Ventajas de la analgesia epidural en cirugía mayor neonatal / Benefits of epidural analgesia in major neonatal Surgery

El objetivo de este trabajo es describir y evaluar las ventajas de la analgesia epidural en cirugía mayor neonatal. Para ello, realizamos un estudio de casos controles emparejado (2:1) de pacientes sometidos a cirugía mayor neonatal (CMN) bajo anestesia general que recibieron analgesia epidural (AE) intra y postoperatoria, y controles con anestesia general convencional. El criterio de emparejamiento fue edad, peso y patología basal. Se administró AE intra y postoperatoria por vía caudal con levobupivacaina mediante catéter epidural colocado con apoyo ecográfico. Se estudiaron el tiempo hasta la extubación, el tiempo de tránsito intestinal (presencia de deposiciones), el tipo de analgesia y las complicaciones. Se estudiaron 11 casos (2 atresias esofágicas, 2 hernias diafragmáticas, 1 enterocolitis necrotizante, 3 atresias intestinales, 2 malformaciones anorrectales y 1 extrofia vesical) y 22 controles. Observamos diferencias estadísticamente significativas en tiempo de extubación (OR 12 IC 95% 1,99-72,35; Chi2 p= 0,004, U Mann Whytney p= 0,013) y del tiempo de tránsito intestinal (U Mann Whitney p< 0,001, Or 100, IC 95% 8,06-1239; Chi2 p< 0,0001). No se observaron complicaciones derivadas de la técnica epidural. Por todo ello, consideramos que la AE intra y postoperatoria ayuda a mejorar el manejo postquirúrgico en neonatos y debe ser de elección en centros en los que esta técnica esté disponible (AU)

The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p <0.001, 100 Or , 95% CI 8.06 -1 239; Chi2 p <0.0001). There were no complications from epidural analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available (AU)

Cuando una peritonitis no parece una peritonitis / When a peritonitis does not seems like a peritonitis

La pancreatitis aguda es una entidad que forma parte del diagnóstico diferencial del abdomen agudo de origen apendicular. Aunque su incidencia es baja, se encuentra en aumento y su correcto diagnóstico evita cirugías innecesarias. El objetivo del trabajo es describir la pancreatitis aguda como diagnóstico diferencial de abdomen agudo de origen apendicular. Se realiza un estudio retrospectivo de los pacientes remitidos para valoración de cirugía pediátrica en la urgencia con sospecha de patología apendicular, que fueron diagnosticados finalmente de pancreatitis aguda desde el año 2010. Se incluyen 5 pacientes. Un paciente fue intervenido y su diagnóstico se realizó en el 5º día postoperatorio. La edad mediana al diagnóstico fue de 5 años (rango de 8 meses a 6 años). La mediana de leucocitos en sangre fue de 16.600 /μL (13.400-31.900 /μL), mediana de neutrofilos 14.432 /μL (11.400-29.348 /μL), mediana PCR 11 mg/L (155-4,6 mg/L), mediana amilasa sérica al diagnóstico 651 U/L (10-1.443 U/L). Todos los casos fueron estudiados con ecografía abdominal y tomografía computarizada o resonancia magnética nuclear. Un caso presentó episodios recurrentes de pancreatitis y como complicación un pseudoquiste y una fístula pancreática, precisando a los 9 meses del inicio del cuadro clínico una derivación cistoentérica en Y de Roux. La mediana global de seguimiento de la serie es de 10 meses, con un rango entre 1 y 22 meses, encontrándose todos los pacientes asintomáticos (AU)

