[Use of laparoscopy in neonatal pathology: our experience]. / Uso de la laparoscopia en la patología duodenal: nuestra experiencia.

The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique.

[Thoracoscopic lobectomy in patients with congenital cystic adenomatoid malformation]. / Lobectomía toracoscópica en pacientes con malformación adenomatoidea quística.

BACKGROUND: The management of asymptomatic patients with congenital cystic adenomatoid malformation (CCAM) is controversial. This report evaluates the video-assisted thoracoscopic (VAT) lobectomy in children with this malformation, and the different intraoperative complications and their resolution are discussed. METHODS: Six patients with CCAM underwent video-assisted thoracoscopic lobectomy. All the patients were under one year and all of them were asymptomatic at the diagnosis. The procedures were performed with single lung ventilation and the chest was insufflated with a low flow and pressure to complete collapse of the lung. We used 3 or 4 thoracoscopic ports depending on the difficulty of the dissection. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. The following features have been taken into account: age at diagnosis, localization, surgical technique, complications, hospital stay, results, and time of follow-up. RESULTS: Four lesions were on the right lower lobe (66.7%) and two (33.3%) in the middle lobe. All the procedures were completed thoracoscopically. Chest tubes were left in all cases. Two patients (33.3%) showed postoperative hemothorax but it didn't need blood transfusion. Mean hospital stay was 6 days. At the moment all the patients are asymptomatic with and the mean time of follow-up has been 2 years and 8 months. CONCLUSIONS: VAT lobectomy avoids the long-term morbidity associated to an open thoracotomy and therefore it is a safe and efficacious technique in asymptomatic children with CCAM. Moreover, a greater number of cases are necessary to validate and to improve the technique.

Uso de la laparoscopia en la patología duodenal: nuestra experiencia / Use of laparoscopy in neonatal pathology: our experience

La patología duodenal neonatal ha sido diagnosticada y tratada concirugía abierta durante muchos años. El uso de técnicas mínimamente invasivas es común hoy en día en la cirugía pediátrica, pero su utilización en neonatos supone un reto. Hemos realizado un estudio de 8 pacientes diagnosticados de obstrucción duodenal congénita que fueron intervenidos por vía laparoscópica en nuestro Hospital entre el 2001 y 2007.Los parámetros analizados fueron el sexo, diagnóstico prenatal, tipo de malformación duodenal, peso medio al nacimiento, tiempo quirúrgico, estancia hospitalaria, inicio de la alimentación, complicaciones y seguimiento. En nuestra muestra (6 niñas y 2 niños) el 62,5% fue diagnosticado tras ecografía prenatal. Las malformaciones duodenales halladas fueron5 atresias, 2 membranas y 1 páncreas anular. En todos ellos se inició la alimentación por sonda transanastomótica a las 48 horas posquirúrgicas. Hubo 3 complicaciones: una reintervención y 2 estenosis de la anastomosis. La estancia media hospitalaria fue de 27 días con un seguimiento medio de 3 años. Pensamos que la laparoscopia es un buen método para tratar la patología duodenal neonatal, aunque el escaso volumen de nuestra serie nos impide generalizar la técnica (AU)

The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique (AU)

Lobectomía toracoscópica en pacientes con malformación adenomatoidea quística / Thoracoscopic lobectomy in patients with congenital cystic adenomatoid malformation

