Síndrome postcolecistectomía en niños ¿realidad o mito? / Postcholecystectomy syndrome in children, fact or fiction?

Introducción. El síndrome postcolecistectomía (SPC) está ámpliamente definido y publicado en adultos, en cambio en la población pediátrica apenas hay artículos al respecto. Hasta un tercio de los adultos presentan síntomas dispépticos sin causa orgánica el primer año después de una colecistectomía. Nuestro objetivo es conocer la incidencia del SPC en nuestro medio. Material y método. Se realizó un estudio observacional, recogiendo datos de los pacientes colecistectomizados por laparoscopia en nuestro hospital desde 2005. Se excluyeron pacientes diagnosticados de quiste de colédoco y atresia de vías biliares. Se recogieron los siguientes datos: tipo de síntomas dispépticos, visitas a consulta de forma programada y urgente en el primer año postquirúrgico y en los años sucesivos. Se realizó encuesta telefónica a los pacientes que no efecturaron ninguna visita. Resultados. Se recogieron datos de 36 pacientes, de los cuales se excluyeron 3 pacientes por presentar causa orgánica. El diagnóstico más frecuente fue la colelitiasis idiopática (64,7%). Dieciséis pacientes (48,5%) presentaron síntomas en el primer año postquirúrgico, de los cuales 14 acudieron a consultas de forma programada y 6 urgente (2 precisaron ingreso). Los síntomas principales postquirúrgicos fueron el dolor abdominal (100%), náuseas (62,5%) y vómitos (50%). Tras el primer año (6 pacientes excluidos por seguimiento menor), solo 5 (18,5%) continuaron con los síntomas (p= 0,015), 2 requirieron visita a consultas de forma programada y ninguna urgente. Conclusión. Según nuestra muestra, el SPC en niños existe y mejora tras el primer año, por lo que es importarte el seguimiento postquirúrgico de los mismos y solo realizar pruebas complementarias ante signos de causa orgánica

Introduction. The postcholecystectomy syndrome (SPC) is broadly defined and published in adults, whereas in the pediatric population are hardly any articles about it. Up to a third of adults have dyspeptic symptoms without organic cause the first year after cholecystectomy. Our goal is to determine the incidence of SPC in our population. Methods. An observational study was performed, collecting data from patients who had been done laparoscopic cholecystectomy in our hospital since 2005. Patients diagnosed choledochal cyst and biliary atresia were excluded. The following data were collected: type of dyspeptic symptoms, scheduled office visits and emergency units in the first postoperative year and in the following. Children who did not make any visits, a telephone survey was conducted. Results. Data from 36 patients, including 3 patients who were excluded for presenting organic cause, were collected. The most frequent diagnosis was idiopathic cholelithiasis (64,7%). Sixteen children (48,5%) had postoperative symptoms in the first year, of which 14 went to scheduled office visit and 6 emergent (2 required hospitalization). The main symptoms were abdominal postoperative pain (100%), nausea (62,5%) and vomiting (50%). After the first year (6 patients were excluded for less follow-up), only 5 patients (18,5%) continued to symptoms (p= 0,015), 2 required visit to programmatically consultation and no one emergent. Conclusion. In our sample, SPC in children exists and improves after the first year. So postoperative follow-up is an important fact, and only further tests must be done if signs of organic cause

[Postcholecystectomy syndrome in children, fact or fiction?] / Síndrome postcolecistectomía en niños ¿realidad o mito?

