15 years' experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure® technology. / Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure®.

INTRODUCTION: Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele. MATERIALS AND METHODS: 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years). RESULTS: Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord's plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh. CONCLUSION: Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum.

INTRODUCCION: El varicocele es una dilatación anormal de las venas espermáticas internas del cordón espermático. Su prevalencia se estima en 15% de varones adultos jóvenes. Aunque la mayoría son asintomáticos, en niños y adolescentes el dolor escrotal y la hipotrofia testicular son frecuentes. Existe controversia sobre las indicaciones y el abordaje óptimo para su tratamiento. Presentamos los resultados de nuestra serie de 15 años en la reparación laparoscópica del varicocele pediátrico. MATERIAL Y METODOS: Revisamos 238 pacientes diagnosticados de varicocele y sometidos a corrección laparoscópica desde 2006 hasta 2020. Las variables registradas fueron: edad, síntomas, grado, atrofia testicular, duración de la estancia, complicaciones perioperatorias, recidivas y formación de hidrocele reactivo. El seguimiento medio fue 5,6 años (6 meses-9 años). RESULTADOS: La edad promedio fue 14,1 años. 188 pacientes presentaban varicocele grado III. En 14 casos el varicocele era bilateral. Se observó atrofia testicular en 42% al diagnóstico, de los que el 74% eran mayores de 15 años. Cincuenta y un pacientes refirieron dolor testicular. Todos los pacientes se sometieron al tratamiento laparoscópico. El tiempo operatorio promedio fue 36 min. La mediana de estancia fue 31 horas. La tasa de recidiva fue 2,1%. Cuarenta y tres pacientes desarrollaron hidrocele (18%); pero solo 27 precisaron hidrocelectomía según plicatura de Lord al menos un año poslaparoscopia (11,2%). De los 16 restantes, dos se resolvieron espontáneamente y 14 se mantuvieron estables en el seguimiento medio de siete años. En 7,1% se notificaron parestesias en la cara anterointerna del muslo izquierdo. CONCLUSION: Basándonos en nuestra serie, creemos que la laparoscopia debe considerarse el gold standard en edad pediátrica. La varicocelectomía laparoscópica es técnicamente fácil y rápida, indolora y con una tasa de recurrencia del 1%. Los procedimientos de preservación de los linfáticos podrían reducir al mínimo las tasas de hidrocele reactivo como complicación a largo plazo.

Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure / 15 years’ experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure ® technology

Introducción: El varicocele es una dilatación anormal de las venas espermáticas internas del cordón espermático. Su prevalencia se estima en 15% de varones adultos jóvenes. Aunque la mayoría son asintomáticos, en niños y adolescentes el dolor escrotal y la hipotrofia testicular son frecuentes. Existe controversia sobre las indicaciones y el abordaje óptimo para su tratamiento. Presentamos los resultados de nuestra serie de 15 años en la reparación laparoscópica del varicocele pediátrico. Material y métodos: Revisamos 238 pacientes diagnosticados de varicocele y sometidos a corrección laparoscópica desde 2006 hasta 2020. Las variables registradas fueron: edad, síntomas, grado, atrofia testicular, duración de la estancia, complicaciones perioperatorias, recidivas y formación de hidrocele reactivo. El seguimiento medio fue 5,6 años (6 meses-9 años). Resultados: La edad promedio fue 14,1 años. 188 pacientes presentaban varicocele grado III. En 14 casos el varicocele era bilateral. Se observó atrofia testicular en 42% al diagnóstico, de los que el 74%eran mayores de 15 años. Cincuenta y un pacientes refirieron dolor testicular. Todos los pacientes se sometieron al tratamiento laparoscópico. El tiempo operatorio promedio fue 36 min. La mediana de estancia fue 31 horas. La tasa de recidiva fue 2,1%. Cuarenta y tres pacientes desarrollaron hidrocele (18%); pero solo 27 precisaron hidrocelectomía según plicatura de Lord al menos un año poslaparoscopia (11,2%). De los 16 restantes, dos se resolvieron espontáneamente y 14 se mantuvieron estables en el seguimiento medio de siete años. En 7,1% se notificaron parestesias en la cara anterointerna del muslo izquierdo. Conclusión: Basándonos en nuestra serie, creemos que la laparoscopia debe considerarse el gold standard en edad pediátrica. La varicocelectomía laparoscópica es técnicamente fácil y rápida, indolora y con una tasa de recurrencia del 1%...(AU)

Introduction: Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele. Materials and methods: 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years). Results: Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord’s plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh. Conclusion: Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum.(AU)

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age.

