La técnica segura para la gastronomía endoscópica percutánea en niños / Safe technique for percutaneous endoscopic gastrostomy (PEG)

La Gastrotomía Endoscópica Percutánea (GEP) tiene ventajas sobre la gastronomía a cielo abierto. La experiencia con 79 niños durante un período dee 4 años nos permitió identificar una serie de poblemas técnicos asociados a la inserción del tubo percutáneo y otras complicaciones del procedimiento que incluyen: infección en la herida, desgarro esofágico durante la extracción de la guía de alambre, perforación del colon, desplazamiento del retén interno, erosión de la mucosa gástrica y reflujo gastroesofágico sintomático subsiguiente a la GEP. Muchas de estas complicaciones pueden ser evitadas siguiendo una técnica precisa de inserción

A practical approach to the investigation and management of long gap oesophageal atresia.

Oesophageal atresia in which there is a long gap between the ends of the oesophagus remains one of the most difficult problems confronting the pediatric surgeon. While it is generally accepted that the best results are obtained if oesophageal continuity is established, this may be difficult to achieve. Various manoeuvres have been advocated to mobilise and lengthen the oesophagus, and if these measures fail, cervical oesophagostomy and oesophageal replacement may become necessary. This paper outlines the situations in which long gap oesophageal atresia might be expected, how infants should be investigated to determine the most appropriate type and time of procedure, and provides a basis for surgical decision-making during the operative procedure itself. These guidelines should enable oesophageal continuity to be obtained in the vast majority of infants with long gap oesophageal atresia.

Influence of associated anomalies on the management of oesophageal atresia.

Associated congenital abnormalities occur in over 50% of infants with oesophageal atresia. Many of them influence the way in which the oesophageal atresia is managed and therefore should be detected as soon as possible after birth. Early recognition of those with no prospect of long-term survival (e.g. Trisomy 18, bilateral renal agenesis) will avoid unnecessary surgery to the oesophagus. About 12% of oesophageal atresia infants will have no surgery performed. This paper presents a protocol for the initial investigation and management of associated anomalies in oesophageal atresia, based on an experience of 670 infants treated at the Royal Children's Hospital, Melbourne, Pre-operative detection of associated anomalies of oesophageal atresia requires clinical examination, pre-operative renal ultrasound (if the child has not passed urine), and an echocardiograph of the heart to exclude duct-dependent lesions. If there is clinical suspicion of a major chromosomal abnormality, surgery should be deferred until chromosomal analysis has been completed.