Analysis of esthetic assessment scales in two surgical approaches for hypertrophic pyloric stenosis. / Evaluación de escalas de valoración estética en dos abordajes quirúrgicos para la estenosis hipertrófica de píloro.

INTRODUCTION: Hypertrophic pyloric stenosis (HPS) is a frequent pathology in neonates, with extramucosal pyloromyotomy being a healing surgery. It may be performed through a transverse subcostal incision (TSI) or a transumbilical incision (TUI). OBJECTIVE: To compare complications, operating times, hospital stay, and esthetic results between both techniques. MATERIALS AND METHODS: A retrospective, descriptive study of patients undergoing HPS surgery between January 2010 and January 2020 was carried out. Qualitative variables (sex and complications) were expressed as absolute frequency and percentage, whereas quantitative variables (age at surgery, operating time, hospital stay, and scar esthetic assessment scales: MVSS [Modified Vancouver Scar Scale] and P-SAS [Patient Scar Assessment Scale]) were expressed as median and interquartile range. RESULTS: 107 patients were analyzed: TSI (60.7%, n = 65) vs. TUI (39.3%, n = 42). Male patients: 89.2%, n = 58 vs. 83.3%, n = 35; age (days): 31 (24.5-39.5) vs. 34.5 (29.5-47.25); operating time (minutes): 41 (33.75-60) vs. 46 (38.5-60); and hospital stay (days): 2 (2-4) vs. 3 (2-3). Clavien-Dindo grade II complications were more frequent in the TUI Group (1.54%, n = 1 vs. 23.81%, n = 10; p <0.001), with most of them being wound infections. The opinion regarding the scar according to the MVSS scale was better in the TUI Group (1.5 [0-4] vs. 0 [0-2]; p = 0.022). No significant differences were found in the P-SAS scale (10 (6-18) vs. 6 (6-9); p = 0.060). CONCLUSIONS: TUI is preferred from an esthetic point of view, and even though surgical wound infections are more frequent, it is not associated with longer operating times, longer hospital stay, or severe complications.

INTRODUCCION: La estenosis hipertrófica de píloro (EHP) es una patología frecuente en neonatos donde la piloromiotomía extramucosa es una cirugía curativa. Puede realizarse a través de una incisión transversa subcostal (IT) o una incisión transumbilical (ITU). OBJETIVO: Comparar complicaciones, tiempo quirúrgico y de hospitalización y resultado estético entre ambas técnicas. MATERIAL Y METODOS: Estudio descriptivo retrospectivo en pacientes intervenidos de EHP entre enero 2010-2020. Variables cualitativas (sexo y complicaciones) expresadas mediante frecuencia absoluta y porcentaje; y cuantitativas (edad en cirugía, tiempo operatorio, días de hospitalización y escalas de estética de cicatrices: MVSS (Modified Vancouver Scar Scale) y P-SAS (Patient Scar Assessment Scale)) expresadas mediante mediana y rango intercuartílico. RESULTADOS: Se analizaron 107 pacientes: IT (60,7%, n = 65) vs. ITU (39,3%, n = 42): varones (89,2%, n = 58 vs. 83,3%, n = 35), días de vida (31 [24,5-39,5] vs. 34,5 [29,5-47,25]), tiempo quirúrgico (41 [33,75-60] vs. 46 [38,5-60] minutos) y días de hospitalización (2 [2-4] vs. 3 [2-3]). Las complicaciones Clavien-Dindo II fueron más frecuentes en el grupo ITU (1,54%, n = 1 vs. 23,81%, n = 10; p <0,001), siendo la mayoría infecciones de la herida. En el grupo ITU presentaban una mejor opinión sobre la cicatriz en la escala MVSS (1,5 [0-4] vs. 0 [0-2]; p = 0,022). La escala P-SAS no alcanzó diferencias significativas (10 [6-18] vs. 6 [6-9]; p = 0,060). CONCLUSIONES: La ITU es mejor aceptada a nivel estético y, aunque presenta más infecciones de herida quirúrgica, no precisa más tiempo quirúrgico o de ingreso, ni asocia complicaciones graves.

Evaluación de escalas de valoración estética en dos abordajes quirúrgicos para la estenosis hipertrófica de píloro / Analysis of esthetic assessment scales in two surgical approaches for hypertrophic pyloric stenosis

