Mid- to long-term outcomes of the 'anatomical approach' to congenital megaprepuce repair.

INTRODUCTION: The understanding of the aetiopathogenesis and the long-term outcomes of correctional repair of congenital megaprepuce (CMP) remains unestablished. Different techniques have been described; however, optimum results have been difficult to achieve. OBJECTIVE: The aim of our study was to review our experience of the 'anatomical approach' to the correction of CMP. MATERIAL AND METHODS: This is a retrospective review of boys who underwent CMP repair between 2003 and 2014. All of them had the anatomical approach: A curved incision is made between the scrotal and penile skin. Circumferential dissection superficial to Buck's fascia frees the penis and allows the scrotum to assume a more caudal position. The dissection distally lifts the preputial sac that is opened ventrally. The redundant inner preputial skin is excised. After full degloving, the dorsal flap of skin is thinned. The base of the flap is anchored, and the rectangle of skin is wrapped around the shaft. The remaining diamond-shaped incision is closed in a vertical line. Postoperatively, foam dressings and urethral catheter are left in place. Symptomatology, hospital stay, postoperative complications, redosurgery, voiding and cosmesis were evaluated. RESULTS: Sixty-one patients had surgery at 5-151 months (median 17 months). Median hospital stay was 24 h (12-168 h). Foam dressings and urethral catheter were used in 47 boys and removed in outpatient clinic after 3-7 days. There were two immediate postoperative complications requiring surgery. One due to severe oedema and constriction ring, and the other had wound infection with wound breakdown, both in patients with no dressings (P < 0.05). Follow-up was available for 58 patients, with a median of 22 months (3-79 months). Two required redosurgery (3.5%), one with poor cosmetic result and one recurrence. In all patients, a normal circumcised appearance had been achieved and in 47, cosmetic result was excellent (81%). Five patients have residual suprapubic fat, and four, excess ventral skin. One with residual suprapubic fat has reached puberty and it has resolved. All declared good stream. The same technique was used for six patients with poor cosmetic result after surgery elsewhere. The outcome is excellent for all, with median follow-up of 20.5 months (5-31 months). CONCLUSION: The 'anatomical' repair provides the ability to create the appearance of a standard circumcision, which is generally accepted as normality. Apart from the penis itself, this technique facilitates correction of the penoscrotal transposition, giving the external genitalia the best appearance. It seems to provide good functional and cosmetic outcomes, and it holds true at mid- to long-term follow-up. Dressings and catheter can potentially prevent postoperative complications. However, a prospective study with standardised parameters is required to confirm these findings.

[Achalasia in children and adolescents, a therapeutic challenge]. / La acalasia en la infancia y la adolescencia, un reto terapéutico.

INTRODUCTION: Treatment of achalasia in children is in permanent discussion. It is a rare disorder without cure, which makes its management challenging. METHODS: Retrospective review of patients under 18 years old treated for achalasia in our Hospital between 2000 and 2012, by either pneumatic dilatation (PD) or Heller myotomy (HM). RESULTS: Thirteen children were treated during this time. Mean age was 12 years (4-18), interval time between the onset of symptoms and diagnosis was 15 months (2-48) and mean follow-up was 66,8 months (4-144). Dysphagia and vomits were the main symptoms (61%). A single PD was performed in 5 patients; four were the oldest children of the series (16-18). Three girls remain asymptomatic and 2 boys suffer from moderate dysphagia. Six patients required multiple PD and, after a mean of 3 dilatations, HM was needed in all of them. The last 2 children of the series received surgery as the first treatment. In total, eight patients underwent HM and fundoplication, with 6 laparoscopic procedures. Two boys suffer from low-moderate dysphagia, but additional treatments have not been required. The mean of total hospital stay was 12,7 days (2-45) for PD and 9 days (3-30) for HM. Two patients were reoperated because of oesophagic perforation, one after PD and one after open HM. CONCLUSION: Although PD and HM could be complementary, laparoscopic Heller myotomy should be considered the first therapeutic option, specially in young boys.

[Ovarian torsion. long-term follow-up of the black-bluish ovary after laparoscopic detorsion]. / Torsión ovárica. Evolución del ovario necrótico tras detorsión laparoscópica.

