The trial of a retired surgeon accused of sexually abusing hundreds of young children over decades, many of them his patients, opened on Friday in France.

In what is considered France's worst-ever incident of pedophilia, Joel Le Scouarnec allegedly abused as many as 349 children, some as young as 4 years old, over more than 30 years.

The trial on Friday in the western city of Saintes involves four seperate cases: those of his two nieces, who he abused between 1989 and 1999 when they were children, a hospital patient who was 4 years old when allegedly abused in 1993, and a 6-year-old child neighbor.

The case of the neighbor was the first to reach investigators; in 2017 the child told her mother that Le Scouarnec had exposed himself to her and forced penetration.

The original investigation led to many further legal complaints. Prosecutors are preparing to undertake further action after the current trial ends.

Le Scouarnec, who had been in pre-trial detention, was brought to the courthouse in a police escort

Notebooks detail child sex abuse

Expert reports described him as a "manipulator fascinated by pedophilia."

According to investigators, Le Scouarnec took sexual advantage of child patients as soon as they were alone in their hospital room. They say he acted strategically, using medical reasons as a pretense and passing off sexual violence as a professional gesture. He targeted patients too young to remember or understand what was happening, they added.

During their search of his home, investigators found more than 300,000 images of child pornography, as well as notebooks in which the 69-year-old surgeon extensively detailed his sexual abuse of children from 1989 to 2017. The entries included both the children's names and the sexual acts inflicted upon them. The diaries also said he abused older patients while they were under the effect of anesthesia.

Prosecutors have gathered extensive judiciary files in the case of Le Scouarnec

Le Scouarnec has acknowledged sexual molestation but denied rape. He said his diaries were in part fantasized and that he supposedly set limits for himself, including no penetration.

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Prosecutors have questioned 229 people named in the notebooks, 200 of whom have filed formal complaints, the regional prosecutor's office told AP news agency. The justice system has registered a total of 349 cases against the doctor. However, many incidents occurred too far back in the past to prosecute.

Le Scouarnec had been in pre-trial detention. He faces up to 20 years in prison, if convicted. The trial is expected to last four days.

He had previously been sentenced in 2005 to a four-month suspended prison sentence on child pornography charges. Critics question why it has taken so long to reveal the extent and gravity of the doctor's sexual violence.

cmb/sms (AP, AFP)

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