Purpose The purpose of this study was to compare the perioperative course and long-term functional outcomes of children with early and late diagnosis of Hirschsprung ' s disease (HD). Methods This retrospective study included patients affected by HD who underwent pull-through between 1984 and 2015. Patients were classified into two groups: early diagnosis of HD (EDHD) before 1 year of age and late diagnosis of HD (LDHD) after 1 year. Functional outcomes at 3, 6, and 9 years after surgery were analyzed. Results One hundred and five patients, 83.8% with EDHD and 16.2% with LDHD. Abdominal distension and vomiting were the main presenting symptoms of EDHD, whereas chronic constipation was the primary symptom of LDHD. Preoperative intestinal obstruction occurred in 59.1% of EDHD versus 5.9% of LDHD (p < 0.0001). Diverting colostomy was performed in 31.8% of EDHD versus 5.9% in LDHD (p = 0.03). Anal strictures needing anal dilatation occurred in 30.7% of EDHD versus 5.9% in LDHD (p = 0.03). At 3 years of follow-up, there was a statistical difference in terms of constipation (10% in EDHD vs. 23.5% in LDHD; p = 0.04), but not in terms of soiling (30.7% vs. 29.4%; p = 0.65); 9 years after surgery, comparable results were shown in terms of both constipation and soiling. Conclusion Long-term functional outcome is generally comparable between patients with EDHD and LDHD.

Surgical management of ovarian masses in girls still challenging. The aim of the study is to report an 8-year experience in managing children with ovarian masses, and to demonstrate the advantages and the limitations of laparoscopy for such lesions. Data of girls aged less than 18 years operated because of an ovarian mass between January 2015 and February 2023 were retrospectively reviewed. Patients were divided into two groups: group A including children operated by laparoscopy, and Group B of patients who underwent open surgery. Eighty-eight children were enrolled. Laparoscopy was performed in 56 patients (63.6

Total nephrectomies for the treatment of Wilms’ tumor (WT) are more and more performed by laparoscopy, although indications for this approach following the UMBRELLA guidelines are currently very restrictive. The purpose of this study was to assess the compliance to the criteria of the UMBRELLA protocol for minimally invasive approach of WT. This retrospective multicenter study included children operated on by laparoscopic total nephrectomy for suspected WT before 2020. Imaging was reviewed centrally. Fifty-six patients (50 WT and 6 nephrogenic rests) were operated on at a median age of 3.3 ± 2.6 years. Thirteen (23

Background:Endoscopic injection (EI) is a safe treatment for vesico-ureteral reflux (VUR) in children, but recurrences are not insignificant. This study aims to show if multiple EI is still the best first line management even if in case of recurrences. Methods:All patients affected by primary VUR, treated with at least one EI and with at least 5 years follow up were included. All general data were analyzed. Recurrence rate after one, two and three EIs were calculated. Results:One hundred and sixty-one patients (total number =210) were healed after 1 injection, 28 after 2 and 4 after 3 with a global success rate of 91.90%. Recurrence rate is higher in patients older than 3 years old and with IV and V reflux grade. Even if 67.7% of recurrent VUR after one injection was symptomatic, diagnosis of recurrences after multiple EI was mainly radiological. Only 8% of the patients underwent EI need an anti-reflux surgery. Conclusions:Thanks to its low costs and the acceptable recurrence rate, Deflux EI should be proposed as the first therapeutic approach for children affected by VUR, especially in those with low and moderate grades of VUR. Multiple injections could be contraindicated only in older children thank 1 year with high-grade VUR (IV symptomatic and V grade).

Background Pyeloplasty is a common surgical operation with a high success rate. However, significant challenges are to be optimized in the design of stenting systems in order to improve perioperative monitoring of urine drainage and enhance patient and family comfort through easier post-operative care. Materials and Methods In a preliminary study in six pigs, handling, mechanical and functional features of this stent system were tested. In our main study, six double-lumen stents (230 mm long each) and 6F/9F external diameter were implanted through the ureteric walls of six domestic pigs to allow postoperative drainage and monitoring following ureteroureterostomy. After a 7-day survival period, monitoring with intravenous antibiotic coverage, and pain control, contrast antegrade pyelogram, under valve control, and renal ultrasonography were conducted and stents explanted and the animals were then euthanized. Results The double-lumen valve-controlled stent supported the healing of the neo anastomoses and helped to monitor perioperative urine drainage and perianastomotic leakage accurately. It also guided a well-controlled more informative radiological contrast-supported imaging before removal of the stents that confirmed the healing of the neo anastomotic site and no leak formation. The double-lumen system demonstrated high feasibility regarding its insertion, functionality, and removal capacities. The excellent flexibility of the individual stents allowed exact anatomically controlled implantation. Conclusion The double-lumen valve-controlled stent system was studied in a porcine model, which demonstrated its feasibility. Preclinical experience revealed favorable results concerning stent implantation, operability and functionality, in the perioperative management of pyeloplasty or ureteric surgery.

