Anal canal duplication and triplication: a rare entity with different presentations.

Anal canal duplication (ACD) is the rarest of gastrointestinal duplications. Few cases have been reported. Most cases present as an opening in the midline, posterior to the normal anus. The aim of our revision is to contribute with eight new cases, some of them with unusual presentations: five presented as the typical form, one with a perianal nodule, and two presented as two separate orifices (anal canal triplication). Complete excision was performed in all patients with no complications. ACD is the most distal and the least frequent digestive duplication. Its treatment should be surgical excision, to avoid complications such as abscess, fistulization, or malignization. Anal canal triplication has never been described before.

High pressure balloon dilation of the ureterovesical junction--first line approach to treat primary obstructive megaureter?

PURPOSE: We describe the efficacy of dilation of the ureterovesical junction to treat primary obstructive megaureter. MATERIALS AND METHODS: A total of 13 patients with primary obstructive megaureter were treated from May 2008 to December 2010. Of these patients 8 were diagnosed prenatally and the others were diagnosed after a urinary tract infection. Preoperative studies included ultrasonography, voiding cystourethrography despite vesicoureteral reflux and diuretic isotopic renogram (mercaptoacetyltriglycine). With the patient under general anesthesia, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A Double-J(®) catheter was positioned, and 2 months later it was withdrawn and the ureterovesical junction was reviewed. A secondary treatment was performed in those in whom the ureterovesical junction was still narrow. Followup was performed with ultrasonography, cystourethrography and isotopic diuretic renography. RESULTS: A total of 18 procedures were performed in 13 patients (median age 7 months, range 4 to 24). Median diameter of the distal ureter was 14 mm (range 10 to 26), and median diameter of the renal pelvis and calyx was 27 mm (range 10 to 47) and 12 mm (range 9 to 26), respectively. Significant postoperative improvement of hydroureteronephrosis was observed in 11 of 13 patients and vesicoureteral reflux was found in 2. Only 3 patients needed ureteral reimplantation after endoscopic treatment due to hydroureteronephrosis in 2 and high grade vesicoureteral reflux in 1. CONCLUSIONS: High pressure balloon dilation of the ureterovesical junction is effective in treating primary obstructive megaureter, but long-term followup is needed.

[Management of rectal traumatism in the pediatric age]. / Manejo del traumatismo rectal en la edad pediátrica.

OBJECTIVE: In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We present our experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. PATIENTS AND METHODS: Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. RESULTS: 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with associated malformations) and non-iatrogenic accidental injuries. A CT was performed in 4 cases. None of them was explored with sigmoidoscopy. We performed colostomy without primary repair in four patients, primary injury repair with colostomy in two patients, and one patient underwent primary repair without colostomy. All patients had a long evolution (mean hospital length of stay was 31,4 days) with many dressings and some of them required relaparotomy. Fecal continence and long term results have been, in all of them, satisfactories. CONCLUSIONS: An early and complete diagnosis of anorectal injuries is basic for an appropriate approach to the treatment. Primary repair of injuries without colostomy could be a safe procedure as a first treatment in selected patients: stables, with no contamination and no associated injuries. It is very important to individualize each patient to minimize the morbidity, reduce the hospital length of stay and reach a full continence.

[Anderson-Hynes pyeloplasty in children under 2 years. Is the laparoscopy the technique of choice?]. / Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección?

OBJECTIVE: To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction in patients under 2 years of age. PATIENTS AND METHODS: Pyeloplasties performed in children under 2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. RESULTS: We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05). CONCLUSIONS: Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long.

Advantages of endoscopic pilonidal sinus treatment. / Ventajas de la cirugía endoscópica para el tratamiento quirúrgico del sinus pilonidal.

