Robotic pyeloplasty in children - a pilot study.

INTRODUCTION: Pyeloplasty for congenital hydronephrosis (pyeloureteral junction obstruction, PUJO) can be performed as an open, laparoscopic or robotic procedure in children. The aim of this study was to analyze a pilot cohort of pediatric patients operated robotically. METHODS: A retrospective analysis of the cohort of patients 3 to 18 years of age who underwent primary robotic pyeloplasty between December 2018 (which is when the robotic program was launched at the University Hospital Motol) and June 2021. Patients already operated on for PUJO in the past were excluded. The indication criteria, clinical symptoms, operation time, hospitalization length and complications were evaluated from the medical records. RESULTS: During this period, we operated on 28 children aged 3 to 17 years (median 8); 2 patients were excluded. Of the 26 children analyzed, 6 (23%) were asymptomatic before surgery, 17 (65%) reported pain, 2 (8%) had acute pyelonephritis before the surgery, and 1 (4%) suffered from nephrogenic hypertension. The most common etiology of PUJO was an aberrant vessel in 22 (85%) patients. The time from incision to skin closure was 106 to 201 minutes (median 142 minutes). Patients were hospitalized for 3 to 5 days (median 4) after the surgery and followed up for 1 to 30 months (median 6). Twenty-four of the 26 patients showed regression of the pelvic dilatation according to the postoperative ultrasound scan and no symptoms of PUJO. Seven (27%) had postoperative complications requiring a procedure under general anesthesia (all Clavien-Dindo 3b); of these, 2 were re-operated. CONCLUSION: Robotic pyeloplasty is an alternative to laparoscopic and open surgery. It is a safe and successful (92%) method. We believe that the higher rate of complications (27%) in our cohort is due to the fact that this is a new technique and more experience is needed.

[Chest injuries in polytraumatized children]. / Poranení hrudníku u detí s polytraumatem.

Chest injuries in children are part of polytrauma resulting from high-energy violence, most often caused by traffic accidents. Blunt chest injuries (95%) are significantly more frequent than penetrating injuries (5%). Lung contusion, rib fracture, pneumothorax or haemothorax, are the more common injuries, but tracheobronchial rupture, cardiac or diaphragmatic injuries may also occur. The anterior X-ray image remains the basic examination method for isolated chest injuries. CT trauma scan with a contrast medium is done in polytraumatized children. Blunt injuries of intra-thoracic organs in haemodynamically stable children are treated mostly conservatively (85%) under full monitoring at the ICU. Surgical treatment is necessary in a minority of patients. Mortality and morbidity of patients with chest injury depend on the actual combination of multiple body systems injury. The severity of total injury can be predicted using objective scoring systems (Abbreviated Injury Scale=AIS; Injury Severity Score=ISS). Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to associated head injuries.Key words: multiple trauma thoracic trauma - paediatric lung contusion Injury Severity Score=ISS.

[Duodenal atresia and stenosis]. / Atrézie a stenózy duodena.

BACKGROUND: Analysis of results of surgical treatment of congenital duodenal obstruction at authors' institution. METHODS AND RESULTS: Retrospective analysis of demographic and clinical data collected from hospital and outpatient documentation. Age at operation, sex, type of duodenal obstruction, associated anomalies, type of operation, time of parenteral nutrition, onset of enteral nutrition, early and late complications were recorded and analyzed. Between January 1991 and December 2006, 77 patients (female to male ration 1.6:1) with duodenal obstruction were operated on. Among them there were 48 patients with duodenal atresia, 20 with duodenal membrane and 9 with annular pancreas. The average age at operation for duodenal atresia was 2.15 days, most patients (33 i.e. 43%) were operated on the 1st day of life. The average age at operation for duodenal membrane and annular pancreas was 7, 35 and 5, 8 days. In 33 patients diamond duodenoduodenoanastomosis (Kimuraes procedure) was performed, excision of membrane was the second most frequent operation (22 times). We noted complications in 38 patients, the most common one was sepsis (14 cases) followed by gastroesophageal reflux (6 times). The mortality in our group was 9,1%--7 infants. One death only was caused by a surgical complication--anastomotic leakage. The period of follow-up was 5 months to 16 years. CONCLUSIONS: Congenital duodenal obstruction has, with appropriate surgical treatment, a good long and short-term prognosis. Ninety to 95% of patients survive without significant sequellae. The mortality is low and is caused by associated malformations, the principal cause of death is sepsis.