[Laparoscopic adrenalectomy for neuroblastoma. Our serie and review of literature]. / Adrenalectomía laparoscópica en neuroblastoma. Presentación de nuestra serie y revisión de la literatura.

INTRODUCTION: Neuroblastoma is the most frequent adrenal mass in paediatric patients. Paediatric series about laparoscopic adrenalectomy are scarce, usually including adrenal masses from different origin. Series referring only to neuroblastoma are very rare. MATERIAL AND METHOD: We present 7 patients between 4 and 48 month of age. RESULTS: We performed 8 laparoscopic adrenalectomy and one biopsy. Lateral transperitoneal approach was used in all patients. We employed 3 ports on the left side and 4 on the right side. All tumours were extracted into a bag through the most posterior incision. One patient underwent a laparotomy because of important adherences. The average operative time was 88 minutes, and average time before discharging was 48 hours. CONCLUSIONS: Laparoscopic adrenalectomy is the gold standard in adult patients. Transperitoneal access achieves better working area. Paediatric patients don't have many surgical indications for adrenalectomy and the space inside the patient's body is smaller. Laparoscopy offers a less painful solution than open surgery, so that sooner discharging, and better scar's results. The outcome is similar to traditional surgery. Laparoscopy is an useful and safe procedure in paediatric patients with adrenal neuroblastoma, in very selected cases.

Adrenalectomía laparoscópica en neuroblastoma. Presentación de nuestra serie y revisión de la literatura / Laparoscopic adrenalectomy for neuroblastoma. Our serie and review of literature

INTRODUCCIÓN: El neuroblastoma es la masa suprarrenal más frecuente en edad pediátrica. Las series de adrenalectomía laparoscópica en niños son escasas, incluyendo masas de diverso origen. Muy pocas se refieren exclusivamente a neuroblastoma. MATERIAL Y MÉTODOS: Presentamos 7 pacientes entre 4 y 48 meses, con neuroblastoma suprarrenal. RESULTADOS: Se realizan 8 adrenalectomías y una biopsia suprarrenal. Los pacientes se colocaron en decúbito lateral para abordaje transperitoneal, empleándose 3 trocares en el lado izquierdo y 4 en el lado derecho. Los tumores se extrajeron con bolsa por la incisión más posterior. En un paciente se convirtió a laparotomía por abundantes adherencias y sangrado, debidos a una biopsia previa. La duración media de la cirugía fue de 88 minutos, y la estancia media postoperatoria de 48 horas. CONCLUSIONES: La adrenalectomía laparoscópica es el tratamiento habitual de las masas suprarrenales benignas del adulto. La vía transperitoneal proporciona mejor exposición. En pacientes pediátricos las indicaciones son muy pocas y el espacio es muy limitado. La laparoscopia permite un postoperatorio menos doloroso que la cirugía abierta, acortando los tiempos de ingreso y recuperación, con cicatrices más estéticas y resultados similares a los de la cirugía abierta. La laparoscopia es una técnica útil y segura en pacientes con neuroblastoma suprarrenal en casos seleccionados

INTRODUCTION: Neuroblastoma is the most frequent adrenal mass in paediatric patients. Paediatric series about laparoscopic adrenalectomy are scarce, usually including adrenal masses from different origin. Series referring only to neuroblastoma are very rare Material and method. We present 7 patients between 4 and 48 month of age. RESULTS: We performed 8 laparoscopic adrenalectomy and one biopsy. Lateral transperitoneal approach was used in all patients. We employed 3 ports on the left side and 4 on the right side. All tumours were extracted into a bag through the most posterior incision. One patient underwent a laparotomy because of important adherences. The average operative time was 88 minutes, and average time before discharging was 48 hours. CONCLUSIONS: Laparoscopic adrenalectomy is the gold standard in adult patients. Transperitoneal access achieves better working area. Paediatric patients don't have many surgical indications for adrenalectomy and the space inside the patient's body is smaller. Laparoscopy offers a less painful solution than open surgery, so that sooner discharging, and better scar's results. The outcome is similar to traditional surgery. Laparoscopy is an useful and safe procedure in paediatric patients with adrenal neuroblastoma, in very selected cases

[Experience in performance of percutaneous endoscopic gastrostomy in 60 children]. / Experiencia en la colocación de la gastrostomía endoscópica percutánea en 60 niños.

