Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair. / Crioanalgesia toracoscópica: nueva estrategia para el control del dolor postoperatorio en cirugía del pectus excavatum.

OBJECTIVE: Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique. MATERIAL AND METHODS: Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019. TECHNIQUE: A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS). RESULTS: Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants introduced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively. CONCLUSIONS: Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum.

INTRODUCCION: Publicaciones recientes reportaron el alta temprana y bajos requerimientos de opioides para el control del dolor postoperatorio en la reparación mínimamente invasiva del pectus excavatum tras crioablación bilateral de nervios intercostales. Nuestro objetivo es describir nuestra experiencia inicial con esta técnica. MATERIAL Y METODOS: Análisis retrospectivo de historias clínicas de pacientes sometidos a crioanalgesia toracoscópica bilateral durante la reparación mínimamente invasiva del pectus excavatum en nuestra institución desde septiembre de 2018 a marzo de 2019. TECNICA: Se aplicó una criosonda a -70°C bajo visión toracoscópica durante 2 minutos del 3º al 7º espacio intercostal, de manera bilateral. El dolor postoperatorio fue evaluado con una Escala Visual Analógica. RESULTADOS: Se incluyeron 21 pacientes, de los cuales el 90% era de sexo masculino con una edad media de 15,2 ± 4,29 años y un peso de 53,6 ± 15,33 kg. El índice de Haller promedio fue de 5,1 ± 2,97 y el índice de corrección de 37,6 ± 13,77%. El número promedio de implantes fue de 2,55 ± 0,74. La duración media de la crioanalgesia fue de 39,9 ± 21,1 minutos. Ninguno recibió anestesia peridural. El tiempo de internación postquirúrgico fue de 1,64 ± 0,73. La necesidad de rescate con opiáceos fue menor a 1 dosis en el 71,3%. La puntuación de dolor en los días postoperatorios 1, 3, 7 y 21 fue, en promedio, de 2,55; 2,01; 0,5 y 0,06, respectivamente. CONCLUSIONES: El empleo de la crioanalgesia toracoscópica bilateral permitió el alta hospitalaria temprana y buen control del dolor postoperatorio en todos los casos, convirtiéndose en el método analgésico de elección en nuestra práctica clínica.

Crioanalgesia toracoscópica: nueva estrategia para el control del dolor postoperatorio en cirugía del pectus excavatum / Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair

Introducción: Publicaciones recientes reportaron el alta temprana y bajos requerimientos de opioides para el control del dolor postope-ratorio en la reparación mínimamente invasiva del pectus excavatumtras crioablación bilateral de nervios intercostales. Nuestro objetivo es describir nuestra experiencia inicial con esta técnica. Material y métodos: Análisis retrospectivo de historias clínicas de pacientes sometidos a crioanalgesia toracoscópica bilateral durante la reparación mínimamente invasiva del pectus excavatum en nuestra institución desde septiembre de 2018 a marzo de 2019. Técnica: Se aplicó una criosonda a -70°C bajo visión toracoscópica durante 2 minutos del 3º al 7º espacio intercostal, de manera bilateral. El dolor postoperatorio fue evaluado con una Escala Visual Analógica. Resultados: Se incluyeron 21 pacientes, de los cuales el 90% era de sexo masculino con una edad media de 15,2 ± 4,29 años y un peso de 53,6 ± 15,33 kg. El índice de Haller promedio fue de 5,1 ± 2,97 y el índice de corrección de 37,6 ± 13,77%. El número promedio de implantes fue de 2,55 ± 0,74. La duración media de la crioanalgesia fue de 39,9 ± 21,1 minutos. Ninguno recibió anestesia peridural. El tiempo de internación postquirúrgico fue de 1,64 ± 0,73. La necesidad de rescate con opiáceos fue menor a 1 dosis en el 71,3%. La puntuación de dolor en los días postoperatorios 1, 3, 7 y 21 fue, en promedio, de 2,55; 2,01; 0,5 y 0,06, respectivamente. Conclusiones: El empleo de la crioanalgesia toracoscópica bilateral permitió el alta hospitalaria temprana y buen control del dolor postoperatorio en todos los casos, convirtiéndose en el método analgésico de elección en nuestra práctica clínica

Objective: Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique. Materials and methods: Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019. Technique: A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS). Results: Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants intro-duced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively. Conclusions: Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum

Pectus carinatum: When less is more.

Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management alternatives have shifted from open resective to minimally invasive strategies, and finally, to reshaping the chest using both surgical and non-surgical modalities. We aim to review the evolution of the diagnosis and treatment of pectus carinatum up to its current management.

Colecistectomía transumbilical mediante técnica híbrida: un nuevo abordaje prometedor / Transumbilical cholecystectomy using hybrid technique: A new promising approach

Objetivos. La utilización de imanes en la colecistectomía transumbilical mejora la triangulación y logra una visión crítica óptima. No obstante, la atracción entre los imanes puede provocar colisiones y su manejo dificulta el proceso, siendo este hecho más relevante en pediatría. Con el objetivo de simplificar la técnica y disminuir la curvad e aprendizaje, hemos elaborado un modelo híbrido con un solo imán. Material y métodos. Revisión retrospectiva de las colecistectomías realizadas en nuestro servicio entre junio 2011 y julio 2012. La técnica combina el uso de un imán y una pinza curva. A través de la incisión transumbilical, colocamos un trocar de 12 mm y otro flexible de 5 mm. Por el primero introducimos el imán encargado de traccionar del fundusvesicular y el laparoscopio con canal de trabajo. El trocar flexible se usa para la pinza curva, manejada por el ayudante para movilizar el infundíbulo. El cirujano opera por el canal de trabajo del laparoscopio. Resultados. Veintiséis pacientes fueron intervenidos con esta técnica. La edad media fue 14 años (4-17) y el peso 50 kg (18-90), siendo el 65% niñas. El tiempo operatorio medio fue 62 minutos (50-70) y la visión crítica de seguridad se logró en todos los casos. No hubo entrecruzamientos de las pinzas ni de las manos de los cirujanos. No existieron complicaciones intraoperatorias ni postoperatorias. La estancia hospitalaria fue 1,4 ± 0,6 días y la mediana de seguimiento 201 días (42-429).Conclusiones. La técnica hibrida, combinando imán y pinza curva, simplifica la cirugía transumbilical. Parece una alternativa factible y segura para la colecistectomía transumbilical y potencialmente reproducible (AU)

Objectives. The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, theattraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. Material and methods. Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved (..) (AU)

[Transumbilical cholecystectomy using hybrid technique: a new promising approach]. / Colecistectomia transumbilical mediante técnica híbrida: un nuevo abordaje prometedor.

OBJECTIVES: The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, the attraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet. MATERIAL AND METHODS: Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved grasper. Through transumbilical incision, a 12 mm trocar and another flexible 5 mm are placed. Laparoscope with working channel uses the 12 mm trocar. The magnet is introduced to the abdominal cavity using the working channel to provide cephalad retraction of gallbladder fundus. Curved grasper is run by the assistant to mobilize the infundibulum across flexible trocar. The surgeon operates through the working channel of the laparoscope. RESULTS: Twenty-six patients were operated on with this technique. Mean age was 14 years (4-17) and weight 50 kg (18-90). 65% were girls. The mean operative time was 62 minutes (50-70) and the critical view of safety was achieved in all cases. Instrumental collision or hands crossing were not seen. There were no intraoperative or postoperative complications. The hospital stay was 1.4 +/- 0.6 days and the median follow-up 201 days (42-429). CONCLUSIONS: The hybrid technique, combining magnet and a curved grasper, simplifies transumbilical surgery. It seems a feasible and safe for transumbilical cholecystectomy and potentially reproducible.

Etiopathology of Arnold-Chiari malformation: a fetal rat model of dysraphism.