Introducción: La estenosis hipertrófica de píloro (EHP) es una patología frecuente en neonatos donde la piloromiotomía extramucosa es una cirugía curativa. Puede realizarse a través de una incisión transversa subcostal (IT) o una incisión transumbilical (ITU). Objetivo. Comparar complicaciones, tiempo quirúrgico y de hospitalización y resultado estético entre ambas técnicas. Material y métodos: Estudio descriptivo retrospectivo en pacientes intervenidos de EHP entre enero 2010-2020. Variables cualitativas (sexo y complicaciones) expresadas mediante frecuencia absoluta y porcentaje; y cuantitativas (edad en cirugía, tiempo operatorio, días de hospitalización y escalas de estética de cicatrices: MVSS [Modified Vancouver Scar Scale] y P-SAS [Patient Scar Assessment Scale]) expresadas mediante mediana y rango intercuartílico. Resultados:S e analizaron 107 pacientes: IT (60,7%, n = 65) vs. ITU (39,3%, n = 42): varones (89,2%, n = 58 vs. 83,3%, n = 35), días de vida (31 [24,5-39,5] vs. 34,5 [29,5-47,25]), tiempo quirúrgico (41 [33,75-60] vs. 46 [38,5-60] minutos) y días de hospitalización (2 [2-4] vs. 3 [2-3]). Las complicaciones Clavien-Dindo II fueron más frecuentes en el grupo ITU (1,54%, n = 1 vs. 23,81%, n = 10; p < 0,001), siendo la mayoría infecciones de la herida. En el grupo ITU presentaban una mejor opinión sobre la cicatriz en la escala MVSS (1,5 [0-4] vs. 0 [0-2]; p = 0,022). La escala P-SAS no alcanzó diferencias significativas (10 [6-18] vs. 6 [6-9]; p = 0,060). Conclusiones: La ITU es mejor aceptada a nivel estético y, aunque presenta más infecciones de herida quirúrgica, no precisa más tiempo quirúrgico o de ingreso, ni asocia complicaciones graves.(AU)

Introduction: Hypertrophic pyloric stenosis (HPS) is a frequent pathology in neonates, with extramucosal pyloromyotomy being a healing surgery. It may be performed through a transverse subcostal incision (TSI) or a transumbilical incision (TUI). Objective: To compare complications, operating times, hospital stay, and esthetic results between both techniques. Materials and methods: A retrospective, descriptive study of patients undergoing HPS surgery between January 2010 and January 2020 was carried out. Qualitative variables (sex and complications) were expressed as absolute frequency and percentage, whereas quantitative variables (age at surgery, operating time, hospital stay, and scar esthetic assessment scales: MVSS [Modified Vancouver Scar Scale] and P-SAS [Patient Scar Assessment Scale]) were expressed as median and interquartile range. Results: 107 patients were analyzed: TSI (60.7%, n = 65) vs. TUI (39.3%, n = 42). Male patients: 89.2%, n = 58 vs. 83.3%, n = 35; age (days): 31 (24.5-39.5) vs. 34.5 (29.5-47.25); operating time (minutes): 41 (33.75-60) vs. 46 (38.5-60); and hospital stay (days): 2 (2-4) vs. 3 (2-3). Clavien-Dindo grade II complications were more frequent in the TUI Group (1.54%, n = 1 vs. 23.81%, n = 10; p < 0.001), with most of them being wound infections. The opinion regarding the scar according to the MVSS scale was better in the TUI Group (1.5 [0-4] vs. 0 [0-2]; p = 0.022). No significant differences were found in the P-SAS scale(10 (6-18) vs. 6 (6-9); p = 0.060). Conclusions: TUI is preferred from an esthetic point of view, and even though surgical wound infections are more frequent, it is not associated with longer operating times, longer hospital stay, or severe complications.(AU)

Re-interventions following appendectomy in children: a multicenter study. / Reintervenciones tras apendicectomía en niños. Estudio multicéntrico.

INTRODUCTION: Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications requiring surgery following appendectomy. MATERIAL AND METHODS: A retrospective study of the appendectomies conducted in three third-level institutions from 2015 to 2019 was carried out. Complications, causes, and number of re-interventions, time from one surgery to another, surgical technique used, operative findings at baseline appendectomy according to the American Association for the Surgery of Trauma (AAST) classification, and hospital stay were collected. RESULTS: 3,698 appendicitis cases underwent surgery, 76.7% of which laparoscopically, with 37.2% being advanced (grades II-V of the AAST classification). Mean operating time was 50.4 minutes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery, p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2 vs. 49.1 ± 19.3, p < 0.001). 76 re-interventions (2.05%) were carried out. The causes included postoperative infection (n = 46), intestinal obstruction (n = 20), dehiscence (n = 4), and others (n = 6). Re-intervention risk was not impacted by the baseline approach used (open surgery or laparoscopy, OR: 1.044, 95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% advanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3). There was a tendency to use the same approach both at baseline appendectomy and re-intervention. This occurred in 72.2% of laparoscopic appendectomies, and in 67.7% of open appendectomies. The minimally invasive approach (50/76) was more frequent than the open one (27 laparoscopies and 23 ultrasound-guided drainages vs. 26 open surgeries) (p < 0.05). 55% of obstruction patients underwent re-intervention through open surgery (p > 0.05). CONCLUSION: Re-intervention rate was higher in advanced appendicitis cases. In this series, the minimally invasive approach (laparoscopic or ultrasound-guided drainage) was the technique of choice for re-interventions.

