monthly focus

video lecture

Острый аппендицит у взрослых: стратегии лечения

Stratégies de prise en charge des appendicites aiguës chez l’adulte

Acute appendicitis in adults: management strategies

Лапароскопическая холецистэктомия по поводу холецистита

Laparoscopic cholecystectomy for cholecystitis

Cholécystectomie laparoscopique pour cholécystite

Cure laparoscopique de hernie ventrale et d'éventration

Лапароскопическое лечение вентральной грыжи

Laparoscopic ventral and incisional hernia repair

surgical intervention video

Лапароскопическая аппендектомия - когда всё понятно без слов

This video gathers several cases of laparoscopic appendectomies without commentary. Enjoy this new video format of self-explanatory surgeries and let the pictures do the talking.

Laparoscopic appendectomies - Let the pictures do the talking

Appendicectomies laparoscopiques - Laissez parler les images

In this educational video, authors present the case of a 43-year-old female patient who had an abdominal incisional incarcerated hernia. During the work-up, the CT-scan showed a 4cm incisional hernia, which included the small bowel and the omentum without any signs of ischemia. Consequently, the patient was considered to be candidate for  laparoscopic hernia repair. During the video, relevant surgical details are highlighted such as small bowel manipulation during hernia reduction and closure with a barbed suture. Technical details for mesh reinforcement are also provided. There were no intraoperative complications, and the postoperative outcome was uneventful as well. 

Laparoscopic intraperitoneal onlay mesh repair (IPOM) plus technique in ventral incisional hernia

Послеоперационная грыжа: стратегия

Prise en charge d’une hernie d'éventration

This video gathers the sequel to several cases of laparoscopic appendectomies without commentary. Enjoy this new video format of self-explanatory surgeries and let the pictures do the talking.

Appendectomies - Let the pictures do the talking 2

Appendicectomies - Laissez parler les images 2

Аппендэктомия - когда изображение важнее слов

The term ‘‘complex (abdominal wall) hernia’’ is often used by general surgeons and other specialists working in the abdomen to describe abdominal wall hernias which are technically challenging and time-consuming. 



Four categories were created to classify and discuss the criteria, which were proposed to be included in the definition of ‘‘complex abdominal wall hernia’’: defect size and location, patient history and risk factors, contamination and soft tissue condition, and clinical scenario. 

Defect size is an important variable; increased size is a risk factor for 30-day readmission rate and recurrence. 

Wound contamination is usually classified according to the US National Research Council Group including clean, clean-contaminated, contaminated, and dirty/infected. It is well-known that contamination and subsequent infection are an important cause of wound dehiscence and reherniation which impair wound healing dynamics. 

A recurrent hernia is considered a risk factor for a new recurrence. 

Patient status is an important factor. Conditions such as abnormal collagen type I/type III ratio and genetic connective tissue disorders are associated with an increased risk of herniation. Older age, male gender, chronic pulmonary disease, coughing, ascites, jaundice, anemia, emergency surgery, wound infection, obesity, steroid use, hypoalbuminemia, hypertension, perioperative shock are also important risk factors. 



The reported incidence of incisional hernia is about 2 to 11% after all laparotomies. 

The ideal repair for an abdominal incisional hernia is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. However, 30 to 50% of defects larger than 6cm recur after primary closure. 

The insertion of a synthetic mesh helps to decrease or relieve tension on the suture line and can reduce the incidence of recurrence to 10% or less. 

But foreign prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization. 

Laparoscopic repair has provided further improvements with lower infection rates, shorter hospital stay, and a reduction in recurrence with rates of 4 to 16% in recent studies. 

In this topic addressing complex laparoscopic cases, we show different scenarios including recurrent infected incisional hernia, fistulization, multi-recurrent incisional hernia, migration, and conversion. 

Recurrent and incisional hernia repair: complex cases

Пластика рецедивной послеоперационной грыжи: сложные случаи

Перфорация желудка в картинках

This video gathers several cases showing the management of gastric perforation without commentary. Enjoy this new video format of self-explanatory surgeries and let the pictures do the talking.

Management of gastric perforation - Let the pictures do the talking

Prise en charge d’une perforation gastrique - Laissez parler les images

This video gathers 2 cases of laparoscopic management of appendicular infiltrates and abscesses without commentary. Enjoy this new video format of self-explanatory surgeries and let the pictures do the talking.

Let the pictures do the talking: laparoscopic management of appendicular infiltrates and abscesses

Laisser parler les images : prise en charge laparoscopique des infiltrats et abcès appendiculaires

Appendicectomie laparoscopique pour appendicite récurrente

In this video, authors present the case of a 78-year-old male patient who had had an acute appendicitis one year ago. Although it was cured via medical treatment, he had a recurrent appendicitis with an appendicular anteroposterior diameter of 18mm with heterogeneous liquid during the subsequent work-up, which was particularly evidenced on CT-scan. Consequently, he was considered the best candidate for a laparoscopic appendectomy. 

