Profissional de saúde: segunda vítima da pandemia COVID-19 / Health professional: second victim of the COVID-19 pandemic

Objetivo: Descrever a tradução para a língua portuguesa de site espanhol sobre Covid-19. Método: Relato de experiência sobre projeto de extensão que incluiu a tradução e postagem do site Segundas Victimas del Convid-19, em abril de 2020, por quatro integrantes do Departamento de Administração da Escola Paulista de Enfermagem, e um colaborador independente com conhecimento da língua espanhola, em trabalho remoto. Resultados: São listados 10 Necessidades e excertos dos 19 Recursos correspondentes para sua mitigação. O conteúdo completo, incluído os infográficos está disponível em https://sp.unifesp.br/epe/dasse/projeto-de-extensao. Conclusão: Compartilhar informações de outros países e instituições que passam ou passaram pela pandemia traz agilidade no auxílio aos profissionais de saúde que vivenciam experiências equivalentes. (AU)

Objective: To describe the translation into Portuguese of the Spanish website about Covid-19. Method: Experience report on an extension project that included the translation and posting of the website Segundas Victimas del Convid-19, in April 2020, by four members of the Administration Department at Escola Paulista de Enfermagem, and an independent employee with knowledge of the language Spanish, in remote work. Results: 10 Needs and excerpts from the 19 corresponding resources are listed for their mitigation. The complete content, including the infographics, is available at https://sp.unifesp.br/epe/dasse/projeto-de-extensao. Conclusion: Sharing information from other countries and institutions that are going through or have been through the pandemic brings agility in helping health professionals who have equivalent experiences. (AU)

Objetivo: Describir la traducción al portugués del sitio web en español sobre Covid-19. Método: Informe de experiencia sobre un proyecto de extensión que incluyó la traducción y publicación del sitio web Segundas Victimas del Convid-19, en abril de 2020, por cuatro miembros del Departamento de Administración de la Escuela Paulista de Enfermagem y un empleado independiente con conocimiento del idioma. Español, en trabajo remoto. Resultados: 10 necesidades y extractos de los 19 recursos correspondientes se enumeran para su mitigación. El contenido completo, incluidas las infografías, está disponible en https://sp.unifesp.br/epe/dasse/projeto-de-extensao. Conclusión: Compartir información de otros países e instituciones que están pasando o han pasado por la pandemia brinda agilidad para ayudar a los profesionales de la salud que tienen experiencias equivalentes. (AU)

Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile

ABSTRACT Objective: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). Subjects and methods: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. Results: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. Conclusions: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.

Uso excepcional da veia epigátrica inferior na anestesia de lactente com acesso venoso impraticável / Exceptional use of inferior epigastric veins in infant anesthesia with impractical venous access / Uso excepcional de la vena epigástrica inferior en la anestesia de lactante con acceso venoso impracticable

Objetivo: Relatar uma condição excepcional de aceso venoso para anestesia por meio da canulação, no campo cirúrgico, da veia epigástrica inferior. Método: Relato de experiência ocorrida em hospital materno-infantil do município de Guarulhos, em São Paulo. Resultado: Relata-se o caso de um paciente de oito meses, submetido ao procedimento de correção de hérnia inguinal esquerda após episódios de encarceramento de difícil redução. Após monitoração de rotina e indução anestésica inalatória, não se conseguiu acesso venoso, mesmo com inúmeras tentativas realizadas por vários profissionais presentes decorrente do excesso de panículo adiposo. Realizado acesso venoso no campo cirúrgico por dissecção e cateterismo com Jelco® da veia epigástrica inferior. Conclusão: Em casos especiais, a veia epigástrica inferior é um vaso passível de cateterização para infusões venosas. É um procedimento de exceção que requer avaliação das condições da criança, preparo para o procedimento e monitorização constante, por todos os profissionais envolvidos na assistência, no período perioperatório.

Objective: To report an exceptional venous access situation for anesthesia by cannulation (at the surgical site) of the inferior epigastric vein. Method: This article reports on the experience obtained in a maternal and children hospital in the city of Guarulhos, São Paulo. Result: We report the case of an eight-month patient who underwent left inguinal hernia repair after incarceration episodes of difficult reduction. After routine monitoring and inhalational anesthetic induction, we obtained no venous access due to excessive adipose panicle, even with numerous attempts by several professionals. Venous access was obtained at the surgical site by dissection and catheterization of the inferior epigastric vein with a Jelco• catheter. Conclusion: In special cases, the inferior epigastric vein is a possible catheterization vessel for venous infusions. It is an exception procedure that requires evaluation of the child's condition, preparation for the procedure and constant monitoring by all professionals involved in the care during the perioperative period.