INTRODUCTION: Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a decrease in patients' quality of life. The objective of our study was to evaluate the effectiveness and advantages of the endoscopic technique vs. conventional surgery of pilonidal sinus in the pediatric population. METHODS: A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution in 2019. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) were compared. The surgical technique chosen was surgeon-dependent. RESULTS: 49 patients were studied - 14 undergoing PEPSiT, 23 undergoing EHSI, and 12 undergoing EPC. Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT, whereas complication rate with EHSI was 69.6%, and complication rate with EPC was 58.3% (p = 0.001). CONCLUSIONS: Endoscopic pilonidal sinus treatment is effective, with a short and painless postoperative period, and easy wound care. It allows for an early return to normal life without restrictions.

INTRODUCCION: Los procedimientos clásicos exeréticos en el tratamiento del sinus pilonidal están relacionados con una alta tasa de complicaciones y conllevan un postoperatorio largo y doloroso, precisando curas tópicas diarias hasta la cicatrización completa, lo que provoca una disminución de la calidad de vida de los pacientes. El objetivo de este trabajo es evaluar la eficacia y las ventajas de la técnica endoscópica frente a la cirugía convencional del sinus pilonidal en población pediátrica. METODOS: Estudio cuasi-experimental en pacientes pediátricos operados de sinus pilonidal durante 2019 en un único centro. Comparamos la exéresis con cicatrización por segunda intención (ESI), exéresis con cierre primario (ECP) y PEPSiT (Pediatric Endoscopic Pilonidal Sinus Treatment). La elección de la técnica fue cirujano-dependiente. RESULTADOS: Se estudiaron 49 pacientes: 14 PEPSiT, 23 ESI y 12 ECP. Se consigue la epitelización completa 11 semanas antes con PEPSiT que con ESI (IC95%: 6,3 a 16,3; p < 0,001). Encontramos menor dolor en escala analógica visual (EVA) con PEPSiT, y paralelamente también necesitaban menos analgésicos (p = 0,001). Con PEPSiT recuperan su vida normal 78 días antes de media que los ESI (IC95%: 42,2 a 114,9; p < 0,001) y 39 días antes que ECP (IC95%: -2,5 a 81,4; p = 0,06). No se registraron complicaciones con PEPSiT frente a un 69,6% con ESI y 58,3% con ECP (p = 0,001). CONCLUSIONES: El tratamiento endoscópico del sinus pilonidal es efectivo, con un postoperatorio corto, indoloro y con fáciles cuidados. Permite la rápida recuperación de la actividad normal sin las restricciones que conlleva la cirugía convencional.

Ventajas de la cirugía endoscópica para el tratamiento quirúrgico del sinus pilonidal / Advantages of endoscopic pilonidal sinus treatment

Introducción: Los procedimientos clásicos exeréticos en el tratamiento del sinus pilonidal están relacionados con una alta tasa de complicaciones y conllevan un postoperatorio largo y doloroso, precisandocuras tópicas diarias hasta la cicatrización completa, lo que provoca unadisminución de la calidad de vida de los pacientes. El objetivo de este trabajo es evaluar la eficacia y las ventajas de la técnica endoscópica frentea la cirugía convencional del sinus pilonidal en población pediátrica. Métodos: Estudio cuasi-experimental en pacientes pediátricos operados de sinus pilonidal durante 2019 en un único centro. Comparamosla exéresis con cicatrización por segunda intención (ESI), exéresis concierre primario (ECP) y PEPSiT (Pediatric Endoscopic Pilonidal SinusTreatment). La elección de la técnica fue cirujano-dependiente. Resultados: Se estudiaron 49 pacientes: 14 PEPSiT, 23 ESI y 12ECP. Se consigue la epitelización completa 11 semanas antes con PEP-SiT que con ESI (IC95%: 6,3 a 16,3; p < 0,001). Encontramos menordolor en escala analógica visual (EVA) con PEPSiT, y paralelamentetambién necesitaban menos analgésicos (p = 0,001). Con PEPSiT recuperan su vida normal 78 días antes de media que los ESI (IC95%: 42,2a 114,9; p < 0,001) y 39 días antes que ECP (IC95%: -2,5 a 81,4; p =0,06). No se registraron complicaciones con PEPSiT frente a un 69,6%con ESI y 58,3% con ECP (p = 0,001). Conclusiones: El tratamiento endoscópico del sinus pilonidal esefectivo, con un postoperatorio corto, indoloro y con fáciles cuidados.Permite la rápida recuperación de la actividad normal sin las restricciones que conlleva la cirugía convencional.(AU)

