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1.
Actas urol. esp ; 43(7): 384-388, sept. 2019. ilus, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-2520

RESUMO

Introducción: El abanico de indicaciones del tratamiento endoscópico del reflujo vesicoureteral (RVU) se abre cada vez más hasta incluir la corrección del reflujo secundario tras cirugía de reimplante ureteral. No obstante, este escenario supone un reto técnico debido a los cambios posquirúrgicos. El objetivo de este trabajo es presentar nuestra experiencia en el tratamiento endoscópico del RVU en unidades ureterales con reimplante tipo Cohen, con especial interés en las particularidades técnicas del procedimiento. Material y métodos: Se ha realizado un estudio retrospectivo de casos de RVU secundario tras cirugía de reimplante tratados mediante inyección subureteral. Técnica: Se coloca la aguja perpendicular al trayecto submucoso y se inyecta medial al orificio, formándose un habón en la cara anterior que ocluya el meato. Resultados: En el periodo comprendido entre 1993 y 2016 se realizaron 21 inyecciones sobre 15 unidades ureterales. La afección ureteral incluía el RVU primario (4), sistema dúplex con RVU al pielón inferior (4), megauréter (3) y ureterocele (2). La edad media de los pacientes fue de 5,7 años (rango: 2-12 años). El éxito se logró en 10 unidades ureterales (66,67%), disminución del grado de RVU en 4 (26,67%) y persistencia/no resolución en un caso (6,67%). Discusión: El mecanismo antirreflujo del reimplante depende de optimizar el trayecto submucoso. Este subgrupo de pacientes es pequeño y los estudios son escasos lo que dificulta el acuerdo sobre la técnica más adecuada. Conclusión: El tratamiento endoscópico del reflujo secundario tras cirugía de reimplante transtrigonal es un procedimiento con cierta particularidad técnica, pero seguro y eficaz que ofrece una alternativa previa a la reintervención quirúrgica


Introduction: The range of indications for endoscopic treatment of vesicoureteral reflux opens more and more until including correction of secondary reflux (VUR) after ureteral reimplantation. However these cases suppose a technical challenge due to postoperative changes. The aim of this work is to present our experience on endoscopic treatment for VUR in ureteral units with Cohen reimplantation surgery, with special interest in the technical peculiarities of the procedure. Material and methods: A retrospective study of cases of secondary VUR after reimplantation surgery treated by subureteral injection. Technique: We put the needle perpendicular to submucous tunnel and inject medially to hole forming a wheal on the anterior face that occludes the meatus. Results: During the 1993-2016 period 21 injections were performed in 15 ureteral units. The ureteral pathology included primary VUR (4), duplex system with lower pole reflux (4), megaureter (3) and ureterocele (2). Average patient age was 5.7 years old (2-12). Succesful outcome had been got in 10 ureteral units (66.67%), a decrease of VUR grade in 4 (26.67%) and perseverance/no resolution of grade IV VUR in 1 (6.67%). Discussion: The anti-reflux mechanism of reimplantation depends on optimizing the submucosous tunnel. This subgroup of pacients is small and there are few studies, hindering the agreement on the most appropiate technique. Conclusion: Endoscopic treatment of secondary reflux after reimplantation surgery is a procedure with certain technical feature, but safe and effective offering an alternative prior to surgical reoperation

2.
Actas Urol Esp ; 43(7): 384-388, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31103394

RESUMO

INTRODUCTION: The range of indications for endoscopic treatment of vesicoureteral reflux opens more and more until including correction of secondary reflux (VUR) after ureteral reimplantation. However these cases suppose a technical challenge due to postoperative changes. The aim of this work is to present our experience on endoscopic treatment for VUR in ureteral units with Cohen reimplantation surgery, with special interest in the technical peculiarities of the procedure. MATERIAL AND METHODS: A retrospective study of cases of secondary VUR after reimplantation surgery treated by subureteral injection. TECHNIQUE: We put the needle perpendicular to submucous tunnel and inject medially to hole forming a wheal on the anterior face that occludes the meatus RESULTS: During the 1993-2016 period 21 injections were performed in 15 ureteral units. The ureteral pathology included primary VUR (4), duplex system with lower pole reflux (4), megaureter (3) and ureterocele (2). Average patient age was 5.7 years old (2-12). Succesful outcome had been got in 10 ureteral units (66.67%), a decrease of VUR grade in 4 (26.67%) and perseverance/no resolution of grade IV VUR in 1 (6.67%) DISCUSSION: The anti-reflux mechanism of reimplantation depends on optimizing the submucosous tunnel. This subgroup of pacients is small and there are few studies, hindering the agreement on the most appropiate technique. CONCLUSION: Endoscopic treatment of secondary reflux after reimplantation surgery is a procedure with certain technical feature, but safe and effective offering an alternative prior to surgical reoperation.

3.
Acta pediatr. esp ; 76(11/12): e161-e163, nov.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177428

RESUMO

Introducción: Los pólipos ureterales constituyen una causa poco frecuente de hidronefrosis en los niños. Presentamos un caso tratado en nuestro centro y realizamos una revisión de la literatura. Caso clínico: Varón de 5 años derivado a nuestra consulta por presentar episodios de dolor cólico en el flanco izquierdo. La ecografía mostró una hidronefrosis izquierda de grado II/IV, y el renograma con MAG-3 una curva de eliminación en la pelvis renal de tipo IIIb. Debido a la persistencia de la sintomatología, se decidió instaurar tratamiento quirúrgico, durante el cual se constató la presencia de pólipos fibroepiteliales en la pelvis renal que justificaban la sintomatología. Conclusión: El tratamiento de los pólipos ureterales en los niños presenta altas tasas de éxito; sin embargo, la inespecificidad de su presentación clínica, así como la dificultad de interpretación de las pruebas diagnósticas, pueden conllevar un importante retraso en el diagnóstico que afecte a la función renal


