Resultados de la utilización de antirreflujo laparoscópico para la prevención de los episodios de apnea, bradicardia y desaturación / Results of the use of laparoscopic anti-reflux procedure for the prevention of episodes of apnea, bradycardia and desaturation

En 1986, el Instituto Americano de la Salud definió los ApparentLife-Threatenig Events (ALTEs) como “aquellos episodios escalofriantes para el observador que se caracterizan por una combinación de apneas (centrales u obstructivas), cambios en la coloración (cianosis, palidez, congestiva) y cambios marcados en el tono muscular (hipotonía), asfixia o atragantamiento”. A pesar de que su exacta etiología sigue siendo un misterio, son muchos los centros que relacionan los ALTE con la enfermedad por reflujo gastroesofágico (ERGE), recomendándose, casi sistemáticamente, tratamiento médico de la ERGE a los pacientes con ALTE. Sin embargo hay muy pocos trabajos en la literatura que muestren la eficacia del tratamiento quirúrgico de los pacientes con ALTE y ERGE. Se realizó una revisión retrospectiva entre2000 y 2008 de aquellos pacientes con ALTE a los que se les realizó técnica antirreflujo gastroesofágico. El estudio incluyó la realización de estudio baritado con técnica de sifonaje, pH metría y endoscopia laríngea, digestiva y (..) (AU)

In 1986 the National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring defined the Apparent Life Threatening Events (ALTEs) as those frightening episodes for the observer which are determined by a combination of apnea (centralor obstructive), changes in colour (cianosis, congestive pallor) and marked changes in muscular tone, asphyxia. Despite the fact that its cause still remains unknown, many centres relate ALTE with gastroesophageal reflux disease (GERD) and therefore recommend medical treatment of GERD to those patients with ALTE. However there are very few articles that proof the efficacy of surgical treatment in patients with ALTE and GERD. We carried out a retrospective review between2000 and 2008 of those patients with ALTE who underwent a laparoscopic antirreflux procedure. The study included the realization of contrast x-ray, pHmetry and laryngeal, digestive and bronchial endoscopy. During this period antirreflux (with either Nissen or D’Or technique) procedure was carried out (.. ) (AU)

Testículo no palpable: resultados a corto, medio y largo plazo con la utilización de técnica exclusivamente laparoscópica / Nonpalpable testes: Short, middle and long-term results with the use of an exclusively laparoscopic technique

El testículo no palpable (TNP) tiene una incidencia del 20% y una importancia que deriva de la posibilidad de degeneración, menor función reproductora y endocrinológica. En los últimos años, el desarrollo de la cirugía minimamente invasiva (CMI) ha permitido un mejor diagnóstico y otro arma terapéutica para utilizar en estos casos. Hemos realizado un estudio retrospectivo que incluyó todos aquellos pacientes a los que se les realizó disección, descenso y fijación del teste mediante técnica exclusivamente laparoscópica en el periodo comprendido entre 1998 y 2008. Se revisaron un total de 156 pacientes, lo que ha supuesto la evolución de 179 unidades testiculares (UT). En 65 ocasiones el teste se situó en orificio inguinal interno o región proximal del canal inguinaly en 68 casos el teste presentó una situación intra-abdominal pura. Se (..) (AU)

Non palpable testis (NPT) has an incidence of 20% and clinical relevance derived from the possibility of malignant degeneration, fertility disfunction. Recently the development of minimally invasive surgery(MIS) allowed more accurate diagnosis and has become a new therapeutic tool. We carried out a retrospective study that included all the patients who underwent laparoscopic orchidopexy between 1998 and 2008.156 patients were reviewed, which represent 179 testis units (TU).In 65 occasions the testis was placed in the internal inguinal orifice and in 68 occasions the testis was purely intraabdominal. Testicular atrophy was evidenced in 32 cases (7%). Laparoscopic orchidopexy was (..) (AU)

[Nonpalpable testes: short, middle and long-term results with the use of an exclusively laparoscopic technique]. / Testículo no palpable: resultados a corto, medio y largo plazo con la utilización de técnica exclusivamente laparoscópica.

Non palpable testis (NPT) has an incidence of 20% and clinical relevance derived from the possibility of malignant degeneration, fertility disfunction. Recently the development of minimally invasive surgery (MIS) allowed more accurate diagnosis and has become a new therapeutic tool. We carried out a retrospective study that included all the patients who underwent laparoscopic orchidopexy between 1998 and 2008. 156 patients were reviewed, which represent 179 testis units (TU). In 65 occasions the testis was placed in the internal inguinal orifice and in 68 occasions the testis was purely intraabdominal. Testicular atrophy was evidenced in 32 cases (7%). Laparoscopic orchidopexy was carried out in 152 TUs except in those that developed agenesia or atrophy-. A prothesis was placed after removing the remaining testis. 18 cases required a FowlerStephens. Inmediate postoperative complications were oedema (18 cases) and escrotal hematoma (9 cases). Testicular atrophy appeared in 12 cases after descent and in 3 cases after the first stage of the FowlerStephens. In 8 cases it was necessary to proceed to a second descent because of ascent after surgery. Laparoscopic orchidopexy has proved to be an efficient technique for the management of NPT which unifies the advantages of MIS and the outcomes of the conventional opened approach.

