[Analysis of the comorbidities and role of laparoscopy in recurrent abdominal pain]. / Análisis de las comorbilidades y papel de la laparoscopia en el dolor abdominal recurrente.

INTRODUCTION AND OBJECTIVES: Recurrent abdominal pain is defined as > 3 episodes of abdominal pain accompanied by affectation of the daily activity, during > 3 months. Our objective is to analyze the role of diagnostic and/or therapeutic laparoscopy. MATERIAL AND METHODS: A descriptive, retrospective study from 2004 to 2016. Patients: <14 years with DAR who underwent laparoscopy. Variables: age, sex, history, surgical findings, histology and follow-up. RESULTS: 55 patients. Mean age: 10.7 years. Female 63, 6%. Probability of allergic comorbidity: 27.27% [16.138-40.962] (CI 95%). Probability of subsequent psychological comorbidity: 12.72% [5.27 -24.48] (95% CI). Histological changes 31/55 (56.36%): lymphoid nodular hyperplasia 10/31, appendicular inflammation 7/31, fecalite 3/31, carcinoid tumor 1/31, appendicular fibrosis 3/31, Meckel diverticulum 1/31, association of several of the above 8/31. Macroscopic alterations 31/55 (56.36%): appendicular pathology 10/31, adhesions 5/31, lymph nodes 2/31, ileitis 2/31, tubal cysts 1/31, Meckel 1/31 diverticulum, several of the previous ones 10/31. Remission of symptoms: 30/55 (54.54%). In some cases, with partial improvement (4/55) or persistence of symptoms (21/55), organic and/ or psychological cause was demonstrated (16/25). CONCLUSIONS: Recurrent abdominal pain seems to have a significant association with an allergic or psychological history. Exploratory laparoscopy is a useful diagnostic and therapeutic technique.

INTRODUCCION Y OBJETIVOS: El dolor abdominal recurrente (DAR) supone > 3 episodios de dolor abdominal acompañados de afectación de la actividad diaria, durante > 3 meses. Nuestro objetivo es analizar el papel de la laparoscopia diagnóstica y/o terapéutica. MATERIAL Y METODOS: Estudio descriptivo, retrospectivo desde 2004 hasta 2016. Pacientes < 14 años con DAR a los que se les practicó laparoscopia. Variables: edad, sexo, antecedentes, hallazgos quirúrgicos, histología y evolución. RESULTADOS: 55 pacientes. Media de edad: 10,7 años. Mujeres 63, 6%. Probabilidad de comorbilidad alérgica: 27,27% [16,138- 40,962] (I.C 95%). Probabilidad de comorbilidad posterior psicológica: 12,72% [5,27 -24,48] (I.C 95%). Alteraciones histológicas 31/55 (56,36%): hiperplasia nodular linfoide 10/35, inflamación apendicular 7/31, fecalito 3/31, tumor carcinoide 1/31, fibrosis apendicular 3/31, divertículo de Meckel 1/31, asociación de varios de los anteriores 8/31. Alteraciones macroscópicas 31/55 (56,36%): patología apendicular 10/31, bridas 5/31, adenopatías 2/31, ileítis 2/31, quistes tubáricos 1/31, divertículo de Meckel 1/31, varios 10/31. Remisión: 30/ 55 (54,54%). En algunos casos con mejoría parcial (sin desaparición completa del dolor) (4/55) o persistencia de síntomas (21/55) se demostró causa orgánica y/o psicológica (16/25). CONCLUSIONES: El dolor abdominal recurrente parece presentar una asociación significativa con antecedentes alérgicos o psicológicos. La laparoscopia exploradora supone una técnica diagnóstica y terapéutica.

Análisis de las comorbilidades y papel de la laparoscopia en el dolor abdominal recurrente / Analysis of the comorbidities and role of laparoscopy in recurrent abdominal pain