Background: Over the past decade, laparoscopic hernia repair was the most performed operation in our department. Equally, it compromises 15% of all pediatric operations performed. We aim, in this study, to review all the cases performed and extrapolate important information like reoccurrences, the incidence of metachronous inguinal hernia, complications amongst other information. Material and Methods: All patients under the age of 18 whom underwent elective laparoscopic hernia repair between 03/01/2007 till the 18/05/2016 were included in our study. We recorded important clinical features and studied their post-operative follow up. Equally reoccurrences, the incidence of metachronous inguinal hernia, complications and other parameters were recorded and studied. Results: A total of 916 patients were operated on during the defined study period. There was a 0.17% reoccurrence rate and a 0.46% incidence of metachronous inguinal hernia. Equally a contralateral patent processus vaginalis was diagnosed and closed in 17.10%. There were no postoperative complications and we had a 0% postoperative hydrocele rate. Conclusion: Laparoscopic hernia repair is safe and carries all the benefits of minimally invasive surgery. We recommend that it is offered to patients and would like to refute previously claimed reports that it carries a higher reoccurrence rate or takes a long time to perform. Our reoccurrence rate of 0.17% is actually lower than many published reoccurrence rates after open repair.

Prenatal diagnosis of an allantoic cyst with a patent urachus is rare. A urological etiology can sometimes be associated with it. We report 4 cases of allantoic cyst with a patent urachus and reviewed the literature to investigate for any etiology using the keywords “allantoic cyst” and “patent urachus”. Diagnosis of an allantoic cyst with a patent urachus was established during the first or second trimester of pregnancy. In two cases, rupture of prenatal cysts occurred and in one case, we described a prenatal vesicourethral abnormality. Surgery was performed with good results and no complications. A literature review collected 12 studies (15 fetuses) with a sex ratio of 3 boys/1 girl. The cysts ruptured in 2/3 of the cases, and in half of the cases, urinary abnormalities were found before birth (enlarged bladder, bladder prolapse). At birth, one boy had posterior urethral valve (PUV) and 4 boys had a bladder prolapse. The postoperative course was uneventful. We present our series with one case showing the etiology of a patent urachus during prenatal life. Cystoscopy seems to be valuable in the post-natal diagnosis. In the literature, we found one case of PUV. Surgery was performed with good results and no complications.

Background: Wilms tumors (WTs) are the most frequent renal tumors in children. Radical nephrectomy (RN) remains the gold-standard surgical treatment for this type of cancer. Excellent results in overall survival (>90%) make it possible to consider nephronic preservation. The objective of this systematic review is to evaluate the relevance of nephron-sparing surgery (NSS) for the treatment of nonsyndromic unilateral Wilms tumor (UWT) in children.Methods: Articles in English related to "unilateral Wilms tumor, unilateral nephroblastoma, partial nephrectomy, nephron-sparing surgery, renal function" identified in the Medline library were screened and data were extracted to perform a qualitative systematic review.Results: We identified 377 articles, 14 of which were integrated into the analysis. Data on 4288 children were included, 3994 (93.1%) underwent RN, whereas 294 (6.8%) underwent NSS. Stage I anatomopathology resulted in 55.1% RN and 79% NSS. Overall survival and event-free survival were similar: respectively 95.7% and 92.8% after RN and 96 and 90.5% after NSS. Positive margin status was higher after NSS (8.5% vs 0.5%), but tumor rupture and local tumor recurrences were similar. The rate of mild to moderate renal function was higher after RN (42% vs 10% after NSS).Discussion: NSS is regularly performed for WT in case of bilateral or syndromic tumors, but the literature considering UWT does not show consensus. The superiority of NSS for renal outcomes has now been fully evaluated, but the main problem of this surgery in case of UWT is to ensure oncologic outcomes as good as outcomes after RN. WTs are usually massive tumors for which partial nephrectomy is contraindicated, but studies showed that chemotherapy before surgery could reduce tumor volume and make NSS possible. This review shows that NSS results seem to be as good as RN results and that preoperative chemotherapy should be highlighted for its participation in the reduction of the positive margin status. Although radiotherapy is used with caution because of its side effects, some studies showed that it gave excellent results for oncologic salvage after local recurrence. Constant progress in medical imaging and detection systems has led to the emergence of a new type of assistance for surgeons such as image reconstruction and vessel or urinary tract system segmentation. Virtual simulation of the operation based on a real case should help evaluate the feasibility of complex procedures in the near future.Conclusion: NSS for UWT seems to be a credible therapeutic alternative. New technologies such as 3D reconstruction should help surgeons define the best parameters to select ideal tumors for this surgery in the near future. For the moment, small tumors (<4cm), distant from the renal hilum (ideally on the upper pole) that respect at least 50% of the renal parenchyma (ideally superficial with exophytic development) seem to be the perfect indication for NSS. (C) 2017 Elsevier Masson SAS. All rights reserved.