INTRODUCTION: The postcholecystectomy syndrome (SPC) is broadly defined and published in adults, whereas in the pediatric population are hardly any articles about it. Up to a third of adults have dyspeptic symptoms without organic cause the first year after cholecystectomy. Our goal is to determine the incidence of SPC in our population. METHODS: An observational study was performed, collecting data from patients who had been done laparoscopic cholecystectomy in our hospital since 2005. Patients diagnosed choledochal cyst and biliary atresia were excluded. The following data were collected: type of dyspeptic symptoms, scheduled office visits and emergency units in the first postoperative year and in the following. Children who did not make any visits, a telephone survey was conducted. RESULTS: Data from 36 patients, including 3 patients who were excluded for presenting organic cause, were collected. The most frequent diagnosis was idiopathic cholelithiasis (64,7%). Sixteen children (48,5%) had postoperative symptoms in the first year, of which 14 went to scheduled office visit and 6 emergent (2 required hospitalization). The main symptoms were abdominal postoperative pain (100%), nausea (62,5%) and vomiting (50%). After the first year (6 patients were excluded for less follow-up), only 5 patients (18,5%) continued to symptoms (p= 0,015), 2 required visit to programmatically consultation and no one emergent. CONCLUSION: In our sample, SPC in children exists and improves after the first year. So postoperative follow-up is an important fact, and only further tests must be done if signs of organic cause.

INTRODUCCION: El síndrome postcolecistectomía (SPC) está ámpliamente definido y publicado en adultos, en cambio en la población pediátrica apenas hay artículos al respecto. Hasta un tercio de los adultos presentan síntomas dispépticos sin causa orgánica el primer año después de una colecistectomía. Nuestro objetivo es conocer la incidencia del SPC en nuestro medio. MATERIAL Y METODOS: Se realizó un estudio observacional, recogiendo datos de los pacientes colecistectomizados por laparoscopia en nuestro hospital desde 2005. Se excluyeron pacientes diagnosticados de quiste de colédoco y atresia de vías biliares. Se recogieron los siguientes datos: tipo de síntomas dispépticos, visitas a consulta de forma programada y urgente en el primer año postquirúrgico y en los años sucesivos. Se realizó encuesta telefónica a los pacientes que no efecturaron ninguna visita. RESULTADOS: Se recogieron datos de 36 pacientes, de los cuales se excluyeron 3 pacientes por presentar causa orgánica. El diagnóstico más frecuente fue la colelitiasis idiopática (64,7%). Dieciséis pacientes (48,5%) presentaron síntomas en el primer año postquirúrgico, de los cuales 14 acudieron a consultas de forma programada y 6 urgente (2 precisaron ingreso). Los síntomas principales postquirúrgicos fueron el dolor abdominal (100%), náuseas (62,5%) y vómitos (50%). Tras el primer año (6 pacientes excluidos por seguimiento menor), solo 5 (18,5%) continuaron con los síntomas (p= 0,015), 2 requirieron visita a consultas de forma programada y ninguna urgente. CONCLUSION: Según nuestra muestra, el SPC en niños existe y mejora tras el primer año, por lo que es importarte el seguimiento postquirúrgico de los mismos y solo realizar pruebas complementarias ante signos de causa orgánica.

Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica? / Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis

Objetivo. Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. Método. Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. Resultados. En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). Conclusiones. Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria

Objective. To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. Methods. Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. Results. During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). Conclusions. Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay

Cierre de ileostomía tras enterocolitis necrotizante. ¿Cuándo es el mejor momento? / Ileostomy closure after necrotizing enterocolitis. When is the best moment?

Introducción. En más del 50% de las enterocolitis necrotizantes intervenidas es necesario realizar una ileostomía. El tiempo óptimo para restablecer el tránsito intestinal continúa siendo un tema controvertido. En muchas ocasiones las ileostomías dan problemas, requiriendo una reconstrucción precoz. El objetivo es comparar el cierre precoz con el cierre diferido, estableciendo el punto de corte en 35 días, desde el momento de realización del estoma, de acuerdo con otros trabajos publicados así como con la práctica realizada en nuestro hospital. Material y Método. Revisión retrospectiva de todos los pacientes que en los últimos diez años han presentado un episodio de enterocolitis necrotizante en nuestro hospital, precisando una derivación intestinal tipo ileostomía y en los que, además, se realizó el cierre de la misma. Resultados. Se han estudiado 39 pacientes, en 22 se realizó un cierre precoz (CP) y en 17 un cierre diferido (CD). En ambos grupos, la edad y el peso presentaron diferencias estadísticamente significativas, siendo menores en el grupo de CP (p< 0,05). Todas las variables de morbilidad estudiadas fueron mayores en el grupo de CP (días de nutrición parenteral total, días de catéter venoso central, uso de inotrópicos, infección de herida quirúrgica y oclusiones intestinales). Los días de ventilación mecánica fueron mayores en el grupo CP (2,33 vs 0 p=0,017). La tasa de reintervención quirúrgica fue mayor en el grupo CP (31%) frente al grupo CD (17%). Conclusiones. Es necesario realizar estudios prospectivos y con mayor número de pacientes para poder recomendar un cierre diferido. En nuestra experiencia el cierre precoz presenta mayor morbilidad, así como mayor tasa de reintervenciones