Introduction: Ureteral polyps are a strange cause of hydronephrosis in children. We report a case of a child treated in our hospital, and review of the related literature. Clinical case: A 5-year-old boy presented with severe, colicky, left lumbar pain. Renal ultrasound showed grade II/IV hydronephrosis, and the 99 m-Tc MAG-3 scan showed an obstructive drainage curve type IIIb. As the symptoms persisted, we decided surgical treatment, finding pyelic fibroepithelial polyps as the cause of the pain. Conclusion: Fibroepithelial polyp treatment in children is highly effective; nevertheless, the interpretation of diagnostic tests can be difficult, delaying the diagnosis and causing affectation of renal function


Assuntos
Humanos , Masculino , Criança , Pólipos/complicações , Pólipos/diagnóstico , Hidronefrose/etiologia , Obstrução Ureteral/complicações , Hidronefrose/terapia , Uretra/diagnóstico por imagem , Uretra/patologia , Doenças Uretrais/patologia , Pelve/diagnóstico por imagem , Urografia , Diagnóstico Diferencial
4.
Cir Pediatr ; 31(4): 171-175, 2018 Oct 17.
Artigo em Espanhol | MEDLINE | ID: mdl-30371028

RESUMO

AIM OF STUDY: To describe our experience in the management of non-tuberculosis mycobacterial lymphadenitits (NTML). METHODS: Retrospective analysis of patients who underwent surgery for NTML in our centre during the period between 2010-2017. Demographic data, diagnostic tests, treatment and follow up information were recovered from medical records. RESULTS: 65 patients (26 male/39 female) with a mean age of 31 months (range 7 months-12 years) were intervened during the period of study. As diagnostic tests, chest X-ray was performed in 92.3% of patients with normal result in all cases, Mantoux test was positive in 20.3%, inconclusive in 12.5% and negative in 67.1%. Preoperative fine needle aspiration was positive for NTML (granulomatous necrotizing lymphadenitis) in 93.7% whereas culture for mycobacteria was only positive in 23.4% of cases, being Mycobacterium lentiflavum the most frequent agent found. Mean preoperative waiting time was 2.5 months with 7.7% of fistulization previous to surgery. Mean hospital stay was 1,1 days and there were no intraoperative complications. Mean follow up time was 5.5 months (range 1-24 months) during which 19 cases of temporal facial paralysis were noted, among which only 2 persisted after one year. CONCLUSIONS: NTML is a disease with a growing incidence in our country. It is important to make an early diagnosis and surgical treatment in order to avoid complications, as surgery has demonstrated to be safe and effective, with a low rate of complications. We believe the actual protocols should be revised/checked due to low effectiveness of diagnostic tests.


Assuntos
Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Biópsia por Agulha Fina/métodos , Criança , Pré-Escolar , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação , Linfadenite/diagnóstico , Linfadenite/microbiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Estudos Retrospectivos , Fatores de Tempo
5.
Cir. pediátr ; 31(4): 171-175, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-172930

RESUMO

Objetivos: Describir nuestra experiencia en el manejo de la linfadenitis por micobacterias no tuberculosas (LMNT). Material y métodos: Análisis retrospectivo de 65 pacientes (26 varones/ 39 mujeres) intervenidos en nuestro centro de LMNT durante los años 2010-2017. Se analizaron datos demográficos, pruebas complementarias realizadas y datos de seguimiento. Resultados: La edad media fue de 31 meses (rango 7 meses-12 años). Para el diagnóstico la radiografía de tórax se realizó al 92,3% de pacientes, siendo en todos normal. El Mantoux fue positivo en 20,3%, dudoso en 12,5% y negativo en 67,1%. La PAAF preoperatoria fue diagnóstica (linfadenitis granulomatosa necrotizante) en 93,7% mientras que el cultivo para micobacterias fue positivo solo en 23,4%, siendo el Mycobacterium lentiflavum el patógeno más frecuentemente encontrado. El tiempo de espera preoperatorio fue de 2,5 meses con un porcentaje de fistulización previo a la cirugía de 7,7%. La estancia hospitalaria media fue 1,1 días y no hubo complicaciones perioperatorias. El tiempo medio de seguimiento fue 5,5 meses (rango 1-24 meses) observándose 19 casos de parálisis facial temporal, de los cuales 2 persistieron al cabo de 1 año. Conclusiones: La LMNT es una enfermedad cada vez más frecuente en nuestro medio. Es importante realizar un diagnóstico y tratamiento precoz, puesto que el tratamiento quirúrgico ha demostrado ser seguro y eficaz asociando baja tasa de complicaciones. Creemos que los protocolos actuales se deben revisar, debido a la escasa rentabilidad de algunas pruebas complementarias


Aim of study: to describe our experience in the management of non-tuberculosis mycobacterial lymphadenitits (NTML). Methods: Retrospective analysis of patients who underwent surgery for NTML in our centre during the period between 2010-2017. Demographic data, diagnostic tests, treatment and follow up information were recovered from medical records. Results: 65 patients (26 male/39 female) with a mean age of 31 months (range 7 months-12 years) were intervened during the period of study. As diagnostic tests, chest X-ray was performed in 92.3% of patients with normal result in all cases, Mantoux test was positive in 20.3%, inconclusive in 12.5% and negative in 67.1%. Preoperative fine needle aspiration was positive for NTML (granulomatous necrotizing lymphadenitis) in 93.7% whereas culture for mycobacteria was only positive in 23.4% of cases, being Mycobacterium lentiflavum the most frequent agent found. Mean preoperative waiting time was 2.5 months with 7.7% of fistulization previous to surgery. Mean hospital stay was 1,1 days and there were no intraoperative complications. Mean follow up time was 5.5 months (range 1-24 months) during which 19 cases of temporal facial paralysis were noted, among which only 2 persisted after one year. Conclusions: NTML is a disease with a growing incidence in our country. It is important to make an early diagnosis and surgical treatment in order to avoid complications, as surgery has demonstrated to be safe and effective, with a low rate of complications. We believe the actual protocols should be revised/checked due to low effectiveness of diagnostic tests


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Linfadenite/complicações , Linfadenite/diagnóstico , Linfadenite/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Micobactérias não Tuberculosas/patogenicidade , Linfadenite/etiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Radiografia Torácica/métodos , Estudos Retrospectivos , Espanha/epidemiologia , Biópsia por Agulha Fina/métodos
6.
Actas urol. esp ; 42(5): 331-337, jun. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174719

