[High resolution surgery: one more step in out-patient surgery]. / Cirugía de alta resolución: un paso más en la cirugía ambulatoria.

OBJECTIVES: One stop surgery (CAR: Cirugía Alta Resolución) is a step forward in outpatient surgery. The new scheme simplifies ambulatory conventional surgery, achieves more satisfaction between patients and optimizes health resources. METHODS: By One stop surgery we mean the performance in the same day of both pre-surgery assessment and surgical procedure. This new working way allows performing a surgical procedure in only one visit to the hospital, instead of the average four visits used before for surgical outpatients. Diagnosis, presurgery assessment and post surgery progress are made by the primary care paediatricians at theirs NHS offices. It is essential to maintain a close relationship between the Paediatric surgeons, the primary care paediatricians as well as with paediatric anaesthesiologists and nurses. An autoevaluation is made once a year in which quality survey results are made public and possible areas for improvement are identified, following the model proposed by the European Foundation for Quality Management (EFQM). RESULTS: We present 416 children treated following this scheme since 2008. Surgery is performed on the abdominal wall, genitals, skin and soft tissues. Families are satisfied with the quality of the whole medical and nursery received care as they qualified it with a 99% satisfaction index. Complications developed in less than 3%. CONCLUSIONS: One stop surgery is a progress in the outpatient surgery and, for us, it is a consolidated, continuously growing and constantly improving scheme of providing medical care.

Cirugía de alta resolución: un paso más en la cirugía Ambulatoria / High resolution surgery: one more step in out-patient surgery

Objetivos. La cirugía de alta resolución (CAR) es un avance más de la cirugía ambulatoria. Esta forma de trabajo logra simplificar la cirugía ambulatoria, consiguiendo una mayor satisfacción por parte del paciente y una optimización de los recursos sanitarios. Métodos. La CAR se define por la realización de la evaluación preoperatoria y la subsiguiente intervención quirúrgica en una única visita hospitalaria. Este nuevo plan de trabajo permite pasar de 4 visitas hospitalarias en la cirugía ambulatoria habitual, a una única visita. El pediatra de Atención Primaria (PAP) en el centro de salud realiza el diagnóstico y la evaluación postoperatoria. Es esencial una estrecha relación entre el cirujano y el PAP así como la formación de un equipo multidisciplinar integrado por cirujanos, anestesistas y enfermería. Anualmente se realiza una autoevaluación, se publican los resultados de las encuestas de calidad obtenidas y se identifican áreas de mejora, siguiendo el modelo de excelencia europea propuesto por la European Foundation for Quality Management (EFQM).Resultados. Presentamos una serie con 416 pacientes intervenidos mediante este sistema, desde 2008. Las intervenciones que se realizan son cirugía de pared abdominal, cirugía genital, cirugía de piel y partes blandas. La valoración global de la asistencia recibida por parte de los (..) (AU)

Objectives. One stop surgery (CAR: Cirugía Alta Resolución) is a step forward in outpatient surgery. The new scheme simplifies ambulatory conventional surgery, achieves more satisfaction between patient sand optimizes health resources. Methods. By One stop surgery we mean the performance in the same day of both pre-surgery assessment and surgical procedure. This new working way allows performing a surgical procedure in only one visit to the hospital, instead of the average four visits used before for surgical outpatients. Diagnosis, presurgery assessment and post surgery progress are made by the primary care paediatricians at theirs NHS offices. It is essential to maintain a close relationship betweenthe Paediatric surgeons, the primary care paediatricians as well as with paediatric anaesthesiologists and nurses. An autoevaluation is made once a year in which quality survey results are made public and possible areas for improvement are identified, following the model proposed by the European Foundation for Quality Management (EFQM).Results. We present 416 children treated following this scheme since 2008. Surgery is performed on the abdominal wall, genitals, skin and soft tissues. Families are satisfied with the quality of the whole medical and nursery received care as they qualified it with a 99% satisfaction index. Complications developed in less than 3%.Conclusions. One stop surgery is a progress in the outpatient surgery (..) (AU)

Cirugía de alta resolución pediátrica: una serie de 75 casos / Paediatric one-stop surgery: a series of 75 cases