Introducción. El tratamiento de los pacientes asintomáticos con malformación adenomatoidea quística (MAQ) es controvertido. En este trabajo evaluamos la lobectomía por vía toracoscópica en pacientes condicha malformación analizando los diferentes aspectos técnicos, las complicaciones y su resolución. Material y métodos. Hemos intervenido 6 pacientes con diagnóstico de MAQ mediante toracoscopia. Todos los pacientes eran menores de un año y en ningún caso habían presentado síntomas. Se realizó toracoscopia con intubación selectiva y neumotórax controlado a baja presión y bajo flujo. Empleamos 3 ó 4 trócares en función de la dificultad de la disección. Para el control de la vascularización pulmonar utilizamos un sellador térmico y el cierre de los bronquios se realizó mediante sutura intracorpórea. Se han analizado los siguientes parámetros: edad, localización de lesión, técnica quirúrgica, complicaciones postquirúrgicas, estancia hospitalaria, resultado final y tiempo de seguimiento. Resultados. La lesión se localizó en lóbulo inferior derecho en cuatro ocasiones (66,7%) y en lóbulo medio en dos (33,3%) En los seis casos la lobectomía fue completada por vía toracoscópica con éxito. Dos pacientes (33,3%) presentaron hemotórax en el postoperatorio inmediato, que no precisó transfusión ni drenaje. El ingreso medio fue de 6días. Actualmente todos los pacientes están asintomáticos, con un tiempo de seguimiento medio de 2 años y 8 meses. Conclusión. El menor número de complicaciones y efectos secundarios de la lobectomía toracoscópica frente a la toracotomía convencional hacen de esta técnica una opción terapéutica válida y eficaz para el tratamiento de los pacientes asintomáticos con MAQ. No obstante, es necesario un mayor número de casos para validar y perfeccionar completamente la técnica (AU)

Background. The management of asymptomatic patients with congenitalcystic adenomatoid malformation (CCAM) is controversial. This report evaluates the video-assisted thoracoscopic (VAT) lobectomy in children with this malformation, and the different intraoperative complications and their resolution are discussed. Methods. Six patients with CCAM underwent video-assisted thoracoscopic lobectomy. All the patients were under one year and all of them were asymptomatic at the diagnosis. The procedures were performed with single lung ventilation and the chest was insufflated with a low flow and pressure to complete collapse of the lung. We used 3 or 4thoracoscopic ports depending on the difficulty of the dissection. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. The following features have been taken into account: age at diagnosis, localization, surgical technique, complications, hospital stay, results, and time of follow-up. Results. Four lesions were on the right lower lobe (66.7%) and two(33.3%) in the middle lobe. All the procedures were completed thoracoscopically. Chest tubes were left in all cases. Two patients (33.3%)showed postoperative hem thorax but it didn´t need blood transfusion. Mean hospital stay was 6 days. At the moment all the patients are asymptomatic with and the mean time of follow-up has been 2 years and 8months.Conclusions. VAT lobectomy avoids the long-term morbidity associated to an open (..) (AU)

[The role of tracheobronchial stenting in the management of pediatric airway obstruction]. / El papel de las prótesis traqueobronquiales endoluminales en la patología obstructiva de la vía aérea del niño.

PURPOSE: Tracheobronchial stenting can aid in the management of pediatric airway problems. We reviewed our experience to determine the role of endoscopic airway stents in children. METHODS: Sixteen children (Age range: 10 days- 19 years) underwent 28 tracheobronchial stents in the period 1991-2006. The stent type chosen depended on patient age and location. All procedures were done under general anesthesia with bronchoscopy. The following features have been taken into account: etiology, obstruction diagnosis, stent type, localization,,associated anomalies, complications, results, and time of follow-up. RESULTS: Etiology of the tracheobronchial obstruction included tracheobronchiomalacia in 13 patients (81.3%), tracheal stenosis in 2 (12.5%) and glotic stenosis in one case (6.2%). The stent used were 15 Palmaz (53.5%), 7 Dumon (25%), 4 Montgomey (14.5%), 1 Poliflex (3.5%) and one Dynamic stent (3.5%). More than one stent were undertaken in seven cases (43.7%). 16 patients had tracheal stents, 11 children had bronchial stent and one infant a carinal stent. Five complications are reported (two patients developed granulation tissue, two stents migrated, and a child presented a left lung atelectasis) and five patients died (only one case related to tracheobronchial stenting). Results have been satisfactory in 14 patients (87.5%) and the mean time of follow-up has been two years and ten months (range 2 months- 12 years and 6 months). CONCLUSIONS: The tracheobronchial stenting in children may represent a valid treatment option for many sick children in particular circumstances. The long-term outcome remains uncertain but the medium-term outlook is encouraging.