Introduction. In more than 50% of the necrotizing enterocolitis that underwent surgery will require an ileostomy. The optimal time to reestablish intestinal transit still is a controversial subject. Many times ileostomies cause medical issues that require early intestinal reconstruction. Our objective is to compare the early closure against late close, being the shift point 35 days according to other published research. Material and Methods. Retrospective study off all patients that in the last 10 years have had an episode of necrotizing enterocolitis which required an intestinal derivation like ileostomy. Results. We studied 39 patients, 22 had an early closure (EC) and 17 in had a late closure (LC). There were statistically significant differences in age and weight between both groups, being younger in the EC group (p< 0,05). All the morbidity factors were greater in the EC group (days of parenteral nutrition, days of central venous catheter, inotropic use, surgical wound infection and intestinal occlusions). The days of mechanical ventilation were greater in the EC group (2,33 vs p=0,017). The rate of reoperation was higher in the EC group (31%) against the LE group (17%). Conclusion. It is necessary to perform prospective studies with larger number of patients to be able to recommend a late closure ileostomy. In our experience the early closure has more morbidity and a higher rate of surgical reoperations

[Ileostomy closure after necrotizing enterocolitis. When is the best moment?] / Cierre de ileostomía tras enterocolitis necrotizante. ¿Cuándo es el mejor momento?

INTRODUCTION: In more than 50% of the necrotizing enterocolitis that underwent surgery will require an ileostomy. The optimal time to reestablish intestinal transit still is a controversial subject. Many times ileostomies cause medical issues that require early intestinal reconstruction. Our objective is to compare the early closure against late close, being the shift point 35 days according to other published research. MATERIAL AND METHODS: Retrospective study off all patients that in the last 10 years have had an episode of necrotizing enterocolitis which required an intestinal derivation like ileostomy. RESULTS: We studied 39 patients, 22 had an early closure (EC) and 17 in had a late closure (LC). There were statistically significant differences in age and weight between both groups, being younger in the EC group (p<0,05). All the morbidity factors were greater in the EC group (days of parenteral nutrition, days of central venous catheter, inotropic use, surgical wound infection and intestinal occlusions). The days of mechanical ventilation were greater in the EC group (2,33 vs p=0,017). The rate of reoperation was higher in the EC group (31%) against the LE group (17%). CONCLUSIONS: It is necessary to perform prospective studies with larger number of patients to be able to recommend a late closure ileostomy. In our experience the early closure has more morbidity and a higher rate of surgical reoperations.

