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

Introduction: Congenital segmental intestinal dilatation has a low incidence within the differential diagnoses of fetal abdominal cyst masses. Suspicion may arise at prenatal ultrasonography, but diagnosis is confirmed at surgery and subsequently at histopathological analysis. There are various theories available to explain its etiopathogenesis. Association with anorectal malformations is rare.

Clinical case: Newborn prenatally diagnosed with an abdominal cystic mass and diagnosed at birth with an associated anorectal malformation, with postoperative confirmation of segmental intestinal dilatation.

Discussion: Segmental intestinal dilatation should be considered within the differential diagnoses when an abdominal cystic mass is prenatally detected at ultrasonography. Association with anorectal malformations at birth has been described, but it is unusual. Suspicion allows diagnosis and adequate treatment to be established.

Background: Anorectal malformations (ARM) with rectoperineal fistula are mainly repaired with a posterior sagittal anorectoplasty (PSARP), which can be challenging given the proximity of the fistula to the vagina and urethra. The posterior rectal advancement anoplasty (PRAA), preserves the anterior wall of the fistula without leaving an anterior or a posterior sagittal incision. It is indicated for selected cases of ARM with rectoperineal fistula in which the anterior aspect of the fistula is partially surrounded by sphincter complex.

Methods: Multicentre and retrospective study of patients with rectoperineal fistula treated with PRAA. We analysed gender, associated malformations, age, operative time, short and long-term results, and complications.

Results: 18 patients aged 93.5 (1.75-312) days underwent PRAA. Surgical time was 35 (25-45) minutes and feeding was started at 24 (5-48) hours postoperatively. There were no vaginal or urethral injuries, no wound infections or dehiscenses. Throughout the 38 (12.75-45.50) months of follow-up there were no anal strictures. All patients are passing stool, 11 (61%) of them with the need of a low dose stool softener.

Conclusion: Selected patients with rectoperineal fistula can be treated with PRAA with a shorter surgical time and hospital stay. This technique provides good results and lower risk of injury to neighbouring structures.

Objective: Laparoscopic cholecystectomy is typically carried out using four ports. The objective of this study was to describe the percutaneous gallbladder traction technique, which allows the number of ports to be reduced, thus optimizing the procedure, with a similar exposure of the surgical site.

Materials and methods: 2 pediatric patients with symptomatic cholelithiasis underwent laparoscopic surgery from January 2021 to January 2024. Cholecystectomy was performed using an umbilical port (5 mm, 30-degree scope) and two accessory ports. A laparoscopic loop with a running knot was used to conduct percutaneous gallbladder traction at the right intercostal level.

Results: All surgeries were successfully completed. Mean operating time was 90 minutes. Hospital stay was 1-2 days. Postoperative progression was favorable in all patients.

Conclusions: These results confirm that cholecystectomy with percutaneous gallbladder traction is safe, cost-effective, and easily reproducible, which means it can be an alternative to the classic technique.

Objective: Our objective was to assess the current status of minimally invasive surgery (MIS) training in Latin America and to identify the primary hurdles for the acquisition of laparoscopic skills.

Materials and methods: An anonymous survey was launched on various social media in November 2022. Surgeon responses were analyzed.

Results: 131 pediatric surgeons from 98 surgical institutions in 16 Latin-American countries replied to the survey. MIS training during residency was found in 45.9% of the surgeons with >  20 years' experience, and in 95.2% of the surgeons with < 10 years' experience. A median of 3 courses (IQR: 2; 5) had been completed by 116 surgeons (88.5%), 70.2% of them ≤ 3 days long, and 85.4% self-funded. The primary hurdles to attend them were the lack of financial resources and/or the absence of local courses (80%). Virtual courses were regarded as a recommendable option to acquire laparoscopic skills by 100 (76.3%) respondents.

Conclusions: MIS training in Latin America has exponentially increased in the last decades. However, training programs have room for improvement, which means training is highly surgeon-dependent, since courses are selected and self-funded by surgeons themselves.

Introduction: Even though certain technical limitations associated with the small size of the patients were taken for granted in the advent of pediatric robotic surgery, we could now be facing a paradigm shift challenging these old beliefs.

Materials and methods: A retrospective study of patients undergoing Da-Vinci-Xi(IS4000)-assisted urological surgery from May 2022 to October 2023 was carried out. Patients were divided into two groups -Group A < 15 kg and Group B ≥ 15 kg. Operating times, hospital stay, and intra- and postoperative complications were compared.

Results: 17 patients (9 in Group A, 8 in Group B) underwent surgery. Median age was 29 months (A) and 109 months (B) (p< 0.001). Median weight was 12.0 kg (A) and 31.5 kg (p< 0.001). Operating time was 162 min (A) and 130 min (p= 0.203). Console time was 99 min (A) and 70 min (B) (p= 0.065). Mean hospital stay was 2 days (A) and 3 days (B) (p= 0.41). No differences were found in terms of intraoperative (p= 0.453) or postoperative (p= 0.485) complications.