Acute pancreatitis should be considered in the differential diagnosis of acute abdominal pain. Although its incidence is low, it has increased in the last years; therefore, an accurate diagnosis is necessary to avoid inappropriate surgeries. The aim of this study is to describe acute pancreatitis in the context of acute abdominal pain, which suggests appendicitis. We performed a retrospective study of all the patients who were admitted in the emergency department due to suspected appendicitis but were finally diagnosed of acute pancreatitis since 2010. Five patients were included in the investigation. One of them underwent surgery and the diagnosis was made on the 5th postoperative day. Median age at diagnosis was 5 years (range from 8 month to 6 years). Median white blood cell was 16,600 /μL (13,400-31,900 /μL), Median differential count of white blood cell was 14,432 /μL (11,400-29,348 /μL) and Median PCR 11 mg/L (155-4.6 mg/L). Median serum amylase at diagnosis was 651 U/L (10-1,443 U/L). All cases were studied with ultrasound and computerized tomography or nuclear magnetic resonance. One case had recurrent episodes of pancreatitis and was complicated by the development of a pseudocyst and a pancreatic fistula, requiring an Y-en-Roux cysto-enteric anastomosis . The median follow up period was 10 months (range: 1 to 22). All patients are asymptomatic at the moment (AU)

[Benefits of epidural analgesia in major neonatal surgery]. / Ventajas de la analgesia epidural en cirugía mayor neonatal.

The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p < 0.001, 100 Or, 95% CI 8.06-1 239; Chi2 p < 0.0001). There were no complications from epidural analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.

[When a peritonitis does not seems like a peritonitis]. / Cuando una peritonitis no parece una peritonitis.

Acute pancreatitis should be considered in the differential diagnosis of acute abdominal pain. Although its incidence is low, it has increased in the last years; therefore, an accurate diagnosis is necessary to avoid inappropriate surgeries. The aim of this study is to describe acute pancreatitis in the context of acute abdominal pain, which suggests appendicitis. We performed a retrospective study of all the patients who were admitted in the emergency department due to suspected appendicitis but were finally diagnosed of acute pancreatitis since 2010. Five patients were included in the investigation. One of them underwent surgery and the diagnosis was made on the 5th postoperative day. Median age at diagnosis was 5 years (range from 8 month to 6 years). Median white blood cell was 16,600/microL (13,400-31,900/microL), Median differential count of white blood cell was 14,432/microL (11,400-29,348/microL) and Median PCR 11 mg/L (155-4.6 mg/L). Median serum amylase at diagnosis was 651 U/L (10-1,443 U/L). All cases were studied with ultrasound and computerized tomography or nuclear magnetic resonance. One case had recurrent episodes of pancreatitis and was complicated by the development of a pseudocyst and a pancreatic fistula, requiring an Y-en-Roux cysto-enteric anastomosis. The median follow up period was 10 months (range: 1 to 22). All patients are asymptomatic at the moment.

Relación entre la transfusión de concentrado de hematíes y la gravedad de la enterocolitis necrotizante en prematuros / Relation between packed red blood cell transfusion and severity of necrotizing enterocolitis in premature infants

Objetivo. Se ha propuesto que las transfusiones de concentrado de hematíes (TCH) determinan formas de enterocolitis necrotizante (ECN)más severas. Se pretende investigar si las ECN con antecedente de TCH alcanzan una mayor gravedad. Material y métodos. En un estudio retrospectivo de prematuros con ECN se consideraron dos grupos: con antecedente de TCH (grupoTR) y sin antecedente de TCH (grupo No-TR). Se consideraron como resultados principales la gravedad de la ECN, determinada según el estadio de Bell (EB) mayor durante el transcurso de la enfermedad, si fue necesario realizar tratamiento quirúrgico y la mortalidad. Posteriormente se analizaron por separado aquellos pacientes que habían recibido la TCH en las 48 h previas al inicio de los síntomas. Al comparar los grupos se utilizó la prueba exacta de Fisher o la de Chi cuadrado para elEB, el tratamiento quirúrgico, la mortalidad y las variables cualitativas (..) (AU)

