Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience.

Introduction: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994.

Role of Intraluminal Esophageal Impedance Baseline in the Diagnosis of Esophagitis in Children.

 Low values of esophageal impedance baseline (EIB) have been related to esophagitis. The aim of this study was to evaluate the diagnostic performance of EIB for erosive esophagitis (ErE) and histological esophagitis (HiE) in children studied for gastroesophageal reflux.  Children who underwent esophageal multichannel intraluminal impedance-pH monitoring (MII-pH) and upper-endoscopy with esophageal biopsies were studied retrospectively.

[Recommendations for the prevention of foreign body aspiration].

The aspiration of a foreign body remains a common paediatric problem, with serious consequences that can produce both acute and chronic disease. Aspiration usually causes a medical emergency that requires a prompt diagnosis and an urgent therapeutic approach as it may result in the death of the child or severe brain injury. It typically involves organic foreign bodies (mainly food or nuts) aspirated by children under 5 years old, and usually at home.

[Long gap esophageal atresia: Schärli versus Foker].

PURPOSE. To submit the short and long term results of long-gap esophageal atresia (EA) with two surgical techniques. METHODS.

Diaphragmatic avulsion with chance fracture: a rare association in the seat belt syndrome.

Traumatic diaphragmatic injuries are uncommon in children. Chance fractures are typical in adults who had motor vehicle accidents but infrequent in children. The seat belt syndrome is characterized by a spectrum of injuries caused by the compression of the abdomen by the seat belt.

[Laparoscopic Kasai portoenterostom: present and future of biliary atresia treatment].

Introduction: Kasai's operation has proved its value in surgical treatment of biliary atresia (BA). Its laparoscopic approach is a new challenge for pediatric surgeons, with all the potential advantages of minimally invasive surgery. The aim of the present study has been to report our experience in laparoscopic management of five patients with biliary atresia.

Long-term assessment of the treatment of recurrent tracheoesophageal fistula with fibrin glue associated with diathermy.

Purpose: Recurrent tracheoesophageal fistula (RTF) is a serious common complication of the surgical treatment of esophageal atresia. We report the results of our technique of bronchoscopic treatment of RTF with fibrin glue (Tissucol), with a follow-up of over 1 decade.

Methods: A retrospective review between 1993 and 2004 was conducted, including all patients diagnosed with RTF and treated bronchoscopically with Tissucol, with over 1 year of follow-up.

[Choledocal cyst: analysis of 29 cases and review or the literature].

Unlabelled: The aim of the present study has been to systematize the clinical presentation of the entity named choledochal cyst, in relation with its probable etiopathology and the intraoperative findings as well as its evolution after surgery, based on the revision of the literature and of our experience in 29 cases.

Material And Methods: 29 cases of cystic dilatation of the biliar duct extra and/or intrahepatic are analyzed. In 4 cases the diagnosis was prenatal and two were excluded of the study after it has been confirmed they suffered biliary atresia type I.

[Evidence-based medicine in Spanish pediatric surgery reports].

Introduction: Pediatric surgical literature is characterized by a high prevalence of observational studies and a paucity of randomized controlled trial, comparing mainly medical therapies.

Aims: To asses scientific evidence level produced by spanish pediatric surgeons.

Material And Methods: Articles reported in Cirugía Pediátrica, surgical reports in Anales Españoles de Pediatría, and reports from spanish authors published in the Journal of Pediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery, from 1997 to 2002.

Urgent distal splenorenal shunt in low-body weight patients.

The authors report two patients with extrahepatic portal hypertension and repeated massive bleeding from esophageal varices who underwent urgent distal splenorenal shunting (DSRS) after having proved refractory to medical treatment, endoscopic sclerotherapy, and ligation of esophageal varices. Their ages and weights were 18 months/10 kg, and 11 months/6.4 kg, respectively.

[Laparoscopic transsection of Ladd's bands: a new indication for therapeutic laparoscopy in neonates].

Within the last ten years and by the introduction of some new instruments, laparoscopy is a safe and effective method that has been further extended in children. We report our experience in the treatment of laparoscopy on a seven day old newborn affected by malrotation with an intermittent duodenal obstruction. The treatment consisted of a duodenal liberation after the section was easily performed in congenital Ladd's bands.