PURPOSE: To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. MATERIALS AND METHODS: Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. RESULTS: Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 L. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism: Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. CONCLUSIONS: Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or age of initial treatment exerts no definite effect on testicular volume improvement r hormonal levels at 18 years of age.

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or ...

Tratamiento conservador del infarto omental / Conservative treatment for omental infarction

El infarto omental es una patología que se presenta cada vez más en los niños debido al mayor uso de los estudios de imagen y al incremento del sobrepeso y la obesidad. Clínicamente se caracteriza por doloren hemiabdomen derecho y puede confundirse con apendicitis, ileítis, adenitis, entre otros cuadros abdominales. Su diagnóstico definitivo requiere la realización de estudios de imagen y su tratamiento puede ser conservador. Presentamos 3 casos de infarto omental con diferente forma de presentación clínica, tratados con éxito de forma conservadora

The omental infarction is a pathology that occurs more and more in children due to the increased use of imaging studies and the increment in overweight and obesity. Clinical presentation is characterized by abdominal pain and can be confused with appendicitis, ileitis, adenitis,a mong other abdominal conditions. Definitive diagnosis requires the performance of radiologic investigations and its treatment may be conservative. We report three cases of omental infarction with different form of clinical presentation, successfully managed conservativel

[Conservative treatment for omental infarction]. / Tratamiento conservador del infarto omental.

The omental infarction is a pathology that occurs more and more in children due to the increased use of imaging studies and the increment in overweigth and obesity. Clinical presentation is characterized by abdominal pain and can be confused with appendicitis, ileitis, adenitis, among other abdominal conditions. Definitive diagnosis requires the performance of radiologic investigations and its treatment may be conservative. We report three cases of omental infarction with different form of clinical presentation, successfully managed conservatively.

Utilización del polietilenglicol con electrólitos en niños menores de 2 años. Dosificación, eficacia y tolerancia. Estudio de 35 pacientes / Polyethylene glycol with electrolytes in patients younger than 2 years old. Dosage, efficacy and tolerance. Study in 35 patients

Objetivo: Evaluar la eficacia, la tolerancia y la dosis óptima de polietilenglicol (PEG) 3350 con electrólitos (PEG+E) en el tratamiento del estreñimiento funcional en niños menores de 24 meses. Pacientes y métodos: Revisamos las historias de niños con estreñimiento funcional (Roma III) tratados con PEG+E. Administramos el PEG mezclado en el biberón o con líquidos, medio sobre al día en menores de 12 meses y 1 sobre al día en mayores de 12 meses. Registramos la dosis inicial y de mantenimiento eficaz, el número de deposiciones/semana y la consistencia de las heces antes y después del tratamiento, la duración y los efectos secundarios. Resultados: Identificamos 35 pacientes (19 niñas y 16 niños), con una media de edad de 13,64 ± 6,10 meses y un peso medio de 11,65 ± 2,72 kg. La duración media del tratamiento fue de 4,6 ± 3,67 meses. La dosis inicial fue de 0,43 ± 0,26 g/kg/día y la dosis de mantenimiento eficaz de 0,57 ± 0,34 g/kg/día. Observamos diferencias estadísticamente significativas en el número de deposiciones/semana y en la consistencia de las heces antes y después del tratamiento. El PEG resolvió el estreñimiento en 34 pacientes (97,14%) a las 12 semanas de tratamiento. Observamos efectos secundarios en 5 pacientes (14,2%), que se resolvieron al ajustar la dosis. Conclusiones: La aceptación, el cumplimiento y la adherencia al tratamiento fueron muy buenos. La dosis efectiva media fue de 0,57 g/kg/día. La mejoría en el número de deposiciones por semana y en la consistencia de las heces fue muy significativa (p <0,001). Los efectos secundarios se resolvieron al ajustar la dosis. El PEG+E es seguro, bien tolerado y altamente eficaz en el tratamiento del estreñimiento funcional en pacientes menores de 24 meses (AU)

