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

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.

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.

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.

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: 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.