The Percutaneous endoscopic gastrostomy (PEG) has radically changed the handling of the children with nutritional problems that until then were forced to receive nutritionals contributions by parenteral or enteral way, by nasogastric tube, conventional surgical gastrostomy or by central venous access. The objective of this work was to evaluate our experience with 60 patients, with diverse pathologies, that needed a PEG so that they could receive a suitable nutritional contribution. Were registered data of age, sex, reason for the accomplishment of the PEG, used surgical time, days of hospital stay and we analyzed the complications derived from the technique. There were two important complications. In one case one was a patient who presented a gastrocolic fistula as a result of the perforation of the colon in the accomplishment of the PEG and in another case a necrotizing fascitis in a girl who presented a choanal bilateral atresia. The rest of the complications were minor and they were treated without problems. The complications have been comparable to the registered in other series. Although the technique is simple and fast, is not free of risks, reason why it is necessary to inform suitably to the parents of the possibility of complications. In general, the degree of satisfaction of the parents was high.

Experiencia en la colocación de la gastrostomía endoscópica percutanea en 60 niños / Experience in perfomance of percutaneous endoscopic gastrostomy in 60 children

La Gastrostomía Endoscópica Percutánea (PEG) ha cambiado radicalmente el manejo de los niños con trastornos alimentarios que hasta entonces estaban obligados a recibir aportes nutricionales por vía enteral ó parenteral, ya sea por sonda nasogátrica (SNG), gastrostomía quirúrgica convencional ó bien mediante la colocación de vías venosas centrales. El objetivo de este trabajo fue evaluar nuestra experiencia con 60 pacientes, con patologías diversas, que precisaron de una PEG para que pudieran recibir un aporte nutricional adecuado. Recogimos datos de edad, sexo, motivo de la realización de la PEG, tiempo quirúrgico empleado, tiempo de ingreso y analizamos las complicaciones derivadas de la técnica. Hubo dos complicaciones importantes. En un caso se trataba de un paciente que presentó una fístula gastrocólica como consecuencia de la perforación del colon en la realización de la gastrostomía y en otro caso se produjo una fascitis necrotizante en una niña que presentaba una atresia de coanas bilateral. El resto de las complicaciones fueron menores y se trataron sin problemas. Las complicaciones han sido comparables a las registradas en otras series. Aunque la técnica es sencilla y rápida no está exenta de riesgos por lo que es necesario informar adecuadamente a los padres de la posibilidad de complicaciones. En general, el grado de satisfacción de los padres fue alto (AU)

Duplicación intestinal independiente / Independent intestinal duplication

Existen algunos tipos poco frecuentes de duplicación intestinal en el tubo digestivo que no cumplen todos los criterios clásicos de su definición. Se presenta el caso clínico de una duplicación intestinal independiente de intestino delgado que debuta con abdomen agudo, encontrándose en la intervención una tumoración quística perforada y separada de la pared de intestino sano, que se pudo resecar completamente conservando el intestino normal adyacente, debido a que presentaba una irrigación vascular propia. Se analiza la nueva clasificación vascular de duplicación intestinal y su importancia en el tratamiento quirúrgico de esta patología. (AU)

[Independent intestinal duplication]. / Duplicación intestinal independiente.

Some types of intestinal duplication are an infrequent clinical condition in the gastroenterology tract that do not meet all classic requisites for their definition. We present a case of independent intestinal duplication from small intestine that starts with acute abdomen; cystic, perforated and separated tumor from wall of normal intestine was founded during surgery. It was totally resected with preservation of normal intestine adjacent, because it was an independent vascular supply. We review a new vascular classification of intestinal duplication and their importance in surgical treatment of this matter.

[Prospective study of 288 cases of acute appendicitis during childhood: characteristics in preschool children]. / Estudio prospectivo de 288 apendicitis agudas en la infancia: Características en los niños menores de 5 años.