Aim: To evaluate the efficacy, tolerance and optimal dose of PEG 3350 with electrolytes for treatment of functional constipation in patients younger than 24 months. Patients and methods: Reviewed the charts patients with functional constipation (Rome III criteria) treated with PEG orally. PEG was administered mixed in the bottle or diluted in fluids, using 1/2 sachet/day in younger than 12 months and 1 sachet/day in older than 12 months. Initial and effective maintenance dose, number of stools per week and stool consistency before and after treatment, duration and the side effects of treatment were recorded. Results: Thirty-five patients (19 female and 16 male) were identified. Mean age was 13.64 ± 6.10 months, mean weight 11.65 ± 2.72 kg. Mean duration of treatment was 4.6 ± 3.67 months. Mean initial dose was 0.43 ± 0.26 g/kg/day and mean effective maintenance dose was 0.57 ± 0.34 g/kg/day. There was a significant difference in the number of stools per week and in the stool consistency score after treatment (p <0.001). PEG relieved constipation in 97.14% of patients (n= 34) after 12 weeks of treatment. Adverse events included 5 patients (14.2%), resolved after adjusting the dose. Conclusions: Acceptance, compliance and adherence of families to treatment was very good. Average effective dose was 0.57 g/kg/day. There was a significant difference in the number of stools per week and in the stool consistency score before versus after treatment (p <0.001). Adverse effects were resolved after adjusting the dose. PEG with electrolytes is safe, well tolerated and highly effective in the management of constipation for patients younger than 24 months (AU)

Tratamiento quirúrgico de los quistes ováricos perinatales / Surgical treatment of perinatal ovarian cysts

Introducción. Los quistes ováricos perinatales se diagnostican cada vez con mayor frecuencia debido al uso rutinario de la ecografía prenatal y neonatal. Objetivo. Presentar nuestra experiencia en el tratamiento quirúrgico de quistes ováricos perinatales. Material y método. Revisión de las historias clínicas de 10 neonatos con diagnóstico de quiste ovárico sometidos a tratamiento quirúrgico en los últimos 20 años. Resultados. Los quistes ováricos se detectaron antenatalmente en8 casos y en edad neonatal en 2. La presentación clínica fue una masa abdominal palpable asintomática en 7 casos, y en 3 la exploración fue normal. El origen ovárico de la masa abdominal se determinó mediante ecografía en 8 pacientes y en 2 se realizó adicionalmente 1 TAC y1 RMN abdominal. La ecografía diferenció 7 quistes complejos y 3 simples. Intraoperatoriamente se evidenciaron 6 quistes complicados, delos cuales 5 fueron torsionados y 1 hemorrágico. El tratamiento quirúrgico consistió en 5 salpingooforectomías, 2 ooforectomías y 3 quistectomías. Conclusiones. La torsión ovárica constituye la complicación más (..) (AU)

Introduction. Actually, the perinatal ovarian cysts are increasingly being diagnosed by prenatal and neonatal ultrasound. Objective. We reported our experience in the surgical management of perinatal ovarian cysts. Patients and methods. We have reviewed the clinical charts of 10female newborns diagnosed of ovarian cysts who underwent surgical management in our hospital from 1989 to 2009. Results. The ovarian cysts were diagnosed antenatally in 8 cases and period neonatal in 2 cases. The clinical presentation was asymptomatic abdominal mass in (..) (AU)

Hernia de Amyand infantil presentándose como escroto agudo / Infantile amyand's hernia presenting as acute scrotum

La hernia de Amyand es una patología de presentación excepcional en los niños y se define por la presencia del apéndice inflamado dentro de una hernia inguinal. Puede manifestarse clínicamente como escroto agudo, linfadenitis inguinal o hernia estrangulada. El tratamiento esquirúrgico y aunque se describen diversos abordajes, la apendicectomíay herniotomía vía inguinal se considera de elección (AU)

Amyand´s hernia is a condition of exceptional presentation in children and is defined by the presence of inflamed appendix inside a inguinalhernia. It may manifest clinically as acute scrotum, inguinal lymphadenitis or strangulated hernia. The treatment is surgical and although several approaches are described, appendectomy with herniotomy byinguinal approach is considered of choice (AU

[Surgical treatment of perinatal ovarian cysts]. / Tratamiento quirürgico de los quistes ováricos perinatales.