OBJECTIVES: We report an experimental fetal rat model with the aim of comparing two surgical methods used to check Arnold-Chiari Malformation (ACM) by dysraphism. We also wanted to (1) determine which type(s) of ACM akin to human anatomical findings were generated with the model and (2) study whether a cerebrospinal fluid pressure gradient could be responsible for ACM's etiopathology. MATERIALS AND METHODS: At E20, a mean of two fetuses per pregnant rat underwent an incision at the 2-3 lumbar level, deep into the medulla oblongata central canal, by two different surgical methods. Cesarian section was performed at E22. Dysraphic fetuses were examined clinically. Those born alive and controls without lesions were anatomically and histologically studied. RESULTS: Method 2 was better than method 1 at reproducing the model. 100% of operated fetuses showed no spontaneous motility or sensibility to pressure on the posterior limbs in addition to anatomopathological evidence of type II ACM. CONCLUSIONS: A high rate of ACM could be checked by dysraphism with both methods. The opening of the central canal was demonstrated to generate a cerebrospinal fluid pressure gradient responsible for the herniation of encephalic structures comparable with human ACM. We believe this model may be useful for evaluating further strategies for prenatal treatment.

Análisis de la evolución clínico-quirúrgica de neonatoscon atresia de esófago con cabos distantes (Long Gap)durante el crecimiento espontáneo de los mismos / Analysis of clinical-surgical course of neonates with long-gap esophageal atresia during their spontaneous growth

Introducción. La atresia de esófago (AE) es una de las patologías quirúrgicas de mayor prevalencia en la etapa neonatal. La corrección quirúrgica es posible despues del nacimiento, pero en ocasiones la distancia entre los cabos esofágicos (CE) imposibilita la anastomosistérmino-terminal (ATT) inicial. La definición de Long Gap (LG) oCE distantes es imprecisa y, si bien hay consenso en que la conservación del esófago propio es la mejor opción terapéutica, existen controversias sobre la oportunidad e impacto clínico que ocasiona la espera del crecimiento de los cabos esofágicos en forma espontánea tal como lo ha propuesto P. Puri. Objetivos. Evaluar la evolución clínico-quirúrgica de los recién nacidos (RN) con AELG durante el ingres en la unidad de cuidados intensivos neonatales (UCIN) de un hospital pediátrico. Material y métodos. Estudio descriptivo, retrospectivo. Se incluyeron todos los RN con AELG ingresados en la UCIN desde enero de2002 a diciembre de 2006. Se analizó sexo, edad gestacional, peso al nacer (PN), tipo de AE, distancia entre CE, complicaciones respiratorias y quirúrgicas, edad al alta y mortalidad. Resultados. En 5 años ingresaron a la UCIN 64 RN con AE; 21(33%) fueron LG (población de estudio). En 8 RN (38%), se logró realizar una ATT (80 ± 40 días); todos tuvieron reflujo gastroesofágico(RGE), el 50% presentó complicaciones: dehiscencia o estenosis de la (..) (AU)

Introduction. Esophageal atresia (EA) is one of the most prevalent surgical conditions in the newborn. Sometimes early oesophagealanastomosis can’t be done due to the esophageal gap. Long gap (LG)definition is not precise. Although consensus exist about conservation of owns esophagus is the best therapeutic option, literature is not clear about how long and under what circunstances is advisable to wait for the spontaneous esophageal pouches to growth (P. Puri approach). Furthermore at present we don’t even know the real repercussion that this waiting can implicate. Objective. The aim of the study was to evaluate the clinical and (..) (AU)

[Laparoscopic appendectomies in pediatric patients using Hem-o-lock clips]. / Uso de clips Hem-o-lock en apendicectomía laparoscópica de pacientes pediátricos.

Appendicitis is the most common surgical emergency of acute abdomen in children, principally at school age and teenagers. Patients are most often treated surgically to remove the appendix, either through a standard small incision in the right lower part of the abdomen or laparoscopically. The current is a retrospective study about the experience of a group of surgeons from the Fundación Hospitalaria--Buenos Aires Private Children Hospital who performed 40 laparoscopic appendectomies in patients under 18 years of age. The data registered and analysed belonged to patients with acute appendicitis diagnosis who underwent closure of the appendicular base with Hem-o-lock clips (Weck Closure Systems, Triangle Park, NC, USA). Our main objective was to describe an alternative technique for the ligation of the appendicular stump with the intrinsic benefits of the minimally invasive procedures. The results obtained at last, were comparable to those reported in the cientific literature. As a conclusion the laparoscopic closure of the appendicular base with nonabsorbable polymer clips is a fast, safe and easily reproducible alternative to conventional surgery in childrens.