INTRODUCCION: La apendicitis aguda es la causa más frecuente de abdomen agudo en niños. El objetivo de este trabajo es estudiar las causas, abordaje y resultados de las complicaciones que requieren intervención quirúrgica después de la apendicectomía. MATERIAL Y METODOS: Estudio retrospectivo de las apendicectomías realizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieron las complicaciones, causas y número de reintervenciones, intervalo entre ambas cirugías, técnica empleada, hallazgos operatorios según la Clasificación de la American Association for the Surgery of Trauma (AAST) en la apendicectomía inicial y tiempo de ingreso. RESULTADOS: Se intervinieron 3.698 apendicitis, un 76,7% por vía laparoscópica, encontrando un 37,2% evolucionadas (grado II-V de la clasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos (laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superior en aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs. 49,1 ± 19,3, p < 0,001). Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infección postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia (n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo de reintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9), pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs. 0,7% incipientes, OR 12,52, IC 95% 6,18-25,3). Hubo una tendencia a reintervenir por el mismo abordaje que la apendicectomía, esto ocurrió en un 72,2% de las apendicectomías laparoscópicas y en un 67,7% de las apendicectomías abiertas. El abordaje mínimamente invasivo (50/76) fue más frecuente que la laparotomía (27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías) (p < 0,05). El 55% de los pacientes obstruidos se reintervinieron por vía abierta (p > 0,05). CONCLUSION: El índice de reintervención fue superior en las apendicitis evolucionadas. En esta serie, el abordaje mínimamente invasivo (laparoscópico o drenaje ecoguiado) fue la técnica de elección en las reintervenciones.

Reintervenciones tras apendicectomía en niños. Estudio multicéntrico / Re-interventions following appendectomy in children: a multicenter study

Introducción: La apendicitis aguda es la causa más frecuente deabdomen agudo en niños. El objetivo de este trabajo es estudiar lascausas, abordaje y resultados de las complicaciones que requieren in-tervención quirúrgica después de la apendicectomía.Material y métodos: Estudio retrospectivo de las apendicectomíasrealizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieronlas complicaciones, causas y número de reintervenciones, intervalo entreambas cirugías, técnica empleada, hallazgos operatorios según la Clasi-ficación de la American Association for the Surgery of Trauma (AAST)en la apendicectomía inicial y tiempo de ingreso.Resultados: Se intervinieron 3.698 apendicitis, un 76,7% por víalaparoscópica, encontrando un 37,2% evolucionadas (grado II-V de laclasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos(laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superioren aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs.49,1 ± 19,3, p < 0,001).Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infec-ción postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia(n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo dereintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9),pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs.0,7% incipientes, OR 12,52, IC 95% 6,18-25,3).Hubo una tendencia a reintervenir por el mismo abordaje que laapendicectomía, esto ocurrió en un 72,2% de las apendicectomías lapa-roscópicas y en un 67,7% de las apendicectomías abiertas. El abordajemínimamente invasivo (50/76) fue más frecuente que la laparotomía(27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías)(p < 0,05). El 55% de los pacientes obstruidos se reintervinieron porvía abierta (p > 0,05).

Introduction: Acute appendicitis is the most frequent cause ofacute abdomen in children. The objective of this study was to analyzethe causes, approach, and results of complications requiring surgeryfollowing appendectomy.Materials and methods: A retrospective study of the appendecto-mies conducted in three third-level institutions from 2015 to 2019 wascarried out. Complications, causes, and number of re-interventions, timefrom one surgery to another, surgical technique used, operative findingsat baseline appendectomy according to the American Association forthe Surgery of Trauma (AAST) classification, and hospital stay werecollected.Results: 3,698 appendicitis cases underwent surgery, 76.7%of which laparoscopically, with 37.2% being advanced (grades II-Vof the AAST classification). Mean operating time was 50.4 min-utes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery,p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2vs. 49.1 ± 19.3, p < 0.001).76 re-interventions (2.05%) were carried out. The causes includedpostoperative infection (n = 46), intestinal obstruction (n = 20), dehis-cence (n = 4), and others (n = 6). Re-intervention risk was not impactedby the baseline approach used (open surgery or laparoscopy, OR: 1.044,95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% ad-vanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3).There was a tendency to use the same approach both at baseline ap-pendectomy and re-intervention. This occurred in 72.2% of laparoscopicappendectomies, and in 67.7% of open appendectomies. The minimallyinvasive approach (50/76) was more frequent than the open one (27laparoscopies and 23 ultrasound-guided drainages vs. 26 open surger-ies) (p < 0.05). 55% of obstruction patients underwent re-interventionthrough open surgery (p > 0.05).

