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Chronic abdominal pain 

Woman in pain

Chronic abdominal pain is pain that persists for more than 3 months. It is found in about 15-25% of the population. The pain is usually poorly localized.


The most common causes are neurogenic, parietal and intestinal. Often underestimated is the intestinal dysbiosis characterized by digestive heaviness, cramps, gas, diarrhea or constipation. These symptoms can be associated with headaches, nausea and weight gain, bad breath, loss of libido, fatigue, allergies, infertility.

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This pathology must absolutely be managed in a complete way. It is therefore important to look for all food intolerances but also imbalances in the population of bacteria in the intestines.


The cornerstone of the treatment is a healthy lifestyle and the use of probiotics, prebiotics and symbiotics.


We offer to help you and do all these examinations and treatments in our office.


Acute abdominal pain

Appendicitis :


Typical pain (periumbilical migrating to the right iliac fossa) accompanied by fever and transit disorder: Stool, Gas, Nausea, Vomiting.   


Generally the treatment is a laparoscopic resection of the appendix (minimally invasive technique).


Occlusion :

Acute bowel obstruction is the complete and persistent cessation of matter and gas from any segment of the intestine.

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Treatment can be medical under the advice of a surgeon: rehydration, intestinal decompression by nasogastric tube and clinical monitoring if no improvement ad Surgery after 36 hours of failure. Surgical treatment requires minimally invasive exploration whenever possible.


Acute cholecystitis (see hepatobiliary chapter) :

Acute lithiasis cholecystitis is an inflammation of the vesicular wall more or less associated with an infection.


We find again:

- Typical pain (in the stomach and liver for more than 6 hours)

- Fever

- Disturbance of transit: stools, gas, nausea, vomiting

- Often other episodes of pain of the same type

Acute cholecystitis .jpeg

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Processing :

- Come to the office on an empty stomach

- Blood test

- An ultrasound

- Antibiotic for at least one week and depending on your progress

- Resection of the gallbladder 6 weeks after the infection episode by laparoscopy. If no infection is found and you have an episode of pain related to gallstones, surgical treatment can be considered as soon as possible (maximum one week's wait).



Diverticular colon disease :

Diverticular disease is characterized by the development of protrusions of the intestinal mucosa through all parietal layers of the colon.


This process can lead to acute but also chronic complications in the long term.

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Surgical treatment is considered if :

- Emergency: Hinchey III and IV peritonitis

- Scheduled: Diverticular stenosis                    

- Entero-vesical/vaginal or uterine fistula to semi-elective

- Cold (3 months after the last acute episode):


There is no evidence that the number of episodes is causally related to the risk of recurrence or perforation. For this reason, no indication is retained in these cases. Nevertheless, these indications must be weighed against the symptoms, co-morbidities and age of the patient (risk of recurrence, mortality, sexual disorders, anastomotic releases).


Inflammatory bowel disease (Crohn's and UCR):

UHR = Ulcero-hemorrhagic Rectocolitis :

It is an inflammatory disease of the rectum which progresses towards the proximal colon. It is predominant in men. To diagnose it, it is necessary to perform a blood test and a colon endoscopy. It depends on the current severity of the disease and on the length of time and type of examination previously performed.


It is important to remember that the most important thing in this type of disease is a healthy lifestyle and medical follow-up to avoid surgery.


Crohn's Disease :

It is an inflammatory disease of the intestine that can reach from the mouth to the anus.

It can manifest itself in a bimodal manner: 15 to 29 years and 55 to 70 years.

75% of patients will present with pain in the lower right side indicating the presence of inflammation of the end of the small intestine. If you present with this type of

to make an appointment at our office so that we can start a quick management consisting of: nutritional assessment, an endoscopy from above and below, an MRI if necessary.


On the other hand, if we have to proceed after a failure of medical treatment, an operation of necessity, we will respect "the principle to be respected is that of maximum savings".

Overweight :

This surgery is in no way a cosmetic or even functional surgery. Its primary objective is to reduce an important and predictable risk of cardiovascular mortality. Its secondary objective is to eliminate diseases secondary to obesity that cause patients to suffer and lead to significant health expenses. Only these objectives ethically allow patients to take the short- and long-term risks of the intervention.