Uso de clips Hem-o-lock en apendicectomía laparoscópica de pacientes pediátricos / Laparoscopic appendectomies in pediatric patients using hem-o-lock clips

La apendicitis es la causa más frecuente de abdomen agudo en niños, principalmente en escolares y adolescentes. El tratamiento quirúrgico consiste en la extirpación del apéndice a través de una pequeña incisión estándar en el flanco inferior derecho del abdomen e incluso también por via laparoscópica. El presente es un estudio retrospectivo sobre la experiencia de un grupo de cirujanos del Hospital Privado de Niños de la Fundación Hospitalaria de Buenos Aires, quienes llevaron a cabo40 apendicectomías laparoscópicas en pacientes menores de 18 años de edad, con diagnóstico de apendicitis aguda. Únicamente fueron incluidos para el registro y análisis de datos aquellos pacientes en los que se procedió al cierre de la base apendicular con clips Hem-o-lock®(WeckClosure Systems, Triangle Park, NC, EE.UU.). Nuestro principal objetivo fue dar a conocer una alternativa de manejo del muñón apendicular con los beneficios propios de los procedimientos mínimamente invasivos. Los resultados obtenidos, finalmente, fueron comparables con los reportados en la literatura científica, concluyéndose que se trata de un abordaje rápido, seguro y fácilmente reproducible en niños (AU)

Appendicitis is the most common surgical emergency of acute abdomen in children, principally at school age and teenagers. Patients are most often treated surgically to remove the appendix, either through a standard small incision in the right lower part of the abdomen or laparoscopically. The current is a retrospective study about the experience of a group of surgeons from the Fundación Hospitalaria – Buenos Aires Private Children Hospital who performed 40 laparoscopic appendectomies in patients under 18 years of age. The data registered and analysed belonged to patients with acute appendicitis diagnosis who underwent closure of the appendicular base with Hem-o-lock® clips (Weck Closure Systems, Triangle Park, NC, USA). Our main objective was to describe an alternative technique for the ligation of the appendicular stump with the intrinsic benefits of the minimally invasive procedures. The results obtained at last, were comparable to those reported in the cientific literature. As a conclusion the laparoscopic closure of the appendicular base with non absorbable polymer clips is a fast, safe and easily reproducible alternative to conventional surgery in childrens (AU)

[Analysis of clinical-surgical course of neonates with long-gap esophageal atresia during their spontaneous growth]. / Análisis de la evolución clinico-quirúrgica de neonatos con atresia de esófago con cabos distantes (Long Gap) durante el crecimiento espontáneo de los mismos.

INTRODUCTION: Esophageal atresia (EA) is one of the most prevalent surgical conditions in the newborn. Sometimes early oesophageal anastomosis can't be done due to the esophageal gap. Long gap (LG) definition is not precise. Although consensus exist about conservation of owns esophagus is the best therapeutic option, literature is not clear about how long and under what circunstances is advisable to wait for the spontaneous esophageal pouches to growth (P. Puri approach). Furthermore at present we don't even know the real repercussion that this waiting can implicate. OBJECTIVE: The aim of the study was to evaluate the clinical and surgical outcome of newborns with EALG during their stay in a neonatal intensive care unit (NICU) at a third level children's hospital. MATERIALS AND METHODS: We retrospectively reviewed the charts of all newborn with EA admitted in the NICU from January 2002 to December 2006 in order to analyze sex, gestacional age, weight, type of EA, LG, respiratory and surgical complications, length of stay and mortality. RESULTS: During the study time period 64 newborns with EAwere admitted, 21 (33%) had EALG (our population). We underwent primary repair with esophageal anastomosis in 8 newborns at 80 +/- 40 days. All of them had gastroesophageal reflux, 50% presented different complications such as anastomotic leak, stricture and mediastinal infections. 13 patients required an esophagostomy at a mean age of 46 +/- 34 days due to a lack of growth of esophageal's pouches and/or serious respiratory complications. There were no deaths. CONCLUSIONS: There were high percentages of esophagostomized patients. The result of waiting for the primary repair was a high number of children with chronic lung disease and a high rate of serious complications. Esophageal anastomosis were accompanied by long hospital stays and no clear benefits. The early application of dynamic esophageal lengthening should be explored as an alternative strategy for newborns with EALG.