Utilidad clínica de la medición del área máxima del trazado del detrusor en el estudio urodinámico en el paciente pediátrico con vejiga neuropática: estudio piloto / Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study

IntroducciónLa vejiga neuropática (VN) es una disfunción del tracto urinario inferior (DTUinf) con riesgo de deterioro de la función renal, siendo el estudio urodinámico (EUD) la prueba patrón para su diagnóstico y seguimiento. El parámetro urodinámico clásico para identificar el riesgo renal es la presión de fuga del detrusor>=40 cmH2O, aunque este valor aislado puede carecer de interés pronóstico. Recientemente se ha descrito el área bajo la curva (ABC) del trazado de la presión del detrusor como factor pronóstico.ObjetivoAnalizar la utilidad clínica del ABC del trazado de la presión del detrusor en edad pediátrica (< 15 años).MétodosEstudio retrospectivo de registros urodinámicos en población pediátrica con VN entre 2011-2020. Se registran: presión detrusor y de fuga ≥ 40 cmH2O, alteración de la acomodación, vaciado e hiperactividad detrusor. Se clasifica la muestra según evolución clínica-radiológica en el momento del EUD. Se calcula el ABC utilizando los métodos de Newton-Côtes (trapecios, Simpson compuesto) y se calculan sus índices según la capacidad vesical (índice trapecios [IT]; índice Simpson [IS]). Significación estadística: p<0,05.ResultadosSe analizan 55 registros. El 41,8% (n=23) tuvo una evolución clínica desfavorable. La alteración en el vaciado, la hipoacomodación y los índices se asociaron a una situación clínica desfavorable(p <0,05). El ABC del rendimiento diagnóstico de los nuevos índices fue: IT (0,736, p=0,0006); IS (0,755, p=0,0001). Los puntos de corte del valor de IT e IS fueron de 10,69 y 8 cmH2O×s/cc, respectivamente. No encontramos diferencias en el rendimiento diagnóstico entre ellos (p> 0,05).ConclusionesLos nuevos índices estudiados son útiles en el diagnóstico de pacientes con VN y situación clínica desfavorable (AU)

IntroductionNeuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP)>=40cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.AimTo analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).MethodsRetrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure>=40cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P<.05.ResultsFifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n=23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P<.05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P=.0006), SI (0.755, P=.0001) with a cut-off value of 10,69 and 8cmH2Os/cc, respectively. We did not find differences in the diagnostic performance between them (P>.05).ConclusionsThe analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition (AU)

Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study.

INTRODUCTION: Neuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) ≥  40 cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor. AIM: To analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years). METHODS: Retrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure ≥ 40 cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P < .05. RESULTS: Fifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P < .05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P = 0.0006), SI (0.755, P = .0001) with a cut-off value of 10,69 and 8 cmH2O·s/cc, respectively. We did not find differences in the diagnostic performance between them (P > .05). CONCLUSIONS: The analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.

[Long term evaluation of transanal surgery with automatic suture in Hirschsprung's disease]. / Evaluación a largo plazo de la cirugía transanal con sutura automática en la enfermedad de Hirschsprung.

OBJECTIVE: Retrospective and descriptive study of patients with diagnosis of Hirschsprung disease (HD) in whom transanal pull-through was performed in our center. MATERIAL AND METHODS: All patients with diagnosis of HD in whom transanal surgery was performed between 2006 and 2018 in our center were selected. In all cases laparoscopic biopsy was performed in the previous dilated area. Once intraoperatory biopsy revealed the presence of ganglionic cells, transanal De la Torre surgery was performed, until reaching the localization of the biopsied area. Circular automatic suture was performed in all cases. RESULTS: Surgery was performed in 21 patients (16 boys and 5 girls) with a median age of 12 months (5-62). No patient had enterocolitis. The median resection length was 14.5 cm (3-45) and no intraoperative complications happened. One patient (5%) developed a rectosigmoideal abscess, which was solved with antibiotic. One case (5%) needed another surgery due to umbilical trochar eventration. No patient had enterocolitis after the surgery. One patient (5%) had stenosis, solved by its section and other case (5%) had sleeve compression which was solved by laparoscopic section. After a median follow up of 97 months (12-159), one child (5%) developed encopresis, which is treated with periodic anal irrigations and other patient (5%) has chronic constipation, which require periodic enemas. The rest of the patients have no symptomatology. CONCLUSION: In conclusion, in our series of cases, transanal pull-through with circular automatic suture was a safe and useful technique. It has a low rate of operative and postoperative complications and provides good prospective results.

