Síndrome de Rapunzel: tratamiento laparoscópico / Rapunzel syndrome: Laparoscopic treatment

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Traumatismo hepático muy grave en la infancia. A propósito de dos casos con tratamiento mínimamente invasivo / Very severe hepatic trauma in childhood. the report of two cases with minimally invasive treatment

Los traumatismos hepáticos en los niños son una patología que presenta una incidencia creciente debido fundamentalmente a que cada vez los menores se ven más implicados en juegos y deportes de aventura, potencialmente peligrosos, y a los constantes accidentes de automóvil. Tradicionalmente el tratamiento es conservador, con soporte vital especializado y reposo absoluto, fundamentalmente. Ello permite en la mayoría de los casos una recuperación completa del paciente sin la agresión de la intervención quirúrgica, lo que previene, además, el daño sobreañadido de la manipulación de la víscera hepática lesionada. Presentamos dos casos clínicos de sendos niños de 6 y 4 años que sufrieron rotura traumática muy grave de hígado, intervenidos quirúrgicamente mediante técnicas mínimamente invasivas que lograron la curación completa (AU)

Liver trauma in children is a pathology that has an increasing incidence mainly due to the implications of growing children in hazardous games and sports adventure, and the frequent car accidents. There has been a shift of management in haemodynamically stable patients towards non-operative management. This allows in most cases a patient’s complete recovery without surgical aggression, preventing further damage derived from the handling of the injured liver. Here with we report two cases of a 6 and 4 year old boys who suffereda very severe traumatic rupture of the liver. They were operated through minimally invasive surgical procedures, achieving complete resolution of the serious damages (AU)

[Very severe hepatic trauma in childhood. The report of two cases with minimally invasive treatment]. / Traumatismo hepático muy grave en la infancia. A propósito de dos casos con tratamiento mínimamente invasivo.

Liver trauma in children is a pathology that has an increasing incidence mainly due to the implications of growing children in hazardous games and sports adventure, and the frequent car accidents. There has been a shift of management in haemodynamically stable patients towards non-operative management. This allows in most cases a patient's complete recovery without surgical aggression, preventing further damage derived from the handling of the injured liver. Herewith we report two cases of a 6 and 4 year old boys who suffered a very severe traumatic rupture of the liver. They were operated through minimally invasive surgical procedures, achieving complete resolution of the serious damages.

Utilización de dermis artificial en el manejo de heridas traumáticas con exposición ósea y/o tendinosa en niños / Use of artificial dermal matrix in the management of traumatic wounds with exposed bone and/or tendon in children

En los últimos años ha aumentado el uso de dermis artificial (Integra®) en niños, siendo su principal indicación la reconstrucción cutánea tras una quemadura o una extirpación de lesiones congénitas. Su uso en heridas traumáticas en niños es todavía poco frecuente, con escasas referencias en la bibliografía. Recientemente hemos utilizado dermis artificial en tres pacientes de 7, 9 y 13 años de edad, que presentaban heridas traumáticas en el miembro inferior izquierdo, el miembro inferior derecho y la región frontal, respectivamente. En todos los casos existía una importante pérdida de sustancia con exposición ósea y/o tendinosa. La dermis artificial se colocó entre los días 7 y 10 de evolución, siguiendo el protocolo habitual, tras el desbridamiento quirúrgico de las lesiones. En los tres casos la evolución ha sido satisfactoria, sin complicaciones y con unos buenos resultados estéticos y funcionales. El uso de dermis artificial en el caso de heridas traumáticas, con una importante pérdida de sustancia y exposición ósea y/o tendinosa, debe considerarse como una alternativa a los injertos de piel parcial o total, a los expansores tisulares e incluso a las transferencias de tejidos. En este tipo de heridas recomendamos la aplicación diferida de la dermis artificial (AU)

In recent years, the use of artificial dermal matrix (Integra®) in children has increased, being its main indication skin reconstruction after burn or removal of congenital lesions. Its use in traumatic wounds in children is rare, with few references in the literature. Recently, we have used artificial dermal matrix in 3 patients of 7, 9 and 13 years of age that presented traumatic wounds in left lower limb, right lower limb and frontal region respectively. In all cases there were important tissue defects with exposed bone and/or tendon. The artificial dermal matrix was applied between the 7th and 10th day of evolution, following the usual protocol, after surgical debridement of the wounds. In all 3 cases the evolution has been satisfactory, without complications and with good aesthetic and functional results. The use of artificial dermal matrix (Integra®) in cases of traumatic wounds, with important tissue subsastances and exposed bone and/or tendon, must be considered as an alternative to split or full thickness skin grafting, skin expansion and even skin flaps. We recommend in these wounds the deferred application of artificial dermal matrix (AU)

