Treatment of pectus excavatum with vacuum bell during puberty. / Tratamiento del pectus excavatum con campana de succión durante la pubertad.

OBJECTIVE: To assess the efficacy of the vacuum bell during puberty, according to the daily hours of use and treatment duration. MATERIALS AND METHODS: A retrospective analysis of patients treated with vacuum bell during puberty in the 2010-2021 period was carried out. Several variables were collected, including baseline and final sinking, repaired sinking expressed in cm and as a percentage from baseline sinking, daily hours of use, treatment duration, and complications. Patients were categorized into groups according to the daily hours of use (≤ 3 hours; 4-5 hours; ≥ 6 hours) and treatment duration (6-12 months; 13-24 months; 25-36 months; > 36 months), and they were statistically analyzed. RESULTS: A total of 50 patients -41 male and 9 female- were studied, with a mean age of 12.5 years (range: 10-14 years). No significant differences among groups were observed in terms of baseline sinking, thoracic index, and final sinking. Repaired sinking did increase with the daily hours of use, with significant differences. Complications were mild. 3 patients withdrew from follow-up, and 5 out of the 25 patients who completed treatment achieved a good repair. CONCLUSIONS: To increase treatment efficacy, the vacuum bell should be used for 6 hours/day during puberty. This method is well-tolerated, causes mild complications, and may be an alternative to surgery in some cases.

OBJETIVO: Evaluar la eficacia de la campana de succión durante la pubertad, según las horas diarias de uso y la duración del tratamiento. MATERIAL Y METODOS: Se evaluaron retrospectivamente los pacientes tratados con campana de succión durante la pubertad en el periodo 2010-2021. Se recogieron diferentes variables, incluyendo el hundimiento inicial y final, el hundimiento corregido expresado en centímetros y en porcentaje con respecto al hundimiento inicial, las horas diarias de uso, la duración del tratamiento y las complicaciones. Se categorizaron los pacientes en grupos según las horas diarias de uso (≤ 3 horas; 4-5 horas; ≥ 6 horas) y la duración del tratamiento (6-12 meses; 13-24 meses; 25-36 meses; > 36 meses), y se analizaron estadísticamente. RESULTADOS: Se estudiaron un total de 50 pacientes; 41 varones y 9 mujeres, con una edad media de 12,5 años (rango 10-14 años). No se observaron diferencias significativas entre los diferentes grupos en relación con el hundimiento inicial, el índice torácico y el hundimiento final. El hundimiento corregido aumentó en relación con las horas diarias de uso, con diferencias significativas. Las complicaciones fueron leves, 3 pacientes abandonaron el seguimiento y 5 pacientes de los 25 que finalizaron el tratamiento, alcanzaron una buena corrección. CONCLUSIONES: Para aumentar la eficacia del tratamiento, el tiempo de uso de la campana de succión durante la pubertad debería alcanzar las 6 horas diarias. Este método es bien tolerado, presenta leves complicaciones y puede ser una alternativa a la cirugía en algunos casos.

Tratamiento del pectus excavatum con campana de succión durante la pubertad / Treatment of pectus excavatum with vacuum bell during puberty

Objetivo: Evaluar la eficacia de la campana de succión durante lapubertad, según las horas diarias de uso y la duración del tratamiento. Material y métodos: Se evaluaron retrospectivamente los pacientestratados con campana de succión durante la pubertad en el periodo 2010-2021. Se recogieron diferentes variables, incluyendo el hundimientoinicial y final, el hundimiento corregido expresado en centímetros y enporcentaje con respecto al hundimiento inicial, las horas diarias de uso,la duración del tratamiento y las complicaciones. Se categorizaron lospacientes en grupos según las horas diarias de uso (≤ 3 horas; 4-5 horas;≥ 6 horas) y la duración del tratamiento (6-12 meses; 13-24 meses; 25-36meses; > 36 meses), y se analizaron estadísticamente. Resultados: Se estudiaron un total de 50 pacientes; 41 varones y9 mujeres, con una edad media de 12,5 años (rango 10-14 años). Nose observaron diferencias significativas entre los diferentes grupos enrelación con el hundimiento inicial, el índice torácico y el hundimientofinal. El hundimiento corregido aumentó en relación con las horas diariasde uso, con diferencias significativas. Las complicaciones fueron leves,3 pacientes abandonaron el seguimiento y 5 pacientes de los 25 quefinalizaron el tratamiento, alcanzaron una buena corrección. Conclusiones: Para aumentar la eficacia del tratamiento, el tiempode uso de la campana de succión durante la pubertad debería alcanzarlas 6 horas diarias. Este método es bien tolerado, presenta leves com-plicaciones y puede ser una alternativa a la cirugía en algunos casos.(AU)