OBJETIVO: Estudio retrospectivo descriptivo de pacientes con enfermedad de Hirschsprung (EH) intervenidos en nuestro centro por vía transanal. MATERIAL Y METODOS: Se seleccionaron a los pacientes con diagnóstico de EH intervenidos por vía transanal con sutura automática circular en nuestro centro entre los años 2006 y 2018. Se realizó biopsia laparoscópica de la zona previa a la dilatación en todos los casos. Tras la confirmación de la presencia de células, se procedió al descenso transanal tipo De la Torre hasta alcanzar la zona de la biopsia. La anastomosis se realizó con sutura automática circular (CEEA 21 o 25 mm). RESULTADOS: Se intervinieron 21 pacientes, 16 niños y 5 niñas, con una mediana de edad de 12 meses (5-62). Ningún paciente presentó enterocolitis preoperatoria. La mediana de la longitud resecada fue de 14,5 cm (3-45), sin incidencias intraoperatorias. Un paciente (5%) presentó absceso rectosigmoideo postoperatorio, resuelto con antibióticos. Un caso (5%) necesitó de nueva cirugía por eventración del acceso umbilical. Un paciente (5%) presentó estenosis, resuelta mediante sección y otro (5%) compresión del manguito seromuscular, que fue tratada con sección laparoscópica. No hubo casos de enterocolitis postoperatoria. Tras una mediana de seguimiento de 97 meses (12-159), un niño presenta encopresis (5%) tratada mediante sistema de irrigaciones transanales periódicas y otro caso (5%) cursa con estreñimiento, en tratamiento con enemas periódicos. El resto se hallan asintomáticos. CONCLUSION: En definitiva, podemos afirmar que en nuestra serie el descenso transanal con sutura automática circular es una técnica segura y eficaz, que presenta una tasa baja de complicaciones intra y postoperatorias, con buenos resultados a largo plazo.

[Dog bites, a current problem in our environment]. / Mordeduras de perro, un problema vigente en nuestro entorno.

AIMS: Dog bites are frequent reason for consultation in pediatrics emergency department. Despite in our environment dog bites are rarely lethal, some of these accidents can have serious aesthetics consequences. The main goal of this article is to analyze dog bites casuistry and their impact in our community. MATERIAL AND METHODS: Retrospective review of patients treated for dog bite in a tertiary pediatric center between 2013-2018. We studied patient's demographic variables, bite localization, dog-patient relationship, antibiotic therapy, need for admission, complications and secondary sequelae. RESULTS: 256 cases were analyzed (average age 6.4 years), 133 boys (51.9%) and 123 girls (48%). In 153 cases, the aggressor dog was from the patient's familiar environment (59.8%). The most frequent location of the wounds was head and neck (94.1%), followed by extremities (4.7%) and genitals (1.6%). In 227 cases (88.7%) antibiotics were administered. Wound infection was the most frequent complication, occurring in 5 patients (2%). 20 patients (7.8%) required hospital admission with a mean stay of 1.6 days. Aesthetic sequelae were described in 10 cases (3.9%), 7 of which required correcting surgery. CONCLUSIONS: Dog bites persist as a frequent reason for medical consultation, most of them are provoked by patient familiar dogs. Wound infection represents the major complication, and the facial aesthetic sequelae are the most frequent indication for surgical intervention. We consider due to the amount of dog bites and their sequelae, the inclusion of preventive measures against these accidents in home prevention guidelines could be useful to reduce the incidence of these injuries.

OBJETIVOS: Las mordeduras de perro son motivo de consulta habitual en urgencias pediátricas. Si bien en nuestro medio raramente son letales, algunas conllevan secuelas estéticas graves. El objetivo del trabajo es analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. MATERIAL Y METODOS: Revisión retrospectiva de pacientes atendidos por mordedura de perro en un centro pediátrico terciario entre 2013-2018. Estudiamos variables demográficas, localización de mordedura, relación perro-paciente, antibioterapia, necesidad de ingreso, complicaciones y secuelas derivadas. RESULTADOS: Se analizaron 256 casos (edad media 6,4 años), 133 niños (51,9%) y 123 niñas (48%). En 153 casos el perro agresor era del entorno del paciente (59,8%). La localización más frecuente de heridas fue cabeza y cuello (94,1%), seguida de extremidades (4,7%) y genitales (1,6%). En 227 casos (88,7%) se administró antibiótico. La complicación más frecuente fue la infección de herida en 5 pacientes (2%). Precisaron ingreso hospitalario 20 pacientes (7,8%) con estancia media de 1,6 días. Se describieron secuelas estéticas en 10 casos (3,9%), 7 precisaron cirugía correctora. CONCLUSIONES: Las mordeduras de perro persisten como motivo frecuente de consulta, produciéndose mayoritariamente por perros del entorno del paciente. La infección de herida representa la complicación más común, y la secuela estética facial supone la indicación más frecuente de intervención quirúrgica. Consideramos que por la cantidad de mordeduras y sus secuelas, la inclusión de medidas preventivas ante estos accidentes en guías de prevención del hogar, podría ser de utilidad para concienciar a la población y disminuir la incidencia de estas lesiones.