INTRODUCTION: Actually, the perinatal ovarian cysts are increasingly being diagnosed by prenatal and neonatal ultrasound. OBJECTIVE: We reported our experience in the surgical management of perinatal ovarian cysts. Patients and methods. We have reviewed the clinical charts of 10 female newborns diagnosed of ovarian cysts who underwent surgical management in our hospital from 1989 to 2009. RESULTS: The ovarian cysts were diagnosed antenatally in 8 cases and period neonatal in 2 cases. The clinical presentation was asymptomatic abdominal mass in 7 cases. Ultrasound confirmed the ovarian mass in 8 patients. CT scan and MRI were necessary for confirm suspected diagnosis in two patients. Ultrasonography showed 7 complex cysts and 3 simple cysts. Surgery of the complicated cysts revealed ovarian torsion in 5 cases and 1 hemorragic cyst. At surgery, 5 patients underwent salpingooophorectomy, 2 patients needed oophorectomy and in 3 cases only cystectomy were necessary. CONCLUSION: The ovarian torsion is the most common complication and the cause of loss of the ovary. The neonatal ovarian cysts greater than 5 centimetres, symptomatic cysts, complex cysts and cysts persisting for more than 6 months need surgical intervention.

[Infantile Amyand's hernia presenting as acute scrotum]. / Hernia de amyand infantil presentándose como escroto agudo.

Amyand's hernia is a condition of exceptional presentation in children and is defined by the presence of inflamed appendix inside a inguinal hernia. It may manifest clinically as acute scrotum, inguinal lymphadenitis or strangulated hernia. The treatment is surgical and although several approaches are described, appendectomy with herniotomy by inguinal approach is considered of choice.

Colecistectomía en niños: nuestra experiencia con 37 casos / Cholecystectomy in children: our experience with 37 cases

Introducción. Las indicaciones de colecistectomía en niños han experimentado un cambio gradual y el número de colecistectomías ha incrementado, considerando a la colecistectomía laparoscópica de elección. Objetivo. Determinar las indicaciones, tipo de colecistectomía, tiempo operatorio, estancia hospitalaria, complicaciones, procedimientos concomitantes y hallazgos anatomopatológicos. Material y método. Estudio descriptivo. Revisión de 37 historiasclínicas de pacientes colecistectomizados. Resultados. Evaluamos 37 pacientes (16 niños y 21 niñas) con edad media 9 años. Las indicaciones fueron: litiasis biliar 33, colecistitis aguda 2, tumor de vesícula 1 y vesícula tabicada 1. El 68% fueron colecistectomías laparoscópicas (tiempo operatorio: 84 minutos y estancia hospitalaria: 8 días) y el 32% abiertas( tiempo operatorio: 103 minutos y estancia hospitalaria: 14 días). Como complicación laparoscópica hubo una apertura accidental del conducto hepático común. Procedimientos concomitantes fueron: 9 colangiografías intraoperatorias, 5 biopsiashepáticas, 3 esplenectomías, 2 apendicectomías, entre otros. La anatomía patológica mostró: colecistitis litiásica crónica 30, vesícula normal3, colecistitis crónica 1, adenocarcinoma de vesícula 1, cambios inflamatorios crónicos 2. Conclusiones. La principal indicación de colecistectomía fue lalitiasis biliar. La mayoría fueron colecistectomías laparoscópicas con tiempo operatorio y estancia hospitalaria más cortos. La colangiografía intraoperatoria, biopsia hepática y esplenectomía fueron los procedimientos concomitantes más frecuentes. El hallazgo anatomopatológico principal fue la colecistitis litiásica crónica (AU)

Introduction. The indications of cholecystectomy in children had undergone a gradual change and the number of cholecystectomies had increased, considering to the laparoscopic cholecystectomy of election. Objective. To determine the indications, type of cholecystectomy, operative time, hospital stay, associate complications, concomitant procedures and pathologic findings. Material and method. Descriptive study. Revision of 37 clinicalhistories of cholecystectomics patients. Results. We evaluate 37 patients (16 boys and 21 girls) with age average 9 years. The indications were: cholelithiasis 33, acute cholecystitis 2, gallbladder tumor 1 and septate gallbladder 1. 68% were laparoscopic cholecystectomies (operative time: 84 minutes and hospital stay:8 days) and 32% open cholecystectomies (operative time: 103 minutes and hospital stay: 14 days). Laparoscopic complication was one unexpectec opening of common hepatic duct. Concomitant procedures were:9 intraoperative cholangiography, 5 hepatic biopsies, 3 splenectomies,2 appendectomies. The pathologic anatomy showed: chronic lithiasiccholecystitis 30, normal gallbladder 3, chronic cholecystitis 1, gallbladder adenocarcinoma 1, chronic inflammatory changes 2. Conclusions. The main indication of cholecystectomy was thecholelithiasis. The majority were laparoscopic cholecystectomies with shorter operative time and shorter hospital stay. The intraoperative cholangiography, hepatic biopsy and splenectomy were the more frequent concomitant procedures. Main pathologic finding was the chronic lithiasic cholecystitis (AU)

Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism.