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Operative indication:

In a recent directive, effective January 1, 2000, the OFAS decided that obesity surgery is a treatment covered by health insurance, provided the following conditions are met:

- After referral to the consulting physician.

- The patient must not be older than 60 years.

- The patient must have a body mass index (BMI) of more than 40 kg/m2.

- Two years of appropriate therapy to reduce weight has not been successful.

- The patient also has one of the following conditions:

> high blood pressure.

> diabetes mellitus.

> sleep apnea syndrome.

> Dyslipidemia.

> Disabling degenerative musculoskeletal disease.

> coronary artery disease.

> Infertility or MPO (micropolycystic ovaries).


Preparation for the procedure :

After patients have consulted us, if they meet the indication criteria described above, candidates for bariatric surgery must undergo, a complete psychological and metabolic assessment. The individual indication of each patient is discussed in a multidisciplinary colloquium with our colleagues from the Chronic Disease Teaching Division and the psychiatrist attached to it. We must then seek prior written approval from the patient's health insurance company, which in principle cannot refuse if the indication criteria described above are met. Finally, patients have interviews with a specialized dietician who explains in great detail what will happen to them after the procedure.


Intervention :

Gastric bypass or Sleeve-gastrectomyby laparoscopic robot-assisted approach.


Immediate postoperative care:

Follow-up after discharge

- Consultation at 1 month after the operation (then at 3 months, 6 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years)

- From 1 to 6 months: appointment with surgeon

- From 1 to 5 years: appointment with nurse

- Biological check-up before each consultation

- From 18 months and if weight is stable: possibility of evaluating a plastic surgery


Blood in the stool :

Most common causes:

- Diverticulosis 20-48%.

- Angiodysplasia 3-40

- Tumors/polyps 6-15

- Colitis/ulcer (including chronic inflammatory bowel disease, infectious/ischemic colitis, vasculitis, and radiation colitis) 6-21

- Anorectal (hemorrhoids, anal fissure, rectal ulcer) 3-14

- Miscellaneous (postpolypectomy hemorrhage, aortocolic fistula, anastomotic hemorrhage, rectal impaction)

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In our practice, hemorrhoids are treated by laser.

This requires a one-day hospitalization (ambulatory), postoperative care for a week but resumption of activities after 72 hours.


In addition, we also treat lower back cysts (sacro-coccygeal cysts), anal fissures and fistulas on an outpatient basis by laser. We currently perform more than ten procedures per month.


Ball in the belly :

Hernia of the inguinal region 



"Outflow" of viscera through a natural opening in the abdominal wall, surrounded by a hernial sac. They may be congenital due to persistence of the peritoneal-vaginal canal or acquired due to weakness of the wall.

Inflammatory bowel disease copy.jpeg

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History :

- The patient usually consults for a "lump" in the groin area. 


Complementary examinations (If necessary):

- Inguinal US

- Pelvic CT


Treatments :

There are many techniques for the repair of groin hernias whether they are inguinal or crural, uni- or bilateral, recurrent or not. The choice of technique depends on the type of pathology, the patient and local habits.


The procedure can be performed under general or locoregional anesthesia (epidural or spinal anesthesia).


Overall, we have the choice of a technique under tension (Bassini, Shouldice, Mc Vay) or without tension by anterior approach (Linchtenstein, Rives or plug) or laparoscopic approach (TEP, TAP). The last technique is the most practiced by me.


Follow-up :

- Stop sport activity and carrying of weight >4 kg during 4-5 weeks

- Stop professional activity 3-4 weeks depending on profession.


Eventration :

Definition : 

Irruption under the skin of abdominal viscera contained in a sac in continuity with the peritoneum at the level of an operative scar. It can form following the presence of a postoperative hematoma, a wound infection, a technical error or a healing disorder.


Investigations :

- CT abdo

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Treatments :

There are many techniques for the repair of groin hernias whether they are inguinal or crural, uni- or bilateral, recurrent or not. The choice of technique depends on the type of pathology, the patient and local habits.


The procedure can be performed under general or locoregional anesthesia (epidural or spinal anesthesia).