Retroperitoneoscopic upper pole heminephrectomy (RUHN) in duplex kidney in children remains a challenging procedure with a need for postoperative functional assessment of the remnant lower pole. We aimed to calculate the incidence of long-term functional renal outcomes in these children and examine the effect of age on those outcomes.

BACKGROUND:Intestinal malrotations with midgut volvulus are surgical emergencies that can lead to life-threatening intestinal necrosis. This study evaluates the feasibility and the outcomes of laparoscopic treatment of midgut volvulus compared with classic open Ladd's procedure in neonates.MATERIALS AND METHODS:The medical records of all neonates with diagnosis of malrotation and volvulus, who underwent surgery between January 1993 and January 2014, were reviewed. We considered the group of neonates laparoscopically treated (Group A, n = 20) and we compared it with an equal number of neonates treated with the classical open Ladd's procedure (Group B, n = 20).RESULTS:The median age at surgery was 8.4 days and the mean weight was 3.340 kg. The suspicion of volvulus was documented by plain abdominal radiograph, upper gastrointestinal contrast study, and/or ultrasound scanning of the mesenteric vessels. All the patients were treated according to the Ladd's procedure. Conversion to an open procedure was necessary in 25% of the patients. The mean operative time was 80 minutes (28-190 minutes) in Group A and 61 minutes (40-130 minutes) in Group B (P = .04). The median time to full diet (P = .02) and hospital stay (P = .04) was better in Group A. Rehospitalization because of recurrence of occlusive symptoms occurred in 30% of patients in Group A (n = 6) and in 40% of patients in Group B (n = 8). Among these, all the 6 patients of Group A underwent redo surgery for additional division of Ladd's bands or debridement; instead in Group B, 4 of 8 patients underwent open redo surgery.CONCLUSIONS:Laparoscopic exploration is the procedure of choice in case of suspicion of intestinal malrotation and volvulus. Laparoscopic treatment is feasible and safe even in neonatal age without additional risks compared with classical open Ladd's procedure.

Objective: To measure the level of noise in our university operating room and to identify different phases during the course of surgical procedures in which noise level exceeding 40 decibels (National Recommendation). Method: This was a prospective randomized single blinded study for a period of 5 months starting from January 2016. A sonometer was placed randomly in the different operating theatres. Its presence did not mean that it should work. Recording started from the patient’s entry to the operating theatre and ended upon his/her exit. We divided our period in three different types: P1 (from the entry of the patient until the start of surgical procedure); P2 (from the surgical incision to the end of the procedure); P3 (from the completion of closure till the exit from the OR). Strict inclusion criteria (general pediatric surgery case, elective surgery, during normal working hours, operations performed by board certified surgeons) and exclusion criteria (non-general pediatric surgery cases, emergency case, after hours, resident performing the procedure as first surgeon) were applied. Results: The sonometer was present in a total of 64 operations. It was recording in 26 operations. The surgical procedures were: 54% open surgery, 34% laparoscopic surgery and 12% were endoscopic procedures. The total recorded time was 2419 minutes, around 40.4 hours. The average P1 time was 25’, P2 65’ and P3 7’. T test was performed and found the average to be significantly P value 70 dBA during P1, 912 incidents during P2 and 293 incidents during P3. Most often the incidents were due to conversations within the staff at the level >75 dBA. Only 1.5% incidents were more than 80 dBA. More rarely we registered sounds of bells from cellular phones sometimes more than 90 dBA. Conclusion: It is as if there is a first period with excited staff before the beginning of surgery. Then, a second period follows, where the staff is quitter due to required concentration: it looks like the major period of the surgical procedure. The third period, at the end of the surgical act, looks like a moment of relaxation with a noisy ambiance. By this point of view, noisy distractions, considered to be a main cause of perioperative incidents, appear to be related to the level of staff seriousness.