OBJECTIVE: To clarify the role of peritoneography in assessing the patency of processus vaginalis (PV) in pediatric patients diagnosed with cryptorchidism. MATERIALS AND METHODS: We designed a prospective clinical trial to evaluate the patency of PV in boys presenting cryptorchidism. Herniography was performed in 310 prepubertal boys. Data about the morphology of PV was compared with operative findings in those surgically treated patients. Retractile and ectopic testes were excluded from the study. RESULTS: Of the 376 undescended testes (310 patients), 281 cases were associated with an obliterated PV. Herniography revealed 95 cases of open PV in cryptorchid boys. The 244 normally descended testes had associated patent processus vaginalis in only 31 cases. CONCLUSIONS: Herniography is the most relevant procedure for accurate diagnosis of persistent PV. The persistence of PV was significantly more frequent when the position of the testes is more cranial. The incidence of an open PV decreases with age.

Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism

OBJECTIVE: To clarify the role of peritoneography in assessing the patency of processus vaginalis (PV) in pediatric patients diagnosed with cryptorchidism. MATERIALS AND METHODS: We designed a prospective clinical trial to evaluate the patency of PV in boys presenting cryptorchidism. Herniography was performed in 310 prepubertal boys. Data about the morphology of PV was compared with operative findings in those surgically treated patients. Retractile and ectopic testes were excluded from the study. RESULTS: Of the 376 undescended testes (310 patients), 281 cases were associated with an obliterated PV. Herniography revealed 95 cases of open PV in cryptorchid boys. The 244 normally descended testes had associated patent processus vaginalis in only 31 cases. CONCLUSIONS: Herniography is the most relevant procedure for accurate diagnosis of persistent PV. The persistence of PV was significantly more frequent when the position of the testes is more cranial. The incidence of an open PV decreases with age.

Seudoquiste pancreático en dos pacientes menores de 24 meses / Pancreatic pseudocysts in two patients under 24 months of age

El seudoquiste pancreático se produce como consecuencia de un proceso inflamatorio y/o traumático; su contenido es estéril y rico en enzimas pancreáticas. Habitualmente, debe sospecharse ante una elevación persistente de la amilasa, puesto que suele ser asintomático, salvo complicaciones. El 40-50% de los seudoquistes se resuelven espontáneamente, y deben drenarse los mayores de 6 cm y/o que persistan más de seis semanas, dado el riesgo de complicaciones. Presentamos los casos de dos pacientes menores de 24 meses con seudoquistes pancreáticos secundarios a pancreatitis agudas: el primero con una evolución típica y el segundo con una elevación aislada de la lipasa

Pancreatic pseudocysts are produced as a result of an inflammatory process or trauma, and contain a sterile, amylase-rich fluid. They should be suspected in the case of persistently increased amylase levels, as they are asymptomatic unless complications develop. Pseudocysts resolve spontaneously in 40%- 50% of cases. Those measuring more than 6 cm and/or persisting for more than 6 weeks are at high risk for the development of further complications and therefore require drainage. We describe two cases of pancreatic pseudocysts secondary to acute pancreatitis in two patients under 24 months of age. The first one exhibited the typical course, whereas, in the second one, an isolated increase in lipase was detected

Endoscopia digestiva intervencionista en Pediatría / Digestive interventional endoscopy in pediatrics

La endoscopia pediátrica se ha trasformado lenta y progresivamente de una técnica puramente diagnóstica en una técnica terapéutica de primer orden. Todo ello gracias a la evolución tecnoló- gica y a la miniaturización del equipamiento. Estos procedimientos invasivos son realizados con anestesia general y representan una pequeña intervención quirúrgica, por lo que debe protocolizarse el uso del consentimiento informado. Muchos de ellos son realizados habitualmente en las unidades de endoscopia pediátrica: extracción de cuerpos extraños, dilatación esofágica, gastrostomía endoscópica percutá- nea, polipectomía; para otras técnicas existen pocas indicaciones: esclerosis de varices esofágicas, hemostasia en hemorragia digestiva, achalasia, y otras, por su excepcionalidad, como la colangiopancreatografía endoscópica retrógrada, son realizadas en colaboración con los endoscopistas de adultos que poseen una mayor experiencia en este campo. La endoscopia terapéutica es una técnica segura, efectiva y posible de realizar en la mayoría de las unidades de endoscopia pediá- trica (AU)

