DR). The aim of this study was to describe the technique and assess its efficacy by comparing two groups of patients operated on with the same repair technique before and after introducing the quilting.

Methods: This retrospective study included data prospectively registered in the French Club Hernie database from 176 consecutive patients who underwent surgery for concomitant VH and DR via the double-layer suturing technique.

Some Additional Data That Might Be Useful for Diastasis Recti Assessment.

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.

Minimally invasive bilayer suturing technique for the repair of concomitant ventral hernias and diastasis recti.

Background: According to EHS guidelines, mesh repair is recommended in case of concomitant diastasis recti (DR) and ventral hernia more than 1 cm in diameter. Since in this situation, the higher risk of hernia recurrence may be attributed to the weakness of aponeurotic layers, in our current practice, for hernias up to 3 cm, we use a bilayer suture technique. The study aimed at describing our surgical technique and evaluating the results of our current practice.

Mid-term results of VTEP (Ventral hernia repair by Totally ExtraPeritoneal approach).

Background: Techniques of retromuscular repair of ventral hernias aim at avoiding complications linked to intraperitoneal patch. Aim of the study was to evaluate results of the VTEP technique.

Methods: On 187 patients who underwent a VTEP, evaluation was carried out on 128 patients with a minimum follow-up of 1 year.

Stapled VTEP (sVTEP), diastasis and the "swollen abdomen".

Background: In the VTEP series, some patients declared that their abdomen was "somewhat swollen", and the authors suggested that this might be related to disruption of the posterior sheath due to the crossing. Following this observation, we decided to evaluate the systematic repair of the posterior sheath.

Methods: In 50 consecutive patients operated for ventral hernias, the VTEP procedure was modified, using the linear stapler to perform simultaneous division and closure of the posterior sheath.

Ventral hernia repair by totally extraperitoneal approach (VTEP): technique description and feasibility study.

Background: The repair of ventral hernias by intra-peritoneal patch (IPOM) involves a risk of pain due to stapling as well as intestinal adhesions. Extraperitoneal placement of the patch without fixation can prevent these drawbacks. Techniques of endoscopic preperitoneal repair were previously described by others.

Transfusion-transmitted hepatitis E in a misleading context of autoimmunity and drug-induced toxicity.

Hepatitis E is currently diagnosed after all other causes of hepatitis have been excluded. Moreover, HEV testing is not performed to prevent blood transmission in developed countries. We report here on the case of a patient with acute hepatitis while receiving potentially hepatotoxic medications for autoimmune disorders, with low-level autoimmune markers and negative "standard" viral markers; it was finally determined that he was suffering from transfusion-transmitted hepatitis E.

Transinguinal preperitoneal patch (TIPP) under local anesthesia with sedation.

Transinguinal preperitoneal placement of the patch (TIPP) combines the advantages of the preperitoneal patch and the simplicity of the inguinal approach. The aim of the study was to evaluate the feasibility of TIPP under local anesthesia (LA) with sedation on a series of unselected patients. All 161 patients referred to one of us for inguinal hernia repair were included in a prospective evaluation; they were operated on for 169 inguinal hernias, in LA with sedation.

Ambulatory groin and ventral hernia repair.

Objective: Ambulatory surgery is not commonly practiced in France today. The aim of this study was to prospectively evaluate the feasibility of ambulatory hernia repair in a consecutive series of unselected patients.

Patients And Methods: From June 2008 to October 2009, 257 patients (238 men and 19 women, median age 65 years) were treated in a same-day surgery unit for 270 hernias (244 groin hernias, 25 ventral hernias and one Spiegelian hernia).

[Who are the recipients of labile blood products? A multicenter nation-wide study--a "donation day." Blood banks, health facilities].

During the years 1994-2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated.

[What are the rules and regulations for blood product transfusion in France?].

