Laparoscopic Upper-pole Nephroureterectomy In Infants

Objective: Report the results of laparoscopic upper-pole nephroureterectomy in infants. Materials and Methods: Six consecutive infants underwent 7 laparoscopic upper-pole nephroureterectomy. Pre and post-operative evaluation included renal sonography, voiding cystourethrogram and renal scintigraphy. All infants showed upper-pole exclusion. Surgery was performed through a transperitoneal approach with full flank position in all infants. Three or 4 ports were used according to the necessity of retracting the liver. The distal ureter was ligated close to the bladder whenever reflux was present and the dysplastic upper-pole was divided with the help of an electrocautery. Data regarding operative time, postoperative use of analgesics, time to resume oral feeding, hospital stay and tubular function were collected and analyzed. Results: All procedures were concluded as planned. Mean operative time was 135 min. One patient underwent staged bilateral upper-pole nephrectomy. There were no complications and the postoperative hospital stay was 48 hours in 5 procedures and 24 hours in 2 procedures. Pain medication was required only in the first day. Renal tubular function showed improvement in half of the cases. Conclusion: Laparoscopic partial nephrectomy is a safe and feasible procedure in infants. Due to the magnification provided by the lenses, a better vision of the structures is achieved, facilitating selective dissection of vascular upper-pole, renal parenchyma and distal ureter. This approach is less damaging to the lower pole, and is associated to low morbidity and a short hospital stay.3318791Peters, C.A., Laparoscopic and robotic approach to genitourinary anomalies in children (2004) Urol Clin North Am, 31, pp. 595-605Robinson, B.C., Snow, B.W., Cartwright, P.C., De Vries, C.R., Hamilton, B.D., Anderson, J.B., Comparison of laparoscopic versus open partial nephrectomy in a pediatric series (2003) J Urol, 169, pp. 638-640Steyaert, H., Valla, J.S., Minimally invasive urologic surgery in children: An overview of what can be done (2005) Eur J Pediatr Surg, 15, pp. 307-313Koyle, M.A., Woo, H.H., Kavoussi, L.R., Laparoscopic nephrectomy in the first year of life (1993) J Pediatr Surg, 28, pp. 693-695Valla, J.S., Breaud, J., Carfagna, L., Tursini, S., Steyaert, H., Treatment of ureterocele on duplex ureter: Upper pole nephrectomy by retroperitoneoscopy in children based on a series of 24 cases (2003) Eur Urol, 43, pp. 426-429Jordan, G.H., Winslow, B.H., Laparoendoscopic upper pole partial nephrectomy with ureterectomy (1993) J Urol, 150, pp. 940-943Horowitz, M., Shah, S.M., Ferzli, G., Syad, P.I., Glassberg, K.I., Laparoscopic partial upper pole nephrectomy in infants and children (2001) BJU Int, 87, pp. 514-516Gill, I.S., Delworth, M.G., Munch, L.C., Laparoscopic retroperitoneal partial nephrectomy (1994) J Urol, 152, pp. 1539-1542Borzi, P.A., A comparison of the lateral and posterior retroperitoneoscopic approach for complete and partial nephroureterectomy in children (2001) BJU Int, 87, pp. 517-520Desgrandchamps, F., Gossot, D., Jabbour, M.E., Meria, P., Teillac, P., Le Duc, A., A 3 trocar technique for transperitoneal laparoscopic nephrectomy (1999) J Urol, 161, pp. 1530-1532Hulbert, W.C., Rabinowitz, R., Prenatal diagnosis of duplex system hydronephrosis: Effect on renal salvage (1998) Urology, 51, pp. 23-26El-Ghoneimi, A., Farhat, W., Bolduc, S., Bagli, D., McLorie, G., Khoury, A., Retroperitoneal laparoscopic vs open partial nephroureterectomy in children (2003) BJU Int, 91, pp. 532-535Jednak, R., Kryger, J.V., Barthold, J.S., Gonzalez, R., A simplified technique of upper pole heminephrectomy for duplex kidney (2000) J Urol, 164, pp. 1326-1328Borzi, P.A., Yeung, C.K., Selective approach for transperitoneal and extraperitoneal endoscopic nephrectomy in children (2004) J Urol, 171, pp. 814-816Guillonneau, B., Ballanger, P., Lugagne, P.M., Valla, J.S., Vallancien, G., Laparoscopic versus lumboscopic nephrectomy (1996) Eur Urol, 29, pp. 288-291Janetschek, G., Seibold, J., Radmayr, C., Bartsch, G., Laparoscopic heminephroureterectomy in pediatric patients (1997) J Urol, 158, pp. 1928-193

The Role Of The Abdominal Ultrasonography And Percutaneous Liver Biopsy In The Differential Diagnosis Of Neonatal Cholestasis [valor Da Ultra-sonografia Abdominal E Da Biopsia Hepática Percutânea No Diagnóstico Diferencial Da Colestase Neonatal.]

