[Surgical treatment of high-type imperforate anus: role of laparoscopy]. / Traitement chirurgical des malformations anorectales hautes du nouveau-né: l'apport de la laparoscopie.

Two anomalies must be corrected in high-type imperforate anus: first, the rectal end is located above the puborectalis muscle, and there is a fistula between the rectum and the urinary tract (male) or the vagina (female). The standard approach is posterior sagittal anorectoplasty, as described by De Vries and Peña, which requires midline section of the muscle complex. Georgeson first reported laparoscopically assisted anorectal pull-through in 2000. This approach offers many advantages, such as division of the fistula under direct visual control, better visualization of the anatomical components of the pelvic floor, and especially avoidance of muscle section. Long-term follow-up will be needed to assess continence outcomes.

[To study the safety and effectiveness of heminephroureterectomy by horizontal lumbar posterior approach for duplicated systems in infants]. / Néphro-urétérectomie polaire pour duplication pyélo-urétérale par voie lombaire postérieure chez le nourrisson.

PURPOSE: To study the safety and effectiveness of heminephroureterectomy by horizontal lumbar posterior approach for duplicated systems in infants. MATERIALS AND METHODS: Thirty-three heminephroureterectomies by lumbar posterior approach were performed in 31 infants at a mean age of 6.7 +/- 5.5 months (range: 1 to 26 months) from January 1994 to December 2005. RESULTS: The mean operative time was 121 +/- 35 minutes (range: 60 to 190 minutes). No intra-operative complication was observed. Blood loss was minimal (< 20 ml) in all cases. The mean hospital stay was 4.6 days (range: 2 to 7 days). No postoperative complication (urinoma, infection or haemotoma) occurred. No atrophy or major functional loss of the remaining moiety was observed. The mean follow-up was 52.6 +/- 40 months (range: 1 to 151 months). CONCLUSIONS: The lumbar posterior approach is safe and reproducible and provides an obvious cosmetic benefit in comparison to the standard anterolateral lumbotomy. It represents a procedure of choice for open heminephroureterectomy in infants.

Percutaneous retrograde endovascular occlusion for pediatric varicocele.

BACKGROUND/PURPOSE: The aim of this study was to assess whether percutaneous retrograde endovascular occlusion (PREVO) is effective and safe for the treatment of varicocele in pediatric patients. METHODS: We retrospectively studied 71 children who underwent PREVO for left-sided varicocele. The primary outcome was the proportion of varicocele-free patients 6 months after PREVO as assessed by ultrasonography. RESULTS: Seventy-one boys with left-sided grade III varicocele underwent PREVO at a mean age of 13.2 years. PREVO was performed under local anesthesia in all boys but 2, who required general anesthesia. The procedure was technically feasible in 68 (96%) patients. In the remaining 3 patients, the internal spermatic vein could not be catheterized. Minor short-term complications occurred in 6 patients and resolved fully. No major complications or deaths were recorded. The proportion of varicocele-free patients 6 months after PREVO was 93% (66/71) overall and 97% (66/68) in the patients whose PREVO procedure was feasible. No clinical recurrence was observed during the mean follow-up of 17.5 months. CONCLUSIONS: Percutaneous retrograde endovascular occlusion is an effective minimally invasive approach for varicocele treatment in pediatric patients. It can be safely performed on an outpatient basis under local anesthesia.