INTRODUCTION: Ovarian torsion presents low incidence in children and unspecific clinical presentation, therefore the diagnostic delay is rather common. Traditionally, necrotic appearance has been synonymous of oophorectomy, however the current trend defends ovary preservation. We present our experience in conservative management of ovarian torsion. METHODS: A retrospective review was made of patients between May 2010 and May 2013. Seven girls were operated by laparoscopy because of ultrasound and clinical suspicion of ovarian torsion. The diagnosis was confirmed in six patients, finding an enlarged, friable and black-bluish ovary. Detorsion and adnexal sparing were performed in all cases, despite the gross appearance. RESULTS: The mean age was 8.5 years (3-12), the time interval between the onset of symptoms to surgery was 6.5 days (1-15) and postoperative stay was 2.6 days (2-3). In 4 cases the damaged ovary was right, and the average size was 5.8 cm. Tumor markers were normal. During the first 6 months the follow-up ultrasound showed good results. However, the long-term outcome evidenced one involved ovary atrophied and two oophorectomies due to recurrent adnexal torsion and ovarian mass consistent with teratoma. CONCLUSIONS: Laparoscopic conservative management with untwisting the ovary, allows that macroscopically nonviable ovaries could be recovered. However, an exhaustive and long-term follow-up is required to confirm the outcome.

Afalia: diagnóstico inesperado en un recién nacido con retraso de crecimiento intrauterino / Aphallia: striking diagnosis in intrauterine growth retardation

La afalia es una es una anomalía extremadamente rara, cuya incidencia es de 1 por cada 30 millones de recién nacidos vivos. Hasta la actualidad se han descrito menos de 100 casos en la literatura médica. Se describe un caso de afalia asociado a cardiopatía congénita de diagnóstico posnatal en un recién nacido con retraso del crecimiento intrauterino, sin otro hallazgo prenatal. Se decidió una reasignación de sexo masculino. En el estudio cromosómico se determinó un cariotipo 46XY. No se describieron otras anomalías asociadas (AU)

Aphallia is a really uncommon anomaly occurring in 1 per 30 million births. At this time, less than 100 cases have been reported worldwide. Herein, we describe a case of aphallia associated with congenital heart disease in a fetus with intrauterine growth retardation. No other congenital anomalies were detected. Karyotype was 46XY. Gender assignment has been to male (AU)

[Implementation of "fast-track" treatment in paediatric complicated appendicitis]. / Aplicación de un modelo terapéuticofast-track en la apendicitis aguda complicada del paciente pediátrico.

OBJECTIVE: Acute appendicitis is the most common emergency surgical pathology in childhood and there is no consensus on its management. Fast-track treatment, based on optimizing perioperative care has reduced morbidity and mortality of surgical pathologies, including simple acute appendicitis. The aim of our study was to assess the effects of a fast-track protocol in complicated acute appendicitis. METHODS: Ambispective cohort study. Historical unexposed cohort: children with complicated appendicitis and appendectomy in our hospital during 2008-2009. Exposed cohort: children operated in 2010-2011 and who performed protocol. The protocol treatment was done after a literature review, adapting the principles of fast-track to a potentially severe urgent disease: early mobilization, limited drainage-tubes and short antibiotic regimens Taking hospital stay as the resulting variable, the calculated sample size for alpha = 0.05 and power = 90% was 54, being X1 = 7 +/- 3DS and X2=5. RESULTS: We included 151 patients, historical cohort 81 and current cohort 70, which excluded 31 children who did not meet protocol because of surgeon choice. Both groups showed homogeneity due to the absence of differences in sex, age, weight, type of appendicitis (gangrenous, perforated, generalized peritonitis) or surgical approach. The average stay decreased 2.71 days (p <0.001) due to the protocol, without any complication increase (abscess, postoperative ileus, readmission). CONCLUSIONS: Complicated appendicitis in children is common and potentially serious, and optimization of treatment should be a primary goal of our practice. Application of a fast-track protocol can provide clinical and economic benefits, although this requires an appropriate multidisciplinary management.

[Testicular cancer and cryptorchidism: myth or reality]. / Cáncer testicular y criptorquidia. Mito o realidad.

