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

Introduction: Open inguinal herniorrhaphy is the most widely used inguinal hernia repair treatment in pediatric surgery. Understanding the anatomy of the inguinal canal is essential to conduct this procedure.

Material and methods: A low-cost, easily reproducible model aimed at training residents was designed to simulate open inguinal herniorrhaphy in children. It simulated the presence of inguinal hernia using low-cost materials such as balloons, transparent dressings, materials simulating the cremaster muscle, and cord elements. The model was validated by 4 pediatric surgeons and built by residents, who completed a post-simulation survey using the Likert scale. The survey assessed general aspects such as usefulness, texture, or grade of recommendation for regular training.

Results: The surgical technique was completed step-by-step in the simulation model by a total of 10 pediatric surgery residents from various Spanish hospitals. Scores of 4.5/5 in general aspects, 4/5 in texture, 4.7/5 in usefulness, and 4.6/5 in grade of recommendation were achieved.

Conclusions: We believe this low-cost, easy-to-build model stands as a useful tool both for surgical training and for understanding the anatomy of the inguinal canal in training residents.

Objective: To assess the diagnostic accuracy of machine learning models and ChatGPT in the interpretation of barium enemas for Hirschsprung's disease (HD), and to compare performance with that of pediatric radiologists.

Material and methods: A retrospective study of the barium enemas of patients < 15 years of age managed at a tertiary institution from 2011 to 2023 was carried out. The images were used to train AI models and divided into training, validation, and test ensembles. Performance was assessed in a separate test ensemble with anonymized images, while calculating sensitivity, specificity, and ROC curves vs. final diagnosis, and it was compared with radiologists' performance.

Results: 266 barium enemas from 218 patients (1,439 images in total) were included. The test ensemble consisted of 54 enemas, with 11 HD positive cases. The support vector model had a sensitivity of 72.7% and a specificity of 93%. The logistic regression model had an AUC-ROC of 0.73, with better results in anteroposterior than in lateral images. When compared with retrospective radiological reports, AI models had a classification capacity similar to that of expert professionals, with a sensitivity of 81% and a specificity of 76%.

Conclusions: AI models showed potential in supporting the diagnosis of Hirschsprung's disease based on barium enemas, with a good capacity to rule out HD. This could improve diagnostic accuracy, especially in environments with little experience or limited availability of specialist radiologists. However, further studies are required to optimize clinical application.

Objective: To assess predictive factors for failure in the conservative treatment of patients with superior mesenteric artery syndrome (SMAS).

Material and methods: A retrospective case-control study was carried out. Cases included pediatric patients diagnosed with SMAS and treated in our institution from 2013 to 2024. Controls included surgically treated SMAS patients under 20 years of age from a PubMed bibliographic review. Of a total of 205 papers, 24 met inclusion criteria. Demographic, clinical, diagnostic, therapeutic, and progression variables were collected. Statistical analysis was performed using chi-square/Fisher and Mann-Whitney U tests.

Results: N= 42 (16 cases and 26 controls). No statistically significant differences were found in terms of BMI (17.25 vs. 14.43; U= 148.5; p= 0.398), progression time (130 vs. 90 days; U= 176.0; p= 0.820), angle (19° vs. 14.1°; U= 159.0; p= 0.206), or aortomesenteric distance (3.5 cm vs. 4.25 cm; U= 62.5; p= 0.068). Cases received conservative treatment, except for one who refused this treatment modality. There were no significant differences regarding final BMI (18.6 vs. 17.9; U= 96.0; p= 0.560), treatment success, or hospital stay (7.0 vs. 6.0 days; U= 168.0; p= 0.308) between both groups.

Conclusions: Conservative treatment is highly successful regardless of progression time, BMI, angle, and aortomesenteric distance. Therefore, surgery is not recommended as the first option in the management of SMAS.

Objective: Primary pneumomediastinum (PP) is an infrequent condition in pediatrics with no standardized management. The objective of this paper was to report our experience with PP and analyze the role of hospitalizations and radiological tests.

Material and methods: A retrospective study of pediatric patients with PP from 2013 to 2023 was carried out. Demographic, clinical, and radiological data was collected.

Results: 24 patients (54% of whom male) with a median age of 9.5 years (3.9-15.2) and a median weight of 32 kg (14.8-49.3) were included. The most frequent reasons for consultation were dyspnea (46%), chest pain (29%), and odynophagia (13%). Patients < 5 years old reported less chest pain (12.5% vs. 75%, p= 0.008) and had more respiratory infections (p= 0.032), with lower SpO2 (95% vs. 98.5%, p= 0.05). 19 (79%) patients required hospitalization, 9 of whom exclusively as a result of PP. Hospitalization was longer (5.5 vs. 3 days, p= 0.017) and aerosol treatment was more frequent (p= 0.005) in patients admitted due to concomitant pathologies. They all received conservative treatment. Early (< 24 h) pain control was achieved with oral analgesia, without complications or rehospitalizations in the first 30 days following discharge. Additional radiological tests, aside from the diagnostic chest X-ray, were carried out in 95.8% of the cases (95.8% X-rays, 12.5% chest CT-scan), with no changes in terms of patient management whatsoever. Subcutaneous emphysema was not significantly associated with more X-rays (3 vs. 1.5, p= 0.235). Median added radiation was 0.05 mSv (0.02-0.1) or 2.5 X-rays.