Neonatal cholestasis still presents a diagnostic challenge, both from the anatomic and etiologic point of view. Distinguishing intrahepatic from extrahepatic causes of cholestasis is of paramount importance since the latter may be treated by surgery but prognosis depends on the age at which operation is performed. Many tests have been proposed to help in differentiating these two entities, among which liver biopsy is the most frequently employed, and ultrasonography one of the most recently included. Our purpose is to present our experience with these two methods in the differential diagnosis of intra and extrahepatic causes of cholestasis. From January 1989 to July 1993, 35 patients with neonatal cholestasis were evaluated through a protocol which included liver biopsy and ultrasonography. The latter was performed after a 4 hour fast and was considered indicative of extrahepatic cholestasis when the gallbladder was not visualized, was hypoplastic or non-functioning, or if a cystic structure was seen at the extrahepatic biliary tree. Sensitivity, specificity, and accuracy were determined for these two tests. Seventeen patients were found to have extrahepatic cholestasis (all with biliary atresia) and 18 intrahepatic cholestasis, on the basis of clinical evolution or operative findings. Sensitivity was 100% for ultrasonography and 76% for liver biopsy in diagnosing extrahepatic cholestasis. Accuracy was 83% for ultrasonography and 86% for biopsy, rising to 96% when both tests were considered together. Based on these findings we strongly recommend ultrasonography with definite criteria as the initial investigation tool in the management of neonatal cholestasis, associated with liver biopsy.312758

1952 - Nr 20

To describe the case of an infant with Hirschsprung's disease presenting as total colonic aganglionosis, which, after surgical resection of the aganglionic segment persisted with irreversible functional intestinal obstruction; discuss the difficulties in managing this form of congenital aganglionosis and discuss a plausible pathogenetic mechanism for this case. Case description The diagnosis of Hirschsprung's disease presenting as total colonic aganglionosis was established in a two‐month‐old infant, after an episode of enterocolitis, hypovolemic shock and severe malnutrition. After colonic resection, the patient did not recover intestinal motor function that would allow enteral feeding. Postoperative examination of remnant ileum showed the presence of ganglionic plexus and a reduced number of interstitial cells of Cajal in the proximal bowel segments. At 12 months, the patient remains dependent on total parenteral nutrition. Comments Hirschsprung's disease presenting as total colonic aganglionosis has clinical and surgical characteristics that differentiate it from the classic forms, complicating the diagnosis and the clinical and surgical management. The postoperative course may be associated with permanent morbidity due to intestinal dysmotility. The numerical reduction or alteration of neural connections in the interstitial cells of Cajal may represent a possible physiopathological basis for the condition. © 2016 Sociedade de Pediatria de São Paulo34338839