OBJECTIVE: To evaluate the previous history of cryptorchidism in patients with testicular cancer. MATERIALS AND METHODS: We carried out a study using 175 patients diagnosed with testicular cancer, in our hospital, from 1999 to 2010. We analyzed the previous history of cryptorchidism and its characteristics, testicular placing, histology and intervention age. RESULTS: 5 out of the 175 patients (2,8%) with testicular neoplasm presented a history of cryptorchidism, The average age was 31 years old, an orchidopexy was only carried out in 2 patients. The histology was different depending on the treatment chosen to battle cryptorchidism and in 2 cases it developed in the adjoining testicle. The average ratio was of 1,9. CONCLUSIONS: Our results reflect that the association of cryptorchidism with testicular neoplasm is in fact lower than in the past. A good and proper handling of cryptorchidism can prevent it from turning malignant, presenting these patients similar incidences to the rest of the population.

[Appendectomy and Crohn's disease]. / Apendicectomía y enfermedad de Crohn.

UNLABELLED: We analyzed the relationship between Crohn's disease and appendectomy in paediatric age. METHOD AND MATERIAL: We studied the patients diagnosed with Crohn's disease and appendectomy (under 20) between 1999 and 2011. We retrieved their previous medical histories and carried out an histological re evaluation of those appendix. RESULTS: 11 patients out of 137 (8,02%) had an appendectomy before the development of Crohn's disease. An average age in which the appendectomy took place and the development of Crohn's disease was diagnosed 14 (5-20 years), having 90% of the patients diagnosed in the early post-surgical stages. A patient did not develop any symptoms until a year later. There were no more appendectomies carried out in comparison with the adult population. The initial anatomopathologic diagnosis and the histological re evaluation agreed in just one case, compatible with Crohn's disease. CONCLUSION: The majority of appendectomies carried out in paediatric patients that later develop Crohn's disease are realized by a bias diagnosis of acute appendicitis and the relation between the two of them can be explained as the not yet developed Crohn's disease at the moment of the appendectomy. Appendectomies at a paediatric age are not associated with a potential development of Crohn's disease. There is no evidence of histological changes compatible with Crohn's disease in the first episode.

[Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele]. / Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele.

OBJECTIVES: Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. PATIENTS AND METHODS: Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. RESULTS: From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. CONCLUSIONS: Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication.

Focal nodular hyperplasia on accessory lobe of the liver: preoperative diagnosis and management.

We report the case of a 13 year-old girl transferred to our department with a one month history of vomiting, weight loss, and abdominal mass that was diagnosed as Focal Nodular Hyperplasia in an accessory lobe of the liver. Accessory liver lobe is a rare congenital anomaly whose preoperative diagnosis is difficult and usually presents as an incidental finding intraoperatively. Depending on their location and size, they can present as acute abdomen or abdominopelvic mass. In the literature reviewed, we found no association of focal nodular hyperplasia and accessory liver lobe in children.

Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele / Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele

Objetivos. El objetivo del presente estudio es examinar los resultados en el tratamiento del varicocele en nuestro hospital durante los últimos 10 años, valorando la de tasa de recurrencia y de hidrocele reactivo en los niños y adolescentes tratados mediante cirugía abierta, embolización o varicocelectomía laparoscópica. Pacientes y métodos. Se revisaron las historias clínicas de los pacientes menores de 17 años intervenidos de varicocelectomía. Las variables recogidas fueron peso, edad, localización, grado de varicocele, indicación de cirugía, tratamiento, estancia hospitalaria, recurrencia, hidrocele postoperatorio, lesión de nervio genitofemoral, infección, sangrado, hernia incisional y necesidad de nueva varicocelectomía. Resultados. 98 pacientes con diagnóstico de varicocele fueron tratados en nuestra institución entre los años 2000 a 2010. La edad media fue de 12 años. Todos los casos fueron de localización izquierda. 94 pacientes tenían varicocele grado III y 4 varicocele grado II. Las indicaciones de cirugía fueron varicocele de alto grado (grado III) en 81 pacientes, dolor crónico en 16 e hipotrofia testicular en 1. Se realizó cirugía abierta en 12 pacientes, embolización en 32 casos y varicocelectomía laparoscópica en 54 pacientes. La tasa global de recurrencia fue de 14,3% y el porcentaje de hidrocele reactivo fue del 24,5% La tasa de recurrencia fue mayor en el grupo tratado con embolización, que en el de cirugía abierta y en el de laparoscopia. En el grupo de tratamiento laparoscópico, tres pacientes presentaron sangrado postquirúrgico y hubo una conversión a cirugía abierta. Conclusiones. Nuestra revisión retrospectiva indica que la varicocelectomía laparoscópica es un tratamiento seguro y eficaz en el manejo del varicocele en los (..) (AU)

