The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4 cm in width. We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47

This study examined patient-related outcome measures (PROMs) after repair of ventral primary or incisional hernias using Symbotex™ composite mesh (SCM), a novel three-dimensional collagen-coated monofilament polyester textile.

Background: The optimal timing for cholecystectomy in patients with acute cholecystitis remains controversial. The aim of this study is to assess prospectively the impact of the duration of symptoms on outcomes in early laparoscopic cholecystectomy (ELC) for acute cholecystitis. Methods: The series consisted of 276 consecutive patients who underwent ELC for acute cholecystitis in 2016. The patients were divided into three groups according to the timing of surgery: within the first 3 days (group 1), between 4 and 7 days (group 2) and beyond 7 days (group 3) from the onset of symptoms. Results: The percentage of surgical procedure rated as difficult was respectively: 12% in G1, 18% in G2 and 38% in G3 (p < .001). Accordingly, we observed an increased mean operative time within groups but no significant difference in the conversion rate. We noted a different overall postoperative complication rate within groups, respectively: 9% in G1, 14% in G2 and 24% in G3 (p < .04). The median hospital stay was also different within groups, respectively: 3 in G1, 4 in G2 and 6 days in G3 (p < .001). On univariate analysis, age >= 60, male gender, ASA 3, WBC >= 13.000/mu L, CRP >= 100 mg/l and delay between onset of symptoms and surgery were factors statistically associated with increased morbidity rate. On multivariate analysis, the delay was the only independent predictive factor of postoperative morbidity (OR: 1,08, 95% CI: 1.01-1.61, p < .031). Conclusion: Our study confirms that it is ideal to perform ELC within 3 days of symptoms onset and reasonable between 4 to 7 days. We do not recommend performing ELC beyond 7 days because of more difficult procedure and significantly increased risk of post-operative complications.

Le renfort Symbotex™ composite (SC) est composé d’un textile en polyester, monofilament tridimensionnel recouvert par un film hydrophile résorbable. L’objectif de l’étude SymCHro était d’évaluer les résultats cliniques du renfort dans le traitement des hernies ventrales avec un suivi postopératoire de 2 ans. Registre observationnel multicentrique administré par le Club Hernie d’une série consécutive de 100 patients traités par le renfort SC. Nous présentons les résultats de fin d’étude avec un suivi postopératoire de deux ans. Cent patients ont bénéficié d’une cure de hernie ventrale (incluant 39 hernies primaires et 66 éventrations). Soixante-dix-sept pour cent des patients ont été traités par voie laparoscopique. Quatre-vingt-treize patients ont été revus à deux ans. La durée médiane d’hospitalisation était de 2,0 jours (0–8 jours). La douleur postopératoire médiane était de 4/10, 2/10, et 0/10, respectivement à j1, j8 et M1. Six sérums mineurs, 2 cas d’iléus transitoire spontanément résolutif et 1 iléus prolongé dans le mois postopératoire. Avec deux ans de suivi, une récidive (1,1 %) n’ayant pas nécessité de ré-intervention a été diagnostiquée. Avec un recul de deux ans, l’étude Symbotex™ composite a montré un très faible taux de complications, et de douleurs et une récidive asymptomatique.

Objectives: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per-and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. Methods: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. Results: Mean age and body mass index were respectively 39 years and 41.5kg/m(2). Ninetyone patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). Conclusions: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.

Aim: The SymCHro study objective is to assess patient outcomes and surgeon satisfaction following ventral hernia repair with a three-dimensional (3D) monofilament polyester mesh (Symbotex composite mesh) that contains an absorbable collagen barrier on 1 side to minimize tissue attachment. Methods: SymCHro is a multicenter observational study of 100 consecutive patients in the French Club Hernie registry who underwent primary and incisional ventral hernia repair with a Symbotex composite mesh. The primary objective is to assess recurrences and complications within 2 years of repair. This analysis reports 1-year results from the ongoing study. Results: A total of 105 hernias (37.1% primary, 62.9% incisional) in 100 patients were repaired by open or laparoscopic surgery. The patient follow-up rate at 1 year was 94%. A total of 6 (6.0%) low-grade seromas; 3 (3.0%) cases of low-grade transitory ileus; and 1 (1.0%) recurrence, which was asymptomatic but was repaired, occurred within 1-year follow-up. No serious adverse events were reported. All surgeons responded as satisfied with mesh flexibility and ease of insertion. Relative to baseline, patient pain reduced significantly at day 1 through month 3 postoperatively. At 1 year, 88.3% (83/94) patients assessed the hernia operation results as “good” or “excellent.” Conclusion: At this 1-year analysis, 94% of patients were followed up and experienced minimal pain and low complication rates, suggesting that Symbotex composite mesh provides an effective and safe repair for primary and incisional ventral hernias.