Hiperhidrosis palmar en la infancia: simpaticolisis toracoscópica y encuesta de satisfacción / Palmar hyperhidrosis in childhood: thoracoscopic sympathectomy

Introducción. El sudor excesivo en las manos, conocido como hiperhidrosis palmar, es un problema que comienza en la infancia y que a los niños les ocasiona una afectación importante, debido al fuerte impacto negativo en su calidad de vida por el permanente rechazo por parte de sus compañeros de juego. Además, la permanente humedad delas palmas de las manos interfiere con sus actividades escolares, juegos y deportes de contacto. Material y Método. Presentamos la técnica quirúrgica, de realización fácil, simple, segura y que mejores resultados ha demostrado aportar: la simpaticolisis toracoscópica. Exponemos nuestra casuística de los últimos 5 años junto con una encuesta de satisfacción realizada a todos los pacientes. Resultados. Hemos tenido resultados excelentes en el 100% de (..) (AU)

Background. Excessive hand sweating, known as palmar hyperhidrosis, is a disabling disorder that starts during the childhood, and can have a strong negative impact on the quality of life of affected children, as they feel rejected by others due to their permanently damp hands, suffering during school activities, contact sports and daily games. Material and Methods. Thoracoscopic sympathicolysis is easy to perform and has proven to be safe, with a short operating time. A review was performed on 48 children who underwent surgical treatment of palmar hyperhidrosis and answered a follow-up questionnaire to evaluate their level of satisfaction. Results. Considering the final surgical results, the 48 patients were completely satisfied with the outcome of the operation. Significant complications or adverse effects were not detected. Conclusions. The primary palmar hyperhidrosis is a pathology that entails an important reduction in the quality of life of those who suffer it. With the results of this technique in hand, we recommend the endoscopic thoracic sympathicolysis procedure for the treatment of this pathology in paediatrics. The level of patient satisfaction was high (AU)

[Palmar hyperhidrosis in childhood: thoracoscopic sympathectomy]. / Hiperhidrosis palmar en la infancia: simpaticolisis toracoscópica y encuesta de satisfacción.

BACKGROUND: Excessive hand sweating, known as palmar hyperhidrosis, is a disabling disorder that starts during the childhood, and can have a strong negative impact on the quality of life of affected children, as they feel rejected by others due to their permanently damp hands, suffering during school activities, contact sports and daily games. MATERIAL AND METHODS: Thoracoscopic sympathicolysis is easy to perform and has proven to be safe, with a short operating time. A review was performed on 48 children who underwent surgical treatment of palmar hyperhidrosis and answered a follow-up questionnaire to evaluate their level of satisfaction. RESULTS: Considering the final surgical results, the 48 patients were completely satisfied with the outcome of the operation. Significant complications or adverse effects were not detected. CONCLUSIONS: The primary palmar hyperhidrosis is a pathology that entails an important reduction in the quality of life of those who suffer it. With the results of this technique in hand, we recommend the endoscopic thoracic sympathicolysis procedure for the treatment of this pathology in paediatrics. The level of patient satisfaction was high.

Nuestra experiencia con el hidro-desbridamiento en lesiones cutáneas variadas. Adelanto técnico e innovador en cirugía pediátrica / Our experience with hydro-debridement in varied skin lesions. Technical and innovating advance in pediatric surgery

Presentamos nuestra experiencia en el uso de la hidro-dermoabrasión con desbridamiento de tejidos necróticos en lesiones cutáneas en niños. El sistema de hidrocirugía funciona mediante un chorro de suerosalino estéril con presión elevada y aspiración simultanea controlable según las condiciones de la lesión. Hemos utilizado este sistema en 15 pacientes con patología diversa (quemaduras, heridas graves traumáticas y necrosis cutánea), logrando su resolución en más corto período de tiempo. Este método constituye una herramienta innovadora en el manejo de los pacientes con lesiones cutáneas agudas y crónicas que requieren curas periódicas Presentamos nuestra experiencia en el uso de la hidro-dermoabrasión con desbridamiento de tejidos necróticos en lesiones cutáneas en niños. El sistema de hidrocirugía funciona mediante un chorro de suero salino estéril con presión elevada y aspiración simultanea controlable según las condiciones de la lesión. Hemos utilizado este sistema en 15 pacientes con patología diversa (quemaduras, heridas graves traumáticas y necrosis cutánea), logrando su resolución en más corto período de tiempo. Este método constituye una herramienta innovadora en el manejo de los pacientes con lesiones cutáneas agudas y crónicas que requieren curas periódicas (AU)