Resultados iniciales del tatamiento de la hernia inguinal por vía laparoscópica / Laparoscpic inguinal herniorrhaphy in children. First results

Introducción: La herniorrafía inguinal tiene una nueva alternativa, la vía laparoscópica. En este trabajo analizamos los resultados iniciales obtenidos mediante esta técnica en el tratamiento de la hernia inguinal, en nuestro hospital, evaluando las indicaciones y su eficacia. Material y métodos: Estudiamos 150 pacientes con diagnóstico de herniainguinal o crural. La técnica la efectuamos con tres trócares: unoumbilical de 5mm para la óptica y dos de 3 mm situados en ambos flancos. La reparación se realizó con bolsa de tabaco, sutura continua o puntos sueltos, utilizando siempre material irreabsorbible. Resultados: Las indicaciones fueron: hernia inguinal recidivada en el12%, hernia inguinal bilateral en el 28%, asociación de hernia inguinal unilateral y hernia umbilical en el 39%, hernia crural en el 4% y en el16% se reparó la hernia al ser encontrada incidentalmente. En la mayoría de los casos (137) el cierre del anillo inguinal se realizó mediante una sutura en bolsa de tabaco sin sección del peritoneo, en 11 se hizo una sutura continua y en 12 casos se cerró mediante puntos sueltos. No hubo reconversión en ningún caso. Se produjo hematoma por punción de los vasos espermáticos en 6 casos (1,4%). Inicialmente el ingreso fue de 1 a 2 días; actualmente lo hacemos de forma ambulatoria. Hemos tenido 2 casos de recidiva (1%) que fueron tratados por vía laparoscópica. Conclusiones: Aunque el número de pacientes tratados impide sacar unas conclusiones definitivas pensamos que el tratamiento laparoscópico de las hernias inguinocrurales, puede ofrecer ciertas ventajas sobre la vía abierta en casos seleccionados (AU)

Introduction: The inguinal hernia repair in the child has anew alternative, the laparoscopic repair. We study our initial results obtained with this technique. We evaluate the indications and the efficiency. Material and methods: 150 patients have been operated with an initial diagnosis of hernia inguinal or crural. Usually this technique is realized with three ports: we put the umbilical one (5mm) for the scope and two ports (3mm) placed in flanks. The repair was realized in purse string fashion or interrupted or no interrupted suture with non-absorbable suture (polipropylen) 3-4/0.Results: Indications of the herniorraphy were: (12 %) recurrent hernia, bilateral hernia (28 %), association inguinal hernia inguinal and umbilical(39 %), crural hernia (4 %) and in 16 % incidental hernia. Most of them (137) was treated in purse string fashion, (11) non interrupted suture and 12 interrupted suture. No conversion to open was require in any case. Haematoma for puncture of the spermatic vessels was seen in6 cases (1'4 %). Today we do this surgery in ambulatory way. We have had 2 recurrent hernias (1 %) that were treated again laparoscopicaly Conclusions: We can’t extract conclusion from this study because of the number of patients but we think that the laparoscopic treatment of inguinal hernias can offer advantages in selected cases (AU)

[Minimally invasive surgery for the management of congenital diaphragmatic patology]. / Manejo de la patología diafragmáitica congénita con cirugía mínimamente invasiva.

INTRODUCTION: Minimally invasive surgery (MIS) plays a major role in pediatric surgery. We reported our experience in MIS management of congenital diaphragmatic patology (CDP). PATIENTS AND METHODS: The authors collected date on children who underwent a MIS for CDP repair from 1998 until 2006. The following features have been taken into account: lesion type, approach, surgical technique, complications, hospital stay and time of follow-up. RESULTS: From 1998 until 2006 11 patients (age range: 2 days-6 years and 6 months) with CDP had undergone an attempt at MIS repair: 6 patients with posterolateral hernia (36.4%), 4 with Morgagni hernia ( 54.5%) and a congenital diaphragmatic eventration case (9%). Eight patients 8 (72.7%) were treated using laparoscopy and three cases using thoracoscopy. Three patients were treated as newborns (27.2%). Four patients presented complications (36.3%): two patients who were repaired initially laparoscopically were converted to a transabdominally approach and two patients had recurrent herniation, which were repaired with MIS. Actually all cases were asymptomatic with a mean time of follow-up of 1 year and 8 months (range: 3 months-two years). CONCLUSIONS: MIS is a feasible, safe, easy to perform and efficient approach to repair CDP but it needs selection criteria for successful outcome.