Overall, we have the choice of a technique under tension (Bassini, Shouldice, Mc Vay) or without tension by anterior approach (Linchtenstein, Rives or plug) or laparoscopic approach (TEP, TAP). The last technique is the most practiced by me.


Follow-up :

- Stop sport activity and carrying of weight >4 kg during 4-5 weeks

- Stop professional activity 3-4 weeks depending on profession.


Varicose veins :

It is a frequently encountered and generally underestimated condition. If you feel heaviness, notice swelling (traces of your socks) or if other people in your family are known to have varicose veins, do not hesitate to come to our practice. We will explain to you how to treat venous insufficiency medically to avoid thrombosis, but also, if necessary, laser treatment, which replaces the old, very painful techniques.

Anal pain :

- Hemorrhoids

- Anal fissures

- Abscesses

- Fistulas

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Treatments :

Treatment is in two stages. The first is to treat the symptoms with medication or ointments. The second is a surgical treatment which is performed in an ambulatory and minimally invasive way under local or general anaesthesia using the Laser.


Gastric cancer :

Stomach cancer usually presents with several symptoms such as pain, abdominal heaviness, anorexia, weight loss, vomiting, bleeding. Its management requires a series of examinations (endoscopy, scanner, blood test). Never hesitate to come and see us if you have this type of sign. In most cases they are completely harmless but prevention is better than cure.


Colonic cancer :

It is widely misunderstood and unfortunately still remains one of the most deadly cancers today. This is due to a lack of communication, screening tests (blood tests or endoscopy) and inadequate treatment. Several parts of the colon can be affected and give different symptoms:

- Right colon: occult bleeding, anaemia and fatigue.

- Left colon: cramping pain, fresh bleeding, >10% low-level obstruction

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The important thing to remember is that if you have any of these symptoms or if you are over 50 years old, consider getting a screening test. However, if several members of your family have already had bowel cancer, come earlier (40 years old).


We welcome you for screening examinations and their interpretation. For this reason we work in collaboration with gastroenterologists. However, we remain at your disposal for the management of cancer, both surgically and in terms of coordinating medical treatment.


Acid reflux :

Gastroesophageal Reflux Disease


Permanent or intermittent reflux of gastric contents

to the oesophagus through the oesophageal hiatus.


Investigations :

- Barium transit

- Endoscopy

- Manometry

- 24 hour pH-metry (involves stopping all anti-scretory drugs for >7 days).

- Blood workup:

> CBC, blood count, blood group

> Blood glucose, Na, K, IC, urea, creatinine


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Therapeutic approaches : 

- Ideal" indication : (all three conditions below are met)

> Symptomatic reflux that responds incompletely to antisecretory therapy and recurs on discontinuation of medication.

> Clearly hypotonic sphincter and normal corporal peristalsis on manometry.

> Peptic esophagitis on endoscopy.


- Complicated reflux:

> Stenosis

> Haemorrhage

> Respiratory or ENT complications


Treatments : 

- Medical in priority

- Surgical techniques:

> In principle, whenever possible, Nissen by laparoscopic approach.

> In case of insufficiency of corporal peristalsis of the oesophagus to a laparoscopic Toupet or Dor.

> Open Nissen should be reserved for cases where another surgical procedure requires a laparotomy, or in the presence of the usual contraindications to the laparoscopic approach (e.g. supra-umbilical scar).


Notes :

Nissen = 360° fundoplication

Toupet = 270° fundoplication

Dor = 180° fundoplication


Post-operative care: 

- No nasogastric tube.

- Drinks on the evening of the operation, re-feeding on Day 1.

- Prophylactic anti-coagulation until discharge.

- No antibiotics.

- Smooth diet until ambulatory check at D10.


Ball in the vagina.jpeg

Feeling of a ball in the vagina (commonly called a rectocele) :

- We need to explain what Vagy-combi is

- The surgical treatment is done on an outpatient basis and consists of repairing the wall of the rectum so that it no longer distorts the inside of the vagina.

Involuntary loss of stool :

- They are often caused by damage to the muscles of the anus (the sphincters). First of all, we use an examination called manometry to determine whether your muscles are dysfunctional.

- The treatment consists of using radiofrequency to allow (see vagy combi)


Musculo-tendinous pain :

- See electroporation

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