Objective. It has been proposed recently that red blood cell transfusions(RBCT) might increase severity in infants with necrotizing enterocolitis (NEC). We intend to study if patients who have received red blood transfusions before the onset of NEC develop more severe forms of this entity. Methods. A retrospective study was carried out including prematures with NEC. Two groups were considered: with previous RBCT(TR) and without previous RBCT (No-TR). The main outcomes of the study were severity of NEC, according to the Bell stage (BS), surgical treatment and mortality. Patients who were treated with RBCT 48hours prior to the onset of NEC symptoms were analysed separately afterwards. Comparison of groups was made with the Fisher test or the Chi square test for the BS, surgery, mortality and nominal variables; the U Mann-Whitney test was used for numeric variables. Results. Forty-six patients were included for the investigation (28 in TR and 18 in No-TR). In the TR Group 20/28 neonates reached a BS II;8/28 BS III; 10 were operated on and there were 7 deaths. In the No-TR group 14/18 patients were classified as EB II; 4/18 as BS III, 3 patients (AU)

Estimación del riesgo de hemorragia digestiva alta en pacientes con cavernomatosis portal / Estimation of the risk of upper digestive tract bleeding in patients with portal cavernomatosis

Objetivos. Determinar el riesgo de hemorragia digestiva alta (HDA)tras el diagnóstico de cavernomatosis portal (CP) en pacientes pediátricos y estudiar las variables que se relacionan con este riesgo. Material y métodos. Analizamos retrospectivamente 13 casos de CP y estimamos las funciones de supervivencia para el evento HDA mediante el método de Kaplan-Meier. Se ha calculado la tasa de incidencia de la muestra y el número de sangrados/año de forma individual. Desde el momento del diagnóstico estudiamos: edad de presentación, plaquetas, leucocitos, hemoglobina, hematocrito, tiempo de protrombina, número de episodios de sangrado. Se ha analizado la relación de estas variables con el riesgo de sangrado individual mediante regresión de Cox. Resultados. Mediana de seguimiento: 7,1 años. 10 pacientes (77%)han presentado algún episodio de HDA tras el diagnóstico. Mediana de supervivencia hasta el primer episodio de HDA después del diagnóstico:314 días. Tasa de incidencia (TI) de HDA tras el diagnóstico: 0,43episodios de HDA por persona-año. Rango del número de sangrados por año individualizados en cada paciente: 0-2,2 episodios al (..) (AU)

Material and methods. We analyzed retrospectively 13 cases of portal cavernoma and estimated the risk of UGB with the Kaplan-Meier survival analysis. We calculated the incidence rate of the sample and the number of haemorrhages per year for each patient individually. From the moment of the diagnosis various parameters were recorded: age, platelets, leukocytes, hemoblobin, hematocrit, prothrombin time and number of bleedings. The relation between these parameters and the risk of bleeding was assessed with the Cox analysis. Results. The patients were followed for a median period of 7.1years. 10 patients (77%) presented at least 1 episode of UGB after the diagnosis. The median survival time until the first haemorrhage was314 days. After the diagnosis the incidence rate of the sample was 0.43episodes of upper gastrointestinal bleeding per person-year. The number of individual bleedings per person had a range of 0 - 2.2 episodesper year. Conclusions. There is very few data about the risk of bleeding in children with portal cavernoma. In our sample, we found out an incidence rate of 0.43 and a median survival time of 314 days until the first (..) (AU)

[Estimation of the risk of upper digestive tract bleeding in patients with portal cavernomatosis]. / Estimación del riesgo de hemorragia digestiva alta en pacientes con cavernomatosis portal.