Introducción y objetivos. El dolor abdominal recurrente (DAR) supone > 3 episodios de dolor abdominal acompañados de afectación de la actividad diaria, durante > 3 meses. Nuestro objetivo es analizar el papel de la laparoscopia diagnóstica y/o terapéutica. Material y métodos. Estudio descriptivo, retrospectivo desde 2004 hasta 2016. Pacientes < 14 años con DAR a los que se les practicó laparoscopia. Variables: edad, sexo, antecedentes, hallazgos quirúrgicos, histología y evolución. Resultados. 55 pacientes. Media de edad: 10,7 años. Mujeres 63, 6%. Probabilidad de comorbilidad alérgica: 27,27% [16,138- 40,962] (I.C 95%). Probabilidad de comorbilidad posterior psicológica: 12,72% [5,27 -24,48] (I.C 95%). Alteraciones histológicas 31/55 (56,36%): hiperplasia nodular linfoide 10/35, inflamación apendicular 7/31, fecalito 3/31, tumor carcinoide 1/31, fibrosis apendicular 3/31, divertículo de Meckel 1/31, asociación de varios de los anteriores 8/31. Alteraciones macroscópicas 31/55 (56,36%): patología apendicular 10/31, bridas 5/31, adenopatías 2/31, ileítis 2/31, quistes tubáricos 1/31, divertículo de Meckel 1/31, varios 10/31. Remisión: 30/ 55 (54,54%). En algunos casos con mejoría parcial (sin desaparición completa del dolor) (4/55) o persistencia de síntomas (21/55) se demostró causa orgánica y/o psicológica (16/25). Conclusiones. El dolor abdominal recurrente parece presentar una asociación significativa con antecedentes alérgicos o psicológicos. La laparoscopia exploradora supone una técnica diagnóstica y terapéutica (AU)

Introduction and objectives. Recurrent abdominal pain is defined as > 3 episodes of abdominal pain accompanied by affectation of the daily activity, during > 3 months. Our objective is to analyze the role of diagnostic and / or therapeutic laparoscopy. Material and methods. A descriptive, retrospective study from 2004 to 2016. Patients: < 14 years with DAR who underwent laparoscopy. Variables: age, sex, history, surgical findings, histology and follow-up. Results. 55 patients. Mean age: 10.7 years. Female 63, 6%. Probability of allergic comorbidity: 27.27% [16.138-40.962] (CI 95%). Probability of subsequent psychological comorbidity: 12.72% [5.27 -24.48] (95% CI). Histological changes 31/55 (56.36%): lymphoid nodular hyperplasia 10/31, appendicular inflammation 7/31, fecalite 3/31, carcinoid tumor 1/31, appendicular fibrosis 3/31, Meckel diverticulum 1/31, association of several of the above 8/31. Macroscopic alterations 31/55 (56.36%): appendicular pathology 10/31, adhesions 5/31, lymph nodes 2/31, ileitis 2/31, tubal cysts 1/31, Meckel 1/31 diverticulum, several of the previous ones 10/31. Remission of symptoms: 30/55 (54.54%). In some cases, with partial improvement (4/55) or persistence of symptoms (21/55), organic and/ or psychological cause was demonstrated (16/25). Conclusions. Recurrent abdominal pain seems to have a significant association with an allergic or psychological history. Exploratory laparoscopy is a useful diagnostic and therapeutic technique (AU)

[Morgagni-Larrey anterior diaphragmatic hernias. Review of 13 cases]. / Hernias diafragmáticas anteriores. Revisión de 13 casos.

OBJECTIVE: A review of anterior congenital diaphragmatic hernias (CDH) treated at our center, analysis of our experience and evolution in the surgical technique in pediatric patients over the last 15 years. MATERIAL AND METHODS: A retrospective descriptive study of patients of our center with anterior CDH (Morgagni, Larrey and Morgagni-Larrey) between 2000 and 2015, through a systematic review of clinical records. The studied variables were: age at diagnosis, age at treatment, diagnostic methods, symptoms, surgical technique, evolution, complications and relapses. Posterior CDH (Bochdalek) and patients older than 14 years old were excluded. RESULTS: 13 patients (8 females) with anterior diaphragmatic hernia. Mean age at diagnosis was 29.4 months (range fetal age 4 months-14 years old) and mean age at surgery 18.5 m (range 1 day-14 years). Three left hernias (Larrey hernia) and n= 2central hernias (Morgagni-Larrey). Two patients were diagnosed prenatally, the rest of them were casual diagnoses. Symptoms: n= 6 asymptomatic, n= 4respiratory symptoms, n= 1abdominal pain, n= 1both symptoms and n= 1 hydrops fetalis. In all cases, a chest X-ray was performed, CT in n= 5 cases and US in other n= 5 patients. The surgical approach was laparoscopic in n= 7 (1 conversion due to bleeding), thoracoscopic in n= 1 (requiring conversion to laparotomy due to technical difficulty), thoracotomy in n= 1patients and laparotomy in n= 4. Prosthetic patches were necessary in n= 2 patients. During the follow-up (3.9 years, range: 1-8), there were n= 2 recurrences (laparoscopy and thoracotomy) and n= 1 exitus 2 years after surgery, due to pathology not associated with diaphragmatic hernia. CONCLUSIONS: The minimally invasive approach is considered of choice in the literature. Our group considers that most patients with anterior CDH should be considered for a laparoscopic repair. The laparoscopic approach is easily reproducible and the conversion rate is low when it is performed by expert surgeons. However, the low prevalence of this pathology would require comparative and long-term multicenter studies to obtain statistically significant conclusions.