Babies With Brain Damage Who Can Not Swallow: Surgical Management

Background: Neonates with severe neurological impairment are often unable to swallow, necessitating gastrostomy for feeding. Because of the risk of developing severe reflux, this procedure is often associated with fundoplication. Objective: To assess the safety and efficacy of gastrostomy and Nissen fundoplication in 22 neonates with swallowing difficulties due to serious neurological impairment. Method: All children underwent an initial period of nasogastric feeding and after informed consent underwent gastrostomy and Nissen fundoplication. Results: There were no significant intraoperative complications. There were two cases of postoperative periostomy leakage. Of the 22 neonates 16 were alive four months after surgery. Six neonates died of complications due to underlying disease. Conclusion: We concluded that gastrostomy and Nissen fundoplication are safe procedures and help parents give a better care to these children.663 B641645Rogers, B.T., Arvedson, J., Msall, M., Demerath, R.R., Hypoxemia during oral feeding of children with severe cerebral palsy (1993) Dev Med Child Neurol, 35, pp. 3-10Coben, R.M., Weintraub, A., DiMarino Jr, A.J., Cohen, S., Gastroesophageal reflux during gastrostomy feeding (1994) Gastroenterology, 106, pp. 13-18Martinez, D.A., Ginn-Pease, M.E., Caniano, D.A., Sequelae of antireflux surgery in profoundly disabled children (1992) J Pediatr Surg, 27, pp. 267-273Ramachandran, V., Ashcraft, K.W., Sharp, R.J., Thal fundoplication in neurologically impaired children (1996) J Pediatr Surg, 31, pp. 819-822Mollitt, D.L., Golladay, E.S., Seibert, J.J., Symptomatic gastroesophageal reflux following gastrostomy in neurologically impaired patients (1985) Pediatrics, 75, pp. 1124-1126O'Neill, J.K., O'Neill, P.J., Goth-Owens, T., Horn, B., Cobb, L.M., Care-giver evaluation of anti-gastroesophageal reflux procedures in neurologically impaired children: What is the real-life outcome? (1996) J Pediatr Surg, 31, pp. 375-380Fonkalsrud, E.W., Ashcraft, K.W., Coran, A.G., Surgical treatment of gastroesophageal reflux in children: A combined hospital study of 7467 patients (1998) Pediatrics, 101, pp. 419-422Guidelines for surgical treatment of gastroesophageal reflux disease (GERD) (1998) Surg Endosc, 12, pp. 186-188. , Society of Gastrointestinal Endoscopic Surgeons SAGEsSachs, G., The safety of omeprazole. True or false? (1994) Gastroenterology, 106, pp. 1400-1401Gunasekaran, T.S., Hassall, E., Efficacy and safety of omeprazole for severe gastroesophageal reflux in children (1993) J Pediatr, 123, pp. 148-154Crombleholme, T.M., D'Alton, M., Cendron, M., Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management (1996) J Pediatr Surg, 31, pp. 156-163Guzzetta, F., Mercuri, E., Spano, M., Mechanisms and evolution of the brain damage in neonatal post-hemorrhagic hydrocephalus (1995) Childs Nerv Syst, 11, pp. 293-296Detoledo, J., Icovinno, J., Haddad, H., Swallowing difficulties and early CNS injuries: Correlation with the presence of axial skeletal deformities (1994) Brain Inj, 8, pp. 607-611Fuloria, M., Hiatt, D., Dillard, R.G., O'Shea, T.M., Gastroesophageal reflux in very low birth weight infants: Association with chronic lung disease and outcomes through 1 year of age (2000) J Perinatol, 20, pp. 235-239Volpe, J.J., Neonatal intracranial hemorrhage. Pathophysiology, neuropathology, and clinical features (1997) Clin Perinatol, 4, pp. 77-102Thompson, W.R., Hicks, B.A., PCJr, G., Laparoscopic Nissen fundoplication in the infant (1996) J Laparoendosc Surg, (SUPPL. 1), pp. S5-S7Mims, J., Crisham, P., Health care management of children with cognitive and physical disabilities: To treat or not to treat (1996) J Neurosci Nurs, 28, pp. 238-251Hutson, J.M., Myers, N.A., The relationship between ethics and phronesis (1999) Pediatr Surg Int, 15, pp. 320-322Esposito, C., Montupet, P., Reinberg, O., Laparoscopic surgery for gastroesophageal reflux disease during the first year of life (2001) J Pediatr Surg, 36, pp. 715-717Smith, C.D., Othersen Jr, H.B., Gogan, N.J., Walker, J.D., Nissen fundoplication in children with profound neurologic disability (1992) High risks and unmet goals. Ann Surg, 215, pp. 654-659Hanimann, B., Sacher, P., Stauffer, U.G., Complications and long-term results of the Nissen fundoplication (1993) Eur J Pediatr Surg, 3, pp. 12-14Bordewick, A.J., Bildner, J.I., Burd, R.S., An effective approach for preventing and treating gastrostomy tube complications in newborns (2001) Neonatal Netw, 20, pp. 37-40St. Cyr, J.A., Ferrara, T.B., Thompson, T.R., Johnson, D.E., Foker, J.E., Nissen fundoplication for gastroesophageal reflux in infants (1986) J Thorac Cardiovasc Surg, 92, pp. 661-666Fonkalsrud, E.W., Bustorff-Silva, J., Perez, C.A., Quintero, R., Martin, L., Atkinson, J.B., Antireflux surgery in children under 3 months of age (1999) J Pediatr Surg, 34, pp. 527-531Quigley, E.M., Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease (2003) Am J Gastroenterol, 98, pp. S24-S30Schatzlein, M.H., Ballantine, T.V., Thirunavukkarasu, S., Fitzgerald, J.F., Grosfeld, J.L., Gastroesophageal reflux in infants and children: Diagnosis and management (1979) Arch Surg, 114, pp. 505-510Wheatley, M.J., Wesley, J.R., Tkach, D.M., Coran, A.G., Long-term follow-up of brain-damaged children requiring feeding gastrostomy: Should an antireflux procedure always be performed? (1991) J Pediatr Surg, 26, pp. 301-304Martinez, D.A., Ginn-Pease, M.E., Caniano, D.A., Recognition of nrecurrent gastroesophageal reflux following antireflux surgery in the neurologically disabled child: High index of suspicion and definitive evaluation (1992) J Pediatr Surg, 27, pp. 983-990Campbell, N., Case selection (1991) Oesophageal atresia, pp. 287-301. , Beasley SW, Myers NA, Auldist AW Eds, Chapman & Hall: LondonSkene, L., Legal issues in treating critically ill newborn infants (1993) Cambridge Quart Healthcare Ethics, 2, pp. 295-30