Conclusions: Even though operating on younger children seemed more complicated than on older ones in the advent of robotic surgery, the results in our series were similar. The fact patients under 12 months of age were not included means larger studies are required to prove this.

Introduction: Wilms' tumor (WT) is the most frequent renal tumor in childhood. Therapeutic management progression has increased survival rates, and as a result, long-term adverse effects.

Materials and methods: A descriptive retrospective study of a case series from 1977 to 2023 was carried out. The characteristics of the treatments received and the adverse effects listed on medical records were analyzed via phone surveys.

Results: 50 patients (25 boys-25 girls) with a mean age of 3.6 years (3 months-11 years) at diagnosis were included. Most of them (94%) were treated according to the protocol established by the European standards of pediatric oncology, which are characterized by the use of neoadjuvant chemotherapy. In one patient, the American treatment scheme was followed. The most common drugs used were vincristine and actinomycin D (78%). Only 12 patients (28%) received anthracyclines. Unilateral nephrectomy was the most frequent surgical technique (84%). Renal disorders were the most common (46%). However, the occurrence of second neoplasias (9%) and reproductive disorders (8% between boys and girls) had a greater impact on patients' quality of life. Multiple - cardiac (23%), endocrine (26%), and pulmonary (15%) - disorders associated with the treatments received were reported.

Conclusions: WT treatment has an impact on health. Adequate and rigorous surgery, close follow-up, and limiting chemotherapy doses and radiation exposure can minimize long-term sequels.

Objective: To find out whether the use of indocyanine green for lymphatic sparing in the laparoscopic Palomo technique reduces the incidence of postoperative hydrocele.

Materials and methods: A comparative cohort study of varicocele patients treated with the laparoscopic Palomo technique from 2008 to 2023 was carried out. Patients were divided into two groups according to whether fluorescence lymphography (intratesticular indocyanine green) had been performed or not. Epidemiological, surgical, and clinical data, as well as complications, were recorded. A hypothesis test was conducted using the SPSS software.

Results: 30 patients undergoing varicocele surgery through the laparoscopic Palomo technique were included. They were divided into two groups -lymphatic sparing (n= 13) vs. spermatic vessel ligation without sparing (n= 17). Mean age at surgery was 14 years. 5 cases of postoperative hydrocele were identified in the no lymphatic sparing group. 1 of them required surgery for hydrocele treatment. No hydrocele cases were noted in the lymphography group. The difference was statistically significant (p= 0.032). There were no statistically significant differences in terms of operating times or mean hospital stay. No recurrences, postoperative testicular atrophies, or indocyanine-green-related complications were recorded. Mean follow-up was 11.4 months.

Conclusions: The use of indocyanine green for lymphatic sparing in the treatment of varicocele through the laparoscopic Palomo technique significantly reduces the incidence of postoperative hydrocele.

Introduction: Preoperative application of botulinum toxin type A has demonstrated to be safe and effective in the closure of complex ventral hernias in adults. However, its use in pediatrics has been little documented.

Case report: We present the case of a 22-month-old girl with a complex abdominal wall ventral hernia secondary to multiple neonatal laparotomies. In a first procedure, botulinum toxin was administered using an intramuscular approach at six sites of the muscle layers surrounding the defect, under general anesthesia and ultrasound control. 4 weeks later, an open hernia repair was conducted, without complications.

Discussion: Botulinum toxin at low doses could facilitate the surgical treatment of complex ventral incisional hernias in children. Even though it is important to adjust dosage and anatomical reference points according to hernia type and patient age and weight, further studies are required to optimize these variables.

Introduction: Surgical exploration in complete ureteropelvic-junction disruption (CUPJD) is still recommended by many authors. Conservative approach to pediatric renal trauma (RT) includes minimally invasive techniques such as nephrostomy, angioembolization or double-J stent placement.

Case report: A 14-year-old patient with CUPJD was treated conservatively. CT-scan revealed active bleeding of the renal artery and significant urine extravasation. Coil angioembolization and nephrostomy placement were performed. An attempt to place a double-J stent was unsuccessful and surgical reconstruction was scheduled. Before surgery, methylene-blue was injected through the nephrostomy observing blue urine output through urethra. Antegrade pyelogram revealed drainage from the urinoma to the ureter. A new attempt to place an internal-external double-J-stent was successful. After 5 weeks, it was removed with total restoration of the urinary tract.

Conclusion: Complete urinary tract restoration in some cases of CUPJD following RT is possible through a nonoperative approach. It can be safe and effective, reducing the risk of complications associated with complex surgeries.