Objectives. Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. Patients and Methods. Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. Results. From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. Conclusions. Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication (AU)

Colecistectomía transumbilical mediante técnica híbrida: un nuevo abordaje prometedor / Transumbilical cholecystectomy using hybrid technique: A new promising approach

Objetivos. La utilización de imanes en la colecistectomía transumbilical mejora la triangulación y logra una visión crítica óptima. No obstante, la atracción entre los imanes puede provocar colisiones y su manejo dificulta el proceso, siendo este hecho más relevante en pediatría. Con el objetivo de simplificar la técnica y disminuir la curvad e aprendizaje, hemos elaborado un modelo híbrido con un solo imán. Material y métodos. Revisión retrospectiva de las colecistectomías realizadas en nuestro servicio entre junio 2011 y julio 2012. La técnica combina el uso de un imán y una pinza curva. A través de la incisión transumbilical, colocamos un trocar de 12 mm y otro flexible de 5 mm. Por el primero introducimos el imán encargado de traccionar del fundusvesicular y el laparoscopio con canal de trabajo. El trocar flexible se usa para la pinza curva, manejada por el ayudante para movilizar el infundíbulo. El cirujano opera por el canal de trabajo del laparoscopio. Resultados. Veintiséis pacientes fueron intervenidos con esta técnica. La edad media fue 14 años (4-17) y el peso 50 kg (18-90), siendo el 65% niñas. El tiempo operatorio medio fue 62 minutos (50-70) y la visión crítica de seguridad se logró en todos los casos. No hubo entrecruzamientos de las pinzas ni de las manos de los cirujanos. No existieron complicaciones intraoperatorias ni postoperatorias. La estancia hospitalaria fue 1,4 ± 0,6 días y la mediana de seguimiento 201 días (42-429).Conclusiones. La técnica hibrida, combinando imán y pinza curva, simplifica la cirugía transumbilical. Parece una alternativa factible y segura para la colecistectomía transumbilical y potencialmente reproducible (AU)

Objectives. The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, theattraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. Material and methods. Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved (..) (AU)

[Evaluation of quality of life in patients operated on for gastroesophageal reflux in the pediatric age]. / Valoración de la calidad de vida en los pacientes intervenidos por reflujo gastroesofágico en la edad pediátrica.

AIM: To assess the quality of life and symptoms of GER patients who underwent laparoscopy in our hospital before and after surgery. MATERIAL AND METHODS: We collect data from patients operated laparoscopically for gastroesophageal reflux disease (GER) in our center before and after surgery in 3 items: nutritional studies, diagnostic methods, interviews with the families of patients about symptoms (preferably differing in digestive or respiratory symptoms) and quality of life; also, determined the age, gender, personal history and surgical technique of patients. RESULTS: 30 patients have been operated for GER, 22 men and 8 women, 11 months to 14 years (median age 5 years) of whom 12 (40%) had some degree of encephalopathy. The most common surgical technique used is Nissen (73% cases). Most patients had significant alterations in their daily activities before surgery. The most common symptom was gastrointestinal (70% cases), although all showed improvement, families of children with respiratory symptoms related predominantly greater reduction in the clinic after surgical correction. All improved in its growth curve. CONCLUSIONS: Surgery for GER patients have a significant improvement in their quality of life, not only by the reduction of their symptoms but also in enhancing from the nutritional status. Patients with respiratory symptoms have a higher satisfaction with surgical treatment than those with gastrointestinal clinical.