El papel de las prótesis traqueobronquiales endoluminales en la patología obstructiva de la vía aérea del niño / The role of tracheobronchial stenting in the management of pediatric airway obstruction

Introducción. Las prótesis traqueobronquiales endoluminales (PTBE) constituyen una opción terapéutica válida en el manejo de los pacientes con patología estenosante de la vía aérea. Mostramos nuestra experiencia en su empleo, estableciendo los criterios para su utilización, y analizamos los resultados obtenidos. Material y métodos. En el periodo entre 1991- 2006 16 niños (rango de edad: 10 días- 19 años) han sido tratados con 28 PTBE. La elección del tipo de prótesis ha dependido de la edad y la localización de la lesión. La colocación de la prótesis y su control posterior se efectuó en todos los casos por medio de broncoscopia. Hemos analizado los siguientes datos: el tipo patología obstructiva, PTBE seleccionada, malformaciones asociadas, las complicaciones, resultado final y el tiempo de seguimiento. Resultados. La indicación de colocación de PTBE ha sido malacia traqueal y/o bronquial en 13 pacientes (81,3%), estenosis traqueal en 2 (12,5%) y estenosis glótica en un caso (6,2%). Se han utilizado las siguientes prótesis: 15 prótesis metálicas tipo Palmaz (53,5%), 7 de silicona tipo Dumon (25%), 4 tipo Montgomery (14,5%), 1 tipo Poliflex (3,5%) y una prótesis traqueobronquial tipo Dynamic (3,5%). En siete pacientes (43,7%) se colocó más de una prótesis. Se han colocado 16 traqueales, 11 bronquiales y una carinal. Cinco pacientes presentaron complicaciones (granuloma en dos casos, migración en 2 pacientes y atelectasia en un caso) y cinco pacientes han fallecido (1 por complicaciones relacionadas con la PTBE). Hemos obtenido un buen resultado en 14 pacientes (87,5%) con un tiempo medio de seguimiento de 2 años y 10 meses (rango 2 meses-12años y 6 meses). Conclusiones. La colocación de PTBE es una alternativa terapéutica válida en pacientes seleccionados. El resultado a corto y medio plazo es satisfactorio pero la evolución a largo plazo es todavía una incógnita (AU)

Purpose. Tracheobronchial stenting can aid in the management of pediatric airway problems. We reviewed our experience to determine the role of endoscopic airway stents in children. Methods. Sixteen children (Age range: 10 days- 19 years) underwent 28 tracheobronchial stents in the period 1991-2006. The stent type chosen depended on patient age and location. All procedures were done under general anesthesia with bronchoscopy. The following features have been taken into account: etiology, obstruction diagnosis, stent type, localization,,associated anomalies, complications, results, and time of follow-up. Results. Etiology of the tracheobronchial obstruction included tracheobronchiomalacia in 13 patients (81.3%), tracheal stenosis in 2 (12.5%) and glotic stenosis in one case (6.2%). The stent used were 15 Palmaz( 53.5%), 7 Dumon (25%), 4 Montgomey (14.5%), 1 Poliflex (3.5%) and one Dynamic stent (3.5%). More than one stent were undertaken in seven cases (43.7%). 16 patients had tracheal stents, 11 children had bronchial stent and one infant a carinal stent. Five complications are reported ( two patients developed granulation tissue, two stents migrated, and a child presented a left lung atelectasis) and five patients died (only one case related to tracheobronchial stenting) Results have been satisfactory in 14 patients (87.5%) and the mean time of follow-up has been two years and ten months (range 2 months- 12 years and 6 months). Conclusions. The tracheobronchial stenting in children may represent a valid treatment option for many sick children in particular circumstances. The long-term outcome remains uncertain but the medium- term outlook is encouraging (AU)