RESUMO

Introducción: Los resultados del tratamiento endoscópico del reflujo vesicoureteral (RVU) a corto plazo son excelentes. No obstante, con el paso de los años se ha identificado un número de pacientes en quienes el RVU que fue resuelto mediante esta técnica vuelve a aparecer. El objetivo de este trabajo es analizar los factores relacionados con este evento. Material y métodos: Se ha realizado un estudio analítico retrospectivo tipo caso-control incluyendo 395 unidades ureterales con RVU primario tratadas con éxito en nuestro centro, con seguimiento mínimo de 3 años. Se han identificado los casos en los que el RVU reapareció y se han analizado variables demográficas, variables relativas al RVU (grado, lateralidad, estudio inicial) y a la intervención (material utilizado). Resultados: Se identificaron 77 unidades ureterales con recidiva de las 395 incluidas (19,5%). La incidencia de recidiva fue del 29,7% en los pacientes tratados con dextranómero/ácido hialurónico (Dx/HA), del 20,2% en los tratados con polidimetilxilosano (MP) y del 12,2% en el caso de politetrafluoroetileno (PTFE). La aparición de recidiva se eleva hasta el 35% en el caso de pacientes tratados antes del año de edad y aquellos con RVU de gradoV. La clínica de disfunción miccional también eleva la incidencia de recidiva al 34,9%. Conclusión: El uso del material reabsorbible Dx/HA está relacionado con la recidiva del tratamiento endoscópico del RVU. Los reflujos de alto grado, junto con el tratamiento en edades precoces, así como la presencia de disfunción miccional, también son factores asociados a la recurrencia


Introduction: The short-term results of endoscopic treatment of vesicoureteral reflux (VUR) are excellent. Over time, however, a number of patients have been identified for whom VUR reappeared after being resolved with this technique. The aim of this study was to analyse the factors related to this event. Material and methods: A retrospective, analytical, case-control study included 395 ureteral units with primary VUR treated successfully at our centre, with a minimum follow-up of 3 years. We identified cases in which VUR reappeared and analysed the demographic variables, those related to VUR (grade, laterality, initial study) and those related to the operation (materials used). Results: We identified 77 ureteral units with recurrence in the 395 included uni:ts (19.5%). The recurrence rate was 29.7% for the patients treated with dextranomer/hyaluronic acid (Dx/HA), 20.2% for those treated with polydimethylsiloxane (MP) and 12.2% for polytetrafluoroethylene (PTFE). The onset of recurrence rose to 35% for patients treated before 1 year of age and those with gradeV VUR. Urinary dysfunction symptoms also increased the recurrence rate to 34.9%. Conclusion: The use of resorbable dextranomer/hyaluronic acid material was related to recurrence in the endoscopic treatment of VUR. The high-grade reflux and treatment at an early age, as well as the presence of urinary dysfunction, are also factors associated with recurrence


Assuntos
Humanos , Masculino , Feminino , Criança , Falha de Tratamento , Refluxo Vesicoureteral/terapia , Ureteroscopia/métodos , Seguimentos , Refluxo Vesicoureteral/diagnóstico , Estudos Retrospectivos , Transtornos Urinários/complicações , Transtornos Urinários/terapia , Procedimentos Cirúrgicos Urológicos/métodos
7.
Actas Urol Esp ; 42(5): 331-337, 2018 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29397210

RESUMO

INTRODUCTION: The short-term results of endoscopic treatment of vesicoureteral reflux (VUR) are excellent. Over time, however, a number of patients have been identified for whom VUR reappeared after being resolved with this technique. The aim of this study was to analyse the factors related to this event. MATERIAL AND METHODS: A retrospective, analytical, case-control study included 395 ureteral units with primary VUR treated successfully at our centre, with a minimum follow-up of 3 years. We identified cases in which VUR reappeared and analysed the demographic variables, those related to VUR (grade, laterality, initial study) and those related to the operation (materials used). RESULTS: We identified 77 ureteral units with recurrence in the 395 included units (19.5%). The recurrence rate was 29.7% for the patients treated with dextranomer/hyaluronic acid (Dx/HA), 20.2% for those treated with polydimethylsiloxane (MP) and 12.2% for polytetrafluoroethylene (PTFE). The onset of recurrence rose to 35% for patients treated before 1 year of age and those with gradeV VUR. Urinary dysfunction symptoms also increased the recurrence rate to 34.9%. CONCLUSION: The use of resorbable dextranomer/hyaluronic acid material was related to recurrence in the endoscopic treatment of VUR. The high-grade reflux and treatment at an early age, as well as the presence of urinary dysfunction, are also factors associated with recurrence.


Assuntos
Cistoscopia , Ureteroscopia , Refluxo Vesicoureteral/cirurgia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento
8.
Cir Pediatr ; 30(2): 83-88, 2017 Apr 20.
Artigo em Espanhol | MEDLINE | ID: mdl-28857530

RESUMO

INTRODUCTION: Dynamic compression system is the elective treatment for chondrogladiolar pectus carinatum. Nevertheless, its high cost poses a problem for its prescription in places where it is not subsidized. This article analyzes the experience of the Paediatric Plastic Surgery Service at a third grade hospital in the treatment of this deformity with a static compression system. MATERIALS AND METHODS: The study presents a descriptive, retrospective analysis of 30 patients with pectus carinatum treated with a static compression system. Furthermore, we describe the protocol of treatment used at our unit, and we analyse the satisfaction with bracing therapy, and its relation to therapeutic compliance. RESULTS: The study includes 28 boys and 2 girls. 93% of the patients presented a chondrogladiolar pectus carinatum. At the moment of finishing the study, 11 patients have completed the treatment, 14 still bracing, and 5 were lost in the follow-up. Satisfaction questionnaires were answered by 19 patients. CONCLUSION: Bracing therapy with static compression system is the treatment of choice for chondrogladiolar pectus carinatum in our unit, because of its effectiveness and lower price. Quality of life questionnaires show better marks in patients that are in the second phase of treatment.