Objetivo: Relatar una condición excepcional de acceso venoso para anestesia por medio de la canulación, en el campo quirúrgico, de la vena epigástrica inferior. Método: Relato de experiencia ocurrida en hospital materno-infantil del municipio de Guarulhos, en São Paulo. Resultado: Se relata el caso de un paciente de ocho meses, sometido al procedimiento de corrección de hernia inguinal izquierda tras episodios de encarcelamiento de difícil reducción. Tras monitoreo de rutina e inducción anestésica inhalatoria, no se consiguió acceso venoso, mismo con innumerables tentativas realizadas por varios profesionales presentes decurrente del exceso de panículo adiposo. Realizado acceso venoso en el campo quirúrgico por disección y cateterismo con Jelco• de la vena epigástrica inferior. Conclusión: En casos especiales, la vena epigástrica inferior es un vaso pasible de cateterización para infusiones venosas. Es un procedimiento de excepción que requiere evaluación de las condiciones del niño, preparo para el procedimiento y monitorización constante, por todos los profesionales involucrados en la asistencia, en el período perioperatorio.

Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile.

OBJECTIVE: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). SUBJECTS AND METHODS: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. RESULTS: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. CONCLUSIONS: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.

Caregivers' reactions to preoperative procedures in outpatient pediatric surgery.

OBJECTIVE:: To identify pediatric caregivers' reactions in outpatient surgery settings. METHODS:: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. RESULTS:: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. CONCLUSION:: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels. OBJETIVO:: Identificar as reações dos acompanhantes de crianças submetidas à cirurgia ambulatorial. MÉTODOS:: Estudo survey descritivo/ exploratório, de caráter quantitativo, realizado em dois hospitais com 62 acompanhantes que responderam um questionário semiestruturado. RESULTADOS:: Constatou-se que a maioria dos acompanhantes era formada por mães (88,7%) e permaneceu em jejum junto das crianças. Todos os acompanhantes referiram sentimentos identificados como nervosismo, ansiedade e preocupação. CONCLUSÃO:: A orientação médica aos procedimentos pré-operatórios foi de grande importância, não somente para o cuidado da criança, mas também do acompanhante, visando diminuir ao máximo o estresse vivenciado por eles.

Caregivers' reactions to preoperative procedures in outpatient pediatric surgery / Reações do acompanhante diante dos procedimentos pré-operatórios em cirurgia pediátrica ambulatorial

ABSTRACT Objective: To identify pediatric caregivers' reactions in outpatient surgery settings. Methods: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. Results: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. Conclusion: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels.

RESUMO Objetivo: Identificar as reações dos acompanhantes de crianças submetidas à cirurgia ambulatorial. Métodos: Estudo survey descritivo/ exploratório, de caráter quantitativo, realizado em dois hospitais com 62 acompanhantes que responderam um questionário semiestruturado. Resultados: Constatou-se que a maioria dos acompanhantes era formada por mães (88,7%) e permaneceu em jejum junto das crianças. Todos os acompanhantes referiram sentimentos identificados como nervosismo, ansiedade e preocupação. Conclusão: A orientação médica aos procedimentos pré-operatórios foi de grande importância, não somente para o cuidado da criança, mas também do acompanhante, visando diminuir ao máximo o estresse vivenciado por eles.

Living donor liver transplantation in children: should the adult donor be operated on by an adult or pediatric surgeon? Experience of a single pediatric center.

BACKGROUND/PURPOSE: Living donor liver transplantation has become a cornerstone for the treatment of children with end-stage hepatic dysfunction, especially within populations or countries with low rates of organ utilization from deceased donors. The objective is to report our experience with 185 living donors operated on by a team pediatric surgeons in a tertiary center for pediatric liver transplantation. METHODS: Retrospective analysis of medical records of donors of hepatic grafts for transplant undergoing surgery between June 1998 and March 2013. RESULTS: Over the last 14 years, 185 liver transplants were performed in pediatric recipients of grafts from living donors. Among the donors, 166 left lateral segments (89.7%), 18 left lobes without the caudate lobe (9.7%) and 1 right lobe (0.5%) were harvested. The donor age ranged from 16 to 53 years, and the weight ranged from 47 to 106 kg. In 10 donors, an additional graft of the donor inferior mesenteric vein was harvested to substitute for a hypoplastic recipient portal vein. The transfusion of blood products was required in 15 donors (8.1%). The mean hospital stay was 5 days. No deaths occurred, but complications were identified in 23 patients (12.4%): 9 patients experienced abdominal pain and severe gastrointestinal symptoms and 3 patients required reoperations. Eight donors presented with minor bile leaks that were treated conservatively, and 3 patients developed extra-peritoneal infections (1 wound collection, 1 phlebitis and 1 pneumonia). Eight grafts (4.3%) showed primary dysfunction resulting in recipient death (3 cases of fulminant hepatitis, 1 patient with metabolic disease, 1 patient with Alagille syndrome and 3 cases of biliary atresia in infants under 1 year old). There was no relation between donor complications and primary graft dysfunction (P=0.6). CONCLUSIONS: Living donor transplantation is safe for the donor and presents a low morbidity. The donor surgery may be performed by a team of trained pediatric surgeons.