Our objective is to report long‐term outcome after fetal cystoscopy for lower urinary tract obstruction (LUTO), as well as to investigate the accuracy of fetal cystoscopy in diagnosing the cause of bladder outlet obstruction.

Background Ultrasonography is a well-established efficient diagnostic tool for ileocolic intussusceptions in children. It can also be used to control hydrostatic reduction by saline enemas. This reduction method presents the advantage of avoiding radiations. Parents can even stay with their children during the procedure, which is comforting for both. The purpose of this study was to present our 20 years' experience in intussusception reductions using saline enema under ultrasound control and to assess its efficiency and safety. Material and methods This retrospective single center study included patients with ileocolic intussusceptions diagnosed by ultrasound between June 1993 and July 2013. We excluded the data of patients with spontaneous reduction or who underwent primary surgery because of contraindications to hydrostatic reduction (peritonitis, medium or huge abdominal effusion, ischemia on Doppler, bowel perforation). A saline enema was infused into the colon until the reduction was sonographically confirmed. The procedure was repeated if not efficient. Light sedation was practiced in some children. Results Eighty-tree percent of the reductions were successful with a median of 1 attempt. Reduction success decreased with the number of attempts but was still by 16% after 4 attempts. The early recurrence rates were 14.5%, and 61.2% of those had a successful second complete reduction. Forty-six patients needed surgery (11 of them had a secondary intussusception). Sedation multiplies success by 10. In this period, only one complication is described. Conclusion Ultrasound guided intussusception reduction by saline enema is an efficient and safe procedure. It prevents exposure of a young child to a significant amount of radiation, with similar success rate. We had very low complication rate (1/270 cases or 3‰). The success rate could be increased by standardized procedures including: systematic sedation, trained radiologists, accurate pressure measurement, and number and duration of attempts.

Les uropathies obstructives basses sont en général dues à la présence de valves de l'urètre postérieur (VUP) ou à une fibrosténose urétrale. La cystoscopie fœtale est un geste intéressant car permet de faire le diagnostic étiologique de l'uropathie, et de photocoaguler au laser des VUP. Nous rapportons un cas de complications après ablation de VUP au laser par cystoscopie fœtale. Notion dès 16 semaines d'aménorrhée (SA) de mégavessie avec «key-hole sign» et hydronéphrose bilatérale. Une cystoscopie fœtale retrouve des VUP, une coagulation laser est réalisée. L'évolution est favorable (affaissement de la vessie et normalisation de la fonction rénale). A 23SA: mégavessie, oligamnios et dégradation de la fonction rénale. Une 2ème cystoscopie met en évidence un diaphragme qui est fulguré, avec bonne évolution. L'enfant nait à 37SA avec une fistule urétro-recto-cutanée. Un traitement en 2 temps a été réalisé cystostomie et colostomie puis une suite de la prise en charge qui rejoint le traitement postnatal des valves de l'urètre postérieur Ce geste est une option séduisante pour le traitement des VUP, non dénué de risques, dont les aspects techniques doivent être optimisés et les critères de sélection des patientes bien définis

La prise en charge récente d’un cas de valve de l’urètre antérieur, 30 fois plus rare que les valves postérieures, nous a amené à une revue de la littérature. Après une suspicion anténatale de valve postérieure de forme favorable (b2uglobuline sur sang et urines fœtales normales), le diagnostic fut établi à J4 sur la dilatation postéro-bulbaire de l’urètre en cystographie et la présence d’un voile antérieurement inséré à l’endoscopie. Après résection mécanique le pronostic néphrologique était excellent (créatinémie 28 umol/l) conformément à la littérature. Avec 1/100000 cas diagnostiqué par cystographie cystoscopie réséqués efficacement par électrocoagulation ou resecteur mécanique, les complications (sténoses, fistules) demeurent rares. Malgré les signes obstructifs persistants, le pronostic reste meilleur (respectivement 4 et 17% d’insuffisance rénale terminale et modérée). Les facteurs de mauvais pronostics restent une créatinémie préopératoire élevée (OR 17, 1, p<0,0001) et le reflux vésico urétéral (OR 22,4 p<0,0001). L’annonce anténatale pessimiste de valve postérieure contraste avec le bon pronostic de valve antérieure diagnostiqué en néonatal. Une bonne nouvelle !

