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Vanishing gastroschisis (VG) is a severe complication of gastroschisis with a high mortality rate. We report here a case of VG with a favorable outcome after a 3-year follow-up. A 26-year-old primigravida woman was referred to Strasbourg University Hospital because her fetus was diagnosed with an isolated gastroschisis at 13-week gestation. The ultrasound evolution was marked by a progressive closure of the abdominal wall defect from 19-week gestation and the appearance of dilated intra-abdominal loops. The child was born with a closed abdominal wall except a small remnant at the level of the former gastroschisis orifice. Explorative laparotomy revealed extensive midgut atresia with only 50 cm of remaining midgut. A jejunocolic anastomosis was performed. The child is now 3 years old and has a favorable outcome with only 2 nights a week of parenteral nutrition. A total of 39 cases of VG type D from Perrone et al. classification are described in the literature from 1991 to 2019, among which 19 (48.7%) are alive at the time of publication but only 4 cases are described with a long-term follow-up of 3 years or more. This is the fifth case described with a favorable evolution after 3-year follow-up.

Clinical history and physical examination represent an important aspect in the management of infants and children with urological diseases. However, the role of instrumental and in particular of radiological examinations is fundamental for making a certain and correct diagnosis in all clinical cases.

But: Apprecier de facon prospective les resultats du traitement laparoscopique des varicoceles. Materiel et Methodes: 87 observations ont ete retenues parmi les 92 recues, 5 ont eu un traitement laparoscopique associe a un geste a ciel ouvert, inguinal ou scrotal; dans 3 cas, il s'agissait de formes bilaterales et ce sont donc 90 varicoceles qui ont ete jugees. Les veines spermatiques dilatees ont eu clips + resection partielle dans 74,7% des cas, coagulation + resection partielle dans 21% et clips seuls dans 4,3%. L'artere spermatique a ete sectionnee dans le meme temps 60 fois et conservee 28 fois; 2 fois cela n'a pas ete precise. Les resultats ont ete apprecies avec un recul moyen de 11,1 mois (2 a 36 mois). Resultats: La varicocele a disparu dans 76 cas (84,4%) et a nettement diminue de taille dans 12 cas (13,2%) alors qu'elle etait volumineuse avant traitement. Deux varicoceles de taille moyenne n'ont pas ete modifiees par le traitement. Les resultats ont donc ete bons ou excellents dans 97,6% des cas. L'artere spermatique a ete conservee 28 fois et le resultat n'a pas ete excellent 9 fois (32,1 %); elle a ete sectionnee 60 fois et le resultat n'a pas ete excellent 5 fois (8,4%) - p

Resume But de l'etude : Le traitement de la maladie de Hirschsprung a ete transforme par l’utilisation de la voie cœlioscopique. Le but de cette etude etait de rapporter les resultats d’une courte serie. Patients et methode : De decembre 1996 a janvier 2000, 13 enfants (sept garcons et six filles) ont ete operes d’une maladie de Hirschsprung. L’âge moyen au moment de l’intervention etait de six mois. Une colostomie avait ete realisee chez dix d’entre eux. Sur le plan anatomique, il y avait neuf formes rectosigmoidiennes, deux rectales, une colique gauche, une colique gauche et transverse droite. L’intervention a ete realisee avec trois trocarts. L’anastomose colorectale a ete faite avec la technique de Duhamel chez dix patients et de Swenson chez trois patients. Resultats : La duree de l’intervention a ete en moyenne de 160 minutes. Une conversion a ete necessaire. Il y a eu une fuite anastomique ayant necessite une colostomie temporaire, et une occlusion par incarceration d’une anse de l’intestin grele sous le colon abaisse, ayant necessite une reprise chirurgicale. Une pseudo-occlusion intestinale chronique est survenue tardivement chez deux enfants, d’evolution favorable. Le recul moyen etant de 26 mois, il etait trop tot pour juger du resultat fonctionnel definitif. Conclusion : L’abord cœlioscopique est apparu comme un progres important dans le traitement de la maladie de Hirschsprung mais plus recemment la voie transanale que nous avons utilisee chez nos cinq derniers patients semble constituer une nouvelle innovation encore plus importante.

Aim: The laparoscopic treatment of paediatric appendicitis remains controversial, especially in the presence of complications. This study evaluated the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) by analysing the data from a multicentre study. Methods: The authors retrospectively reviewed a series of 2,332 appendectomies (1,506 LA and 826 OA) performed in children and adolescents (median age 8 years) in 9 different centres of paediatric surgery. For the patients operated using laparoscopy, an IN procedure was employed in 921 (61.2%), an OUT procedure in 571 (37.9%) and a MIXED procedure in 14 (0.9%). In the open surgery, a McBurney incision was adopted in 795 patients (96.4%). Results: Median duration of surgery was 40 minutes for LA and 45 minutes for OA. Median hospital stay was 3 days (LA) and 4.3 days (OA) in case of simple appendicitis and 5.2 days (LA) and 8.3 days (OA) in case of peritonitis. Complications were recorded in 124 LA cases (8.2%) and 65 OA cases (7.9%). The conversion rate in laparoscopy was only 1.6% (25 cases). The statistical analysis was performed using the Mann–Whitney test, and the main significant difference that emerged was the length of hospital stay, which was in favour of laparoscopy compared with open surgery (P < 0.0001). Conclusions: We conclude that in clinical settings where laparoscopic surgical expertise and equipment are available and affordable, LA seems to be an effective and safe alternative to OA. Three out 9 centres participating in our survey perform LA in all patients with a suspicion of appendicitis. Our study shows that laparoscopy significantly reduces hospital stay in case of appendicitis and peritonitis and presents an extremely low conversion rate (1.6%) to open surgery. Laparoscopic transumbilical appendectomy (37.9%) in our series seems to be a simple option, even for less-skilled laparoscopic surgeons.