Intestinal fistula after magnets ingestion.

Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. The case of an 18-month girl who developed an intestinal fistula after ingestion of two magnets is reported.

Fístula intestinal após ingestão de magnetos / Intestinal fistula after magnets ingestion

Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. The case of an 18-month girl who developed an intestinal fistula after ingestion of two magnets is reported.

A ingestão acidental de corpo estranho magnético tem sido mais observada, devido à disponibilidade cada vez maior de brinquedos e objetos com imãs. A maioria deles é eliminada pelo trato digestivo espontaneamente. Porém, a ingestão de duas ou mais peças podem desencadear situações de resolução cirúrgica. Relatamos aqui o caso de uma menina de 18 meses que desenvolveu fístula intestinal após a ingestão de 2 peças imantadas.

Conjoined twins: twenty years' experience at a reference center in Brazil.

OBJECTIVE: This study reports on the experience of one hospital regarding the surgical aspects, anatomic investigation and outcomes of the management of 21 conjoined twin pairs over the past 20 years. METHODS: All cases of conjoined twins who were treated during this period were reviewed. A careful imaging evaluation was performed to detail the abdominal anatomy (particularly the liver), inferior vena cava, spleen and pancreas, either to identify the number of organs or to evaluate the degree of organ sharing. RESULTS: There were eight sets of ischiopagus twins, seven sets of thoracopagus twins, three sets of omphalopagus twins, two sets of thoraco-omphalo-ischiopagus twins and one set of craniopagus twins. Nine pairs of conjoined twins could not be separated due to the complexity of the organs (mainly the liver and heart) that were shared by both twins; these pairs included one set of ischiopagus twins, six sets of thoracopagus twins and one set of thoraco-omphalo-ischiopagus twins. Twelve sets were separated, including seven sets of ischiopagus twins, three sets of omphalopagus twins, one set of thoracopagus twins and one set of craniopagus conjoined twins. The abdominal wall was closed in the majority of patients with the use of mesh instead of the earlier method of using tissue expanders. The surgical survival rate was 66.7%, and one pair of twins who did not undergo separation is currently alive. CONCLUSION: A detailed anatomic study of the twins and surgical planning must precede separation. A well-prepared pediatric surgery team is sufficient to surgically manage conjoined twins.

Conjoined twins: twenty years' experience at a reference center in Brazil

OBJECTIVE: This study reports on the experience of one hospital regarding the surgical aspects, anatomic investigation and outcomes of the management of 21 conjoined twin pairs over the past 20 years. METHODS: All cases of conjoined twins who were treated during this period were reviewed. A careful imaging evaluation was performed to detail the abdominal anatomy (particularly the liver), inferior vena cava, spleen and pancreas, either to identify the number of organs or to evaluate the degree of organ sharing. RESULTS: There were eight sets of ischiopagus twins, seven sets of thoracopagus twins, three sets of omphalopagus twins, two sets of thoraco-omphalo-ischiopagus twins and one set of craniopagus twins. Nine pairs of conjoined twins could not be separated due to the complexity of the organs (mainly the liver and heart) that were shared by both twins; these pairs included one set of ischiopagus twins, six sets of thoracopagus twins and one set of thoraco-omphalo-ischiopagus twins. Twelve sets were separated, including seven sets of ischiopagus twins, three sets of omphalopagus twins, one set of thoracopagus twins and one set of craniopagus conjoined twins. The abdominal wall was closed in the majority of patients with the use of mesh instead of the earlier method of using tissue expanders. The surgical survival rate was 66.7%, and one pair of twins who did not undergo separation is currently alive. CONCLUSION: A detailed anatomic study of the twins and surgical planning must precede separation. A well-prepared pediatric surgery team is sufficient to surgically manage conjoined twins.

