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Les progrès récents concernant le diagnostic prénatal, la ventilation oscillatoire à haute fréquence et les thérapeutiques de l’hypertension artérielle pulmonaire (HTAP) ont progressivement amélioré la survie des patients porteurs de hernie diaphragmatique congénitale (HDC). Cependant, la HDC s’accompagne d’une morbidité élevée qui touche environ la moitié des enfants survivants. Les principales séquelles observées sont respiratoires (asthme, HTAP persistante [HTAPP], dysplasie broncho-pulmonaire, infections respiratoires) et digestives (reflux gastro-oesophagien [RGO]).

Background:: This multicenter survey includes neonates and infants who underwent surgery for primary gastroesophageal reflux (GER) who presented with supraesophageal symptoms of unknown origin with a minimum of 12 months postoperative follow-up. Methods:: A total of 726 patients underwent GER surgery in 10 European Centers in the period 1998–2002. Respiratory symptoms were present in 204 patients (28%); 135 patients (17%) had surgery under 1 year of age, and 46 of them (6.3%) because of respiratory symptoms. Surgery was performed without any previous medical treatment in 10 cases (21%). The type of procedure included 37 complete 360° wraps (80%) (Nissen, 12, and Rossetti, 25) and nine partial wraps (20%) (Thal five, Lortat Jacob one, Toupet one, others two). Gastrostomy was associated in 17 cases (37%) (6 PEG and 11 modified Stamm). No gastric emptying procedures were recorded. Results:: No major intraoperative complications were reported. Six patients developed complications (13%) and a redo operation was performed in three (6.5%). Respiratory outcome after antireflux surgery was good in 35 patients (76%) and fair with significantly improved respiratory symptoms in 11 (24%). Conclusions:: This multicenter survey underlines that GER has to be suspected and aggressively treated in infants with difficult-to-treat supraesophageal symptoms, and also in high-risk cases, in order to prevent major complications.

The aim of this study was evaluate a novel technique of laparoscopic hernia repair in children. Eighty two consecutive patients aged ≥2 years old were operated on for hernia repair using a laparoscopic technique that reproduced every step of the conventional open procedure. Technical details and clinical results are reported. Ninety six sacs were divided in 82 patients (15 girls and 67 boys). Fourteen bilateral hernias that had been diagnosed before operation in nine cases and during laparoscopy in five cases were repaired. Nine controplateral dimples were left and not repaired. Mean operative time was 23 min in girls and 28 min in boys for unilateral hernias, and 30 min in girls and 40 min in boys for bilateral hernias. Sixty-seven of the children were followed up 6 months later. None of them suffered recurrences. No unsightly scars were observed at the port sites. Discomfort did not extend beyond 48 h after the operation, enabling a rapid return to normal activities. Dividing the sac and suturing the peritoneum is feasible and efficient by laparoscopy. Compared with the other techniques that have previously been reported, either without any dissection of the sac or any ligature, our technique seems to be advantageous. It is not time consuming and does not require any special laparoscopic skill.

Most pediatric surgical teams have adopted nonoperative treatment for a traumatic kidney lesion in children. In the emergency setting and at long-term followup dimercaptosuccinic acid (DMSA) scintigraphy enables us to identify the consequences on global renal function as well as on the function of each individual kidney.