[Results of the use of laparoscopic anti-reflux procedure for the prevention of episodes of apnea, bradycardia and desaturation]. / Resultados de la utilización de antirreflujo laparoscópico para la prevención de los episodios de apnea, bradicardia y desaturación.

In 1986 the National Institutes of Health Consensus Developement Conference on Infantile Apnea and Home Monitoring defined the Apparent Life Threatening Events (ALTEs) as those frightening episodes for the observer which are determined by a combination of apnea (central or obstructive), changes in colour (cianosis, congestive pallor) and marked changes in muscular tone, asphyxia. Despite the fact that its cause still remains unknown, many centres relate ALTE with gastroesophageal reflux disease (GERD) and therefore recommend medical treatment of GERD to those patients with ALTE. However there are very few articles that proof the efficacy of surgical treatment in patients with ALTE and GERD. We carried out a retrospcective review between 2000 and 2008 of those patients with ALTE who underwent a laparoscopic antirreflux procedure. The study included the realization of contrast x-ray, pHmetry and laryngeal, digestive and bronchial endoscopy. During this period antirreflux (with either Nissen or D'Or technique) procedure was carried out by laparoscopic approach in the patients with ALTE and GERD. Median of gestational age was 32 week, mean birth weight was 1800 g, mean age at the time pof surgery was 217 days (range 32-410). All these patients had previously presented 3 or more events of ALTE and had been treated medically for GERD. pHmetric studies were no conclusive, In 6 out of 15 patients had different grades of arithemoid oedema. All the patients presented gastroesophageal reflux (grades II-III) in the constrast x-ray. Mean follow up was 1258 days. 7 from 8 patients presented clear improvement. Morbimortality derived from surgery was null.

Tiroidectomía profiláctica en el síndrome de neoplasia endocrina múltiple / Prophylactic thyroidectomy in multiple endocrine neoplasia syndrome

La neoplasia endocrina múltiple (MEN) 2A se caracteriza por la asociación de carcinoma medular de tiroides (CMT), feocromocitomae hiperparatiroidismo, ser hereditaria y tener una transferencia autosómica dominante. La identificación del protooncogen RET en 1993 ha cambiado el pronóstico de esta enfermedad. El objetivo del presente trabajo es realizar un estudio retrospectivo de los pacientes diagnosticados de síndrome MEN2a en nuestro centro en los últimos 7 años para establecer la edad más apropiada para la cirugía. Presentamos 10 casos diagnosticados de MEN2a entre 1,5 y 11años; estos se han intervenido con una edad media a la cirugía de 6,4años.En el preoperatorio se realiza ecografía cervical, determinación decalcitonina, catecolaminas y metanefrinas en orina. El tratamiento quirúrgico consiste en todos los casos en tiroidectomía total y en casos seleccionados (mayores de 5 años) vaciamiento (..) (AU)

Multiple endocrine neoplasia (MEN) 2a consists on medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The identification of the RET proto-oncogene in 1993 has changed the prognosis of the disease. We have retrospectively studied the patients diagnosed of MEN 2a in our centre for the last 7 years in order to establish the most adequate age to undergo surgery. We present ten patients diagnosed with MEN 2a, whose ages ranged from 1’5 to 11 years old. Mean age at time of operation: 6,4 years An ultrasound study, calcitonin determinations and cathecholamines and urinary metanephrine levels were obtained before surgery. The surgical treatment is based on total total thyroidectomy, inselected cases lymph node resection in the central zone lf the neck. The most frequent RET mutation is the one affecting codon 634(exon 10), which was found in children. Both of them had an alterationin codon 611 (exon11). No complications appeared after surgery and hospital discharge took place in the 2nd-4th day after surgery. Pathological findings were medullary thyroid microcarcinoma (..) (AU)

[Short term evaluation of transanal pull-through with automatic suture]. / Valoración a corto plazo del descenso transanal con sutura automática.

For the last ten years many centres have adopted transanal pull-through (TP) as the first choice technique for the treatment of Hirschsprung's Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5-months-old to 5-years-old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly, a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place between the fourth and the tenth postoperative day. Oral feeding was started in the 2nd-7th postoperative day. Medium term outcomes show a single case of complications: a patient Developer a skin stricture due to the low suture, which has been treated conservatively with rectal dilatations. Patients older than three (42.8%) are continent, although one presents occasional fecal soiling. The rest of the children present normal stools for their age. Automatic suture involves several advantages such as celerity and safety. We ought to point out that this method should not be used in children under 5 months because the autosuture size does not allow to do so.

