Gastroschisis: A Successful, Prospectively Evaluated Treatment Model in a Middle-Income Country.

BACKGROUND: This research adopted a care protocol from high-income countries in a level II/III hospital in a middle-income country to decrease morbidity and mortality associated with gastroschisis. METHODS: We established a multidisciplinary protocol to treat patients with gastroschisis prospectively from November 2012 to November 2018. This included prenatal diagnosis, presence of a neonatologist and pediatric surgeon at birth, and either performing primary closure on the patients with an Apgar score of 8/9, mild serositis, and no breathing difficulty or placing a preformed silo, when unable to fulfill these criteria, under sedation and analgesia (no intubation) in the operating room or at the patients' bedside. The subsequent management took place in the neonatal intensive care unit. The data were analyzed through the Mann-Whitney and Student's t-distribution for the two independent samples; the categorical variables were analyzed through a chi-square distribution or Fisher's exact test. RESULTS: In total, 55 patients were included in the study: 33 patients (60%) were managed with a preformed silo, whereas 22 patients (40%) underwent primary closure. Prenatal diagnosis (P = 0.02), birth at the main hospital (P = 0.02), and the presence of a pediatric surgeon at birth (P = 0.04) were associated with successful primary closure. The primary closure group had fewer fasting days (P < 0.001) and a shorter neonatal intensive care unit length of stay (P = 0.025). The survival rate was 92.7% (51 patients). CONCLUSION: The treatment model modified to fit the means of our hospital proved successful.

Orchiopexy-laparoscopy or traditional surgical technique in patients with an undescended palpable testicle.

OBJECTIVE: To compare orchiopexy by laparoscopy versus traditional surgical technique in patients with an undescended palpable testicle in the inguinal canal. MATERIALS AND METHODS: A prospective, comparative, observational, longitudinal, and double-blind research was done between August 2006 and March 2009 in the Centro de Especialidades Médicas del Estado de Veracruz, "Dr. Rafael Lucio"; 63 patients underwent surgery, age 1-10 years, all with the diagnosis of palpable undescended testicle in the inguinal canal; in 33 patients, the traditional surgical technique and in 30 patients laparoscopy were done. A visual analogue scale (VAS) was used to evaluate post-surgery pain. A testicle ultrasound was practiced before surgery and at 6 months after it. RESULTS: The majority of patients were 1-4 years old with a median age of 2.3 years; 51 cases were unilateral and 12 cases were bilateral; 37 testicles were descended with the open traditional surgical technique and 38 through laparoscopy (75 testicles); 44 on the right side and 31 on the left side; there was a hernia associated with 37 undescended testicles, 23 with open surgical technique, and 14 by laparoscopy, without relapsing in any patient. The median surgery time with the open surgical technique was 38 minutes and by laparoscopy, it was 45 minutes. The gobernaculum testis was sectioned by laparoscopy in 23 descended testicles to facilitate the procedure, in the remaining 11 it was not necessary; whereas in the open technique, all the gobernaculum testis were sectioned. In 80% of cases, the laparoscopy caused less pain when compared with the other technique. All patients regardless of the technique used left hospital during the first 24 hours. All have had follow-up for more than 6 months with a median of 18 months, with satisfactory results in relation to size and location of the testicle, with a good ultrasound correlation, and not finding any statistical differences between surgical techniques. There were no accidents with any of the techniques, and 1 patient with the open technique had an important hematoma; hemophilia was later diagnosed in the patient. The esthetical aspect was better with laparoscopy, but the cost was 15% more expensive with the open technique. CONCLUSIONS: Both techniques had satisfactory results without any significant differences to make us choose one over the other. It is the surgeons' decision based on experience and training on laparoscopy to choose any of the techniques.

Trichobezoar can be treated laparoscopically.

Various therapeutic modalities have been proposed to treat trichobezoar and Rapunzel syndrome. The treatment options were modified with the advent of laparoscopy. We reported two 7- and 12-year-old female patients with Rapunzel syndrome and thrichobezoar, respectively, who were successfully operated by laparoscopy.

Infarto segmentario idiopático del epiplón mayor, resuelto por cirugía endoscópica: Reporte de un caso / Idiopathic segmentary infarction of the great omentum treatment by laparoscopy: A case report

Introducción. El infarto segmentario idiopático primario del epiplón mayor se presenta de manera ocasional en la etapa pediátrica, predomina en niños con sobrepeso y se confunde con apendicitis aguda. Caso clínico. Paciente masculino de 6 años de edad con dolor abdominal y febrícula de 36 horas de evolución. Peso de 25 kg (p-90), talla 115 cm (p-50), discreta deshidratación, dolor importante en fosa iliaca y flanco derechos así como irritación peritoneal localizada. La biometría hemática mostró leve leucocitosis, y la radiografía simple de abdomen reacción peritoneal. Durante la cirugía endoscópica se encontró un segmento del epiplón infartado, el cual se ligó, se resecó y se extrajo. La evolución fue satisfactoria. Conclusión. La cirugía endoscópica proporciona una excelente exposición para el diagnóstico y tratamiento del infarto del epiplón mayor.

Introduction. The primary idiopathic segmentary infarction of the great omentum is rarely found in the pediatric age group; it is predominant in overweight children and it is mistaken for acute appendicitis. Case report. Six year old masculine patient presented abdominal pain for 36 hours associated with low grade fever; he weighed 25 kg (p-90), his height was 115 cm (p-50), on physical examination he showed slightly dried oral mucosa, pain on lower right quadrant with peritoneal irritation signs. The white blood count showed slight leukocitocys and the abdomen radiograph showed inflammation and peritoneal irritation. Endoscopic surgery was done and an infarcted segment of greater omentum was found, it was ligated, resected and extracted. Clinical evolution was satisfactory. Conclusion. Endoscopic surgery gives us an excellent resource for diagnosis and treatment of this pathology.

Quiste hepático gigante resuelto por laparoscopia / Giant non-árasitic liver cyst resolved by laparoscopy

Introducción. Los quistes simples no parasitarios del hígado, son malformaciones congénitas revestidas de epitelio cuboide o escamoso, que pueden ser únicos o múltiples.Caso clínico. Se presenta el caso de un paciente del sexo femenino de 8 años de edad, que ingresó con el diagnóstico de masa abdominal. Se sometió a protocolo de estudio reportando el ultrasonido (USG) y la tomografía axial computada (TAC) abdominal una gran imagen quística dependiente del hígado. Por medio de laparoscopia se efectuó destechamiento del quiste y colecistectomía por estar involucrada la vesícula. El resultado es satisfactorio a 3 años.Conclusiones. Laparoscopia se debe considerar como una buena alternativa de manejo curativo en los quistes hepáticos.

Perforación Intestinal por fiebre tifoidea en niños / Intestinal perforation by typhoiol fever in children

Se revisaron 35 pacientes con fiebre tifoidea complicados con perforación intestinal, en el Instituto Nacional de Pediatría en México, D.F. durante 13 años. Se manejaron intensivamente desde el punto de vista médico, utilizando cloramfenicol asociado a un aminoglucosido solamente en 10 casos. Todos ellos se intervinieron quirúrgicamente, realizando en el 80% de los pacientes resección y cierre primario de la perforación en dos planos. La frecuencia de las complicaciones fue del 60%, predominando la infección de la herida y el bloqueo intestinal. Todos los pacientes con reperforaciones, dehiscencias y dos de tres que cursaron con absceso intraabdominal no recibieron cloramfenicol. La mortalidad fue de 3%