Manejo de la patología diafragmática congénita con cirugía mínimamente invasiva / Minimally invasive surgery for the management of congenital diaphragmatic patology

Introducción. La cirugía mínimamente invasiva (CMI) juega un papel cada vez más importante dentro de la cirugía pediátrica. Presentamos nuestra experiencia en la reparación de la patología diafragmática congénita (PDC) mediante CMI. Material y métodos. Hemos realizado un estudio retrospectivo descriptivo analizando los pacientes que fueron intervenidos desde 1998 a 2006 de patología diagragmática congénita con CMI, estudiando: tipo de lesión, vía de abordaje, técnica quirúrgica, complicaciones posquirúrgicas, estancia hospitalaria, resultado final y tiempo de seguimiento. Resultados. Entre 1998 y 2006 11 pacientes (rango de edad 2 días- 6 años y 6 meses) con PDC han sido tratados mediante CMI: 6 pacientes con hernia posterolateral (36,4%), 4 con hernia retroesternal (54,5%) y 1 caso de relajación diafragmática congénita (9%). Se abordaron por vía laparoscópica en 8 ocasiones (72,7%) y por vía toracoscópica en 3 (27,3%). Tres casos se operaron en período neonatal (27,2%). Cuatro pacientes presentaron complicaciones (36,3%): en dos pacientes intervenidos por laparoscopia se reconvirtió a laparotomía por dificultades técnicas y dos pacientes presentaron recidiva de la hernia, que también fue reparada mediante CMI. Actualmente el 100% de los pacientes está asintomático con un tiempo de seguimiento medio de 1 año y 8 meses (rango de 3 meses a 2 años). Conclusiones. La CMI es una opción terapéutica válida para la reparación de la PDC. Esta vía de abordaje reduce la morbilidad postoperatoria pero requiere una adecuada selección de los pacientes para conseguir unos resultados óptimos (AU)

INTRODUCTION: Minimally invasive surgery (MIS) plays a major role in pediatric surgery. We reported our experience in MIS management of congenital diaphragmatic patology (CDP). PATIENTS AND METHODS: The authors collected date on children who underwent a MIS for CDP repair from 1998 until 2006. The following features have been taken into account: lesion type, approach, surgical technique, complications, hospital stay and time of follow-up. RESULTS: From 1998 until 2006 11 patients (age range: 2 days-6 years and 6 months) with CDP had undergone an attempt at MIS repair: 6 patients with posterolateral hernia (36.4%), 4 with Morgagni hernia ( 54.5%) and a congenital diaphragmatic eventration case (9%). Eight patients 8 (72.7%) were treated using laparoscopy and three cases using thoracoscopy. Three patients were treated as newborns (27.2%). Four patients presented complications (36.3%): two patients who were repaired initially laparoscopically were converted to a transabdominally approach and two patients had recurrent herniation, which were repaired with MIS. Actually all cases were asymptomatic with a mean time of follow-up of 1 year and 8 months (range: 3 months-two years). CONCLUSIONS: MIS is a feasible, safe, easy to perform and efficient approach to repair CDP but it needs selection criteria for successful outcome (AU)

La laparoscopia en el manejo de los tumores ováricos en la infancia / Laparoscopy for ovarian tumors in children