Assuntos
Braquetes , Tratamento Conservador/métodos , Pectus Carinatum/terapia , Qualidade de Vida , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Cooperação do Paciente , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
9.
Cir. pediátr ; 30(2): 83-88, abr. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-166515

RESUMO

Introducción. El corsé de compresión dinámica constituye el tratamiento de elección de las formas condrogladiolares de pectus carinatum. Sin embargo, su elevado coste supone un problema para su prescripción en las comunidades en las que no se encuentra subvencionado. El presente trabajo analiza la experiencia de la Unidad de Cirugía Plástica Infantil de un hospital terciario en el manejo de esta patología mediante tratamiento ortopédico con corsé de compresión estática. Material y métodos. Se realiza un estudio descriptivo, de carácter retrospectivo, de 30 pacientes afectos de pectus carinatum tratados mediante ortesis estática. Además, se expone el protocolo de actuación de la unidad, y se analiza la satisfacción de los pacientes con el tratamiento, y su relación con la adherencia terapéutica. Resultados. La muestra incluye 28 varones y 2 mujeres. El 93% de los pacientes presentaban una malformación de tipo condrogladiolar. En el momento de finalización del estudio, 11 pacientes habían completado la terapia, 14 continuaban en tratamiento, y 5 fueron pérdidas en el seguimiento. Las encuestas de satisfacción pudieron ser realizadas a 19 pacientes. Conclusión. La terapia con corsé de compresión estática resulta eficaz, con un coste asociado más bajo al de la terapia dinámica, convirtiéndose en el tratamiento de referencia de nuestra unidad. Los cuestionarios de calidad de vida empleados muestran mejores puntuaciones en pacientes en fase de mantenimiento, respecto a pacientes en fase de corrección (AU)


Introduction. Dynamic compression system is the elective treatment for chondrogladiolar pectus carinatum. Nevertheless, its high cost poses a problem for its prescription in places where it is not subsidized. This article analyzes the experience of the Paediatric Plastic Surgery Service at a third grade hospital in the treatment of this deformity with a static compression system. Materials and methods. The study presents a descriptive, retrospective analysis of 30 patients with pectus carinatum treated with a static compression system. Furthermore, we describe the protocol of treatment used at our unit, and we analyse the satisfaction with bracing therapy, and its relation to therapeutic compliance. Results. The study includes 28 boys and 2 girls. 93% of the patients presented a chondrogladiolar pectus carinatum. At the moment of finishing the study, 11 patients have completed the treatment, 14 still bracing, and 5 were lost in the follow-up. Satisfaction questionnaires were answered by 19 patients. Conclusion. Bracing therapy with static compression system is the treatment of choice for chondrogladiolar pectus carinatum in our unit, because of its effectiveness and lower price. Quality of life questionnaires show better marks in patients that are in the second phase of treatment (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Pectus Carinatum/terapia , Bandagens Compressivas , Aparelhos Ortopédicos , Procedimentos Ortopédicos/métodos , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Cooperação do Paciente/estatística & dados numéricos
10.
Acta pediatr. esp ; 74(2): 45-49, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-150592

RESUMO

Introducción: El objetivo de este estudio es analizar a los pacientes remitidos a cirugía para practicar una frenotomía en el periodo neonatal y revisar su correcta indicación, ya que en la actualidad no existe consenso en el diagnóstico y tratamiento de la anquiloglosia. Material y métodos: Se realizó un estudio retrospectivo de 136 pacientes con anquiloglosia derivados a la consulta de cirugía plástica pediátrica. Se recogieron datos sobre la remisión a la consulta, problemas de lactancia y experiencia anterior y posterior a la intervención. Resultados: Los principales motivos de consulta se relacionaron con problemas en la técnica de lactancia materna (69 pacientes [65,7%]). El dolor durante la toma era el síntoma más habitual, aunque 33 pacientes (31,4%) no presentaban síntomas. En la mayoría de los casos, la remisión a cirugía la realizó el pediatra de zona (85 pacientes [80%]). El tipo más frecuente de anquiloglosia en la muestra fue el tipo II. Sólo se detectó 1 caso de recidiva. La ansiedad debida a la separación durante la frenotomía fue la experiencia negativa más frecuente entre las madres. Discusión: La falta de indicaciones establecidas para la frenotomía, así como la relativa facilidad de la aplicación de la técnica en la edad neonatal y el auge de las campañas de lactancia materna, está derivando en un exceso de indicación quirúrgica como tratamiento de la anquiloglosia. Debe promoverse la creación de guías que definan unos criterios adecuados de tratamiento, así como favorecer la remisión a la consulta de lactancia como un paso previo a la cirugía (AU)


Introduction: The aim of this study is to analyze patients referred to frenotomy surgery during neonatal period and to review their correct indication, as nowadays there is no consensus on the diagnosis and treatment of ankyloglossia. Material and methods: A retrospective study of 136 patients with ankyloglossia referred to pediatric plastic surgery. Data collection was based on the consultation, breastfeeding problems and experiences before and after intervention. Results: The main reasons to attend consultation were related to breastfeeding technique (69 patients [65.7%]), and pain in between takes the more frequent symptom, nevertheless 33 patients (31.4%) had no symptoms. In most cases, referral to surgery was done by the pediatrician (85 patients [80%]). The most common type of ankyloglossia in the sample was type II. Only one case of recurrence was detected. Separation anxiety during frenotomy was the most frequent negative experience among mothers. Discussion: The lack of guidelines established for frenotomy and the relative ease of application of the technique in the neonatal age and the rise of breastfeeding campaigns, is leading to an excess of surgical indication as treatment of ankyloglossia. To create guidelines defining an appropriate criteria of treatment should be promoted, and to facilitate referrals to lactation consultation as a step prior to surgery (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Freio Lingual/patologia , Aleitamento Materno/efeitos adversos , Freio Lingual/cirurgia , Aleitamento Materno/métodos , Freio Lingual/diagnóstico por imagem , Estudos Retrospectivos , Transtornos da Lactação/cirurgia , Ansiedade de Separação/complicações , Inquéritos Epidemiológicos/métodos
11.
Cir Pediatr ; 27(2): 53-56, 2014 Apr 15.
Artigo em Espanhol | MEDLINE | ID: mdl-27775271