Evaluación a largo plazo de la cirugía transanal con sutura automática en la enfermedad de Hirschsprung / Long term evaluation of transanal surgery with automatic suture in Hirschsprung's disease

Objetivo. Estudio retrospectivo descriptivo de pacientes con en-fermedad de Hirschsprung (EH) intervenidos en nuestro centro por vía transanal. Material y métodos. Se seleccionaron a los pacientes con diagnóstico de EH intervenidos por vía transanal con sutura automática circular en nuestro centro entre los años 2006 y 2018. Se realizó biopsia laparoscópica de la zona previa a la dilatación en todos los casos. Tras la confirmación de la presencia de células, se procedió al descenso transanal tipo De la Torre hasta alcanzar la zona de la biopsia. La anastomosis se realizó con sutura automática circular (CEEA 21 o 25 mm). Resultados. Se intervinieron 21 pacientes, 16 niños y 5 niñas, con una mediana de edad de 12 meses (5-62). Ningún paciente presentó enterocolitis preoperatoria. La mediana de la longitud resecada fue de 14,5 cm (3-45), sin incidencias intraoperatorias. Un paciente (5%) presentó absceso rectosigmoideo postoperatorio, resuelto con antibióticos. Un caso (5%) necesitó de nueva cirugía por eventración del acceso umbilical. Un paciente (5%) presentó estenosis, resuelta mediante sección y otro (5%) compresión del manguito seromuscular, que fue tratada con sección laparoscópica. No hubo casos de enterocolitis postoperatoria. Tras una mediana de seguimiento de 97 meses (12-159), un niño presenta encopresis (5%) tratada mediante sistema de irrigaciones transanales periódicas y otro caso (5%) cursa con estreñimiento, en tratamiento con enemas periódicos. El resto se hallan asintomáticos. Conclusión. En definitiva, podemos afirmar que en nuestra serie el descenso transanal con sutura automática circular es una técnica segura y eficaz, que presenta una tasa baja de complicaciones intra y postoperatorias, con buenos resultados a largo plazo

Objective. Retrospective and descriptive study of patients with diagnosis of Hirschsprung disease (HD) in whom transanal pull-through was performed in our center. Material and methods. All patients with diagnosis of HD in whom transanal surgery was performed between 2006 and 2018 in our center were selected. In all cases laparoscopic biopsy was performed in the previous dilated area. Once intraoperatory biopsy revealed the presence of ganglionic cells, transanal De la Torre surgery was performed, until reaching the localization of the biopsied area. Circular automatic suture was performed in all cases. Results. Surgery was performed in 21 patients (16 boys and 5 girls) with a median age of 12 months (5-62). No patient had enterocolitis. The median resection length was 14.5 cm (3-45) and no intraoperative complications happened. One patient (5%) developed a rectosigmoideal abscess, which was solved with antibiotic. One case (5%) needed another surgery due to umbilical trochar eventration. No patient had enterocolitis after the surgery. One patient (5%) had stenosis, solved by its section and other case (5%) had sleeve compres-sion which was solved by laparoscopic section. After a median follow up of 97 months (12-159), one child (5%) developed encopresis, which is treated with periodic anal irrigations and other patient (5%) has chronic constipation, which require periodic enemas. The rest of the patients have no symptomatology. Conclusion. In conclusion, in our series of cases, transanal pull-through with circular automatic suture was a safe and useful technique. It has a low rate of operative and postoperative complications and provides good prospective results

Mordeduras de perro, un problema vigente en nuestro entorno / Dog Bites, a current problem in our environment

Objetivos. Las mordeduras de perro son motivo de consulta habitual en urgencias pediátricas. Si bien en nuestro medio raramente son letales, algunas conllevan secuelas estéticas graves. El objetivo del trabajo es analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno Material y métodos. Revisión retrospectiva de pacientes atendidos por mordedura de perro en un centro pediátrico terciario entre 2013-2018. Estudiamos variables demográficas, localización de mordedura, relación perro-paciente, antibioterapia, necesidad de ingreso, complicaciones y secuelas derivadas. Resultados. Se analizaron 256 casos (edad media 6,4 años), 133 niños (51,9%) y 123 niñas (48%). En 153 casos el perro agresor era del entorno del paciente (59,8%). La localización más frecuente de heridas fue cabeza y cuello (94,1%), seguida de extremidades (4,7%) y genitales (1,6%). En 227 casos (88,7%) se administró antibiótico. La complicación más frecuente fue la infección de herida en 5 pacientes (2%). Precisaron ingreso hospitalario 20 pacientes (7,8%) con estancia media de 1,6 días. Se describieron secuelas estéticas en 10 casos (3,9%), 7 precisaron cirugía correctora. Conclusiones. Las mordeduras de perro persisten como motivo frecuente de consulta, produciéndose mayoritariamente por perros del entorno del paciente. La infección de herida representa la complicación más común, y la secuela estética facial supone la indicación más fre-cuente de intervención quirúrgica. Consideramos que por la cantidad de mordeduras y sus secuelas, la inclusión de medidas preventivas ante estos accidentes en guías de prevención del hogar, podría ser de utilidad para concienciar a la población y disminuir la incidencia de estas lesiones