Cirurgias plásticas para readequação de contorno corporal de pacientes submetidos a cirurgia bariátrica durante a adolescência / Plastic surgery for readjustment of body contours of patients who underwent bariatric surgery during adolescence", "_e": "n

INTRODUÇÃO: A partir da década de 1990 foram iniciados os primeiros tratamentos cirúrgicos da obesidade em adolescentes, seguindo a sequência cirurgia bariátrica, perda ponderal e dismorfismo corporal, criando demanda por cirurgias plásticas para readequação do contorno corporal. O objetivo deste estudo foi identificar fatores associados a cirurgias plásticas de readequação de contorno corporal (morbidade e mortalidade), realizadas em pacientes submetidos a cirurgia bariátrica durante a adolescência. MÉTODO: Entre janeiro de 2008 e janeiro de 2011, 5 pacientes submetidos a gastroplastia redutora durante a adolescência, com consequente perda e estabilização de peso, foram submetidos a cirurgias plásticas do contorno corporal. A média de idade no início das cirurgias plásticas foi de 19,7 anos, sendo 3 (60%) pacientes do sexo feminino. Foram realizadas dermolipectomias abdominais em todos (100%) os pacientes, dermolipectomias crurais em 4 (80%), dermolipectomias braquiais em 2 (40%), mamoplastia com inclusão de implantes de silicone em 2 (40%) pacientes do sexo feminino, mastopexia na terceira paciente do sexo feminino (20%) e correção de ginecomastia em 1 (20%), toracoplastia em 2 (40%), torsoplastia em 2 (40%) e torsoplastia reversa em 1 (20%). Foram realizadas, em média, 3 intervenções cirúrgicas por paciente, sendo operados 20 sítios cirúrgicos. RESULTADOS: Ocorreram deiscências em 3 (15% dos sítios cirúrgicos) casos e foi necessário revisar a ressecção dermogordurosa por flacidez residual em 3 (15% dos sítios cirúrgicos) casos. CONCLUSÕES: Foram identificados alguns fatores associados às cirurgias plásticas de readequação de contorno corporal na amostra de 5 pacientes submetidos a cirurgia bariátrica durante a adolescência, comparáveis aos da literatura específica.

BACKGROUND: Surgical treatments for obesity in adolescents were introduced in the 1990s, resulting in individuals undergoing bariatric surgery, and exhibiting weight loss and dysmorphic body features. This produced a demand for plastic surgery in order to readjust the body contour. The aim of this study was to identify factors associated with morbidity and mortality for these corrective body contouring plastic surgeries in patients who underwent bariatric surgery during adolescence. METHODS: Between January 2008 and January 2011, 5 adolescent patients underwent gastric bypass surgery, with a consequent loss and stabilization of weight, and then underwent plastic surgery for correcting body contours. The average age of the patients at the time of plastic surgery was 19.7 years; 3 (60%) patients were female. Abdominoplasty was performed in all patients (100%), crural dermolipectomy in 4 (80%) patients, brachial dermolipectomy in 2 (40%) patients, thoracoplasty in 2 (40%) patients, torsoplasty in 2 (40%) patients, and a reverse abdominoplasty in 1 (20%) patient. In addition, mammoplasty with inclusion of silicone implants was performed in 2 (40%) female patients, whereas the other female patient (20%) underwent mastopexy. A male patient (20%) underwent correction of gynecomastia. An average of 3 surgical interventions were performed on each patient (range, 2 - 5), and the number of surgical sites was 20. RESULTS: Dehiscence occurred in 3 (15% of the surgical sites) cases, and it was necessary to revise the resection because of residual skin laxity in 3 (15% of the surgical sites) patients. CONCLUSIONS: Some factors associated with body contouring plastic surgeries in adolescents were identified and compared with the literature data.

Management of gallstone disease in children: a new protocol based on the experience of a single center.

