RESUMEN
INTRODUCTION: Minimally invasive surgery (i.e., laparoscopy) and minimally invasive anesthesia (i.e., caudal anesthesia with spontaneous respiration) have separately shown benefits for inguinal hernia repair in infants, yet to what degree these techniques can be combined remains unknown. This study investigated whether laparoscopy impacts the feasibility of performing caudal anesthesia with spontaneous respiration in infants. METHODS: Prospectively collected data of all infants less than 12 months old and over 3 kg weight who underwent laparoscopic indirect hernia repair (LAP) at our department from 2019 to 2021 were compared with a historical control-matched group of infants who underwent open repair (OPEN) from 2017 to 2021. We assessed the patients' characteristics, anesthesia, and surgical data as well as intra- and postoperative complications. RESULTS: A total of 87 infants were included (LAP n = 29, OPEN n = 58). Caudal anesthesia with spontaneous respiration was feasible in 62.1% of cases (LAP n = 55.2%, OPEN n = 65.5%; nonsignificant). Neither group registered anesthetic intra- or postoperative complications. Sedatives were utilized in 97% of LAP patients versus 56.9% of OPEN patients (p < 0.00001). The airway was secured with a laryngeal mask in 89.7% of patients during LAP versus 41.4% during OPEN (p < 0.00001). No significant differences were found regarding the use frequency of opioids (48.3% LAP vs. 34.5% OPEN; nonsignificant) or neuromuscular blockers (6.9% LAP vs. 5.2% OPEN; nonsignificant). CONCLUSION: This is the first comparative study on caudal anesthesia and spontaneous respiration in infants undergoing laparoscopic versus open inguinal hernia surgery. Laparoscopy increased the need for ventilatory support and sedatives but did not significantly impair the feasibility of caudal anesthesia and spontaneous respiration.
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Anestesia Caudal , Hernia Inguinal , Laparoscopía , Humanos , Lactante , Hernia Inguinal/cirugía , Laparoscopía/métodos , Complicaciones Posoperatorias/cirugía , Hipnóticos y Sedantes , Herniorrafia/métodos , RespiraciónRESUMEN
BACKGROUND/PURPOSE: The surgical treatment for patients with progressive familial intrahepatic cholestasis (PFIC) is either liver transplantation (LTX) or partial external biliary diversion (PEBD). Both procedures achieve a good short-term outcome. However, the treatment strategy for these children remains controversial because the long-term outcome after PEBD is unknown. The aim of our study was to assess the long-term outcome and complications after PEBD in our institution. METHODS: We retrospectively analyzed the characteristics of all patients with PFIC undergoing PEBD in our department from 1994 to 2008. The course of serum bile acids, pruritus, and liver enzymes was assessed in a regular follow-up. RESULTS: Twenty-four patients underwent PEBD. Thirteen patients (54%) improved significantly, with a normalization of serum bile acids (P < .001 vs postoperatively) and lessened pruritus (P < .05 vs preoperatively) at 12 months after PEBD. None of these patients showed progression of cholestasis during a median follow-up of 9.8 years (range, 1.6-14.3 years). Partial external biliary diversion failed to normalize bile acids in 11 patients, of whom 9 required secondary LTX at a 1-year follow-up, with a median interval of 1.9 years (range, 0.5-3.8 years). All 7 patients (100%) with liver cirrhosis at the time of PEBD and 2 of 17 patients without cirrhosis (12%) required secondary LTX (P < .001). CONCLUSIONS: Clinical improvement with normalization of serum bile acids within 1 year was associated with an excellent long-term outcome in patients with PEBD. The presence of liver cirrhosis at the time of PEBD indicated an unfavorable outcome. Thus, we recommend primary LTX only in PFIC patients with liver cirrhosis.
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Ácidos y Sales Biliares/sangre , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Colestasis Intrahepática/cirugía , Estomía , Adolescente , Biomarcadores/sangre , Niño , Preescolar , Colestasis Intrahepática/sangre , Colestasis Intrahepática/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Lactante , Cirrosis Hepática/etiología , Cirrosis Hepática/cirugía , Trasplante de Hígado , Masculino , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: This prospective study investigated the therapy-induced changes in the quality of life (QoL) experienced by neurologically healthy and neurodevelopmentally delayed children and their parents after laparoscopic anterior 270 degrees fundoplication (LAF). METHODS: In this study, 40 patients (21 impaired) with a mean age of 7.8 years underwent LAF for gastroesophageal reflux disease (GERD) and were evaluated before surgery and then 3 and 6 months afterward using the Gastrointestinal Quality-of-Life Index (GIQLI) supplemented by conventional symptom markers. RESULTS: Growth, proton pump inhibitor use, and frequency of supraesophageal/respiratory symptoms improved significantly (p < 0.001) as did feeding parameters (p < 0.05). The global GIQLI score improved by 49 +/- 21% (p < 0.001). The greatest improvement occurred in the symptoms domain (p < 0.001). However, positive alterations also were found in the dimensions of emotions (58%), social functions (37%) and physical functions (27%) (p < 0.001). Comparison of the overall benefit did not show any differences between the subgroups of neurologically fit and impaired children. However, for the child-centered symptoms domain, the benefit increased stepwise with the degree of impairment. This was counterbalanced by an inverse relationship for the parent-centered emotions domain (p < 0.05). CONCLUSIONS: Besides the known improvement in symptoms, LAF achieves a significant improvement in QoL for children and their parents. There is no overall difference in the benefit experienced by neurologically impaired and healthy children.
