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The aim of this prospective study was to evaluate the laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia.Between November 1995 and February 1998, 91 consecutive children (78 boys, 13 girls) under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral hernia was diagnosed by a laparoscopy through the inguinal hernia sac before ligation. Results of this technique were correlated with those of herniography (79 cases) or with inguinal exploration (12 emergency).Laparoscopy was performed in 88 patients. Laparoscopy was impossible in three cases: one inguinal sac too thin, two cases of ectopic testis in the inguinal canal. Sensitivity was 73% and specificity 92%. The only complication arising from the procedure was wound infection in two patients.This method is a simple, safe and accurate procedure in order to select children for contralateral surgical exploration.

The Duhamel abdominoperineal pull-through is the authors' preferred treatment for children with Hirschsprung's disease (HD). Advances in instrumentation and technique now make laparoscopic correction possible. This procedure was successfully performed in six children aged 5 weeks to 6 years. No colostomy was performed before or after the Duhamel procedure. The technique and its potential role in the treatment of HD are discussed.

From 1979 to 1990 37 children with sickle cell disease underwent surgery for cholelithiasis. Mean age was 11,3 years. Twenty-four children had a history of recurrent abdominal pain; 8 of them were admitted for an acute gallstone complication. In 9 cases the stones were detected by systematic echography. The incidence of gallstones increasing with age, the rate of complications, the frequent resolution of recurrent abdominal pain after cholecystectomy justify elective surgery at the time of diagnostic of the stones. A transfusion preparation considerably reduces the risk of post-operative complications.