OBJECTIVE: The purpose of this study was to verify that preschool children with acute appendicitis show some clinical characteristics which, associated with the faster evolution of the infection at this age, result in a higher incidence of perforations, peritonitis and complications. PATIENTS AND METHODS: A group of 288 children between 9 months and 17 years of age with acute appendicitis was studied over a 17-month period, ending July 1993. They were divided into two age groups: Group I (< 5 years: n = 45) and Group II (5 or more years: n = 243). Comparisons between clinical, laboratory and radiological findings, appendiceal pathology, microbiology and complications were made. RESULTS: Children fro Group I showed a higher incidence of perforations (29% vs 7.8%), peritonitis (69% vs 36%), appendiceal masses (37% vs 10.2%), positive cultures (66% vs 18%) and complications (24% vs 9.8%) than those from Group II. All differences were found to be significant (p < 0.05). Children from Group I more frequently showed a set of clinical characteristics forming an atypical picture consisting of: 1) Diffuse abdominal pain (69% vs 30%); 2) Associated infections with non-specific symptoms (33% vs 11.5%); 3) Previous therapy with antimicrobial agents (40% vs 9.8%); 4) X-ray findings compatible with gastroenteritis (27% vs 7.4%); and 5) Inability of the child to specify the intensity and location of pain. CONCLUSIONS: All these factors justified the delay in the diagnosis and its significant relationship with the higher incidence of peritonitis in this age group.

[Prospective and comparative study of cefoxitin and ceftizoxime in appendicitis surgery]. / Estudio prospectivo y comparativo entre cefoxitina y ceftizoxima en cirugía apendicular.

OBJECTIVE: Acute appendicitis is the most common acute surgical disease in childhood and it still presents frequent septic complications. This prospective and randomized study compares the efficacy of two cephalosporins (cefoxitin and ceftizoxime) in terms of clinical response, in vitro activity and characteristics of use in clinical practice. PATIENTS AND METHODS: Of the 288 children with acute appendicitis admitted over a period of 15 months, 148 received cefoxitin (100 mg/kg/24 h; Group I) and 140 ceftizoxime (100 mg/kg/24 h; Group II) RESULTS: No significant differences were seen between these two groups in clinical response or infectious complication rates. In addition, activities of both antimicrobial agents against pathogens recovered from the peritoneal cultures of all patients were similar. The overall most common isolates were E. coli (75.5%), bacteroides species (33.7%) and Pseudomonas (32.4%). CONCLUSIONS: We conclude that ceftizoxime is as effective as cefoxitin and can be surely employed in the treatment of acute appendicitis in children. Its addition, its longer half-life simplifies its use in clinical practice.

[The histopathological diagnosis of Hirschsprung's disease. Our experience over 18 years]. / Diagnóstico histopatológico de la enfermedad de Hirschsprung. Nuestra experiencia en dieciocho años.

Having had several cases of difficult interpretation from the anatomopathological point of view, we make a review of all intestinal biopsies carried out in 54 patients for diagnosis of Hirschsprung's disease and above all of the suction rectal biopsies. The result has been seven cases with false diagnosis that represents 22 per 100 of the series. We analyse the possible causes that can lead to false positives and negatives results with the suction rectal biopsy, like the height where the biopsy has been taken, the age of the patients (71 per 100 of false results were in children under one month) and finally other diagnosis like hyperganglionisme.

[Meckel's diverticulum in children. A series of cases over 16 years]. / Divertículo de Meckel en la infancia. Casuística de dieciseis años.

The authors review 45 cases of patients with Meckel's Diverticulum, 28 were symtomatics and 17 asymtomatics. DM symtomatics were more frequent in males 3:1 and usually the diagnosis was made between 0 and 4 years of age. 85% apared with rectal bleeding, diverticulitis and intestinal obstruction. Near all cases with rectal bleeding and diverticulitis were associated with heterotopic mucosa (90%). The best method of diagnosis is the Tc-99 pertechnetate scan although it has been used in small number of cases because of the emergency. The results have been goods except one death, two intestinal obstructions and two wound infections.