Introducción. La laparoscopia juega un papel cada vez más importante dentro de la cirugía pediátrica. En esta revisión presentamos nuestra experiencia en el manejo laparoscópico de los tumores ováricos. Material y métodos. En el período comprendido entre 1998 y 2005, 22 pacientes diagnosticadas de tumor ovárico fueron intervenidas en nuestro hospital mediante técnica laparoscópica. De manera retrospectiva hemos analizado las técnicas empleadas para cada intervención, los materiales utilizados tanto para resección y extracción de los tumores, el tiempo quirúrgico, la estancia hospitalaria, las diferentes complicaciones postoperatorias y el tiempo de seguimi ento. Resultados. De las 22 niñas diagnosticadas de tumor ovárico, 21 fueron teratomas maduros, y el caso restante correspondió a una metástasis de osteosarcoma. La edad media de las pacientes intervenidas fue de 9,5 años (rango 1,5-1,7 años). El 47,3% de los casos debutó como abdomen agudo, un 10,5% como un dolor crónico y un 42,2% fueron hallazgos casuales. En 8 niñas (36,4%) se hizo anexectomía, en 11 ooforectomía (50%) y en 3 ocasiones quistectomía (13,6%). En una paciente se encontró un quiste hemorrágico contralateral que se trató en el mismo acto quirúrgico y cuatro pacientes fueron diagnosticadas de hernia inguinal en la exploración laparoscópica, procediéndose posteriormente a la reparación de las mismas. Conclusiones. La laparoscopia es una técnica válida en el manejo de los tumores ováricos. Mediante este abordaje se puede tratar el tumor de manera reglada, valorando las posibilidades de extirpación tumoral en los casos de malignidad y/o la toma de biopsias bajo visión directa. También permite diagnosticar otras lesiones e incluso repararlas en el mismo acto quirúrgico (AU)

Introduction. Laparoscopic techniques play a major role in pediatric surgery. We reported our experience in the laparoscopic management of ovarian tumors. Patients and methods. 22 patients with ovarian tumor were treated with laparoscopy in our hospital from 1998 to 2005. The following features have been taken into account: surgical techniques in the dissection and extraction of the tumors, time of surgery, hospital stay, complications and time of follow- up. Results. 21 benign teratomas and one osteosarcoma metastasis were observed in this group of 22 patients. The average of age at diagnosis was 9.5 years (range 1.5-17 years) The chief symptom was acute abdominal pain in 47.3% of cases, in 10.5% was chronic pain and in 42.2% of patients was an incidental finding. In 8 girls (36.4%) were performed adnexectomy, in 11 (50%) ooforectomy and in three cases (13.6%) the cyst was enucleated with preservation on the ovary. In one patient a haemorrhage cyst was found and it was treated in the same time and in four patients an inguinal hernia as seen in the laparoscopic surgery and they were repaired subsequently. Conclusions. Laparoscopic management of ovarian tumor is safe and effective. It allows the surgeon to dissect the tumor, to determine respectability in ovarian cancer and taking biopsy under direct vision. This approach lets to diagnose other lesions that can be repaired in the same procedure or subsequently (AU)

[Laparoscopic inguinal herniorrhaphy in children. First results]. / Resultados iniciales del tratamiento de la hernia inguinal por vía laparoscópica.

INTRODUCTION: The inguinal hernia repair in the child has a new alternative, the laparoscopic repair. We study our initial results obtained with this technique. We evaluate the indications and the efficiency. MATERIAL AND METHODS: 150 patients have been operated with an initial diagnosis of hernia inguinal or crural. Usually this technique is realized with three ports: we put the umbilical one (5mm) for the scope and two ports (3 mm) placed in flanks. The repair was realized in purse string fashion or interrupted or noninterrupted suture with non-absorbable suture (polipropylen) 3-4/0. RESULTS: Indications of the herniorraphy were: (12%) recurrent hernia, bilateral hernia (28%), association inguinal hernia inguinal and umbilical (39%), crural hernia (4%) and in 16% incidental hernia. Most of them (137) was treated in purse string fashion, (11) non interrupted suture and 12 interrupted suture. No conversion to open was require in any case. Haematoma for puncture of the spermatic vessels was seen in 6 cases (1,4%). Today we do this surgery in ambulatory way. We have had 2 recurrent hernias (1%) that were treated again laparoscopicaly. CONCLUSIONS: We can't extract conclusion from this study because of the number of patients but we think that the laparoscopic treatment of inguinal hernias can offer advantages in selected cases.