OBJETIVO: Revisión de las hernias diafragmáticas congénitas (HDC) anteriores intervenidas en nuestro centro, análisis de nuestra experiencia y evolución de la técnica quirúrgica a lo largo de 15 años en el paciente pediátrico. MATERIAL Y METODOS: Estudio descriptivo retrospectivo de pacientes pediátricos intervenidos de HDC anterior (Morgagni, Larrey y Morgagni-Larrey) en nuestro centro entre 2000 y 2015, mediante revisión sistemática de historias clínicas. Variables estudiadas: edad al diagnóstico, edad al tratamiento, pruebas diagnósticas, síntomas, técnica quirúrgica, evolución, complicaciones y recidivas. Fueron excluidas las hernias posteriores (Bochdaleck) y los pacientes mayores de 14 años. RESULTADOS: 13 pacientes (8 mujeres) con hernia diafragmática anterior. Media de edad al diagnóstico: 29,4 meses (rango: 4 meses de edad gestacional-14 años). Media de edad en el momento de la intervención: 18,5 meses (rango: 1 día-14 años). Tres hernias izquierdas (hernia de Larrey) y 2 centrales (Morgagni-Larrey). Dos diagnósticos prenatales, siendo el resto hallazgos casuales. Síntomas: n= 6 asintomáticos, n= 4 síntomas respiratorios, n= 1 dolor abdominal, n= 1 ambos síntomas, n= 1 hidrops fetalis. En todos los casos se realizó radiografía de tórax, en n= 5 casos TAC y en otros n= 5 ecografía. El abordaje quirúrgico fue laparoscópico en n= 7 (1 conversión por hemorragia), toracoscópico en n= 1 casos (precisando conversión a laparotomía por dificultad técnica), toracotomía en n= 1 y laparotomía en n= 4. Fue necesario el uso de parches protésicos en 2 pacientes. Seguimiento: media 3,9 años (rango: 1-8). Dos recidivas (laparoscopia y toracotomía) y n= 1 exitus a los 2 años de la intervención por patología no asociada a la hernia diafragmática. CONCLUSIONES: El abordaje mínimamente invasivo es considerado de elección en la literatura. Nuestro grupo defiende que la mayoría de los pacientes con HDC anterior deben considerarse para una reparación laparoscópica por ser fácilmente reproducible, con una tasa de conversión baja en manos de cirujanos expertos. Sin embargo, la baja prevalencia de esta patología requeriría estudios multicéntricos comparativos y prolongados en el tiempo para obtener conclusiones estadísticamente significativas.

Hernias diafragmáticas anteriores. Revisión de 13 casos / Morgagni-Larrey anterior diaphragmatic hernias. Review of 13 cases

Objetivo: Revisión de las hernias diafragmáticas congénitas (HDC) anteriores intervenidas en nuestro centro, análisis de nuestra experiencia y evolución de la técnica quirúrgica a lo largo de 15 años en el paciente pediátrico. Material y métodos: Estudio descriptivo retrospectivo de pacientes pediátricos intervenidos de HDC anterior (Morgagni, Larrey y MorgagniLarrey) en nuestro centro entre 2000 y 2015, mediante revisión sistemática de historias clínicas. Variables estudiadas: edad al diagnóstico, edad al tratamiento, pruebas diagnósticas, síntomas, técnica quirúrgica, evolución, complicaciones y recidivas. Fueron excluidas las hernias posteriores (Bochdaleck) y los pacientes mayores de 14 años. Resultados: 13 pacientes (8 mujeres) con hernia diafragmática anterior. Media de edad al diagnóstico: 29,4 meses (rango: 4 meses de edad gestacional-14 años). Media de edad en el momento de la intervención: 18,5 meses (rango: 1 día-14 años). Tres hernias izquierdas (hernia de Larrey) y 2 centrales (Morgagni-Larrey). Dos diagnósticos prenatales, siendo el resto hallazgos casuales. Síntomas: n= 6 asintomáticos, n= 4 síntomas respiratorios, n= 1 dolor abdominal, n= 1 ambos síntomas, n= 1 hidrops fetalis. En todos los casos se realizó radiografía de tórax, en n= 5 casos TAC y en otros n= 5 ecografía. El abordaje quirúrgico fue laparoscópico en n= 7 (1 conversión por hemorragia), toracoscópico en n= 1 casos (precisando conversión a laparotomía por dificultad técnica), toracotomía en n= 1 y laparotomía en n= 4. Fue necesario el uso de parches protésicos en 2 pacientes. Seguimiento: media 3,9 años (rango: 1-8). Dos recidivas (laparoscopia y toracotomía) y n= 1 exitus a los 2 años de la intervención por patología no asociada a la hernia diafragmática. Conclusiones: El abordaje mínimamente invasivo es considerado de elección en la literatura. Nuestro grupo defiende que la mayoría de los pacientes con HDC anterior deben considerarse para una reparación laparoscópica por ser fácilmente reproducible, con una tasa de conversión baja en manos de cirujanos expertos. Sin embargo, la baja prevalencia de esta patología requeriría estudios multicéntricos comparativos y prolongados en el tiempo para obtener conclusiones estadísticamente significativas