This video demonstrates the typical steps to achieve a laparoscopic appendectomy for appendicitis. There were no intraoperative complications, and the postoperative course was uneventful as well. 

Laparoscopic appendectomy for recurrent appendicitis

Intervention de Hartmann laparoscopique pour le traitement des diverticulites compliquées

In this educational video, authors present the case of a 63-year-old male patient who had been diagnosed with a sigmoid diverticulosis in 2013. He had a left lower quadrant pain with constipation for a period of 8 days and he was referred to the emergency department. The CT-scan showed the presence of intra-abdominal free air, as well as an increased panniculitis around the sigmoid colon, and fluid. The patient was diagnosed with a diverticular perforation. Consequently, he was considered for laparoscopic surgical management. This video demonstrates the technical steps of a laparoscopic sigmoidectomy in an acute setting. During the video, relevant technical details are stressed in order to prevent any complications. Appropriate dissection and energy application are exemplified during the entire procedure. 

Laparoscopic Hartmann’s procedure for the treatment of complicated diverticulitis

In this educational video, authors present the case of a 73-year-old male patient who has had a right upper quadrant pain, vomiting, and fever for 2 days. The CT-scan showed gallbladder enlargement, gallbladder wall thickening, a gallstone, and an increased panniculitis around the gallbladder. The patient was diagnosed with an acute cholecystitis. Consequently, he was considered the best candidate for a laparoscopic cholecystectomy. Although authors are faced with a difficult cholecystectomy with a vascular biliary anatomical variation, they managed to obtain the critical view of safety (CVS), which is required to identify the cystic duct and the cystic artery during any laparoscopic cholecystectomy. There were no intraoperative complications, and the postoperative course was uneventful as well.

Feasibility and value of the critical view of safety in difficult cholecystectomies in an acute setting

Faisabilité et valeur de la vision critique de sécurité dans les cholécystectomies difficiles dans un contexte d'urgence

In this video, authors present the case of a 55-year-old male patient who had had a robotic gastric bypass with 75cm of biliopancreatic limb and 150cm of alimentary limb in 2018. He presented with abdominal pain and vomiting 20 months after gastric bypass surgery. The CT-scan showed a volvulus in the small bowel located proximal to the jejunojejunostomy as well as hydroaeric levels located in the distal biliopancreatic limb. As a result, he was considered the best candidate for a laparoscopic exploration to identify and solve the cause of the ileus. 

This video demonstrates the presence of an internal hernia due to a band, which is managed surgically. In addition, the surgical steps necessary to manage a strangulation ileus are also provided. There were no intraoperative complications, and the postoperative course was uneventful as well. 

Laparoscopic surgery for a strangulation ileus after robotic Roux-en-Y gastric bypass

Chirurgie laparoscopique pour iléus de strangulation après bypass gastrique robotisé selon Roux

This video demonstrates the laparoscopic management of a strangulated umbilical hernia in an obese patient who has had an umbilical hernia operated on about 14 years ago. Sudden pain and hernia irreducibility led the patient to the emergency department and the diagnosis was confirmed via CT-scan. The bowel in the hernia sac showed signs of ischemia. An emergency laparoscopy was decided upon. The video demonstrates essential operating steps, namely cutting of the hernia ring in order to allow for the reduction of the content, resection of the ischemic bowel and intracorporeal anastomosis, followed by closure of the defect and placement of the reinforcement mesh. 

Laparoscopic management of strangulated umbilical hernia with bowel necrosis

Prise en charge laparoscopique d'une hernie ombilicale étranglée avec nécrose intestinale

This video demonstrates the transabdominal retromuscular approach to an epigastric incisional hernia in an obese patient who had a sleeve gastrectomy in 2011 and a gastric bypass in 2018. The patient consulted for epigastric pain with a reducible painful hernia at clinical examination. The work-up was completed with gastroscopy, which was strictly normal. Ultrasound confirmed a 20 by 15mm epigastric hernia. A retromuscular approach was decided upon in this obese patient with a BMI of 32. The anatomical landmarks and the technical steps are demonstrated progressively. Drawings of the abdominal wall anatomy indicate the site of incision and dissection at each step. Scar tissue on the midline rendered the dissection difficult, and the peritoneum was torn apart around the hernia sac. Consequently, a right transversus abdominis muscle release was necessary in order to develop a sufficient space to place the mesh in the retromuscular space. Six days later, the patient developed an acute cholecystitis with biliary peritonitis, necessitating emergency surgery. This intervention shows that the mesh is perfectly covered by the posterior peritoneal and aponeurotic layer, the mesh being protected from biliary contamination. This allowed for mesh preservation and ensured an uneventful postoperative course, with no mesh infection. 

Focus on emergency surgeries