[Gastric tube esophagoplasty using the retroesternal route in children]. / Sustitución esofágica con estómago tubulizado retroesternal en la infancia.

INTRODUCTION: Esophageal replacement is a surgical alternative once native esophagus can't be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. PATIENTS AND METHODS: We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. RESULTS: Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. CONCLUSIONS: Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can't be preserved. In our experience is a safe option, related to few complications.

INTRODUCCION: La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. PACIENTES Y METODOS: Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. RESULTADOS: Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. CONCLUSIONES: La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones.

Sustitución esofágica con estómago tubulizado retroesternal en la infancia / Gastric tube esophagoplasty using the retroesternal route in children

Introducción. La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. Pacientes y métodos. Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. Resultados. Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. Conclusiones. La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones

Introduction. Esophageal replacement is a surgical alternative once native esophagus can’t be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. Patients and methods. We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. Results. Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. Conclusions. Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can’t be preserved. In our experience is a safe option, related to few complications

[Hepatopulmonary syndrome in children: evaluation and treatment]. / Síndrome hepatopulmonar en niños: evaluación y tratamiento.

Hepatopulmonary syndrome is a rare disease that affects patients of any age with acute or chronic liver disease. Its diagnosis is based on the presence of hypoxemia and the demonstration of an intrapulmonary shunting by echocardiography with contrast or perfusion lung scanning. Pulmonary angiography is useful to demonstrate macroscopic arteriovenous communications. We describe five paediatric cases with a different natural history and evolution. Two of them were diagnosed with hepatopulmonary syndrome type 1, another two with type 2 and a fifth one with type 1 and 2, which required a different therapeutic approach in each case.

[Management of choledochal cyst: laparotomy or endoscopic]. / Tratamiento del quiste de colédoco: cirugía abierta o endoscópica?

The most generally accepted therapy of choledochal cyst is cystectomy and biliar derivation by laparotomy. Last years, endoscopic papilotomy by ERCP has been a valuable therapeutic alternative, no only a diagnostic method. In this study, we reviewed five pediatric patients operated in our Deparment in last five years for choledochal cyst. The initial therapy was laparotomy (n=4) and endoscopic papilotomy by ERCP (n=1) This one was made in other Hospital. Follow-up has been between one and five years. All patients are living. Four patients who were operated by laparotomy are asyntomatic. Patient who was treated by ERCP needed a new ERCP in first posoperative month. Five years ago, she had a seriuos acute pancreatitis and we decided laparotomy and biliar derivation. Since laparotomy, she had two new episodes of acute pancreatitis and she has needed a new endoscopic dilatation with ballon by ERCP. She has been asyntomatic for four months. In conclusion, we think laparotomy with biliar derivation is safer than ERCP in management of children with choledochal cyst. ERCP must be reserved to emergency situations before laparotomy or after postoperative complications, never as exclusive therapy.

Tratamiento del quiste de colédoco: ¿cirugía abierta o endoscópica? / Management of choledochal cyst: laparotomy or endoscopic

El tratamiento de elección en los quistes de colédoco ha sido su exéresis por laparotomía unida a derivación biliar, aunque en los últimos años se ha preconizado la papilotomía endoscópica no sólo como método diagnóstico, sino como posibilidad terapéutica. En este trabajo realizamos un estudio retrospectivo de cinco pacientes pediátricos intervenidos por quiste de colédoco en los últimos cinco años en nuestro Servicio. Los quistes se clasificaron en tipo I (n=4), uno de ellos asociados a malunión pancreatobiliar, y en tipo IV (n=1). El tratamiento inicial de los quistes consistió en resección del quiste (n=4) y en papilotomía endoscópica (n=1) en la paciente con malunión pancreatobiliar, técnica que fue realizada en otro Centro. Con un tiempo de seguimiento medio de tres años, todos los pacientes sobreviven. Los cuatro pacientes intervenidos inicialmente mediante cirugía abierta se encuentran asintomáticos desde la intervención. La paciente tratada mediante CPRE requirió al mes una nueva papilotomía y extracción de cálculos. A los cinco años presentó episodio severo de colangiopancreatitis aguda indicándose cirugía abierta exerética del quiste con derivación bilioentérica. Desde entonces ha presentado dos nuevos episodios de pancreatitis leve y ha requerido una nueva dilatación endoscópica con balón. Tras cuatro meses desde dicha dilatación, ha permanecido asintomática. En conclusión, la cirugía exerética con derivación biliar nos parece la opción más segura para el tratamiento de los niños con quiste de colédoco. Desde el punto de vista terapéutico, en quistes de colédoco y canal común biliopancreático, la CPRE debería ser utilizada con mucha cautela, y quizás reservarse para situaciones de emergencia previas a la cirugía o como tratamiento de rescate para complicaciones posquirúrgicas (AU)

The most generally accepted therapy of choledochal cyst is cystectomy and biliar derivation by laparotomy. Last years, endoscopic papilotomy by ERCP has been a valuable therapeutic alternative, no only a diagnostic method. In this study, we reviewed five pediatric patients operated in our Deparment in last five years for choledochal cyst. The initial therapy was laparotomy (n=4) and endoscopic papilotomy by ERCP (n=1) This one was made in other Hospital. Follow-up has been between one and five years. All patients are living. Four patients who were operated by laparotomy are asyntomatic. Patient who was treated by ERCP needed a new ERCP in first posoperative month. Five years ago, she had a seriuos acute pancreatitis and we decided laparotomy and biliar derivation. Since laparotomy, she had two new episodes of acute pancreatitis and she has needed a new endoscopic dilatation with ballon by ERCP. She has been asyntomatic for four months. In conclusion, we think laparotomy with biliar derivation is safier than ERCP in management of children with choledochal cyst. ERCP must be reserved to emergency situations before laparotomy or after posoperative complications, never as exclusive therapy (AU)

Futuro del trasplante en el siglo XXI / Future of the transplant in the XXI century

No disponible

[A clinical analysis of internal or external diversion in biliary atresia]. / Análisis clínico de la derivación interna o externa en la atresia biliar.

Cholangitis has been the most common postoperative complication of Kasai's operation for biliary atresia. A host of ingenious surgical procedures have been used to prevent this complication, some including exteriorization of the bilioenteric conduit. The purpose of this report was to investigate the role of the derivation on the incidence of cholangitis, liver function and the survival of patients with biliary atresia treated with Kasai's operation. We have analyzed the clinical data of thirty-six patients with biliary atresia treated with Kasai's portoenterostomy during a seven year period (1987-1993). The patients were divided into two groups: Group I, patients treated with portoenterostomy and exteriorization of the bilioenteric conduit (n = 18) and Group II, patients treated with portoenterostomy without enterostomy. Our results suggest that the use of the exteriorization of the bilioenteric conduit was not shown to be effective in the prevention of episodes of cholangitis. The survival for both groups was not statistically significant and there was no increase in morbidity after the postoperative period or during the liver transplant.