INTRODUCCION: En más del 50% de las enterocolitis necrotizantes intervenidas es necesario realizar una ileostomía. El tiempo óptimo para restablecer el tránsito intestinal continúa siendo un tema controvertido. En muchas ocasiones las ileostomías dan problemas, requiriendo una reconstrucción precoz. El objetivo es comparar el cierre precoz con el cierre diferido, estableciendo el punto de corte en 35 días, desde el momento de realización del estoma, de acuerdo con otros trabajos publicados así como con la práctica realizada en nuestro hospital.. MATERIAL Y METODOS: Revisión retrospectiva de todos los pacientes que en los últimos diez años han presentado un episodio de enterocolitis necrotizante en nuestro hospital, precisando una derivación intestinal tipo ileostomía y en los que, además, se realizó el cierre de la misma. RESULTADOS: Se han estudiado 39 pacientes, en 22 se realizó un cierre precoz (CP) y en 17 un cierre diferido (CD). En ambos grupos, la edad y el peso presentaron diferencias estadísticamente significativas, siendo menores en el grupo de CP (p<0,05). Todas las variables de morbilidad estudiadas fueron mayores en el grupo de CP (días de nutrición parenteral total, días de catéter venoso central, uso de inotrópicos, infección de herida quirúrgica y oclusiones intestinales). Los días de ventilación mecánica fueron mayores en el grupo CP (2,33 vs 0 p=0,017). La tasa de reintervención quirúrgica fue mayor en el grupo CP (31%) frente al grupo CD (17%). CONCLUSIONES: Es necesario realizar estudios prospectivos y con mayor número de pacientes para poder recomendar un cierre diferido. En nuestra experiencia el cierre precoz presenta mayor morbilidad, así como mayor tasa de reintervenciones.

[Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis]. / Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica?

OBJECTIVE: To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. METHODS: Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. RESULTS: During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). CONCLUSIONS: Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay.

OBJETIVO: Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. METODO: Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. RESULTADOS: En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). CONCLUSIONES: Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria.

[Conservative management of retained central venous catheters]. / Manejo conservador de los catéteres venosos centrales retenidos.

BACKGROUND: Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed. MATERIAL AND METHODS: We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs. RESULTS: An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-. CONCLUSIONS: The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients.

Manejo conservador de los catéteres venosos centrales retenidos / Conservative management of retained central venous catheters

Introducción. La retirada de los catéteres venosos centrales (CVCs) suele ser un procedimiento quirúrgico sencillo. Sin embargo, en algunos casos el catéter se encuentra englobado en la pared del vaso y su extracción no es posible si no se realizan intervenciones más invasivas. Material y métodos. Se ha realizado un estudio retrospectivo desde 2003 a 2011 de los pacientes a los que se les ha retirado un CVC y de los factores que podrían haber intervenido en la imposibilidad de retirada. Se han comparado los tipos de catéter, la zona de inserción, el tiempo transcurrido desde la inserción a la retirada, el diagnóstico principal y el tipo de medicación. Además, se ha realizado un seguimiento clínico y mediante pruebas de imagen en los pacientes con CVCs retenidos. Resultados. Se realizaron 174 intervenciones. En 5 casos no se pudo extraer el CVC. Estos 5 casos fueron pacientes diagnosticados de LLA B y llevaron tratamiento quimioterápico idéntico. Además, en el momento de su retirada, todos llevaban el CVC por un periodo mayor a 2 años (de 29 a 84 meses). En los pacientes con fragmentos retenidos no se produjo ninguna complicación derivada de esta condición. El periodo medio de seguimiento fue de 36 meses (máximo de 48 meses).Conclusiones. Las posibles complicaciones derivadas de la presencia de fragmentos de los CVCs retenidos son la infección, la trombosis venosa y la migración del catéter. En base a nuestros resultados, planteamos que se podría considerar en estos pacientes una actitud expectante y un manejo conservador (AU)

Background. Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed. Material and methods. We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs. Results. An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-.Conclusions. The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients (AU)

Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome dedumping tras cirugía de Nissen laparoscópico / Modifications of the glucose curves and gastric voiding of children with dumping syndrome after laparoscopic nissen surgery