La cirugía de alta resolución (CAR) se define por la realización de la evaluación preoperatoria y la subsiguiente intervención quirúrgica en una única visita hospitalaria. El plan piloto de implantación de CAR se diseñó para la provincia de Bizkaia, y comprende una población de 124.494 niños de 1 a 14 años. El nuevo plan de trabajo permite pasar de 4 visitas hospitalarias en la cirugía ambulatoria habitual, a una única visita. El pediatra de atención primaria (PAP) en el centro de salud realiza el diagnóstico y la evaluación postoperatoria. Durante un período de 10 meses se han operado 75 niños siguiendo este programa. Las intervenciones realizadas fueron cirugía de pared abdominal, cirugía genital y cirugía de piel y partes blandas. Hubo 2 complicaciones menores. La valoración global de la asistencia recibida por parte de los familiares fue excelente en el 32,7% de los casos, muy buena en el 36,2%, buena en el 24,1% y regular en el 3,4% de los casos. La CAR es un avance más de la cirugía ambulatoria. La estrecha relación entre el cirujano y el PAP es esencial. Se consiguen los siguientes objetivos: disminución del número de consultas y tiempo de espera, reducción de los costes de los procesos, disminución de la sobrecarga del trabajo de los facultativos en jornada matinal, mejora de la organización y agilidad de su actividad, y aumento de la calidad percibida por los usuarios (AU)

By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount (AU)

[Paediatric one-stop surgery: a series of 75 cases]. / Cirugía de alta resolución pediátrica: una serie de 75 casos.

By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount.

Diseño e impacto de un proceso de cirugía de alta resolución pediátrica / No disponible

Introducción: La cirugía de alta resolución se define por la realización de la evaluación preoperatoria y la subsiguiente intervención quirúrgica en una única visita hospitalaria. Material y métodos: El plan piloto de implantación de cirugía de alta resolución se diseñó para la provincia de Bizkaia, que comprende una población de 124.494 niños de 0 a 14 años. El nuevo plan de trabajo permite pasar de 4 visitas hospitalarias en la cirugía ambulatoria habitual, a una única visita. El diagnóstico y la evaluación postoperatoria son realizados por el pediatra de atención primaria en el centro de salud. Resultados: Durante un periodo de 12 meses se han operado 120 niños siguiendo este programa. Las intervenciones realizadas fueron: cirugía de pared abdominal, cirugía genital y de piel y partes blandas. Hubo dos complicaciones menores. La valoración global de la asistencia recibida por parte de los familiares fue positiva en el 98% de los casos. Conclusiones: La cirugía de alta resolución es un avance más de la cirugía ambulatoria. La buena coordinación entre el cirujano y el pediatra de Atención Primaria es esencial en este proceso. Se consiguen los siguientes objetivos: disminución del número de consultas y tiempo de espera, reducción de los costes de los procesos, disminución de la sobrecarga del trabajo de los facultativos en jornada matinal, mejora de la organización y agilidad de su actividad y aumento de la calidad percibida por los usuarios (AU)

Background: By one-stop surgery we mean the performance of both pre-surgery assessment and surgical procedure on the same day. Material and methods: We report our experience with a pilot study of a one-stop surgery in the province of Bizkaia, with a population of 124.494 children aged 1 to 14 years. Under the new scheme, the average of four visits per patient to the hospital’s outpatient clinics was cut down to only one. Diagnosis and presurgery assessments were made by the children’s. Primary care paediatricians at their NHS offices. Results: One hundred and twenty children were treated overone year. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care and 98% scored it as good or very good. Conclusions: We think that one-stop surgery is a breakth rough in ambulatory surgery. It does not only dramatically lower the number of visits to the hospital´s outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon´s workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is essential (AU)

[Total mobilization of the urogenital sinus in the treatment of cloaca]. / Movilización total del seno urogenital en el tratamiento de la cloaca.

Persistent cloaca is one of the most complex forms of anorectal malformation in girls. Surgical treatment is complicated and laborious especially when the common channel is long. The aim of this report was to emphasize the importance of the joint mobilization of the urogenital sinus after separation from the rectum. This maneuver avoids separation of the urinary tract from the genital tract and reduces operating time by more than 60 %. This is only possible when the common channel of the cloaca is less than 3 cm. We present the cases of two girls treated in the last 2 years with this technique. Operating time was significantly shortened to approximately 4 hours and the procedure was considerably simplified. The functional and cosmetic results were excellent. To obtain good results in the treatment of cloaca, a precise clinical and radiologist diagnosis must be made, surgical needs should be prioritized and the appropriate technique chosen. The best procedure for patients whose common channel is less than 3 cm is total mobilization of the urogenital sinus, subsequently sutured to the perineum, and placement the rectum within the anorectal sphincter complex.