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Discapacidades del Desarrollo/complicaciones , Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Enfermedades del Sistema Nervioso/complicaciones , Padres/psicología , Calidad de Vida , Niño , Preescolar , Discapacidades del Desarrollo/psicología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/psicología , Humanos , Lactante , Masculino , Enfermedades del Sistema Nervioso/psicología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The response of mesothelial cells to surgical trauma and bacterial contamination is poorly defined. We have recently shown that CO(2) pneumoperitoneum increases systemic metastasis of neuroblastoma cells in a murine model. Thus, we hypothesized that CO(2) alters the morphology and function of mesothelial cells and facilitates transmesothelial tumor cell migration. MATERIALS AND METHODS: Murine mesothelial cells were exposed to 100% CO(2) and 5% CO(2) as control. Scanning electron microscopy (SEM) investigations, as well as LPS-induced granulocyte-colony stimulating factor (G-CSF) production and mitochondrial activity (MTT assay) were measured. Transmesothelial migration of neuroblastoma cells (Neuro2a) was determined using a transwell chamber system. RESULTS: CO(2) incubation was associated with a significant destruction of the microvillar formation in SEM. Migration studies showed that the barrier function of the mesothelial monolayer decreased. A significantly increased migration of neuroblastoma cells was identified after 100% CO(2) exposure (P < 0.05). Although the conversion of MTT as an indicator of mitochondrial activity was only slightly and not significantly reduced after CO(2) incubation, the release of G-CSF induced by LPS was completely blocked during the incubation with 100% CO(2) (P < 0.05). The capacity of G-CSF release recovered after the incubation. CONCLUSION: We observed that peritoneal mesothelial cells lose their typical cell morphology by CO(2) incubation, which is accompanied by facilitated migration of neuroblastoma cells. Moreover, the synthesis of immunological factors is blocked, but this effect is not long lasting. These mechanisms may explain an increased metastasis rate of neuroblastoma cells after CO(2) pneumoperitoneum, which was recently observed in a murine model.
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Dióxido de Carbono/toxicidad , Movimiento Celular/efectos de los fármacos , Células Epiteliales/ultraestructura , Neuroblastoma/patología , Neoplasias Peritoneales/patología , Animales , Células Cultivadas , Células Epiteliales/efectos de los fármacos , Células Epiteliales/metabolismo , Factor Estimulante de Colonias de Granulocitos/biosíntesis , Ratones , Ratones Endogámicos C57BL , Microscopía Electrónica de Rastreo , Neoplasias Experimentales , Neuroblastoma/metabolismo , Neoplasias Peritoneales/metabolismo , Neumoperitoneo Artificial/efectos adversosRESUMEN
BACKGROUND: Minimally invasive techniques are increasingly used for biopsy and resection of neuroblastoma, but the impact on the behavior of spilled tumor cells is unknown. We aimed to investigate whether CO(2) pneumoperitoneum can affect local or systemic tumor manifestation after spillage of neuroblastoma cells into the peritoneal cavity. METHODS: Murine neuroblastoma cells (Neuro2a, 1x10(6)) were inoculated into the peritoneal cavity of 25 male A/J mice, which subsequently underwent CO(2) pneumoperitoneum (n = 12) or laparotomy (n = 13) for 1 h. At the 28th postoperative day, local (peritoneal and surface of the gut) and systemic (liver, lung, spine) tumor spread was graded in a blinded manner (1-4 point scale) and specimens were histologically examined for tumor manifestation (hematoxylin and eosin stain) and tumor cell proliferation rate (Ki-67-stain). In the case of no visible lesion, five random sections were histologically examined. Peritoneal carcinosis was graded macroscopically. RESULTS: Tumor manifestations were detected in 10 out of 12 (83%) animals after CO(2) pneumoperitoneum, and in 9 out of 13 (69%) after laparotomy (n.s.). Incidence of liver metastasis was higher after CO(2) pneumoperitoneum versus laparotomy (83% versus 31%; p < 0.05). Incidence and grading of peritoneal carcinosis was not significantly different between the groups (n.s.). Intrapulmonary metastasis was found in one mouse of each group, but no metastasis of the spine. However, the grading of liver metastasis was higher after CO(2) pneumoperitoneum compared to laparotomy (p < 0.05). Tumor cell proliferation (Ki-67 stain) in the liver did not differ between both groups. Moreover, proliferation always exceeded 50% of tumor cells, irrespective local or systemic tumor manifestation. CONCLUSIONS: CO(2) pneumoperitoneum increased intrahepatic metastasis, but not local peritoneal carcinosis in a murine neuroblastoma model. This suggests that laparoscopy could promote systemic dissemination of intraperitoneally spilled tumor cells when no chemotherapy is applied. It remains to be determined whether this is due to local immune suppression or direct modulation of tumor cell behavior.
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Laparoscopía/efectos adversos , Siembra Neoplásica , Neuroblastoma/secundario , Neoplasias Peritoneales/cirugía , Neumoperitoneo Artificial/efectos adversos , Animales , Dióxido de Carbono , Línea Celular Tumoral/trasplante , Laparotomía , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/secundario , Masculino , Ratones , Ratones Endogámicos A , Trasplante de Neoplasias , Neuroblastoma/patología , Neuroblastoma/cirugía , Neoplasias Peritoneales/etiología , Neoplasias Peritoneales/secundario , Reproducibilidad de los Resultados , Método Simple CiegoRESUMEN
The etiology of gastroschisis is still unclear. To the authors' knowledge, there are only 14 cases of familial gastroschisis in the literature. The authors add the second case of mother-and-son occurrence and a case of siblings occurrence, thereby updating the current literature for family gastroschisis.