Aims. Dog bites are frequent reason for consultation in pediatrics emergency department. Despite in our environment dog bites are rarely lethal, some of these accidents can have serious aesthetics consequences. The main goal of this article is to analyze dog bites casuistry and their impact in our community. Material and methods. Retrospective review of patients treated for dog bite in a tertiary pediatric center between 2013-2018. We studied patient’s demographic variables, bite localization, dog-patient relation-ship, antibiotic therapy, need for admission, complications and secondary sequelae. Results. 256 cases were analyzed (average age 6.4 years), 133 boys (51.9%) and 123 girls (48%). In 153 cases, the aggressor dog was from the patient’s familiar environment (59.8%). The most frequent location of the wounds was head and neck (94.1%), followed by extremities (4.7%) and genitals (1.6%). In 227 cases (88.7%) antibiotics were administered. Wound infection was the most frequent complication, occurring in 5 patients (2%). 20 patients (7.8%) required hospital admission with a mean stay of 1.6 days. Aesthetic sequelae were described in 10 cases (3.9%), 7 of which required correcting surgery. Conclusions. Dog bites persist as a frequent reason for medical consultation, most of them are provoked by patient familiar dogs. Wound infection represents the major complication, and the facial aesthetic sequelae are the most frequent indication for surgical intervention. We consider due to the amount of dog bites and their sequelae, the inclusion of preventive measures against these accidents in home prevention guidelines could be useful to reduce the incidence of these injuries

Comparative study of the effect of PTH (1-84) and strontium ranelate in an experimental model of atrophic nonunion.

UNLABELLED: This study aimed to set up an experimental model of long bone atrophic nonunion and to explore the potential role of PTH-1-84 (PTH 1-84) and strontium ranelate (SrR). A model of atrophic nonunion was created in Sprague-Dawley rats at the femoral midshaft level. The animals were randomised into four groups. Group A1: control rodents, fracture without bone gap; Group A2: rodents with subtraction osteotomy (non-union model control) treated with saline; Group B: rodents with subtraction osteotomy treated with human-PTH (PTH 1-84); and Group C: rodents with subtraction osteotomy treated with strontium ranelate (SrR). The groups were followed for 12 weeks. X-rays were be obtained at weeks 1, 6 and 12. After sacrificing the animals, we proceeded to the biomechanical study and four point bending tests to evaluate the resistance of the callus and histological study. In second phase, the expression of genes related to osteoblast function was analysed by reverse transcription-quantitative PCR in rats subjected to substraction osteotomy and treated for 2 weeks. The animals were randomised into three groups: Group A2: rodents treated with saline; Group B: rodents treated with PTH 1-84 and Group C: rodents treated with SrR. RESULTS: No significant histological differences were found between animals subjected to subtraction osteotomy and treated with either saline or PTH (p=0.628), but significant difference existed between animals receiving saline or SrR (p=0.005). There were no significant differences in X-ray score between the saline and PTH groups at either 6 or 12 weeks (p=0.33 and 0.36, respectively). On the other hand, better X-ray scores were found in the SrR group (p=0.047 and 0.006 in comparison with saline, at 6 and 12 weeks, respectively). In line with this, biomechanical tests revealed improved results in the SrR group. Gene expression analysis revealed a slightly decreased levels of DKK1, a Wnt pathway inhibitor, in rats treated with SrR. CONCLUSIONS: SrR increases has a beneficial effect in this atrophic non-union model in rats. This suggests that it might have a role may have important implications for the potential clinical role in the treatment of fracture nonunion.

Enhanced production of a lutein-rich acidic environment microalga.

AIMS: This study was aimed at increasing productivity of a novel lutein-rich acidic environment microalga, Coccomyxa onubensis, based on efficient inorganic carbon use. METHODS AND RESULTS: Productivity was determined based on dry weight data; inorganic carbon concentration mechanisms were determined by means of carbonic anhydrase activity; carotenoids were extracted with methanol and measured by HPLC techniques. The existence of carbon concentration mechanisms and conditions that might lead to use them for addressing increased productivity of C. onubensis was studied. Best growth and carbon uptake capacity occurred at acidic pH, proving acid-tolerant behaviour of C. onubensis. Incubation in air followed by shift to high carbon conditions enhanced carbon-use efficiency in terms of growth rate and biomass productivity, based on the action of both carbonic anhydrase activities. Lutein accumulated in the microalga at high concentrations above 5-6 g kg(-1) dry weight and did not depend on inorganic carbon conditions. CONCLUSIONS: Consequently, repeated cycles of air incubation and high CO2 incubation of C. onubensis might become a suitable tool to perform production processes of lutein-enriched biomass. SIGNIFICANT AND IMPACT OF THE STUDY: This study intends to show that acidic environment microalgae can be produced at similar productivities of nonextreme microalgae, with the added advantage of their growth in highly selective culture medium. Particularly, it is applied to C. onubensis which accumulates lutein at commercially relevant concentrations.

[Lasers in urology]. / Láser en urología.

UNLABELLED: The objective of this article is to quote under the form of a document the opinions expressed by the participants of the round table "Lasers in Urology Today" (january 2006). The material and method used is the compilation of critical and updated notions on the usefulness of lasers in urology, supplemented by bibliographic references, a limited iconography. The results achieved by lasers today enable us to state that: Holmium laser is the choice treatment for in situ lithotripsy; however, it has not significantly improved previous results when treating urologic tumours and stenoses. Nowadays we have two types of lasers: KTP and HoL, which obtain results similar to surgery regarding BPH, but with reduced morbidity. The usefulness of laser in laparoscopic surgery is still under development. CONCLUSION: Lasers in Urology Today play an active role in in situ lithotripsy (HoL), and a competitive one in BPH surgery (KTP and HoL). Regarding the rest of indications, i.e. tumours, stenoses, laparoscopic surgery, etc., further studies and enough follow-up times are still needed.

