RESUMO
BACKGROUND: Girls with cloacal malformation are at risk of bladder dysfunction, with nearly 90% exhibiting some degree of dysfunction. Surgical dissection, particularly with total urogenital mobilization (TUM), has been hypothesized as a cause of worsening bladder function despite this population commonly having associated vertebral and spinal cord abnormalities that may also explain bladder dysfunction. More recently there has been great effort to select the appropriate surgical technique for cloacal repair in each patient in order to minimize dissection and potential damage to the bladder. We aimed to evaluate the effect of surgical cloacal repair on bladder function based on pre and post-surgery urodynamics (UDS) testing. METHODS: A prospectively collected database of patients with anorectal malformation at a single center was queried for girls with cloacal malformations who had undergone surgical repair from 2015 to 2022. It is our current protocol to perform UDS before and after cloacal repair. Only patients who completed both pre and post-surgery UDS were included. UDS were evaluated and classified using the UMPIRE protocol. RESULTS: A total of 48 patients were included in the cohort. The majority of patients (79.2%) had stable or improved UDS post-op leaving 10 patients (20.8%) who had worsening UDS. Long common channel (≥3 cm) was the only factor significantly associated with worsening UDS. (p = 0.03) Nearly 30% (n = 8) of those undergoing UGS had worse post-op UDS compared to 9.5% (n = 2) with TUM. All patients who worsened UDS initially had safe UDS that changed to intermediate, except for one who worsened to hostile in the setting of significant social challenges and non-compliance. Only common channel length was predictive of worsening UDS, while the type of surgical approach and spine status were not. While the overall risk of worsening UDS after TUM is only 9.5%, patients with normal spines undergoing TUM had the lowest risk, seen in only one in 15 patients (6.6%). CONCLUSIONS: Common channel length was the most significant predictor of worsening UDS, while spine status and surgical technique (TUM vs UGS) did not significantly impact this finding. By following this established surgical protocol based on common channel and urethral lengths, is rare for the surgical cloacal repair to result in worsening post-op UDS, particularly in those undergoing TUM for short common channel and normal spine.
RESUMO
Se comunica un caso de pentalogía de Cantrell en embarazo gemelar, en el cual solo uno de los fetos presentó el síndrome; el segundo feto no portaba malformación congénita. Este hecho podría reforzar teorías epigenéticas sobre su origen. Se hace alcances sobre el diagnóstico prenatal, la etiología y posibilidad de manejo en estos casos.
A case of pentalogy of Cantrell pathology in only one fetus of a twin pregnancy is reported; no congenital malformation was found in the second fetus. This fact would endorse epigenetic theories on its origin. Some thoughts on prenatal diagnosis, etiology and management of these cases are discussed.
RESUMO
INTRODUCCION: Estudios previos realizados en pacientes pediátricos operados de apendicitis aguda complicada (AAC), muestran resultados contradictorios con respecto a la efectividad de la Apendicetomía Laparoscópica (AL) comparada con la Apendicetomía Abierta (AA), en la disminución del riesgo de complicaciones infecciosas postoperatorias, y del tiempo operatorio. MATERIAL Y METODOS: Se analizó el riesgo de complicaciones postoperatorias dentro de las tres primeras semanas, en pacientes menores de catorce años operados de apendicitis aguda complicada, por AL o AA, en la Unidad de Cirugía Pediátrica de un Hospital de IV nivel, en el período de Enero del 2008 a Diciembre del 2011. Se empleó regresión multivariada para corregir factores confusores potenciales como severidad de apendicitis, y el factor cirujano. También se evaluó el tiempo operatorio, la estancia hospitalaria, y el tiempo de inicio de la tolerancia oral. RESULTADOS: Se analizaron 253 historias clínicas de pacientes con apendicitis aguda complicada, de los cuales 87(34.4 por ciento) fueron operados por AA, y 166 (65.6 por ciento) por AL. Ninguna AL requirió conversión a AA. La regresión multivariada mostró que los pacientes operados por AL tienen 69 por ciento menos riesgo de presentar complicaciones postoperatorias en general comparados con los operados por AA, ajustado por tipo de apendicitis y cirujano (OR: 0.31 IC 95 por ciento 0.123-0.7, p<0.01). La AL tienen 76 por ciento menos riesgo de infección de sitio operatorio que la AA (OR: 0.24 IC 95 por ciento=0.08-0.69). No se encuentra diferencia estadísticamente significativa entre el riesgo de absceso intrabdominal, fistula enterocutánea, ni obstrucción intestinal, respecto al tipo de abordaje quirúrgico. No hay asociación entre el riesgo de estas tres complicaciones postoperatorias con el grupo etario del paciente, ni con el cirujano. El tiempo operatorio es mayor en la AL, independientemente del cirujano y de la severidad de la apendicitis...
INTRODUCTION: Previous studies carried out in children undergoing surgery for complicated appendicitis (CA), show conflicting results regarding effectiveness of laparoscopic appendectomy (LA) versus open appendectomy (OA), in diminishing risk of postoperative complications, and also in operative time. MATERIAL AND METHODS: Risk of postoperative complications until the third week after appendectomy was analyzed, in children under fourteen years old operated of CA, either by OA or LA, in the Pediatric Surgery Division of a fourth Level Hospital in Peru, from January 2008 until December 2011. Multivariable Regression analysis was employed in order to correct potential confounder factors, like severity of appendicitis and surgeon. Operative time, length of hospitalization, and oral intake were also analyzed. RESULTS: 253 charts of patients with complicated appendicitis were reviewed, 87 (34.4 per cent) were operated by OA, and 166 (65.6 per cent) by LA. No cases of LA required conversion to OA. Multivariable Logistic Regression showed that children undergoing LA have 69 per cent les s risk of total postoperative complications compared with OA, adjusted by severity of appendicitis and surgeon (OR: 0.31 IC 95 per cent 0.123-0.7, p<0.01). LA have 79 per cent less risk of wound infection compared with OA (OR: 0.24 IC 95 per cent=0.08-0.69). There is not significant statistical difference between type of surgical approach (LA vs. OA) and the risk of postoperative intraabdominal abscess, enterocutaneous fistula, or intestinal obstruction. Children age and surgeon are not risk factors for these complications. Multivariate linear regression demonstrated that LA is associated with longer operative time, adjusted by surgeon and severity of appendicitis (IC 95 per cent=9.3-30.1, p<0.01). Children undergoing LA have three times more. Chance of shorter length of hospitalization, and twice the chance of earlier oral intake, than those undergoing OA (p<0.01). CONCLUSIONS...
