After reviewing the available classifications for groin hernias, the European Hernia Society (EHS) proposes an easy and simple classification based on the Aachen classification. The EHS will promote the general and systematic use of this classification for intraoperative description of the type of hernia and to increase the comparison of results in the literature.

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The place of pancreatic resection in the treatment of acute pancreatitis is still much debated. Because of the bad results after insufficient resection, such as recurrence of extensive pancreatitis and infection, we decided to perform gastroduodenopancreatectomy (GDP) if more than 75% of the gland was necrotic. We have performed 52 operations for acute necrotizing pancreatitis since 1972 in the Surgical Clinic of Broussais Hospital; of 20 GDP patients, 8 are still alive. All have easily controlled diabetes,S were able to resume work, and 3 retired. After study of the deaths of the other patients, we conclude that it is important to carry out operative excision early, resecting all areas of necrosis before the lesions become the focus of uncontrollable infection. Four categories of patients are described on the basis of creatinine level, blood culture, appearance of the pancreas, and spread of necrosis. According to the gravity of the lesions treated with this method (necrosis of more than 75% of the pancreas), the death rate is usually 90% or higher. We believe that GDP offers the possibility of improvement.

In this series of 15 personal cases, the authors emphasize the unusual colonic complications which occur during acute necrotizing pancreatitis. These lesions always indicate a particularly severe pancreatitis and depend on 2 factors: extension of pancreatic necrosis into the mesocolon with encasing pericolic tumoral fibrosis, and parietal ischemic necrosis secondary to shock and thrombosis with infection. Laparotomy followed by colectomy is indicated in these severely ill patients. Prognosis is poor (8 deaths of 15 patients), sometimes in spite of extensive pancreatic excision. The existence of colonic complications gives evidence of the particular severity of certain forms of pancreatitis.

These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.

According to the European Hernia Society groin hernia classiWcation a type 3 hernia is larger than 2 Wngers and not restricted to ¸3 Wngers as now mentioned in the publication. Therefore the text should be read as follows: As can be seen in Table 2, the size of the hernia oriWce is registered as 1 (•1 Wnger), 2 (1¡2 Wngers) and 3 (>2 Wngers).

Summary: Complete and rapid cellular ingrowth is the necessary condition of an ideal parietal mesh. However, this property obtained with conventional meshes induces visceral adhesion formation in 8o to loo% of the cases when the mesh is intraperitoneally implanted. In order to combine both cellular ingrowth on one side and adhesion prevention on the other, a new generation of polyester mesh protected by a hydrophilic absorbable film has been developed. The purpose of this study was to assess the performance and tolerance of this mesh in clinical use. 80 patients (mean age: 58 + 12 )7) were included in a prospective multicenter clinical trial: 75% for incisional hernia, 25% for umbilical hernia. Patients were treated via an open approach (64%) or laparoscopically (36%). All meshes were implanted in a midline intraperitoneal location. The main outcome was to evaluate the antiadhesive capability of the mesh as regards the viscera. In order to objectively assess the absence of visceral adhesion, a specific ultrasound (US) examination was firstly validated (preoperative prediction vs. operative findings) and secondly used during follow-up as well as usual the clinical parameters. Pre-op US prediction vs. per-op macroscopic findings: sensitivity 77%, specificity 74%, overall accuracy 75%, negative predicive value 84% (probability illustrating that a negative test really identified an adhesion-free patient). After two months, 80% of the patients were ultrasonically adhesion-free (88% in the laparoscopic group, 76% in the open surgery group, 77% in the incisional hernia group, 88% in the umbilical hernia group). Early postoperative complications were: seroma/hematoma 16.25~ subcutaneous infection 3.7%, cutaneous necrosis 2.5% and obstructions (outside the mesh) z.5%. No mortality was observed. Clinically, after lo months, no complication related to postoperative adhesions to the mesh was observed: (obstruction o%, fistula or sepsis 0%). The observed recurrence rate was 2.5%. The intermediate results obtained in this prospective multicenter clinical trial demonstrated the safety and efficiency of this composite mesh in the intraperitoneal treatment of both incisional and umbilical hernia.

Plasma immunoreactive glucagon, C-peptide and substrates (glucose, lactate, and alanine) were measured in 21 pancreatectomized patients and 28 patients with chronic calcifying pancreatitis during arginine infusion. Results were compared with those obtained in control and in insulin-dependent diabetic subjects, and in pancreatectomized subjects receiving a combined infusion of glucagon and arginine or somatostatin and arginine. Plasma immunoreactive glucagon in the pancreatectomized patients was 230 +/- 26 pg/ml (control subjects 100 +/- 13 pg/ml, p less than 0.001), but was unchanged following arginine or somatostatin. Following ethanol extraction of plasma it became undetectable. Similar results were obtained in patients with chronic pancreatitis. In contrast to the insulin-dependent diabetic subjects, no changes in blood glucose, lactate, and alanine concentrations were found during arginine infusion in the pancreatectomized or pancreatitis patients. Addition of glucagon restored the metabolic response to arginine in the pancreatectomized patients. Our results confirm previous smaller studies that in pancreatectomized patients, A cell function is absent or insignificant.