RESUMO

INTRODUCTION: Rhabdomyosarcoma (RSM) becomes the most common tumour of the soft tissues during the paediatric age. It represents among 2-3% of child tumours. The genital-urinary location is the second most common location, only after head and neck. The treatment is usually medical, being the surgery a mere contribution, except for the cases in which the situation is not under control, when very aggressive surgery is necessary. The aim of this study is to analyse the cases of genial-urinary RMS that have been treated in our centre and the role that surgery has in their treatment. MATERIAL AND METHODS: Retrospective study of 20 patient (7 girls and 13 boys) with a median age of 24 months (range from 1 month to 12 years) with RMS in the aurochs-genial tract who have been treated in our hospital from 1990 to 2012. The variables described are demographic, location of the primary tumour, state at diagnosis, received treatment, both medical and surgical, with greater emphasis on the kind of surgery applied and monitoring in terms of survival. RESULTS: The location of the primary tumour was: bladder (6), paratesticular (5), vagina (3) retroperitoneal space (3), lesser pelvis (2) and prostate (1). All of them received medical treatment with chemotherapy and radiotherapy following International Society of Pediatric Oncology protocol after diagnostic biopsy. Surgery, which was always used as help, was: reappraisal of biopsy (1), orchiectomy (5), tumoral resection (8) and radical surgery (cystoprostatectomy or pelvic exenteration) in 6 patients. There were 3 deaths, 2 because of the evolution of the disease and 1 because of postoperative sepsis. The survival rate is 80% with a median follow - up of 14 years. CONCLUSIONS: The RMS is the most common tumour of soft tissues in childhood and the genital-urinary location is the second most common after the parameningeal one. The treatment is multidisciplinary and the surgery has a contributing role when there is no answer to the medical treatment or when there is a residual tumour even if some patients do not respond to medical treatment and they need a radical surgery for recovery.

12.
Cir. pediátr ; 27(3): 135-139, jul. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-131763

RESUMO

Objetivos. La litiasis del aparato urinario en la infancia es una entidad poco frecuente con una tasa de incidencia en España de 1/4.500 niños admitidos en un hospital y una tasa de expulsión espontánea entre 34-47%, precisando el resto de tratamiento activo La formación de litiasis urinaria en edad pediátrica presenta un alto riesgo de recurrencias, por lo que es necesario un diagnóstico y tratamiento protocolizado Presentamos nuestra experiencia en el tratamiento de las litiasis en el tracto urinario en niños. Material y métodos. Realizamos un estudio retrospectivo de todos los pacientes ≤16 años ingresados en nuestro centro con diagnóstico de litiasis en tracto urinario desde el año 2000 al año 2013, mencionándoselos datos de tratamiento, tasa libre de cálculo y complicaciones. Resultados. Un total de 69 pacientes fueron tratados del 2000 al 2013. La edad media de nuestros pacientes fue de 8,2 años (rango 1-18 años). La clínica de presentación más frecuentes fue dolor (52%). En el 100% de los casos el diagnóstico se obtuvo mediante ecografía. Respecto a la localización, 21 cálculos se localizaron en vejiga (V), 12 en uréter distal (UD), 8 en uréter medio (UM), 3 en uréter proximal (UP) y 13 en pelvis renal (P). El tamaño medio fue de 13 mm. En 21 pacientes se mantuvo tratamiento conservador (fluidoterapia, analgesia y tratamiento profiláctico antibiótico), en 14 se realizó litotricia extracorpórea y en 22 se realizó ureteroscopia con extracción (n=9) o fragmentación (n=13) del cálculo. No se produjeron complicaciones de interés. La tasa de éxito (tasa libre de cálculos) fue del 79% (n=55). Conclusiones. La litiasis en el tracto urinario infantil es una patología poco frecuente, con características especiales respecto al diagnóstico y tratamiento que requiere atención en centros especializados. El tratamiento óptimo dependerá principalmente de la edad del paciente, de la localización y tamaño del cálculo, así como de la experiencia del equipo


Purpose. Kidney stone disease in children is a rare pathology, with a low incidence in Spain (1/4,500 hospitalized children). The spontaneous expulsion rate is about 34-47% which means that more of 50% of children need active treatment. Paediatric patients forming urinary stones have a high risk of recurrence, therefore, a standard diagnosis and treatment are needed. We present our experience in urolithiasis treatment in children. Materials and methods. We reviewed retrospectively all the patients ≤16 years hospitalized in our hospital with urolithiasis diagnosis from 2000 to 2013, citing treatment modality, stone-free rates and complications. Results. A total of 69 patients with a mean age of 8,2 years (range1-16 years) were treated in our hospital during that period. The main clinical presentation was pain (52%). The diagnosis was made by abdominal ultrasounds in all cases. About localization, 21 lithiasis were found in distal urether (UD), 8 in medium urether (UM), 3 in proximal urether (UP) and 13 in renal pelvis (PR). The mean size was 13 mm.21 (30%) patients had a spontaneous expulsion of the stone, 14 (20%) patients were treated with extracorporeal shock wave lithotripsy and in 22 (32%) patients the elected therapy was ureterosopic stone fragmentation (n=13) or removal (n=9). No complications were observed. The overall stone-free rate was 79% (n=55). Conclusions. Kidney stone disease in children is a rare pathology, with its own features about diagnosis and treatment, which requires medical care in a specialized center. The optimal treatment should be considered regarding the age of the patient, localization and size of the stone, as well as the team experience


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Cálculos Urinários/cirurgia , Litotripsia/métodos , Ureteroscopia/métodos , Urolitíase/cirurgia , Fatores de Risco , Fatores Etários
13.
Cir. pediátr ; 27(2): 53-56, abr. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-127336

