Colecistectomía laparoscópica en niños y adultos: lo que podemos aprender / Laparoscopic cholecystectomy: what we can learn about

Objetivos. La colecistectomía laparoscópica (CL) es un procedimiento muy habitual en adultos, pero no es tan frecuente en la edad pediátrica. Nos preguntamos si existen diferencias entre ambas poblaciones en cuanto a morbilidad y evolución postoperatoria. Material y métodos. Revisión retrospectiva de 39 casos consecutivos que precisaron CL en nuestro Servicio entre 2003-2013 y de una muestra similar de casos intervenidos en el Servicio de Cirugía General del mismo centro en pacientes entre 18 y 40 años. Resultados. 39 niños y 40 adultos cumplieron criterios para incluirse en el estudio. La indicación más frecuente fue la colelitiasis en ambos grupos. El tiempo quirúrgico medio fue significativamente mayor en los niños (niños: 127 min, adultos: 70 min, p< 0,01) pero no encontramos diferencias significativas en la tasa de reconversión o la incidencia de complicaciones (niños: 7.7%, adultos 15%). En cuanto a los factores preoperatorios, solo el sexo masculino se relacionó con mayor incidencia de complicaciones (p 0,037). Por otra parte descubrimos que, en ausencia de complicaciones, la estancia postoperatoria (niños: 2,1 días, adultos: 0,5 días), y el tiempo hasta tolerancia oral (niños: 21 h, adultos: 8 h) fueron significativamente mayores en niños (p< 0,01). Conclusiones. 1) La CL en niños es un procedimiento seguro que no presenta más morbimortalidad que en adultos, a pesar de un mayor tiempo quirúrgico. 2) Creemos que el tiempo de ingreso más prolongado se debe en parte a una falta de confianza con la técnica y que la tendencia en el futuro debe encaminarse a fomentar un inicio temprano de la tolerancia y un alta precoz (AU)

Background. Laparoscopic cholecystectomy (LC) is a very usual procedure within adult population, but not as frequent in childhood. The aim of this study was to assess the outcome of LC in children compared with those performed in adulthood. Materials and methods. We reviewed 39 consecutive patients who underwent LC between 2003 and 2013 at our Department and a similar sample of patients from 18 to 40 years of age from the General Surgery Department. Results. 39 children and 40 adults fulfilled criteria to be included in the study. The most frequent indication was cholelithiasis in both groups. The mean operating time was significantly higher among children (127 min, adults 71 min, p< 0.01) but we didn’t find differences neither in conversion nor in complication rates (children 5% and 7.7%, adults 2.5% and 15% respectively). In regard to preoperative factors, only male gender was correlated to a higher complication rate (p 0.037). On the other hand we found out that, in absence of complications, both the average length of stay (children 2.1 days, adults 0.5 days) and mean time to first feeding (children 21 hours, adults 8 hours) were significantly higher among children (p< 0.01). Conclusions. 1) LC in childhood is a safe procedure that does not imply more morbidity than the same intervention in adults, even though a more prolonged operating time. 2) We believe that our longer hospital stay is due to certain lack of confidence with the technique and, in the future, the trend should be bent on encouraging a shorter time to first feeding and an earlier discharge (AU)

[Laparoscopic cholecystectomy: what we can learn about]. / Colecistectomía laparoscópica en niños y adultos: lo que podemos aprender.

BACKGROUND: Laparoscopic cholecystectomy (LC) is a very usual procedure within adult population, but not as frequent in childhood. The aim of this study was to assess the outcome of LC in children compared with those performed in adulthood. MATERIALS AND METHODS: We reviewed 39 consecutive patients who underwent LC between 2003 and 2013 at our Department and a similar sample of patients from 18 to 40 years of age from the General Surgery Department. RESULTS: 39 children and 40 adults fulfilled criteria to be included in the study. The most frequent indication was cholelithiasis in both groups. The mean operating time was significantly higher among children (127 min, adults 71 min, p < 0.01) but we didn't find differences neither in conversion nor in complication rates (children 5% and 7.7%, adults 2.5% and 15% respectively). In regard to preoperative factors, only male gender was correlated to a higher complication rate (p 0.037). On the other hand we found out that, in absence of complications, both the average length of stay (children 2.1 days, adults 0.5 days) and mean time to first feeding (children 21 hours, adults 8 hours) were significantly higher among children (p < 0.01). CONCLUSIONS: 1) LC in childhood is a safe procedure that does not imply more morbidity than the same intervention in adults, even though a more prolonged operating time. 2) We believe that our longer hospital stay is due to certain lack of confidence with the technique and, in the future, the trend should be bent on encouraging a shorter time to first feeding and an earlier discharge.

Molecular genetics of familial hypercholesterolemia in Spain: Ten novel LDLR mutations and population analysis.

Mutations underlying FH in Spain are largely unknown because only a few and limited surveys have been carried out on Spanish FH patients up to now. To gain information on this issue, we have analysed a group of 113 unrelated Spanish FH patients from an eastern area of Spain (Valencian Community). We have screened the LDLR gene by Southern blot and PCR-SSCP analysis to detect large rearrangements and small mutations, respectively. In addition, we have screened the Apo B gene for mutations known to cause FDB by PCR-SSCP analysis. We have identified a total of 47 different mutations in the LDLR gene (5 large rearrangements, and 42 small mutations, which were characterized by DNA sequencing), 19 of which have not been described in other populations (Valencia-1 to -4, 112insA, P160R, 790DelATGA, 920insTCAG, G642E, and the ten novel mutations E246A, 884delT, I289T, S305F, Q328X, Y354C, I603del, 2312-3C>A, V779M, and N804K). Three of these mutations (15%) were present in more than 1 proband, being mutation 112insA the most prevalent (frequency approximately 8%) in our sample. The Apo B gene R3500Q mutation was found in only one patient and no underlying defect was found in about 27% of patients. Our data support the notion that Spaniards represent a heterogeneous population with its own spectrum of LDLR gene mutations and that, in our population, FDB has a lower frequency or a milder expression than in central Europe countries.