Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale. / Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional.

INTRODUCTION: Dysphagia is defined as difficulty swallowing. Up to 84% of patients undergoing esophageal atresia surgery have dysphagia beyond the neonatal period. MATERIALS AND METHODS: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. The Functional Oral Intake Scale (FOIS) was used to assess dysphagia in 4 age groups (< 1 year old, 1-4 years old, 5-11 years old, and > 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversion were regarded as dysphagia. RESULTS: 63 patients were analyzed. 74% (47/63) had dysphagia during follow-up. Prevalence was 50% in patients < 1 year old (FOIS mean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patients aged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOIS mean 6.8). The most frequent causes of dysphagia were stenosis, which occurred in 38% of the patients (n=24), and gastroesophageal reflux (n=18), which was present in 28% of the patients. Both conditions were associated with significantly lower mean FOIS scores (p< 0.05) in the patients under 11 years of age. Differences (p< 0.05) were found in the dysphagia-associated perinatal factors in the various age groups, with longer ventilation assistance times, parenteral nutrition, and hospital stays. CONCLUSIONS: Dysphagia is an extremely frequent symptom at any given age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.

INTRODUCCION: La disfagia se define como dificultad en el proceso de alimentación. Hasta un 84% de pacientes intervenidos de atresia de esófago tienen disfagia más allá del periodo neonatal. MATERIAL Y METODOS: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS (Functional Oral Intake Scale) para cuantificar la disfagia en 4 grupos de edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años). Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria. RESULTADOS: Se obtuvieron datos de 63 pacientes. El 74% (47/63) presentó disfagia durante el seguimiento. La prevalencia fue del 50% < 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11 años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causas más frecuentes de disfagia fueron la estenosis, que presentó un 38% de los pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentó a su vez un 28% de los pacientes. Ambas condiciones se asociaron con unos valores medios de FOIS significativamente menores (p< 0,05) en los pacientes menores de 11 años. Se encontraron diferencias (p< 0,05) en factores perinatales asociados a disfagia en los distintos periodos de edad, a destacar mayor tiempo medio de: asistencia ventilatoria, nutrición parenteral e ingreso hospitalario. CONCLUSIONES: La disfagia es un síntoma extremadamente frecuente a cualquier edad en los pacientes intervenidos de atresia de esófago. Un seguimiento estandarizado y multidisciplinar es esencial para mejorar la calidad de vida de estos pacientes.

Pilonidal sinus in adolescence: is there an ideal surgical approach? / Sinus pilonidal durante la adolescencia: ¿existe el abordaje quirúrgico ideal?

OBJECTIVE: The objective of this work was to compare excision with primary closure according to Karydakis technique (KT) with en bloc resection with secondary healing (EB) in the treatment of pilonidal sinus in adolescents. MATERIAL AND METHODS: An observational, retrospective, multi-center study was carried out in adolescent patients (11-18 years old) diagnosed with pilonidal sinus and undergoing surgery from 2011 to 2017. Patients were divided into 2 groups: KT (pediatric surgeons) and EB (general surgeons). RESULTS: Our sample consisted of 61 patients (KT: 26 patients; EB: 35 patients). Mean total recovery time (days) was significantly shorter in the KT group (37.77 KT vs. 107.76 EB, p< 0.001). In terms of postoperative complications, no differences were noted regarding overall complication rate (53.8% KT vs. 40% EB). However, differences were found in postoperative bleeding (0% KT vs. 25.7% EB, p=0.005), seroma occurrence (23.1% KT vs. 0% EB, p=0.003), and surgical wound dehiscence (42.3% KT vs. 8.6% EB, p=0.002). Recurrence rate was lower in the Karydakis group than in the en bloc resection group (4% vs. 28.6%, p=0.015). CONCLUSIONS: Both surgical techniques (KT and EB) are acceptable and safe, but in our study, Karydakis technique demonstrated to be more effective than en bloc resection with secondary closure, since it allowed for shorter recovery times and lower recurrence rates. Therefore, Karydakis surgical technique can be an excellent alternative in the treatment of pilonidal sinus in the adolescent population.

OBJETIVOS: El objetivo de este trabajo es comparar la escisión con cierre primario según la técnica de Karydakis (TK) y la exéresis en bloque con cicatrización por segunda intención (EB), para el tratamiento del sinus pilonidal en adolescentes. MATERIAL Y METODOS: Estudio observacional, retrospectivo y multicéntrico en pacientes en edad adolescente (11-18 años), con diagnóstico de sinus pilonidal e intervenidos entre 2011-2017, divididos en 2 grupos: TK (cirujanos pediátricos) y EB (cirujanos generales). RESULTADOS: Presentamos una muestra de 61 pacientes (TK: 26 pacientes y EB: 35 pacientes). El tiempo medio (días) de recuperación total fue significativamente más corto en el grupo TK (37,77 TK vs 107,76 EB; p< 0,001). En cuanto a las complicaciones postoperatorias, no se encontraron diferencias respecto a la tasa global de complicaciones (53,8% TK vs 40% EB). Sin embargo, se demuestran diferencias en el sangrado postquirúrgico (0% TK vs 25,7% EB; p= 0,005), aparición de seroma (23,1% TK vs 0% EB; p= 0,003) y dehiscencia de herida quirúrgica (42,3% TK vs 8,6% EB; p= 0,002). La tasa de recurrencia ha sido menor en el grupo de Karydakis respecto al grupo de exéresis en bloque (4% vs 28,6%; p= 0,015). CONCLUSIONES: Ambas técnicas quirúrgicas son aceptables y seguras, pero en nuestro estudio la técnica de Karydakis se ha mostrado más eficaz que la exéresis en bloque con cierre por segunda intención, ya que requiere un menor tiempo de recuperación del paciente, con una tasa de recurrencia inferior. Por ello, la técnica quirúrgica de Karydakis puede suponer una alternativa excelente en el tratamiento de la enfermedad pilonidal en población adolescente.