Objective: To assess the efficacy of the vacuum bell during puberty,according to the daily hours of use and treatment duration.Materials and methods: A retrospective analysis of patients treatedwith vacuum bell during puberty in the 2010-2021 period was carried out. Several variables were collected, including baseline and finalsinking, repaired sinking expressed in cm and as a percentage frombaseline sinking, daily hours of use, treatment duration, and complications. Patients were categorized into groups according to the daily hoursof use (≤ 3 hours; 4-5 hours; ≥ 6 hours) and treatment duration (6-12months; 13-24 months; 25-36 months; > 36 months), and they werestatistically analyzed.Results: A total of 50 patients – 41 male and 9 female – were studied, with a mean age of 12.5 years (range: 10-14 years). No significantdifferences among groups were observed in terms of baseline sinking,thoracic index, and final sinking. Repaired sinking did increase withthe daily hours of use, with significant differences. Complications weremild. 3 patients withdrew from follow-up, and 5 out of the 25 patientswho completed treatment achieved a good repair. Conclusions: To increase treatment efficacy, the vacuum bell shouldbe used for 6 hours/day during puberty. This method is well-tolerated,causes mild complications, and may be an alternative to surgery insome cases.(AU)

Postoperative hyperlipasemia in perforated appendicitis in children. / Hiperlipasemia posoperatoria en apendicitis perforada en niños.

OBJECTIVE: The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis. MATERIALS AND METHODS: A retrospective analysis of the perforated appendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperative serum lipase levels were available were included. The variables collected were statistically assessed by means of a descriptive, univariate analysis. RESULTS: A total of 88 patients were studied. They were divided into 3 groups according to postoperative lipase levels - 57 were allocated to Group 1 (lipase: 70-194.0 U/L, normal range), 20 were allocated to Group 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (lipase: > 582 U/L, which triples normal levels). Statistically significant differences were found in the following variables: sex, postoperative abscess, postoperative subocclusion/intestinal occlusion, preoperative lipase levels, days of parenteral nutrition, days of ICU stay, and days of hospital stay. Postoperative lipase had a moderate correlation with preoperative lipase, and none of the cases met acute pancreatitis diagnostic criteria. CONCLUSIONS: Hyperlipasemia in the postoperative period of perforated appendicitis is not associated with developing clinical pancreatitis, but it is associated with worse progression in terms of increased complications, such as subocclusion/intestinal occlusion and intra-abdominal abscess, and longer ICU stay, hospital stay, and parenteral nutrition. There is a moderate correlation between preoperative and postoperative lipase, which means they could both prove useful as prognostic markers.

OBJETIVO: El objetivo del estudio es evaluar los casos de hiperlipasemia detectados en el posoperatorio de la apendicitis perforada. MATERIAL Y METODO: Se evaluaron retrospectivamente los casos de apendicitis perforada en nuestro centro durante 7 años (2013-2019), seleccionando aquellos con mediciones preoperatorias y posoperatorias de lipasa sérica. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva y univariante. RESULTADOS: Se estudiaron un total de 88 pacientes que se dividieron en tres grupos según el valor de la lipasa posoperatoria: 57 corresponden al grupo 1 (lipasa 70-194 U/L, rango normal), 20 al grupo 2 (lipasa 195-582 U/L) y 11 al grupo 3 (lipasa > 582 U/L, valor tres veces por encima del normal). Las variables que mostraron diferencias estadísticamente significativas fueron el sexo, el absceso posoperatorio, la suboclusión/oclusión intestinal posoperatoria, la lipasa preoperatoria, los días de nutrición parenteral, los días de ingreso en UCI y los días de estancia hospitalaria. La lipasa posoperatoria mostró una correlación moderada con la lipasa preoperatoria y ningún caso cumplió criterios diagnósticos de pancreatitis aguda. CONCLUSIONES: La hiperlipasemia en el posoperatorio de la apendicitis perforada no se asocia al desarrollo de pancreatitis clínica, pero sí se asocia a una peor evolución en relación con un aumento de complicaciones, como la suboclusión/oclusión intestinal y el absceso intraabdominal, y un mayor número de días de ingreso en UCI, de días de nutrición parenteral y de estancia hospitalaria. Existe una moderada correlación entre la lipasa preoperatoria y posoperatoria, de modo que ambas podrían ser útiles como marcadores pronósticos.