With development and improvement of the endoscope equipment, the paediatric endoscopy is developing from the diagnosis endoscopy to the interventional endoscopy. It is realized under general anaesthesia as a minimal invasive surgery and it is necessary to regularize the legal requirements. The main acts are realized in a current way in paediatrics endoscopy units: extraction of foreign body, dilation of oesophageal strictures, gastrostomy, polipectomy. Other indications are less frequent: injection sclerotherapy, haemostasis of upper GI bleeding or endoscopic achalasia treatment. The biliary and/or pancreatic lesions is rare in children, in these cases, interventional endoscopy is usually done with the collaboration of the adult endoscopists, with a far experience. Interventional endoscopy is a safe and effective technique that can be performed in all the pediatrics endoscopy units (AU)

Endobronchial tuberculous granuloma in children.

Endobronchial tuberculosis is rare in children, in whom it is usually a complication of primary tuberculosis. Endobronchial involvement may adopt several forms, with granuloma being infrequent. Here we report on 10 cases of endobronchial tuberculous granuloma diagnosed and treated in our Paediatric Surgery Service between 1991 and 2004. In 2 cases the presentation was acute and constituted the first manifestation of TB; the remaining patients were undergoing treatment or had been treated for primary TB, and presented with clinical symptoms or radiological signs that led us to suspect endobronchial involvement. In all cases the granuloma was removed by bronchoscopy. Patients received conventional medical TB treatment, with corticoids for 4 weeks following granuloma removal. The clinical course was favourable in all cases and on follow-up we saw no complications. Endobronchial tuberculous granuloma should be borne in mind in children with symptoms or signs of airway obstruction and especially during the course of tuberculosis treatment.

[Digestive interventional endoscopy in pediatrics]. / Endoscopia digestiva intervencionista en pediatría.

With development and improvement of the endoscope equipment, the paediatric endoscopy is developing from the diagnosis endoscopy to the interventional endoscopy. It is realized under general anaesthesia as a minimal invasive surgery and it is necessary to regularize the legal requirements. The main acts are realized in a current way in paediatrics endoscopy units: extraction of foreign body, dilation of oesophageal strictures, gastrostomy, polipectomy. Other indications are less frequent: injection sclerotherapy, haemostasis of upper GI bleeding or endoscopic achalasia treatment. The biliary and/or pancreatic lesions is rare in children, in these cases, interventional endoscopy is usually done with the collaboration of the adult endoscopists, with a far experience. Interventional endoscopy is a safe and effective technique that can be performed in all the pediatrics endoscopy units.

Formación de fitobezoar en divertículo de Meckel / Formation of phytobezoar within Meckel's diverticulum

El divertículo de Meckel (DM) es la malformación congénita del tracto gastrointestinal más frecuente, presentándose en un 2 por ciento de la población general. Sólo un 4-6 por ciento de las personas con DM desarrollarán síntomas a lo largo de su vida. Las formas clínicas de presentación más comunes son la hemorragia digestiva, la obstrucción intestinal y la diverticulitis. La formación de un fitobezoar en el interior de un DM es excepcional, con muy pocos casos recogidos en la literatura. Presentamos el caso clínico de un niño de 13 años con un cuadro clínico de dolor abdominal y vómitos. Con la sospecha diagnóstica de apendicitis aguda se realizó una laparotomía encontrándose un fitobezoar dentro de un gran DM. Son factores predisponentes para la formación de un fitobezoar la ingestión de grandes cantidades de alimentos ricos en fibra y la existencia de una zona intestinal hipoperistáltica que favorezca la impactación del bolo alimenticio (AU)

Handlebar hernia in children: two cases and review of the literature.

Localised traumatic abdominal hernias are rare. Most such hernias are due to the direct impact of the handlebars of a bicycle or motorcycle, with 20 cases reported to date in the English language literature, 12 in children. We report two new cases of handlebar hernia, in children aged 6 and 10 years. In both cases, physical examination revealed an area of contusion and bruising in the lower abdomen. However, the muscle defect was detected during the first examination in only one of the patients, and not until several days later in the other patient. Abdominal ultrasonography proved useful for diagnosis in both patients. Early surgical correction is necessary to prevent possible complications. This type of hernia should be borne in mind when evaluating children who have suffered abdominal trauma in a bicycle accident.