PURPOSE: The aim of this study is to find out the risk of upper gastrointestinal bleeding (UGB) after the diagnosis of portal cavernoma in children, and to investigate several potential risk factors. MATERIAL AND METHODS: We analyzed retrospectively 13 cases of portal cavernoma and estimated the risk of UGB with the Kaplan-Meier survival analysis. We calculated the incidence rate of the sample and the number of haemorrhages per year for each patient individually. From the moment of the diagnosis various parameters were recorded: age, platelets, leukocytes, hemoblobin, hematocrit, prothrombin time and number of bleedings. The relation between these parameters and the risk of bleeding was assessed with the Cox analysis. RESULTS: The patients were followed for a median period of 7.1 years. 10 patients (77%) presented at least 1 episode of UGB after the diagnosis. The median survival time until the first haemorrhage was 314 days. After the diagnosis the incidence rate of the sample was 0.43 episodes of upper gastrointestinal bleeding per person-year. The number of individual bleedings per person had a range of 0-2.2 episodes per year. CONCLUSIONS: There is very few data about the risk of bleeding in children with portal cavernoma. In our sample, we found out an incidence rate of 0.43 and a median survival time of 314 days until the first episode of bleeding after the diagnosis, but we were not able to find a statistically significant association between the studied variables and the risk of bleeding.

[Relation between packed red blood cell transfusion and severity of necrotizing enterocolitis in premature infants]. / Relación entre la transfusión de concentrado de hematíes y la gravedad de la enterocolitis necrotizante en prematuros.

OBJECTIVE: It has been proposed recently that red blood cell transfusions (RBCT) might increase severity in infants with necrotizing enterocolitis (NEC). We intend to study if patients who have received red blood transfusions before the onset of NEC develop more severe forms of this entity. METHODS: A retrospective study was carried out including prematures with NEC. Two groups were considered: with previous RBCT (TR) and without previous RBCT (No-TR). The main outcomes of the study were severity of NEC, according to the Bell stage (BS), surgical treatment and mortality. Patients who were treated with RBCT 48 hours prior to the onset of NEC symptoms were analysed separately afterwards. Comparison of groups was made with the Fisher test or the Chi square test for the BS, surgery, mortality and nominal variables; the U Mann-Whitney test was used for numeric variables. RESULTS: Forty-six patients were included for the investigation (28 in TR and 18 in No-TR). In the TR Group 20/28 neonates reached a BS II; 8/28 BS III; 10 were operated on and there were 7 deaths. In the No-TR group 14/18 patients were classified as EB II; 4/18 as BS III, 3 patients needed surgery and Idied. No relation was found between RBCT and BS (p = 0.39), RBCT and surgery (RR = 2.7; CI 95%: 0.64-11.97; p = 0.19), or RBCT and mortality (RR = 4.5; CI 95%: 0.6-36.6; p = 0.09). In those patients who received a RBCT 48 hours before the initial symptoms there were 3 EB II and 3 EB III; 4 infants required surgical treatment and there were 2 exitus. Comparing this subgroup and the rest of the sample there were only significant differences in the need of surgical treatment: patients who received a RBCT 48 hours before the onset of NEC were at an increased risk for surgery of 2.6 (CI 95%: 1.2-5.1; p = 0.045) but there were not different when surgical treatment and mortality were considered. CONCLUSIONS: These results do not support clearly the hypothesis that there is a relation between previous treatment with RBCT and the severity of NEC.

Resultados de la utilización de antirreflujo laparoscópico para la prevención de los episodios de apnea, bradicardia y desaturación / Results of the use of laparoscopic anti-reflux procedure for the prevention of episodes of apnea, bradycardia and desaturation

En 1986, el Instituto Americano de la Salud definió los ApparentLife-Threatenig Events (ALTEs) como “aquellos episodios escalofriantes para el observador que se caracterizan por una combinación de apneas (centrales u obstructivas), cambios en la coloración (cianosis, palidez, congestiva) y cambios marcados en el tono muscular (hipotonía), asfixia o atragantamiento”. A pesar de que su exacta etiología sigue siendo un misterio, son muchos los centros que relacionan los ALTE con la enfermedad por reflujo gastroesofágico (ERGE), recomendándose, casi sistemáticamente, tratamiento médico de la ERGE a los pacientes con ALTE. Sin embargo hay muy pocos trabajos en la literatura que muestren la eficacia del tratamiento quirúrgico de los pacientes con ALTE y ERGE. Se realizó una revisión retrospectiva entre2000 y 2008 de aquellos pacientes con ALTE a los que se les realizó técnica antirreflujo gastroesofágico. El estudio incluyó la realización de estudio baritado con técnica de sifonaje, pH metría y endoscopia laríngea, digestiva y (..) (AU)