Objective: A review of anterior congenital diaphragmatic hernias (CDH) treated at our center, analysis of our experience and evolution in the surgical technique in pediatric patients over the last 15 years. Material and methods: A retrospective descriptive study of patients of our center with anterior CDH (Morgagni, Larrey and MorgagniLarrey) between 2000 and 2015, through a systematic review of clinical records. The studied variables were: age at diagnosis, age at treatment, diagnostic methods, symptoms, surgical technique, evolution, complications and relapses. Posterior CDH (Bochdalek) and patients older than 14 years old were excluded. Results: 13 patients (8 females) with anterior diaphragmatic hernia. Mean age at diagnosis was 29.4 months (range fetal age 4 months-14 years old) and mean age at surgery 18.5 m (range 1 day-14 years). Three left hernias (Larrey hernia) and n= 2central hernias (Morgagni-Larrey). Two patients were diagnosed prenatally, the rest of them were casual diagnoses. Symptoms: n= 6 asymptomatic, n= 4respiratory symptoms, n= 1abdominal pain, n= 1both symptoms and n= 1 hydrops fetalis. In all cases, a chest X-ray was performed, CT in n= 5 cases and US in other n= 5 patients. The surgical approach was laparoscopic in n= 7 (1 conversion due to bleeding), thoracoscopic in n= 1 (requiring conversion to laparotomy due to technical difficulty), thoracotomy in n= 1patients and laparotomy in n= 4. Prosthetic patches were necessary in n= 2 patients. During the follow-up (3.9 years, range: 1-8), there were n= 2 recurrences (laparoscopy and thoracotomy) and n= 1 exitus 2 years after surgery, due to pathology not associated with diaphragmatic hernia. Conclusions: The minimally invasive approach is considered of choice in the literature. Our group considers that most patients with anterior CDH should be considered for a laparoscopic repair. The laparoscopic approach is easily reproducible and the conversion rate is low when it is performed by expert surgeons. However, the low prevalence of this pathology would require comparative and long-term multicenter studies to obtain statistically significant conclusions

[Modifiable prognostic factors in the morbidity-mortality of gastroschisis]. / Factores pronósticos modificables en la morbi-mortalidad de la gastrosquisis.

OBJECTIVE: The low incidence of gastroschisis makes impossible a consistently study of the factors that determine its evolution. The presence of other alterations associated is an important determinant of prognosis known. We analyze the factors implicated in morbidity and mortality in our center that can be modified. MATERIAL AND METHODS: We performed a retrospective study from hospital records. We analyzed the morbidity and mortality versus gestational age, mode of delivery, surgery performed, presence of prenatal diagnosis, herniated viscera and associated anomalies. We studied the postoperative differences occurred as a result of implantation of fetal surgery group. The variables were analyzed with SPSS 15.0 using non-parametric test. RESULTS: Since 1987 25 patients have been operated (12 men) with a mean birth weight of 2,328 g +/- 364. The 44% of them had prenatal diagnosis and 72% were born by cesarean. Only 4 had intestinal atresia. Preterm birth (< 36 weeks) did not improve the complications, but did reduce hospital stay in 10.68 days and the time of parenteral nutrition in 6 days. Cesarean delivery and prenatal diagnosis was improved all the previous factors. Primary closure however was associated with higher rates of postsurgical complications (46.2% vs. 18.2%). The 5 patients who died was during the immediate postoperative period, all before developing the fetal diagnostic program. CONCLUSIONS: Prenatal diagnosis and preterm delivery by elective cesarean reduces the complications of gastroschisis. Interdisciplinary coordination is essential to improve the prognosis of these patients.

[Urethroplasty with lateral pedunculated flap for complicated hypospadias]. / Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas.

UNLABELLED: With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fistulas associated to uretral stenosis that can finish all the surgical possibilities. MATERIAL AND METHODS: Retrospective review. Lateral based flap uretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. RESULTS: From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glans fistula. CONCLUSIONS: Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra.