Empiema pleural. Tratamiento toracoscópico / Pleural empyema. Thoracoscoopic treatment

Objetivo. Comparar el uso de la toracoscopia primaria y secundaria en niños con empiema paraneumónico. Material y métodos. Efectuamos un estudio retrospectivo de 24 niños ingresados en nuestro hospital entre los años 1998 y 2003. Resultados. La toracoscopia precoz no influye en el número de días de ingreso tras la misma. De los 24 niños, 12 (50%) fueron tratados con drenaje pleural previo y otros 12 (50%) sin él. La mayor diferencia se establece en cuanto a la estancia media total. El número de días de desaparición de la fiebre tras toracoscopia es el mismo, no así desde el inicio de la enfermedad que se disminuye notablemente. Conclusión. La toracoscopia precoz disminuye en número de días de estancia media en el hospital y de desaparición de la fiebre desde el inicio de la enfermedad (AU)

Objective. To compare the use of primary and secondary thoracoscopy in children with parapneumonic empyema. Material and méthods. We present a retrospective study of 24 children entered our hospital between years 1998 and 2003. Results. Early thoracoscopy doesn’t influence in length of stay. 12 children (50%) were treated with previous chest tube and other 12 children (50%) without it. There is statistical significance in length of hospital stay. The days with postoperative fever didn’t decrease, but it was seen if we compare it from the beginning of the disease. Conclusions. An early thoracoscopy decrease length of hospital stay and the duration of fever postoperative (AU)

[Pleural empyema. Thoracoscoopic treatment]. / Empiema pleural. Tratamiento toracoscópico.

OBJECTIVE: To compare the use of primary and secondary thoracoscopy in children with parapneumonic empyema. MATERIAL AND METHODS: We present a retrospective study of 24 children entered our hospital between years 1998 and 2003. RESULTS: Early thoracoscopy doesn't influence in length of stay. 12 children (50%) were treated with previous chest tube and other 12 children (50%) without it. There is statistical significance in length of hospital stay. The days with postoperative fever didn't decrease, but it was seen if we compare it from the beginning of the disease. CONCLUSIONS: An early thoracoscopy decrease length of hospital stay and the duration of fever postoperative.

Masas cervicales en la infancia / Head and neck sinuses and masses in childhood

La variedad de lesiones que afectan a la cabezay el cuello en niños se pueden subdividir según suetiología en infecciosas, neoplásicas o de origencongénito. Las masas congénitas en el cuello incluyenquistes branquiales, los quistes tiroglosos, losquistes ectópicos del timo, los quistes dermoides,las anormalidades vasculares, y las malformacioneslinfáticas tales como el higroma quístico. Este artículose centra principalmente en las patologíasmás comunes: los quistes branquiales, los quistesdel conducto tirogloso y las malformaciones linfáticas

The variety of lesions involving the head and neckin children can be subdivided by etiology into thosethat result from infection or neoplasm and those ofcongenital origin. Congenital masses in the neck includebranchial cleft cysts, thyroglossal duct cysts,ectopic thymus cysts, dermoid and teratoid cysts,cystic vascular abnormalities, and lymphatic malformationssuch as the cystic lymphangioma. This articlemainly focuses on the common entities of branchialcleft cysts, thyroglossal duct cysts and lymphaticmalformations

Laceración traqueal producida por un traumatismo cervical cerrado / Tracheal laceration due to blunt neck trauma

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[Results of laparoscopic treatment of complicated appendicitis]. / Resultados del tratamiento laparoscópico en la apendicitis complicada.