BACKGROUND/PURPOSE: Gallstones and cholelithiasis are being increasingly diagnosed in children owing to the widespread use of ultrasonography. The treatment of choice is cholecystectomy, and routine intraoperative cholangiography is recommended to explore the common bile duct. The objectives of this study were to describe our experience with the management of gallstone disease in childhood over the last 18 years and to propose an algorithm to guide the approach to cholelithiasis in children based on clinical and ultrasonographic findings. METHODS: The data for this study were obtained by reviewing the records of all patients with gallstone disease treated between January 1994 and October 2011. The patients were divided into the following 5 groups based on their symptoms: group 1, asymptomatic; group 2, nonbiliary obstructive symptoms; group 3, acute cholecystitis symptoms; group 4, a history of biliary obstructive symptoms that were completely resolved by the time of surgery; and group 5, ongoing biliary obstructive symptoms. Patients were treated according to an algorithm based on their clinical, ultrasonographic, and endoscopic retrograde cholangiopancreatography (ERCP) findings. RESULTS: A total of 223 patients were diagnosed with cholelithiasis, and comorbidities were present in 177 patients (79.3%). The most common comorbidities were hemolytic disorders in 139 patients (62.3%) and previous bariatric surgery in 16 (7.1%). Although symptoms were present in 134 patients (60.0%), cholecystectomy was performed for all patients with cholelithiasis, even if they were asymptomatic; the surgery was laparoscopic in 204 patients and open in 19. Fifty-six patients (25.1%) presented with complications as the first sign of cholelithiasis (eg, pancreatitis, choledocolithiasis, or acute calculous cholecystitis). Intraoperative cholangiography was indicated in 15 children, and it was positive in only 1 (0.4%) for whom ERCP was necessary to extract the stone after a laparoscopic cholecystectomy (LC). Preoperative ERCP was performed in 11 patients to extract the stones, and a hepaticojejunostomy was indicated in 2 patients. There were no injuries to the hepatic artery or common bile duct in our series. CONCLUSIONS: Based on our experience, we can propose an algorithm to guide the approach to cholelithiasis in the pediatric population. The final conclusion is that LC results in limited postoperative complications in children with gallstones. When a diagnosis of choledocolithiasis or dilation of the choledocus is made, ERCP is necessary if obstructive symptoms persist either before or after an LC. Intraoperative cholangiography and laparoscopic common bile duct exploration are not mandatory.

[Videosurgery in infancy and childhood: state of the art. Experience with 1408 procedures in the Instituto da Criança "Pedro de Alcântara"]. / Videocirurgia na criança: estado da arte. Experiência com 1408 procedimentos no Instituto da Criança "Pedro de Alcântara"

The videosurgery in Pediatric Surgery has a large field of applications unfortunately still underexplored. There are few services that routinely use this techinic , and Brazilian articles published are scarce. The Institute of Children's Hospital of the Faculty of Medicine, University of São Paulo, has been using for fifteen years the videosurgery which is now the first choice of treatment, among other diseases as gastroesophageal reflux, the cholecystolithiasis, the nonpalpable undescended testicles and megaesophagus. In this article we report our experience in laparoscopic pediatric surgery, acquired with 1408 surgical procedures, to present this useful method, and beneficial to a large number of situations and still underused in Pediatric Surgery.

Midgut volvulus after laparoscopic appendectomy.

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Videocirurgia na criança: estado da arte. Experiência com 1408 procedimentos no Instituto da Criança "Pedro de Alcântara" / Videosurgery in infancy and childhood: state of the art. Experience with 1408 procedures in the Instituto da Criança "Pedro de Alcântara"

A videocirurgia em Cirurgia Pediátrica encontra um imenso campo de aplicações ainda, infelizmente, pouco explorado. São poucos os serviços que utilizam rotineiramente essa via de acesso e são escassas as referências nacionais publicadas. O Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr) há uma década e meia a utiliza e hoje a videocirurgia é a via de primeira escolha para tratar, entre outras doenças, o refluxo gastresofagiano, a colecistopatia calculosa, o testículo não palpável e o megaesôfago. Neste artigo relataremos a experiência em videocirurgia pediátrica do ICr, adquirida com 1408 pacientes operados, para divulgar e popularizar esta via de acesso, útil e benéfica para um grande número de situações e ainda subutilizada em Cirurgia Pediátrica.

The videosurgery in Pediatric Surgery has a large field of applications unfortunately still underexplored. There are few services that routinely use this techinic , and Brazilian articles published are scarce. The Institute of Children's Hospital of the Faculty of Medicine, University of São Paulo, has been using for fifteen years the videosurgery which is now the first choice of treatment, among other diseases as gastroesophageal reflux, the cholecystolithiasis, the nonpalpable undescended testicles and megaesophagus. In this article we report our experience in laparoscopic pediatric surgery, acquired with 1408 surgical procedures, to present this useful method, and beneficial to a large number of situations and still underused in Pediatric Surgery.

Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity.

OBJECTIVE: To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity. BACKGROUND: Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects. METHODS: A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum. RESULTS: Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. CONCLUSIONS: SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.

Midgut volvulus after laparoscopic appendectomy / Volvo de intestino delgado após apendicectomia laparoscópica

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.