Factores pronósticos modificables en la morbi-mortalidad de la gastrosquisis / Modifiable prognostic factors in the morbidity-mortality of gastroschisis

Objetivo. La baja incidencia de la gastrosquisis impide el estudio consistente de los factores que determinan su evolución. La presencia de otras alteraciones asociadas es un factor determinante del pronóstico muy conocido. Queremos analizar los factores implicados en la morbi-mortalidad en nuestro centro, que podamos modificar. Material y métodos. Realizamos un estudio descriptivo retrospectivo a partir de los registros hospitalarios. Analizamos la morbi-mortalidad frente a la edad gestacional, tipo de parto, cirugía realizada, existencia de diagnóstico prenatal, vísceras herniadas y anomalías asociadas. Estudiamos las diferencias postoperatorias acontecidas a raíz de la implantación del grupo de cirugía fetal. Los variables se analizan con SPSS 15.0 utilizando test no paramétricos. Resultados. Desde 1987 se han intervenido 25 pacientes (12 varones), con un peso medio al nacimiento de 2.328 g ± 364. De ellos un 44% presentaban diagnóstico prenatal y el 72% nació por cesárea. Sólo 4 presentaban atresia intestinal. El parto pretérmino (<36 semanas) no mejoró las complicaciones, pero sí redujo la estancia hospitalaria en 10,68 días y el tiempo de nutrición parenteral en 6 días. El parto por cesárea y el diagnóstico prenatal si mejoró todos los factores previos. El cierre primario, sin embargo, se asoció a mayor tasa de complicaciones post-quirúrgicas (46,2% vs. 18,2%).Los 5 pacientes fallecidos fueron, durante el post-operatorio inmediato, todos antes del desarrollo del programa de diagnóstico fetal. Conclusiones. El diagnóstico prenatal y el parto pretérmino por cesárea electiva reducen las complicaciones de las gastrosquisis. Es fundamental la coordinación interdisciplinaria para mejorar el pronóstico de estos pacientes (AU)

Objective. The low incidence of gastroschisis makes impossible a consistently study of the factors that determine its evolution. The presence of other alterations associated is an important determinant of prognosis known. We analyze the factors implicated in morbidity and mortality in our center that can be modified. Material and methods. We performed a retrospective study from hospital records. We analyzed the morbidity and mortality versus gestational age, mode of delivery, surgery performed, presence of prenatal diagnosis, herniated viscera and associated anomalies. We studied the postoperative differences occurred as a result of implantation of fetal surgery group. The variables were analyzed with SPSS 15.0 using non-parametric test. Results. Since 1987 25 patients have been operated (12 men) with a mean birth weight of 2,328 g ± 364. The 44% of them had prenatal diagnosis and 72% were born by cesarean. Only 4 had intestinal atresia. Preterm birth (<36 weeks) did not improve the complications, but did reduce hospital stay in 10.68 days and the time of parenteral nutrition in 6 days. Cesarean delivery and prenatal diagnosis was improved all the previous factors. Primary closure however was associated with higher rates of postsurgical complications (46.2% vs. 18.2%). The 5 patients who died was during the immediate postoperative period, all before developing the fetal diagnostic program. Conclusions. Prenatal diagnosis and preterm delivery by elective cesarean reduces the complications of gastroschisis. Interdisciplinary coordination is essential to improve the prognosis of these patients (AU)

Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas / Urethroplasty with lateral pedunculated flap for complicated hypospadias

Las técnicas habituales de los hipospadias permiten resolver la práctica totalidad de esta patología con resultados muy positivos. Desgraciadamente, existen pacientes que se fistulizan repetidas veces, agotando las posibilidades quirúrgicas. Generalmente se asocian a estenosis uretral. Queremos presentar una técnica que nos ha facilitado la reparación de estos pacientes con resultados esperanzadores . Material y métodos. Revisión retrospectiva de una serie de casos. La técnica del colgajo lateral pediculado consiste en un desmontaje dela uretra y exposición de la misma, para proceder a su reconstrucción en un solo tiempo por medio de la piel lateral de la uretra que se tubulariza sobre la neouretra primitiva. Resultados. Desde 2008 hemos intervenido 5 pacientes con una edad media de 12,1 años (9-15) y un peso de 55,34 kg (22-98 kg).Previamente habían sufrido de 3 a 7 operaciones de corrección de hipospadias, siempre fistulizadas. En consulta se comprobó la estenosis uretral en todos los pacientes. La intervención se realizó en un tiempo de 90-110 minutos y los resultados fueron favorables en todos los pacientes, resolviéndose las estenosis, con un seguimiento medio superior al año. Tan solo los dos pacientes más mayores han presentado mínimas fístulas glanulares. Conclusiones. La uretroplastia con colgajo lateral pediculado es una técnica útil para el tratamiento de los hipospadias complicados permitiendo la resolución de las fístulas y, especialmente, de las estenosis de uretra (AU)