Pieloplastia sin drenaje intrarrenal en pacientes pediátricos / Pyeloplasty Without Intrarenal Stent in Pediatric Patients

Objetivos: A pesar del avance de cirugías mínimamente invasivas, la pieloplastia desmembrada a cielo abierto sigue siendo una cirugía muy utilizada en Pediatría, especialmente en niños pequeños. El propósito de este trabajo es presentar nuestra experiencia en la realización de esta técnica a través de una mínima incisión y sin dejar catéteres intrarrenales transanastomóticos. Materiales y métodos: Revisión retrospectiva desde julio de 1992 a julio de 2009, tiempo en el que 348 pacientes fueron operados de pieloplastia desmembrada a cielo abierto. Un total de310 pacientes (89%), 223 niños y 87 niñas, fueron intervenidos sin dejar catéter intrarrenal. La incisión fue de 2 a 2,5 cm en flanco. En todos los pacientes se dejó drenaje perirrenal y sonda vesical, esta última las primeras 24 h. Resultados: En total se realizaron 319 pieloplastias sin catéteres intrarrenales, 174 (54,5%) del lado izquierdo, 127 (39,8%) del lado derecho y 9 (5,6%) bilaterales. El intervalo de edad fue de14 días a 18 años, siendo el 58% de los niños menor de 12 meses. Con un seguimiento medio de 6,7 años (17 años a 11 meses), 312 pieloplastias (97,8%) fueron realizadas con éxito, con persistencia del patrón obstructivo en 7 pacientes que precisaron una nueva pieloplastia a cielo abierto (2,2%). Otras complicaciones fueron: drenaje prolongado (6), infección de herida (1) y fiebre/infección urinaria (2). La estancia media fue de 22 h. Conclusiones: La pieloplastia desmembrada a cielo abierto es altamente efectiva en el tratamiento de la estenosis pieloureteral en niños, y prescindir de los catéteres intrarrenales no perjudica su éxito (AU)

Purpose: In spite of advances in minimally invasive endoscopic surgery, open dismembered pyeloplasty continues to be used in many pediatric centers, especially in small children. The purpose of this work is to present our experience in the performance of this technique using a minimally invasive open pyeloplasty without intrarenal stents. Material and methods: A retrospective review was made of patients between July 1992 and July 2009. During this time, 348 patients underwent open dismembered pyeloplasty. A total of 310 patients (89%), 223 boys and 87 girls, underwent open pyeloplasty without intrarenal stent. The incision was from 2 to 2.5 cm in the flank. An extrarenal drain (3-5 days) and a bladder catheter (< 24 hs) were placed in all patients. Results: A total of 319 pyeloplasties were performed without intrarenal catheter in our Service. Of these, 174 (54.5%) were on the left side, 127 (39.8%) on the right side and 9 (5.6%) were bilateral. Age interval was 14 days to 18 years, 58% of the children being younger than 12months at the time of surgery. With a mean follow-up of 6.7 years (17 years to 11 months), 312pyeloplasties (97.8%) were successful, with persistence of the obstructive patient in 7 patients who required a new open pyeloplasty (2.2%). Other complications were: prolonged drainage (6), wound infection (1), and urinary infection (2). Mean stay was 22 hours. Conclusions: Open dismembered pyeloplasty is a safe and effective treatment choice for pyeloureteral stenosis in children and can be done without intrarenal stents with no detriment to its success (AU)

[Pyeloplasty without intrarenal stent in pediatric patients]. / Pieloplastia sin drenaje intrarrenal en pacientes pediátricos.

PURPOSE: In spite of advances in minimally invasive endoscopic surgery, open dismembered pyeloplasty continues to be used in many pediatric centers, especially in small children. The purpose of this work is to present our experience in the performance of this technique using a minimally invasive open pyeloplasty without intrarenal stents. MATERIAL AND METHODS: A retrospective review was made of patients between July 1992 and July 2009. During this time, 348 patients underwent open dismembered pyeloplasty. A total of 310 patients (89%), 223 boys and 87 girls, underwent open pyeloplasty without intrarenal stent. The incision was from 2 to 2.5 cm in the flank. An extrarenal drain (3-5 days) and a bladder catheter (< 24 hs) were placed in all patients. RESULTS: A total of 319 pyeloplasties were performed without intrarenal catheter in our Service. Of these, 174 (54.5%) were on the left side, 127 (39.8%) on the right side and 9 (5.6%) were bilateral. Age interval was 14 days to 18 years, 58% of the children being younger than 12 months at the time of surgery. With a mean follow-up of 6.7 years (17 years to 11 months), 312 pyeloplasties (97.8%) were successful, with persistence of the obstructive patient in 7 patients who required a new open pyeloplasty (2.2%). Other complications were: prolonged drainage (6), wound infection (1), and urinary infection (2). Mean stay was 22 hours. CONCLUSIONS: Open dismembered pyeloplasty is a safe and effective treatment choice for pyeloureteral stenosis in children and can be done without intrarenal stents with no detriment to its success.