Introducción. Se ha asistido a una importante evolución del tratamiento quirúrgico en los últimos años por la generalización progresiva de la cirugía laparoscópica. Todas las técnicas disponibles pueden hacerse laparoscópicamente con similares resultados a los de la cirugía abierta. En 1978, Villet et al. describieron el síndrome de Dumping (SD) como una complicación frecuente de la fundoplicatura de Nissen. EL SD es un complejo de signos y síntomas que aparecen poco después de la cirugía, incluyendo dolor abdominal, palidez, sudoración, diarrea, náuseas, palidez, incluso pérdida de peso. Los síntomas se pueden diferenciar en dumping precoz, que ocurre entre 30 y 60 minutos después de la comida, y tardío, que ocurre entre 90-240 min. del período postprandial. Material y métodos. Se han estudiado 8 pacientes (3 niños y 5niñas) de edades comprendidas entre 3 y 12 años (media de 9 años) diagnosticados de síndrome de dumping tras la realización de Nissen-Rosseti laparoscópico. A todos ellos se les realizó un estudio de vaciadogástrico por gammagrafía tras administración de un volumen de leche adecuado a su peso marcado con Tc99 DTPA y Test de sobrecarga ora (..) (AU)

Introduction. There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet etal. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period (..) (AU)

[Modifications of the glucose curves and gastric voiding of children with Dumping syndrome after laparoscopic Nissen surgery]. / Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome de dumping tras cirugía de nissen laparoscópico.

INTRODUCTION: There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet et al. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period. MATERIAL AND METHODS: A total of 8 patients (3 boys and 5 girls) have been studied. Their ages ranged from 3 to 12 years (mean 9 years), and they were diagnosed of dumping syndrome after performing the laparoscopic Nissen-Rossetti. All underwent a gastric voiding study by scintigraphy after administration of a volume of milk adjusted to their weight labeled with 99Tc-DTPA and oral glucose overload test with 1.75 g/kg of glucose, determining the baseline glycemia and every 30 minutes post-intake, at 0, 30 and 90 minutes. Insulin was also measured to obtain the glucose/insulin ratio. This study was conducted for all patient diagnosed of dumping syndrome before and after laparoscopic Nissen-Rossetti surgery. RESULTS: The following results were obtained: Glucose Curve: 1. Maximum glycemia. PreNissen. The mean of the maximum glycemia values before surgery was 133.9+/-32.11 mg/dl. Post-Nissen. Mean maximum glycemias after surgery was 208.5 +/- 45.07 mg/dl with a range of 147-276 mg/dl. These differences of maximum glycemia were clearly significant with a p <0.002. Minimum glycemia. The mean value of the minimum glycemias after the surgery, compared with the previous value, did not show significant differences: 62.6+/- 11.51 mg/dl versus 71.8 +/- 28.04 mg/dl. Glucose/insulin ratio. The hyperinsulinism values after the intervention studied by means of the glucose/insulin ratio were abnormal in 70.5% (defined as ratio under 3). The mean value was also characteristic of hyperinsulinism (2.3 +/- 1.62). The mean value of the coefficient prior to the surgery was 4.6 with a deviation of 3.04, the differences not being statistically significant with a p= 0.097. Measurement of gastric voiding: The T1/2 (decay) value in post-Nissen patients was significantly lower than in pre-Nissen patients. The postsurgical mean and standard deviation was 29.74 +/- 7.92 min, while in the presurgical group, the mean and standard deviation was 73.75 +/- 28.34 min with p< 0.011; statistically significant. CONCLUSIONS: From the values obtained, we can state that a significant increase in maximum glycemia has been found in all children after surgery who were diagnosed of dumping syndrome and a significant decrease in the mean time of gastric voiding and therefore an increase in the acceleration of gastric voiding after the performance of the Nissen regarding the previous values. The dumping syndrome is a frequent side effect that we must keep in mind in patients who have been previously operated for anti-reflex surgery, the symptoms being greater in most of the transitory cases. Furthermore, it is important to keep in mind because it has an easy treatment that reverts the symptoms in a short time

[Use of somatostatin in five neonates with chylothorax]. / Tratamiento con somatostatina en cinco recién nacidos con quilotórax de diferentes etiologías.

