RESUMEN
Laparoscopy is useful in both the diagnosis and the management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchidopexy. A second-stage vasal-based orchidopexy can then be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of 6 years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies and one microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchiectomies for atrophic testes and 8 testicular vessel clippings followed by 6 second stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.
Asunto(s)
Criptorquidismo/diagnóstico , Criptorquidismo/cirugía , Laparoscopía , Adolescente , Niño , Preescolar , Conductos Eyaculadores/cirugía , Humanos , Lactante , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Palpación , Reimplantación , Testículo/anomalías , Testículo/irrigación sanguínea , Testículo/patología , Testículo/cirugía , Factores de Tiempo , Conducto Deferente/cirugíaRESUMEN
Laparoscopy is useful in both diagnosis and management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchiopexy. A second-stage vasal-based orchidopexy than can be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of six years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies, and 1 microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchietomies for atrophic testes and 8 testicular vessel clippings followed by 6 second-stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.
Asunto(s)
Criptorquidismo/cirugía , Laparoscopía , Adolescente , Algoritmos , Niño , Preescolar , Criptorquidismo/diagnóstico , Humanos , Lactante , Masculino , Orquiectomía , Testículo/irrigación sanguínea , Testículo/cirugíaRESUMEN
Gastroesophageal reflux (GER) usually presents with digestive symptoms, failure to thrive, and/or respiratory symptoms. During the 8-year period from 1981 to 1989, 1,153 children underwent 20-hour pH monitoring to assess GER. All patients were graded using the scoring system of Euler and Byrne. Patients were classified as severe (score greater than 50), moderate (score 25 to 50), and normal (score less than 25). Five hundred (43.3%) of these patients presented with respiratory symptoms including apnea, cyanosis, or "near miss" sudden infant death syndrome (36%), poorly controlled asthma (28%), recurrent bronchopneumonia (13%), bronchiolitis (9%), and miscellaneous symptoms such as intermittent dyspnea, chronic cough, and stridor (12%). Eight patients (2%) had cystic fibrosis. The ages ranged from 1 month to 20 years (mean, 19.5 months). Twelve patients had technically inadequate studies and were excluded. Severe reflux was present in 156 patients (31%) and moderate reflux in 159 patients (31%). All patients were treated initially by medical therapy for a minimum of 8 weeks. The majority of patients (81%) had resolution of their symptoms with change in position, thickened feedings, and, when indicated, additional therapy with metoclopramide, cisapride, or domperidone. Most of these patients were found to have a specific position, usually prone, which decreased reflux. The remaining 57 patients had documentation of persistent reflux by pH monitoring and underwent an antireflux procedure. Of those patients undergoing surgery 51 had severe reflux and 6 had moderate reflux. Forty-four patients had a posterior 270 degrees wrap (Toupet), 10 had a 360 degrees wrap (Nissen), and 3 had an anterior 180 degrees wrap (Boix-Ochoa).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Monitoreo Fisiológico , Trastornos Respiratorios/complicaciones , Adolescente , Adulto , Niño , Preescolar , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/terapia , Humanos , Concentración de Iones de Hidrógeno , Lactante , Recién Nacido , MasculinoRESUMEN
The relationship between gastro-esophageal reflux (GER) and asthma, and the role of treatment of this disorder in severe asthma cases remain ill-defined. Using esophageal pH monitoring, pathological GER was demonstrated in 57 of 139 children with severe asthma. Among these 57 patients medical treatment of GER lessened the respiratory symptoms in 24 and was without effect in 33. In the latter group, asthma was improved in 29 with surgical treatment of the GER, the results being less satisfactory in those patients without GER digestive symptoms. Our results suggest that there is a place for treatment of GER in selected children with severe asthma. Esophageal pH monitoring appears useful to detect pathological GER and to determine which patients may benefit from surgical treatment.
Asunto(s)
Asma/complicaciones , Reflujo Gastroesofágico/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/fisiopatología , Humanos , Concentración de Iones de Hidrógeno , Lactante , MasculinoRESUMEN
Over a period of four years (September 1986 to September 1990), 32 impalpable testes were found in 24 cryptorchid boys at Sainte-Justine Hospital, Montreal. 11 (34%) of the impalpable testes were intra-abdominal. Of these, 5 testes were hypoplastic and were removed, 3 by a traditional inguinal transperitoneal orchiectomy and 2 by laparoscopy; 2 testicles were brought down by classic orchiopexy whereas two others underwent a Fowler-Stephens procedure. One of these underwent preliminary laparoscopic clipping of the spermatic vessels followed six months later by open surgery to bring the testis down on the vas and deferential artery and its well-developed collateral circulation. One patient underwent a two-stage open orchiopexy and another had unilateral testicular autotransplantation. The literature is reviewed and surgical indications for therapeutic laparoscopy are discussed.