A case–control study was performed to compare laparoscopic ventral hernia repair (LVHR) using the Ventralight ST™ lightweight surgical mesh with LVHR using other types of mesh.

Objectives: The aim of the study is to evaluate the feasibility, the morbidity and the efficacy of transanal excision by endoscopic microinvasive surgery using the SILS (R) port for the treatment of rectal tumors. Methods: From January 2010 to December 2013, 94 patients had a transanal excision of a benign rectal lesion (n=72) or malignant tumor (n=22). The mean diameter of the lesions was 2,9 mm +/- 1,2 (1-7) and the mean height compared to the anal margin was 7,5 cm +/- 3,5 (4-10). Results: The mean operating time was 52,3 min +/- 28,6. There were 2 conversions (2,1 %) for intraperitoneal perforation, one needing proctectomy with total mesorectal excision (TME). Mortality was nil and morbidity was 14,7 %, with 22 patients Clavien 1-2 and 4 patients Clavien 3. Mean hospital stay was 3 days +/- 3. Excision was complete by histological confirmation in 84 cases (89,4 %). With an average follow-up of 39,2 months +/- 15, the rate of local recurrence in case of benign lesion was 7 % (n=5). One patient was reoperated to have a proctectomy with TME, the 4 others had another transanal excision. In case of malignant tumor, recurrence rate was 6,2 % (1 patient). It was a lesion T1sm1 that was reoperated by transanal endoscopy. Conclusion: Transanal endoscopic excision of rectal tumors with the SILS (R) port is workable and reproducible, with no mortality, little morbidity, and macroscopic quality excision.

Aim: To assess the initial results of single umbilical incision laparoscopic cholecystectomies (SUILC) performed by the members of the Club Coelio.Patients and methods: This multicenter study involved 65 consecutive patients undergoing SUILC between September 2008 and December 2009. The operation was performed with a 0 degrees scope in 35 and with a 30 degrees scope in 30 patients. There were 56 women and nine men with a mean age of 49 +/- 14 years and a mean body mass index of 25 +/- 4. The main perioperative parameters analyzed were duration of operation, conversion, morbidity and duration of hospitalization. One month after surgery, the esthetic result was assessed by each patient on a visual analogue scale (VAS). A VAS score between 9 and 10 was considered as an excellent result.Results: During laparoscopy, some degree of cholecystitis was seen in 10 patients. Intraoperative cholangiography was performed in 57 patients and the mean duration of operation was 68 +/- 22 min. Conversion to conventional laparoscopic cholecystectomy (CLC) was required in eight patients (12%). We noted three complications (4%): two wound abscesses and one hemoperitoneum. The mean hospital stay was 2 +/- 1 days. The esthetic result was considered as excellent by 45 patients (69%). Multivariable analysis revealed that duration of operation was shorter after five procedures (61 +/- 25 vs. 72 +/- 18 min, regression coefficient: -7, P < 0.032) and when a 30 degrees scope was used (56 +/- 18 vs. 76 +/- 20 min, regression coefficient: -14, P < 0.011), the conversion rate was higher in cholecystitis (60% [6/10] vs. 4% [2/55], OR: 33, P < 0.002) and the percentage of excellent esthetic results was greater in patients who did not required a conversion to CLC (77% [44/57] vs. 12% [1/8], OR: 18, P < 0.012).Conclusions: Our study showed that SUILC is feasible with low morbidity but duration of operation is long and conversion to CLC is frequent in cholecystitis. However, duration of operation decreases with rising experience of the surgeon and when a 30 degrees scope is used. The major value of this technique is cosmetic. (c) 2010 Elsevier Masson SAS. All rights reserved.