Zum 150. Geburtstag von César Roux (1857–1918)

César Roux was one of the few universal surgeons at the end of the 19th century who dominated all fields of surgery and influenced current surgery with his innovative spirit. Pioneering spirit and the story of the success of modern surgery are linked with his name. On the occasion of his 150th birthday, we recall the memory of this great surgeon. The personality and the history of Professor César Roux form a part of our medical and surgical heritage.

Reduction of groin lymphatic complications by application of fibrin glue: preliminary results of a randomized study

Lymphoceles and lymph fistulas are common complications after exposure of the common femoral artery in the Scarpa triangle because of operative transsection of overlying lymphatics. The purpose of this prospective randomized study was to determine the incidence of groin lymphatic complications and to assess the impact of routine application of fibrin glue on lymphatic structures and subcutaneous tissue prior to closure. All patients undergoing exposure of the common femoral artery in the Scarpa triangle were included in this study. They were divided into two groups according to closure technique. In group A, closure was performed without fibrin glue. In Group B, fibrin glue was applied to lymphatic structures prior to closure. The efficacy of fibrin glue application was estimated on the basis of two criteria: incidence of local complications and amount of lymphatic fluid in the Redon drain. The preliminary findings suggest that application of fibrin glue leads to a significant reduction in the incidence of lymphatic complications after femoral artery exposure in the Scarpa triangle.

[Laparoscopic treatment of small bowel obstruction arising on adhesions]

OBJECTIVES

Determine the feasibility of laparoscopy, with the objective as well as the subjective benefits offered to patients, and the possible contra-indications of this type of surgery in the treatment of mechanical intestinal ileus.

PATIENTS AND MATERIAL

This concerned 20 patients who came to the hospital with a picture of intestinal obstruction. All had a history of at least one abdominal operation. The diagnosis of mechanical occlusion due to band adhesions was presumed on the basis of the clinical and complementary examinations, particularly x-rays, and confirmed in the course of the operation. All patients were operated by laparoscopy after failure of non-invasive treatment.

RESULTS

Results obtained are encouraging since 60% of the patients were successfully treated by laparoscopy alone. The patients' comfort and length of hospital stay are improved by laparoscopy. There is no relation between previous surgical history and the results of the technique.

CONCLUSIONS

Most failures were due to the time interval between onset of symptoms and the operation. Early operation therefore seems to increase the chances of success.

[The window in the falciform ligament. A rare case of hernia of the small intestine through the falciform ligament]

The most common causes for small-bowel obstructions with subsequent strangulation are intra-abdominal adhesions and external hernias. We report an unusual case of strangulated small-bowel hernia through a congenital window in the falciform ligament. The diagnosis and surgical treatment are discussed.

[Chronic saphenous venous access: an interesting alternative in the case of vena cava superior syndrome]

An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). We describe the operative technique and we analyze the indications, the results and the complications of this rarely used technique.