We present our experience in the use of Hydrosurgery with debridement of necrotic tissues from skin wounds in children. The Hydrosurgery system uses a high velocity stream of sterile saline solution, which can be controlled according to the state of thelesion. We have used this system in 15 patients suffering from a wide range of pathologies (burns, severe traumatic wounds, skin necrosis etc),achieving its complete resolution in shorter period of time. This method is an innovative technique in the management of patients with acute o r chronic skin lesions that require periodic procedure (AU)

[Our experience with hydro-debridement in varied skin lesions. Technical and innovating advance in pediatric surgery]. / Nuestra experiencia con el hidro-desbridamiento en lesiones cutáneas variadas. Adelanto técnico e innovador en cirugía pediátrica.

We present our experience in the use of Hydrosurgery with debridement of necrotic tissues from skin wounds in children. The Hydrosurgery system uses a high velocity stream of sterile saline solution, which can be controlled according to the state of the lesion. We have used this system in 15 patients suffering from a wide range of pathologies (burns, severe traumatic wounds, skin necrosis etc), achieving its complete resolution in shorter period of time. This method is an innovative technique in the management of patients with acute o r chronic skin lesions that require periodic procedures.

Estudio comparativo de la incidencia de abscesos de pared abdominal en niños intervenidos quirúrgicamente por apendicitis aguda: tratamiento convencional vs con suturas recubiertas de antiséptico o con apósitos impregnados de antibiótico / Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial suture or gentamicin impregnated collagen fleeces

La infección de la herida, tras la apendicectomía en la infancia, esun problema frecuente y que produce trastornos muy molestos. Revisamos prospectivamente a los niños operados por apendicitis aguda, con técnicas quirúrgicas convencionales, durante un período consecutivo de 9 meses (Grupo Control: 58 pacientes), y a los niños intervenidos durante los 9 meses siguientes, bajo las mismas circunstancias quirúrgicas excepto utilizar, de manera aleatoria, sutura recubierta de antiséptico (Vicryl Plus®, Ethicon Johnson & Johnson Medical), para el cierre de la pared abdominal en un Subgrupo o esponja de colágeno impregnada en gentamicina (Collatamp EG®, Acuña Fombona, S.A.;Schering-Plough, S.A.), introducida entre la musculatura de la incisión, en el otro Subgrupo (Grupo Estudio: 101 pacientes).Estudiamos en los dos grupos, fundamentalmente, la incidencia de abscesos de pared y la estancia media hospitalaria. La introducción de suturas recubiertas de antiséptico y/o esponja de colágeno impregnada en gentamicina, en el cierre de la herida quirúrgica postapendicectomía, ha contribuido a reducir de manera estadísticamente significativa la incidencia de abscesos de pared y de la estancia media hospitalaria de los niños incluidos en el Grupo Estudio, con respecto a los pertenecientes al Grupo Control (AU)

Postappendectomy wound infection is frequent in the pediatric age. It causes them important discomfort. We have conducted a prospective clinical study to evaluate this incidence under different surgical management. The subjects were children undergoing appendectomy for acute appendicitis. The patients belonging to the Control Group were operated, by standard surgical technique, along the first 9 months of the study period (n: 58).The Study Group was constituted by 101 children operated during the 9 consecutive months, identical on the basis of demographics and operations undergone, except for the use of, in an aleatory manner, sutures with antiseptic impregnation (Vicryl Plus®, Ethicon Johnson& Johnson Medical), to close the incision in children included in Study Sub-Group A, or gentamycin-containing collagen sponge (CollatampEG®, Acuña Fombona, S.A.; Schering-Plough, S.A.), placed within the muscles before wound closure,. In the children belonging to the Study Sub-Group B. We have analyzed in the two Groups the incidence of postoperative wound infection and the mean Hospital stay. The use of sutures with antiseptic impregnation and/or gentamycin containing collagen sponge, significantly reduced the wound infection rates in the children operated on for appendectomy included in the Study Group, compared with the ones in the Control Group, therefore contributing to decrease the Hospital length of stay (AU)

[Tubulized gastric fundus in the treatment of esophageal atresia]. / Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo.

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay.

Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo / Tubulized gastric fundus in the treatment of esophageal atresia

Cuando resulta imposible restablecer la continuidad esofágica en las atresias de esófago (AE), el ascenso del estómago sólo y/otubulizado y la interposición de colon son las técnicas más realizadas, normalmente a partir de los 6 meses de edad, en varios tiempos y con alta morbilidad, larga estancia hospitalaria y alto coste social, familiar y económico. Hemos tratado a tres niños con AE, de un total de 34 AE diagnosticadas, en un período de 11 años, tubulizando el fundus gástrico, con suturas mecánicas, en continuidad con el cabo distal esofágico, en período neonatal. La técnica (basada en la técnica de Schärli) conlleva la tubulización desde la curvatura menor gástrica del fundus gástrico, mediante el uso de suturas mecánicas en continuidad con el cabo distal esofágico. De esta manera se efectúa una anastomosis esofago esofágica conservando el cardias y tubulizando el estómago en sentido isoperistáltico. Todos los pacientes han requerido dilataciones neumáticas de la anastomosis esofago esofágica. El control y seguimiento tras 11 años, 8 años y 8meses es satisfactorio en los tres pacientes, los cuales se encuentran bien, sin problemas de deglución y con un aceptable y adecuado desarrollo pondoestatural. Creemos que este tipo de intervención y realización de un neoesófago es útil para tratar las AE de segmento largo en neonatos, al emplazar un tubo esofagogástrico ortotópicamente de calibre homogéneo en continuidad isoperistáltica en período neonatal y en un solo tiempo, prescindiendo de la gastrostomía realizada a las pocas horas de vida, consiguiendo una importante reducción de la morbilidad y estancia hospitalaria (AU)

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulizedor complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay (AU)

Nuestra experiencia con el uso de Biobrane© en el tratamiento de las quemaduras y otras lesiones en la edad pediátrica / Our experience with the use of Biobrane® in the treatment of burns and other injuries in children

Las quemaduras en la infancia constituyen un accidente que reviste un alto grado de dramatismo, fundamentalmente por la aparatosidad de las mismas y sus consecuencias inmediatas, y por otro lado por lo doloroso y elevado número de las curas, prolongada hospitalización y las secuelas estéticas e incluso funcionales que suelen dejar de por vida. Presentamos nuestra experiencia con el uso de Biobrane©, entre 1995 y 2000, en el tratamiento de 196 pacientes (edades: 4 meses a 14 años): 141 pacientes con lesiones por quemaduras de primer y segundo grado, 45 recubrimientos de zonas dadoras, 4 protecciones de injertos mallados, 3 dermoabrasiones traumáticas, 2 exéresis de tatuaje cutáneo post-traumático y 1 necrolisis epidérmica tóxica. Ventajas apreciadas al finall del tratamiento: • Cicatrización excelente.• Ausencia de dolor durante los cambios de apósitos. • Menor necesidad de autoinjertos.• Muy útil para el recubrimiento de zonas dadoras e injertos mallados. • Disminución considerable de la estancia hospitalaria e ingresos. • Mayor nivel de satisfacción en pacientes, en sus padres y en el personal sanitario.• Posibilidad de tratamiento ambulante en Consultas externas y en Centros de Atención Primaria.• Disminución de los costos hospitalarios en general. (AU)

[Our experience with the use of Biobrane in the treatment of burns and other injuries in children]. / Nuestra experiencia con el uso de Biobrane en el tratamiento de las quemaduras y otras lesiones en la edad pediátrica.

Burns in the pediatric age are accidents which cause a lot of trauma, on the one hand because of their immediate consequences and on the other hand because of the severity of the pain, the amount of times the dressings need to be change, the lengthy hospital stay and the scars that remain for life. Between 1995 and 2000 we have treated 196 children, (4 months to 14 years old), with Biobrane: 141 patients affected of first and second degree burn injuries, 45 skin donor sites covering, 4 reinforcing of meshed autografts, 3 traumatic dermoabrasions, 2 extirpation of post-traumatic cutaneous tattoo and 1 Toxic epidermic necrolisis. Advantages noticed at the end of the treatment: Excellent skin healing. No pain while changing dressings. Reduction the need to use skin grafts. It is very useful to cover the skin donor sites and meshed autografts. Shorter Hospital stay and less need to be kept in hospital. A higher level of satisfaction is shown by children, their parents and sanitary workers. It offers the possibility of outpatients treatment in First Aid Health Centers. It reduces hospital costs.