RESUMO

Introducción. El rabdomiosarcoma (RMS) constituye el tumor de tejidos blandos más frecuente en la edad pediátrica, representando el 2-3% de los tumores infantiles. La localización genitourinaria es la segunda en frecuencia tras la cabeza y cuello. El tratamiento suele ser médico, quedando la cirugía como coadyuvante, excepto en casos no controlados en que se precisan cirugías muy agresivas. El objetivo del estudio es analizar los casos de RMS de localización genitourinaria tratados en nuestro Centro y el papel que la cirugía tiene en su tratamiento. Material y métodos. Estudio retrospectivo de 20 pacientes (7 niñas y 13 niños) con una mediana de edad de 24 meses (rango de 1 mes a 12 años) con RMS del tracto urogenital tratados en nuestro Hospital desde 1990 hasta 2012. Se describen variables demográficas, localización del tumor primario, estadio al diagnóstico, tratamiento recibido, tanto médico como quirúrgico, con especial atención al tipo de cirugía realizada y seguimiento en términos de supervivencia. Resultados. La localización del tumor primario fue: vejiga (6), paratesticular (5), vagina (3), retroperitoneo (3), pelvis menor (2) y próstata (1). Todos recibieron tratamiento médico con quimioterapia y radioterapia según protocolo de la Sociedad Internacional de Oncología Pediátrica (SIOP) previa biopsia diagnóstica. La cirugía, practicada en todos los casos como coadyuvante fue: reevaluación por biopsia (1), orquiectomía (5), resección tumoral (8) y cirugía radical (cistoprosta-tectomía o exanteración pélvica) en 6 pacientes. Hubo 3 fallecimientos, 2 por progresión de la enfermedad y 1 por sepsis postoperatoria. Los 17 restantes están vivos, lo que supone una supervivencia del 80% con una mediana de seguimiento de 14 años. Conclusiones. El RMS es el tumor de tejidos blandos más frecuente en la infancia y la localización genitourinaria la segunda en frecuencia tras las parameníngeas. El tratamiento es multidisciplinar y la cirugía tiene un papel coadyuvante en casos de no respuesta al tratamiento médico o de tumor residual aunque hay pacientes que no responden al tratamiento médico y precisan de cirugía radical para su curación


Introduction. Rhabdomyosarcoma (RSM) becomes the most common tumour of the soft tissues during the paediatric age. It represents among 2-3% of child tumours. The genital-urinary location is the second most common location, only after head and neck. The treatment is usually medical, being the surgery a mere contribution, except for the cases in which the situation is not under control, when very aggressive surgery is necessary. The aim of this study is to analyse the cases of genial-urinary RMS that have been treated in our centre and the role that surgery has in their treatment. Material and methods. Retrospective study of 20 patient (7 girls and 13 boys) with a median age of 24 months (range from 1 month to 12 years) with RMS in the aurochs-genial tract who have been treated in our hospital from 1990 to 2012. The variables described are demographic, location of the primary tumour, state at diagnosis, received treatment, both medical and surgical, with greater emphasis on the kind of surgery applied and monitoring in terms of survival. Results. The location of the primary tumour was: bladder (6), par-atesticular (5), vagina (3) retroperitoneal space (3), lesser pelvis (2) and prostate (1). All of them received medical treatment with chemotherapy and radiotherapy following International Society of Pediatric Oncology protocol after diagnostic biopsy. Surgery, which was always used as help, was: reappraisal of biopsy (1), orchiectomy (5), tumoral resection (8) and radical surgery (cystoprostatectomy or pelvic exenteration) in 6 patients. There were 3 deaths, 2 because of the evolution of the disease and 1 because of postoperative sepsis. The survival rate is 80% with a median follow - up of 14 years. Conclusions. The RMS is the most common tumour of soft tissues in childhood and the genital-urinary location is the second most common after the parameningeal one. The treatment is multidisciplinary and the surgery has a contributing role when there is no answer to the medical treatment or when there is a residual tumour even if some patients do not respond to medical treatment and they need a radical surgery for recovery


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Rabdomiossarcoma/epidemiologia , Neoplasias Urogenitais/epidemiologia , Estudos Retrospectivos , Estadiamento de Neoplasias , Intervalo Livre de Doença , Neoplasias de Tecidos Moles/epidemiologia
14.
Cir Pediatr ; 27(3): 135-9, 2014 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-25845103

RESUMO

PURPOSE: Kidney stone disease in children is a rare pathology, with a low incidence in Spain (1/4,500 hospitalized children). The spontaneous expulsion rate is about 34-47% which means that more of 50% of children need active treatment. Paediatric patients forming urinary stones have a high risk of recurrence, therefore, a standard diagnosis and treatment are needed. We present our experience in urolithiasis treatment in children. MATERIALS AND METHODS: We reviewed retrospectively all the patients ≤ 16 years hospitalized in our hospital with urolithiasis diagnosis from 2000 to 2013, citing treatment modality, stone-free rates and complications. RESULTS: A total of 69 patients with a mean age of 8,2 years (range 1-16 years) were treated in our hospital during that period. The main clinical presentation was pain (52%). The diagnosis was made by abdominal ultrasounds in all cases. About localization, 21 lithiasis were found in distal urether (UD), 8 in medium urether (UM), 3 in proximal urether (UP) and 13 in renal pelvis (PR). The mean size was 13 mm. 21 (30%) patients had a spontaneous expulsion of the stone, 14 (20%) patients were treated with extracorporeal shock wave lithotripsy and in 22 (32%) patients the elected therapy was ureterosopic stone fragmentation (n = 13) or removal (n = 9). No complications were observed. The overall stone-free rate was 79% (n = 55). CONCLUSIONS: Kidney stone disease in children is a rare pathology, with its own features about diagnosis and treatment, which requires medical care in a specialized center. The optimal treatment should be considered regarding the age of the patient, localization and size of the stone, as well as the team experience.