Láser en Urología / Lasers in urology

El objetivo de este artículo, es reproducir en forma de texto las opiniones vertidas por los componentes de laMesa Redonda "Lásers en Urología Hoy", durante su celebración (enero 2006). El material y método empleados ha sido la recopilación de los conceptos críticos y actuales sobre la utilidad de los lásers en urología, acompañados de bibliografía/iconografía limitada y seleccionada. Los resultados conseguidos por los lásers en la actualidad permiten establecer que: EL láser Holmium es el tratamiento de elección como litotricia in situ pero que no ha mejorado significativamente los resultados precedentes, en el tratamiento de los tumores y estenosis urológicos. Disponemos hoy de dos tipos de lásers: KTP y HoL que consiguen resultados similares a los de la cirugía en la HBP, pero con menor morbilidad. La utilidad del láser en cirugía laparoscópica está todavía en desarrollo. En conclusión: los Lásers en Urología Hoy desempeñan un papel electivo en litotricia in situ (HoL) y competitivo en cirugía de la HBP (KTP y HoL). En el resto de sus indicaciones: tumores, estenosis, cirugía laparoscópica etc., se precisan estudios y tiempo de seguimiento suficientes para establecer conclusiones fiables

The objective of this article is to quote under the form of a document the opinions expressed by the participants of the round table "Lasers in Urology Today" (january 2006). The material and method used is the compilation of critical and updated notions on the usefulness of lasers in urology, supplemented by bibliographic references, a limited iconography. The results achieved by lasers today enable us to state: Holmium laser is the choice treatment for in situ lithotripsy; however, it has not significantly improved previous results when treating urologic tumours and stenoses. Nowadays we have two types of lasers: KTP and HoL, which obtain results similar to surgery regarding BHP, but with reduced morbidity. The usefulness of laser in laparoscopic surgery is still under development. Conclusion: Lasers in Urology Today play an active role in in situ lithotripsy (HoL), and competitive one in BPH surgery (KTP and HoL). Regarding the rest of indications, i. e. tumours, stenoses, laparoscopic surgery, etc., further studies and enough follow-up times are still needed

[Laparoscopic-extraperitoneal colposuspension]. / Colposuspensión laparoscopica-extraperitoneal.

Female stress urinary incontinence is a highly prevalent disease with a broad range of surgical approaches with different percentages of success depending on the severity of the condition and the appropriateness of the technique in the indication. A few years ago, laparoscopy was introduced as another therapeutical possibility. The paper presents the Burch-like colposuspension through an extraperitoneal laparoscopic approach for the first time in our country, describing the technique and the preliminary results with a mean follow-up of over 6 months. Our preliminary results, as well as the more numerous from other authors seem to indicate that when a Burch-like colposuspension is indicated, extraperitoneal laparoscopic approach may be the ideal one once the learning curve for laparoscopic surgery is overcome.

[Lymphatic staging by laparoscopic surgery]. / Estadiaje ganglionar mediante cirugía laparoscópica.

Lymphadenectomy is mandatory in vesical and prostatic tumours for a precise staging of candidates to radical surgery. Presentation of our series of 18 ilioobturative lymphadenectomies between May 1992 and February 1993, performed in 14 prostate carcinoma and 4 vesical tumours. As most interesting results, the average number of nodes removed, which was 8, and the discovery of nodular affectation in 5 cases, understaged by the non-invasive procedures, are highlighted; likewise, the reduction in surgery duration up to the current frame of 80 to 120 minutes must be emphasized. Mortality due to the procedure was null. We believe that laparoscopic lymphadenectomy should be the choice technique in the staging of tumoral dissemination in the ilioobturative domain.

[Laparoscopic exeresis of a completely duplicated kidney]. / Exéresis laparoscópica de riñón con duplicidad completa.

During the '80s, laparoscopy in general has undergone an enormous boom as representative of minimally invasive surgery, urology standing out in that progression as the specialty leading the endoscopic approach both for the tradition and profusion of techniques developed. In Spain, major scope laparoscopic surgery started with lymphadenectomy in which we are the second Spanish and first Andalusian group to perform it. The experience accumulated by our group has allowed us to perform and present one case of laparoscopic nephrectomy, this being the first time in Andalusia and second in Spain that an Urology Unit develops this technique, the distinct feature being the presence of complete duplicity of the kidney. The procedure had no peri or post-operative complications and the patient was discharged four days later. We conclude that although presently the indications of renal exeresis for this procedure are limited, these will soon be expanded thanks to the urologists' concern, the accumulation of experience and the improvement of the instrumentarium.