Introduction: Classic treatment of pilonidal sinus is associatedwith a high rate of complications and a long and painful postoperativeperiod requiring daily wound care, with a decrease in patients’ qualityof life. The objective of our study was to evaluate the effectiveness andadvantages of the endoscopic technique vs. conventional surgery ofpilonidal sinus in the pediatric population. Methods: A quasi-experimental study was carried out in pediatricpatients undergoing pilonidal sinus surgery at a single institution in2019. Excision and healing by secondary intention (EHSI), excisionand primary closure (EPC), and Pediatric Endoscopic Pilonidal SinusTreatment (PEPSiT) were compared. The surgical technique chosenwas surgeon-dependent. Results: 49 patients were studied – 14 undergoing PEPSiT, 23undergoing EHSI, and 12 undergoing EPC. Full healing process wasfaster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p< 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to returnto normal life was shorter with PEPSiT – 78 days earlier than EHSI(95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95%CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT,whereas complication rate with EHSI was 69.6%, and complication ratewith EPC was 58.3% (p = 0.001). Conclusions: Endoscopic pilonidal sinus treatment is effective, witha short and painless postoperative period, and easy wound care. It allowsfor an early return to normal life without restrictions.(AU)

Use of high-pressure balloon dilatation of the ureterovesical junction instead of ureteral reimplantation to treat primary obstructive megaureter: is it justified?

OBJECTIVE: To compare outcomes between high-pressure balloon dilatation of the ureterovesical junction (UVJ) and ureteral reimplantation with ureteral tapering to treat primary obstructive megaureter (POM). PATIENTS AND METHODS: Retrospective review of clinical data from patients who underwent surgical treatment of POM from 2005 to 2010. Patients were divided into two groups: endoscopic treatment (ET) with UVJ dilatation and ureteral reimplantation (UR) with Cohen's or Leadbetter-Politano neoureterocystostomy and Hendren's tapering. Preoperative studies included ultrasound scan (US), voiding cystourethrography, and diuretic isotopic renogram. Outcome parameters were US, differential renal function (DRF), presence of postoperative vesicoureteral reflux, need for secondary reimplantation and complications. RESULTS ET: 13 patients with a median age of 7 (4-24) months; UR: 12 patients with a median age of 14 (7-84) months, with no statistical differences in age and gender between groups. Preoperative US parameters were similar. ET: mean diameter of renal pelvis, calices and ureter was 23.5 mm, 13.46 mm and 15.77 mm respectively. UR: mean diameter of renal pelvis, calices and ureter was 22.25 mm, 11.75 mm, and 19.08 mm, respectively. Preoperative DRF was 45.62% and 39.33% for ET and UR, respectively (p > 0.05). Significant improvement of hydroureteronephrosis was observed in 11/13 patients of ET and 11/12 patients of UR (p > 0.05). Postoperative DRF was 42% and 48% for ET and UR, respectively (p > 0.05). Postoperative vesicoureteral reflux was observed in 2 patients of ET and 1 of UR (p > 0.05). Secondary ureteral reimplantation was needed in 3 patients of ET and 2 of UR (p > 0.05). CONCLUSION: Endoscopic treatment of POM is as effective as ureteral reimplantation but further randomized clinical trials are needed to support these results.

Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage.

