PEG versus LAP: hacia una técnica más segura para la nutrición enteral a largo plazo / PEG versus LAP: towards a safer technique for long-term enteral nutrition

Objetivo: Comparar los resultados y las complicaciones de las gastrostomías laparoscópicas (LAP) frente a las gastrostomías endoscópicas percutáneas (PEG). Material y Métodos: Estudio retrospectivo de 79 pacientes intervenidos quirúrgicamente para la realización de una gastrostomía en nuestro centro (2010-2017). Comparamos las complicaciones menores y mayores entre ambas técnicas. Resultados: Realizamos 24 LAP (14 varones) y 55 PEG (29 varones). La edad media fue de 4,77 [0,15-15,56] años en las LAP y 5,37 [0,12-16,58] años en las PEG. La mediana del tiempo de presentación de las complicaciones fue de 59 [2-975] días. No se encontraron diferencias significativas en las complicaciones menores entre ambas técnicas, sin embargo, son más frecuentes en las LAP (5,16% en LAP frente a 34,55% en PEG), siendo principalmente granulomas y fugas perigastrostomías. Encontramos asociación estadísticamente significativa entre pacientes con comorbilidad oncológica y la aparición de complicaciones menores (p<0,05), así como una asociación estadísticamente significativa entre las PEG y las complicaciones mayores (4,17% en LAP frente a 21,82% en PEG), con p=0,045. Las complicaciones mayores fueron, en las LAP un descolgamiento y en las PEG 9 síndrome de Buried-Bumper, un atrapamiento de colon sin perforación, una perforación de colon, un atrapamiento de epiplón, dos descolgamientos y una perforación de intestino delgado. Conclusiones: Dada la asociación existente entre las complicaciones mayores y el grupo PEG, siendo evidente la mayor frecuencia y gravedad de estas complicaciones con esta técnica, consideramos la LAP una técnica más segura. Sin embargo, son necesarios estudios con un mayor tamaño muestral y, a ser posible, multicéntrico

Objective: To compare the outcomes and complications between laparoscopic gastrostomies (LG) and percutaneous endoscopic gastrostomies (PEG). Methods: Retrospective review of 79 patients who had their gastrostomies inserted in our hospital (2010-2017). We compared surgical techniques, minor and major complications. Main results: A total of 24 LG (14 males) and 55 PEG (29 males) were performed. The mean age was 4.77 [0.15-15.56] years for LG and 5.37 [0.12-16.58] years for PEG. The median time of presentation of complications was 59 [2-975] days. No statistical differences were found in minor complications between both techniques; however, minor complications were more frequent in LG (54.16% in LG versus 34.55% in PEG), mainly, overgranulation and peristomal leakage. A statistically significant association was found between patients with oncological comorbidity and minor complications (p<0.05). A statistically significant association was found between major complications and PEG (4.17% in LG versus 21.82% in PEG), p=0.045. The major complications were one tube dislodgement in the LG group, and 9 Buried-Bumper syndrome, one colon interposition without perforation, one colon perforation, one omentum interposition, two tube dislodgements and one small bowel perforation in PEG group. Conclusions: Given the statistically significant association between major complications and the PEG group, being the higher frequency and severity of these complications with this technique evident; we consider the LG a safer technique. However, studies with larger number of patients and multicentric are necessary

[Pediatric endoscopy: state of the art]. / Endoscopia: estado actual.

INTRODUCTION: Our society has shown always a great concern with the limits of our speciality. However, we have never approached the issue of pediatric endoscopy. For this reason, we have decided to carry our a survey to assess the present situation of endoscopy among surgeon pediatricians. MATERIAL AND METHODS: Twenty-four hospitals whose services include pediatric surgery were sent a survey centred on the following items: name of hospital, number of beds, in pediatrics, number of surgical interventions per year (which enabled us to classify the services in four groups, depending on their surgical volume), which unit is in charge of esophagus-gastroscopy, colonoscopy, esophageal dilatation, percutaneous endoscopic gastrostomy (PEG), endoscopic retrograde colangio-pancreatography (ERCP), rigid and flexible bronchoscopy, and number of such examinations per year. RESULTS: We received twenty-two answers to the survey (91,88%). The upper endoscopies are carried out in 47,43% of the cases by Pediatric Surgery, (ten units carry out the 100% of the endoscopies in their hospital). All but two ERCP are carry out by the unit of adult gastroenterology, whereas esophageal dilatation and PEG are carry out in 89.33% of cases by Pediatric Surgery. Rigid bronchoscopy is performed by Pediatric Surgery in fifteen units, while flexible bronchoscopy is performed by Pediatric Surgery, Otorhinolaryngology, Pneumology and Pediatrics. CONCLUSIONS: The high degree of response proved the concern with strengthening certain techniques in the field of Pediatric Surgery. Esophageal dilatations and PEG are techniques in the hands of pediatric surgeons, while ERCP is in the hands of adult endoscopists. The units that offer flexible bronchoscopy carry out many more examinations. It would be necessary to reach a consensus regarding various issues related to these examinations, ranging from who is qualified to carry them out to their legal assistance.

[Foreign body aspiration in children]. / Aspiración de cuerpos extraños en la infancia.

The aim to this study is evaluate the history, symptoms, radiographic and endoscopic findings in 420 children who were admitted for suspected foreign body aspiration in our hospital between 1972 and 2005. In 13 children we didn't find foreign body and in 16 children the foreign bodies were lodged in larynx. The mean age was 33 months. The medical history, phisical exploration, auscultation and radiological findings were positive in 91,4%, 78,3%, 91,6% and 81%. The frecuency or foreign body aspiration is undervaluate and sometimes is excluded as diagnosis. Only 218 (51,9%) patients went to the hospital in the first 24 hours, although 87,8% of patients presented symptoms and 75,4% presented severe symptoms. Moreover the removed foreign bodies and suspected foreign bodies are the same in 82,95%. We think that bronchoscopy should by performed in all children who have had a choking episode.