Mortality in neonates with giant omphalocele subjected to a surgical technique in Barranquilla, Colombia from 1994 to 2019.

No studies of the efficacy and safety of surgical techniques for the primary closure of giant omphalocele have been performed in Colombia. To determine the mortality rate and factors associated with mortality in neonates with giant omphalocele subjected to the surgical technique of early closure with a surgical silo described by Abello in Barranquilla, Colombia from 1994 to 2019. Retrospective cohort study of 30 neonates diagnosed with giant omphalocele and subjected to early closure of the defect. Medical history data were collected, information bias was controlled for, and descriptive statistical analysis was performed using Fisher's exact test and the Mann-Whitney U test in SPSS 25.0. Of the patients in the cohort, 36.7% presented technique-related complications, 56.7% developed sepsis, 23.3% had low birth weight, 26.7% were preterm births, 43.3% had other malformations, 26.7% had congenital heart defects, and 13.3% presented pulmonary hypertension. The mean hospital stay was 26 days. The mortality rate was 16.7%; it was significantly higher among patients with other malformations, congenital heart defects, pentalogy of Cantrell and pulmonary hypertension. The Abello technique for the treatment of giant omphalocele showed a high neonatal survival rate and a low rate of procedure-related complications. The main factors associated with the death of neonatal patients were the presence of other malformations, congenital heart defect, pentalogy of Cantrell and pulmonary hypertension.

Systematic review of mortality associated with neonatal primary staged closure of giant omphalocele.

INTRODUCTION: Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and atomized. OBJECTIVE: To analyze the studies about of mortality associated with neonatal primary staged closure of giant omphalocele. METHODS: Systematic review in three databases using ex-ante search protocol and selection of studies following the phases suggested by PRISMA and MOOSE criteria. Reproducibility and evaluation of methodological quality were guaranteed by using CARE and STROBE. RESULTS: Seven studies of clinical cases with nine patients, and six cross-sectional studies with 85 individuals were analyzed. These were conducted in the USA mainly, between 1985 and 2018. In the case studies, the death was 11.1% owing to hepatic necrosis and portal system angiomatosis. On the cross-sectional studies, mortality was registered in 18.8% of patients owing to coarctation of the aorta, heart, kidney, intestinal, respiratory or multiple organ failure, an anomaly of venous return, prematurity, ruptured omphalocele, pulmonary hypoplasia, trisomy 13, ARDS, sepsis, and septic shock. The main complication was wound infection with subsequent confection of the silo, found in 5.4% of patients. CONCLUSION: Only a few studies on staged closure of giant omphalocele were found on a low number of patients. The high survival rate and the low percentage of complications on the 94 analyzed patients suggest the effectiveness and safety of the procedure. LEVELS OF EVIDENCE: According to the Journal of Pediatric Surgery this research corresponds to type of study level II for retrospective studies, and level IV for case series with no comparison group.

Tumor testicular de senos endodermicos: manejo conservador y marcadores tumorales / Testicular endodermal sinus tumor: conservative management and tumor markers

Se presentan dos casos: un paciente de 9 meses de edad y otro de dos anos, en los cuales se encontro aumento de volumen y consistencia de un testiculo, el izquierdo y el derecho en los respectivos casos, vistos en el ano 1987. Por las caracteristicas clinicas y los niveles preoperatorios de alfa fetoproteina elevados, fueron sometidos a orquidectomia radical con ligadura alta del cordon espermatico. El diagnostico histopatologico fue carcinoma embrionario infantil. Al mes de postoperatorio los niveles regresaron a lo normal y continuan asu despues de un ano y nueves meses de seguimiento. Clinica, radiologica y ecograficamente no hay evidencia de recidiva, metastasis retroperitoneales o pulmonares. Siguiendo las conductas actuales se omitio la linfadenectomia retroperitoneal y la quimioterapia. Se reitera la importancia de la alfa fetoproteina como marcador especifico para este tipo de tumores testiculares