Long-gap esophageal atresia: reconstruction preserving all portions of the esophagus by Schärli's technique.

For distances of over 4-5 cm, esophageal replacement is almost always necessary in esophageal atresias. We present the technical details and describe our experience with esophageal reconstruction by elongation of the lesser curvature (Schärli's technique) in four cases of very long atresias. A retrosternal transposition was made without a thoracotomy in two children, and an orthotopic mediastinal route through a right thoracotomy was done in two others.

Rectal drainage: unusual evolution of a psoas abscess.

We report two cases of primary psoas abscess in two patients of 15 months and 4 years of age. As the first case showed the natural history of this process the second one was large enough to produce a huge ureterohydronephrosis and to drain through the rectal wall to the rectum spontaneously, although this natural way did not achieve complete drainage. Both were treated by open drainage and systemic antibiotics with good response.

Cantrell's pentalogy. Report of four cases and their management.

Four neonates with the uncommon Cantrell's pentalogy seen in our hospital within a 6-month period without any apparent factor in common are described, with a review of the world literature. The first case was diagnosed prenatally at 15 weeks' gestation, the earliest intrauterine finding in the literature. The occurrence of imperforate anus with the syndrome, observed in one of the cases, has not been previously reported.

[Hepatoporto-appendicostomy. Our experience in 3 cases of biliary cystic disease].

This report details our preliminary experience with hepaticoporto-appendicostomy in three patients with biliary cystic disease. The surgical procedure was total resection of choledochal cyst and vascularized appendix interposition between biliary tree and duodenum. The children have been followed by clinical, ultrasonography and endoscopic (ECPR) during a period between 1-4 years.

Congenital intrahepatic portocaval shunt associated with trimethylaminuria.

A case of congenital portal-systemic shunting due to an intrahepatic connection diagnosed by ultrasound scanning and color Doppler in an 8-month-old girl is reported. She began to manifest trimethylaminuria 3 years later. At 7 years of age, she is asymptomatic without therapeutic measures except for diet.

Congenital intrahepatic portocaval shunt associated with trimethylaminuria.

A case of congenital portal-systemic shunting due to an intrahepatic connection diagnosed by ultrasound scanning and color Doppler in an 8-month-old girl is reported. She began to manifest trimethylaminuria 3 years later. At 7 years of age, she is asymptomatic without therapeutic measures except for diet.

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied.

[The prolapse of the rectum. Treatment with fibrin adhesive].

Injection of sclerosing solutions into the rectal submucosa or into the perirectal space is one of the many therapies designed to correct rectal prolapse. Since 1994, four patients affected with this condition have been treated with fibrin adhesive percutaneous injection. Up to now, this product had not been used to this aim.

[Treatment with Ethibloc of lymphangiomas and venous angiomas].

Lymphangioma and venous angioma are a group of pathological entities which have required surgical treatment since years. Extension, localization and poor delimitation of some lesions have resulted in technical difficulties and serious complications. Our group began the sclerosing therapy with an injection of fibrin adhesive and, due to the lack of response in the first patient, a program with Ethibloc as an alternative substance was developed.

[Prenatal diagnosis of biliary atresia associated with choledochal cyst].

We report a case of biliary atresia promptly detected by its association with a choledochal cyst, prenatally diagnosed at 20 weeks' gestation. The baby was operated at 14 days of life. A choledochal cyst was found and fibrosis of the extrahepatic bile ducts was also noted.

Recurrent tracheoesophageal fistula treated with fibrin glue.

Recurrent tracheoesophageal fistula (RTF) after repair of esophageal atresia with tracheoesophageal fistula is a serious complication, with the need for a second operation. The mortality rate is high. The authors report on the eradication of RTF using fibrin glue.

Treatment of cervical lymphangioma using fibrin adhesive.

We present a case of cervical lymphangioma operated on when one month old. Three weeks later he suffered a relapse which caused respiratory problems since it affected the retropharyngeal pouch, with movement and compression of the upper airway. Given the technical difficulty of operating again, the transoral injection of fibrin adhesive was used as a sclerotic agent, which resulted in remission of symptoms and acceptable reduction in tumor size.