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.

[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.

[Mesenteric and omental cysts. Apropos of 2 cases]. / Quistes mesentéricos y omentales. A propósito de dos casos.

Two cases of abdominal lymphatic cysts are described, one had an omental origin , and the other arose from jejunal mesentery. Both patients presented with non-specific abdominal pain, and a vague clinical picture. Diagnosis was made through echography findings, which were unmistakable .

[Congenital vesico-vaginal fistula (author's transl)]. / Fístua vesicovaginal congénita.

The case of a girl of five years with a congenital vesico-vaginal fistula derived from a persistent left mesonephric duct (or Wolffran duct) is described. The only associated malformation found in this patient was a left renal agenesis.