Curative surgery of Hirschsprung's disease (HD) was performed in 32 infants younger than 3 months of age from January 1, 1977, December 31, 1986. There were 24 males, seven of whom presented with total colonic aganglionosis. Preoperative relief of obstruction was carried out by only enemas in 25 patients (81%), with addition of total parenteral nutrition of 8 to 27 days in case of severe enterocolitis. Colostomy was never performed as a routine procedure. Preoperative morbidity occurred in three cases: one enterocolitis and two sigmoid performations that were successfully treated by colostomy. Weight at operation ranged from 3.3 to 6.0 kg (mean, 4.9 kg). Swenson's (25), Duhamel's (5), and Soave's procedures (2) were performed. There was no mortality. Follow-up varied from 2 to 10 years. Postoperative morbidity occurred in five patients (one anastomotic leak, two stenosis, one volvulus, and one recurrent enterocolitis). All other patients are considered as definitively cured. Comparison with data in the literature permits one to advocate primary corrective treatment of HD without decompression in infants less than 3 months of age.

Age Factors↗

PubMed1989

[Pediatric organ transplantation].

Since we started our pediatric kidney transplant program in 1970, we advocate children's transplantation to be performed in pediatric surgery units. Recent progress in immuno-suppression with ciclosporine and in operative procedures lead us to extend the program to liver transplantations in 1986, then to heart and lung transplantations in 1988. The Pediatric Transplant Unit was designed to assume the pre-operative evaluation of the recipients and the post-operative course of transplanted patients, closely connected to all specialists dealing with medical and surgical diseases of children. 29 patients were transplanted (kidney: 8, liver: 14, heart: 1, lungs: 6) with a 83% overall survival rate. The goal of this paper is not to discuss and compare indications or results with others series. Through our experience of pediatric organ transplantation, we shall try to point out the main advantages of a Pediatric Transplantation Unit: it optimizes the management of the rare pediatric donnors, and allows better skill and efficiency of the numerous specialities concerned by organ transplantation, such as intensive care, infectiology, immunology, radiology... The common medical and para-medical staff, common operative theater, and common use of equipment in the same department for transplantation of different organs is also an important matter to be considered now in term of cost-effectiveness.

Adolescent↗

PubMed1989

[Cancer of the thyroid in children].

Study of a personal series of 10 cases of thyroid cancer in children and a review of the literature reveals what we consider to be the 3 problems which are posed by this pathology in children: 1. The frequency of isolated cervical adenopathy in the initial symptomatology may be confused with congenital swelling or inflammatory adenopathy. 2. The surgical management depends on the histological nature: total thyroidectomy, lymph node excision, risk to the parathyroid gland and IRAtherapy all depend on the histological data. 3. Finally, the long term prognosis of these cancers is unknown. Schematically, differentiated cancers including papillary carcinomas have a good or indeed excellent prognosis, while medullary carcinomas have a prognosis which will imminently depend on the extrathyroid involvement, the quality of thyroidectomy and lymph node clearance. This highlights the problem of screening for subclinical disease in familial forms of the disease.

Adolescent↗

PubMed1989

[Urologic complications secondary to sacral agenesis].

In a series of 41 cases of caudal regression syndrome, 6 cases of misdiagnosed partial sacral agenesis are reported. All had been previously treated surgically and only poor results led to diagnosis. Major symptoms were recurrent urinary tract infection and/or incontinence. Associated anomalies were ano-rectal malformations (1 case), male hermaphrodism (1 case), lipoma and tethered cord in 3 patients, myelocystocele in 1 case. Neuro-surgical associations must be cured first. Urologic implications are the same as in other forms of neurogenic bladder. The authors stress the need for careful examination of plain standard X-rays.

Child↗

PubMed1988

Ureteropelvic junction obstructions: prenatal diagnosis and neonatal surgery in 47 cases.

In a series of 150 patients with congenital urologic disorders diagnosed in utero and managed in the neonatal period from 1980 to 1985, 48 cases were ureteropelvic junction obstructions. One was a false positive, and 47 were documented pyelocaliceal distension and retention; 12 of them were bilateral. Five cases had a spontaneous resolution. Three had a nephrectomy performed (destroyed kidney). Fifty kidneys have been operated on (Anderson-Hynes dysmembered pyeloplasty). Ninety percent of the cases are reported as clinically, biologically, and radiologically fair. Six percent postoperative complications are reported. The authors pointed out the great interest in neonatal repair of this condition, using microsurgical techniques without stent or nephrostomy. A comparison is made of the overall results with an identical series of older patients operated on during the same period.