Conclusions: PP is a benign condition that can be conservatively treated. In the absence of intercurrent pathologies, hospitalization might prove unnecessary. Additional ionizing tests increase radiation while not adding a clear clinical benefit.

Introduction: Nephrogenic adenoma (NA) is an extremely rare benign tumor in children that may be misdiagnosed as malignant.

Case report: An 8 years-old male with history of previous pyeloplasty and bilateral ureteral reimplantation that during follow-up presented with an excrescent asymptomatic lesion in the bladder. A cystoscopy to take biopsies was performed, consistent with a metaplastic lesion or NA. Finally, a partial cystectomy was conducted and confirmed the diagnosis of a NA. No recurrence has been observed after 5 years of follow-up.

Discussion: NA is a rare condition, but it must be considered in the differential diagnosis of urinary tract tumors specially in patients with previous urological procedures. It can appear as an incidental finding, but the elective treatment is resection. Malignant transformation has been described in adults. Besides, recurrence rates are quite high in pediatric patients, so long-term follow-up is mandatory.

Introduction: Non-parasitic splenic cysts (NPSC) are a rare entity in the pediatric population. Surgical treatment remains controversial, with splenic function preservation being a key objective. We present our experience with the treatment of NPSC in pediatric patients through laparoscopic unroofing and omentoplasty, while assessing short- and long-term results.

Material and methods: A retrospective study of 12 pediatric patients with NPSC treated with laparoscopic unroofing and omentoplasty from 2000 to 2024 was carried out. Demographic, clinical, and surgical variables, as well as short- and long-term results, were analyzed.

Results: Mean age was 11 years. 67% of the patients were female. No intraoperative or postoperative complications were recorded. Median follow-up was 18 months. 2 patients (17%) had a persistent cyst, but they remained asymptomatic and under follow-up. No recurrences were noted.

Conclusions: Laparoscopic unroofing and omentoplasty is a viable and safe technique for the treatment of NPSC in pediatric patients, with acceptable recurrence rates and less morbidity. This technique can be an effective option to preserve splenic function and reduce the risk of complications. Further studies with a long-term follow-up are required to confirm these results.

Introduction: Excision of cervical lymph nodes in children can be technically demanding when nodes are small or deeply located. Combining ultrasound-guided tracer injection with an intraoperative portable gamma camera allows functional guidance during surgery.

Case report: A pediatric patient with persistent unilateral cervical lymphadenopathy underwent ultrasound-guided injection of a technetium 99mTc-labeled tracer. In the operating room, the portable gamma camera identified focal uptake and guided a targeted nodal excision through a limited cervical approach. The specimen was obtained safely, the procedure was uneventful, and recovery was rapid.

Discussion: The use of ultrasound-guided tracer deposition combined with an intraoperative portable gamma camera provided precise, real-time navigation for pediatric lymph node excision. This approach may help reduce the extent of dissection and operative time while maintaining safety. It represents a feasible adjunct for selected pediatric cervical procedures.

Objective: The role of endoscopic treatment in the management of vesicoureteral reflux (VUR) remains controversial. This study aims to identify the prognostic factors of endoscopic treatment success for VUR repair.

Material and methods: A retrospective, analytical study of patients -expressed as ureteral units (UU)- with endoscopically treated congenital VUR from 2000 to 2020 was carried out. Follow-up was maintained for 5 years after the last treatment, with clinical and radiological controls. Treatment success was defined as the absence of VUR at postoperative cystourethrography.

Results: 167 UUs were treated, 80% of which had high-grade VUR (III-V). Overall endoscopic treatment success was 92.8%. 90.9% of low-grade VUR cases were resolved in the first procedure. The poor prognosis factors identified included high-grade VUR (p= 0.02), early age at treatment (p= 0.001), and preoperative anteroposterior diameter of the renal pelvis (p= 0.001). 23% had other urological malformations; no statistical relationship as a poor prognosis factor was found (p= 0.08), but up to 45% required more than one treatment.

Conclusions: The endoscopic approach is effective for VUR treatment, especially in low-grade VUR cases. High-grade VUR and early age at surgery are poor prognosis factors. The association with other urological malformations does not reduce treatment success.

Introduction: The primary objective was to conduct the translation and subsequent transcultural adaptation into Spanish of the Pectus Carinatum Body Image Quality of Life questionnaire (PeCBI-QOL), designed to assess Pectus Carinatum (PC)'s quality of life impact.

Material and methods: A translation and transcultural adaptation process was carried out according to WHO guidelines. The process consisted of the following steps: direct translation, Delphi pilot study, retro-translation, cognitive survey to patients, and analysis/validation.

Results: 42 patients and their respective caregivers replied to the validation questionnaire. Principal component factor analysis of the patient questionnaire showed a 4-factor solution, whereas in the caregiver questionnaire, it showed a 3-factor one. The questionnaires demonstrated good reliability, with internal consistency alpha coefficients of 0.78 and 0.85, respectively. The subscale-based concordance analysis also revealed good results in terms of reliability, except for the Motivation/treatment adhesion subscale in the patient questionnaire.

Conclusion: The Spanish version of the PeCBI-QOL questionnaire is valid and reliable for assessing PC's impact on patients' body image and quality of life.