In 1986 the National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring defined the Apparent Life Threatening Events (ALTEs) as those frightening episodes for the observer which are determined by a combination of apnea (centralor obstructive), changes in colour (cianosis, congestive pallor) and marked changes in muscular tone, asphyxia. Despite the fact that its cause still remains unknown, many centres relate ALTE with gastroesophageal reflux disease (GERD) and therefore recommend medical treatment of GERD to those patients with ALTE. However there are very few articles that proof the efficacy of surgical treatment in patients with ALTE and GERD. We carried out a retrospective review between2000 and 2008 of those patients with ALTE who underwent a laparoscopic antirreflux procedure. The study included the realization of contrast x-ray, pHmetry and laryngeal, digestive and bronchial endoscopy. During this period antirreflux (with either Nissen or D’Or technique) procedure was carried out (.. ) (AU)

Testículo no palpable: resultados a corto, medio y largo plazo con la utilización de técnica exclusivamente laparoscópica / Nonpalpable testes: Short, middle and long-term results with the use of an exclusively laparoscopic technique

El testículo no palpable (TNP) tiene una incidencia del 20% y una importancia que deriva de la posibilidad de degeneración, menor función reproductora y endocrinológica. En los últimos años, el desarrollo de la cirugía minimamente invasiva (CMI) ha permitido un mejor diagnóstico y otro arma terapéutica para utilizar en estos casos. Hemos realizado un estudio retrospectivo que incluyó todos aquellos pacientes a los que se les realizó disección, descenso y fijación del teste mediante técnica exclusivamente laparoscópica en el periodo comprendido entre 1998 y 2008. Se revisaron un total de 156 pacientes, lo que ha supuesto la evolución de 179 unidades testiculares (UT). En 65 ocasiones el teste se situó en orificio inguinal interno o región proximal del canal inguinaly en 68 casos el teste presentó una situación intra-abdominal pura. Se (..) (AU)

Non palpable testis (NPT) has an incidence of 20% and clinical relevance derived from the possibility of malignant degeneration, fertility disfunction. Recently the development of minimally invasive surgery(MIS) allowed more accurate diagnosis and has become a new therapeutic tool. We carried out a retrospective study that included all the patients who underwent laparoscopic orchidopexy between 1998 and 2008.156 patients were reviewed, which represent 179 testis units (TU).In 65 occasions the testis was placed in the internal inguinal orifice and in 68 occasions the testis was purely intraabdominal. Testicular atrophy was evidenced in 32 cases (7%). Laparoscopic orchidopexy was (..) (AU)

[Nonpalpable testes: short, middle and long-term results with the use of an exclusively laparoscopic technique]. / Testículo no palpable: resultados a corto, medio y largo plazo con la utilización de técnica exclusivamente laparoscópica.

Non palpable testis (NPT) has an incidence of 20% and clinical relevance derived from the possibility of malignant degeneration, fertility disfunction. Recently the development of minimally invasive surgery (MIS) allowed more accurate diagnosis and has become a new therapeutic tool. We carried out a retrospective study that included all the patients who underwent laparoscopic orchidopexy between 1998 and 2008. 156 patients were reviewed, which represent 179 testis units (TU). In 65 occasions the testis was placed in the internal inguinal orifice and in 68 occasions the testis was purely intraabdominal. Testicular atrophy was evidenced in 32 cases (7%). Laparoscopic orchidopexy was carried out in 152 TUs except in those that developed agenesia or atrophy-. A prothesis was placed after removing the remaining testis. 18 cases required a FowlerStephens. Inmediate postoperative complications were oedema (18 cases) and escrotal hematoma (9 cases). Testicular atrophy appeared in 12 cases after descent and in 3 cases after the first stage of the FowlerStephens. In 8 cases it was necessary to proceed to a second descent because of ascent after surgery. Laparoscopic orchidopexy has proved to be an efficient technique for the management of NPT which unifies the advantages of MIS and the outcomes of the conventional opened approach.