Operación de Ladd laparoscópica en el recién nacido / Ladd laparoscopic procedure in the neonate

El tratamiento de la malrotación intestinal con o sin vólvulo del intestino medio con el procedimiento de Ladd por vía laparoscópica ha sido propuesto por varios autores desde 1995. Nosotros realizamos este tratamiento en una paciente de 15 días de vida con malrotación intestinal y vólvulo del intestino medio. Tras el diagnóstico clínico y de imagen, el procedimiento consistió en la devolvulación antihoraria cuidadosa del intestino, la liberación de las bandas de Ladd, la incisión en el mesenterio común y la apendicectomía. El yeyuno e íleon fueron colocados a la derecha y el colon a la izquierda. La evolución postoperatoria fue satisfactoria. Recomendamos el procedimiento de Ladd laparoscópico como una alternativa en los pacientes con vólvulo del intestino medio que cumplan con criterios mínimos durante el estudio preoperatorio que permitan llevar a cabo la cirugía con seguridad (AU)

The treatment of the intestinal malrotation with or without midgut volvulus with the Ladd procedure for laparoscopic way has been proposed by several authors since 1995. We carry out this treatment in a patient of 15 days old with intestinal malrotation and midgut volvulus. After clinical and radiologic diagnosis, the procedure consisted in the careful counterclock reduction of the volvulus, division of the Ladd's bands, incision of the common mesentery and appendectomy. The jejunum and ileum was positioned on the rigth and the colon on the left in the abdominal cavity. The postoperative evolution was appropiate. We recommend the laparoscopic Ladd's procedure like an alternative in the patients with midgut volvulus that fulfill minimum approaches during the preoperative study that allow to carry out the surgery with security (AU)

[Ladd laparoscopic procedure in the neonate]. / Operación de Ladd laparoscópica en el recién nacido.

The treatment of the intestinal malrotation with or without midgut volvulus with the Ladd procedure for laparoscopic way has been proposed by several authors since 1995. We carry out this treatment in a patient of 15 days old with intestinal malrotation and midgut volvulus. After clinical and radiologic diagnosis, the procedure consisted in the careful counterclock reduction of the volvulus, division of the Ladd's bands, incision of the common mesentery and appendectomy. The jejunum and ileum was positioned on the rigth and the colon on the left in the abdominal cavity. The postoperative evolution was appropiate. We recommend the laparoscopic Ladd's procedure like an alternative in the patients with midgut volvulus that fulfill minimum approaches during the preoperative study that allow to carry out the surgery with security.

[Minimally invasive approach of Nuss for the correction of pectus excavatum]. / Abordaje mínimamente invasivo de Nuss para la corrección del pectus excavatum.

Since December 1999 to November 2003, we treated 68 patients with pectus excavatum using the Nuss minimally invasive procedure. Their ages were between 6 and 24 years old, with a mean of 12 years. Average Haller index was 4.1. Lateral stabilisers were used in all the cases, in 28% of them, two stabilisers were used. Mean operative time was 70 minutes (range 40 to 120). A thoracic epidural catheter was used for postoperative analgesia in 87% of the cases, with a mean duration of 3 days. The most frequent early complication was residual pneumothorax, which resolved spontaneously in 24% of the cases. The average hospital stay was 5.7 days. 93% of patients had excellent, very good or good results, in 5% of the cases the results were fair, and 2% had poor results due to thoracic asimetry and/or sternal rotation. The Nuss minimally invasive procedure is a useful method for treatment of pectus excavatum's patients.