Gastric emptying of water in children with severe functional fecal retention

The objective of this study was to evaluate gastric emptying (GE) in pediatric patients with functional constipation. GE delay has been reported in adults with functional constipation. Gastric emptying studies were performed in 22 children with chronic constipation, fecal retention and fecal incontinence, while presenting fecal retention and after resuming regular bowel movements. Patients (18 boys, median age: 10 years; range: 7.2 to 12.7 years) were evaluated in a tertiary pediatric gastroenterology clinic. Gastric half-emptying time of water (reference range: 12 ± 3 min) was measured using a radionuclide technique immediately after first patient evaluation, when they presented fecal impaction (GE1), and when they achieved regular bowel movements (GE2), 12 ± 5 weeks after GE1. At study admission, 21 patients had reported dyspeptic symptoms, which were completely relieved after resuming regular bowel movements. Medians (and interquartile ranges) for GE1 and GE2 were not significantly different [27.0 (16) and 27.5 (21) min, respectively (P = 0.10)]. Delayed GE seems to be a common feature among children with chronic constipation and fecal retention. Resuming satisfactory bowel function and improvement in dyspeptic symptoms did not result in normalization of GE data

Doença De Hirschsprung – Dismotilidade Intestinal Pós-cirúrgica

To describe the case of an infant with Hirschsprung's disease presenting as total colonic aganglionosis, which, after surgical resection of the aganglionic segment persisted with irreversible functional intestinal obstruction; discuss the difficulties in managing this form of congenital aganglionosis and discuss a plausible pathogenetic mechanism for this case. Case description The diagnosis of Hirschsprung's disease presenting as total colonic aganglionosis was established in a two-month-old infant, after an episode of enterocolitis, hypovolemic shock and severe malnutrition. After colonic resection, the patient did not recover intestinal motor function that would allow enteral feeding. Postoperative examination of remnant ileum showed the presence of ganglionic plexus and a reduced number of interstitial cells of Cajal in the proximal bowel segments. At 12 months, the patient remains dependent on total parenteral nutrition. Comments Hirschsprung's disease presenting as total colonic aganglionosis has clinical and surgical characteristics that differentiate it from the classic forms, complicating the diagnosis and the clinical and surgical management. The postoperative course may be associated with permanent morbidity due to intestinal dysmotility. The numerical reduction or alteration of neural connections in the interstitial cells of Cajal may represent a possible physiopathological basis for the condition. © 2016 Sociedade de Pediatria de São Paulo34338839

Not Complicated Acute Appendicitis In Adults: Clinical Or Surgical Treatment? [apendicite Aguda Não Complicada Em Adultos: Tratamento Cirúrgico Ou Clínico?]

[No abstract available]392159163McBurney, C., Experience with early operative interference in cases of disease of the vermiform appendix (1889) NY Med J, 50, pp. 676-684Coldrey, E., Five years of conservative treatment of acute appendicitis (1959) J Int Coll Surg, 32, pp. 255-261Mason, R.J., Surgery for appendicitis: Is it necessary? (2008) Surg Infect, 9 (4), pp. 481-488Sisson, R.G., Ahlvin, R.C., Harlow, M.C., Superficial mucosal ulceration and the pathogenesis of acute appendicitis (1971) Am J Surg, 122 (3), pp. 378-380Vianna, A.L., Otero, P.M., Cruz, C.A.T., Carvalho, S.M., Oliveira, P.G., Puttini, S.M.B., Tratamento conservador do platrão apendicular (2003) Rev Col Bras Cir, 30 (6), pp. 442-446Fitzmaurice, G.J., McWilliams, B., Hurreiz, H., Epanomeritakis, E., Antibiotics versus appendectomy in the management of acute appendicitis: A review of the current evidence (2011) Can J Surg, 54 (5), pp. 307-314Liu, K., Fogg, L., Use of antibiotics alone for treatment of uncomplicated acute appendicitis: A systematic review and metaanalysis (2011) Surgery, 150 (4), pp. 673-683Wilms, I.M., de Hoog, D.E., de Visser, D.C., Janzing, H.M., Appendectomy versus antibiotic treatment for acute appendicitis (2011) Cochrane Database Syst Rev, 9 (11), pp. CD008359Hansson, J., Körner, U., Khorram-Manesh, A., Solberg, A., Lundholm, K., Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients (2009) Br J Surg, 96 (5), pp. 473-481. , Erratum in: Br J Surg. 2009;96(7):830Vons, C., Barry, C., Maitre, S., Pautrat, K., Leconte, M., Costaglioli, B., Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial (2011) Lancet, 377 (9777), pp. 1573-157