[Transumbilical cholecystectomy using hybrid technique: a new promising approach]. / Colecistectomia transumbilical mediante técnica híbrida: un nuevo abordaje prometedor.

OBJECTIVES: The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, the attraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. MATERIAL AND METHODS: Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved grasper. Through transumbilical incision, a 12 mm trocar and another flexible 5 mm are placed. Laparoscope with working channel uses the 12 mm trocar. The magnet is introduced to the abdominal cavity using the working channel to provide cephalad retraction of gallbladder fundus. Curved grasper is run by the assistant to mobilize the infundibulum across flexible trocar. The surgeon operates through the working channel of the laparoscope. RESULTS: Twenty-six patients were operated on with this technique. Mean age was 14 years (4-17) and weight 50 kg (18-90). 65% were girls. The mean operative time was 62 minutes (50-70) and the critical view of safety was achieved in all cases. Instrumental collision or hands crossing were not seen. There were no intraoperative or postoperative complications. The hospital stay was 1.4 +/- 0.6 days and the median follow-up 201 days (42-429). CONCLUSIONS: The hybrid technique, combining magnet and a curved grasper, simplifies transumbilical surgery. It seems a feasible and safe for transumbilical cholecystectomy and potentially reproducible.

[Congenital solitary infantile myofibroma: report of two cases]. / Miofibroma infantil solitario congénito. Presentación de dos casos.

UNLABELLED: The infantile myofibromatosis is a rare pathology usually affecting children under 2 years. More than half are congenital, located in head and neck in a 30% of the cases. Myofibroma is a benign mesenchymal tumor that appear an isolated lesion or multiple, with or without visceral involvement. Case 1: A newborn girl that presents lump in scalp suspected of encefalocele. Ultrasound and RM: solid and heterogeneous mass 4 x 2 cm with increased peripheral vascularisation. Case 2: A 7-month-old baby boy with lump in right occipital zone detected at 4 months. Ultrasound and RM: injury 1 x 1.5 cm in head esplenio muscle suggestive of hemangioma. RESULTS: After surgical total resection, the histological study and immunohistochemical identified the lesion as myofibroma. The evaluation of disease dissemination was normal and the recovery of the patients was favorable. The differential diagnosis of myofibroma must be carried out with other mesenchymal tumors and with non neoplastic injuries characteristics of the region affects. The visceral location and multiple forms worsen the prognosis, so is important do an exhaustive study. Treatment is conservative surgery, but if there is no risk to the child, the possibility of spontaneous regression makes the abstention therapeutic a correct alternative.

Evidence that temporary complete occlusion of splenic vessels prevents massive embolization and sudden death associated with intrasplenic hepatocellular transplantation.

It has been reported elsewhere that liver cell suspensions injected at several locations retain some proper hepatic functions, significantly improve the survival rate of rats with different models of acute fulminant hepatic injury, correct some congenital enzyme deficiency diseases, and improve liver function in cirrhotic animals. Among several locations, the splenic parenchyma has been shown to be the most suitable place for hepatocellular transplantation. Unfortunately, infusion of cells into the splenic pulp is not without risk. In fact, portal hypertension and hepatic embolizations have been described after intrasplenic transplantation of hepatocytes or pancreatic islets or fragments. In addition, pulmonary hepatocyte embolizations have been observed in rats with spontaneous (unpublished observations) or surgically induced portosystemic shunts. In this work, we evaluate the efficacy of temporary occlusion of splenic vessels to prevent hepatic and pulmonary embolizations after liver cell transplantation into the spleen in portal hypertension cirrhotic rats with portosystemic shunts.