Assuntos
Cálculos Renais/terapia , Cálculos Ureterais/terapia , Cálculos da Bexiga Urinária/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
15.
Acta pediatr. esp ; 70(8): 322-325, sept. 2012.
Artigo em Espanhol | IBECS | ID: ibc-106574

RESUMO

El objetivo de este trabajo es presentar nuestros resultados del abordaje de la incontinencia diurna refractaria al tratamiento médico mediante uroterapia. Para ello, se han revisado retrospectivamente las historias de los niños sometidos a este tipo de tratamiento en nuestro centro. Los criterios de inclusión fueron niños con incontinencia diurna refractarios al tratamiento farmacológico, incontinencia de la risa, vejiga hipoactiva y niños en los que se detectó en la cistomanometría una hiperactividad del detrusor y/o incoordinación vesicoesfinteriana. Doce pacientes completaron el seguimiento, con una media de edad de 8,5 años. La indicación más frecuente fue la incontinencia con hiperactividad del detrusor (58,33%). Los resultados fueron satisfactorios en el 83,3% de los casos, con desaparición de los síntomas en 8 pacientes sin tratamiento médico asociado, y 2 más con tratamiento asociado para la eneuresis nocturna. Sólo dos pacientes no presentaron mejoría. La uroterapia es una parte importante del abordaje de la disfunción del tracto urinario inferior en la edad pediátrica. Cabe destacar la importancia de la correcta selección de pacientes y la aplicación adecuada de las diferentes intervenciones, entre las que el biofeedback con imágenes animadas desempeña un papel fundamental(AU)


The aim of this essay is to present our initial results in applying urotherapy to patients with urinary incontinence not responding to pharmacological treatment. We performed ach art review of all the patients treated with urotherapy in our institution. We included all children with incontinence refractory to pharmacological treatment, giggle incontinence, underactive bladder, overactive bladder and dysfunctional voiding. 12 patients completed follow up. Mean age was 8.5 years. The most frequent finding in cystomanometry was detrusor over activity (58.33%). We achieved full response in 83.3% of our patients, 8 of them without any pharmacological treatment, and another 2 with associated administration of desmopressin. Only two patients did not respond to therapy. Urotherapy is an important part of management of lower urinary tract dysfunction in children. Careful selection of the patients and adequate use of every intervention are crucial for its effectiveness(AU)


Assuntos
Humanos , Masculino , Feminino , Incontinência Urinária/terapia , Incontinência Urinária/diagnóstico , Biorretroalimentação Psicológica , Reologia/métodos , Reologia/tendências , Urodinâmica/fisiologia , Doxazossina/uso terapêutico , Metilfenidato/uso terapêutico , Estudos Retrospectivos , Incontinência Urinária/prevenção & controle , Enurese/complicações , Infecções Urinárias/complicações , Refluxo Vesicoureteral/complicações
16.
Cir. pediátr ; 25(3): 126-128, jul.-sept. 2012.
Artigo em Espanhol | IBECS | ID: ibc-110133

RESUMO

El neumoperitoneo necesario para la laparoscopia provoca modificaciones, fundamentalmente a nivel cardiorrespiratorio, que se deben conocer para realizar procedimientos laparoscópicos en neonatos y lactantes pequeños. El objetivo de este trabajo es describir los cambios hemodinámicos y ventilatorios que se producen en una serie de estos pacientes sometidos a un procedimiento laparoscópico estándar. Para ello, hemos realizado una revisión retrospectiva de pacientes sometidos a piloromiotomía laparoscópica en nuestro centro. Se han recogido datos demográficos, datos de la intervención, evolución y complicaciones, y parámetros hemodinámicos (frecuencia cardiaca –FC– y tensión arterial –TA–) y respiratorios (saturación de O2 –SO2– y CO2 espirado –ECO2–) en distintos momentos de la cirugía. Se ha realizado un análisis estadístico de los mismos. Un total de 55 pacientes fueron incluidos, con una edad media de 34 días y peso medio de 3.785 g. En todos los pacientes se utilizó ventilación controlada por presión y recibieron sueroterapia de mantenimiento. Tanto la TA como la FC y la SO2 se mantuvieron estables a lo largo de la cirugía, sin mostrar diferencias significativas. El ECO2 presentó un incremento significativo tras la insuflación, que se controló aumentando la frecuencia respiratoria. En conclusión, la respuesta hemodinámica y ventilatoria en estos pacientes es controlable con medidas anestésicas y quirúrgicas, pero es importante tener en cuenta las posibles consecuencias del neumoperitoneo en pacientes tan pequeños (AU)


The pneumoperitoneum induced during laparoscopy has cardiovascular and respiratory effects that have to be taken into account to perform laparoscopic procedures in neonates and small infants. The aim of this paper is to describe the hemodynamic and ventilatory changes that occur in a group of these patients undergoing standard laparoscopic procedure. We performed a retrospective review of patients undergoing laparoscopic pyloromyotomy in our institution. We collected demographic data, data from the intervention, outcome and complications and hemodynamic parameters (heart rate –HR– and blood pressure –BP–) and respiratory (O2 saturation –SO2– and exhaled CO2 –ECO2–) at different times during surgery. We performed statistical analysis of these data. We reviewed a total of 55 charts. Mean age was 34 days and average weight 3,785 g. All patients were ventilated with pressure control mode and received maintenance fluid therapy. BP, HR and SO2 were stable throughout the surgery not showing significant differences. The ECO2 increased significantly after inflation, however it was controlled by increasig respiratory rate. In conclusion, the hemodynamic and ventilatory response in these patients is controllable with anesthetic and surgical measures but it is important to consider the possible consequences of pneumoperitoneum in this group of patients (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Fenômenos Fisiológicos Cardiovasculares , Laparoscopia , Doenças do Recém-Nascido/cirurgia , Fenômenos Fisiológicos Respiratórios , Pneumoperitônio Artificial/efeitos adversos , Respiração Artificial/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Estudos Retrospectivos
17.
Rev. esp. pediatr. (Ed. impr.) ; 68(4): 262-270, jul.-ago. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-114239

RESUMO

El reflujo vésico ureteral (RVU) sigue planteando grandes dilemas, principalmente en el diagnóstico como en el tratamiento. Actualmente hay tres dilemas clínicos importantes: ¿Quién se beneficia del diagnóstico?, ¿quién tiene riesgo de sufrir daño renal si no se trata el RVU? Y ¿quién se beneficia del tratamiento? Lo principal tras un cuadro de ITU no debe ser visualizar si hay RVU si no comprobar si existe daño renal, y si lo hay descartar el RVU. Otro que su presencia obligará a tratarla antes de decidir sobre el RVU. De los tratamiento actuales, expectante, profilaxis antibiótica y cirugía (abierta, endoscópica, laparoscopia y robótica) se ha comprobado que no hay ninguno superior a otro y la elección dependerá de las características de cada paciente, teniendo en cuenta la opinión familiar previa información de cada uno de ellos. Lo que sabemos es que si se quiere resolver el RVU de forma rápida y disminuir la presencia de ITU asociadas, el tratamiento quirúrgico es la primera opción, y dentro de este endoscópico es el más indicado, pero sin olvidarnos que deberemos analizar a cada paciente individualmente (AU)