Female↗

PubMed1988

Combined approach in the treatment of anorectal malformations: the MOPE procedure.

No single major procedure is able to achieve all necessary goals without problems in the treatment of anorectal malformations. The Mollard-Pena (MOPE) procedure adds the benefits of an anoplasty based on the original perineal flap described by Mollard, but slightly modified, and the precise recognition of all muscle structures as reported by Pena and De Vries. Cosmetic as well as functional early results are encouraging.

Anal Canal↗

PubMed1988

The Mayer-Rokitansky syndrome. Report of 5 cases.

Five cases of uterus didelphys, unilateral imperforate vagina and ipsilateral renal agenesis are reported with a follow-up from 1 to 5 years. Diagnosis included typical revelation at puberty (2 cases) but also in the first months of life (2 cases). One case was only diagnosed at the age of 6 years, and the presence of an ectopic ureter was noted in the imperforate vagina. The authors point out the necessity of precise evaluation and careful management in order to maintain an intact reproductory tract. Simple excision of the septum is recommended which can most of the time be done by the vaginal approach.

Adolescent↗

PubMed1988

[Artificial urinary sphincter in the treatment of neurogenic bladder in children].

Over a two years period, the model AS 800 artificial urinary sphincter was implanted in 10 children (mean 14 years old) with incontinence due to a neurogenic bladder (7 spina bifida; 3 sacral agenesis). Goal of continence was achieved in 100% of 7 boys and 3 girls with a follow up between 6-32 months (mean 17 months). Patients selection was rigid and incontinence have failed to response at pharmaceutic manipulation (6) intermittent catheterisation (5) and previous classical surgery enterocystoplasty (2), Young-Dees procedure (1). Age minimum was 8 years. All sphincters were implanted around the bladder neck. Associated surgical techniques were performed in 4 cases: 2 detubularized enterocystoplasties, 1 Teflon injection for vesico ureteral reflux, 1 closure of previous cystostomy. Sphincterotomy was never done. 5 patients are submitted post implantation to intermittent catheterisation without any problem. 2 patients required one revision. Nocturnal desactivation is used in 2 cases. Authors focus on the necessity of correcting previously or at the time of implantation bladder compliance and vesico ureteral reflux.

Adolescent↗

PubMed1988

[Magnetic resonance imaging of high anorectal malformations. A preliminary study apropos of 15 cases].

High level ano-rectal anomalies were evaluated by Magnetic Resonance Imaging (MRI) in 15 patients. One neonate and two infants were evaluated preoperatively. Sagittal slices identified properly the blind rectal end in the 3 cases. Associated anomalies (tethered spinal cord, right ectopic kidney in 1 case, recto-urinary fistula in another case, upper excretory dilatation in 2 cases) were found during the same examination. In the post-operative period (12 cases), major data were obtained on axial transverse slices. When pulled-through intestine is outside the levator sling, re-do-surgery can be indicated. MRI appears as an accurate tool to assess these anomalies.

Adolescent↗

PubMed1987

Transverse island flap and double flap procedure in the treatment of congenital epispadias in 32 patients.

According to major reports in the literature satisfactory cosmetic and genital results after correction of male epispadias have been achieved in only 50 per cent of the patients. Since 1976 we have been using the Duckett transverse island flap principle adapted to epispadiac anatomical conditions. The original technique was used in our initial 18 patients and the Asopa double flap technique was performed in the subsequent 14. Excellent results were obtained in both series. However, there was a high percentage of fistulas that required secondary repair. The techniques and results are described.

Abnormalities, Multiple↗

PubMed1987

[Anorectal manometry. Practical use in a pediatric surgical clinic].

Over a series of 158 cases of anorectal manometry the authors describe the technique used in a general pediatric surgery department. Results are reported in Hirschsprung's disease specially in the neonatal period, chronic constipation, fecal incontinence after anorectal malformations and meningomyelocele, encopresis. Biofeedback was performed in 28 patients. Technique varies with the etiologies and results are reported. Anorectal manometry to be effective must be simple, reliable, safe and non invasive. The reported technique seems effective for this goal.

Anal Canal↗

PubMed1987

[Autologous transfusion in pediatric surgery. Technics, possibilities and limitations].

Explore the source record for details and available documents.

Adolescent↗

PubMed1987

Dermatologic manifestations associated with an anorectal malformation.

Explore the source record for details and available documents.

Adolescent↗