Laparoscopic appendectomy in children is a generally accepted procedure for the treatment of non-complicated acute appendicitis. Nevertheless, the role of laparoscopy in complicated cases is controversial. We show our experience with 40 cases of complicated acute appendicitis treated by means laparoscopy between February 2000 and October 2002. In every case we used 3 ports, one umbilical and the other two in both lower quadrants. The appendix was gangrenous in 31 patients and in the other 9 was perforated. Appendectomy was performed in an extracorporeal way in most of the cases. Average surgical time was 71 minutes and mean hospital stay was 8.8 days. Intraoperative complications occurred in 8 cases (20%) and postoperative complications were observed in 9 patients (22.5%). Four patients were reoperated (2 open and 2 laparoscopic) in order to drain two abscesses and treat two obstructions. The results of this serie is compared with another group of 40 complicated appendicitis operated in a classic open way in the same period of time. Postoperative complications were less often in the laparoscopic group. Oral intake, need for analgesia and hospital stay are more favorable in the laparoscopic group.

Resultados del tratamiento laparoscópico en la apendicitis complicada / Results of laparoscopic treatment of complicated appendicitis

La apendicectomía laparoscópica (AL) en niños es un método cada vez más aceptado para el tratamiento de la apendicitis aguda no complicada. Sin embargo, el papel de la laparoscopia en la apendicitis complicada es más controvertido y, a su vez, está menos estudiado. Presentamos 40 casos de apendicitis complicadas dentro de una serie de 120 pacientes apendicectomizados por laparoscopia entre febrero del 2000 y octubre del 2002 en el Servicio de Cirugía Pediátrica del Hospital 12 de Octubre de Madrid. En todos los casos se utilizaron 3trócares, uno umbilical para la óptica y otros dos de trabajo colocados en ambas fosas ilíacas. En los 40 casos el apéndice era gangrenoso, estando además perforado en 9 de ellos. Encontramos absceso apendicular localizado en 28 casos y peritonitis más o menos diseminada en 24. La apendicectomía se realizó en la mayoría de los casos deforma extracorpórea y en otros mediante sección intraabdominal. El tiempo quirúrgico medio fue de 71 min y la media del ingreso postoperatorio fue de 8,8 días. Las complicaciones intraoperatorias se produjeron en 8 casos (20%) (6 roturas del apéndice y 2 reconversiones por mala visualización) sin que tuvieran repercusión posterior. Hubo algún tipo de complicación postoperatoria en 9 de los pacientes (22,5%):4 abscesos intraabdominales (10%), 2 casos de obstrucción (5%), 2abscesos de la herida de alguno de los trócares (5%) y un caso de íleoprolongado que cedió con tratamiento conservador. Fueron reintervenidos4 de los pacientes (2 por vía laparoscópica y 2 por vía abierta),para drenar 2 de los abscesos intraabdominales y resolver las 2 obstrucciones. El resto evolucionaron bien con antibioterapia. Los resultados se compararon con los de otro grupo de 40 apendicitis complicadas intervenidas en el mismo periodo por vía abierta (AA). Las complicaciones postoperatorias fueron menos frecuentes en las AL. El inicio de la tolerancia oral, la necesidad de analgesia, el tiempo de antibioterapia y el ingreso postoperatorio fue menor en el grupo de las AL.A pesar de que el número de casos es pequeño parece que la laparoscopia es un método válido para el tratamiento de las apendicitis complicadas (AU)

Laparoscopic appendectomy in children is a generally accepted procedure for the treatment of non-complicated acute appendicitis. Nevertheless, the role of laparoscopy in complicated cases is controversial. We show our experience with 40 cases of complicated acute appendicitis treated by means laparoscopy between February 2000 and October 2002. In every case we used 3 ports, one umbilical and the other two in both lower quadrants. The appendix was gangrenous in 31patients and in the other 9 was perforated. Appendectomy was performed in an extracorporeal way in most of the cases. Average surgical time was 71 minutes and mean hospital stay was 8.8 days. Intraoperative complications occurred in 8 cases (20%) and postoperative complications were observed in 9 patients (22.5%). Four patients were reoperated (2 open and 2 laparoscopic) in order to drain two abscesses and treat two obstructions. The results of this serie is compared with anothergroup of 40 complicated appendicitis operated in a classic open way in the same period of time. Postoperative complications were less of tenin the laparoscopic group. Oral intake, need for analgesia and hospital stay are more favorable in the laparoscopic group (AU)