Vesicoureteral reflux (VUR) remains a major dilemma, particularly in the diagnosis and treatment. Currently there are three important clinical dilemmas: Who benefits the diagnosis? Who is at risk for kidney damage if left untreated VUR? And who benefits from treatment? The main thing behind a box should not be viewed ITU if VUR if not check for kidney damage, and if there is rule out VUR. Another important factor is the association of bladder dysfunction and that their presence will force before deciding to treat VUR. Current treatments, expectant, antibiotic prophylaxis and surgery (open, endoscopic, laparoscopic and robotic) has shown that there is none superior to another and the choice will depend on the characteristics of each patient, taking into account the opinion information from previous family each. What we know is that if you want VUR resolved quickly and reduce the presence of UTI associated with surgical treatment, the first option, the endoscope, is the most appropriate but without forgetting that we have to analyze each patient individually (AU)


Assuntos
Humanos , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/terapia , Fatores de Risco , Infecções Urinárias/diagnóstico , Nefropatias/diagnóstico , Ureteroscopia
18.
Cir Pediatr ; 25(3): 126-8, 2012 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-23480007

RESUMO

The pneumoperitoneum induced during laparoscopy has cardiovascular and respiratory effects that have to be taken into account to perform laparoscopic procedures in neonates and small infants. The aim of this paper is to describe the hemodynamic and ventilatory changes that occur in a group of these patients undergoing standard laparoscopic procedure. We performed a retrospective review of patients undergoing laparoscopic pyloromyotomy in our institution. We collected demographic data, data from the intervention, outcome and complications and hemodynamic parameters (heart rate--HR--and blood pressure--BP--) and respiratory (O2 saturation--SO2--and exhaled CO2--ECO2--) at different times during surgery. We performed statistical analysis of these data. We reviewed a total of 55 charts. Mean age was 34 days and average weight 3,785 g. All patients were ventilated with pressure control mode and received maintenance fluid therapy. BP, HR and SO2 were stable throughout the surgery not showing significant differences. The ECO2 increased significantly after inflation, however it was controlled by increasig respiratory rate. In conclusion, the hemodynamic and ventilatory response in these patients is controllable with anesthetic and surgical measures but it is important to consider the possible consequences of pneumoperitoneum in this group of patients.


Assuntos
Hemodinâmica/fisiologia , Laparoscopia , Monitorização Intraoperatória , Respiração , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
19.
Cir. pediátr ; 24(4): 241-244, oct. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-107363

RESUMO

Introducción. La heterotaxia es un fallo en el desarrollo embrionario para la consecución de una simetría izquierda-derecha .Objetivo. Presentación de un caso de heterotaxia y mostrar una vía de abordaje para la fundoplicatura. Material y métodos. Niña con síndrome de heterotaxia-poliespleniacon reflujo gastroesofágico y dolor abdominal recurrente. Se decide realizar tratamiento antirreflujo laparoscópico con funduplicatura tipo Nissen con acceso derecho al hiato y a los pilares diafragmáticos. Conclusiones. Está en discusión la cirugía en este tipo de síndromes, indicándose únicamente en los casos de dolor abdominal recurrente, cuadros suboclusivos o cuando existe un diagnóstico de reflujo gastroesofágico; el dilema está entre el abordaje laparoscópico o la laparotomía clásica. La mayor dificultad del abordaje laparoscópico es la centralización de un hígado grande y la colocación del estómago a la derecha a pesar de que el hiato esofágico se sitúe normalmente en el lado izquierdo (AU)


Introduction. Heterotaxy is a failure in embryonic development to achieve left-right symmetry. Objective. To report a case of heterotaxy and show a surgical approach for fundoplication. Material and methods. A girl with heterotaxy-polysplenia syndrome with gastroesophageal refl ux and recurrent abdominal pain. It was decided to perform laparoscopic antire flux treatment with Nissen fundoplication with approach by the right side of the diaphragmatichiatus and pillars. Conclusions. Surgery is being discussed in these syndromes, indicatingonly in cases of recurrent abdominal pain, subocclusive lesions or when diagnosis of gastroesophageal refl ux is done. The dilemma is between laparoscopic or classical laparotomy. The main difficulty of the laparoscopic approach is the enlarged liver and stomach placement right despite the esophageal hiatus is normally on the left side (AU)


Assuntos
Humanos , Feminino , Pré-Escolar , Síndrome de Heterotaxia/cirurgia , Fundoplicatura/métodos , Laparoscopia/métodos , Refluxo Gastroesofágico/cirurgia , Dor Abdominal/etiologia
20.
Cir Pediatr ; 24(4): 241-4, 2011 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-23155640

RESUMO

INTRODUCTION: Heterotaxy is a failure in embryonic development to achieve left-right symmetry. OBJECTIVE: To report a case of heterotaxy and show a surgical approach for fundoplication. MATERIAL AND METHODS: A girl with heterotaxy-polysplenia syndrome with gastroesophageal reflux and recurrent abdominal pain. It was decided to perform laparoscopic antireflux treatment with Nissen fundoplication with approach by the right side of the diaphragmatic hiatus and pillars. CONCLUSIONS: Surgery is being discussed in these syndromes, indicating only in cases of recurrent abdominal pain, subocclusive lesions or when diagnosis of gastroesophageal reflux is done. The dilemma is between laparoscopic or classical laparotomy. The main difficulty of the laparoscopic approach is the enlarged liver and stomach placement right despite the esophageal hiatus is normally on the left side.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Síndrome de Heterotaxia/complicações , Pré-Escolar , Feminino , Humanos
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