With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fi stulas associated touretral stenosis that can finish all the surgical possibilities. Material and methods. Retrospective review. Lateral based flapuretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. Results. From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glansfistula. Conclusions. Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra (AU)

Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia / Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy

Objetivo. Analizar los resultados del trasplante renal de donante vivo relacionado (TDVR) en nuestro centro. Pacientes y método. Entre diciembre de 2005 y 2008 se han realizado en nuestro centro 34 trasplantes renales en receptores pediátricos, de los que 7 (20,58%) han sido TDVR con injertos obtenidos por vía laparoscópica. El donante fue la madre en 4 casos y el padres entres. La edad media de los donantes fue de 43 años (38-48) y la de los receptores de 12,5 años (9-17). Cuatro fueron un primer trasplante (uno (..) (AU)

Objective. Analyze the results of the living related donor kidney transplant (LRDKT) in our center. Patients and methods. Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7(20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17).Four were a first transplant (one of them planned) and three (..) (AU)

[PHACES syndrome]. / Síndrome de PHACES.

INTRODUCTION: PHACES syndrome associates a segmental facial hemangioma with cerebral malformations, aortic branches/cranial arteries anomalies, cardiac defects, eye anomalies or ventral wall defects. The aim of this study is to analyze our experience with this syndrome. MATERIAL AND METHODS: Retrospective study of the cases seen at our unit in the last year. RESULTS: We treat 4 cases; 3 girls and 1 child. Besides the segmental hemangioma they presented: 3 vascular cerebral malformations; 2 structural cardiopathies; 2 cerebral malformations, 1 microftalmia. We did not find ventral wall defects. A case received treatment with two cycles of metilprednisolone i.v. and oral prednisone, with favourable course; two cases received initial treatment with oral prednisone continued of oral propanolol in rising pattern up to 2 mg/kg/day, Obtaining both the detention of the tumour growth and regression of the lesion, with very good tolerance. A 7-year-old patient has been treated with colouring pulse laser for her residual lesions. CONCLUSIONS: When we see a segmental facial hemangioma we must perform a wide diagnostic study in order to discard a PHACES syndrome. Multidisciplinar approach to the patient by a wide expert's group gets an earlier diagnose and improves the outcome. Propranolol is a promising therapeutic alternative.

[Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy]. / Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia.

OBJECTIVE: Analyze the results of the living related donor kidney transplant (LRDKT) in our center. PATIENTS AND METHODS: Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7 (20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17). Four were a first transplant (one of them planned) and three retransplantations. RESULTS: Cold ischemia time was < 2 hours in every case while warm ischemia did not show significant differences with the cadaveric donor transplant. None had initial graft dysfunction. No vascular complications occurred, but there was a urinary fistula secondary to ureteral necrosis, resolved with a new reimplantation. Survival of the patient and graft is 100%, superior to that of the cadaveric grafts within the same period. Current mean plasma creatinine is 0.8 mg/dl (0.7-1.39) and mean creatinine clearance is 80 cc/min/1.73 m2 (75-90). No donor had surgical complication and all maintain good kidney function. CONCLUSIONS: The short term results of the LRDKT with grafts obtained by laparoscopy in our center are similar to those described by groups with large experience, which makes it possible to continue offering it with guarantee.

Manejo quirúrgico del tumor de Wilms bilateral: Nuestra experiencia con 18 casos / Surgical management of the bilateral wilm's tumor: Our experience with 18 cases

Objetivo. Mostrar nuestra experiencia en el manejo quirúrgico del tumor de Wilms bilateral. Material y métodos. Se analizaron los datos de 18 niños con diagnóstico de TW bilateral entre 1971 y 2007, evaluando la edad al momento del diagnóstico, sexo, presentación clínica, métodos diagnósticos, histología, tratamiento quimioterápico, radioterápico y quirúrgico, complicaciones y el estado clínico actual de los pacientes. Resultados. El 65% de los TW sincrónicos se encontraban en estadios I / II; el 30% mostraban al menos un tumor en estadio III. Un caso en estadio IV (5%). Los pacientes con TW metacrónicos se encontraban en el 100% de los casos en estadios I /II. Todos los tumores fueron de bajo o intermedio grado de malignidad, con predominio del tipo mixto. Las complicaciones quirúrgicas fueron 4 suboclusiones intestinales,2 fístulas ureteropiélicas y 1 quiste urinario.15 niños permanecen convida (83%) con un período libre de enfermedad entre 1 y 24 años, delos cuales 3 se han trasplantado con buena evolución. Un paciente falleció por insuficiencia renal progresiva y otros dos pacientes por evolución de la enfermedad. Conclusiones. La quimioterapia preoperatoria citorreductora permite una cirugía renal más conservadora con una alta tasa de supervivencia (80-90%). El tratamiento quirúrgico individualizado conlleva resecciones más conservadoras y una menor incidencia de insuficiencia renal a largo plazo (AU)

