Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica最新文献

Objective: To describe our experience with anorectal malformation (ARM) patients, while analyzing complications and risk factors.

Materials and methods: A retrospective study of ARM patients aged 0-18 years old undergoing surgery from 2006 to 2023 was carried out. Demographic variables, associated malformations, age and repair surgery operating times, presence and type of colostomy, previous intestinal preparation, and presence and type of surgical complications -intestinal occlusion, anal prolapse, stenosis, bleeding, dehiscence, extrusion, anoplasty misposition, urethral perforation, and stomal complications- were collected.

Results: 89 patients were studied. 44 patients were boys and 45 were girls. Median age was 7 years (3-18). Baseline treatment was posterior sagittal anorectoplasty (PSARP) in 61 (69%) patients, and colostomy in 24 (27%) patients (4/24 loop, 1/24 Hartmann, 19/24 divided ends). Median age at PSARP was 5.4 months (5 days-7 years), with a mean operating time of 112 min (38-259). The incidence of complications was 38% (34/89). The most frequent complication was anal prolapse (19%) (1/3 reintervention as a result of pain/bleeding), followed by dehiscence (17%). Statistically significant differences were noted between intestinal preparation (p= 0.001, -1.49 95% CI: -2.69 to -1.24), presence of colostomy (p= 0.05, -2,54 95% CI: -6.5 to -0.987), and age at surgical repair (p= 0.047, 1.198 95% CI: 1.1 to 3.15) with the incidence of complications. The age-complications correlation score was 0.21 (p= 0.046). No differences in terms of operating time (p= 0.073) and type of colostomy (p= 0.81) were observed.

Conclusions: 38% of the patients had complications. Intestinal preparation, presence of colostomy, and age at repair can have an impact on the incidence of complications. The first two could stand as protective factors (RR= -1,49 and -2.54, respectively). Age would increase the risk by 1.2-fold.

Introduction: Giant omphalocele poses a conflict between eviscerated content and abdominal capacity, with associated risks such as compartment syndrome or cardiovascular compromise.

Clinical case: We present the case of a prenatally diagnosed hepato-omphalocele, without associated abnormalities. At week 37, botulinum toxin was injected in the right hemiabdomen under fetal and maternal sedation. Following Cesarean section, scheduled at week 39, injection was completed in the left hemiabdomen, and full hepatic content reduction and total amnion inversion were achieved. Definitive repair with component separation was carried out on day 8 postnatally, and the patient was discharged on day 14.

Discussion: Botulinum toxin induces muscle relaxation, which can help reintroduce the eviscerated content within the abdominal cavity. The maximum effect is achieved following two weeks, which means prenatal injection may favor early amnion inversion, thus reducing hospital stay.

Introduction: Chordoma is a rare, slow-growing notochordal neoplasm typical of adults. Less than 5% of the cases occur in children, where they are located at the skull base. Treatment involves surgical resection with or without radiotherapy.

Clinical case: 14-month-old patient with a left dorsal lumbar mass, pain, and limited mobility in the lower limbs. MRI showed a left paravertebral mass infiltrating the spinal canal (T11-L1), in contact with the parietal pleura, along with abdominal extension. Chordoma diagnosis was established based on percutaneous biopsy. Full resection without safety margins was carried out using the posterior approach. One month later, tumor recurrence caused hemothorax, pleural infiltration, and rib infiltration. Two chemotherapy cycles were administered, with a good response. Reintervention was successfully conducted one month later. After 9 months, the patient is free from disease, under chemotherapy treatment and proton therapy.

Discussion: Although unusual, chordoma is included within the differential diagnosis of retroperitoneal masses. Prognosis depends on full resection.

Objective: To assess the outcomes of three surgical techniques in the management of simple gastroschisis.

Materials and methods: An observational, descriptive, retrospective, longitudinal study was carried out. Medical records of patients diagnosed with simple gastroschisis and treated with different surgical techniques -Simil-Exit, primary closure, and deferred closure- were reviewed.