OBJECTIVE: To present our cases of ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR) with dextranomer/hyaluronic acid (Dx/HA). PATIENTS AND METHODS: We collected data from patients who had suffered ureteral obstruction after endoscopic treatment of VUR with Dx/HA in our institution. RESULTS: From April 2002 to April 2011 we treated endoscopically 475 ureters with VUR, and detected 5 ureteral obstructions. Median age at reflux treatment was 39 months. Reflux grade before treatment was III in one patient and IV in four. Three ureterovesical junctions (UVJ) were blocked after a second endoscopic treatment. The median of Dx/HA injected was 1 ml (0.6-1.1). In two patients ureteral obstruction presented acutely and was treated with a ureteral stent. In the other three, the ureteral obstruction appeared gradually and was detected by ultrasound scans and MAG3 diuretic renogram; one underwent nephrectomy because of poor renal function, and the other two were treated with endoscopic dilatation of the UVJ. In all these patients both reflux and obstructions have resolved. CONCLUSIONS: On preoperative cystography, three of the patients had a narrowed distal ureter, and probably had a refluxing and obstructive megaureter. Other causes are not clear, except for those patients with acute presentation in whom edema of the UVJ was found. Ureteral obstruction after endoscopic treatment of VUR is rare. Endoscopic intervention such as ureteral stent placement or high-pressure balloon dilatation of the UVJ has good results as a treatment of acute and delayed obstruction.

Manejo del traumatismo rectal en la edad pediátrica / Management of rectal traumatism in the pediatric age

Objetivo. En pediatría, las heridas anorrectales son infrecuentes y su manejo ha incluido clásicamente la derivación intestinal. Actualmente, y si las condiciones son favorables, se tiende a realizar una reparación primaria de la lesión sin colostomía. Presentamos nuestra casuística y experiencia en el manejo de esta patología, revisando la literatura con el objetivo de crear unas pautas de actuación a seguir en estos casos. Material y métodos. Estudio retrospectivo, descriptivo, de pacientes con herida anorrectal en nuestro centro entre 2005-2011. Se analizan los datos demográficos de cada paciente, mecanismo de la lesión, malformaciones asociadas, tiempo de evolución lesión-cirugía, tratamiento, estancia hospitalaria y evolución. Resultados. Los 7 pacientes revisados se clasifican según el tipo de lesión en dos grupos; lesiones iatrogénicas (todas con malformaciones asociadas) y lesiones accidentales no iatrogénicas. En 4 de ellos se realizó una TC (tomografía computerizada). Ninguno se exploró mediante sigmoidoscopia. En los pacientes revisados, se realizó colostomía de (..) (AU)

Objective. In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We presentour experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. Patients and methods. Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. Results. 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with (..) (AU)

Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección? / Anderson hynes pyeloplasty in children under 2 years. is the laparoscopy the technique of choice?

Objetivo. Demostrar que la laparoscopia es tan eficaz como la cirugía abierta en el tratamiento de la estenosis pieloureteral en menores de 2 años. Material y métodos. Pieloplastias en menores de 2 años entre 2007y 2010. Dos grupos: pieloplastia abierta (PA) y pieloplastia laparoscópica(PLap). Se han analizado: peso, diámetro de la pelvis renal y delos cálices pre y postoperatorios, tiempos quirúrgicos, estancia media y complicaciones. Resultados. 35 PA y 13 PLap. No han existido diferencias significativas ni en el peso medio, ni en los diámetros de la pelvis renal y cálices pre ni postoperatorios, ni en las complicaciones. Sí hemos encontrado diferencias estadísticamente significativas en el tiempo quirúrgico medio y la estancia media (p<0,05).Conclusión. Este estudio sugiere que la pieloplastia laparoscópica en niños menores de 2 años es una buena técnica alternativa a la cirugía abierta. El único inconveniente es el mayor tiempo quirúrgico, que irá disminuyendo con la experiencia (AU)

Objective. To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction inpatients under 2 years of age. Patients and methods. Pyeloplasties performed in children under2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. Results. We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05).Conclusions. Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long (AU)