BACKGROUND: The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. OBJECTIVE: To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. PATIENTS: Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 microg/kg/12 h to continuous perfusion at 10 microg/kg/h. RESULTS: In all patients the chylous drainage was stopped. No adverse effects were observed. CONCLUSIONS: Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment.

Tratamiento con somastotina en cinco recién nacidos con quilotórax de diferentes etiologías / Use of somatostatin in five neonates with chylothorax

Antecedentes. En pacientes aislados se ha descrito el uso de la somatostatina como una opción terapéutica adicional al tratamiento convencional del quilotórax neonatal. Objetivo. Describir nuestros resultados en una serie de 5 pacientes con quilotórax neonatal tratados con somatostatina. Pacientes. Se incluyeron 5 recién nacidos (29-39 semanas de edad gestacional) diagnosticados de quilotórax de diferentes etiologías: dos congénitos, dos secundarios a cirugía reparadora de hernias diafragmáticas congénitas, y uno secundario a trombosis venosa de la vena cava. Tras la confirmación diagnóstica se inició en todos los niños tratamiento conservador y somatostatina intravenosa en diferentes pautas, desde bolos de 2 μg/kg/12 h, hasta perfusión continua de 10 μg/kg/h. Resultados. En todos los pacientes se logró el cese del drenaje linfático y no se observaron efectos secundarios. Conclusiones. La somatostatina puede ser una opción terapéutica eficaz y segura en el tratamiento del quilotórax, tanto primario como secundario, refractario al tratamiento conservador

Background. The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. Objective. To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. Patients. Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 μg/kg/12 h to continuous perfusion at 10 μg/kg/h. Results. In all patients the chylous drainage was stopped. No adverse effects were observed. Conclusions. Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment

Low prevalence of complications of delayed herniotomy in the extremely premature infant.

AIM: To study the relationship between the delay of herniotomy in the extremely premature infant and the rate of complications in comparison with full-term children. METHODS: A follow-up study of three groups of neonates operated on for inguinal hernia was performed. The groups were defined as: a) the short-waiting group (SWG): prematures (mean gestational age: 32.56 +/- 0.62; n = 9) operated on within 2 wk of diagnosis (median: 5 d); b) the long-waiting group (LWG): prematures (mean gestational age: 28.38 +/- 1; n = 21) operated on after more than 2 wk (median: 39 d); and c) control group of full-term children (FTG); (mean gestational age: 38.18 +/- 0.29; median of timing: 3 d; n = 11). Several variables (gestational age, weight at birth and at surgery, side of the inguinal herrnia, timing, duration of surgery, type of anaesthesia, length of hospitalization), as well as the occurrence of apnoea, incarceration and testicular atrophy were compared between groups. RESULTS: Timing was the only variable that was different between the LWG and the other two groups (p < 0.001, ANOVA). Seven preoperative episodes of incarceration occurred: one in the SWG, two in the LWG and four in the FTG (p = 0.138, chi2). In the follow-up study two testicular atrophies, related to previous episodes of incarceration, were found: one in the FTG and the other in the SWG (p = 0.221, chi2). CONCLUSION: The deferral of herniotomy in the extremely premature infant, until the child is ready to be discharged from the neonatal unit, does not seem to increase the risk of incarceration episodes or testicular atrophy.

Long-term follow-up of Nissen fundoplication.

A study of 68 children under 7 years of age, who had had an abdominal approach Nissen operation, with a postoperative follow-up of between 4 and 14 years, is presented. The patients were classified into three groups, according to radiological appearance and cuff site. In the first group (40 patients) the cuff was intraabdominal and competent; in the second group (22 patients) the cuff was partially displaced into the thorax and was competent. 92% of the patients of these groups are currently asymptomatic and none required reoperation. In the third group (6 patients), there was disorganization of the cuff, together with its displacement into the chest, recurrence of symptoms and the authors recommended reoperation. Nissen's operation is an effective treatment for gastrooesophageal reflux in children unresponsive to medical treatment. Although displacement occurs frequently, valve competence is unaffected except in those where the cuff has disappeared and there is herniation into the thorax in which case reoperation is necessary.