Abordaje mínimamente invasivo de Nuss para la corrección del pectus excavatum / Evidence-based medicine in spanish pediatric surgery reports

Desde Diciembre de 1999 hasta Noviembre de 2003 tratamos quirúrgicamente a 68 pacientes con pectus excavatum utilizando la técnica mínimamente invasiva de Nuss. El rango de edades al momento de cirugía fue de 6 a 24 años, la media de edad 12 años. La media para el índice de Haller en esta población fue de 4,1. Se colocaron estabilizadores laterales en todos los pacientes, en el 28% se colocaron en ambos lados. Se colocó catéter epidural para el manejo analgésico postoperatorio en el 87% de los casos, con duración media de 3 días. El tiempo operatorio promedio fue de 70 min (rango 40- 120 min). La complicación temprana más frecuente fue la presencia de neumotórax de resolución espontánea en el 24%. El tiempo de internación medio fue de 5,7 días. En 93% de los pacientes, los resultados fueron muy buenos y buenos; 5% regulares y malos en 2% debido a la presencia de asimetría torácica y/o rotación esternal. La técnica mínimamente invasiva de Nuss resulta una útil herramienta para el tratamiento de los pacientes con pectus excavatum (AU)

Since December 1999 to November 2003, we treated 68 patients with pectus excavatum using the Nuss minimally invasive procedure. Their ages were between 6 and 24 years old, with a mean of 12 years. Average Haller index was 4,1. Lateral stabilisers were used in all the cases, in 28% of them, two stabilisers were used. Mean operative time was 70 minutes (range 40 to 120). A thoracic epidural catheter was used for postoperative analgesia in 87% of the cases, with a mean duration of 3 days. The most frequent early complication was residual pneumothorax, which resolved spontaneously in 24% of the cases. The average hospital stay was 5,7 days. 93% of patients had excellent, very good or good results, in 5% ot the cases the results were fair, and 2% had poor results due to thoracic asimetry and/or sternal rotation. The Nuss minimally invasive procedure is a useful method for treatment of pectus excavatum´s patients (AU)

[Laparoscopic splenectomy in pediatrics. Review of 72 cases]. / Esplenectomía laparoscópica en pediatría. Análisis de 72 casos consecutivos.

Splenectomy in childhood is nearly always related to hematologic disorders such as hereditary spherocytosis, immune thrombocytopenic purpura, sickle cell anemia and others. In recent years, laparoscopic splenectomy evolved into a safe and effective procedure that requires less hospital stay, and benefits the patient with a best postoperative period and excellent cosmetic results. The authors reveal a 6 year experience in treating 72 children with different diseases that required laparoscopic splenectomy. After progressing in their training curve and with the acquisition of new technology for endoscopic thermocoagulation, the authors conclude that minimally invasive surgery is the procedure of choice for most surgical spleen diseases in children.

Esplenectomía laparoscópica en pediatría. Análisis de 72 casos consecutivos / Laparoscopic splenectomy in pediatrics. Rewiew of 72 cases

La esplenectomía en pediatría es indicada en niños con enfermedades hematológicas como la esferocitosis hereditaria, la púrpura trombocitopénica idiopática, la talasemia, la drepanocitosis y otras menos frecuentes. En los últimos años, la esplenectomía laparoscópica demostró ser una técnica segura y efectiva que resulta en un menor tiempo de internación, mejor confort postoperatorio y excelentes resultados cosméticos. Los autores detallan la experiencia con el tratamiento video-laparoscópico mínimamente invasivo de 72 pacientes con afectación del bazo por patología diversa, operados en un período de 6 años. El afianzamiento y el progreso en la curva de entrenamiento junto con la disponibilidad de nuevas tecnologías de termocoagulación, han permitido a la cirugía video-laparoscópica ocupar el lugar de elección en el tratamiento de las esplenopatías quirúrgicas de la infancia. (AU)