Movilización total del seno urogenital en el tratamiento de la cloaca / Total mobilization of the urogenital sinus in the treatment of cloaca

La persistencia de la cloaca es una de las formas más complejas de las malformaciones anorrectales que se produce en las niñas. El tratamiento es complicado y laborioso, sobre todo cuando el canal común es largo. El objetivo de esta comunicación es subrayar la importancia de la movilización conjunta del seno urogenital tras la separación del recto. La primera maniobra evita la separación del tracto urinario del genital, acortando el tiempo de intervención en más del 60%. Esto sólo es posible realizarlo en las cloacas con canal común menor de 3 cm. Se presentan los casos de dos niñas intervenidas en el transcurso de los últimos 2 años con esta técnica. Los resultados en cuanto al acortamiento del tiempo quirúrgico fueron significativos pudiéndose realizar en aproximadamente 4 h, la intervención se simplificó de manera importante y los resultados funcionales y estéticos fueron excelentes. Creemos que para obtener buenos resultados en el tratamiento de la cloaca, es necesario establecer un diagnóstico clínico y radiológico preciso, evaluar el orden de preferencia de las necesidades quirúrgicas y elegir la técnica adecuada. Se considera que la mejor opción para aquellos casos cuyo canal común es inferior a 3 cm es la movilización total del seno urogenital, su abocamiento al perineo y la colocación del recto en el complejo esfinteriano anorrectal (AU)

[CO(2) laser treatment of sialolithiasis]. / Tratamiento de la sialolitiasis con láser de CO(2).

Sialolithiasis of the submaxillary gland is rare in the pediatric population. We report the case of a 13-year-old boy who presented submandibular tumefaction of 7 months evolution, which increased after meals. Localized lithiasis in Wharton s duct was observed in submaxillary sialolithiasis. Treatment was intraoral extraction with CO(2) laser and after recovering from the anesthetic, the patient was discharged.This technique shortens surgical time, facilitates hemostasia and reduces edema and postoperative pain. The procedure is suitable for ambulatory surgery.

Tratamiento de la sialolitiasis con láser de co2 / Treatment of sialolithiasis with co2 laser in children

La sialolitiasis de la glándula submaxilar es una entidad infrecuente en pediatría. Aportamos un caso en un adolescente de 13 años que presentaba una tumefacción submandibular de 7 meses de evolución, que aumentaba después de las comidas. En la sialografía submaxilar se observaba una litiasis localizada en el conducto de Wharton. Tras decidir su extracción quirúrgica, se optó por un abordaje intraoral con láser de CO2 y una vez recuperado de la anestesia fue dado de alta. Esta técnica acorta el tiempo quirúrgico, facilita la hemostasia y disminuye el edema y el dolor postoperatorio, lo que facilita la realización de este procedimiento como cirugía ambulatoria (AU)

[Neuroblastoma with bone marrow invasion. A multicenter study. Work Group of the Spanish Society of Pediatric Surgery]. / Neuroblastomas con médula ósea invadida. Estudio multicéntrico. Grupo de Trabajo de la Sociedad Española de Cirugía Pediátrica.

By means of a retrospective study made of multiple centres, it was aimed to determine which variables could be influential at the moment of diagnosis in the prognostic of patients suffering neuroblastoma and medullary bone affection. Fifty four cases of patients belonging to a total of ten hospital centers have been revised in a period of five years. The ages under study spanned from three months to eight years of age (mean = 2.83 years). For the analysis of the patients, they were divided into two groups: one being composed of the deceased patients and the other of the surviving. The deceased patients were of a more advanced age, the delay in the diagnosis was greater, the primitive tumor was found to be more frequently located in the adrenal glands, the metastasis appeared more readily in multiples, and the effectiveness of the treatment was less, resulting in lower cases of remission and a less radical surgery. The only difference with respect to other publications is that in the case of surviving patients, the number of cases of enolase and ferritin is more frequently pathological.

[Simultaneous bilateral Wilms tumor]. / Tumor de Wilms bilateral sincrónico.

Bilaterality is uncommon in Wilms' tumor, being present in 4% to 8% of the cases. Definite progress has been made in the treatment with marked improvement in prognosis. The recent trend toward more conservative sugery, preoperative chemotherapy an avoidance of high-dose radiation therapy has yielded good results. This is confirmed in our two cases with synchronous tumors.