[Our experience with caustic substance ingestion in children]. / Nuestra experiencia en la ingesta de cáusticos en los niños.

We discuss the protocol followed in our Service for the diagnose, treatment and follow-up of patients younger than seven years old, diagnosed as "caustic substance ingestion". We report on 157 cases seen from 1987 to 1991, from which 14 showed severe oesophageal burnings which required further oesophageal dilatation with general or local anesthesia. The usefulness of pH-metry in this patients is also analyzed. The relatively mild degree of abrasiveness produced by bleach is also described, despite being the most frequent caustic agent in our group of patients. The usefulness of the different techniques applied for the treatment and follow-up of this patients is also discussed.

[Cystic duplication of the rectum]. / Duplication kystique du rectum.

Cyst or intestinal duplications can arise anywhere along the gut, however those located in the rectum are very rare and only a few dozen cases have been reported. The reason that induced us to report this patient is double: first to present a new case of rectal duplication diagnosed at 45 days old that had a normal barium enema previously, second to confirm once more that the muscular complex of the rectum can be cut in the posterior middle line without any damage to the rectal continence function, as Peña's surgical approach for anorectal atresias. The case reported correspond to a newborn weighing 2,850 grs who had exomphalos of 5 cm. Wide with an integral sac and was operated by primary closure. When he was 10 days old, and because he had some intestinal disturbances compatible with malrotation, a barium enema was done that was normal. He was discharged and returned 30 days later because of striped feces and constipation. Rectal examination showed a retrorectal tumor located at left posterolateral space. Ultrasound showed a cystic mass and barium enema displayed a narrowed rectum channel. First we did a Wangesteen colostomy. Ten days later, by a sagittal posterior approach cutting the Levator and Muscular Complex of the rectum in the middle line and without opening the lumen, a tumor like a nut, sharing its muscular coat with the rectum, was excised. The Muscular Complex and the Levator were repaired with the aid of the electrostimulator. After the 7 day postoperation we made some rectal dilatations and closure of colostomy at 21 day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Physiopathology of hypertrophic stenosis of the pylorus: a proposal]. / Fisiopatologia de la estenosis hipertrófica de piloro: una propuesta.

The aim of this report is finding a physiopathologic explanation for the Infantile Hypertrophic Pyloric Stenosis. We studied two groups: The group one were children with infantile hypertrophic pyloric stenosis (n = 43) and the group two were infants who died at one month old due to a non-related cause. We studied the pylorus in both groups, took biopsies and found neurological and muscular lesions with muscular hypertrophy and degeneration of the myenteric plexus of Auerbach. We suggest the diagram of self-maintenance of the lesions.

[Esophageal endoscopy and gastroesophageal reflux]. / La endoscopia esofágica como base para la clasificación y pauta a seguir en el reflujo gastroesofágico.

Authors expose the value of different tests performed in 166 patients diagnosed of gastroesophageal reflux (GER). In 24 patients, less than three months old, only radiological studies were performed. Another group of 142 patients had radiology, endoscopy and biopsy performed, with a total of 180 endoscopic procedures. From the results obtained patients were classified in four grades: Grade I, included 28 patients less than three months old, GER is due to the immaturity of antireflux system. Grade II, included 75 patients of all ages with radiology and/or positive scintigram, but endoscopy and biopsy within normal limits. Grade III, 46 patients, in whom endoscopy and biopsy revealed presence of edema, fibrinous exudates and other inflammatory changes. Grade IV, 17 patients, endoscopy revealed healing strictures or deep bleeding ulcers. Grades I, II and III should be treated with medical measures. Grade IV requires immediate surgical treatment. In 2.7% and 6.4% of grade II and grade III cases respectively, endoscopy revealed progressive disease and necessity of final surgical treatment. Authors believe that endoscopy and biopsy are not only valuable to detect complicating progression of disease, but are also an efficient method of grading and prognosis of GER disease.