Results: 38 gastroschisis patients undergoing either the Simil-Exit (n= 10), the primary closure (n= 11), or the deferred closure (n= 17) techniques were analyzed. The Simil-Exit technique involved a shorter operating time than primary closure and deferred closure. Both Simil-Exit and primary closure patients required a shorter mechanical ventilation time, fewer days of parenteral nutrition, shorter time to oral feeding initiation, and a shorter hospital stay than deferred closure patients. The deferred closure technique had more frequent complications, such as sepsis.

Conclusions: The Simil-Exit and the primary closure techniques demonstrated favorable outcomes in patients with simple gastroschisis. In addition, the former involved shorter operating times, it required less exposure of the small bowel loops to the environment, it was easily reproducible, and it provided a better cosmetic result.

Introduction: Robotic surgery has revolutionized surgical practice globally since the first Da Vinci device was launched in 2000. Adoption in Spain has been more moderate than in other countries, especially in the field of pediatric surgery, which represents less than 0.5% of all robotic procedures. This paper features a review of the scientific literature on the pediatric robot-assisted surgeries published in Spain. The objective was to provide a full overview of the cases documented in Spain and to highlight opportunity areas for the growth of this technology.

Materials and methods: A comprehensive search of scientific papers on PubMed, Scielo, and Google Scholar databases was carried out. Search terms included "robotic surgery," "pediatric," "Spain," "robot-assisted surgery," and "pediatric surgery." Specialists in the field and the Da Vinci robot distributor in Spain were also contacted to collect additional scientific evidence.

Results: Of the 87 papers identified, 6 met inclusion criteria. The studies reviewed document the experience with pediatric robotic surgery in three Spanish hospitals -Vall d'Hebrón Hospital, San Carlos Clinical Hospital, and Reina Sofía Hospital. Clinical results were mostly positive, with low complication rates and good postoperative recoveries. However, some challenges, such as long operating times, a certain difficulty in robotic arm placement, and the high cost of this device, were also pointed out.

Conclusions: Pediatric robotic surgery in Spain is in an early developmental stage, with a limited number of publications, and experience that is available in very few institutions. Further research is required to reinforce scientific evidence and promote investment in this technology.

Introduction: Pain control following Nuss thoracoplasty remains a challenge. Cryoanalgesia of the intercostal nerves has been demonstrated to reduce postoperative pain in these patients. The objective of this study was to understand how and how widely cryoanalgesia is used in pediatric patients undergoing funnel chest surgery in Spain.

Materials and methods: Nationwide online submission of an author-designed survey.

Results: 18 hospitals replied to the survey. 9 (50%) said they do not use cryoanalgesia, primarily as a result of difficulties in accessing this technique, whereas the other 9 said they do employ it. In most institutions, cryoanalgesia is percutaneous and ultrasound-guided, and it is conducted 1-3 days before surgery (77.8%). The associated use of other analgesic modalities varies widely, including various combinations of intravenous opioid-based PCA (77.8%), epidural catheter (66.7%), oral pregabalin (66.7%), and erector spinae plane block (22.2%). In the institutions where cryoanalgesia is used, mean hospital stay is 4.7 days. Most surgeons believe cryoanalgesia significantly reduces pain in the long-term (88.9%), and only partially in the immediate postoperative period (66.7%).

Conclusions: The use of cryoanalgesia for pain control following Nuss thoracoplasty is an emergent technique. In the Spanish institutions where this technique is used, varying protocols with different associated analgesic modalities can be found.

Introduction: Gastric leaks and gastrocutaneous fistulae (GCF) after digestive surgery are unusual in children. Common treatments are based on conservative measures and surgery but endoscopic techniques are not a widespread option in pediatrics.

Case report: An underweight child developed a GCF after surgery (esophagocoloplasty with right colon). It was managed endoscopically, placing double J ureteral stents (DJUS) with one tip in the gastric lumen and the other tip exiting through the cutaneous orifice via the fistula. A laminar drain was used to evacuate the intra-abdominal cavity. The patient was fed with a gastro-jejunal tube and the diameter of DJUS was reduced progressively. Ninety-two days after the initial endoscopic therapy the gastric orifice was closed. There were no severe complications or recurrences.

Discussion: The relevance of this case lies in the low prevalence of this complication and in the innovative endoscopic approach in children, which was safe and effective.