Aim. To show our experience in the surgical management of bilateral Wilms’ tumor. Methods. We have reviewed the medical records of 18 patients diagnosed of bilateral Wilms’ tumor between 1971 and 2007, evaluating age, sex, clinical situation, imaging studies, histology, treatment, complications and follow-up. Results. 65% of patients with synchronous Wilms’ tumor was stageI-II, 30% stage III and 5% stage IV. 100% of patients with metachronous Wilms’ tumor was stage I-II. All the tumors had favourable histology. Surgical complications were: 4 bowel pseudobstructions, 2ureteropielic fistulae and 1 urinary cyst. 15 patients are alive (83%) with a mean follow-up of 12 years.3 of these patients had a renal transplant with a good evolution. One patient died of a progressive renal failure and two patients died of the evolution of the oncological disease. Conclusions. Preoperative chemotherapy allows a conservative surgical resection with a high overall survival (80-90%). Individualized surgical treatment offers a conservative surgical resection with a lower incidence of long-term renal failure (AU)

Evaluación quirúrgica y nutricional de los niños con gastrostomía endoscópica percutánea / Surgical and nutritional evaluation of children with percutaneous endoscopic gastrostomy

Introducción. La gastrostomía endoscópica percutánea (PEG) ha representado un gran avance para mantener el estado nutricional en pacientes con problemas deglutorios. Hemos evaluado, quirúrgica y nutricionalmente, aquellos pacientes que se les realizó una PEG. Material y métodos. Realizamos un estudio descriptivo retrospectivo analizando individualmente los parámetros quirúrgicos, nutricionales y satisfacción de los cuidadores. Resultados. Se han implantado 83 PEG (1994-08) en pacientes de edad media 7 años (4 meses-25 años) por enfermedades de tipo neurológico (63,8%) seguido de Fibrosis quística (13,8%). Dos pacientes presentaban una válvula de derivación ventrículo-peritoneal (DVP) y (..) (AU)

Introduction. Percutaneous endoscopic gastrostomy (PEG) has suppoused an improvement in the nutritional management of patients with deglution difficulty. Surgical and nutritional aspects have been evaluated in our patients with PEG. Material and Methods. A descriptive retrospective study with individual analysis of surgical, nutritional and satisfaction items has been developed. Results. 83 PEG (1994-08) have been implanted in neurological (..) (AU)

Protocolo antibiótico “fast-track” en la apendicitis aguda / Fast track antibiotic protocol in acute appendicitis

Introducción. El auge de las resistencias antimicrobianas, ha producido un descenso en la efectividad de la tradicional triple terapia antibiótica, con el consiguiente aumento de las complicaciones. En este contexto, decidimos cambiar a Cefuroxima-Metronidazol o Ertapenem en función del riesgo de presentar resistencias. Este nuevo protocolo se ajusta a la filosofía Fast-Track, siendo factible el alta tras 72 horas de antibioterapia. Nuestro objetivo es conocer si ha mejorado nuestra tasa de complicaciones infecciosas y si es factible el alta precoz. Material y métodos. Realizamos un estudio de cohortes históricas:– A la cohorte histórica (CH) pertenecen pacientes apendicectomizados entre octubre 05 a octubre 06.– La cohorte actual (CA) comienza a recogerse en junio 2007.En ambos grupos se procede con idéntico protocolo de recogida de datos (un solo observador). Se procede a comparar la homogeneidad entre las cohortes y posteriormente al análisis de los resultados ( a<0,05).El análisis estadístico se realizó con el SPSS 15.0.Resultados. Se revisan 226 pacientes cursando 110 como apendicitis complicadas (CH: 61/135; CA: 49/91). No existen diferencias (..) (AU)