[Results of the use of laparoscopic anti-reflux procedure for the prevention of episodes of apnea, bradycardia and desaturation]. / Resultados de la utilización de antirreflujo laparoscópico para la prevención de los episodios de apnea, bradicardia y desaturación.

In 1986 the National Institutes of Health Consensus Developement Conference on Infantile Apnea and Home Monitoring defined the Apparent Life Threatening Events (ALTEs) as those frightening episodes for the observer which are determined by a combination of apnea (central or obstructive), changes in colour (cianosis, congestive pallor) and marked changes in muscular tone, asphyxia. Despite the fact that its cause still remains unknown, many centres relate ALTE with gastroesophageal reflux disease (GERD) and therefore recommend medical treatment of GERD to those patients with ALTE. However there are very few articles that proof the efficacy of surgical treatment in patients with ALTE and GERD. We carried out a retrospcective review between 2000 and 2008 of those patients with ALTE who underwent a laparoscopic antirreflux procedure. The study included the realization of contrast x-ray, pHmetry and laryngeal, digestive and bronchial endoscopy. During this period antirreflux (with either Nissen or D'Or technique) procedure was carried out by laparoscopic approach in the patients with ALTE and GERD. Median of gestational age was 32 week, mean birth weight was 1800 g, mean age at the time pof surgery was 217 days (range 32-410). All these patients had previously presented 3 or more events of ALTE and had been treated medically for GERD. pHmetric studies were no conclusive, In 6 out of 15 patients had different grades of arithemoid oedema. All the patients presented gastroesophageal reflux (grades II-III) in the constrast x-ray. Mean follow up was 1258 days. 7 from 8 patients presented clear improvement. Morbimortality derived from surgery was null.

[Short term evaluation of transanal pull-through with automatic suture]. / Valoración a corto plazo del descenso transanal con sutura automática.

For the last ten years many centres have adopted transanal pull-through (TP) as the first choice technique for the treatment of Hirschsprung's Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5-months-old to 5-years-old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly, a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place between the fourth and the tenth postoperative day. Oral feeding was started in the 2nd-7th postoperative day. Medium term outcomes show a single case of complications: a patient Developer a skin stricture due to the low suture, which has been treated conservatively with rectal dilatations. Patients older than three (42.8%) are continent, although one presents occasional fecal soiling. The rest of the children present normal stools for their age. Automatic suture involves several advantages such as celerity and safety. We ought to point out that this method should not be used in children under 5 months because the autosuture size does not allow to do so.

Valoración a corto plazo del descenso transanal con sutura automática / Short term evaluation of transanal pull-through with automatic suture

En los últimos 10 años el descenso transanal (DT) se ha popularizado en muchos centros como técnica de elección para el tratamiento de la enfermedad de Hirschsprung (EH). Presentamos nuestra experiencia de DT con autosutura, inédita en la literatura. En nuestro programa de tratamiento de la EH aplicamos el DT para las formas de afectación recto-sigmoidea de fácil manejo ambulatorio. Hemos practicado un estudio retrospectivo de la evolución de 7pacientes con edades comprendidas entre 5 meses y 5 años a los que se les ha realizado un descenso transanal con autosutura en los dos últimos años. Nuestra técnica se desarrolla en dos pasos. En un primer tiempo practicamos una biopsia laparoscópica, en el segundo tiempo se realiza un descenso endorrectal según la técnica de De La Torre, modificado con autosutura circular de 21mm. En ningún caso se han precisado reintervenciones. Nuestros pacientes empezaron a realizar deposiciones entre el 2º y 4º día postoperatorio (DPO). La complicación más frecuente fue distensión abdominal en (..)

For the last ten years many centres have adopted transanal pull-through(TP) as the first choice technique for the treatment of Hirschsprung’s Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5 months old to 5 years old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly,a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place (..) (AU)