Les Invaginations Intestinales Aigües (IIA) sont réduites par 2 méthodes irradiantes, lavement à l'air ou aux hydrosolubles, sous contrôle radioscopique. L'immobilisation sur table de radiologie est éprouvante pour l'enfant et mal vécue par les parents assistant au traitement derrière une vitre de plomb. La réduction des IIA par lavement à l'eau se fait sous contrôle échographique en présence des parents, et ne nécessite ni irradiation, ni contention. Le but de l'étude est de connaître les résultats et complications des réductions d'IIA à l'eau sous contrôle échographique Etude rétrospective sur 20 ans, monocentrique, descriptive, 270 IIA iléocoliques, avec tentative de réduction à l'eau sous échographie. 88,2% des IIA idiopathiques sont réduites par lavement à l'eau. Le sexe, poids, âge et délai depuis les symptômes jusqu'à la réduction n'interfèrent pas sur le taux de succès. 84,6% des échecs aux lavements baryté ou hydrosoluble sont réduits secondairement par lavement à l'eau. La prémédication multiplie par 10,8 le succès. Un épanchement de moyenne abondance en échographie est voué à 80% d'échec. Seulement 1 complication après réduction à l'eau (perforation secondaire). Réduction d'IIA à l'eau efficace et non irradiante

La rate baladeuse est une entité rare chez l’enfant, caractérisée par un défaut de fixité. La torsion du pédicule splénique en est une complication redoutable, engageant la viabilité de la rate mais aussi celle des organes avoisinants. Nous rapportons le cas d’une fillette de 34 mois, admise en urgence pour un tableau abdominal aigu associant douleurs abdominales et vomissements depuis 48 heures. Devant la présence d’un pneumopéritoine et d’un pneumothorax gauche, d’une altération rapide de l’état général, un traitement chirurgical par laparotomie a été réalisé, mettant en évidence une péritonite généralisée. Il s’agissait d’une perforation gastrique liée à une ischémie étendue de la grande courbure. Il existait un volvulus du pédicule splénique avec une rate dépourvue d’attaches ligamentaires, ayant entrainé dans sa torsion un volvulus partiel de l’estomac en regard des vaisseaux courts. Le traitement a consisté en une détorsion du pédicule splénique, une gastrectomie partielle avec gastropexie, un lavage-drainage péritonéal, un drainage du pneumothorax. Outre le risque à terme, d’une splénectomie chez de jeunes enfants présentant un volvulus splénique par défaut congénital de fixité de la rate, il existe des complications digestives immédiates pouvant engager le pronostic vital.

Objective: To choose between laparoscopic "vascular hitch" (VH) and dismembered pyeloplasty (DP) in treatment of aberrant lower pole crossing vessels potentially responsible for pelviureteric junction obstruction (PUJO) in older children.Patients and methods: Retrospective study of 19 patients treated laparoscopically for PUJO. Based on videos of the procedures, we studied the anatomical relationship between the renal pelvis, the pelviureteric junction, and the aberrant vessels.Results: Eight patients had laparoscopic VH and 11 had DP. All patients with DP needed drainage. In the VH group, 7/8 patients were asymptomatic and had decreased pelvic dilation. Half of them accepted MAG3 scintigraphy, and in these patients the obstructive syndrome disappeared completely. The last patient in this group was lost to follow-up. We observed three anatomical variations in the location of polar vessels: type 1 (in front of the dilated pelvis), type 2 (in front of the pelviureteric junction), type 3 (under the pelviureteric junction, resulting in ureteral kinking).Conclusion: Laparoscopic VH is a simple technique involving no urinary anastomosis or drainage, but we cannot guarantee that the crossing vessels are the sole etiology for PUJO. Following our experience, only patients with type 3 anatomical variations and with a normal pelviureteric junction should be proposed for VH. (c) 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

INTRODUCTION:We present our experience with the thoracoscopic treatment of congenital diaphragmatic eventration (CDE) in children through 15 years to evaluate the efficiency of the procedure and the potential risk of recurrence. Materials andMETHODS:We reviewed the medical files of patients treated for CDE through thoracoscopy from 2000 to 2011. Age at surgery, sex, side of the lesion, procedure's details, postoperative course, and complications were analyzed. Mean follow-up was 12 months.RESULTS:In this study, eight patients (five males and three females) aged from 6 months to 7 years underwent thoracoscopic plication for six right and two left eventrations; one conversion was necessary due to a too small operative field. Mean operative time was 60.5 minutes. A chest drainage was placed in six patients. We observed two recurrences from which the first one was treated thoracoscopically by endostapler resection/suturing and the other one by laparotomy. At follow-up, all patients were asymptomatic with a correct level of the diaphragm.CONCLUSIONS:Thoracoscopic plication is feasible and safe, and we consider this approach as the gold standard for the treatment of CDE. However, we still need to carefully consider the possibility of introducing certain modifications to reduce the potential risk of recurrence.