Objectives: Necrotizing enterocolitis (NEC) is a main cause of neonatal morbimortality. Gut prematurity and ischemia-reperfusion injury contribute to NEC and characterize two different scenarios: prematurity and congenital cardiopathy (CC). Our aim is to investigate whether CC worsens NEC gastrointestinal and general prognosis.

Materials and methods: NEC episodes from 2015-2023 were reviewed and classified into CC and non-CC. Patients with focal intestinal perforation were excluded. Data regarding NEC debut and management, surgical timing, intestinal segment involved and short-term outcomes were compared.

Results: Out of 205 neonates, 15 were excluded for unavailable records or uncertain diagnosis. 190 cases were included, 59 with CC. Comparing CC and non-CC, no significant differences were found in weight or age at diagnosis, or NEC stage. Hemodynamic (HD) shock [38.98% vs 24.43% (p <  0.05)] and need for vasoactive support at debut were more frequent in CC patients [44.07% vs 23.66% (p < 0.05)]. No differences were found regarding need for surgery at debut, length of resected intestine or segment affected or days on parenteral nutrition. CC conditioned longer hospital stay [110.8 ± 68.4 days vs 68.4 ± 44.6 (p <  0.05)] and higher mortality [30.5 vs 11.5 (p <  0.05)].

Conclusions: NEC in CC patients presents more HD instability at debut and worse global prognosis, probably due to inherent cardiovascular compromise, but need for surgery, type of intestinal involvement and short-term outcomes are similar to non-CC NEC.

Objective: To determine risk factors (RF) of progression to end-stage chronic renal disease (ESCRD) and the need for renal replacement therapy (RRT) in patients with posterior urethral valve (PUV).

Materials and methods: A retrospective case and control study of patients diagnosed with PUV in the 1995-2023 period was carried out. Two study groups were created -RRT vs. no-RRT. Clinical, laboratory, and radiological variables were collected. A bivariate analysis and a binary logistic regression were conducted to detect RFs of the need for RRT.

Results: 127 patients were included, 12.% of whom had undergone RRT (n= 20). Mean follow-up was 9.87 years. Mean age at clinical onset was younger in the RRT group (3 months vs. 1.23 years; p= 0.010). Pathological prenatal ultrasonography (p< 0.001), increased Nadir creatinine levels (p< 0.001) and maximum creatinine levels in the first year of life (p<  0.001), and onset with acute renal insufficiency (p= 0.03) were more frequent in the RRT group. Increased creatinine levels in the first week of life (OR: 4.74) and younger age at clinical onset (OR: 1.2) were the only independent RFs to predict the need for RRT. Diagnostic-therapeutic delay and the presence of UTIs during follow-up are not predictive of the risk of final RRT.

Conclusions: In PUV children, renal functional reserve at birth is the only ESCRD risk predictor. Early clinical onset implies a higher risk of RRT.

Objectives: The Mitrofanoff principle has been extensively evaluated in terms of associated morbidity and mortality. However, there is limited literature specifically addressing quality of life (QoL), particularly concerning the laparoscopic procedure. The aim of this study was to assess the impact of laparoscopic appendicovesicostomy (LA) on QoL by using a specific questionnaire targeted at patients and their families.

Materials and methods: This observational and descriptive study involved patients who underwent LA between May 2018 and December 2023. A survey consisting of 29 questions, organized into three sections was used: satisfaction with the surgery, outcomes, and current continence status. Responses were graded according to the Likert scale (1-5) (1 = strongly disagree, 5 = strongly agree).

Results: Of the 29 contacted families, 24 (82.8%) responded. The average age was 12.3 years (SD 4.4), with 75.9% being male. The primary indication for surgery was pain during urethral catheterization (69%). Mean postoperative follow-up was 36.5 months. Regarding satisfaction with surgery: overall satisfaction,hospitalization duration and pain control was rated with a score of 5 by 66.7%, 58.3% and 58.3%, respectively. In terms of outcomes: 54.2% rated aesthetic results with a score of 5, and 83.3% rated improvement in QoL with a score of 4 or 5. Concerning current continence status, 66.6% were very satisfied with the results and reported total absence of leakages or on a very specific occasion (score of 4 or 5).

Conclusions: This study supports the improvement in perceived QoL among patients requiring an LA. Overall satisfaction with the procedure and outcomes related to continence were perceived as very good by both patients and their families.