[Hypertrophy of labia minora. A growing problem in adolescence]. / Hipertrofia de labios menores. Un problema creciente en la adolescencia.

OBJECIVE: Hypertrophy of labia minora in adolescence is a little known disease. However, the growing demand for the solution of this problem pushes us to include it in our clinical practice. We evaluated the aesthetic and functional results of labiaplasty using straight amputation of the protuberant tissue of the labial edges. METHODS: Patients treated by hypertrophy of labia minora were reviewed. We evaluated the results of aesthetic, functional and surgical complications. A survey on the degree of satisfaction was also conducted. RESULTS: We collected 16 patients with 28 labioplasty, indicated by discomfort with the clothing and exercise. They were performed at a median age of 13.43 years (range 11.25-14.31). Bilateral 11 (64.7%), left 4 (23.5%) and rights 2 (11.8%). The median hospital stay was 1 day (range 1-3). There was evidence of immediate complications (partial dehiscence of the scar) in 1 (3.57%) patient and late complications in 2 (7.14%) patients (granuloma in the scar and recurrence), in a median follow up time of 1.58 years (range 0.19-7.76). The survey was answered by 13 patients. All of them said that preoperative discomfort was resolved. Postoperative discomfort (pain or straps) were nothing or very few in 61.54% and the median time of inconvenience was 5 days (range 1-30). They felt an improvement in self-esteem 69.23% and the 30.77% remaining never presented a problem about that. Median overall satisfaction was 8 (range 7-10) over 10, and the 100% of patients would repeat surgery. CONCLUSION: The labiaplasty by straight amputation in adolescence is an effective technique with few complications, and with a high degree of satisfaction for patients.

OBJETIVO: La hipertrofia de labios menores en la adolescencia es una patología poco conocida. Ante la creciente demanda de pacientes con este problema, fue necesaria su inclusión en nuestra cartera de servicios. El objetivo del presente estudio es la valoración de los resultados estéticos y funcionales de la labioplastia mediante la resección simple lineal de los bordes labiales. METODOS: Revisamos a pacientes intervenidas por hipertrofia de labios menores. Evaluando resultados estéticos, funcionales y complicaciones quirúrgicas. Asimismo, realizamos una encuesta sobre el grado de satisfacción. RESULTADOS: Intervenimos 16 pacientes con 28 labioplastias, indicadas por molestias con la vestimenta y el ejercicio. Se realizaron a una mediana de edad de 13,43 años (rango 11,25-14,31). Siendo bilaterales 11 (64,7%), izquierdos 4 (23,5%) y derechos 2 (11,8%). La mediana de estancia hospitalaria fue un día (rango 1-3). Se evidenció una complicación inmediata (3,57%) (dehiscencia parcial de la herida) y 2 (7,14%) tardías (granuloma en la cicatriz y recidiva), en una mediana de seguimiento de 1,58 años (rango 0,19-7,76). A la encuesta respondieron 13 pacientes, el 100% refirieron que las molestias preoperatorias estaban resueltas o mucho mejor; el 61,54% no indicó ninguna o muy pocas molestias postoperatorias (tirantez o dolor), siendo la mediana de tiempo de las molestias 5 días (rango 1-30). Sintieron una mejora de la autoestima el 69,23% y el 30,77% restante nunca presentaron problema al respecto. La mediana de grado de satisfacción global fue 8 (rango 7-10) y el 100% repetirían la cirugía. CONCLUSION: La labioplastia mediante resección simple en la adolescencia es una técnica efectiva con pocas complicaciones, y con un alto grado de satisfacción para las pacientes.

[What can we do to improve our management of intestinal atresia?]. / ¿Qué podemos mejorar en el tratamiento de las atresias intestinales?

OBJECTIVE: To review our management of intestinal atresia (AI). MATERIAL AND METHODS: A retrospective review of patientes with AI, from 1995 to 2011. RESULTS: AI was identified in 41 patients, 29,2% had maternal polyhydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduodenostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunostomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel. CONCLUSIONS: Prenatal diagnosis of AI is difficult, especially AYI, which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It's important to keep in mind colorectal atresias, which can not be identified.

[Primary torsion of the greater omentum]. / Torsión primaria de epiplón mayor.

OBJECTIVE: Primary torsion of the greater omentum is an infrequent cause of acute abdomen in children. A retrospective review was conducted to establish the prevalence and clinical features of omental torsion as a cause of acute abdominal pain in childhood. PATIENTS AND METHODS: We reviewed the clinical histories of the children given surgical treatment for torsion of the greater omentum in our hospital in the last 25 years. The following data were studied: age at presentation, sex, predisposing factors, symptomatology, complementary investigations, treatment and evolution. RESULTS: The male:female ratio among the 15 patients who underwent surgery was 2:1. Symptomology was similar to that of acute appendicitis with certain peculiarities such as a longer period of evolution at the moment of diagnosis, lower temperature and leucocytosis lower than would be expected in appendicitis at the same time of evolution and, in 12 patients, absence of vomiting. After surgical treatment evolution was satisfactory. Torsion was primary in 13 patients, secondary to inguinal hernia in 1 and secondary to cystic lymphangioma of the omentum in 1. The etiology and pathogenesis, as well as the diagnostic and therapeutic problems of this process, are discussed. CONCLUSIONS: In all the patients with primary torsion the clinical diagnosis was of acute appendicitis. Although primary torsion is classically associated with obesity, only 1 of the 13 patients weighed significantly more than the average for the same age and sex in our region and none of the patients showed a clearly associated anatomic malformation.