Summary.Three-flap anoplasty was first described in 1987 by Yazbeck for the treatment of rectal prolapse after pull-through operations for imperforate anus, and in 1992 in a case of anterior perineal approach. It is intended to reproduce the normal anatomy of a sensitive anal canal. The purpose of this study is to evaluate 14 children (9 boys and 5 girls) operated for imperforate anus. METHOD: Eleven children had an intermediate or high imperforate anus and 3 had a low imperforate anus. Nine were operated for the first time with a three-flap anoplasty (GrA), and 5 were reoperated with this technique because of fecal incontinence and/or rectal prolapse (GrB). Seven patients had associated malformations: one Hirschsprung's disease, one cloacal defect with renal insufficiency, three complex caudal malformations with tethered cord, one Down syndrome, and two psychological and psychomotor troubles. The patients (average age = 6 years) have been evaluated every year since 1997, with a questionnaire based on a clinical score validated with 30 healthy children, used as a control group. Ten anal manometries were carried out. RESULTS: In 1998, the GrA score was 16.1 (control = 22.5) and the GrB score was 11.5 (p = 0.25). In 1999, GrA and GrB score were approximately the same. The score of those without associated anomalies was 19.6 whereas the score of the children with other malformations or anomalies was 10 (p = 0.02). Anal manometry is almost normal in patients with low or intermediate imperforate anus (rectoanal relaxation reflex for 10 cm H2O, and basal resting pressure more than 40 cm H2O). Even though anal manometry is subnormal in patients with Down syndrome or psychomotor troubles, the clinical score remains low (score = 10). In cases of complex caudal malformations or high imperforate anus, the results of anal manometry and clinical score are bad (score 9.7). CONCLUSION: The three-flap anoplasty can be carried out in newborns without colostomy and often represents the only possible surgical approach to avoid a laparotomy. This plasty, proposed secondarily to correct a defect of continence, can be performed without colostomy, with satisfactory results.

We report our experience with the endoscopic treatment of vesicoureteral reflux by submucosal injection of Teflon in children. During a period of 40 months, 450 children and a total of 678 ureters were treated; 606 ureters were available with a follow-up of more than 3 months and examined by cystography. The overall success rate was 84.2% after one injection and 94.3% after two injections; 96.2% of the primary refluxes disappeared after two injections. We believe that in duplicated ureters and grade IV and V refluxes only one injection should be tried. If this fails we undertake surgical reimplantation. The success rate in neurogenic bladders and failures of previous surgical reimplantations allows surgery to be avoid in these difficult cases. We found seven non-pathological Teflon granuloma calcifications that had no influence on the results.

Bronchopulmonary sequestration with associated non‐immune hydrops has been previously reported with generally poor prognosis for the neonate. The vast majority of sequestrations are discovered postnatally, and less than half are correctly identified as sequestration before birth.

Diagnosis of appendicitis in infants can be challenging. We report the imaging findings in a 4 year-old girl with a misleading history of fever and right hip pain. Hips X-ray was normal and ultrasound scan did not show any effusion in the right hip joint. Bone scan was performed to eliminate osteo-arthritis or early osteomyelitis. This examination showed no bone metabolism alteration, but demonstrated increased blood pooling in the right iliac fossa that turned out to be a ruptured appendix with abscess. Besides the identification on bone abnormalities, bone scan is able to demonstrate soft-tissue or visceral hyperemia that can reveal misleading differential diagnostics.

Diagnostic et quantification de reflux gastro-oesophagien chez les sujets infirmes moteurs cérébraux IMC. Les jeunes patients IMC moteurs cérébraux peuvent présenter simultanément plusieurs pathologies, parmi lesquelles il est parfois nécessaire d’authentifier un reflux gastro-oesophagien. Les techniques habituelles peuvent être limitées : la pHmétrie ne permet la recherche que des reflux acides, les techniques radiologiques sont éloignées des repas habituellement pris. Les explorations isotopiques, techniques anciennes, parfois jugées désuètes, permettent le suivi d’aliments radiomarqués ne traversant pas la barrière digestive : solide, liquide, nutrition entérale, lait (« milk scan »).

La granulomatose septique chronique est une maladie familiale rare due à un déficit immunitaire primaire du métabolisme oxydatif des cellules phagocytaires. Le défaut de fonctionnement du complexe NADPH oxydase membranaire des phagocytes entraîne un tableau clinique d’infections fongiques et bactériennes sévères à répétition, en général, dès le plus jeune âge.

Two cases of haemorragic renal cyst presenting in the neonatal period are described. Ultrasound examination, excretory urogram and MRI, gave diagnosis in the second case. The remarkable histopathologic pattern of these two cases has led to propose correct diagnosis of pure cystic mesoblastic nephroma, an unusual variety of mesoblastic nephroma.