Hiperlipasemia posoperatoria en apendicitis perforada en niños / Postoperative hyperlipasemia in perforated appendicitis in children

Objetivo: El objetivo del estudio es evaluar los casos de hiper-lipasemia detectados en el posoperatorio de la apendicitis perforada.Material y método: Se evaluaron retrospectivamente los casos deapendicitis perforada en nuestro centro durante 7 años (2013-2019),seleccionando aquellos con mediciones preoperatorias y posoperatorias de lipasa sérica. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva y univariante. Resultados: Se estudiaron un total de 88 pacientes que se dividieron en tres grupos según el valor de la lipasa posoperatoria: 57 correspondenal grupo 1 (lipasa 70-194 U/L, rango normal), 20 al grupo 2 (lipasa 195-582 U/L) y 11 al grupo 3 (lipasa > 582 U/L, valor tres veces por encimadel normal). Las variables que mostraron diferencias estadísticamentesignificativas fueron el sexo, el absceso posoperatorio, la suboclusión/oclusión intestinal posoperatoria, la lipasa preoperatoria, los días denutrición parenteral, los días de ingreso en UCI y los días de estanciahospitalaria. La lipasa posoperatoria mostró una correlación moderadacon la lipasa preoperatoria y ningún caso cumplió criterios diagnósticosde pancreatitis aguda. Conclusiones: La hiperlipasemia en el posoperatorio de la apendicitis perforada no se asocia al desarrollo de pancreatitis clínica, perosí se asocia a una peor evolución en relación con un aumento de complicaciones, como la suboclusión/oclusión intestinal y el absceso intraabdominal, y un mayor número de días de ingreso en UCI, de díasde nutrición parenteral y de estancia hospitalaria. Existe una moderadacorrelación entre la lipasa preoperatoria y posoperatoria, de modo queambas podrían ser útiles como marcadores pronósticos.(AU)

Objective: The objective of this study was to assess the hyperli-pasemia cases detected in the postoperative period of perforated ap-pendicitis. Materials and methods: A retrospective analysis of the perforatedappendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperativeserum lipase levels were available were included. The variables collectedwere statistically assessed by means of a descriptive, univariate analysis.Results: A total of 88 patients were studied. They were divided into3 groups according to postoperative lipase levels – 57 were allocatedto Group 1 (lipase: 70-194 U/L, normal range), 20 were allocated toGroup 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (li-pase: > 582 U/L, which triples normal levels). Statistically significantdifferences were found in the following variables: sex, postoperativeabscess, postoperative subocclusion/intestinal occlusion, preoperativelipase levels, days of parenteral nutrition, days of ICU stay, and daysof hospital stay. Postoperative lipase had a moderate correlation withpreoperative lipase, and none of the cases met acute pancreatitis di-agnostic criteria. Conclusions: Hyperlipasemia in the postoperative period of perfo-rated appendicitis is not associated with developing clinical pancreatitis,but it is associated with worse progression in terms of increased compli-cations, such as subocclusion/intestinal occlusion and intra-abdominalabscess, and longer ICU stay, hospital stay, and parenteral nutrition.There is a moderate correlation between preoperative and postoperativelipase, which means they could both prove useful as prognostic markers.(AU)

Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?

BACKGROUND: Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported. METHODS: From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups. RESULTS: Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay. CONCLUSION: The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.