In France, there are many rules and regulations for blood product transfusion. The clinician who prescribes a blood transfusion must go step by step, except for a vital emergency (must be procedured). He must have: informed consent, immunohaematologic results, specific prescription with quantity and quality of products, realisation of blood transfusion with many administrative and technical necessary controls, and prevent adverse events.

[Supplying surgery blocs in red cell concentrates: a collective approach to improve practices].

The need to adapt red blood cells concentrates management in surgery blocs and resuscitation to the changes of the legal framework has lead to a collective approach to improve practices. Gathered by the regional hemovigilance coordinators of the Drass Ile-de-France (regional office of health and social actions), representatives of doctors' ordering transfusions and hemovigilance correspondents of the Assistance publique-Hôpitaux de Paris and representatives of the EFS (French blood establishment) Ile-de-France, together with representatives of the Afssaps (French health products safety agency), have coordinated an assessment of local transfusion practices in surgery blocs and resuscitation that have to be compliant. Each hospital then offered local improvement actions, approved by regional and national instances.

[Inguinal hernia. What techniques are available for the surgeon? Theoretical and practical advantages and disadvantages].

There are many hernia repair techniques. Among the most popular, the Shouldice Hospital method was the most widely used in the 1980s. Since then, methods employing prosthetic mesh have taken over, mainly because they are tension-free and therefore seem to lead to less recurrence and cause less postoperative pain.

Transinguinal preperitoneal repair with the Polysoft patch: prospective evaluation of recurrence and chronic pain.

Objective: The Polysoft patch was conceived to facilitate performance of the transinguinal preperitoneal patch method and combine the advantages of patch placement in the preperitoneal space and the open inguinal approach. The aim of this prospective study was to evaluate the rate of recurrence and chronic pain at midterm follow-up.

Methods: In a cohort of 200 hernia repairs involved in a prospective evaluation, midterm results of 171 cases operated on from 1 July 2004 to 31 December 2005 were assessed.

The Polysoft patch: prospective evaluation of feasibility, postoperative pain and recovery.

Introduction: The Polysoft patch was conceived to associate the advantages of placement of the patch in the preperitoneal space (PPS) and easiness of the inguinal incision. The aim of this study was to evaluate prospectively the feasibility and postoperative outcome of this method.

Methods: Two hundred Polysoft repairs were performed in 191 consecutive patients with Nyhus types III and IV hernias.

[Subperitoneal inguinal hernioplasty by anterior approach, using a memory-ring patch. Preliminary results].

Objective: Incidence of chronic pain is lower following laparoscopic hernioplasty than open surgery, probably due to the location of the patch in the preperitoneal space. But since laparoscopy is more demanding, the rates of complications and recurrences are higher. The aim of this study was to evaluate the results of a procedure consisting of placement of a patch, endowed with some memory of shape, provided by a thin peripheral memory ring, in the preperitoneal space, by inguinal incision, through the hernia orifice, under spinal or local anesthesia.

Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience.

The aim of this prospective study was to set up and evaluate a technique allowing, by the mean of a memory ring, easy placement of the patch in the preperitoneal space (PPS), directly via the hernia orifice, so as to associate the advantages of the preperitoneal patch, anterior approach and minimally invasive surgery. The memory-ring patch was made by basting a PDS cord around a 14 x 7.5 cm oval shaped polypropylene mesh.

[Pre-peritoneal continuous infusion of local anesthetics for pain relief after laparotomy. A preliminary report].

Introduction: Continuous administration of local anesthetic through a catheter placed in the scar of a laparotomy is a postoperative analgesic technique, which seems effective but remains little developed and poorly codified.

Methods: In this prospective evaluation, we present a series of 25 observations of adult patients scheduled for abdominal laparotomy, to which a multiperforate catheter was placed at the end of the intervention by the surgeon in pre-peritoneal position, allowing the continuous perfusion of ropivacaïne over the first 48 postoperative hours. Patients received intravenous paracetamol associated with ketoprophene or nefopam.