Introduction. The increase of antimicrobial resistances, has affected the efficacy of antimicrobial triple therapy, increasing appendicitis morbidity. We decided to change to a fast-track protocol of 72 hours ofCefuroxime-Metronidazol or Ertapenem. Aim: to know if our infectious morbidity rate has improved and if early dischargement is possible. Material and methods. Analytic historic cohort study:– Historical cohort (HC): patients intervened of appendicitis between October 2005and October 2006.– Current cohort (CC): started in June 2007.A data collection protocol is designed for both groups. Homogeneity among cohorts is proved and data are analysed (a=0,05). Statistics are analyzed by SPSS 15.0.Results. 226 patients were controlled, being 110 complicated appendicitis (HC: 61/135; AC: 49/91). There are no differences among cohorts about evolution time, temperature and leukocytes rate at admission, interval to intervention, use of laparoscopy, drainage or antimicrobial (..) (AU)

[Incidence of metachronic contralateral inguinal hernia]. / Incidencia de la hernia inguinal contralateral metácrona.

INTRODUCTION: There are many observational studies about the incidence of metachronous contralateral inguinal hernia (MIH). Metaanalysis allows to resume the results of individual studies in one with a higher level of evidence. AIM: to know the incidence of MIH in order to decide the contralateral exploration. MATERIAL AND METHODS: We do an extensive bibliographic review in Medline, Embase and Cochrane Central. Data analysis is done with RevMan 4.2. RESULTS: 632 abstracts were screened by only one revisor who selected 27 studies: 17802 inguinal hernias and 1209 MIH. Follow up is between 6 months and 10 years. Due to high heterogeneity, a randomized effect analysis (Der Simonian and Lard) is done. The incidence of MIH is 6,96% (6,07-7,85); 14 hernia must be operated to avoid one MIH (NNT). If the original side of the hernia is left, the probability of MIH is 1.81 times higher (NNT =10). The secondary analysis indicates that there is no important publication bias. CONCLUSIONS: Rutinary bilateral inguinal exploration is not justified. Only in high anaesthetic risk patients, bilateral exploration should be suggested.

Incidencia de la hernia inguinal contralateral metácrona / Incidence of metachronic contralateral inguinal hernia

Introducción. Existe una gran cantidad de estudios observacionales que valoran la incidencia de la hernia inguinal contralateral metácrona (HIM).El metaanálisis es un tipo de estudio estadístico que permite sumarlos resultados de estudios individuales en uno solo, de forma que se logra un trabajo con mayor grado de evidencia. Deseamos conocer la incidencia real de la HIM para valorar la intervención contralateral. Material y métodos. Realizamos una búsqueda bibliográfica extensiva en Medline, Embase y Cochrane Central con criterios de selección estrictos, analizando los datos con el Rev Man 4.2.Resultados. Se obtienen 632 títulos y abstracts que fueron cribados por un solo revisor, seleccionando 27 estudios. Suponen un total de 17.802 hernias intervenidas y 1.209 HIM. El seguimiento oscilaba entre6 meses y 10 años. Dada la gran heterogeneidad de los datos, se utiliza un análisis de efectos randomizados tipo Der Simonian and Lard. La incidencia de la hernia metácrona es de 6,96% (6,07-7,85), con (..) (AU)

Introduction. There are many observational studies about the incidence of metachronous contralateral inguinal hernia (MIH). Metaanalysis allows to resume the results of individual studies in one with a higher level of evidence. Aim: to know the incidence of MIH in order to decide the contralateral exploration. Material and methods. We do an extensive bibliographic review in Medline, Embase and Cochrane Central. Data analysis is done with (..) (AU)

[Surgical management of bilateral Wilms' tumor: our experience with 18 cases]. / Manejo quirúrgico del tumor de Wilms bilateral: nuestra experiencia con 18 casos.

AIM: To show our experience in the surgical management of bilateral Wilms' tumor. METHODS: We have reviewed the medical records of 18 patients diagnosed of bilateral Wilms' tumor between 1971 and 2007, evaluating age, sex, clinical situation, imaging studies, histology, treatment, complications and follow-up. RESULTS: 65% of patients with synchronous Wilms' tumor was stage I-II, 30% stage III and 5% stage IV. 100% of patients with metachronous Wilms' tumor was stage I-II. All the tumors had favourable histology. Surgical complications were: 4 bowel pseudobstructions, 2 ureteropielic fistulae and 1 urinary cyst. 15 patients are alive (83%) with a mean follow-up of 12 years. 3 of these patients had a renal trasplant with a good evolution. One patient died of a progressive renal failure and two patients died of the evolution of the oncological disease. CONCLUSIONS: Preoperative chemotherapy allows a conservative surgical resection with a high overall survival (80-90%). Individualized surgical treatment offers a conservative surgical resection with a lower incidence of long-term renal failure.