Valoración a corto plazo del descenso transanal con sutura automática / Short term evaluation of transanal pull-through with automatic suture

En los últimos 10 años el descenso transanal (DT) se ha popularizado en muchos centros como técnica de elección para el tratamiento de la enfermedad de Hirschsprung (EH). Presentamos nuestra experiencia de DT con autosutura, inédita en la literatura. En nuestro programa de tratamiento de la EH aplicamos el DT para las formas de afectación recto-sigmoidea de fácil manejo ambulatorio. Hemos practicado un estudio retrospectivo de la evolución de 7pacientes con edades comprendidas entre 5 meses y 5 años a los que se les ha realizado un descenso transanal con autosutura en los dos últimos años. Nuestra técnica se desarrolla en dos pasos. En un primer tiempo practicamos una biopsia laparoscópica, en el segundo tiempo se realiza un descenso endorrectal según la técnica de De La Torre, modificado con autosutura circular de 21mm. En ningún caso se han precisado reintervenciones. Nuestros pacientes empezaron a realizar deposiciones entre el 2º y 4º día postoperatorio (DPO). La complicación más frecuente fue distensión abdominal en (..)

For the last ten years many centres have adopted transanal pull-through(TP) as the first choice technique for the treatment of Hirschsprung’s Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5 months old to 5 years old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly,a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place (..) (AU)

[Prophylactic thyroidectomy in multiple endocrine neoplasia syndrome]. / Tiroidectomía profiláctica en el síndrome de neoplasia endocrina múltiple.

Multiple endocrine neoplasia (MEN) 2a consists on medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The identification of the RET proto-oncogene in 1993 has changed the prognosis of the disease. We have retrospectively studied the patients diagnosed of MEN 2a in our centre for the last 7 years in order to establish the most adequate age to undergo surgery. We present ten patients diagnosed with MEN 2a, whose ages ranged from 1.5 to 11 years old. Mean age at time of operation: 6,4 years An ultrasound study, calcitonin determinations and cathecholamines and urinary metanephrine levels were obtained before surgery. The surgical treatment is based on total total thyroidectomy, in selected cases lymph node resection in the central zone lf the neck. The most frequent RET mutation is the one affecting codon 634 (exon 10), which was found in children. Both of them had an alteration in codon 611 (exon11). No complications appeared after surgery and hospital discharge took place in the 2nd-4th day after surgery. Pathological findings were medullary thyroid microcarcinoma (MTMC) in 3 out of 10 patients, calcitonin preoperative tests were high in one of them. No tumoral cells were found in the lymph nodes. During the follow up period, 9 out of 10 from the operated patients, maintained normal calcitonin, CEA, PTH, calcium, cathecholamines and urinary metanephrine levels. Since there are 3 cases of MTC in patients between 3 and 6 years old, and diagnostic test data are not conclusive, we thoroughly recommend prophyilactic thyroidectomy at early ages, from 3 to 4 years old.

[Endoscopic treatment of recurrent tracheoesophageal fistula]. / Tratamiento endoscópico de la fístula traqueoesofágica recurrente.

UNLABELLED: Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopic treatment with fibrin glue and diathermia. MATERIAL AND METHODS: A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to 4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-up time vary from 1 to 13 years and the number of sessions was limited to 3 per patient. RESULTS: Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no major complications. DISCUSSION: Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE.

Tratamiento endoscópico de la fístula traqueoesofágica recurrente / Endoscopic treatment of recurrent tracheoesophageal fistula

Una de las complicaciones más graves del tratamiento de la Atresia de Esófago (AE) con fístula traqueal, es la repermeabilización (RTE)de la misma. Presentamos los resultados a largo plazo de nuestra técnica de tratamiento broncoscópico con Adhesivo de Fibrina y Diatermia. Material y Métodos. Se presenta un estudio retrospectivo de 10pacientes con RTE tratados entre 1993 y 2006, en enfermos de 14 días a 2 años, cuatro de ellos de otros centros Un paciente asoció una fístula congénita superior, desapercibida en la intervención abierta. Se utilizó un procedimiento broncoscópico, utilizando instrumentación rígida. La fístula fue sellada con Adhesivo de Fibrina y en los últimos 7 se asoció al procedimiento Diatermia previa, con un catéter ureteral. En todos los casos se realizó seguimiento clínico y radiológico. Controlendoscópico en 6. El seguimiento incluye de 1 a 13 años y número de sesiones se limitó a 3 por paciente. Resultados. Es evidenció cierre de la fístula en 9 casos (90%), que precisaron un total de 15 sesiones (Media: 1,5). El grupo de asociación con Diatermia 70% necesitó 9 (Media: 1,2) No se presentaron complicacionesgraves. Conclusiones. La reparación quirúrgica de RTE comporta a menudo serias complicaciones, por lo algunos grupos han intentado desarrollar diferentes técnicas broncoscópicas, con diferentes materiales. La revisión de la literatura no aporta una opción concluyente, pues son pacientes aislados sin evolución a largo plazo. A la vista del presente estudio opinamos que la aplicación de Diatermia y Adhesivo de Fibrina debe considerarse en el tratamiento de la RTE, como opción de inicio (AU)

Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopictreatment with fibrin glue and diathermia. Material and methods: A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue ; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-uptime vary from 1 to 13 years and the number of sessions was limited to3 per patient. Results: Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no majorcomplications. Discussion: Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE (AU)